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SOUTH LAKEWOOD HILLS #1 BLK 4 LT 3
Onsite File South Lakewood Hills #1 Block 4 Lot 3 #015-151-39 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211373 PID Number: 015-151-39 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name HEATHER L. IHLEN ABSORPTION FIELD ® Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 11101 ROCKRIDGE DRIVE, ANCHORAGE ❑ Other Phone Number o f Bedrooms Soil Rating Total depth from original grade 4 2 GPD/SF $ Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2.9 Ft. Gravel depth beneath pipe 5.1 Ft. Subdivision Block Lot SOUTH LAKEWOOD HILLS #1 4 3 Fill added above original grade VARIES 0.4-1.2 Ft. Gravel length 35 Ft. Township Range Section Gravel width 3 Ft. Beds: Number of Lines -- Distance between lines -- Ft. SEPARATION DISTANCES TO Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 357 Ft2 1 -- Ft. Well 50'+ 50'+ -- 25'+ TANK ® Septic ❑ S.T.E.P: ❑F61ding 0 Other ADVANTEX Manufacturer ORENCO / ANCH. TANK Capacity 1500 Gal. Surface water 50'+ 50'+ -- Material Number of compartments Lot Line 5'+ 5'+ __ NA COMPOSITE PLASTIC 2 Foundation 10'+ 10'+ ILIFT STATION Manufacturer ORENCO Capacity 1500 Gal. Remarks Alarm location GARAGE Electrical installed by RISING SUN Installer MIKE ANDERSON PIPE MATERIAL House to tank 3034 Tank to 3034 _ drainfield Drainfield 3034 CO/MT 3034 Inspector FWC & MNA BENCH MARK (Assumed elevation) 100 ft Inspdection 1st 2/7/22 2nd 2/7/22 Location and description 3`d 2/8/22 4" 2/11/22 TOP OF ADVANTEX POD ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional • Approval: Date ��Q.,.•' .tQ,� �� meg.• •:9 *: 49 7H ....�:* WWI Septic System • • • • • • • • • •V• % Curtis Huffman Approved - / �• ��� Fc�s� Date 2 72—S Z •. 2/ 2/22 •.����/ • �,l;F�pROFESSION�Aw Note: this approval does not include well permit requirements. PID: 015-151-39 PERMIT OSP211373 WELL ry PAVED � p PARKING g O GYRO w O ED I�DO Ci ]— Do 30 (� 1C) PAVED _ SHED I O S (0 D/W •- 72.5' CURB GPN p moo. O�G� 50' WELL Lil RADIUS > oo s Of W CO x O O H GT �� G) `0 I O o. O _ 0 Z Of O GAZEBO 0G� 48.2' Ile 0 0 z TH21-1 A ti Gp .. LOT 3 DCO S. BLK 4 D C DECOMMISSIONED EXISTING 30 MH DFCO SEPTIC500-GAL A VANTEXLSYST. NEW W/ NEW DFCO & DCO. 5' UTILITY ESMT N89 52'27"E 190.12' (S89 59'00"E 190.00' R) LOT 5 A—C=54.6'M POD TOP DFCO DCO CO MT Co — C = 21.8' 99.7 AX20 POD MH 97.5 FINAL GRADE ff"98.3 A—D=60.7' ORIGINAL GRADE/97.1FlLTER FABRICTH21-1 � B—D=22,7' ORG/OL A—E=74.0' 94.0 1500 -GAL 94.9 94.2 84.2 3' B—E=31.5' FAP 2.0 SEWER ROCK ADVANTEX 89.1 89.1 A—F=76.3' TANK NO GRND.WTR. sM-9m/ml B—F=34.1' 89.5 8/28/21 I-6=63.0' SEPTIC SECTION B—G=41.1' SCALEi NTS t4 BOH I—H=63.6'' B—H=42.2' SOUTH LAKEHOOD HILLS #1 134, L3 SUPPORT SERMCES: PREPARED FOR: ��� OF A44 HEATHER IHLEN 11101 ROCKRIDGE DRIVE C * 9 TH ANCHORAGE, AK 99516 FIRST WATER CONSULTING DATE: 02/22/22 rtis Huffman 13030 Sues Way SURVEY. JL202 CE 128991 `� Anchorage, Alaska 99516 DRAWN: FWCS 02/22/22'x$ (907)350-9566 SCALE: 1" = 30'ssi0��' FirstWaterAK@gmail.com LOT 5 ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: SOUTH LAKEWOOD .DILLS FIRST ADD. ®= FND 5/8" REBAR LOT 3 BLOCK 4 PLAT P-611 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a OF AL physical survey of this property as shown on this drawing and that the ,® ,. ' ' improvements situated hereon are within the property lines and no NJ enchroachments exist other than noted. Under no circumstance should4 1 any information on this drawing be used for construction of fences, ?� ' �z .................. �....... structures, improvements, or for establishing boundary lines. ® ' , . EXCLUSION NOTES: It is the owners responsibility to determine' x ' ''' ° f the existence of any easements, covenants, or restrictions Nvhieh •.JOHN L. SCH* U' M R: o �+ LS -10408 do not appear on the recorded subdivision plat. a WORK ORDER NUMBER: DAZE sca E E-NNL!