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HomeMy WebLinkAboutSOUTH LAKEWOOD HILLS #1 BLK 3 LT 2South Lokcwood Hills #1 Lot 2 Block 3 #015-151-15 Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 995t 9-6650 Page 1 of 3 www.cLanchorage.ak.us (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW000244 PID Number: 0'15~'15'1-'15 K~vin & Unnic~ Knwal Wastewater System: [] New [] Upgrade 6300 Wnndmnnf Drive_ 9§S'1~ ABSORPTION FIELD 3411-127~ 3 [] Deep Tre[~ch £]ShallowTrench ~]eed [~Moun6 ~Olher: LEGAL DESCRIPTION soil Rating: Tolal Depth frora original grade: Block: Lot: Su~Msion: ~ ~Dep~ to pipe ~ffom from original grade: Gravel dep~ benea~ 3 2 South Lakewood Hills 3 Ft. I ,~. 45 each ~. Well: ~ New ~ Upgrade Gmvel~dtb: Numberoflines: [ DJs~ncebe~een~Jnes: 3 ~. 2, ! 2 Exist'g Private~ ~. [~. 1080 ~t~ ~10/3034 ~ I A+ Home Se~ice 8/1/2000 Yield: ~ Pump Set ab ~ Casing Height Above Ground: GPM/ Ft.~ Ft. TANK SEPARATION DISTANCES ~ septic ~ Holding ~ S.T.E.P. ~ Other: T~ To Septic Absorption Li~ Holding Public/Private Man~cturer; Capaci~: Tank Field Station Tank Sewer Line ExistiRg Gal. w~r, 105 100 80 *.~w~, 100+ 100+ ~/ LIFT STATION Cu~inDrain J t00+ 100+ el E~ectd~llnspectionspe~o~edby: ~o,~L~ ~A,~ P-~'~o ~' BENCH MARK ~ ~,A ~'~ ~i~, Front Deck 100.0 F~. Engineer's Stamp Inspections peflormed by: Pannone Enfl. Svc Dates: 1~t7/3~/2000 ~/ ~ ,.....~-~...........~ ' ' ........ A.....~ ""0s/omooo Depa~ment of Health and Human Sewices ~pproval -- ~:~727,"~""2' ............ PERMIT NO, AS-BUILT P,i,D, NO, 015-151-15 WASTE~/ATER ABSORPTIHN SYSTEM LOT 2, BLOCK 3 ~UTH LAKEWO~D HILL~ WF1BDHBNT DRIVE EXIST'G DRAINFIELD REPLACEMENT SYSTEM FAILURE-TI] 3E REUSED--~ T8 TRENCHE~ 45LF~G'X3 ~ ~ ~ ~X iEXIST'a FIBER6LASS ~ N ~ VERIFIED INTEGRITY. ~EX~ST G 3 BR ~ ~> , HOUSE ~ . ~EX~ST G ~ C,\ WoF~N.~DRA WING\8-3~:LAKE.DWG PREPARED FDR~ Mr, Kevln & Nonlc~ Kowo. t 6300 Woodmoun~ Drive Anchor~§e, AK 99516 (907) 346-1275 / AS-BOILT, 3 BEDROOM HOU~:E PERC RATE 45 MIN/INCH 1000 SF REQUIRE]) 5' EFFECTIVE DEEP TRENCH 100' LONG 11' TOTAL DEPTH 1000 SF TOTAL PANNONE ENG. SVC P. B. BOX 108954 ANCHORAGE, ALASKA 99510 878-8818 Phone & Fax iDATE, 8-14-00 SCALE~ 1'=40' IAS-BUILT I PERMIT N~, aS-3UILT DETAILS P.I,D. NO' 015-151-15 w,~,~ i ~_~/ATER ABSORPTION SYSTEM LOT 2, 3LOCK 3 SOWTH LAKEWOOD HILLS o W C,\Work\DRAWINO\2-3SLAKE.DWO 1~90N¥390 ~ w PREPARED FOR~ Mr, Kevlm & Momlcm Kow~L 6300 Woodmount Drive Anchoroge, AK 99516 (907) 346-1275 PANNONE ENG, SVC, P, O, BOX 102954 ANCHORAGE, ALASKA 99510 878-8818 PHONE & FAX I]AT£~ 8-14-00 J NOT TO SCALE± AS-3UILT i MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jul 18, 2000 Expiration Date: Jul 18, 2001 Permit Number: SW000244 Pamel ID: 015-151-15 Legal Description: SOUTH LAKEWOOD HILLS #1 BLK 3 LT 2 Design Engineer: 0062 Pannone Engineering Services Site Address: 006300 WOODMONT DR Owner Name: Kevin & Monica Cole Lot Size: 32000 SQ. FT. Owner Address: 6300 Woodmont Dr. Total Bedrooms: 3 Permit Bedrooms: 3 Anchorage, AK 99516-1813 This permit is for the construction of: [] Disposal Field [] 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 DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 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. Received B~ Date: Pannone Engineering Services, LLC Consulting Engineers (907) 227-3522 P.O. Box 102954 