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Home My WebLink AboutSOUTH LAKEWOOD HILLS #1 BLK 1 LT 12South Lakewood Hills # 1. Lot 1.2 Block i #015-151-12 Municipality of Anchorage Page / of c~)_ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: '% ¢'¢ ? '? 0/~[ PID Number: ._C0/~' ~/~/~/~ Name: ~ ~ ~C' ~ Wastewater System: ~ New ~ Upgrade Phone: ~/~_~o~ No, of Be~oms: ~ Deep Trench ~ Shallow Trench ~Bed ~Mound DOther Soil Rating: Total Depth from original grade: LEGAl. DESCRIPTION D, ~ ~/s~. ~. //' Subdiv~ion- Depth to pipe boffom from original grade: Gravel depth beneath pipe WELL:DNew [D Upgrade Gravelwidth~ ,~ / Number of [ines: lOistancebehveenlines: ~assification (Private, A,B,C): Total Depth: Cased To: Total abs~rmion area: Pipe material: ~ Date installe : Yield: Pump Set at: J Oasing Height Abov~ Ground TANK SEPARATION DISTANCE8 ~ s~pti~ o Holding ~ S.T.~.~. Ma ufaoturer: Capacity in gallons: Material: Number of Compartments: Sudace ~ / ' Water /¢0 ¢ /~0~ % LIFT STATION ~ Lot / Size in gallons: Manuf~c Remarks: BENCH ~ARK Location and De ~ription: I A~umed Elevation: Inspections pedormed ~4 EaOe Rivar Loop Eoad No. ~o~ates: ls~¢~/~ - ¢ ? ~~~,~ Eagle River, Alasba 99577 2nd ¢-/~- ¢ '7 ~5 ~ ~ .o~E~ c. COWAN ./,~ 79-013 (Rev. 9/91 ) MOA 25 PERMIT NO, SW970191 PAGE 2 OF 2 D ........ H_.u D i.c_ i p. ~ I, i fl:. y ...o, f' Anchor'aae b:I'-'AN/MIzN/ Ut- Hb. AL/H AND ktUI'd'AN SERVICES ENVIRONMENTAL SERVICES DIVISION P,O, Box 196650 ®Anchorage, A. Lt~sk~ 99519-6650 · TeLephone, 343-4744 ON-SITE WASTEWATER DISPOSAL 5YSTEH AND/OR WELL INSPECTION RI=PORT LEOAL LOT 12, BLOCK 1, SOUTH LAKEWOOD HILLS P.I.D. NO, 015--151--12 ~ ~ ~.. 10' UTILITY EASEMENT ALT. -- ~1 ~ ~ FIVE BEDROOM [I Il SEPT[01500 OALLONTAUK ~ S HOUSE , S I I~ I I co~ , oau - s,~ s~ FCO 7.0' 1 8.5' 96.~ ~PINAL 8RAD? ST1 15.5' 28.0' _ ST2 1 5,5' 29,0' DBL1 16.5' 29.5' D~L2 17,5' 50,0' -~ _ ~m~ FD 18,5' 50.5~ 9o.2~ tsoo OA~ ~0' C01 54,5' 57,5' ssP~c . MT1 55,0' 58,()~ TAN~ C02 58.5' 65.5' FINAL G~ADE MT2 59,0' 66.0' COl = 98.8', cot co2 CO~ 17.5' 28.5' cos sm3~. MT1 ¢03, AT~ CO4 /CO~c04 == 98.7'S8'6' C04 29.0' 42.0' ~ ~ ok 4L~, ,,.., MTi = 83.7'~ MT2 = 83,5'/ NO WATER FOUND 77.5' B.0.H. From : RLPINE DRILL 90? 345 ~202 Nay. 03. 1998 09:55 P~I POi '~:!'.'/;~.~/,.. ~,'~ ~ ~ .... '~ ~ ........ · · ~F'~" ~'' .'h'~ ...... ' '.:' : ' DVS~NOFMiNING&WATERMGMT .'... ': WELL OWNER: OA'~Ai top E]orouna eurfeBa · Depth From ,. :Fo .H Depth o( hole:..'2' '~ ~ ft '" DEPTH TO 8TAT:lC : WATER LEVEL: below,~ .top of Casln( METHOD OF DRILUNO: ~ a~he:~ ,. .... USE OF'WELL;~ domestic ~.krigatlon ~.,~B]tor Casing tVpeL WEL~ iNTAK~:OPENINO TYPE:')~ open: ~nd Depths 0f openings: ', , ,, SOF~EEN 'rYPE~ ' :',. O~AVE~ PACK ~VPe: ":: Volgme.used: OROUT TYPE: Depth:. tro~ ' ' Duration: 3 LEVEL AND YIELD:· KE DEPTIt:' . WEL[~ UPON :coMPLETIOI~i · Phoflo {8071762,3~38, FAx 907 66~-q,~B4 ' , , . SEWER & WATER INSPECTION WELl. INSPECTION & FLOWTEST ROAO DESIGN SOiLTEST STRUCTURAL& MECHANICAL INSPECTIONS ~OBER'rC. COWAN, RE. ROBER'rA, SHAFER, RE. Date, JO ? V /. 7 ~unicipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 OCT 6 1997 Mu~iclpality of Anch0rageo ',s Oept Health & Human oervme REFERENCE: The septic in~pegtions for t~e referenced property were performed on 9~$'~/~ 7 and ~ 6 /q7 . Prior to submitting the On-site Wastewater Disposal System and/or, Well Inspection Report we are waiting for the J'~?