� Na :t ; FEB 19, 2022 1"=30' schuller@ak.net A , AW 22-005 ORA. er: cr�«ED er aa0 rxmt�x aooK ncE � rOfessiona� L°AWOAw JLS SW2638 220121 �`®� " y 5 q C> 5 � 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax I LOT 1 N89'S1'12"1N 189.72' (N89°59'00"W 190.00' R) _ 5' UTILITY ESMT _ WELL p PAVED PARKING F - O GYRO w LOT 3 I 00 0 B LK 4 '5.0 no 6I] Zo I p� Q p PAVED SHED Lij W cfl m D/W C.j Q L. O _ 1 GP�� �� O�G� 72.5' ry m a�G� yf 1° o. °$a I O 0� �P O SEPTIC % Lwt?1 moo. �� moo- I 0 O U-) (typ)�d 48.2' Z O v b GAZEBO OtiG� d O Z ti$' n OPa� VAU�j 90 in MH 30' 5' UTILITY ESMT` N89°52'27"E 190.12' (S89°59'00"E 190.00' R) LOT 5 ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: SOUTH LAKEWOOD .DILLS FIRST ADD. ®= FND 5/8" REBAR LOT 3 BLOCK 4 PLAT P-611 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a OF AL physical survey of this property as shown on this drawing and that the ,® ,. ' ' improvements situated hereon are within the property lines and no NJ enchroachments exist other than noted. Under no circumstance should4 1 any information on this drawing be used for construction of fences, ?� ' �z .................. �....... structures, improvements, or for establishing boundary lines. ® ' , . EXCLUSION NOTES: It is the owners responsibility to determine' x ' ''' ° f the existence of any easements, covenants, or restrictions Nvhieh •.JOHN L. SCH* U' M R: o �+ LS -10408 do not appear on the recorded subdivision plat. a WORK ORDER NUMBER: DAZE sca E E-NNL!� Na :t ; FEB 19, 2022 1"=30' schuller@ak.net A , AW 22-005 ORA. er: cr�«ED er aa0 rxmt�x aooK ncE � rOfessiona� L°AWOAw JLS SW2638 220121 �`®� " y 5 q C> 5 � 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax MUNICIPALITY OF ANCHORAGE On -Bite Water & Wastewater Program � PO Box 1906M 4700 Elmon Road A � AnChW;p9e, AlaeAe 66570-6650 mane: 007) 3i3-76# Fax: (907) $Q-79 7 � hkipJh�Y+w,muni,4rg�on�iko CI)a1`f iuni OSI -Site Wastewater Disposal System Permit PermitNumber; OSN211373 EfFer-tive Date; -911012021 Wark Type: Septic Upgrade Expiration lute; -911012022 Tdj. cutju tq un iLb i . 01.D 10 1 390D Site Legal Address; SOUTH LAKEWOOD HCLLB #1 BLK 4 LT 3 G;2638 Site Mailing Address; 11101 ROC KRID G E DR, Anchorage Own or: I H LEN H EATHER L t_ of 5 iaa in Sq Ft: 304DO resign Eng ineer: FIRST VVATE R CON BU LTI NO '1' ota I tae d rooms: 4 This porml t is for the co nstruction fit. 0 Disposal Field Rf Septic Tank ❑ Holding Tank 0 Privy El Private dell ❑ Water St-orage Al € c o nstructic n s ha I I be in acccrdanc$ with, 1- The attached apprawed -design. Z. All Fequiremen1s specified in Anchorage Municipal code Chapters 15-5:5 and 15-55 and the State of Alaska a 51ewater disposal Reg ulakions (1 WO72) a nd Drin king Watef Regelatiow; (13AAC80) 3- Th 13 wamawate r L,xie iequ iras inspbctlons clu fing the i i7stal lation- Th 6 s 11all itu Iffy 11 le DQMVlul I I:ue I I -Service s Department per AM C 16.65. Provid a notifi cation by ca ll ing ( 907) 343-791)4 (24;7). 4- From October 15 to April 15, a subsurface soil absorption system under constJuction during freezing we -a the r shall be ellhor,. a- Opened and Cloned on the same day, or b- vfen�d, sealed. and heated to preveni freazIn0 L P wis ion s: Th a po r ion of existing feld IoCIted iin tf1 a utility easements h al I be completed rsmGved ❑r a wey encroach me nl pear it ah211 be ohta ined prior to flno I inspectio rL report a pproval- Received By: Issued By- 9110/2021 y - 9110/ 0 1 Dale; ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-151-39 Property owner(s) HEATHER I H LEN Day phone, Mailina address 45-172 LEHUUILA PLACE, KANEOHE, HI 96744 Site address 11101 ROCKRIDGE DRIVE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) SOUTH