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Home My WebLink AboutSOUTH LAKEWOOD HILLS #1 BLK 6 LT 4South Lakewood Hills Block 6 Lot 4 #015-151-23 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page I of 2 www.ci anchorage ak.us (907) 343-79D4 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: ,$W 06001 Q PID Number: Na. Wastewater System: ❑ New ® Upgrade P ! t A° .*s►�t�✓t 110 O Rid CrP1f , ABSORPTION FIELD P,r Nun d ae*ooms, S Z9 _OJ , / Al �°sep Tf.nm j al Pr Tranm 139.0 ❑ ManO rnnn LEGAL DESCRIPTION SW Rnrp �± 0.6 GPD*e Total Dapin Ran apuul gra0a I Z.O FI. 8l La SIDE Vm Depen Ip P" boean Ran mgn* graft 13.814,1"h I»naam plp {/. Sr, i l: H',• K f - 0 Fl. 7.6 Ft A CVC4'cl TP i,Jvp Range Saaxn FA W] a mpnn paw Gravel L.rgth GU O Ft. FI. Well: El New ❑ Upgrade Gravel w ..ry g' ZSF,. NV111Rw d IMI / D.SMI Wlwaen IMI -- FL EJ�S% cusunratmn(Pvale.A.B.C) TOWDepn cou 1p- TpW*apaOrplwn*Ia Pq,sMa'en* P✓�F "r-l" Ft. Ft 6'1 FY .O-jc, 3 /t/Un - Drdiw Dna Drill" SwK Wm. Lav* Inslalw 1,8797 ns a+uNlw 7 / os ywdPump Snn Cannq Ile"Amw G'O TANK GPM FI. FI SEPARATION DISTANCES ® septic ❑ Holding ❑ S.T.E.P. ❑ Other. To From Septic Tank Absorption Field Lift Station Holding I Tank ublk?nvate Sewer Line i1°r Ant Ap!- e Ta.nt:- ap.-sr 12S G* Mal" Nunxror d Garyanmarns Won I O,i 1 t 031 — - > 2s' Sfe,•/ LIFT STATION solar. wn*> >l SI i�JN Ld Lint 3S t 1 s Gal 'Pump on NVNn 'Pump oM NVNn Hr7 10*rm- FO.nOrwn 1 7 1 I Z. s n n N Purrp Make a MOON Electoral nsp� Wm ny Como Drrn - - Ramarkl '•'°� IFn w6 ttl N ,Stt4ec% On, oral '=' ' "� BENCH MARK Corium rr0 D.sapum !" CO� Ioap FL ' I Engineer's Stamp Inspections performed by: fEYa Ffrp Tedi Svt Dates: 1"t< 2ne G/I7/Of ;6�-.••�•��"fib Development Services Department Approval.:'• �a ..i'• :i' q :4-- (a,-- j to * Conditional Approval Date: r...././.......so...�*,.�•_.i.. , J9..00..0 .t : TWODOPE F. LJOORE ; CE-3589 *� jam' •••^�• Reviewed and approved by, C Date: �"' ,�, PERMIT NO: SWO80010 PAGE 2 OF 2 PID NO: 015-151-23 NEW 60-FOOT LONG SOIL ABS. TRENCH T.H. w. 7.0' GRAVEL UNDER DIST. PIPE }��#1 NEW 1250-GALLON •, </ SWING TIES: N SEPTIC TANK ,,•' 60' FROM: COR. "A" COR. "B" TBM ^H" TO: -DBL. C.O. "E" S.T. C.O. "C" 22.5' 25' -DIV. VALVE "F" S.T. C.O. "D" 31' 32' ISTIN G" DBL. C.O. "E" 32.5' 34' 4-BDRM ,,••`•� "C" "D" DIV VALVE "F" 33.5' 35' OUSE p TR. C.0 "G" 23' 15' ORIGINAL TR. M.T. "H" 47' 37' TRENCH ' TR. C.O. "1" 79.5' 69' , = 100 DRIVE ♦♦�__```,��R �� E �:.A� WELL r t,. •. ,i_----——-———— '•�* j*'':' 49 m VA �.. ..................../ PLAN VIEW K/ := .. ....U= ~• SCALE: 1" = 30' `♦ :• THEODORE F. MOORE : � % • �� •.• CE-3589 :•��/ GROUND SURFACE in— 4'+ SOIL COVER 4'+ SOIL COVERI -2" RIGID. INS. 1 INV. _ INV. 1250-GALLON '' 951, INV. 94.9' ANK SEPT T 94.6 6IC 94 „ .60-FOOT LONG SOIL ABS. TR ; w. 7.0' EFFECTIVE GRAVEL .... ; ... ol LOT 4, BLOCK 6, SOUTH LAKEWOOD HIL BOTTOM TRENCH ELEV. 87.6 SEPTIC SYSTEM UPGRADE AS-BUILT INSPECTION REPORT PROFILE VIEW BOTTOM T.H. #1 FLATTOP TECI INICAL SERVICES ,SCALE: AS NOI REL. ELEV. 81.6' 14530 ECI10 CANYON ROAD DRAWN BY TF NOT TO SCALE NO WATER ; ANCIIORAGF., ALASKA 99516 AUGUST, 20C MUNICIPALITY OF ANCHORAGE Development Services Department Onsite Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Feb 13, 2008 Expiration Date: Feb 12, 2009 Permit Number: SW080010 Parcel ID: 015-151-23 Legal Description: SOUTH LAKEWOOD HILLS #1 BLK 6 LT 4 Design Engineer: 0019 FLATTOP TECHNICAL SERVICES Site Address: 011050 RIDGECREST DR Owner Name: PETE BERGA Lot Size: 30566 SO. FT. Owner Address: 11050 RIDGECREST DRIVE Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE, AK 99516 - This permit is for the construction of: ❑✓ Disposal Field n Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by tailing (907) 343-7904 ( 24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. Received By. Date: Z/ 2e%' / UE Municipality of Anchorage --1 Development Services Department •' Building Safety Division On -Site Water and Wastewater Program ` 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519.6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcell.D._ Property owner(s) Paltc aeya Day phone 5'29 —o ss -i Mailing address / I oa-o A I V e c.brtD� ,}„Cq Zip Code _ 99s7ler - v6 Site address ca Tc Zip Code Legal description (Sub'd., Block & Lot) _I_c ky. 0 /k So., lr, L p Hlwooc( /f /� / Legal description (Township, Range & Section) Lot Size 30 f 6 -6 Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR (® all that apply): THIS APPLICATION IS AN: Absorption Field ® Initial ❑ Septic Tank ® Upgrade Holding Tank ❑ Renewal ❑ Privy ❑ Private Well ❑ Water Storage ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Mho = Waiver Fees: 176' Date of Payment: _ 2 / /2- aE Date of Payment: '-/ rt / GS Receipt Number. JOy64t1 011111/ Receipt Number: (Rev. 11/05) a � MunicipaRty of Anchorage 1'O. Ma 196010 / Andmrngc,.11nskn 9f),iMfiGiO • 47(M) flmnrc Rind -� Oaicc: (1X)7) 343 -Flog • Fac: (fM)7) 34.448 -^(NI help://��r.munLory; Mayor Mark Bcgich Dcvclopnlcnl Scn3ccs Delm lnlcnl February 14, 2008 Ted Moore, P.E. Flattop Technical Services 14530 Echo Street Anchorage, AK 99577 Subject: Waiver Request for South Lakewood Hills #1, B6 L4 Waiver Request WR#: 080004 Parcel ID # 015-151-23 SW0800010 Dear Ted 1lloore, P.E.: Nov m�nl. S Q Department Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 1.0 foot. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Deb Wockenfus Civil Engineer On -Site Water & Wastewater Program Conlnzunity, Security, Prosperity Municipality of Anchorage Development Services Department • Building Safety Division On -Site Water and Wastewater Program _ 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Waiver Review Worksheet WR#:080004 PID#: 0 15-151-23 HA/Permit# SW0800010 Date Received: February 14, 2008 Legal Description: South Lakewood Hills #1, B6 L4 Engineer. Ted Moore, P.E. Flattop Technical Services 14530 Echo Street Anchorage, AK 99577 Applicant: Pete Berga Waiver Requested: 1' Lot line waiver Criteria: Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Waiver is Granted: X Waiver is not Granted: List Conditions or Reasons for above: Points: Date: 2/14/08 By: Deb Wockenfuss Name of Reviewer Rec#: 104644 Amount: $175 Date Paid: 2/1412008 y \ t k'LATTTOP TEGHNIGAL SERVICES. .._ , Y_ y CIVIL & ENVIRONMENTAL ENGINEERING - ENERGY CONSERVATION & ANALYSIS TED MOORE, P.E. 14530 ECHO CANYON ROAD PH.1FAX: (907)345-1355 ANCHORAGE, AK 99516 E -Mail: tgmoore@gci.net February 11, 2008 M.O.A. DSD P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: The purpose of this letter is to provide the required design narrative in support of our application for a permit to upgrade the wastewater disposal facilities on Lot 4, Block 6, South Lakewood Hills S/D #1, located at 11050 Ridgecrest Drive. Soils logs, pert test results, a site plan, design drawings and specifications are enclosed for your review. In order to allow this construction and continued use of the existing soil absorption system we are also requesting a lot line waiver allowing the existing and proposed soil absorption systems to be as close as 1.0 feet from the east property line abutting Ridgecrest Drive. In conjunction with this waiver we are also requesting a waiver of the normally required 50 -foot setback from slopes in excess of 25%. Justification for these waiver requests is included below. The proposed system will be constructed in the vicinity of test hole # 1. As can be seen from the soil log, the native material between 4 and 16.5 feet below ground level is a gravelly silty sand with a measured pert rate of slightly 7 minutes per inch. The gravelly silt material encountered between 16.5 and 18 feet does not appear to be impermeable because no water was encountered at the interface. Using the soil application rate of 0.8 gpd/sq. ft. specified in the wastewater ordinance, this 4 - bedroom residence requires a total absorption area of (4 x 150)/0.8 = 750 square feet. The proposed 60 - foot long soil absorption trench 7 feet of effective gravel is conservatively sized to have a total absorption area of 840 square feet. The topography of the lot in the area of proposed construction slopes downwards towards the west at approximately 3%. The topography at a distance of 5 — 15 feet north of the proposed soil absorption trench slopes downwards towards a Swale at slopes ranging from 20% to 30%. The location of the proposed upgrade trench was selected to be in the best drained soils and to allow installation of a diverter valve allowing future switching back and forth between the original and the upgrade trenches as needed to promote longevity of the system. The invert of the distribution line will be 5 feet below ground surface. Because the location is less than 50 feet from natural slopes in excess of 25% I have prepared an illustration of an imaginary 25% slope line originating 2 feet higher than the top of the sewer gravel. When extended outward a distance of 35 feet from the edge of the trench this imaginary slope line is still significantly below the natural gradient, indicating that there should be no concerns with regard to trench effluent migrating laterally and daylighting. The requested lot -line waiver is to an existing road right-of-way; thus granting the requested waiver will not adversely impact the ability to construct future wastewater disposal systems on adjoining properties. The proposed project will have no significant impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have an), significant impact on reserved space -surface and subsurface, or on drainage. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, Ted Moore, P.E. LOT 1, BLOCK 6 ---------------- ---------------- LOT 3, BLOCK 6 \ \ \ LOT 5, BLOCK 6 i WELL ; Lu rn0 x N" 1 LOT 2,BLOCK 6 WELL ---- '' O SEPTIC AREA 0 --------------/-------------------------- --------- LOT4,BLOCK6 / SOUTH LAKEWOOD HILLS #1 f 1 BOTTOM SWALE 6% -------------- T.H. INSTALL NEW I��cnr_el 1 nra A 11 WELL ABANDON EXISTING - -SEPTIC TANK .r LOT LOT 6, BLOCK 6 nAt `\ 3% \ EXISTING_ !TRENCH I� II I /I / I I I I I I I I I I I I I I CONSTRUCT NEW 60 -FOOT LONG SOIL ABS. TRENCH W. 7.0' EFF. GRAVEI I I DRIVE - - I -.r ------- - ----------- ---------- --- / / i n1.4 WELL 1 , 1:4CODORE F. MOORE•� L° t CE - 358 1; �ll 1 / o SEPTIC AREA I `I I ,'\ � m ui ui �I \ \ xl + 1 1 I ' SEPTIC AREA MACBETH DRIVE SEPTIC WEST SIDE OF LOT fV UY e O � mW �m 0< oM LOT 4, BLOCK 6, SOUTH LAKEWOOD HILLS 01 SEPTIC SYSTEM UPGRADE SITE PLAN FLATTOP TECI INICAL SERVICES ' 1 INCH = 50 FEET 14530 ECI10 CANYON ROAD DRAWN BY TFM ANCI IORAGf ALASKA 99516 JANUARY, 2008 NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. CONSTRUCT NEW 60 -FOOT LONG "A" SOIL ABSORPTION TRENCH w. 7.0' EFF. GVL. betty. 