~v~ ~¢~¢~7 to be completed. If we may be of further service please contact us. Sincerely, Robert C. Cowan, P.E. 17034 NORTH EAGLE RIVER LOOP · SUITE 204. EAGLE RIVER, ALASKA 99577 STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING & WATER MGMT WATER WELL RECORD LOCATION OF WELL BOROUGH 'fig t~L~I'I~DiViSION LOT eLOCK SECTION QTRS 'SECTION'TOWNSHIP RANaE MERIDIAN I I LOCATION/SKETCH: WELL OWNER: DEPTHS MEASURED FROM~]casing top []ground surfaco BOREHOLE DATA: Material 'rype and Color Depth From 1'o Munic of Anchom WELL DEPTH: DATE OF COMPLETION Depth of ho e:-, ,~ , ft Depth of casing:k;:." :,' - ft r;''~? / .'':'' / ' / i" DEPTH TO STATIC WATER LEVEL: /",/ '~ ' ' ft below [] top of casing Date: .';, ~ " / " ' [] ground surface METHOD OF DRILLING: ~] air rotary [] cable tool [] other USE OF WELL: ,[-1 domestic [] irrigation [] monitor .{~ public er CASING STICK-UP: ft, Diam: in. to ft Ca'~ir;{~ type: .~'- '., i'~- in. to ~ ft WELL INTAKE OPENING TYPE: '[-1 open end [] uerforated I--1 goon hole Depths of openings: to [] screened ft SCREEN TYPE: Diam: in. Slot/Mesf Size: Length:__ ft GRAVEL PACK TYPE: Volume used: Depth to top: GROUT TYPE: tVolume: "' Deoth; from . It :o ft DEVELOPMENT METHOD; Duration: - -, PUMPING LEVEL AND YIELD: ft after - hrs pumping.,'' ~'./~ gpm PIJMP INTAKE DI:.PTH: . ft Horsepower: __ WELL DISINFECTED UPON COMPLETION? [] YES [] NO CONTRACTOR INFORM.ATION: · .:. ~ , ' /,.'/ /i,4~' - t ,." ,::' Registered Business Name t/' t' ':" ~ignature of Authorized Respresen, tative Date REMARKS: PLEASE ~IAIL:WHITE COPY O1: LOG TO: DNR/DIVISION OF MINING & WATER MGMT 3601 ~C',St, Suite 800 ANCH0.RA(~E AK 99503-5935 · Phone {907)'762-2538, Fax {907)562-1384- PAGE 1 OF MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW970191 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:AUTEN IVAN DALE OWNER ADDRESS:10900 RIDGECREST DRIVE ANCHORAGE, ALASKA 99516 DATE ISSUED: 7/16/97 EXPIRATION DATE: 7/16/98 PARCEL ID:01515112 LEGAL DESCRIPTION: SOUTH LAKEWOOD HILLS ~1 BLK 1 LT 12 LOT SIZE: 33854 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM 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 (18kAC72) AND DRINKING WATER REGULATIONS (18A-AC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SANE DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: DATE: '7/17 HEALTNAUTHORiTY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES ANO REPORTS WELL INSPECTION &ELOWTEST ROAD DESIGN SO]LTEST EERCOLATION TEST STRUCTURAl& MECHANICAt. INSPECTIONS ROBERT O. COWAN, RE. ROBER"I' A. SFIAFER, RE. June 27, 1997 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 12, Block 1, South Lakewood Hills S/D Request you issue a permit to drill a well and install a septic system to serve the proposed five bedroom house on the referenced property. Test holes were excavated and percolation tests performed. The approximate location of the test holes are located on the attached site plan. The monitoring tubes within the test holes have been checked and found to be dry. This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact; us. Sincerely, Cowan, P.E0 RCC/mg Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 1" = 60' 80ALE DESIGN WILDWOOD 5/O TH/I 1 · ! SITE-PLAN c0m°o @ ~ ~m L'~ tOT z ~ ~ m ~ N.T.S. 8GALE SITE-PLAN - I DETAIL Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ,~.,~.