Anchorage, Alaska, 99510 (907)272-8218 Fax June 28,2000 Municipality of Anchorage Dept. of Health & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 2, Block 3 S. Lakewood Hills S/D Septic Upgrade Permit Gentlemen: My firm was contacted to conduct a Health Authority Investigate at the above referenced property. The septic system was found to be in failure, having 92 inches of liquid in an 72-inch deep trench system. A single test hole was excavated on June 22, 2000 for a potential replacement system. The soil report and percolation test results are attached. Ground water was not encountered in this test hole. No bedrock was encountered in the test hole. The Iot is approximately 1.3 acres in size. Lot 2 slopes to the north at a rate of approximately 2 to 4 percent. The proposed installation will be located in the northeastern portion of the lot on a fiat area. The proposed location wilI be greater than 100 feet away from the existing well serving this property and 25 feet from the water service lines. The surrounding systems are located greater than 100 feet from the proposed installation. The lots surrounding this lot are developed, but do not conflict with the proposed installation. The proposed installation will not impact the future development of the surrounding or existing lots. See attached design. The new system will maintain over six feet vertical separation to the bedrock and over four feet vertically to the ground water. A diverter valve will be installed between the old and new system. Please contact me at 272-8218 or 227-3522 if you have any questions. Sincerely, ~ 4~ ..... .................. Attachments: *~ C:~WORK~L~ERS~2 3SLAKEWOODHILLS.001.DOC D E S I G N p,~,~, Nh, OlS-lSl-lS ~/ASTE~/ATER ABSBRPTION SYSTEM LOT 2, BLOCK 3 SOUTH LAKE~/ODD HILLS WDDDNDNY DRIVE VERIFY INTEGRITY, 10] U~clL Esmt ~ C~\~/ork\D .P.A~VlNG\2-3SLAKE,3~G 3 BEDROOM HOUSE PREPARED FOR: Mr, Kevln 8, Morale(1 Cole 6300 ~/OOdMouni; Drive Anchorage, AK 99516 (907) PERC RATE 45 MIN/INCH I000 SF REQUIRED 6' EFFECTIVE DEEP TRENCH 90' LONG ll~ TOTAL DEPTH 1080 SF TOTAL PANNDNE ENG, SVC p, n, ]]DX 102954 ANCHDRAGE, ALASKA 99510 272-8218 Phome & F~x ]]ATE, 6-P8-00 ] DESIGN SCALE' 1'=60' i I PERMIT ND~ DESIGN DETAILS P,I,D, NO, 015-151-15 ~/ASTE~JATER ABSORPTION SYSTEM LOT 2, BLOCK 3 SOUTH LAKE~OOD HILLS S/D C~\~/oPk\DRAVING\2-3$LAKE.D~/G Z W o o w > W PREPARE]] FOR~ Mr, Kevln & Monic~ Cole 6300 Woodmount Drive Anchorage, AK 99516 (907) 346-1275 PANNONE ENG, SVC, P, O, BOX 102954 ANCHORAGE, ALASKA 99510 272-8818 PHONE & FAX DATE, 6-88-00 NOT TO SCALE DESIGN SOIL8 LO(}- PERCOLATION TEST PANNONE ENGINEERING SERVICES, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 (907) 272-8218 PERFORMED FOR: Ms Monica Cole Bixton DATE PERFORMED: 6-22-00 LEGAL DESCRIPTION: Lot 2~ Block 3 South Lakewood Hills O~ganic- Topsoil OR Brown Silts Gray Silty Grovels GM with Cobbles Gray Gravely SP Sand BOH TEST HOLE 103 U~ll WAS GROUND WATER ENCOUNTERED? No IF YES, AT WHAT DEPTH? .... DEPTH TO WATER AFTER MONITORING? Dry DATE: 6-28-00 TEST HOLE ~SS ~2E WATER DROP PEROLATION RATE 45 {min//nch) PERC HOLE DIAMETER 6 inches TEST RUN BEWTEEN 7 FT and 8 FT COMMENTS: Test hole excaw*ed by A+ Home Services. Test Hole was presoaked before peru test. PERFORMED BY: Scott Crowther, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. GREI' ANCHORAGE AREA BOP 'IGH Depsrtment of EnvironmentsI Ousliw 3330 C Street Anchorsge, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME~9~ ! (~.!e~OV~ MAILING ADDRESS ~-2) C).