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SOUTH LAKEWOOD HILLS BLK 1 LT 3
Onsite File • 1�� us N_ yylrau 11\GV vol VL/ 10) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 AUn6 2 e 1 ''of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221288 PID Number: 015-151-03 Dwelling: ❑ Single Family (SF) 0 with ADU 0 Duplex (D) ❑ Two Single Family Project: ❑ New ❑®Upgrade Name Jake Masog ABSORPTION FIELD 0 Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 6300 O'Malley, Anchorage AK 99507 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 5 0.60 GPD/SF 12.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 6.0 Ft. Gravel depth beneath pipe 6.5 Subdivision Block Lot South Lakewood Hills 3 1 Ft. Fill added above original grade 0.0 Ft. Gravel length 100 Ft. Township Range Section Gravel width 2.5 Ft. Beds: Number of Lines na Distance between lines na Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 1,300 Ft2 2 14.2 Ft. Well 100'+ 100+ NA NA 25+ TANK IN Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1500 Gal. Surface Water 100'+ 100+ NA NA Material Number of compartments Lot Line 20.1 20.0 NA NA NA HDPE 2 Foundation 11.0 15.0 NA NA LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Whitters Excavating Drainfield 3034 CO/MT3034 Inspector Pannone Engineering BENCH MARK (Assumed elevation) 100 ft Inspectionv 08/01/22 08/03/22 Location and description es: 2nd 3`d 08/09/22 4'h 08/10/22 FF of Office/ADU ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date of AC.�s�� Steen R. Pannone � �F _ CE��:, Septic System Approv Date ' �3' Zz� l�R�O5�?v'� Note: this approval does not include well permit requirements. 11\GV vol VL/ 10) -Q-10--3- i v�=C> rr- 0 � M, i� �nmv-,M< I -<pgZrx � 'OZNOt*tVl O � C >-maz_ = _0 y rD-OC=' zo—I z ooc�NoO m �-1c or-mz z m D o cn z 0 o o� C m N r- � m r- _0 Z C-) m m m r r ZO —i ONC N) r—..r o cn D n'ZmAUi m D cy, Z :� m D "p o� n� m p N2 pi—i H m m pco m 00 -F -P C4 w N N (3 N N Z r cn c11 m Z -0 O C U) F9 ZI:o o^' z w � y �m _p N Ln (� 'TlO —i ONC D p-uO z ZpDmm C (� r—..r o cn D n'ZmAUi m D cy, Z :� m D "p m� m p N2 pi—i H m m pco m 00 -F -P C4 w N N (3 N N n cn c11 m Z -0 O C U) F9 n to r frl w w �m _p N Ln (� rl 0 D rn a w D DATE 08/26/2022 RECORD DRAWING PHONE (907) 745-8200 FAX (907) 745-8201 ;'iv- = �P s�'� REV: 07/21/2022 ' 9'y REV: 08/03/2022 SCALE 1" = 50' SOUTH LAKEWOOD HILLS BLOCK 1 LOT 3 P.I.D. NO DRAWNLJC/DRM JAKE MASOG Steven R. Pannone �;c+'. N N N N N N PERMIT N0. OSP221288 SITE PLAN ANCHORAGE, AK U1 O U1 (9 U .A 0) OF 3 N 01 00 W co o Du J 6i V c0 N U1 -F -pWO Lo6J w V CO u co —i ONC D p-uO z ZpDmm C (� r—..r o cn D n'ZmAUi m D cy, Z :� m D "p m� m p N2 pi—i H m m pco m D X ,u,D_0 = o m (3 � <n cn c11 m Z -0 O C U) F9 n to r frl rn n �m _p N Ln (� rl 0 D C- ' �o o I� I1 r �ro ND 'Cn" � a u, cn to nry�oo o orri'+' _ ti (3 Z NOTES: PANNONE ENG SVC LLC (C.f. 10$$) P.O. BOX 1807 PALLMER, AK 99645 "++1 �F A(q'1+1 REVISIONS DATE 08/26/2022 RECORD DRAWING PHONE (907) 745-8200 FAX (907) 745-8201 ;'iv- = �P s�'� REV: 07/21/2022 ' 9'y REV: 08/03/2022 SCALE 1" = 50' SOUTH LAKEWOOD HILLS BLOCK 1 LOT 3 P.I.D. NO DRAWNLJC/DRM JAKE MASOG Steven R. Pannone �;c+'. 015-151-03 SITE: 6300 O'MALLEY ROAD CE -8749 PERMIT N0. OSP221288 SITE PLAN ANCHORAGE, AK ',,';°'?'' SHE 2 OF 3 DOUBLE CLEAN OUT m CLEAN OUT nO a_ O D� I— W z_ T ',.. CLEAN OUT m DOUBLE z N CLEAN OUT Wz CA� s TH-1 N m m tp to FLOW SPL ITER 91 a, ( CLEAN OUT MONITOR TUBE to to s z A O m Z x n rn s m m 0 MONITOR TUBE I I CLEAN OUT z z t o ) m T ',.. rn to to 01 O n N � O _ Wz CA� s TH-1 N � � O O N z O D m NOTES: PANNONE ENG SVC, LLC (C.S. 1088),""""++,, P.O. BOX 102954 ANCHORAGE, AX 99510 "v OF..ALq''a, REVISIONS DATE 08/26/2022 RECORD DRAWING PHONE (907) 272-8218 FAX (907) 272-8211 -= SCALE :. .•. • ..... .• .. . �� A ��_ Steven R. Ponnone ,� 2 CE -8149 = .. NTS SOUTH LAKEWOOD HILLS BLOCK 1 LOT 3 JAKE MASOG SITE: 6300 0 MALLEY ROAD P.I.D. NO 015-151-03 DRAWN LJC/DRM --- PERMIT NO. osP221288 SECTION ANCHORAGE, AKe,Ant '+ ° �,' SHEET ` 3 OF 3 DIEVELOPIMENT SERVICES DEPART�AENT 907-343-7904 On -Site Water and Wastewater Section Fax: 343-7997 �; LL ..* Legal Address: Subdivision i`)UlkA- L -t ,4;kA ;L Block Lot T R Section Lot On-site Water & Wastewater Section certified contractor performing the well decommission- g: F Napie: tt < Signature: Company' Well decommissioning date ` 1 �r� Method of decommissioning: AMC 15.55.060L1 a. ❑ b. ❑ C. Location: Use the space below to provide a drawing of the property showing the following items: • North arrow • Decommissioned well location • Location of other water wells on the property • Two separate swing -tie distances for each well shown on the drawing Note: The swing -tie distances shall be measured from either permanent structures or the property corners PIP S f J f � J 1 6 i{A -------------------- ServicesM3uilding Safety\On Site Water and Wastewater\Forms\Client Forms\Well Decommisioning R u. L• )L CI o; 1 G ci CjWGW 1-- 4 4 yiu Ci � rn K lli 7 n' w 7 ti ti O V tiJ u W v W (3) ti C'J 7?O S = 1 H 4 J�.� 3: W =•i O x G v rt O U c n: yqt.-UJ n�ti C7 lu c�iL CIN zi Orny 0 V � W U� J4 Y102 p V LL:-n-oa 3: Ui �j U tL a ti LLI0 Ig en LJ r' -Os ]; OOSa;G�, 4 G{ °Why y +r Q �r ��E14 14 r - Q Q�eo h Lu tu h t WJE R u. L• )L CI o; 1 G ci CjWGW 1-- 4 4 yiu Ci � rn K lli 7 n' w 7 ti ti O V tiJ u W v W (3) ti C'J 7?O S = 1 H 4 J�.� 3: W =•i O x G v rt O U c n: yqt.-UJ n�ti C7 lu c�iL CIN zi Orny 0 V � W U� J4 Y102 p V LL:-n-oa 3: Ui �j U tL a ti LLI0 Ig en LJ r' -Os ]; OOSa;G�, MUNICIPALITY OF ANCHORAGE On -Site Water Q. VVaytavveter Program pnBox 19085O 47OVElmore Road Anchorage, Alaska 9851a 6050 ph '7304 Fax: (907) 343-7997 n,np://vwmmun/ongmnx'm On -Site Wastewater Disposal System Permit Permit Number: OSP221288 Work Type: Septic Upgrade Tax Code Number: 01515103800 Site Legal Address: SOUTH LAKEWOOD HILLS BLK 1 LT 3 G:2638 Site Mailing Address: G3OOD1NALLEYRD, Anchorage Owner: SMITH MARTIN Design Engineer: PANNONE ENGINEERING SERVICES This permit hsfor the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 7/22/2022 7/22/2023 0 Disposal Field R1 Septic Tank 0 Holding Tank [] Privy [] Private Well 0 Water Storage All construction shall be' inaccordance with: 1. The attached approved design. 2. All requirements apeoifiadinAnchorage Municipal code Chapters 15.55and 15.G5and the State ofAlaska VVoetavvater 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.S5.Provide notification bycalling (9O7)343-7SO4(24/7) 4. FronnOctober 15toAph[15,asubuu�noesoi|obaoqpUonayatemunderconotru��iunduhn'" freezing weather nhaUbneithec ' a. Opened and Closed onthe same day, or � / Special Provisions: 1. Construction may proceed at your own risk prior to 7 -day groundwater monitoring of the August1 2022 test hole. Please submit results with the inspection report. 2. The well used amayard light base hetoba decommissioned prior to|Rapproval. 3. The septic system on the west side is to be decommissioned prior to IR approval. 4. Locate the water line serving the smaller house and document with the record drawings. 5. The area around the trenches are hobevegetated prior to/Rapproval. - Received Bk Issued By: a, J | M. �f�ov"°�_ J ~/ -- `- Date: — Date: ZL/ZZZ-Z- 6 S 1�, MUNICIPALITY Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-151-03 Property owner(s) Jake Masog Mailing address Site address 6300 O'malley Road Day phone Legal description (Sub'd., Block & Lot) South Lakewood Hills Block 1 Lot 3 Legal description (Township, Range & Section) Lot Size 32,130 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field X❑ Initial ❑ Single Family (SF) X❑ (w/wo ADU) Septic Tank 0 Upgrade ❑X (D) ❑ Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) c �1 Permit/Rush Fees: (5 0� Waiver Fees: Date of Payment: Receipt Number: Permit No. 05P,2a 1 Permit App_:- : ._.,:c Date of Payment: Receipt Number: Waiver No. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221288, Deb Wockenfuss, 07/22/22 o_ = _ H: D -icnO�0 I I ON U) -<�0_ mDz Cm m z cn m -';0 z fel ow C:: n m-0 --r IT1 D r n j CO K p 50 Cn O�Zr-xMrl I D� Z��D��p -°z p�in0O Oto w< �>izDj n_1.bDz=, o D m� �fTt�Z Fll 0 mz r OO O O I I D NvM NomO m�=' D�z gocnn r1 D - cl1 z � * Oo x � � � O D fl J z z o to D 0 0 �> min ''mom 0UO Fri C) zo = cn a -i n m 9 ETl Iv �u Ln rli br) m _ p r r -r 0 r Z � � O O O � m m O n Lf) n Omo � Z m co < -r Q)� C) Zjoxm O _ Frl ZO �Z bo r�0a rmoo�arqb o_ �zo< Gy ��� �o m n7 % Zrla - - - - - p n m 0 200 rn m �ao Co M` `a �y 5 E E E k E E "13 b I ~ \ �z E E E \ �� rl E E E Z y ( E E 11 bZ E o I cn Imo\ a0 �bI bpm E E E 0' E l r` b jq . :'0 :1-0 Oa� L CZZ coE -E � - -p E E y(�i� "t f cz co�k0�� COti� r Z� -�-ZNZ \ — OOyO�n Ute- 4 Q) r't "� "i30 co r'l (n b (n r 1 O r (n " i to O oo�o�ama�mC) Nw o �aZaM D rr ^ic)o�x o'a npn bar � y o�nnZ �oma � �p2zo� � ooj vS O O NOTES: PANNONE ENG SVC LLC (C.I. 1088) " REVISIONS DATE (� CHANGE ORDER #1 P.O. BOX 1807 PAUMER, AK 59645 OF 114G? 20/2022 \� PHONE (907) 745-8200 FAX (907) 745-8201 _�� '' ti S�'+� REV: '-)7-/ STALE - -- --- ;-F REV: �' REV: 08/03/2022 1" 50' SOUTH LAKEWOOD HILLS BLOCK 1 LOT 3 P.I.D. NO DRAWN EJC JAKE MASOG015-151-03 i St_v n . Pannone ; ,go .. CE -8149 PERMIT NO. SITE: 6300 O'MALLEY ROAD '�, �S -. OSPXXXXXX SITE PLAN a =- ANCHORAGE, AK +' 1 of 2 'h o� SHEET ........" ' ` TEST HOLE 1 1 2 3- GW PIT RUN GRAVEL WATER LEVEL READING 4- 456 (MPI) 1 1 AUG2022 5- 4.51 6 2 7 30 MIN 6.51 2.00 GM/SM SILTY GRAVEL 8 AND SAND 9 4 10 11 30 MIN 6.01 12 20.0 5 13 4.51 14 6 15 30 MIN 5.99 16 20.3 17 18 19 BOH DATE PERFORMED: IAUG2022 SOILS LOG - PERCOLATION TEST SLOPE TEST HOLE 605 SITE PLAN GRAVEL' I-_ W y DRIVENIAY W W W W W 670 i W W y y W y Y W W W ♦ W W W W W W W W W GRASS y W AREA (P) y W y y y W y WAS GROUND WATER ENCOUNTERED? N IF YES, AT WHAT DEPTH? —DRY—' DEPTH TO WATER AFTER MONITORING? — XXX — DATE: XXXXXXXXX READING DATE CLOCK NET TIME WATER LEVEL READING NET DROP (MPI) 1 1 AUG2022 12:25 4.51 2 12:55 30 MIN 6.51 2.00 15.0 3 12:55 4.51 4 1:25 30 MIN 6.01 1.50 20.0 5 1:25 4.51 6 1:55 30 MIN 5.99 1.48 20.3 C=� SLOPE TH 1 Ca A l 615 SOIL TEST RESULTS/ANALYSIS • PERCOLATION RATE 20.3 (min/inch) (Hydrologic Soils Group: HSG A) • PERC HOLE DIAMETER 6" • TEST RUN BETWEEN 4 FT AND 5 FT. COMMENTS: Test hole excavated by WHITTERS EXCAVATING. . PERFORMED BY: PES. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE NOTES: PAMONE ENG SIC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-:8211 SOUTH LAKEWOOD HILLS BLOCK 1 LOT DRAWN DRM JAKE MASOG SITE: 6300 O'MALLEY ROAD SOILS LOGS ANCHORAGE, AK Date 07/21/2022 @�� • ...... • • Scale _w. a '. NTS .......... . .., .I.D..NO iSOnnolge, 015-15.1-03 PERMIT NO. CE 8149 • OSPXXXXXX Sheet 1 OF 1 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221288, Deb Wockenfuss, 07/22/22 45.3' RESIDENCE W/ DAYLIGHT BSMT. 0 —SEPTIC PIPE [of 2 nc��/wc wmu 8 *�� �� C) u�x�x ~� rf 33.13O'3.F |m |m. ~ lb EPTI IPE S 89 NOTE: THE NORTH 25' OF LOT J WAS TAKEN FOR 0'QALLEY ROAD R.O.W. (PLAT No. 78-187) 12.1'xl6.1' 9.2' LEAN—TO*S ON BOTH SIDES PLOT PLAN --- AS BUILT J�— SCALE ~ ' 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone (907) 522-4625 Fax Professional Land Surveyors ken*iangsurvey.com OF A | hereby certify that I have surveyed the following described property: REMAINDER of LOT 3, BLOCK 1, SOUTH LAKEWOOD HILLS (PLAT No. P-355) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on sold property except as indicated hereon. Doted this the Day of . '��r�� , at AnuhuroQo. /Uumko It Is the responsibility of the owner to determine the enbtmnua of any m*nts, covenants, or restrictions which do not appear on the recorded subdivision plat. AECCgB3 Kirn Johnson From: Wockenfuss, Deborah M.<deborah.wockenfuss@anchorageak.gov> Sent: Wednesday, August 3, 2022 2:16 PM To: Kirn Johnson Subject: South Lakewood Hills B1 L3 Change Order n r ( + t South Lakewood Hills B1 L3 Change Order comments: 1. Label flow splitter. a6etcC 2. The test hole location does not appear correct.f% 3. Tank location does not appear correct (LA FS to 4. It does not appear that the proposed trenches will be within 30' of the percolation test. exception and justify the application rate. -Tr �t j �;, -T i Please use the code r-0 0�, J S Deb Wockenfussa C-c�� o Onsite Water and Wastewater c' MOA,n 907-343-7906 1 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221138 PID Number: 015-151-03 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New n Upgrade Name Martin Smith ABSORPTION FIELD ❑® Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 6300 O'Malley Road, Anchorage AK ❑ Other Phone Number of Bedrooms Soil Rating — ITotal depth from original grade 15 0.8 GPD/SFJ 19.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 10.5 Ft. Gravel depth beneath pipe 9.0 Ft. Subdivision Block Lot South Hills 1 3 Fill added above original grade 0 Ft. Gravel length 2@30 Ft. Township Range Section Gravel width 2.5 Ft. Beds: Number of Lines N/A Distance between lines N/A • Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 1080 Ftz 2 101+ Ft. Well 100'+ 100'+ NA I NA 25'+ TANK ®❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCH. TANK Capacity 2000 Gal. Surface Water 100'+ 100'+ NA NA Material Number of compartments Lot Line I 10'+ 10'+ , NA ( NA NA SEPTIC/STEEL 2 Foundation 101+ 10'+ I NA NA LIFT STATION Manufacturer Capacity Remarks Record Drawings Submitted To ADEC Gal. Information Not On File Alarm location Electrical installed by Installer PIPE MATERIAL House to tank 3032 Tank to 3032 drainfield Home Owner (Previous) Drainfield 3032 cO/MT3032 Inspector Pannone Engineering Services, LLC BENCH MARK (Assumed elevation) ft Inspdection v 09/1999 Location and description nd 2 31d 4d' ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval:,.- %� Date of AC.jk1 5 avers R. 15,0 orae ���� Septic System , (1 149 Approved pP Date AFF Ct ����a�®��d Note: this approval does not include well permit requirements. Pannone Engineering Service, LLC JOB TITLE P.O. Box 100217 Anchorage, AK 99510-0217 SUBJECT Phone: (907) 272-8218 a Fax: (907) 272-8211 www.panengak.com BY NO. CHECKED DATE SHEET OF h �� � � ink � • � •Ni �� m f� • � � �� a i-.:+,. ~•; OWNER OF LAND: Martin Smith ADDRESS: 6300 O'Malley Rd. LEGAL DESCRIPTION South Lakewood Hills Block 1 Lot 3 DATE: 5-23-22 Bore Hole Data Depth From To 0 2 PERMIT NUMBER: OSP221138 DATE OF ISSUE: 5-19-22 TAX IDENTIFICATION NUMBER 01515103000 Is well located at approved permit location: ®Yes ❑No Method of Drilling: ®air rotary ❑cable tool Depth of Well: 135' Casing Type: Steel Wall thickness .250 inches Diameter: 6 inches, depth 135 feet Liner type Static Water Level: 94 feet Recovery Rate 20 ® gpm ❑ gph Method of Testing Air Well Intake Opening Type: ® open end ❑open hole ❑ Screened Start feet Stopped ❑ Perforations Start feet Stopped Grout Type: Bentonite Volume: 50 lbs Depth: from 2 feet, to 42 feet Well Disinfected Upon Completion: ®yes ❑ no Method of Disinfection: Chlorine 50 PPM Comments: 2 4 4 8 8 47 47 53 53 69 69 75 75 97 97 118 118 129 129 135 Casing Stickup Overburden Tight Silty Sand & Gravel Tight Silty Sand & Gravel w/ Cobbles Tight Silty Sand w/ Gravel Tight Silty Sand & Gravel w/ Boulders Tight Silty Sand w/ Gravel Silt Hardpan & Boulders Silty Hardpan Silty Sand & Gravel Water Sand & Gravel Water Drillers Name: Cole Sullivan ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. Matsu Borough: Department of Environmental Conservation. Well Drilling Permit Number: SW OSP221138 Date of Issue 5-19-22 Parcel Identification Number: 01515103000 Description [legal outh Lakewood Hills Block 1 Lot 3 11 Pump Installation Date: 5-26-22 11 Pump Intake Depth Below Top of Well Casing: 112 Pump manufacturer's Name: Grundfos Pump Model: 15SQE10 Property Owner Name & Address Martin Smith feet ') Pump Size: 1 hp 11 Pitless Adapter Burial Depth: 10 feet Pitless Adapter Installer: Unknown Disinfected Upon Completion? ® yes ❑ no Method of Disinfection: Chlorine 50 PPM II Comments: Pitless Manufacturer: Unknown NOTE: Pump was exisiting in old well, swapped over to new well. 11 Pump Installers Name: Sullivan Water Wells Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Municipality of Anchorage Community Development Department On -Site Water & Wastewater Program 4700 Elmore St. m P.O. Box 196650 is Anchorage, AK 99507-6650 MBiu.; ;,,�;_-o ,si c_ m (907) 343-7904 Well Decommissioning Log A Legal Address: -Subdivisi®n Lot T R Section Lot Block _ On-site Water & Wastewater Program certified contractor performing the well decommissioning: Name: Signature/t Company: F� [i� �,; 1,A_ 1 a .r L`\ sf'. f : 4d ;, fjA Well decommissioning date: j �jJ- J -Method of decommissioning: AMC 15:55.060L1 a. EJb. Elc. P Location: Use the space below to provide a drawing of the property showing the following items; • North Arrow • Decommissioned well, o Other water wells on the property, ®Two separate swing -tie distances for each well shown in the drawing, Note: The swing -tie distances shall be measured from either permanent structures of property corners. / a a n FA O O LOf 2 RETAINING WALL rn LOt 4 N Ln 1 c�R caRacE 35.3' ' -X6.6'':...:: •- aR ,�,. 