~ .,,.. ~ ",~=-~ LEGAL DESCRIPTION:~'0~ J~ ~O, b~¢~oea ~ownsmp, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 13- 14- 15- 16- 17----- 18- 19- 20- COMMENTS ~ .o.H. SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? DEPTH?IF YES, AT WHAT Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE /t ~. ~ (mmutes/~nch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~__ FT PERFORMED BY: ,..,,**,, , I//.,~'~-// //~-~ .-*,~,._._ _ CERTIFY THAT THIS TEaT WAS PERFORMED IN / ACCORDANCE WlT~,'~_I.e~Ii.~,A~q~J~II~J~.~_ GUIDELINES IN EFFECT ON THIS DATE. gATE: "~ / "~ / fl 'J . 72-008 (Rev. 4/85) 825 "L" .~t~¢et! Anchorage, ^la~l<a 99~02-0650 SOILS· LOG ~ PERCOLATION TEST 4 6 7 9 ,i MJ~nil~'ing? 'T RUN °~' AC~OR£ ANCI~ WITH ALL STATE AND MUNiCiPAL GUID6LIN[. ~O'd l: ]:~:P69 C£RTI~Y TNAT 1 P~RFORME(,) IN THiS DATF_ DATEr A~±BNISDD DISSDqD NO~d Nd9~:£0 £66~-PT-GB SEWER&WATER MAIN EXTENSIONS ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST ROAD DESIGN SOILTEST ONSITE WASTEWATER DISPOSALSYSTEM DESIGN ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERItLL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 REFERENCE.' Lot 12, Block 1, South Lakewood Hills S/D June 27, 1997 GENERAL: 1. The scope of this project includes the installation of a 1~00 gallon septic tank and ~ leachfield trench~to serve the proposed {/~= bedroom residence located on the referenced property. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates· Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling· Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. ~EPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 7034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Page Two Lot 12, Block 1, June 27, 1997 South Lakewood Hills S/D Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level wi. th the perforations faced downward. Grave[[ is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill· Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page Three Lot 12, Block 1, June 27, 1997 South Lakewood Hills S/D Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONSI Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: ~¥pe of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick burial polystyrene (Dow Chemical Company equal). extruded direct Styrofoam HI or 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the II200 sieve° When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. Page Four Lot 12, Block 1, June 27, 1997 South Lakewood Hills S/D INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. Page Five Lot 12, Block 1, South Lakewood Hills S/D June 27, 1997 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER 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. Ct CERTIFICATE OP HEALTFI AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 01515112 1. GENERAL INFORMAl'ION Complete legal description Lot 12; Block 1; South Lakewood Hil]a ~1 Location (site address or directions) Property owner Mailing address Lending agency Mailing address Laura McArd]e 10900 Ridqecrest Drive Michigan Blvd & Ridqecrest Drive Anchorage, AK Day phone 346-8285 Anchnrag~ AN qq516 Day phone Agent Address Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. 