LAKEWOOD HILLS #1 134, L3 Legal description (Township, Range & Section) Lot Size 30,400 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field M Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank El Upgrade (D) ❑ Holding Tank ❑ Renewal ElDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ 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 property owner or authorized agent) Permit/Rush Fees: S 515 Waiver Fees: Date of Payment: Fla?120,21 Date of Payment: Receipt Number: 717,240 Receipt Number: Permit No. OS P2 I f 3 7 3 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / FirstWaterAK@gmail.com August 26, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: SOUTH LAKEWOOD HILLS #1 BLOCK 4, LOT 3 The septic field has failed and we have been requested to obtain a septic permit to upgrade the system on the above referenced lot. We propose to install one deep trench with and Advantex system to serve the existing 4-bedroom residence. The design is based on the recent test hole conducted on August 19, 2021. The slopes are moderate at 3-8% at the proposed upgrade location. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Attachments: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211373, Rebecca Carroll, 09/10/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211373, Rebecca Carroll, 09/10/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211373, Rebecca Carroll, 09/10/21 4661 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 firstwaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: S. LAKEWOOD HILLS #1 B4, L3 PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 8/26/2021 DEPTH FEET OG SOILS 1 ORG/OL 2 3 4 5 6 7 8 SM-gm/ml 9 10 11 12 13 14 15 BOH 16 17 18 19 20 Reading Date Gross Time Net Time Depth to Water Net Drop 8/20/21 30 min 6 1 13/16 30 min 6 1 13/16 30 min 6 1 13/16 PERCOLATION RATE 17 (MIN / INCH) TEST RUN BEWTWEEN 4 & 5 FT PERC HOLE DIAMETER 6 PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16 TH. GROUND WATER ENCOUNTERED: NO IF YES, AT WHAT DEPTH: NA DEPTH TO WATER AT MONITORING: DRY DATE: 8/26/21 TESTHOLE # 21-1 DATE PERFORMED: 8/19/21 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: HEATHER IHLEN 8/26/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211373, Rebecca Carroll, 09/10/21 LOT 1 N89"51'1 2"W 189.72' (N89°59'00"W 190.001 R) 5' UTILITY ESMT- WELL PAVED PARKING 0 0 0 00 LOT 3 Uj BLK 4 0 j>' 00 (0 0 0 0 - PAVED SHED < 0 D/W LLJ Lj 0 M 72.5' Q Lj_ CURS ry 0 y 10, C) 10 < .0, Nd- 0 Mo �S� 0 00 L0 0 0 P C7 �ti .0, Z C) CD (z) L0 z GAZEBO O48.2 0 0 z • SEPTIC VENT • (typ) TEST HOLE 30' 5' UTILITY ESMT N89'252'27"E 190.122 (S89°59'00"E 190.00' R) ANCHORAGE RECORDING DISTRICT, ALASKA LOT 5 AS-BUILT OF: SOUTH LAKEWOOD HILLS FIRST ADD FND 5/8" REBAR LOT 3 BLOCK 4 PLAT P-611 "D S SURVEY CERTIFICATE: 1. John L. Schuller. Have conducted a AW OF �'Lw Al�o LANb '4 41 physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and noof 4;; 10, A.. Yk- enchroachments exist other than noted. Under no circumstance should .'• 49TH any information on this drawing be used for construction of fences. OAF.* .. '• I ... ............ structures,, improvements, or for establishing boundary lines. ? 17-1 V4 1;L PA PA% r� t—{ EXCLUSION NOTES: It is the owners responsibility to determine ?A... ... ............... * �. . ••.J HN L. SCHULLER.-OR " ' the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. LS-10408 i831 Talkeetna Street WORK ORDER NUMBER: DAM SCALL E-MAIL JULY 26, 2021 =30 schullerftk.net ASW Anchorage, Alaska 99508 k�'C�o f 21-106 DRAWN By. CHECKED BY GRID NUMBER: BOOK/PAGE: \,CP ,®„ (907) 227-1455 office JLS SW2638 210 240 (907) 274-4992 fax MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entere into as of this Day of of 204/, by and between herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as AN ADVANTEX SYSTEM located at (legal description) SOUTH LAKEWOOD HILLS #1 BLOCK 4, LOT 3 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) h11-11 Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in W/1 accordance with the equipment"s approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/1812018) Page 1 of 3 Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. 1� Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction. Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 0511812018) Page 2 of 3 OWNER: By: _(signature) Date: /A (print name) STATE OF ALASKA ss. THIRD JUDICIAL DISTRICT eN The foregoing instrument was acknowledged before me this day of 20'21, by iVe ST-MROVALAWA N 0 T'AMYTTJ IrL I!CexpiF 0 R ALAS A S A NWMYPUBW expires: I p My Commission res: Re" B. UVieden M OXMISSIon Expires Sep 18, 2024 MUNICIPALITY: By: & & M-, tt ('14, �, (signature) lee,iecGe, (�rqff (print name) (rev. 05/18/2018) Date: Title: Page 3 of 3 ) MUNICIPALITY OF ANCHORAGE ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchora§e, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE [~EW MAILING ADDRESS LEGA~ DESCRIPTION ~ ~ DISTANCE TO: /~ ~ r¢Tn ~- t Dwelling /d / ~Z~< LiqManuf~cturercap/~city in gallons *~ ~F HOMEMADE: Inside length W,d'Materi '.t ~ ~/~ N°' °f c°mpartmentSLiquid depth ~ DISTANCE TO: Well~¢ [~ ' Foundadol~ ~ Nearest lot lir~ / PERMIT NOt~ ~ -~~' No, of ii nes / Length o,//~ea~ Ii ne' Total length¢~ofli ne~ Trench ¢~w] d,h inches Distance '~tween *~ Top of tile to fin]sh grade--1/''~1, Material beneath die 7 I ~s ' OTHER 'T -- .... 72-013 (Rev. 3/78) Box ].~{~9~ STAR ItOUTE A AI~CItORAGE~ ALASKA 9950~ six INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF DRILLED AT THE rate OF ~19o00 PEr FOOT. PrOPERtY OWNER [/b~o SA~e~v~e~ ?.i~ 349-47£3 SP~ ff47~-$ 178 99507 DRILLER WELL LOG: 0 ..... 127 ~ Scu~b~ c.~ 27 .... 49' ~ 60 f~ of S~ce. 3/4 Ro~e S~m~ ~ho~ ~ ~~ 5 ~o lO .D,z,LU.X~9. ~19 X 178 f~e~L: $3352,,00 Sea, L. COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF ~q~82~00 THANK YOU VERY MUCH. BErNie CLAUS OF RAMPART DrlLI4~NG WORKS SERVICE CHARGE O F 1V=% PER MONTH WILL ~ASSESSED ON PAST DUE ACCOUNTS, PERMIT NO'~ MUN I C: I PFIL I TV OF" I=INCHORFIGE DEPGRTMENT ¢--,HERLTH RND ENVIRONMENTRL .~ROTECTION 825 'L STREET, RNCHORBGE, 8Ko $-~ ;1 264-4720 WELL FII~ID ON--E; I TE ( FlPPLICFl~ TYPE OF soil RBSORBTI°~ MRXlMUM NUMBER OF BEDROOMS LOT SIZE '~()4-/© SQUnRE FEET SOIL RATING THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM DEPTH= ('!( LENGTH== THE LENGTH DIMENSION IS THE LENGTH (iN FEET> OF THE TRENCH OR DRRINFIELD. THE DEPTH OF 8 TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFRCE OF THE GROUND 8ND THE BOTTOM OF THE E×CRVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE E×CRVGTION (IN FEET). REL~.U I RED dE;EPT I'6 TPINK dE; I ZE-- i ,~. Ii~) GI=iLLONdE; PERMIT 8PPLICRNT HHS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE INSTRLLATION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. TWO ( 2 ) I NdE;PECT I Ol'-idE; tIRE REQLI I RED BGCKFILLING OF 8NY SYSTEM WITHOUT FINRL INSPECTION 8ND 8PPROVHL BY THIS DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN A WELL AND RNY ON-SITE SEWAGE DISPOSRL SYSTEM IS 100 PEET POP R PRIYGTE WELb OR 150 TO ~00 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. HELL LOGS 8RE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DGYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MRY RPPLY. SPECIFICATIONS 8ND CONSTRUCTION DtRGRRMS ~RE RVGIL~BLE TO INSURE PROPER INSTRLLRTION. PERI~I I T EXP I REDE; DECEMBER I 1: FORTH BY THE MUNICIPALITY OF RNCHORf~GE. 2: I HILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. -?.: I UNDERSTRND THAT THE ON-SITE SB4ER SYSTEM MRY REQUIRE ENLRRGEMENT RESIDENC~ IS REMO~ELED~LUDE MORE THSN , BEDR00MS. /1~~ S I GNED: .....