1 r 12.1'x16.1' SHED w/ 9.2' .SEPTIC . LEAN—TO'S ON BOTH SIDES PIPES —J —_--- N 89'59'W 126' 6 0 r: • GRr`VE� vrAu. PORCH . t'C 1 STORY -Cqo RESIDENCE w/ DAYLIGHT BSMT. S 89'59'E 126' WELL N LO 45.3' PIPE T NOTE: THE NORTH 25' OF LOT 3 WAS TAKEN FOR O'MALLEY ROAD R.O.W. (PLAT No. 76-197) PLOT PLAN _ _ A5 BUILT _x_ SCALE 1" = 50' GRID SW 2638 Project No 22-3Za/A2 �Q,^ � „ 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & A S S o c i a 1 e S9 inc. (907) 522-6476 Phone (907) 522-4625 Fax a�Qo o4/Q��� Professional Land Surveyors ken®Iangsurvey.com v .. „ �C, . •. • -95 4 jonathan0langsurvey.com v'` I hereby certify that I have surveyed the following described property: REMAINDER of LOT 3, BLOCK 1: SOUTH LAKEWOOD HILLS (PLAT No. P-355) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the —_— Day of ___, _ at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 49TH T' .. KENNETH G. LA o F LS -5202. 4 VR���fSSiONA� �?o AECC963 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 http://www.muni.org/onsite On -Site Water System Permit Permit Number: OSP221138 Work Type: Well Upgrade Tax Code Number: 01515103000 Site Legal Address: SOUTH LAKEWOOD HILLS BLK 1 LT 3 G:2638 Site Mailing Address: 6300 O'MALLEY RD, Anchorage Owner: SMITH MARTIN Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: �ri�enr �o 2 1 v Ueparunent Lot Size in Sq Ft: Total Bedrooms: 5/19/2022 5/19/2023 32130 Q 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: To close out this permit, please submit the following: 1) Well log 2) Pump install log 3) Water sample results for total coliform, nitrates and arsenic 4) Well decommissioning log for existing well. Received By: Date: Issued By: Date: a �a 2uSN MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTICIWELL PERMIT APPLICATION Parcel 1. D. _(71 S % S ' y 3 Property owner(s) rKcr--� y1 S nd 1 )41 Day phone Mailing address [® _� p U tp `mc, t (c`t Site address -5 a r»_ Legal description (Sub'd., Block & Lot) Sn v� Vl �� L� r , r (�, l i S ✓J % Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms APPLICATION IS FOR: (® all that apply) -Absorption Field ❑ Septic Tank Holding Tank Privy Private Well Water StorageEl APPLICATION IS AN: TYPE OF DWELLING: Initial ❑ Single Family (SF) L�' Gwo ADU) Upgrade Duplex (D) Renewal ❑ Multiple Dwellings (SF and/or D) THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of owner or authorized agent) Permit/Rush Fees: 4- 13 5 Waiver Fees: Date of Payment: 5h pQ 2 5 "71 Date of Payment: Receipt Number: 0 6 5 1 `-(6 101566 Receipt Number: Permit No. OJP ,?Z I [ 3 S Waiver No. GADevelopment ServicesTuilding Safety\On Site Water and WastewaterTormsUient FormsTermit Application.doc TONY KNOWLES, COVERNOR DIVE OIF ENVIRONNI[ENTNf, CONSERVA"140N DIVIRCIN O,VENVIRONNIENTAL 11EAL"I'll DIUNKINC. WATERaitd WASTEWATE.R PROGILNNI 555 CORDOVA s,rRFE'r 'I'Viepholle: (907) 209-7096 ANCH0R,,xGE,.-Ui- �)9501 F;I-V: 007) 269-76-50 October 20,1999 MT. Steven R. Pannone, 11,17. VC), BOX 102954 -Anchorage, A Laska 99510 Subject: 1-01 3, Bfib& L SOUL11 Lakewo0d llillS, Ubdi'ViSi-011. [Crnlit Jk) Class C Public Water System Sourot Well tind Wasic,watcr Dispwad Dear Mr, Pannone: This is in resporiseto your submitial received in thisoftice on hepwrnber 7 and 23. 1949 regarding thi huldlation of a ('lass C1 Public Wateystern Source Well and malyuwawi disposal system to serve two Wmes at the my review of the suinninoxf hiRrmadolt diseussium, ""'2111 Ioc,jl �,Igcrlcies alt 'd review of the S"we Drinklrl'Navy and Wmewer Flspusal Based oti Ilii� review, I iii Iiic Coflov.-ing conin-lents, --- rinking Water It zippea.Ts that IN: J1111PONAl CISS C pubhc �valk,-rsyslem souo:v well hahet�n Ioc�'a�d iji accardrinee with thj- Drinking '011111101'AgUITAORS, 'I herefort- ccnistruction al.,quovat tO inStall the prOPOSCd SOLD WCH Aboinggratik-,d, Cousirtioi(,in Caj-tjr Icate- constiuitin,g this at)proval is enclosej. Prior to providing ivawr EO the pill& and yow cliCllt,l III-1at 01)erl-1601) aj,)f1f0Wi1 �Vilt FICCLI to be obtabed Kum this Dcptryinjelit. The following iter is evill need to be provide Goo review, Verificalion 1 -1 -1 -at [tie riew soayct: Well flleet� .111 F)10vi-Siojv1 ol' 18 AAC sonnoy A loQ alld Well Yield 10SL JIM J�Vejj JoL, Will need to bc ill dic in thc Dcpaittjwitt 0-MAW-Vid RV,0LITue-S ( I I AAC 93 3, Record drawings of the water system under the statrip of a Professional Hriginem. The reconi dramdngs vvill,need tcj vcri(y benveen the suur&: "A and the disposal, syswyn 4. Culcu hidons shoting i hat the well yield can rrie.Qt peak- (Jerii LI cun not meet peak damand, the calctllatiOfiS will Ireed 10 ShOW h(AV W4(el stolaLle'volunle "Vas determined. l he 11)tparrInem does ixg oluccpt the use t' Seven R. Ninnone the Nvater fibund in die %Ydl cashly above the kw4l purnp tu, !-,%, wied as vx'ari Clic wawr storage calCL1Ia1iO1lS- 5, W,,itt:r sarriplu rosWls Ar total coh livik Imetuia and nknac 'as Nuumen 6, l(itntif ication of systeni ownership, argil the individual ins1wrisihic 10 ssten-1 y openam trainwance, and irpir. T Verific,ttion illat ejnly lead-ftee I)ipC, 11U.-�: --D.Fld 120MAI'Lldiffl'1 of flic- ilnblie Water Systcu'L Vedficatilit dint si Nva!ldr rights apphanion hcen 1-yarunctit O'Natural Resuiuces. m this 011 .. the inuarict WAR o1wouhm NOW A AI YU)i bc 11t1d Lq;1' 0 1 i--: is I ii,t Ip! ---ir2d- 'Verifitc-,-iiiun Mar din MY, sow cc "M 41!,; proplzrl",. Wastewater CO lite t iqt—ia —nd PjA�()�al It UPPCaTS flIAL the VYaStewater di�;posal systeni will �be iPSt,11JQd it! UCLTWdaHC(:, iv'101 ttlL State Nkamewater Regpdoions ( 18 AM 72035b FhavArc, conmmck�i UPI)rOVal tO iftStall die proposed,;()UrCc Well is 13VIng gnwitcd Constituting this approval is Arjd dj,spcis; l E��-,tejlj rvjl[ jjr.-t�(j [ij lig- 111ollitored b" a I'Irofissional Lngin,.-et or someone uruier the Novi ralperviskni 00 VE- Recual dra"Ings of the wasiewarei WROKIM 111A MIMS SYS RM "It! i9. he stAmiked P) dis Wee under din direcl, super%ision cW;1 P1"- I IU, subt-nitind wo.-J dralvings, will nevd to verHy Wk wN All hodywo! w�-! wrtiad ;xparmion chmnces- The attached DomeWWW"wer M'iler',, iatt:11,lcnt and Ulij Sl!' �,-i llcvd to hu i�oiuplu&d and rdunwd w Go AW: llwse approvals do nol. ;i3 }3 A: graiHilig w wo, KNOW AMP"r- any siatc. 1�"deral. or lcwai ret",Ltiatory body io gnu" rNowed amhnnwown,� Ilmnk you kv Y, lur 4 oopen0jon and emmUhlation NO W DUPITUTint. If 11% We on,,� quemionn Weas: do not 1(i c.cint.1ci Elie, Keven K Kfew,--no. Envirorlinerital Enclosures: As Stated Ce: briles Cross! P:F_ MOA.,�`DHIJSw/o Bw, Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICF-S 825 "L" Street, Anchorage, Alaska, 99502--0650 SOILS LOG PERCOLATION TEST - — - - - - - -4f 4L DA r- PERFO LEGm. bESC 43 l4A -T f Qj Township, Range. Section: I S 4 A '-X-zC 14 DEPTH SLOPE SITE PLAN 1FEETI I - 2- (f-2 Uj .3 - 4 - 7 1 Li 12- 13- 14- 15- 16 17 18- 19 201 We" —� L' Ck f Af� I I I I I 6SOAVL'IL4 4t WAS GFZOUNDWATER SgVk7Advi ENCOUNTERED? L IF YES, AT 01HAT 0 C, e 4jlt, DEPTH? P E OeNh to Water May monilaning? — OHIL., -T—U-S-r- � Q E? -LL Cr fl kb 8-b 6,4,VIN Read;ngDate Gross T;njF Net Depth - i: --r me[ Time Water Drop 9 to - ev e. "K C9 72 V16 2 C> q3iC2 -2- PERCOLATION RATE /-:5Mlkrwtetst�nchj PERC HOLE DIAMETER TESI FIUNBEVNEEN 16 Ft AND rl , L IFRFORIMED BY: I CERTIFY THATTHI-S TESI WAS PERFORMED IN kGCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE: 2-00a(Revs 4435j m DESIGN DETAILS PID, NO m5-i5vn WASTEWATER ABSORPTION SYSTEM LOT 3, BLOCK I SOUTH LAKEWOOD HILLS S/D \Qork\DRAVlNG\3-lsLAKE,DW5 La 0 z ID lu . I Kt-l'AoXLlJ I- UXV Mt-. Chuck D-avls 63OG E, llMaUey Road Anchorage, AK 99-516 (507) 346-3e7l- lroh IMINVTO inmv3"m z I'M N , V3-10 Norlv1(mnmJ I PANNONE ENG, SVC, P 0, BOX 102954 i ANCHORAGE, ALASKA 99510 1 272-82Xl8"P.lA0N;—* P. FAX i Nmt- nT -rn �rAl Fl DESIGN PERMIT ND DESIGN F'J,D, 101 015-151-01 WASTEWATER ABSORPT-10N SYSTEM LOT 3. BLOCK 1 SOUTH LAl<EWOOD HILLS S/Tl DMAL LEY ROAD 150' WELL PROPOSED RPDiUS�a� CLRSS C� VELL a, - EXIrPG 0RA7N FIS EIi TO IE AHANDDNEII! A1�� REGS _ li L}L isT'GItrdaN SEPTIC BYTE. t �r S�r i itf 5"aS i �.TA W ADANbONED WITHIN 150 QF PROPOSED FT !;'. EXiS"tcuk Yx 4 9R ! 7tiST G TO � ADANMW-D --::/% VEIL PROPOSED 200 4 SEP TIC TA �*s= ,,-, %iS1'G i FSR APPARI'MGNf -- PRII T) nEEP, TRENMES '. 