~ ~-L ~ ,'~ ~. PHONE LOCATION LEGAL DESCRIPTION 50~ _b'.~_~,,~f~L~00 ~L [,-4 i!L~._/~ SEPTIC TANK: DISTANCE NUMBER OF FROM WELL (¢30 i MANUFACTURER ~)O.B~¢ ~-' MATERIAL ~'~'Y]'~v~[O,~' COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY JOgS) GALLONS. DISTANCE FROM WELL FOUNDATION NEAREST LOT LINE TOTAL LENGTH __OF LINES NUMBER OF LINES ' j DISTANCE BETWEEN LINES '~ TRENCH WIDTH"~2"'IN. TOTAL EFFECTIVE ABSORPTION AREA L~-~ (~ SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE ~ i DEPTH OF FILTER MATERIAL BENEATH TILE 41~. ABOVE TILE___ [~0 IN. WELL: TyPE _&.',_ ._1 CONSTRUCTION- BUILDING NEAREST NEAREST SEPTIC FOUNDATION LOT LINE SEWER LINE(O~' I, TANK CESSPOOL. OTHER SOURCES APPROVED DISAPPROVED REMARKS DEPTH_ DISTANCE FROM: SEEPAGE ~ f SYSTEM ~ ~ DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: REMARKS: __ Form LQ-032 DIAGRAM OF SYSTEM GrE~ .:R ANCHORAge AREA BOF 'JgH t"*~" PERMIT NO. DEPARTMENT OF ENVIRONMENTAL QUALITY SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT COMPLETION DATE ANTICIPATED FINAL iNSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK -- FOUNDATION TO SE~GE PIT , SEPTIC TANK TO St~E~ PIT WALL SEPTIC TANK ~ / , SEEPAGE PIT TO NEAREST LOT LINE. DRAIN FIELD /~ ~"'~' ~I WATER MAIN TO SE~J~T~NK DRAIN FIELD SEPTIC TANK, SEEPAGE PIT TO RIVER, LAKE, STREAM. , ALSO CONSIDER AREA WELLS. /¢~ DRAIN FIELD CAST IRON INTO AN]E) OUT OF SEPTIC TANK AND INTO CRib CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SO[L, 4 ]NCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT GREATER ANCHORAGE AREA BoRou RDINANCE NO. 28-68 AND THAT THE ABOVE DESCR]B SYSTEM IS IN ACCORDANCE WITH SAID CODE. -~ / GREATER ANCUORAGE AREA BOROUr' Department of Environmental Qu~ .ty 3330 "C" Street Anchorage, Alaska 99503 SOlidS LOG - PEROLATION TEST Performed f o r_~.~/~.>~ Legal Description:._? /o/_~¢ This form reports: Soils Date Pe r fo rmed_¢/)//~5 - Percolation test Depth Feet 1 6- 8- 10- '11 - ~ 2 ~ 13~- 14- Was ground water encountered? ...... _/~.© If yes, at what depth? Reading Date Gross Time Net Time Depth to l~ate~ Net Drop Percolation rate Proposed i s~alla~l~h-i-'~i]~.le Pit Drain Field :)epth of Inlet ............. DeptS--~'i;~'trE~5~-))it or trench COOl, fEInTS: WATER WET.L DRILLERS LOG DO N~T FILL IN USGS No.~ Drilling Driller Vernon L. Nowell ~ Area Well owner Virgil ~lemenson Use of well Locatio~:~~ge~ & section, f ~in r~d 0 ~alley Rd. a~ove Rocky Size of casl~ ~o'0;~?~feet ~sed ~ ]w~,7 aT" feet Static ~ter level lo0' fet (~)(belo~) land s~face. Fl~sh of (check one)Op~X), Screen( )~ Perforated ( ). Describe screen or perforations Well p~ping test at~l[] gallons ~r~r .~ours '~ feet of drawdown from static level Remarks M~O. ~er fast . · De~th l-'---n 'f$$t from~------"-Gi'~e details of formations pene~ra~e~ s~ze ~e colo~,; and hardness. O' to ll', ~11~ ~__to 20' ___b~_own g_r~.vel till ,,2o' to 2__~41~ _hard pan ..... _ , ~ .... gr~yUbrown g~av~ely ~m±_L __~!