5.0'& 12.0' [Orel FROM EXISTING FDN. C.O. INSTALL NEW 1250 -GALLON SEPTIC TANK m M.T. DBL. C.07)) I.All 01 10. a?JTA1 . *Tw ......................:...! H-•THcODORE F, MOCREJO CE flog. •¢o 4" DIA. F-810 PERF. PIPE "BULL RUN" DIV. VALVE TO ORIGINAL TRENCH PLAN VIEW SCALE: 1" =10' MONITOR TUBE CLEANOUT— ORIGINAL LEANOUT— ORIGINAL GROUND OPE UNE 12 35 �2 mirA BOTTOM EXCAVATION --I 112" - 212" SEWER GRAVEL [9103 FILTER FABRIC 4" DIA. F-810 PERF. PIPE CROSS-SECTION "A - A" LOT 4, BLOCK 6, SO. LAKEWOOD HILLS #1 SCALE: 1" = 6' SEPTIC SYSTEM UPGRADE PLAN AND CROSS-SECTION FLATTOP TECIINICAL SERVICES SCALE: AS SI IOUN 14530 EC110 CANYON ROAD DRAWN BY: TFNI ANCIIORAGE, AK, 99516 JANUARY, 2003 FLATTOP TECHNICAL SERVICES k w <, (.�• At _' yid 14530 ECHO ST. A• / ANCHORAGE. ALASKA 99516 w 4_F: • r T i :•�j✓ TEST HOLE # 1 0 r. - • k SOILS LOG - PERCOLATION TEST °^• •••••••••••••••""4 4 LEGAL DESCRIPTION: Lot 4,.Block 6. South Lakewood Hilts #I.- _ f' `' ` •` °'':�AE DATE PERFORMED: ____ _September 21, 2007 ._ 4? PERFORMED FOR: - ., . _.. Pete Berga DEPTHSLOPE 25% SITE PLAN (feet)PL 1 2 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS: _ SM Reddish sandy loam 0% BOTTOM SWALE— — —j \25% T.H. N ML Gravelly sandy silt 11 54 �1 0% PERFORMED BY FLATTOP TECHNICAL SERVICES. I ;/�YGtp...,,� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 2./// p EXISTING SM Gray gravelly silty sand t SEPTIC 1� Dry, non -cohesive Some boulders below 12' DRIVE ' Depth to Groundwater Date - 3% _ No groundwater 9/21/07 100/a _ Monitor tube dry _ 9/28/07 . SLOPE DateClock Reading Net Time _ Percometer Net Drop - Time (minutes) - Reading (inches) 921 . . 12" Presoak _ _ - 273/4. :— _ . ;,, -12" Resoak _. _..... � 273/4 , Add water 8 startI 7:23:20. - ..... 233/8 i #1 . 7:38:20, _ .. 7:38:20. 15 21 23/8 Add water 7:39:20; _, 233/8 ML Gravelly silt #2- . _ 7:54:20 15 2015/16 27/16 Not impermeable Add water _ . 7:55:20 _ 233/8 , B.H. — #3 . ; . -- 8:10:20 15 .20 15/16 2 7/16 PERCOLATION RATE _ 7 _ (minutes/inch) PERC HOLE DIAMETER 6" TEST RUN BETWEEN 6.5 . FT AND _ 7.0 FT PERFORMED BY FLATTOP TECHNICAL SERVICES. I ;/�YGtp...,,� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 2./// p ,Flattop 7echnicalServices 14530 Echo Canyon 9?pa4 Anchorage, A2C 99516 Thone (907) 345-13SS Lot 4, Block 6, South Lakewood Hills S/D t/1 11050 Ridgecrest Drive Wastewater disposal system upgrade Specifications 1.0 General: 1.1 The scope of the project consists of abandoning an existing septic tank per code and installing a new 1250 -gallon septic tank that discharges effluent into a new 60 -foot long soil absorption trench with an effective gravel depth of 7.0 feet. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform to Municipal and State requirements. All separation distances shall be in conformance with Municipal requirements, unless specifically waived. 1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buried utilities. 1.4 Prior to the start of construction the property owner shall arrange for a registered land surveyor to mark the location of the cast property line in the vicinity of the existing and proposed soil absorption trenches and also stake the location of the 100 -foot protective radius surrounding the well in the vicinity of the proposed septic tank and soil absorption trench. 1.5 The contractor shall provide adequate cover material and rough grading over all system components to ensure that proper drainage is achieved after settlement and that there are no residual depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas. 1.6 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction. 2.0 Septic Tank: 2.1 The existing 1250 -gallon steel septic tank shall be properly abandoned per code by thoroughly pumping, removing its top and backfilling with soil. 2.2 The new 1250 -gallon, 2 compartment septic tank shall be Municipally approved and shall be set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4" cleanout. 2.3 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The waste line from the residence to the septic tank shall have a minimum slope of 1/4"' per foot, and the waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A cleanout shall be installed 1 - 4 feet from the building foundation, and a double cleanout shall be installed within 5 feet downstream of the septic tank. A "Bull Rud' diverter valve shall be installed downstream of the double cleanout allowing future switching back to the original trench, as desired. 3.0 Soil absorption trench: 3.1 The new soil absorption trench shall be constructed by excavating a 60 -foot long trench at the location shown on the site plan to a depth of 12 feet below ground level. The long axis of the excavation shall parallel an existing contour of the ground. 3.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be raked to allow proper infiltration. 3.3 A total of 7.5 feet of approved sewer gravel shall be placed in the trench with the perforated distribution pipe laid level such that the pipe invert is no less than 7.0 feet above the bottom of the sewer gravel. 