5 NOTE: Individual wetl xxx Community well Public water If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAl..: NOTE: XXX Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and statue of system. 72-025 (Rev. 1/91) 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 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 Address Engineer's signature $ & $ ENGINEERING 'i~03'4 Eagb River Loop Road No. 204 Eagle Rive. r, A.~as!ca.~9~l$77 , ~ Phone Date £~-//5"/' ¢/ ~" DHHS SIGNATURE ~ Approved for '~ ~- Disapproved. Conditional approval for bedrooms. ,., *t~DOpZ~ ......... Z,, ~ ~ bedrooms, with the following stipulations: Additional Comments 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 DH HS 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 Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. RECEIVED Municipality of Anchor~'lge MAy 1 5 1998 DEPARTMENT OF HEALTH & HUMAN SERVIC¢~' Environmental Services Division MUNICIPALFI'Y OF ^NCHORAGE ~'~----~ 825 L Street, Room 502. Anchorage, Alaska 995()1~8~t~,~'-~CtEs I)IVlSlON Health AuthoritY Approval Checklist Legal Description:~'0~ ~ ~.l< / ,Cf). ~.4/c~,~,~x~ /-/~4,~ # / Parcel I.D.: O I .J-~ I,f'/ '- I ~ A. WELL DATA Well type [~RIVgT~-. Log present Total depth Sanitary seal If A. B. or C, attach ADEC letter. ADEC water system number [)ate completed. I o / )3 ] ¢/ ? cased to D-~(o Casing height (above ground) Wires properly protected ,(.~N) ~.e 5 FROM WELL LOG AT INSPECTION Static water level ) Well production g.p.m. WATER SAMPLE RESULTS: Coliform 42 Nitrate Date of sample: E' / ,¢- / ~ r~ B. SEPTIC/HOLDING TANK DATA Date installed ~'//~/~"~ _ Tank size ) '~'¢ Foundation cleanout~N) ~/£ 5 Date of Pumping .,~/,4 - ~ .,,,, Pumper Collected by:_ Other bacteria O s & s ENGINEERING Eagle River, Alaska 99577 . Number of Compartments ~L Cleanoutsf~"'~N). Y~ ~' _ Depression (Y~[~ /" g High water alarm (Y/~'~ .,,,, 8 C. ABSORPTION FIELD DATA D;tteinstalled q//,(,/q'~' _Seilrating~:~p~../ft~orft~/bdrm) Length 9 ~, ~-oz,¢ c Width ~, 5'~ Gravel thickness below pipe Effective absorption area' ~ ~ 6 t? ~- Monitoring Tube present ~N) Date of adequacy test ~/4 - ~ r~ ~¢ Results (Pass/Fail) Fluid depth in absorption field before test (in.)~/~mediately after gah water added (in.): Fluid depth /~ine~s later: Absorption rate = .g.p.d. ~e treatment (pa~t 12 months) (Y/N) If yes, give date bedroom,,; 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons _---~'"--- Manhole/Access (Y/N) "Pump on~f" level at*. High water alarm level at_~* ~-~~*Datum Cyc~ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: / / Foundation .S" --h Property line / 0 ~- Absorption field Water main/service line /0 'P Sudace water/drainage Jo 0 ~ Wells on adjacent lets SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Surface water Curtain drain ) O Building foundation. ) 0 '~ Water main/service line / o "~ Driveway, parking/vehicle storage area ? 