3a , [Axis' EFmcnvE 1 I TPl ; INSK LE11 I _ i WOODMONT DRI'V'E Ci\Wcrk\DRAWING\3-1SLAKUWG DESIGN, G BEDRUGM H1lLJSE PERC RATE 15 MIWINCH 533 SF REQUIRED �'�[7- `••- 40 9' EFFECTIVE BEEP TRENCH 60' LONG .' 20' TOTAL DEPTH !....::.r.. ..................s..... 1080 SF T QTAL I-KC-t-fiXt fE r UNI Mr•, Chuck Duvls 5300 E. [YMaUey Floud Anchorage, AK 99516 0907) .346--3874 PANNONE ENG. SVC R ; O. BUX 102954 ANCHORAGE, ALASKA 99510 272-82118 Phone & Fax aTE'�9,1g. 99 DESIGN MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PoBox 1ysmm 4700 Elmore Road Anchorage, Alaska esa1ysssu p» -7e04 Fax: (9o,)a4a7usr Permit Number: O8P221138 Work Type: Well Upgrade Tax Code Number: 01515103000 Site Legal Address: SOUTH LAKEWOOD HILLS BLK 1LT 3 G:2838 Site Mailing Address: G3OO{7MALLEYRD, Anchorage Owner: SMITH MARTIN Design Engineer: PANNQNEENGINEERING SERVICES This permit iofor the construction of: LJ Disposal Field [] Septic Tank [] Holding Tank 0 Privy Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 5/19/2022 5/19/2023 Private Well El Water Storage All construction shall bainaccordance with: 1. The attached approved design. 2. All requirements specified inAnchorage Municipal code Chapters 1655 and15G5 andth State f Alaska Wastewater Disposal Regulations (I 8AAC72) and Drinking Water Regulations (1 8AAC80) _ The wastewater code requires "inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.G5.Provide notification byUi~``24/7). 4. From 0�ober15tuApril 15.asubmudboosoil mbnorp�onoys�m underconstruction '�onm|r.cndoringhaazingweother shall beeither: a. Opened and Closed onthe same day, or b. Covered, sealed, and heated 0oprevent freezing ' Special Provi To close please submit the following: � . '._ll ..g 2 Pump install log 5Water sample results for total coliform, nitrates and arsenic 4)Well decommissioning log for existing well. Received By: Issued By: Date Aoft 0 _22ft— MUNICIPALITY OF ANCHORAG"F'o ! 90 s =' ;4, Development Services Department l` N-: Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. (7 J S I S/- 03 Property owner(s)e Sym,, ( �(41 Day phone Mailing address _ (o _� D U o r ,nc, t (c�� Site address ,S a rr,-P— Legal description (Sub'd., Block & Lot) Sn v � (���� , ��y �, l S ✓1J % �� Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms APPLICATION IS FOR: (N all that apply) -Absorption Field ❑ Septic Tank Holding Tank Privy Private Well Water Storage APPLICATION IS AN: Initial ❑ Upgrade ©� Renewal ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: TYPE OF DWELLING: Single Family (SF) Gwo ADU) Duplex (D) Multiple Dwellings (SF and/or D) Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of pro owner or authorized agent) Permit/Rush Fees: 1522 -5 + � 135 Waiver Fees: Date of Payment: 5/19 b 02 9 5 17/zZ Date of Payment: Receipt Number: 06 5 1 `{6 x'015 66 Receipt Number: Permit No. OJ/� �2 3 0 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\FormsUient FormsTermit Applicalion.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221138, Rebecca Carroll, 05/19/22 i3 III rONYIWOWLE5, 00VEflNofl DEPT. OF EWERONMENTAL CONSERVATION DIVISION OF ENVIRONMENTAL HEALTH DRINKING WATER and WASTEWATER PROGRAM 555 CORDOVA STREET Telephone: (907) 269-7696 ANCHORAGE,AK 99501 Fax: (907)369-]650 http:/hvwrvslate.akus/der/homePotm October 20. 1999 Mc Steven Box 2 Pannone, P.P. P.O. orage, las Anchorage, Alaska 99510 Subject Lot 3,Block ],South Lakewood dills Subdivision, Permit to comments Claes C Public Water System Source Well and Wastewater Disposal System;ADECProject Number:658; Review Dear Mr. Pannone: This is in msporse to yaw submittal received in this allies on September'/ and n, 1999 r regarding the installation of Class C Public Water System Source Well and wastewater disposal system to serve two homes at the abovcmfemrxed hand w. 1 have completed my review of the submitted information. discussions wi dm local agencies end yourself. review of the Slate Drinking Water ant Wuuewmer Disposal kegundors. Baud on this. review, I huve the hollowing comments. Drinduat Wme It appears that the proposed Class C public water system source wall has been located in occurrence with the Stele Drinking Water Regulations. 'I'hmetrme, ronanuctionapproval as ]oral the proposed source well Is being granter. A Construction Certificate, constituting this approval is enclosed. Prior to pmviding water to the public and your client, final operation approve] will and an be obtained from this Ikparlmanc The following items will need to be provide for review: I. Verifundon that die new source well meets all provisions of 18 AAC x0.013(6). 2. A copy of the well log and well yield rest. ]'he well log will need to ho in We format fund in the. Dcpartaan ufNamnil RmUuwo.%(I I AAC 93). 3. Record drawings of the water system under one stamp of a Prof somal Engineer, The rocwd drawings will teed to verify the seporm ion chases between the source wall and the wastewater disposal system. 4. Calculations showing that the well yield can mem peak demand. 11voul yield can not meet peak demaml, the calculadmis will used to show how water storage volume was determined. ThelSepanmem domnol aaeept the use of the water found in the well casing above the well pump to he used as pad of the water strange calcaladow. Water simple n'Sulta for low Coll floor harb ria mid nitrate mss Ntropent. Identification of synem ownership and the individual responsible for system operation, mainte come, and repair. Verification that only lead-free pipe. Ilex, and raider were card during construction of the public water system. Verification [but a water rights application has been submitted in the Alnxku Dcparmwrn of Natural Resonates. At time, the lemance ofdm opemuuu aenifieatc will not he held up iI that is not compkwd. Verification that the existing source well Jilts been properly decommissioned will need m he pm vided Wastewater Collection load D3ssoral It appears that the wastewater disposal system will he i walled in accordance with flu State Wastewater Disposal Regulations (I g AAC ]2.035). l'herefo[e, cotuwcdun approval to install me pmpased source well is being granted. A Construction Certificate_ constituting this approval is confused. 1. The installation of the w aCnisor additional and disposal system will need to be monitared by a Professional Engineer (P.E.) or someone under the direct supervision of a P.E. 2. Record drawings tartar wastewater collection and disposal system will be to be submitted to this office order the direct supervision of a P.F, TM: submitted record drawings will need to vori fy soils and all bonstudial and vertical separation dicta was 3. The attached Domestic Wastewgrr Owner x Statement and Data threat will aced to be completed and returned to This office. l' beer approvals do not imply the graming of only nddi 11011.11 dIllitr cions, not obligut: any state, federal. or local regulatory body to pram report autboriemmna. Thank you for your cooperation and coordination with this Department. II' you have ran questions, please du not hesitate to canasta tire. tin sly. Kevan K Klewene, P.E. EnvionmenW F.ngineri Enclosures: As Stated Cc: lames Cross, P.E., MDA01HIS, w/o has. © Steven R_ Pannone Page2 tol the water found in the well casing above the well pump to he used as pad of the water strange calcaladow. Water simple n'Sulta for low Coll floor harb ria mid nitrate mss Ntropent. Identification of synem ownership and the individual responsible for system operation, mainte come, and repair. Verification that only lead-free pipe. Ilex, and raider were card during construction of the public water system. Verification [but a water rights application has been submitted in the Alnxku Dcparmwrn of Natural Resonates. At time, the lemance ofdm opemuuu aenifieatc will not he held up iI that is not compkwd. Verification that the existing source well Jilts been properly decommissioned will need m he pm vided Wastewater Collection load D3ssoral It appears that the wastewater disposal system will he i walled in accordance with flu State Wastewater Disposal Regulations (I g AAC ]2.035). l'herefo[e, cotuwcdun approval to install me pmpased source well is being granted. A Construction Certificate_ constituting this approval is confused. 