~-~fl,~ bro~,m ~andy 91Dy Vi_~t'__n silt b~wn ce~e~ravel gra~ gravely, ,9~----~ ' .... cem,ente~,,, gravel, lithe i[20 ..... ~ ~lenses of brown clay s~nq__~ gr_ ~ av~l~heav~a-' ~ ...... to · to to Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 ~L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak, us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-151-15 HAA# Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 2, Block 3 South Lakewood HilI~'TD Location (site address or directions) 6300 Woodmont Drive Current Property owner(s) Maili'ng address Lending agency Mailing address Real Estate Agent Yon.q Pienin,q Mailing Address Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3 Kevin & Monica Kowal Day phone 346-1275 6300 Woodmont Drive, Anchora.qe, AK 995i6 Day phone Day phone 727-6830 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Holding tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 5. STATEI~IENT 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 Health Authority Approval Guidelines for this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein, I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the site water supply and/or wastewater disposal system is in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Enq. Svc. Address P.O. Box 102954, Anch, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Phone 272-8218 Date 8/11/2000 DHHS SIGNATURE / Approved for ~ Disapproved. Conditional approval for ......... ~<-,% Nc CE 814c' bedrooms. ~ ~:.'.,..~17¢,fi~,: ~ bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Expiration Date: / ~' /¢ - (DO Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: ,,x,~lssue Date. Date installed "Pump on" level at __ Datum Size in gallons NiA in"Pump off" level at Cycles tested SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 105 Absorption field on lot 100 Public sewer main N/A Sewer/septic service line 80 in Manho e/Acces,~ High water alarm level at __ in Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/deanout N/A Holding tank i00+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 23 Water main 50 Drainage 100+ Property line 33 Water service Fine 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~ '~¢,Z~j~'- Building foundation 37.. Sufiace water 100+ Water Service line 65 Curtain drain 100+ F. COMMENTS Absorption field 10 Surface water 100+ Water main 65 Driveway, parking/vehicle storage G. ENGINEER'S CERTIFICATION Wells on adjacent lots 100+ I certify that I have determined through ~blo' inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on th/s date. Engineer's Printed Name Steven R. Pannone, P.E. Date 8-12-00 HAAFee $ ¢:~0-O, ~ Date of Payment Receipt Number ~, '~/¢ (Rev, 1 t/99) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Department of Health and Human Service 'CEI D Division of Environmental Services ', On-Site Services Section 825"L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www,ci, anchorage.ak.us ,MUNIC/PALi]'¥ O~ (907) 343-4744 '~dPONMENTAL HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type PRIVATE Date completed 6/t/1974 Total depth 126.5 ft L 2, B 3, SOUTH LAKEWOOD HILLS S/D IfA, B, or C provide PWSID # __ Sanitary seal Cased to, 126.5 ft Date of test Static water level 100 Well production 18 WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi Date of sample: 8/17/2000 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Fiber Glass Parcel I.D.: 015-i51-15 FROM WELL LOG 611119'/4 ft g,p.m Well Log _Y_ Wires properly protected Y Casing height (above ground) 24 