0 -) / /o0 Wells on adjacent lots ENGINEER'S CERTIFICATION , ce~ify ,hat l have determined thru field inspections and review of Municipal recor~e abo;~ are in conformance with MO& HAA.quideli~s in effect on this date. Signature ~ ~'-'~ En~ineer'sName /(88¢¢~ 6. ~¢~ HAA Fee $ '1~ ,.~ r~ O , Date of Payment ~/ ReeeiptNumber ( Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Parcel I.D. 015-151-12 1. GENERALINPORMATION ' C0mp!ete.legal description Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 625 %" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEAl.TH AUTHORITY AppRovAL FOR A SINGLE FAMIL'~:DWEi_LIN(~ '"' NAA# Expiration Date: Lot 12~ Block I ~ South Lakewood Hills~S/D 'Location (site address ar directions) 6525 Michigan Blvd. Current Property owner(s) L Mailing address ~/o ,4,'z~o Lending agency Day phone Day phone Mailing address Real Day phone '~ -73 - -73~,/ Mailing Address Unless otherwise requested. HAA will be held by DHHS for pickup. HAA picked up by: NUMBER OF BEDROOMS: 5 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 Ftuman Services (DHHS) issues Certificates of Health Authority Approval (I--IAA) 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) en 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. 72-025 (Rev. 01100)* 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 Health Authority Approval Guidelines for the Health Authority Approval application show 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 all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. $ & S ENGINEERING Name of Firm 17034 Eagle River Loop Road No, 204 Eagle River, Alaska 99577 Address Engineer's Printed Name DHHS SIGNATURE Approved for Disapproved. Phone Date ~/;) ,.. ,?.. ~ ~, ~ ROBERT C. COWAN ~ bedrooms. ~ .... , Conditional approval for __ bedrooms, with the following stipulations." Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Expiration Date: Reissue Date: 75-025 (Rev. 01/00)* Municipality of Anchorage J~ fi, IV D Department of Health and Human Services Division of Environmental Services APR 2 5 2000 On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 MUNICIP^LIT¥ OF ANQ-IO~GF www,ci.anchorage.ak.us "mr'HMENTAL SE~VI¢'~, (907) 343-4744 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type Date completed Total depth 'D '~ ~ ft If A, B, or C provide PWSID # Sanitary seal ¥g-¢' Cased to 2. 7~, ft 015~-i,,c'/ -/~, Well Log Y~; J- Wires properly protected _),¢ d' Casing height (above ground) ~¢ -~. FROM WELL LOG Date of test I~ ]~.y'/q ') Static water level ) Well production WATER SAMPLE RESULTS: ft g.p.m AT INSPECTION /-)/~.o /o~ ft g.p.m Coliform o colonies/100 mi Date of sample: O B, SFPTIC/HOLDING TANK DA'rA Tank Type/Material ~- E,~-r , r_ // Date installed o~//6 Cleanouzs _"//¢ Date of pumpinc~ Nitrate O, ~ Collected by: Tank size / $'4) o Foundation cleanout )'~? mg/~ Other bacteria_ o celonies/100 mi S & $ ENGINEERING 17034 Eagle River ILoop Road No. 204 Eagle River, Alaska 99577 gal Number of Compartments 2__ Depression over tank ~ o H gn wmer alarm ____ Pumper ~ ~ ,~-/)- c. _f C. ABSOFiPTION FIELD DATA Date installed cl/'~/q *) Soil rating (g~..d.