1. The installation of the w aCnisor additional and disposal system will need to be monitared by a Professional Engineer (P.E.) or someone under the direct supervision of a P.E. 2. Record drawings tartar wastewater collection and disposal system will be to be submitted to this office order the direct supervision of a P.F, TM: submitted record drawings will need to vori fy soils and all bonstudial and vertical separation dicta was 3. The attached Domestic Wastewgrr Owner x Statement and Data threat will aced to be completed and returned to This office. l' beer approvals do not imply the graming of only nddi 11011.11 dIllitr cions, not obligut: any state, federal. or local regulatory body to pram report autboriemmna. Thank you for your cooperation and coordination with this Department. II' you have ran questions, please du not hesitate to canasta tire. tin sly. Kevan K Klewene, P.E. EnvionmenW F.ngineri Enclosures: As Stated Cc: lames Cross, P.E., MDA01HIS, w/o has. PERMIT NO, DESIGN Psn NN 215-MAKI WASTEWATER ABSORPTION SYSTEM LOT 3, BLOCK 1 SOUTH LAKEWOOD HILLS S/➢ OMALLEY ROAD fkLZhl 4. \ WOODMONT DRIVE ' p AwouG 3-IsEaxr. Iva BESMN, 5 HEDRNOM HWSE �(Es� 933 SF TES /INCH 9' EFFECTIVE ➢EEP TRENCH 60' LUNG 4J07m 20' TOTAL ➢EPM1080 SF IRTAL PREPARE➢FOR, PANONE ENG. SVC Mr. Cm Nevs P, O. BOX 102954 63N E. 9+Meloy RoodAnGormon, NM 99916pNCNGRpGE, ALASKA 99510 K90D 346-3874 2)8-8210 Phone L Fax 9-19- DESIGN %E mR : FAMNI€ FTG _AC R NO. : P 2h9 _ `.se. m 1999 BS:Z m �17 NO DESIGN DETAILS PIA, NO, m9-151-03 WASTEWATER ABSORPTION SYSTEM LOT 3. BLOCK I SOUTH LAKEWOOD HILLS S/B MuNE IM W AncMr+Ye C OEPARTMEM OF HEALTH $ HUMAN SERVICES 1-1" SITZ AnCNgege, ANI835 CSIGG SOILS LOG — GESCOLATION TEST PERFGREERFORI OR VNOCFE�Wurc GATE LEGAL DESCRIPTION: 4d "A 1 S l.Al<G.. +9MILL I QWlI nage, oecwn: DGTH SLOPE DUE PLAN 1 1 2 d 6 P } P a TO �y} LAI GaA�u) 4nquu..S. I`^(SAr:Fy ZNLY � 4RAVYL( W'-(/"ssPXg W0.5 GNGVuo WATER MEMEMEMEMI. GP` �nda�t��v�sr�s PEI -f sAmb. 0,*BIgs 6-9'tp 6A6:"piN4iuy. Tby+ WWNL 46NLm 5w]5 ■■■■■■■■■■ MEMEMEMEMI. ■■■■■...■■ �nda�t��v�sr�s ��mrse��e PERCOLATONOOPE ,—s InunWw�RNIFFACHOIEaMMETEP�y- xz �anxc PuaareA TESTNVNNATWEEM 16 FTAND /ar n _ sw PEPFONMEO BY. I CENTIry iINl iXK 1FSi WABFFPFONMEG IN ACCORDANCE WITH HL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS GATE GATE 12um Mx AN51 FROM : PANNONE ENG SUC Consulting Engi~leer PHONE NO. Post-ItTM brand fax transmittal memo 7671 # of pages September 4, 1999 Mr. Kevin Kleweno State of Alaska Dept. of Environmental Conservation 555 Cordova Street Anchora~,e, Alaska 99501 Dear Mr. Kleweno: EC VE SEP 0 7 1999 IDE., PJ~ ~'1~ ENT O~ Subject: Lot 3, Block 1 South Lakewood Hills S/D Permit to Construct Class C Well 1 arn writing to request thc State of Alaska's to ~ssue a permit to construct a Class C well on the referenced property. As we discussed last week, Mr. Chuck Davis owns this property and has been vv_der action from the Municipality of Anchorage Department of Health .and Human Services (MOA DHHS). I was hired by Mr. Davis to find a solution to these issues. On Site Waste Disposal This lot s currently se:wed by a smgle-famdy septic system Iocated in the front part of the lot. A single bedroom apartment is located in the middle of this lot. 1'he cesspool serv~n~, this apartment was taken out of service by the MOA DHHS during theqast week of AugusL Mr. Davis had co~2structed a soil absorption system on this lot in accordance with 'I 8AAC 72.035. The system was installed by a certified excavator and met the requirements of 72.035. I plan to verify that the system was installed accordiag to the requirement of T2.035 when construction commences. The new system wa~s installed approximately 25 feet fi'om the existing well and was not connected to either of thc two structures. The MOA DHHS removed the septic tank from the ground under their action. A new 2000-gallon septic tank will be installed. Water Supply q'his lot is currently set/ed by an unpermited Class C well. The records show that the well meets the separation requirements for a private well. Mr. Davis would like to construct a ne;v Class C well in the northern portit*n of his lot. See the attached site plan. There are no septic systems within 150 feet of thc proposed location. 'D~ere is a septic system located approximately 220 feet west of the proposed location. To accomplish this, he will need to abandoa the existing wastewater disposal system located in thc northern portion of the lot. Following is the proposed schedule to perform tlnese actions: ( ':kw( )~. K\D {'FI'I {1~. b%1- I SI .A K I .'.WOO DI JILLS.001 ,I)OC FROM : PANHONE ENG SUC PHONE NO. : 272 8218 S~p. 06 1999 04:24AM P5 ~ yJc¥in Kleweno September 4, 1999 ~>n ge 2 · Drill new well. h¢stall bentonite ~out fi'om the surface to 10 feet below ground level and around pitless adapter. · Install new water line from new well to house, routing water line around the existing septic system. - Install new 2000-gallon septic tank. Co~ect to field. Veri~ that the system at the southern portion of the lot is constructed ac~rding to 18~C72- Run new sewer lines to both dwelling u~jts. Do Not CogBect Lo units until existing well is abandoned. Abandon existing well in accordance ~th ADEC regulations. Abandon existing septic ~stem in accordance with ~EC regulations and UPC. · Connect ~ew well and septic system to units for use. Submit record information to ~EC for ApprovM to O~rate. I feel that this transformation can occur with out endangering the public or the families using this system. 1 request that approval be granted in a timely mariner, since the single bedroom unit is xvithout a waste water disposal system at this time. It is currently operating with a honey bucket. It' you have auy questions or concerns, please contact me at 227-3522. Sincerely, _ Stcvcn R. Pannone, P.E. Civil Engineer Attachments (:\wOP, KU,i~]' ]'; ~.~3- S ~AKI~WOODI I~ILLS,00LI)OC FROM : PRHNONE ENG SUC PHONE NO. : 272 8218 Sep. B6 1999 D4:24RM P4 DESIGN WASTE~/ATER ABSORPTION SYSTEM LOT 3, BLOCK i SOUTH LAKE~/OOB HILLS S/D 186,00 C,\Work\]]RA~N G\3- ISLA KE,D~/G OMALLEY P,Z,~, NOI 01,5-151-83 WOODMONT DRIVE 189,00 ~F~IGNI 5 BEDROOM HOUSE PERC RATE 5 MIN/INCH 750 SF REQUIRED 9' EFFEOTIVE I~F'SR TRENCH 60' LBNG ~O' TOTAL DEPTH 1080 ~F TOTAL PANNONE ENG, SVC P. O, BOX 10~954 ~ ANCHORAGE, ALASKA 99510 /272-8818 Phone & Fox I~CAL E~ 1'=60 PREPARED FDR' Hr, Chuck D~vI¢ 6300 E, m'Mo, l~ey Rowel (907) 346-3874 FROM : PANNONE EN8 SUC PHONE HO. : 272 8218 Smp. ~6 1999 04:85AM P5 PEP, MIT N~ DESIGN DETAILS W'ASTE~/ATER ABSORPTION SYSTEM LOT 3, BLOCK i sOUTH LAKE~/OOD HILLS P,I,]], NO' 015-151-03 W C,\~ork \DRA~INr,\3-1~LAKE.D~dG I~DN¥39J PREPARED FOR~ Mt", Chuck De, vis 6300 E, O'M~lley Ro~d Anchor=ge~ AK ggs1G ('907) 346-387,$ PANNONE ENG, SVC, P, 0, BOX 108954 ANCHORAGE, ALASKA 99510 272-8~18 PHONE & FAX T~ATE~ 9-5-99 NOT TO SCALE DESIu,~ OCT 22 1999 DEPT. OF ENV1RONMLNTAL CONSERVA~ ION Municipality ot Anchorage OepL Health & Human Services DIVISION OF ENVIRONMENTAL IIEALTH DRINKING WATER and WASTEWATER PROGRAM 555 CORDOVA STREET ANCHORAGE, Al( 99501 http://www.state.ak.us/dec/home/htm Mr. Steven IL. Pannone, P.E. P.O. Box 102954 Telephone: (907) 269-7696 Fax: (907) 269-7650 October 20, 1999 Anchorage, Alaska 99510 ~ ' r3 Subject: Lot 3, Block 1, South Lakewood Hills Subdivision, Permit to construct C!:tss C Pubhc '~Tater System SOL ZCC V/ell and Wa:;tcw tic I) spo3t ~ System; AJ)l;C Project Number: 658; Review Dear Mr. Pannonc: This is in response to your submittal received in this office on September 7 and 23, 1999 regarding the installation of a Class C Public Water System Source Well and wastcwater disposal system to serve two homes at the above-referenced location. I have completed my review of the submitted information, discussions with local agencies and yonrself, review of the State Drinking Water and Wastewater Disposal Regulations. Based on this review, I have the lbllowing comments. Drinking Water It appears that the proposed Class C public water system source ~vell has been located in accordance with the State Drinking Water Regulations. Theretbre, construction approwfl to install the proposed source well is being granted. A Construction Certificate, constituting this approval is enclosed. Prior to providing water to the public and your client, final operatiou approwfl will need to be obtained from t a s Departme/~t, The f~okowi ~-g items will need to be provide for review: 1. Verification that the new source well meets all provisions of 18 AAC 80.015(b). 2. A copy of the well log and well yield test. The well log will need to be in the format found in the Department of Natural Resources (11 AAC 93). 