in. AT INSPECTION 8/1112000 104 ft 5.5 g.p,m Nitrate d~-S'u~ mg/I Other bacteria ¢-~ colonies/100ml Collected by: S.R.PANNONE Date installed 61911975 Tank size 1000 gal Cleanouts _ Foundation cleanout _ Depression over tank N Date of pumping 7/3i/2000 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 8/1/2000 Soil rating (g.p.d./ft Length 90...ft Width 3 ft Total depth _9 ft Effective absorption area t080 ft~ Date of adequacy test ~ Results (Pass/Fail) ;"ASS Fluid depth in absorption field before test NEW in Water added Elapsed Time: __ rain Final fluid depth .-- in Any rejuvenation treatment (past 12 mo.) (YIN & type) (Rev. 11/99) Number of Compartments High water alarm .NIA System type .D'[ Gravel below pipe.6.0 ft Monitoring tube Y Depression over field N For _~bedrooms gal. New depth in. Absorption rate >= __ g.p.d. If yes, give date 561550i T-057 P.O,/OS F-lO? Matrix D~i/ng WaTer PWS~ 0 Client PO~ Printed Da~;~Ti,~e 05G2~000 14:12 Co~c~cd D~te/Time 08/17/2000 13:4~ ~teived Dative 08/17~000 14:00 Sample EPS00 N~-at~: L~barato~ Conlrol Smnple was outside acceptance criIeth (S9.7%). Sample val~e miry be bflts low. R~l~s PQL uait~ M~lhixt Ntt't~e-N O.iO0 ~J 0,$00 m,~/L EPA 300.0 10 max 0W17100 SCL ¢O1/100n~- SMI~ 922'~B 1 Pannone Engineering Services PO Box 102954 Anchorage, AK 99510- August 28, 2000 Subject: Waiver Request for SOUTH LAKEWOOD HILLS #1 BLK 3 LT Waiver # WR000062 Lot Line Request for Parcel ID 015-151-15 Dear Engineer: Your request for a waiver of the required 10 feet horizontal separation of the on-site wastewater disposal system to the lot line has been approved. The approved separation distance is 1 feet. This waiver approval applies to the current on-site wastewater disposal system and lot line separation only. Any future upgrade to the on-site wastewater disposal system and lot line will require all separation distances to be met or another waiver approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely,~ ~~ Jeff Poet Engineering Technician III On-Site Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health & Human Services On-Site Services Waiver Review Worksheet WR#: WR000062 PID#: 015-151-15 HA#: HA000390 Date Received: August 25, 2000 Legal Description: South Lakewood Hills #1, Lot 2, Block 3 Engineer: Pannone Engineering Services PO Box 102954, Anchorage, AK 99510 Applicant: Kevin & Monica Kowal Waiver Requested: t foot lot-line waiver Permit~: SW000244 Criteria: 1. Geology Points: A. Water Table B. soir Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation 2. Special Conditions: 3. Other: Total: Waiver is Granted: List Conditions or Reasons for above: Waiver is not Granted: Date: ~ ",.~, ~ - ~ O Rec#: 6237 Amount: $115.00 Date Paid: 8/25100 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES_ Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage,'Alaska 99519-6650 343-4744 Parcel I.D. # 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ( -/ ~--000 HAA #)-{/~q/-..~(~)~:~~ (~ Lot 2; Block;3; So; Lak~ood H~ ~I Location (site address or directions) Property owner ~Mailing address 6500 Wocdmont Drive Anch.o~agz, AK Estate of Llyw~ln Kahklen C/O Mo~ZC~Day phone 269-6523 Powers P.O. Box 112224 Anchorage, AK 99511 Lending agency Mailing address Day phone Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: ? 