3.4 The monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on the design drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated. 3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. A minimum of 3 feet of soil cover is to be placed over the filter fabric. 3.6 The top surface of the cover material shall be raised a minimum of 6 inches higher than the surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill slopes shall be no steeper than 3:1. 3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and seed to promote rapid revegetation of all areas disturbed by the construction. 4.0 Inspections: 4.1 A total of 4 engineering inspections will be required during the course of the project: (1) initial stakeout with the contractor to establish the location of the system and to discuss the plans, specifications and construction procedures, (2) after the native material has been excavated to expose the infiltrative surface to ensure that it is at the right elevation, and conforms with the soil test information, (3) after the sewer gravel is in place and the distribution pipe has been laid and connected up to the septic tank, but prior to placement of filter fabric, and (4) after rough backfill and grading is complete. The septic tank requires one inspection after it is set level and the piping connected, but prior to backfill. This inspection may be incorporated with any of the above inspections. 4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. (� MUNICIPALITY OF ANCHORAGE �. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME// PH�O/NE LvJ NEW l.m//� 7n oo /-��Q� CO / ry .37/_.�ZOS/ El UPGRADE MAILING ADDRESS 'T& fox IL7- `j0,T C J1 0ef)61= LEGAL DESCRIPTION LO T y ��Jl (� SOIJT)f cI)/c[?w004> H/Ll- s LOCATION NO. OF BEDROOMS D Y DISTANCE TO: Well NOT /.✓ Absorption area d % Dwelling ZO PERMIT NO. H zManufacturer Material No. of compartments w G Rig ft C'rL/E c, N Liq. capacityin gal_ons GI IF HOMEMADE: Inside length Width Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. J(7z = z H Manufacturer Material Liquid capacity in gallons ❑ DISTANCE TO: Well Foundation, �S Nearest lot line / PERMIT NO. ��n �� w= /✓or /A/O u ❑ No. of lines Len th of each line g Total length of lines Trench widt�i Distance between lines Pzw .6'0 kd 1V inches Q Fes- Top of tile to finish grade / j Material beneath tile Total effective absorption area p 2 /1—P Q inches / 00 Q Length Width Depth PERMIT NO. w QF- Type of crib Crib diameter Crib depth Total effective absorption area wa w rn Well Building foundation Nearest lot line DISTANCE TO: J Class Depth Driller Distance to lot line PERMIT NO. J w Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALS pL4ST/ C efis 7 'T(i0r " ne vif TO 'T/)Ne 'To DAA/&T/Ltr7 SOIL TEST RATING 2y6 INSTALLER REMARKS O N /od �I 3 � c +1 APPROVED DATE LEGAL sh9/83 L'1 3 41 -COOT)e LR/firwnaf "'L -Ls 72-013 (Rev. 3/78) DEPARTMENT C HEALTH AND ENVIRONMENTAL : _iTECTION 825 'L'" STREET: ANCHORAGE, AK. 9_ 501 264-4720 AAi=L-L- &B 04 ED k7)i i-- TEE = i=i 1EEi4_ i="E�'i'°� I PERMIT NO. ; 830260 j APPLICANT CARLE,ONd CONST. PO BOX 10+-905 ANdCH. 349-20+57 LOCATION LEGAL LOT 4 BLK 6 SOUTH LAN.'.EWOOD HIL LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS 4 _OIL RATING (SQ FT/BR)= 2401 THE REQUIRED SIZE OF THE OIL. ABSORPTION SYSTEM I S : E-OE4' "i"bl"m dmf utED CAFQ = %AE° L_ 130E0'-1-01= it -114 THE LENGTH DIMENSIONd I_• THE LENGTH (IN FEET) OF THE TRENCH OR DRAINdFIELD. THE DEPTH OF A TRENCH OR PIT I_=, THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE E<,CAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINdIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). i*_ E ® Ttl A_J I F=. E E E F=' T I n__ T FR IA i-==: _" I ,= E = Ki>15EA C FAL_ L_ CD i°'4 -" PERMIT APPLICANT HAS THE RESPONSIBILITY TO INdFORM THIS DEPARTMENT DURING THE INdSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THI5 PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --------- T i -°-i r_Y > I P4 F° E CI T 1134400 F A FR E Fc E C a LJ I Fc E C:0 BACKFILLING OF ANY SYSTEM WITHOUT FINAL IN'=F'ECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM I • 100 FEET FOR A PRIVATE WELL OR 1501 TO 200 FEET FROM A PUBLIC: WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINdIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE I= 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN•a 301 DAY' OF THE WELL COMPLETIONd. OTHER REQUIREMENTS MAY APPLY. SPECIFICATION:_ AND CONa=TRUCTIONd DIAGRAMS ARE AVAILABLE TO IN=URE PROPER: INSTALLATION. F000000-1 I T Ee ; aEPARTML-P ' O HE'rTt.TM HNLt NY[R Nmer4rAL €RoTEr,TS+7N �s +3215 'L` ;rKECT, ANCHORAGE, W. -99501 264-472x3 pcRIFIT NO. .". O30360 ) 8PPLICANT CARL ESON CONST. sox i9-905 ANCH. 349-200? LOCATION LE€1AL LOT 4 SLK 6 SOUTH LAI eNOOD HIL LOT SIZE 599999 SQUAPNE FE`' r?PE r iF SOIL H651DRP T ION `YSTEN 1*;: TRENCH MAXIMUM t•!! MOOR OF BEDROOMS = 4 SOIL RATINQ {l@ >`irSR}= 240 T14E SIZE OF THE -501L HSSORP T I Ott S'O'S TEN IS: THE LECWTH DIi`0-65113N IS THE LENCITH {IN FEET) OF THE TRENCH OR DRHINFIE�b THE DEPTH OF A TRENCH OR PIT I5 THE 0I5TANCE BETWEEN THE SURFRCE Off' .TIDE SilZrJU4D AND THE BOTTOMOF THE E {t 1 Vt i I+ N {rt! FE£I 3. THERE IS NO SET WIDTH FOR TRENCHE1.. THE fsftFt4}1li GEFTt# IS THE MINUIUM DEPTH OF GRAVEL OETI.IEEN ?ItE +]tJt ALL tail E t9ilD i1 PCE 813TtOM OF THE EXCAVATION €IN FEET). -I° 7# 3 F1 a T I Tr lae" ar c� Lt3 y fi�1e-�P� 'PERt•1IT APPLICANY HEIS THE RESPONSIBILITY TO INF+SRN THIS T L DEPRRTNE I+RIN* rHE: � IN'3TAu ArxON INSPE+3TION'3 OF ANY WELLS awricENT TO THIS PR+SPERT�AND THE, k�11t1'IBER OF €#ESIDENa S THAT THE WELL WILL SERVE _ � __ / $A+'1LFILL.LtvG 4F ANY SYSTEM WITHOUT FINAL i# 513E+;TION AND NPPRoviiL 8Y T141S DEPNRTf1LNT WILL SuajECT TO PRO-SECUTION. e HININUM Dl�TRNCE eETWEEN A WELL FIND HAlY ON-SITE SEWFli-X DE P4519L '3Y5TEP9 I5 10 FEET FOR A PRtYATE 14EL.L OR 350 TO 2013 FEET FROM A PiiBLIC WELL DEPENDIf4ra " JON iYiEE TYPE OF1 -PUOL Ii_: }.;C4.t,,. 