-~'],~or ft2/bdrm) 0- ~' System tyoe Length ~' ~ ft Width 9, ,~ ft Gravelbelow p~pe ~o ft Total depth I~ ft Effective absorption area~]~1 (~ f¢ Monitoring tube ¥'~-J Depression over field ~'O Date of adequacy test ~//~'-//gO Results~as~Fail) ~'f~' For '-~'-' bedrooms Fluid depth in absorption field before test '7" in Water added ~ ¢''~ gal. New depth ~"~ ' in. Elapsed Time: ~ 0 min Final fluid depth ~' '.3" in Absorption rate >= -~'0--~ g.p.d. · Any rejuvenation treatment (past 12 mo.) (Y/N & type) ~v ~ If yes, give date ~ 72-026 (Rev. 01/00)* D. LIFT STATION Date installed Size in gallon~Access "Pump on" level at in "Pummel at in High water alarm level at __ Datum. .~~go es tested E. SEPARATION DISTANCES in Meets alarm & circuit requirements SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot ] O 0 '¢ On adjacent lots Absorption field on lot I o 0 .-'k On adjacent lots Public sewer main N Sewer/septic service line Public sewer manhole/cleanout Holding tank ~' /~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Building foundation Water main Drainage Property line I '7 /.-~ Water service line Wells on adjacent lots Absorption field Surface water F. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 7'(~4,,,~.'L ~k-'O'U~u~l~i~foundation 17' Water main Water Service line )0 -/-- Surface water ) o D + Curtain drain ~vo,.,~ ¢:,vo~,v Wells on adjacent lots COMMENTS 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 HAA guidelines in effect on this date. Engineer's Printed Name ~O/~¢-,'b~-- ~ Date ~/ ~'~//o o Driveway, parking/vehicle storage HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 01/00)* Waiver Fee $ Date of Payment Receipt Number MAY-Ii-1998 20:45 CT&E ESI ANCHORAGE ,4~i~,~, CT&E Environmental Services 90?$615301 P.02703 CT&E Ref,# Client Name Project Name/# Client Sample ID Ordered By PWSID 982081001 S & S Euginccriag Lo~ 12 Bk 1 S Lake'wood Hills 1 I2 12 Bk 1 S Lakewood Hills 1 Drinking Water S~npl¢ Remarks: Client PO# l'rinted Date/Time 05/11/98 15:19 ColleetedDate/TIme 05/05/98 15:05 :Received D~te/Time 05/05/98 16:00 Technical Director: Stephen C. Erie Resq~t~ Prep 0 co[/lOOmL $g10 9~E28 05/05/9§ TH~ 0,214 0.100 aO/L EPA 300,0 10 max 05/07/98 RMV MAY-ii-1998 20:45 CTgE ESI ANCHORAGE 9095615301 P.03/03 ZtK C T&E Eh v ir Ohm eh ti I Se tv ices in c, Drinking Water Analysis Repoc~ for Total Coliform Bacteria ~® ~ncho~O, A~ 99518-1605 ~ h~R~T[O,~ ON ~E~ ~/D~ ~FO~' CO~:Y~ ~MP~ Tel: ~90?) ~62.~343 DATE: SAMPLE TYPE: f Routine Repe=t $Omple (for rouUne ~arnple with I~b mR no. ~- -~) SA;,IPL,£ LOCATION Collected By Fax: 1907) $81-$30T Analysis sho~ ~hie Water SAMPL~ r3 ~ple over ]0 hOu~ ~Jd. ~ul~ m~v be unreliable ' S~pl= too Ion~ in :~nsh; sample should nor be OVer a8 hours old a~ ~ MM~MIJO IOOmL Slake whb BACTERIOLOGICAL WATER ' - A~NALYSIS RECORD MMO-.ML'(~ Result: To~t Colifot'm g- C',~4'i Membr'~ne Filler; Direr COunt ~. .... :~--~-"' ~. Coh)niesl]O0 mi VeHfi~;jon: LTB ~~ ~GB .... ~ , COLJFIR~I El TOTAL P. 03 g4-Z5-'O0 13:1~ FROM-CIE ENVIRONt~ENIAL ~81§3gl T-~O~ P 0~/02 F~181 CT&E Environmental Seruices Inc, I_abe~atorV Diviaion r, ea~l~,m~'~~ 200 w. Pot~or Drive )rinking Water Analysis Report fo~ Total Coliform Bacteria A.c.o,..,, AK Tek {907} 562-2343 READ iNSTRUCTIONS ON REVEP~.E SIDE BEFORE C, OLLECTING SdMPLE Fax' ~907} 561 MUST BE ~oMPL~TED BY W:~T~R. SUPPLI£g TO B/ECOMPLET£D BY LABORATORY .A~,~'SlS sho'~s this Waler SAMPLE to be: ?UBLIC WATER SYSTEM I.D. ~ pRIVATE WATER SYSTEM - ~ ~ ~le R~vor, Alaska 99571~ Day SAMPLE T~PE: ~ Roudue Repeax Snmpl~ (for rouUne ~mpte with lab ref. no+ .