__~_ ~ ~~ ' ~/=Z== ..... ISSUED B -- CERTIFY THRT I 8M FRMILIGR WITH THE REQUIREMENTS FOR ON-SITE SEHERS RND WELL~ RS SET IF THE VD. 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-222'~ SOILS LOG - PERCOLATION TEST DATE PERFORMED: /J~ SOl LS L~GG [] PERCOLATION TEST 1 2 3 4 5 6 7 8 10 12 ~3 14- 16- 17- 18- 10- 20- COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? DEPTH?IFYES'ATWHAT S ol Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN , FT AND / (minutes/inch) -- FT 1,~-~ .~ /~ ,z~ ?/7 PERFORMED BY: 72 008 (7/76) CERTIFIED BY: MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-151-39 1. GENERAL INFORMATION Expiration Date: S- 2-5—` ZZ Complete legal description SOUTH LAKEWOOD HILLS #1 BLOCK 4, LOT 3 Location (site address) 11101 ROCKRIDGE DRIVE, ANCHORAGE AK 99516 Current property owner(s) HEATHER L. IHLEN Day phone Mailing address Real estate agent 45-172 LEHUUILA PLACE, KANEOHE HI 96744 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number COSA # Waiver # Distance: 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 FIRST WATER CONSULTING Phone_ 907-350-9566_—_ Address 13030 SUES WAY, ANCHORAGE AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 2/22/22 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the 1�\\\ system and maintenance. The operational life of all well and septic systems are subject to 4�� k these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory �,�A� . •'z !� for current or future occupants or guarantee that no unseen encroachments, deficiencies or g.' discrepancies exist can be given by First Water Consulting & FW(S . % * : ..... 6. DSD SIGNATURE •CurtisHuffman System #1 Approved for bedrooms <r��F��sT,.,CE 128991 .,����� .2122/22. System #2 Approved fork �k z",Ro ES510 P��`�� Disapproved Conditional approval for bedrooms, with the following l�kiR I gF1w�� OF nN SITE G� WATER AND z o WAS jJJ �0,0 JJJJ,"1NT SER11�1��,1 By, Original Certificate Date: 2 -y� —2-?— The 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 Legal Description: SOUTH LAKEWOOD HILLS #1, BLOCK 4 LOT 3 Parcel ID: 015-151-39 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) Well production at time of test 6.4 qpm Date drilled 5/6/1980 _ Water storage tank volume gallons Total depth 178 ft Well disinfected for coliform test? ❑ Yes ® No Cased to 178 ft ® Coliform bacteria is Negative ® Sanitary seal is functioning correctly Nitrate mg/L ® Nitrate less than MRL (ND) ® Wires are properly protected Arsenic ug/L ® Arsenic less than MRL (ND) Casing height (above ground) 12+ in. Collected by Fkr5 Date of flow test for COSA 8/11/2021 Static water level at beginning of test 74 ft. Date of Sample 8/30/2021 Comments B. TANK DATA Age of tank(s) *NEW TANK years Tank type/material ADVANTEX / FIBERGLASS Measured operating fluid level in septic tank NA ® Standpipes/foundation cleanout per, record drawing Date of pumping D. ABSORPTION FIELD DATA — NEW FIELD Which system tested (date installed) 2/7/2022 ® ALL standpipes present per record drawing Total measured depth from grade 9.2 ft (max) Measured depth to pipe invert from grade 3.3 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) Gallons introduced gallons Comments/Deficiencies: C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date NEW FIELD Results ❑ Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) N If yes, enter date on E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) ® Yes if No Septic Tank/Lift Station on Lot > 100' Surface Water > 100' Community Sewer Manhole/Cleanout > 100' Property Line > 5' ❑ Yes if No *50+ ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No *50+ ft Holding Tank > 100' ® Yes if No ft Neighboring. Absorption Fields -> 100'- - Animal Containment > 50' - Yes if No ft ® Yes if No ft From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation.> 10' Manure/Animal Excreta Storage > 100' if No ft 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' ® Yes if No ft Surface Water > 100' ❑ Yes if No *50+ ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ❑ Yes if No *50+ ft Water Main > V'. Yes. if No ft Community Wells > 200' _ 0 Yes if No ft 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' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No *5'+ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ❑ Yes if No *50'+ ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ❑ Yes if No *50'+ ft F. ENGINEER'S COMMENTS * SYSTEM MEETS CAT III SEPARATION DISTANCE REQUIREMENTS. G. ENGINEER'S CERTIFICATION I 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. Aftw AWe • • Curtis Huffman % ��� �'���•.� CE 128991 }��,F9FQpR0EESS ONP�'�..�� MUNICIPALITY OF ANCHORAGE o,.I" .b.-, Development Services Department -J Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-151-39 1. GENERAL INFORMATION Expiration Date: 2, I — 2-0 Z Z_ Complete legal description SOUTH LAKEWOOD HILLS #1 BLOCK 4, LOT 3 Location (site address) 11101 ROCKRIDGE DRIVE, ANCHORAGE AK 99516 Current property owner(s) HEATHER L. IHLEN Mailing address Real estate agent Day phone 45-172 LEHUUILA PLACE, KANEOHE, HI 96744 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment Receipt Number 9 2 6 Date: Waiver Fee $ Date of Payment Receipt Number COSA # 0_5C,21 .1 ( 6- 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 FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 10/28/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to OF these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory ��P• for current or future occupants or guarantee that no unseen encroachments, deficiencies or g•'� '.9 �r discrepancies exist can be given by First Water Consulting & *� TM '. . 6. DSD SIGNATURE � • • .. I • .. V'1 . / • • Curtis Huffman Irk - System #1 Approved for bedrooms ����F��s•, CE128991�� System #2 Approved for bedrooms �1lFOPROFESSI00 r Disapproved Conditional approval for �' bedrooms, with the following stipulations: r Original Certificate Date: // r 2 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 Legal Description: SOUTH LAKEWOOD HILLS #1, BLOCK 4, LOT 3 Parcel ID: 015-151-39 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 5/6/1980 Total depth 178 ft Cased to 178 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 8/11/2021 Static water level at beginning of test 74 ft. Comments B. TANK DATA Age of tank(s) *NEW TANK PENDING years Tank type/material ADVANTEX / FIBERGLASS Measured operating fluid level in septic tank NA ® Standpipes/foundation cleanout per record drawing Date of pumping * D. ABSORPTION FIELD DATA — NEW FIELD PENDING Which system tested (date installed) NA ❑ ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Structure served by this system Well production at time of test 6.4 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate mg/L ® Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by FWE Date of Sample 8/30/2021 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date NEW FIELD PENDING Results ❑ Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min ❑ Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced gallons FWC Comments/Deficiencies: ;;; 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' Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No Water Main >.10' ® Yes if No ft Community lNells > 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' 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' Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *PROPOSED SYSTEM MEETS CAT III SEPARATION DISTANCE REQUIREMENTS. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. _Aw ��OF : �t,t low %• .. • '. Curtis Huffman � �'cc,•.