3-lINIPUJM DISTANCE FROM A PRtVATC WELL Tp N :PRIVATE ''SEWED LINE 2S FEV AND To A CONNUN E TY aEWER LINE IS 75 FEET. WELL LOO'S ARE PEOUIRCUO ANP MUST 8E RETURNED TO THE UEPARTHENT WITHIN 36 019Y!5 .s31= THE WELL ': aO 4PLETION. t3THEl? REa UIREPlrNTS ['1A'd t;FPLY. SPECIFICATION'' HMD CONSTRUCTION DIt1r3RRMi+ RRE AVAIL�AS[`LEyy'rO IIN5tJRE PROPER �INSTAI(a't.,cIT i ML - ��is(�l-.i { b E �i4 Y— .A E"+S,�s ��•4 L.a��il'�a�1Fa. ��1 �� • I CCRT IFY dTHAT L: F- Am FAMILIAR WITH THE 1REQUIREtiFNT;; F+3R. ON-SITE AND WELLS AS _ET FOR-rH BY THE MUNICIPP+I ITY OF ANCHORP13E. 2; I WILL INST1ILL THE SYSTEM IN WITH THE CODES. s: I UNOERSTHNO !THAT THE ON-SIT9 _eWER SYSTEM MAY REfAIJIRE* ENLflRGENEDIT IF I'll RESIOFf-4cE IS REMODELGO TO INCLUDE MORE THAN 4 BEDROOMS. iGNED: __------------------------------------ NT '_---_a--C y ---_ NT CAPLESON CONST. LEGALbtscRIPT10N: +9 'fin- (:.wlly.,.o.e� '. '1I%Y' •`;raP' SLO E GM G"vd'LI.Y TILE log 2 '{, <�OCC11S t`ouAt," ;(t-Avy 4. 3 i 4 Cv�1 Slk rY GRAY15% 5 Co IS 131,.E5 5 - µI;IOCCAS ioUAl. CILAYSI 8 (j/V� SILTY GttAvtFt 9. .VARY. TtGNT- i SITE PLAN 10 - WAS GROUNDWATER, !' S 11 ENCOUNTERED? /•1 O L P E 12WHAT IF -YE -S, AT .. _DEPTH? I 13 ' - Gross Net ,1$ - Reading Oatw .Time Time i l: 15- 5 BOILS LOG ORO :o 44 E,� .. R*Io.Y8 18/0 fiR 7- 0� - 'MUNICIPAL.ITY OF. -ANCHORAGE ., PERCOLATION ' 'k'' ``" ''DEPARtMENTO.r-HEALTH ANDaENVIRONMENTAL�PR07EC71ON TEST �� - 825... L. Street, Anchorage, Alaska 99501 264-0720 5T 83 20 _ II9 Leroy Old 1r 8 / ' 1 SOILS LOG --PERCOLATION TEST • '. No. 251�E, •a• C�/�`: PERCOLATION RATE F f 1 Nl' <NEPPI"i LC.!-- DATE.PERFORMED: 2.'%SLS- , `PERFORMED -FOR: COMMENTS y4 r A LEGALbtscRIPT10N: +9 'fin- (:.wlly.,.o.e� '. '1I%Y' •`;raP' SLO E GM G"vd'LI.Y TILE log 2 '{, <�OCC11S t`ouAt," ;(t-Avy 4. 3 i 4 Cv�1 Slk rY GRAY15% 5 Co IS 131,.E5 5 - µI;IOCCAS ioUAl. CILAYSI 8 (j/V� SILTY GttAvtFt 9. .VARY. TtGNT- i SITE PLAN 10 - WAS GROUNDWATER, !' S 11 ENCOUNTERED? /•1 O L P E 12WHAT IF -YE -S, AT .. _DEPTH? I 13 ' - Gross Net ,1$ - Reading Oatw .Time Time i l: f 1 I I 1 Depth to Net Water. Z Drop r.I -- ,9„ DATO 15- 5 16 16 ORO :o 44 E,� .. R*Io.Y8 18/0 fiR 7- 0� - OR i, 79 /........ + v 20 _ II9 Leroy Old 1r 8 / ' 1 • '. No. 251�E, •a• C�/�`: PERCOLATION RATE F .........• r,:. PA0F$1 Q1P� TEST RUN BETWEEN ' COMMENTS r A ' PERFORMED BYi Nwo2 OL- VAN. y - _CERTIFIED BYEA �.. .% f 1 I I 1 Depth to Net Water. Z Drop r.I -- ,9„ DATO 09/12/2007 03:29 Mark Begich Mayor 9072430742 AWPS, INC. Development Services Department Building Safety Division -Site Water & Wastewater Program 4700 Brogaw Street P.O Box 196650 Anchorage. AK 99519-6650 VAIA nVni ON /prJRe (907)343-7904 Pump Installation Log Well Drilling Permit Number: SSV_ Date of Issue: Parcel Identification Number: DI5-I51�o�3 Legal Description Property ohne N,2Mt&.Addrec¢ . - �>< tf.. �!o .. ,�� •sem _ • Pump Installation Date: e6' I -1/O �-, Pump Intake Depth Below Top of Vv eu CasinyV6Lfeet Pump Dlanufacturer's Name:��1%A pump Model: "7$F3 1�+�, lb hp Pitless Adapter Burial Depth: ISI' feet . Pitiess Adapter Manufacturer's Name: Pitless Adapter Installer:. Well Disinfected Upon ( Method of Disinfection: Comments: Pump Installer Nair 330 Attention: The pump QO Yes ❑ No rs . WELL & PUMP SERVICE, INC AVE. ANCHORAGE. ALASKA 99518 1-0740 - FAX:(907)243-0742 pumpmanjim@att.net PAGE 02/07 a pump installation log to the DSD within 30 days of pump installation. Parcel I.D. 015-151-23 Certificate of On -Site Systems Approval Expiration Date: Legal description SOUTH LAKEWOOD HILLS #1 BLK Site address 11050 Ridgecrest Dr Anchorage AK Current property owner(s) Mary George X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 1/3/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 NMPAUTY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-151-23 Complete legal description South Lakewood Hills #1; Block 6, Lot 4 Location (site address) 11050 Ridgecrest Drive *Anchorage, AK Current property owner(s) Mary George 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 971-371-6003 3. TYPE OF WATER SUPPLY: ❑Q Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ■❑ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: X Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 14 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed 0 Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Waiver Fee $ Date of Payment Date of Payment COSA# 05C2a(GT(0 Waiver# COSA Application—June 2022 COSA Checklist Legal Description: South Lakewood Hills #1; Block 6, Lot 4 Parcel ID: 015-151-23 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 8/25/83 