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE:- If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation !~pm State ADEC ~/~, attesting to the legality and status of system, r~:' ': . , '~~ 72-025(Rev, I/91) Front MOA#21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage flies 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 S & s ENGINEERING Phone ~'~ -~' 17034 Eagle River Loop Road NO. ~ Address . ~,~_/Z,-/~/ ,~ ~---- /~_5~_/~.~, Engineer's signature ·/Tu- ~- ~.~ ~ ~ ..~.v Date // = DHHS SIGNATURE ~ Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the folloWing stipulations: Additional Comments ~',,A' ' / C '. Date 1 ~)-"/?/~:~ ~-'/' Th~e Muni(~ pa ~)i~An~horage Department of Health and Human Services (DHHS) issues Health Authority Approval ,Certifi(~a{es 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 ~3efore a certificate is issued, The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work, Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST ~ ~_~K~,~' '~1~'~ ~ / LegalDescription:£¢r- ~'i ~coc¢ ~ , ParcelI.D. A. Well Data Well type i ,¥ Log present ~N) Total depth Sanitary seal Casing height Wires properly protected (~/N) FROM WELL LOG AT INSPECTION Dateoftest (o /TV ]) // 7 ,'/~)~ Static water level / o o ' / O ;~ Well flow ] ~ .g.p.m. ~-]- ~ g.p.m~ SEPARATION DISTANCES FROM WELL TO: Septic/; ,uld;r,~i ~ on lot /O o / Absorption field on lot / (2 5- Public sewer main ,w //J Sewer service line ~ ~'- /~ If A, B, or C, attach ADEC letter. ADEC water system number /v // Date completed (~ /'7*/ Driller '~IE.~ Cased to ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank /'/ }0 o leo / "/-- WATER SAMPLE RESULTS: Coliform O Nitrate Date of sample: / / / / J- / c4 ~/ ©. 'P~ 3 "~//-~ Other bacteria Collected by: .5' ~- 5' B. S E PTI C/H(HJ~NG-T-ANK--D AT A Date installed (~ / 'i / '7 ,~- Tank size / o eD ¢.,~z. Compartments Cleanouts (~N) ~/ Foundation cleanout (Y/~ h/ .Depression (Y~I High water alarm (Y/N) /',/ /4 Alarm tested (Y/N) ~ /,4 /V Date of pumping ~/ / ! c~ / ~f7 Pumper SEPARATION DISTANCES FROM SEPTIC/N~EBiN~ TO: / Well(s) on lot ) o© On adjacent lots To property line ~ ~ Absorption field Surface water/drainage ,V lA Foundation Water main/service line )0 /+ CONTINUED ON BACK PAGE 72-026 (3/93)* Front C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access~ Vent (Y/N) "Pump on" level at ~ "Pump off" Level at High water alarm level ..~ CYcles tested Meets MOA electrical codes (Y/N) SEPARATION DISTA.hlGE'F'~M LIFT STATION TO: Well o..n..le¢~ On adjacent lots Surface water Length .~, ¥ Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y(~ ~J o,vE D. ABSORPTION FIELD DATA Date installed (~ / q / -7 ~ Width Soil rating (6PD/F¢) IL :~- Fxz/'/~'/.~ Systemtype 'I /'~.~. " Gravel thickness (~ / Total depth / I / Cleanout present (~'N) Y Depression over field (Y~i '/~/ Results a~)'fail) ~P¢~-~ /-o,~ ,). f~,/~ for Bedrooms / '~ /' After test / -3 // /~/v 0 uv If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /Lq S- To building foundation On adjacent lots ,~. o -/- Surface water ~ //A Curtain drain /v /4 On adjacent lots /Oo ' '¢-' Property line To existing or abandoned system on lot Cutbank /"/ //~ Water main/service line Driveway, parking/vehicle storage area / E. ENGINEER'S CERTIFICATION Date of Payment Receipt Number 72-026 (3/93)* Back I certify that I have checked, verified, or conformed to al MOA and HAA gu defines n effec?