3. Record drawings of the water system under the stamp of a Professional Engineer. The record drawings will need to verify the separation distance between the source well and the wastewater disposal system. 4. Calculations showing that the well yield can meet peak demand. If well yield can not meet peak demand, the calculations will need to show how water storage volume was determined. The Department does not accept the use of Steven R. })annone Page 2 10/20/~)9 the water lbund in the well casing above the well pump to bc nsed ,ts t~a~rt oi' the water storage calculations. 5. Water sample results lbr total colit~)rm b~tctcria ami nitrate (as nitS'ogen). 6. Ideutification of system ownership and ibc individt~al responsible l~r systc~ operation, maintenance, and repair. 7. Verificatiol~ that only lead-lkee pipe, t]ux. ~mcl solder were used during construction of the public water system. 8. Verification that a water rights application has been submitted to the Alaska Department of Natural Resources. At this time, the issuance el'the operation certificate will not be held up if this is not completed. 9. Verification that the existing source ~vell has been properly decommissioned will need to be provided. Wastcwater Collec~,iol~ and Disposal it appears that thc wastcwatcr disposal system will be installed in accordance with thc State Wastewater Disposal Regulations (18 AAC 72.035). 'l'herelbrc, construction approval to install the proposed source well is being granted. A (]onstruction Certific~t~', constitnting this approval is enclosed. 1. The installation of the wastew~ter co/tectiol~ ~ct disposal system will ~ecd [~> be monitored by a ['rofhssio~ml li~[,.it~cc!' (19./'i.) t)r somco~c ttncter tile (]irczc:[ supervisicm cfa P.[¢. 2. Record drawings oflhe wastcwaaer collectior~ and disposal systcn~ will k)c to be submitted to this elect under the direct supervision of a P.E. 'l'}~e submitted record drawings will need to veri[~ soils and all horizontal and vertical separation distances. 3. The attached Domestic Wastewater Owner's Statement and Data Sheet will need to be completed and returned to this offset. These approvals do not imply the granting of any additional authorizations, nor obligate any state, federal, or local regulatory body to grant required authorizatious. Thank you *{Ur your coopermion and coordination with this l)epartment. It' you haw~ questions, please do not hesitate to contact me. Enclosures: As Stated Cc: James Cross, P.E., MOA/DHHS, w/o Enc. TONY KNOWLE$, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION DIVISION OF ENVIRONMENTAL HEALTH DRINKING WATER and WASTEWATER PROGRAM 555 CORDOVA STREET ANCHORAGE, AK 99501 http://www.state.ak.us/dedhomeJhtm Telephone: (907)269-7695 Fax: (907) 269-7655 Chuck & Nancy Davis P.O. Box 22255 6300 O'Malley Road Anchorage, Alaska 99592-2255 October 2, 1998 Return Receipt Certified Mail P 388 516 876 Subject: Lot 3, Block 1 South Lakewood Hills Subdivision. Unapproved Class C Public Water System Dear Mr. & Mrs. Davis: We have not received a response from you to the Department's February. 12. 1998. In this letter, you were notified that the existing water system was classified as a Class C Public Water System and did not have an operation approval as required by State Drinking Water Regulations. Discussions with the Municipality of Anchorage, Department of Health and Human Services (MOA, DHHS) staff reveals that there may be a separation distance issue between the existing public water system source well and on-site wastewater disposal systems. As noted in the February. 12, 1998 letter, operation of a public water system without ;witten approval is in violation of State Drinking Water Regulations ( 18 AAC 80.300). The following items will need to be provided to this office within 30 days of receipt this letter: 1. The marked items in the attached Plan Approval Checklist for Engineering Plans Class C Public Water System. or 2. Verification that the existing received operation approval from either the Greater Anchorage Area Borough (now the Municipality of Anchorage), or this Department. ..Ptea~e be a~tvised that conventional financing for this property may not be available without verification of approval ~or me on-s~te public water system and wastewater disposal area. Your cooperation in solving this issue would be greatly appreciated. If you have any questions, please contact me. Enclosure: As Stated cc: Jim Cross, P.E.. MOA. DHHS, w/o Enc. Sincerely, Keven K Kleweno, P.E. Environmental Engineer Rick Mystrom, Mayor January 30, 1998 Chuck & Nancy Davis Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Property Owners of Lot 3, Block I S. Lakewood Hills Subd. PO Box 222255 6300 O'Malley Road Anchorage, Alaska 99502-2255 Re: Complaint #98-00202 Dear Property Owners: As a result of a complaint received January 13, 1998 our office investigated the status of the wastewater disposal system and water supply system for the property at 6300 O'Malley Road. We found that the permit issued from our office on October 20, 1989 for a new septic system was installed. However, the wastewater disposal system serving the apartment to the south of the house was not abandoned as per the permit requirements. The wastewater disposal system serving the apartment is undocumented and its location is unknown. The apartment's system must be abandoned and the 1989 system properly documented to be eligible for Health Authority Approval from this office to obtain conventional financing for purposes of selling or refinancing the property. The 1989 permit was obtained by Federal Alaska FCU and presumably installed while they were the property owners. Unfortunately you as the current property owners are responsible for the proper abandonment of the apartment system and documentation of the 1989 system unless Federal Alaska FCU will take responsibility. Since the well on Lot 3, Block 1 S. Lakewood Hills serves both the primary residence and the apartment it does not meet the definition of a single family private well and is therefore regulated by the Alaska Department of Environmental Conservation. We are informing them of this situation. If you have questions, feel free to contact me at 343-4744. Sincerely, Donna C. Mears Civil Engineer On-Site/Water Quality Program cc: Michael Lu, ADEC Tom Fink, Mayor Municipality Anchorage Department of Health and Human Services 825 "L" Street P.©. Box 196650 Anchorage, Alaska 99519-6650 January 8, 1990 Federal Alaska Federal Credit Union PO Box 7505 Anchorage, Alaska 99510 Subject: Lot 3 Block 1 South Lakewood Hills S/D Permit #890241, PID #015-~51-03 The subject permit, issued by this office for a single family well and/or on-site wastewater system has expired as of December 31, 1989. Permits are issued on a calendar year basis by authority of the Municipal Code of Regulations. A new permit must be obtained from this office for an well and/or on-site wastewater system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this office for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site wastewater system, the original as-built inspection report (three-part form) must be sent to this office for review, approval and documentation. When applying for a new permit, the fees are: $90.00 for an on-site wastewater permit; $50.00 for a well permit; $140.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. Sincerely, John Smith, P.E. Program Manager On-site Services JW/ljm:200 enc: Copy of Permit Kids Are Our Future" SCALE -4 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 1 5 6 7 8 9 10 11 12 13 14 17 18 19 20 Township, Range, Section: SITE PLAN SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? E Depth to Water AJ~,r~ , ~0nitoring? ~ Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE '~'~f (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN OOMMENTS 17034 Eagle River Loop Ro Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ~--~~ SEAL) LEGAL DESCRIPTION: 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19- 20- Township, Range, Section: WAS GROUND WATER ENCOUNTERED? SITE PLAN I ,I s IF YES, AT WHAT ~ DEPTH? p E Depth to Water A~Jle.r~,~ ~ · Monitoring? j,r ~,.