Total depth 176 ft Cased to 176 ft n Sanitary seal is functioning correctly X Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 12/4/22 Static water level at beginning of test 124.9 ft. Comments B. TANK DATA Measured operating fluid level in septic tank 50° Date of pumping ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 2008 Q ❑ ALL standpipes present per record drawing Total measured depth from grade 12.16 ft (max) Measured depth to pipe invert from grade *4.83 ft (min) ❑ N/A — pressurized field. F1 Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced _gallons date Any rejuvenation treatment (past 12 months) NO Well production at time of test 7.0+ qpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ® No M Coliform bacteria is Negative Nitrate 1.25n ❑ N't t I h MRL ND Arsenic Collected by Date 12/4/22 mg i ra a ess t an ( ) _ ug/L X Arsenic less than MRL (ND) GEG, Ltd. C. LIFT STATION El Required maintenance completed Age of lift station N/A years Lift station material N/A Comments: N/A Adequacy test date 12/4/22 Results Q Pass Fluid depth prior to test 18 in Water added 867 gal New fluid depth 38 in Elapsed time 120 min Final fluid depth 2911 in Absorption rate 600+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 84 in Effective depth used ` in t " Effective depth remaining in If yes, enter date � I 5 S Comments/��Dl�eficiencies: *At trench C/O **Tested 2008 trench - no pipes found for 1983 trench ***House vacant on 11/16/22 �." l:�' b ty `3 i1i a0yLe:—vL -v�U A 6i 'riD , 9 v`t p,,LiJeJ3- 40 ; ao 10 COSA Checklist June 2022 /-I S 6 is i..'-- �:J Qx""-y Is E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' Yes if No ft 0 Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' ME Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' n Yes if No ft rol Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft Q Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5+ ft Surface Water > 100' [E Yes if No ft Tank to Property Line > 5' ❑o Yes if No ft Field to Property Line > 10' ❑Yes if No **� ft Water Main > 10' Q Yes if No ft Water Service Line > 10' 0 Yes if No ft F. ENGINEER'S COMMENTS *Met code at time of installation **WR080004 Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' 0 Yes if No ft Q Yes if No ft If tank or field is under driveway comment below G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Garness Engineering Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Garness Date 1 -_71 3 p ) ZZ In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may Fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or parry (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. COSA Checklist June 2022 #Z&14 Municipality of Anchorage •. • '� Development Services Department Building Safety Division On -Site Water &Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 ✓✓✓/ If CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-15-17Z COSA# 1000114 / 1. GENERAL INFORMATION Expiration Date: -( -' � % ' 0 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address SOUTH LAKEWOOD HILLS #1: BLOCK 6, LOT 4 11050 RIDGECREST DRIVE • ANCHORAGE. AK • 99516 BERGA ROBERTA M REVOC TRUST Day phone Day phone DAR WALDEN W/ KELLER WILLIAMS Day phone 865-6405 101 W. BENSON BLVD • ANCHORAGE. AK • 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined In the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A GARNESS, P.E. Date ZO ! t: Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines d Regulations. The reported results described 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 soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the systema These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTO. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal tight whatsoever. 5. DSD SIGNATURE Approved for q bedrooms. Disapproved. .4 ,111� y. .... .... P�ijD ........•J essr Conditional approval for bedrooms, with the filowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Nitrate Advisory al ' / Other By: /N . i (R.. 11AS) :R,\QP�,��(Y F�cyo J• •••ON-SITE••.��: WATER AND ; M: WASTEWATER ; PROGRAM Original Certificate Date: / — a 6 _/ O Municipality of Anchorage Development Services Department = `' Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorago, AK 99519-6650 www.muni.org/onsite (9343-7904 CERTIFICATE OF ON-SITE MTEMS APPROVAL CHECKLIST Legal Description: SOUTH LAKEWOOD HILLS #1: BLOCK 6, LOT 4Parcel ID: n(S'^ A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 8/25/1983 Sanitary seal (YIN) YES Total depth 176 ft. Cased to 176 ft. FROM WELL LOG Date of test 8/25/1983 Static water level 123 ft. Well Log (YIN) YES Wires properly protected (YIN) YES Casing height (above ground) 12+ in. AT INSPECTION 1/15/2010 120 ft. Well production 20 g.p.m. 5.6+ — 9 -p.m -WATER SAMPLE RESULTS: o.'73S Coliform colonies/100 ml. Nitrate mg./L. Other bacteria colonies/100 ml. Arsenic: —15—ug./L. Date of sample: 1/12/2010 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL I Date installed 6/16-17/2008 Tank size 1250 gal. Number of Compartments E Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN)No High water alarm (YIN) N/A Date of pumping 9 01 Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATA ow EXISTING GRADE 5/19/83 240 TRENCH Date installed 6/16-17/200 Soil rating .p.d. ' r ft'/bdrm) 0_8 System type TRENCH .50 2.83 ' 1 10 Length 60 ft. Width 12.5 ft. Gravel below pipe 7 ft. •15 1000 Total depth +12.5 ft. Eff. absorption area -840 ft' Monitoring tube YES Depression over field NO Date of adequacy test NEW Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test = in. • Water added =gal. New depth =in. Elapsed Time: = min. Final fluid depth in. Absorption rate >= 600+ g.p,d, Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — DRAINFIELD WAS VISUALLY CHECKED DURING SITE INSPECTION. LIQUID LEVELS IN NEW FIELD WERE MEASURED AT 15 INCHES & THE OLD DRAINFIELD WAS DRY ON 1/15/10. D. LIFT STATION Date Installed Size in gallons Manhole/Access (YIN) "Pump on' level at in. 