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Home My WebLink AboutSOUTH LAKEWOOD HILLS #1 BLK 3 LT 1South Lakewood Hills Block 3 Lot 1 x#015-151-14 Municipality of Anchorage Development Services Department Building Safety Division - On-Site Water and Wastewater Program, 4700 S. Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. S tYiO l 03a 3 PID Number. 016 — 1-:57 — Hanoe e tf Wastewater System: []New Upgrade tr1 -o Address D I DdGI rill r Dr ABSORPTION FIELD PThorha: NuniMr of B F Trani, O shone, Trend, O Bad 0 Mand O Ober LEGAL DESCRIPTION Soil Raentr Olt, reef Depot, "m arVad grads. t 1 p ,� BIO& La: / stEdiHaion / '3 I SO✓ 5 Devah N ppe bottom m boangnel grade: Grave dept, asnaan ptW: /.!(IfILIJ v!•N rl FL Ft Township: Range: srdlurt Fd added above ripina pse: Grant Lrpm: Ft. S Ft. Well' ❑ New ❑ Upgrade Grew eed" Number of tires' Dntenu bws em mea Ft. Ft. Claeanrauan (PMate. A B. C� Taal Caen m I Taal aheorprn rear Pope Monona. Ft. FI logo Fe /1j 303L/ Dnler, 1 e Dn : data war Lew: lowaller �eAH Dona "mow. BiZ% �� Ft 9"- D vara: V— Pump set K Caang MVM Above Grauha TANK GPM FL FL SEPARATION DISTANCES septic []Holding ❑ s.T.E.P. ❑ Other. To Septic Absorption Lift Holding Pub4UPffvat // caparnY From Tank Field Station Tank Sewer Line Gs-t / 6tH � 1;150D.1. VMt o -7�.o -- o �' Monona: �'� ./ ,e Pit Nwnbxp Companmams: 2 surfeea water q10 N/ p LIFT STATION tie Mrv4surer Ld Lina 55 (3 Ga. 'Prmp on' Nva ac 'P.M are' Nw al: Hpn welt a. ac Farvdagn 4 b -30 N. M In, CuNin Oren H'v N Pump Make a Mods ENrJrca UaM performs by n Reonams. BENCH MARK L=bm and Deempbon /7 /uw nee ENvewrt rs-I Lev o-✓1 9r � IM[t ��FL `r EnglnerafS Startgd 'Rv r� y,�•,' C'r ( • Y' Inspections performed by: Dates: 1a ' 8zG ep 2n0 S 97 d ... Development Services Department Approval ,: ✓cam=�=s ". ;;^.,^ (r';: w Reviewed and approved by: Date: $-30' n / .......... `.N (Rev. I.aa) 1V I I I I I I I I I I WellI I-- — -- — I I 25 0 25 50 n 100 125 150 IAa u1 a J 1 ACsi 1 I 1 AO � ¢ IIe11 1 RD 56 54 R2 0.00 67.5- 1 iN STANDARD 4-BEDR STEM I I P 2 } 1250 GAL S£ IQ ANK 1 _'• 85 FEET L G ENCH p 11 FEET D EP I 6 FEE OC 1 c 5 FEE F CO R AB D EXISTIMG SYSTEM 1 CRUSHED AND BURI D TANK) ON SITE I I dr jw I 49th I I ......��Gli •N PURKLAND •p I I I No. E-zzzs I I I �0 SSIi� I I I I Well MW I ussc�an u[v. laaao TOBBEM SPURKLAND P.E. LOT 1 BLOCK 3 SOUTH LAKEIIDOD lilll. I SEPTIC SYSTEW AS BUILT 103 W 15TH. AVENUEDAT£: AUG 28, 1001 ANCH. AK. 99501 10901 RLA TIBGf DRIVE 907 179-3916 CARlBBETTS SHEET. 213 GRID: 2638 PERMIT k SV010323 PID ! 015-151-14 SLVH3012.DVG Standard Trench, 2' Wide 85' Long 11' Deep 6.0' Sewer rock 5' Cover NZI SCALE Sl1 t 910 ' 6.0 ft of Septic Rock Effective O O O 42 o 1250 gal Septic tank c w v m 3 C Monitor Cleanouts - 5' Cover NO SCALE 946 65.0 .' 