~ -) S~PLE L~A~ON Coll~ Untrta~l Collected B~ C~ {:1 Sampl~ over 30 hourS old, ms~lm may be umeliablc San~_ le um long in tranS, i~; sample should ~Tot 1~e ov~ 48 ~u~ ol~ at eX~l~aBo~ Analyst 100170E F'hka Jue [] Fax~ BACTERIOLO~31CAL WATER ANALYSIS RECORD MMO. MI/01~I~ T~i Co~o~'m ~_ ~ Colani~S/IO~ mi Membrunm ~'ll~ ~ C~I. F~tt Collfo~ Contigen .... ................... e~,n~,,~, r-, nnlnA ILLllqOI~. MARYLAND. MICHIGAN, MIS~OLIRI, NEW JERSEY, OHIO, wEST VIRGINIA CT&E ReLn Client Name Proicet Name~ Client Sample ID Matrix Ordered By PWSID Szmple Remarks' 1001706001 S & £ Engineering Lot 12 BIk 1 SD Lakewood Hills Lot 12 Bile 1 SD Lakewood Hil}s Drmking Watcr Client POJI Printed DatedTime 04/25/51000 13.07 Collected Date/Time 04/20/2000 20:00 Received Date/Time 04/21/2000 11:00 Technical Director Stephen C. Ede POL Prep Analys~s ~ATER$ D~PT O.$oo u 0.500 mg/L EPA ~00.0 (<10) 04/21/00 SCL cot/lOOmb SM18 9222G 0~/21/00 Rick Mystrom. Mayor Municipalitty of Anchorage Department of Health and Human Services 825 %" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 http://www.(;i anchorage ak us May 1, 2000 Robert Cowan S & S Engineering 17034 Eagle River Loop Road, #204 Eagle River, AK 99577 Subject: Waiver Request for South Lakewood Hills #1, Lot 12, Block 1 Waiver Request #WR000019 Parcel ID #015-151-12 HA000162 Dear Mr. Cowan: Your request for a waiver of the required 10 feet horizontal separation from the on-site wastewater disposal system to property line has been approved. Tire approved separation distance is 6.0 feet. This waiver approval applies to the existing on-sitewastewater disposal system 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 343-4744. Sincerely, Daniel J. Roth Civil Engineer On-Site Water Quality Program MUNiCIPALiTY OF ANCHORAGE Department ef Health & Huraan Services On-Site Services Walw~r Review Workaheet WR# 000019 PI[:)#: 015-151-12 HA#: HA000162 Permit# Date Received: April 25 2000 Legal Descriatien: South Lakewood Hills #1 ~./~'7- /. Engineer: S & S Engineerm=.g. 17034 Eagle River Loop Read, #204. Eagle River, AK 99577 Applicant: Steven Dunn & Laura McArdle Waiver Requested: Lot line waiver of 6 feet, Criteria: 1. Geology Points: A. Water Table B. Soi Sorption C. Permeability [3. Water Table Gradient E. Horizontal Separation 2. Special Conditions: 3. Other: Total: Waiver is Granted: /~ Waiver is not Granted: List Conditions or Reasons for above: Date: Name of Reviewer Rec#: 05838 Amount: $115.00 Date Paid: A_Eri125, 2000 WELLINSPEGTION &FLOWYES~ SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ROBERT C. COWAN, P.E. CIVIL ENGINE[ERS (907) 694-2979 FAX (907) 694-1211 April 25, 2000 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 12, Block 1, South Lakewood Hills #1 Subdivision Request you grant a waiver on the referenced property for the horizontal separation distance between the leachfield and the south property line at 7 feet. Adjacent property is a right of way. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/gk 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577