~t~e.E~[~.~¢t.~s nspect on / ~ ~ ie (: ~'.~ C[: ~ 8801 :,<:/,,) HAA Fee $ ~¢~ ¢ d ~ Waiver Fee $ /,Z - ¢ - ~ Date of Payment ~ 7 (l~ ¢) Receipt Number Commercial Testing & Engineering Co. Environmental Laboratory Services LABORATORY ANALYSIS REPORT CT&E Ref.~ 94.5800-1 Client Sample ID L2 BLK3 I~AKEWOOD HILLS $/D Matrix WATER Client Name S & S ENGINEERING WORK Order 10873 Ordered By R.J.S. Printed Date 11/18/94 @ 18:46 hrs. Project Name Collected Date 11/15/94 ~ 13:05 hrs. Project# Received Date 11/15/94 ® 14:30 hrs. PWSID UA Technical Director STEPHEN C. EDE Sample Remarks: ROUTINE SAMPLE COLLECTED BY: S.S. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Inlt Nitrate-N 0.23 mg/L EPA 353.2/300.0 10 11/16/94 MCE * See Special Instructions ~bove UA = Unavailable ~** See Sample Remarks ;~bove NA = Not Analyzed ~U = Undetected, Reported value is the practical q~/antification limit. LT = Less Than ~D = Secondary dilution. GT = Greater Than 5633 B Street, Anchorage, AK 99518-1600 -- Tek (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA Date OF ANCHORAGg-=, _ Alaska or 25 PROTECTION 9950]. ired: May 26, 1977 ~3: T:ime Ua t e Insp REQUEST FOR APPROVAL OF INDIVIDUAL S %ND WATEH AC 1. LI 2I[,o Lending !nstituizion Request: Alaska Mutual Savings Bank Mailing Address: Post Office Box 1120 Phone: 274-3561 2. Property Owner: ___V.i~l Clen?n_s,?_n ................................ Phc)nc': .......... Mailing Address: % Ron Harris, 276-3513 3. Legal Description~ Lot 2 Block 3 South Lakewood Hills Subdivision #1 Single Family Residence: ( J Multiple Family Residence: ( Number of Bedrooms: Number of! ]~edrooms 5. Well System: Individual Well (x~ Communil~y/Pub].ic Sys[:em ( ) Permit t~ ..~/~ Depth of Well _l_~_SJ_ ................ Well Log on File Construction ___~ ......... Bacterial Ar~alysis 6. Sewage Disposal_ System: On-site System ~ Public Utility ( ) Permit ~ ......... Installed .... Instal]er _ .Z~_ AbsorptJ.on Area __g~[_____ Soils Rate _?_g~i .... Material ~~ , 7. Distances: Well to ' ~ ' ' /~O .... Se_~t.lc, Tank .... ho Absorption Area to Sewer Line _~a.(~l ......... Nearest Lot ]_ine ___/_~_.~l.__ Absorption Area to Nearest L O~ Line __~.~.f. P a,g e · [~o Department of Health and Environmental Protection Request for Approva~ of Individual Sewer and Water Facilities Legal Description: Lot 2 Block 3 South Lakewood Hills Subdivision #1 AffadavSt A%tached: ( ) I,etter Attached: Department 1. Type of Inspection: VA 2. Property Owner: ..... ~cx-~z¥-~D:v~ MUNICIPALITY OF ANCHORAGE '.:U; DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION i: pi. (,~ 825 L Street, Anchorage, Alaska 99501 279-2511, ext. 224, 225 REQUEST FOR APPROVAL OF ~, ;~'\¥ INDIVIDUAL SEWER and WATER FACIUTIES FHA .......... CONV Mailing Address: .............................. Day Phone:.. 3. Name of Buyer: '~~ Mailing Address: ~_~g 4. Name of Lending Institution: MailiugAddress:~.,~,), ~, L-I~0 .Phone:_ ~') 5. Name of Realtor or Agen[: ~'~ Mailing Address:. 5 7. Type of Facility to be Inspected: ..... No. Bdrms.. ~" Water Supply 'Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well j ,2_ ~ / Individual__ J~.. Sewage Disposal System Type of System: Public Utility_ __Individual (on-site) If Individual, date of installation 72-003(3/76)