~ Date: [0,-* I ~ ~ Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~'~l (minutes/inch) PERC HOLE DIAMETER COMMENTS ' Eagle River~ Alaska 995~ Z ~~ '~ ' / "~ 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 [] NEW E~0'PG RAD E NAME MAILING ADDRESS LEGAL DESCRIPTION LOCATIQN DISTANCE TO: I Wel,l~t ~,,I ILlq. capacity in gallonsI '~ "~^~E No. of lines Length of each line Top of tile to finish grade ~ Length Width Type of crib Crib diameter Well DISTANCE TO: ~ ,~ BuiJding foundation Foundation Total length of lines Material beneath tile Depth Crib depth Building foundation Driller Sewer line OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER P REMARKS Material Nearest lot line Trench width NO. OF BEDROOMS PERMIT NO. No. of compartments Liquid depth PERMIT NO, Liquid capacity in gallons PERMIT NO, Distance between lines inches Total effective absorption area PERMIT NO. Total effective absorption area Nearest lot line Septic tank t Absorption area(s) Distance to lot line PERMIT NO. APPROVED DATE LEGAL 72-013 (Rev. 3/78) ~) ,,~' MUNICIPALITY OF ANCHORAGE Department '~' Health and Environmenta? -,rotection 825 ~ Street, Anchorage, AK. _,)501 264-4720 " * * * HANDWRITTEN PERMIT * * * Permit ~ ~J~C~/. WELL AND/OR 0N-SITE SEWER PERMIT Applicant: "~i~% J~ ~L,~ Mailing Address: ,%~t') Location: Q ~.)~ ~C~Phone____ Nu~er: ,~ ~ ~'~ ~ ~ Leqal Description:~.~ ~(~C~ ~~o~ ~[~ Lot Size: Type of Soil ~sorption System Is: Trench: Drainfield: Seepage Bed: Holding Tank Maximum Number of Bedrooms: ~/ Soil Rating(sq.ft/br) The Required Size of the Soil A2Dsorption System Is: DEPTH ~i>~- LENGTH t~/~ . GRAVEL DEPTH ~'~{ 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 the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimu/n depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /,25-cP 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 residences that the well will serve. * * * TWO(2) INSPECTIONS 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 31~ 1 9 8 3 * * * I certify'that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) i will install the system in accordance with codes. I understand that the on-site to (3) t ~h~:~sl~ ~i_s~,~ ~-~ :modeled ppiican~ ~ .... SWP/024(1/81) sewer system may require enlargement if include more that 3 bedrooms. Date: ALASKA i uIRO[lm E/TAL COIBTROL $ RUiC $, IRC. ~nqipeerinq $ ~nuironmental Studies AUGUST 11 1983 MRS DURHAM SRA BOX 21R ANCHORAGE AK 99507 SELLER - MRS DURHAM BUYER - SUBDIVISION - SOUTH LAKEWOOD HILLS BLOCK - 1 LOT - 3 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A CRIB WITH AN AREA OF 654 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 1500 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 900 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 4 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1000 GALLONS IS INADEQUATE BY 250 GALLONS FOR THIS HOUSE OF 4 BEDROOMS. 1200 [Uest 33rd/~uenue, Suite [~ · ~nchoroqe, ~[oskct 99503 · (907) 276-1361 oGRE ANCHORAGE AREA BO~ JGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LEGAL DESCRIPTION' :P':( SEPTIC TANK: /-~7 ~ ,~P-.f/ DISTANCE j FROM WELL //'7 j (/~f ..... ~"-/ /' NUMBER OF MANUFACTURER ~z~/C~d; , MATERIAL, 2~¢rC [ COMPARTMENTS INSIDE LENGTH ~"-- INSIDE WIDTH ~- LIQUID DEPTH ~' .LIQUID CAPACITY,/~('~ ( / GALLONS. SEEPAGE Pit: NUMBER OF PITS /, DIAMETER , WIDTH LENGTH DEPTH LINING MATERIALk ,~12/h !G~ CRIB SIZE: D AMETERO¢ DEPTH DISTANCE FROM: WELL/ /~ '~, ~ / 5~ fi" TOTAL EFFECTIVE BUILDING FOUNDATION · , ', NEAREST LOT LINE '~-O * ABSORPTION AREA (WALL AREA) (~P (2~¢- SQ. FT. ADDITIONAL ABSORPTION WELL: BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION .P,- /> c' ~ / NEAREST p() ,/' NEAREST LOT LiNE~ SEWER LINE DEPTH /] ~" Cp / DISTANCE FROM: OTHER SOURCES DISAPPROVED__ REMARKS SEPTIC TANK SEEPAGE SYSTEM DISTANCES: INSTALLED BY: ~J'i(~ ~; "' Form No. EQ-031 DIAGRAM OF SYSTEM ph t~', G ~ ¸5' G.A.A.B. GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY , 0-'D SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PER/v~IT pERMIT NO. NAME Of APPLICANT [j' INSTALLATION LOCATION PHONE OTHER _ TO BE INSTALLED BY ~OIL TEST RESULTS l~'/(.;~)/i :! PFRMIT VJUJ. D I3NF YFAR 5 f~. FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT 20 fi, DRAIN FIELD ]_.~0 ft. SEPTIC TANK 5 f$~ SEEPAGE Pit 20 ft. DRAIN FIELD --]0 ft~ TO NEAREST LOT LINE. WELL TO SEPTIC TANK ~ z~ WATER MAIN TO SEPTIC TANK 10 fi, DRAIN FIELD 10 ft* ALSO CONSIDER AREA WELLS. SEEPAGE PIT 10 SEPTIC TANK, 25 f~e SEEPAGE PIT 100 f~e i DRAIN FIELD 50 / DEPAR,,.cNT OF ENVI~qON,I~,,~..,L QUAi..I~( 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 CASE Performed For Legal Description: Lot 3 Block This Form Reports Soils Log.. xx · Date Performed..Jnne 7~ 1973 Subdivision SouthL~ Hills f~l-~ t 1 o n [est Depth Feet Soil Characteristics ~1 ~'' organlcs - roots, e~c. 1-- 2 -- Gravelly silty sand [o 2" max. 4 -- GM-SP Gravelly reed.and fine sand, silty with medium sand lenses scattered · vertically - total of 2570 sands GM-SP was Ground Water Encountered.? No If Yes,~At What Depth? , Reading Date Gross Time Net Time Depth to ~20 Net Dro I ' :o'la~iot Rate Minute Proposed Insta'i"lagion: Seepage Pit / Drain Field Depth Of Inlet Depth To Bottom Of Pit Or Trenchl2' = COMMENTS: Soils characteristics reqmre 185 sq.ft, per bedroom, ?est Performed By. W.F.Atwood ALASKA MINERAL & MATF, RTALR I,AR' T~r~ D'ata C e r t i'f-f'~]-~--By: Date:~¢9 ~, 1973 'f O�a C-) RA � ��'"� . � j 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. 015-157-03 1. GENERAL INFORMATION Expiration Date Complete legal description South Lakewood Hills Block 1 Lot 3 Location (site address) 6300 O'Malley Current property owner(s) Jake MaSog Mailing address Real estate agent 2. TYPE OF DWELLING: Fx_1 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic n Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distan Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $_ Waiver Fee $ Date of Payment Date of Payment Receipt Number . cjz_-1 i :5 Receipt Number COSA# (")SC ZZ( 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 Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. Date Z� JTY OFNo , 6. DSD SIGNATURE ' �p VVgEE , ... S � -_ WAST,; ..M. ......... _K System #1 Approved for bedrooms M- V A-teven. =f . Pcn„orie y Approved for bedrooms J�-o PROG�q �s Zc 0�4� ` System #2 A O Disapprovedtij �� '��FE��U�`� � 9i JJ Conditional approval for bedrooms, with the follastipulations: I�yN.9 Civ\ \ y: `'`— _ Original Certificate Date:” ZZ 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 Legal Description: South Lakewood Hills Block 1 Lot 3 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 5123122 Total depth 135 ft Cased to 135 ft 0 Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 5/23/22 Static water level at beginning of test 94 ft. Comments B. TANK DATA Age of tank(s) 0 years Tank type/material SEPHDPE Measured operating fluid level in septic tank NA 0 Standpipes/foundation cleanout per record drawing Date of pumping new system D. ABSORPTION FIELD DATA DEEP TRENCH Which system tested (date installed) 8/3/2022 ❑ ALL standpipes present per record drawing Total measured depth from grade 12.5112.1 ft (max) Measured depth to pipe invert from grade 6/6 ft (min) ❑ N/A — pressurized field 0 Monitor tubes go to bottom of effective. If not, state depth into effective 0 Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: new system COSA Checklist yellow sheet Parcel ID: 015-157-03 Structure served by this system 1 Well production at time of test 20 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes R No 0 Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Sullivan's water wells Date of Sample 5/23/22 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date $/3/22 Results ❑✓ Pass For 5 bedrooms Fluid depth prior to test 1— 6Lt'Ll Water added gal New depth in Elapsed time min Final fluid depth •5 in Absorption rate 750+ 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' Fv Yes if No ft Cj✓ Yes if No ft Neighboring Tank > 100' F/ Yes if No ft Private Sewer/Septic Line > 25'F71 Yes if No ft Absorption Field on Lot > 100' F-1 Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' [/✓ Yes if No ft ❑✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' MYes if No ft PD Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' MV Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5✓Q ❑✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' El Yes if No ft Private Wells > 100' Yes if No Water Main > 10' ✓l Yes if No ft Community Wells > 200'✓[] 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' ✓Q Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓l Yes if No ft Private Wells > 100' ❑✓ Yes if No Water Service Line > 10' R Yes if No ft Community