� w� CE 128991 •. �A p OFESS OW -11-0-- ltN�.��`� ft ft ft ft ft ft ft ft First GE. ` d Water INN 3f5 V f.:s C O N S U L T I N G J t 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com October 28 2021 Municipalities of Anchorage On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: CONDITIONAL COSA LEGAL: SOUTH LAKEWOOD HILLS #l, BLOCK 4, LOT 3 Due to unprecedented events contributing to material and labor shortages, we are requesting a Conditional COSA for the above referenced property. The pending permitted 4 -bedroom septic system upgrade has been impeded due these conditions and other factors with no known date on when the Advantex system components may be available. The system will be installed once the components become available. The system has been working for the occupants and granting of this Conditional COSA will not impact any of the neighboring properties or pose a public health risk. Attached are installation quotes, including the awarded bid from Mike Anderson and escrow letter from title for the pending installation. Please contact us if you have any questions. Sincerely, 0 �� Curtis Huffinan, P.E. r 1 GE. ` d xgGGt1 Ili( INN 3f5 V f.:s i✓%� sitneife 3Tt 1.. 1414f MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot 3; Bloc~ 4; South Lak~wood Hills No. I Location (address or directions) 11101 Roekrid~ Road (b) Property owner Richard & Barbara RcZCrso~tTelephone: (home) ' Business Mailing Address P.O. Box 213609' Anchorage, AlaSka 99521-3609 (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent Address 2~00 Co,ta(oua S~. R~.IMaz Prop~r~2.~s. ATTN: Charlott~ Schlosst~in Ano_ho~ag~.~ Alaska 99503 Telephone (e) Mail the HAA to the following address: (or check here ,~ if hold for pick up.) List contact person and day phone number below: 1 ?034 Eagle River Loop Road No. 2, TYPE OF RESIDENCE Single-Family ~ Number of bedrooms 3. WATER SUPPLY Individual Well ~X Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ~ Public [] Community [] Holding Tank [] Note: If oommunity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of th is Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with alt Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address 17034 Eagle Ri'~er L~op Road No. 204 Telephone 6. DHHS APPROVAL Approved for Approved bedrooms by ~//~~/~ Disapproved Conditional Terms of Conditional Approvat The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The M unicipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 ~/,~,,~."r~¢UNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 A. WELL DATA Well Classification -~'~?}~ ~ .,~A.,'/~ Well Log Present (Y/N) L~ Date Completed S-- - (o - Total Depth !'"~, f~ Cased to ./'~_ ~ Depth of Grouting If A, B, C, D.E.C. Approved (Y/N) ~/~ Yield ~, ""'~ ~ ~/W Static Water Level ~'~ ~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ,/ CO ~1~ Pump Set At. ~ (C Sanitary Seal on Casing (Y/N) · ~ Depression Around Wellhead (Y/N) ~ ; On Adjoining Lots ~ '-b To Nearest Edge of Absorption Field on Lot. ~/ CO '/' ; On Adjoining Lots ! To Nearest Public Sewer Line ,AJ//~ To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot ,~ ~' '~ Water Sample Collected by ,~ ~ .~ ~0~,0c:~.¢';~)~.~ ; Date Water Sample Test Results ~,~ Ft ¢"1~ T~(z.~b £~ -- ~"s,/~r"-'/L~¢;/,~' ~'~ Comments B. SEPTIC/HOLDING TANK DATA Date installed ?-75'-~ Size /-~ Standpipes (Y/N) cI Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped % - '~ -" ~'~ ;for Holding Tank High-Water Alarm (Y/N) ¢ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Suppl.y. Well To 'Properh(. Line ~ To Water Main/Service Line Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake or Major Drainage Course Comments ~.~/'c. '~A)/'(/ ~O/WC?