'Pump off' leve High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: NEW TRENCH/OLD TRENCH Property line •1'+/10'+ Building foundation 10'+/10'+ Water main N/A/N/A Water service line 10'+ 0'+ Surface water 100'+/100'+ Driveway, parking/vehicle storagel0'+ 5'+ Curtain drain NONE KNOWN Wells on adjacent lotS100'+100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION o�(L OF 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 s 0 date. f r s: O Engineer's Printed Name. JEFFREY A. GARNESS �Q O�795 :� r�e''•. 1 o�p.••c��o I c Date 0 � to proreaslon°o'er COSA Fee y%d Date of PaymentI�.1I b Receipt Number. 0'!9 �' 3 (Rev. 11105) . Waiver Fee $ Date of Payment Receipt Number 12 I No N 39°5937°E 191 .1 3' 5 89°5937°W 1 91.1 3' THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON.(UNLESS INDICATED) NOTE: ANY FENCELNES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES OR LOCATE STRUCTURES. PAVING MAY BE SHOWN APPROXIMATELY DUE TO SNOW CONDITIONS. I 1 I I 1 At, -BUILT SRVEY SCALE: I" = 30' t3F P-11 49TH SHANE A. HOLT.- LS-6914 OLT.'LS-6914 L 4 J QAAA Pea .O „� F£S s1ONP�" p`9 I HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 4, BLOCK 6, SOUTH LAKEWOOD HILLS NO. 1 ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE, ALASKA THIS _12TH_ DAY OF _JANUARY 2010_ HOLT LAND SURVEYING 11210, FB 139.54 TEL. 3455513 o MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES M�'t Division of Environmental Services On -Site Services Section P.O. Box 196660 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # i11L,_ 1a1 -,q�2 HAA# iol�� 1. GENERAL INFORMATION Complete legal description Lot 4; Btoek 6; South Lakewood HiM -T-4- ) Location (site address or directions) 11050 R.Ldgeotat D/cive Property owner -RobeAt 9 Connie- we.e.!? Day phone 562=2665 — R" Mailing address 11050 eCllnrtt Q& vo AHohoxa� 9516 — - -� Lending agency Day phone Mailing address L. Agent)-`' Ise Eti.ahon FORTUNE PROPERTIES, INC. Day phone' 562-7653 Address 3000 A Smoot Awoha&aQt9Ah 22503 Unless otherwise requested, HAA will be held for pickup. - 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Fro.1 MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify thai my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Phone S & 5 ENGINEERING Address 17034 Eaale River Loon Road No. _9.9_4 Eagle River, Alaska 99577 Engineer's signature Date 8 c>yA �r Opq FF''S7�`� 6. DHHS SIGNATURE — .Approved for z6e'(y2 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments M The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(R.. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Parcel I.D. A. WELL DATA Well type -Si N11e Q If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed 8-25--€ 3 - Driller.�I iNe �rtj�t�_ Total depth Cased to I:t (0r Casing height Sanitary seal (Y/N) r-( Wires properly protected (Y/N) �} M � FROM WELL LOG AT INSPECTION 3 Date of test 8 -2�_ - S 3 FE C Z 3 rn z� Static water level rn V Well flow z Og.p.m. co . � g.p.mC � po � Dz_ Pump level U !( V K rn ti o 0 <_ D SEPARATION DISTANCES FROM WELL TO: Z Septic/holding tank on lot I 00'f ; On adjacent lots ( Cc? rt Absorption field on lot (�prt ; On adjacent lots ( r rpo t �� Public sewer main Public sewer manhole/cleanout Sewer service line 1 0 t Petroleum tank a orie, (`Nowt) WATER SAMPLE RESULTS: Coliform 6 R I +� C.-fo — t Nitrate -SASTrFc%ru \ '' Coll') Other bacteria Z e ✓O Date of sample: 8 - 2 O Collected by: S ��INPef1Ua B. SEPTIC/HOLDING TANK DATA Date installed 5-/l - €33 Tank size 1 Z SD y A j Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) 11 iDepression (Y/N) ti High water alarm (Y/N) iiItA Alarm tested.jY/N) A-),I� Date of pumping R - z o -Gj I Pumper J} t NOMe- C�tePUK.G 5 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: r � We] I(s)onlot (o0 t On adjacent lots ( L90 'f Foundation I To property line to I Absorptionfield Water main/service line Surface water/drainage 1 00 t 72-026 (Rev. 7191) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on"le I at High water alarm level Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access(Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at Cycles tested Surface water _ Date installed S " I q " 8 Soil rating 040 `�6p- System type TAetoc In Length 13-0 Width 34 9Gravel thickness I n Total depth Total absorption area I DOO d' Cleanouts present (Y/N) 14 Depression over field (Y/N) ti Date of adequacy test 2 I -V Results (pass/fail) to A SS for bedrooms Peroxide treatment (past 12 months) (Y/N) rJlb If yes, give date — SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ( nD / f- On adjacent lots f o0 1t J Property line /n + To building foundation (n It To existing or abandoned system on lot i'(A On adjacent lots O t Cutbank P48 Water main/service line to f Surface water 1 00 t Driveway, parking/vehicle storage area (O f Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. 