Wells > 200' FZ Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS Old well being used as a light pole was decommissioned. See receipt from Sullivan's Water Wells, G. ENGINEER'S CERTIFICATION l certify that 1 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. COSA Checklist yellow sheet OF A�qs��� C' I 49 TH Steven 'R. Pan none CE 8149 ' r?O;rE;S1� ft ft ft ft eDevelo mntServices Department � 433-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-151-03 1. GENERAL INFORMATION Expiration Date:�' cS. � ` zZ- Complete legal description South Lakewood Hills Block 1 Lot 3 Location (site address) 6300 O'Malley Current property owner(s) Martin Smith Mailing address Real estate agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 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: Dista Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 5 5 O Waiver Fee $ 05/_20�� Date of Payment Date of Payment Receipt Number 0 f 1� I �G Receipt Number COSA # O 5 C a a 1'D t a 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 engineers tart ys s of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of �e�l e conditions encountered at the time of the test, and separation distances measured to readily identifiable features. T e����tidn'ai'Pif��i�ji�lls and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, water usage off �y�ily being served by the system. These conditions are outside the control of the evaluator of this system. A� ems even�y�1I�t fail satisfactory test results do not guarantee future performance of the system, nor do they guarantee that they �_ no hidVi rte`tl?bt—Soren ments. Therefore we cannot provide any warranty for future performance, nor can we estimate remain Ne ofVyATEsRrr NID corltt;ri�of this report is for the sole benefit of the owner listed above. Reliance on this report by another persona t tag q risk p ne eerin Services LLC highly recommends buyers hire their own engineer to evaluate this report. UdAJ I i �'lHT� U g 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 PROGKAM Qe Phone 745-8200 --- Phone 221 OF AL System #1 A �'" X� y Approved for bedrooms Steven R onnome System #2 Approved for bedrooms �`��' CE 81Z.0 •��� Disapproved �A�F�Ff'OFES510>>t`4� Conditional approval for bedrooms, with the following stipulations: 4'( k 0.14101 VP L/ V cod C.W /r"w �✓ , c a �� I -e•edl � v �' v�r�e + �� --� U r VYA e t S eC/ RLP_ / rl C C 1r<l dkC l ( 14p5 By: - l -� ►�� �/y�''� Original Certificate Date:— 62 The Municipality of Anchorage Development Services Diuision DSt�)5 ues Cert�icate o on -S to Systems Approval pproval (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 S� l AjC i�o Fjn(✓;S i o►',l Legal Description: South Lakewood Hills Block 1 Lot 3 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 5/23/22 Total depth 135 ft Cased to 135 ft N Sanitary seal is functioning correctly INM Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 5/23/22 Static water level at beginning of test 94 ft. Comments B. TANK DATA Age of tank(s) 23 years Tank type/material SEP 15T[El Measured operating fluid level in septic tank NA ❑ Standpipes/foundation cleanout per record drawing Date of pumping Tank Pumped Prior to Adequacy Test D. ABSORPTION FIELD DATA DEEP TRENCH Which system tested (date installed) 1999 ❑M ALL standpipes present per record drawing Total measured depth from grade ""ft (max) Measured depth to pipe invert from grade 10.5/9.5 ft in) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 3.6/6.2 ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Parcel ID: Structure served by this system 1 015-157-02 Well production at time of test 20 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ❑✓ No ❑ Coliform bacteria is Negative Nitrate (9-34o mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L 4 Arsenic less than MRL (ND) Collected by Sullivan's water wells Date of Sample 5/23/22 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 5/25/22 Results M Pass For 5 bedrooms r3•�- Fluid depth prior to tes,� Water added 75 al w r3.S New de h 'fb�' i Elapsed time 104 min Final fluid depth "" in � .fig• S" Absorption rate 600 gpd Any rejuvenation treatment (past 12 months) Gallons introduced gallons If yes, enter date Comments/Deficiencies: WEST FIELD APPROX. 72% USED, EAST FIELD APPROX 90% USED. COSA Checklist yellow sheet 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' Q Yes if No Community Sewer Manhole/Cleanout > 100' (Q Yes if No ft [7v Yes if No fl Neighboring Tank > 100' (l Yes if No ft Private Sewer/Septic Line > 25' Fv-1 Yes if No ft Absorption Field on Lot > 100' Fv-1 Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' R Yes if No ft 0✓ Yes if No ft if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' (�✓ Yes if No ft [✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 21 Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5 Q Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No -ft Private Wells > 100' Yes if No Water Main > 10' Yes if No ft Community Wells > 200' Q Yes if No Water Service Line > 10' Cj 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' Yes if No ft If absorption field is under driveway comment below Property Line > 10' Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' [1 Yes if No ft Community Wells > 200' R Yes if No Surface Water > 100' El Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that / 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. COSA Checklist yellow sheet ���. FL���p.�rr�tzlli•i��-�� �� ft ft ft ft Septic 'Tank Advisory Certificate of On -Site Systems Approval #OSC OSC221282 Subdivision: South Lakewood Hills Block 1 lot 3 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks The septic tank for this COSA / property is 23 years old. A leaking septic tank may be a source of contamination to the aquifer. Typical replacement costs range from $10,000 to $15,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of a 16 -year-old septic tank in failure and should be replaced. MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-8301 Private Development Fax: 907-343-8200 Mayor Dave Bronson June 27, 2022 Jacob Masog Anchorage, AK Re: Undocumented Onsite Wastewater System Acknowledgement 6300 O'Malley Road, Anchorage AK, 99507 Parcel No. 01515103000 Dear Mr. Masog: Per your request for a conditional COSA to facilitate the purchase of the referenced property the Municipality of Anchorage requires your acknowledgement of the following items: 1. Mr. Masog acknowledges that he is aware that the system is undocumented, meaning that the seller is unable to produce certified record drawings showing that the onsite wastewater system was designed and installed in compliance with State and/or Local code requirements. 2. Mr. Masog acknowledges that issuance of the conditional COSA for the subject property is in no way an acknowledgment by the Municipality of Anchorage that the onsite wastewater system is in compliance with state and/or local code requirements. 3. Mr. Masog agrees to hold the Municipality of Anchorage harmless should the onsite wastewater system fail or be proven to be out of compliance with state and/or local code requirements after purchasing the property. 4. Mr. Masog acknowledges that he is required to obtain a valid COSA from the Municipality of Anchorage prior to any future sale of the property. This will require submitting complete record drawings of the onsite wastewater system certified by a Civil Engineer licensed in the State of Alaska. 5. The above statements are also acknowledged by all others party to the purchase of the property. ACKNOWLEGED: DATE Ax�- Jacob r sog 9"�'a� '�""4F'•T.Ffn 'g""+'iS"�S'ta''2' �",a��P'�� x '�,�'�## aih ddress �rv�Oox 196650 • dnc o� asKa995 665 ��YIunor f x.ffiv uocusign Envelope ID: 8CF6D384-E94B-42AD-9644-99B6C57C717D Martin Smith 6300 O'Malley Road Anchorage, Alaska, 99507 907-240-9137 Martininak@gmail.com 31May, 2022 Kim Johnson Project Coordinator Pannone Engineering Dear Ms. Johnson: I have owned the house at 6300 O'Malley Road approximately 5 years. In all the time I lived there, we have never had any issues with the septic system or drain field. Specifically, you asked if we have had any issues with freezing. The answer is no, it has always performed well, no matter how cold it gets. The previous owner said he never had any freeze up issues either. I hope this clarification is helpful. Sincerely, Kim Martin Smith [PI DocuSignedd bNy: pk4Zf� h4P 9C42FD9428FA468_.