_J, 72 026 (Rev 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field /-~ Depth of Field ___// '- / 2 Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~' Oo "fi' To Property Line _ '¢ To Building Foundation ,,~.o _ To Existing or Abandoned System on O/ Lot &,)//A' ; On Adjoining Lots ~ To Water Main/Service Line { O To Cutback (if present) __ To Stream, Pond, Lake, or Major Drainage Course [ OO To Driveway, Parking Area, or Vehicle Storage Area ,~ c, / Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of inspection. Signed S & 2 Company 17034 Eagle River Loop Road No. Eagle River, Alaska 99572' Date ,crC--/~/¢- MOA No. ~"~? 72-026 (Rev. 7/88) 8ack Receipt No. _ Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. /~.%~ 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ~'"',:~'o~o~',E;"~ FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE £or Work Order $ 20187 Cate Report Printed: ~AR E 90 @ 12:26 Client Sample ID:L3, B4 SO. LANEWOOD RILLS PWSID ;UA Collected mR 5 90 @ 13:30 Received ~AR 5 90 @ 16:00 hzs. ?resezved with :AS REQUIRED Client Name : S & $ ENGR Client Acct : SNSENGP P.O.~ NONE RECEIVED Req # Ordered By Analysis Completed :mR ? 90 Send Repozts to: Laboratozy Supezvispr ~TEPUEN C. EDE 1)S & S ENGR Released By : Special Instruct: Chemlab Rei ~: 900313 Lab Smpl ID: 2 Matrix: WATER Allowable Parameter Tested Result U~Mts Method Limits NtTRATE-N ND(O.lO) mR/1 EPA 353.2 10 Sample ROUTINE SAMPLE Rem~rRs: SAMPLE COLLECTED BY R.J.D. 1 Tests Pezformed See Special Instructions Above UA=Unavailable ND= None Detected ** See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Greatez Than ,I . DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR I NSPECTOR/~ , MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTII~II~/IRONMENL~L ;:;C'I ECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 R E C E i V E D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER B/ j.~ J PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from above) / PHONE 2. BUYER PHONE MAILI GADDRESS 3. LENDING INSTITUTION ~ PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS B, LEGAL DESCRIPTION '- W' 3L //,' c_r-. STREET LOCATION 6. TYPE OF RESIDENCE / [~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four [] Two [] Five [~ Three [] Six [] Other 7. WATER SUPPLY ~" INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975. For weLls drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~' INDIVIDUAL/ON-SITE** ('c~~° YEAR ON-SrTE SYSTEM WAS INSTALLED. [] PUBLIC UTI LITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FiVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified iNSTALLER []Septic Tank or [] Holding Tank Size: I ~.:~'O If Tank is homemade ! SOILS RATING give dimensions: TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: Septlc/Holding]d_O~ Tank Absorption, TL/~-~ Area Sewer LineII Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS [~J~--APPROV ED FOR ~-~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED ,~~ DATE BY 72-010 (Rev. 6/79) Mun ,c[pa, l ty' Anchorage 825 "L" STREB?~' ANCHORAGE, ALASKA 9950~i ......... (907) 264-4111 ~>,.~ ~ ~bt~ ~) ~.~:~V DEPARIMENTOF HEAL FH AND ENVIRONMENTAL PROTECTION August 28, 1980 Steve Piza Star Route A Box 475-S Anchorage, Alaska 99507 Subject: Lot 3 Block 4 South Lakewood Hills Subdivision Approval for your individual sewer and water facilities cannot be granted until the following items have been completed: (].) The water analysis report be delivered to this ~b department from Chem Lab, 5633 B Street, for [/ our review. %f~ (2) A well log submitted to this department for our review. tf there are any further questions, please call this department at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: Alaska Statebank 310 East Northern Lights Boulevard Terrie Piza % Star Route A Box 475-S 99507 99503