1 S & S ENGINEERING Signature 17034 Eagle Rimer Lean Reed No �g4 j i S Eagle River, Alaska 99577 -� Engineer's'Name ell 5 Date r,1 :n, flG.. V �� HAA Fee $�10,0,9 Date of Payment Receipt Number J 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS REPORT BY SAMPLE for WOREorder# 37508 Date Report Printed: AUG 23 91 @ 16:31 Client Sample ID:L4 B6 SOUTH LAKEWOOD HILLS PWSID :UA Collected AUG 20 91 @ 12:40 his. Received AUG 21 91 @ 16:30 hus. Preserved with :AS REQUIRED Client Name :S & S ENGINEERING Client Acct :SNSENGP BPO t PO # NONE RECEIVED Req # Ordered By :SHANI Analysis Completed :AUG 23 91 Send Reports to: Laboratory Supervisor RPHEN C. RDE 1)S & S ENGINEERING Released By G - VA----- 2) .................................................................................................................................... Chemlab Ref #: 914284 Lab Smpl ID: 3 Matrix: WATER Parameter Tested NITRATE -N Sample ROUTINE SAMPLE COLLECTED BY: R.D.J. Remarks: Allowable Result Units Method Limits -------------------------------------------------- 0.16 mg/1 EPA 353.2 10 ........................................................................................................ 1 Tests Performed See Special Instructions Above UA -Unavailable ND- None Detected " See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than %� SGS Member of the SGS Group (Societe Gdndrale de Surveillance) a CHEMICAL & GEOLOGICAL LABORATORY f A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. r` TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM I.D. it IQ PRIVATE WATER SYSTEM S & S ENGINEERING Mailing Address 17134 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 SAMPLE DATE: LUJFeJ Mo. SAMPLE TYPE: LFLLI Day Year EL Routine ❑ Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected No. LOCATION Collected By 2 3 4 5 TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. a Date Received ;? I q Time Received 1636 Analytical Method: Membrane Filter No. of colonies/100 ml. Lab Ref. No. ]g Result' Analyst u m u m u m Atnmr ?-'291 lANU BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter: Direct Count �1� COLLECTING SAMPLE Verification: LSB Fecal Coliform Confirmation BGS Collform/100 ml Final Membrane Filter Results Coliform/100 ml Reported By Datey1e7 ' Q TNTC = Too Numerous To Count Za.m. p.m. PART ONE OF TWO OB = Other Bacteria REMAINDER TO FOLLOW o �— Time APPLI(--'�NT FILLS OUT UPPER HA[ '' ONLY Property Owner '" s 6gts9 Inc. Time Phone Mailing Address .O.PslonvTj& AnchorageAnchoragel, AK - Zip Code 99511 349-2057 Buyer Inspector Inspector Address Inspector Zip Code Lending Institution pgg6p , gg 644p W es t625 ifl Phone Address Anchoraize, AK Zip Code 99501 263-3245 Realty Co. & Agent - Phone RECEIVE® N/A 'CONDITIONS OF APPROVAL Address Zip Code ( ) CONDITIONAL APPROVAL' Legal Description Lot 4, Block 6, DATE South Lakewood Hills NF1 NhN Ridgecrest St. Street Location Soils Rating Type of Residence Well To Absorption Area 00�-�Septl og ReceivedZY 3k Single Family 6 s- y �% —&; ❑ Multiple Family No. of Bedrooms 4 ❑ Other Water Supply ® Individual - ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal ® Individual Year Individual Installed: 1983 ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. o �— Time Time Time Time Date Date Date Date fl), Inspector Inspector Inspector Inspector Field Notes: rEPT. OF H`�' i! -I ENVi'nONA/,'-NTAL PROTECTION r �O}�P J 7 Sid? RECEIVE® (qj APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE B Soils Rating Date Sewer Installed Well To Absorption Area 00�-�Septl og ReceivedZY Tank Size S 6 s- y �% —&; Well to Tank % (D a 72023 (3182) CHEMICAL & Gf�T OGICAL LABORATORIES ^' ALASKA, INC TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street ,.e,.a,peta Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER., TO BE COMPLETED BY LABORATORY WATER SYSTEM: Analysis shows this Water SAMPLE to be: � 1 I.D. NO. 9Satisfactory Water System Name none tins. Mailing Address - City State '.. Zip Code - SAMPLE DATE: f l) Mo. Day Year SAMPLE TYPE: Routine ❑ Check Sample (for routine sample) , ❑ ,Treated Water with lab ref. ❑ Untreated Water ❑ Special Purposee SAMPLE ` Time Collected. NO. LOCATION - _ Collected By. _ READ INSTRUCTIONS `BEFORE nsatis ac or ❑ Sample too long in transit; sample should not be over 48 hours old at examination to Indicate reliable results. ;Please send :_.:...new sam4ple: O Date Received Time Received l-13 Analytical Method: Fermentation Tube Membrane Filter Lab Ref. No. Result" Analyst 3;70 1- ED ,;� . FTI FT -1 -*W of colonies/ 100 m1 orNo'ofPositive portions - GG -2220 (b)BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Date a.m. EMB prow, ae noura: - teruur •e ::ti.' - COLLECTING SAMPLE Multiple Tube Report: 10ml Tube. Po.nlve/T,tal loml porno,. Membrane Filter: Direct Count - Collform/loom) Verification: LTB BGS Final Membrane Filter Result$ ,f Coliform/looml Reported BY Data Time- it a.m. p.m