49th )RE' SPURKLAND No. CE -2225 , 96! SIX 1250 got sept/c tank 3 L2 TOBBEN SPURKLAND P.E. fl LOT I BX al SOUTH LA)ffWOOD HILLS SEPTIC SYSTEM SCHEMATIC 203 W15th AveDATE- AUG. 28, 2001 Anchorage Ak 99501 10901 ROCKRIDGf OR/Vf 9 CARD i61fe11S SHEETS 3/3 GRIDS 2638 PERMIT SWO10323 PARCEL ID / 015-151-14 SLWH3013.DWG MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade "�97 �P q 8 Date Issued: Aug 16, 2001 Expiration Date: Aug 16, 2002 Permit Number: SWO10323 Parcel ID: 015-151-14 Legal Description: SOUTH LAKEWOOD HILLS #1 BLK 3 LT 1 Design Engineer. 0007 Tobben Spurkland, PE Site Address: 010901 ROCK RIDGE DR Owner Name: Carla Tibbetts Lot Size: 35200 SO. FT. Owner Address: 10901 ROCKRIDGE DRIVE Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE. AK 99516-1841 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (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. 'b � 2%'v/ GyC/Chpt� /p -c ,e C -/o gs %r I'"Grl , /I'o.'/c f.. Qi-. Xe Received By: Issued By: Date: 9--/7-0( Date: 9— //7 ^ 1/1 Municipality of Anchorage • -. Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 015- 151- Ll Permit Number SWO/O 23 Property owners) CA(L L A i 1 R i3 T� S Day phone Mailing address (1) 10g n t �oLILlZ1l�Fa D (L - Mailing Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) 1-071. R K S o VTH LAY-F-VIOuD RILL E Legal description (Section, Township & Range) Lot Size -3 52_�O Q Acres/Sq.Ft. Number of Bedrooms Y THIS APPLICATION IS FOR: Sewer Only ❑ Well Only 13 Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 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 authorizid agent) Permit Fees: as/U Date of Payment: �` 7 w Waiver Fees: Date of Payment: Receipt Number: :9 36 -7 Receipt Number: (Rev. 12100) T.SI URZ,LA1JD P.E. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 1 BLOCK 3 SOUTH LAKEWOOD HILLS CARLA TIBBETTS Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bmgaw Street Anchorage, Alaska 99519-6650 Aug. 7, 2001 We are submitting an application for the upgrade of the septic system for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic system design is based on the following : No Ground Water or Impervious Layer to 17 ft. Use Standard Trench Soil Rating. From Testhole 07/26/01 40 min/in =.6 gal per sq.ft/day No. of Bedrooms 4 Required Area per Bedroom: 150/.6 = 250 sq.ft. Total area required: 250 x 4 = 1000 sqft Testhole depth 17 feet Bottom Rock At 11 feet Top Rock At 4 feet Rock Depth 7 feet Minimum Trench Length 1000 / 14 = 72 ft. SYSTEM CONFIGURATION STANDARD TRENCH TOTAL LENGTH 75 FT TOTAL WIDTII 2 FT TOTAL DEPTI I 11 FT ROCK DEPTH 7 FT COVER 4 FT SEPTIC ANK 1250 GAL The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. O'HALLEY I We I 1 I I TRACT ID 1 I I I el! I I I � VOOD /C7 I my R2�0.00I 1 L? Ce -zeds _ lY 3 I I BIL OCK 11 50 0 100 150 av 250 300 SSALE !' -100 FT, DRIVE 0111 I , IIII jWell HICHIGAN BL VD JVvnnL lvv r.c. LOT 1 BLOCK 3 SOUTH LAKEWOOD HIL fS SEP T/C SYSTEA/ DESIGN 203 W 15TH. AVENUE 10901 ROCKR/DGE OR/VE DATE.• AUG. 3, 2001 (NCH. AK. 99501 CARLA T/BB£TTS SHUT.• 1 3 GRID: 2638 (907) 279-3916 / PERMIT # SVoloXXX PID ! 015-151-14 SLVH3O11.DVG 1 STANDARD 4-B :. 1 to @VI :'< .�;.,c 1250 GAL SE 1� ANK ~ _ 75 FEET L G ENC D' 11 FEET t D EP 7 FEET OC 4 FEE F 01 R EXISTING SYSTE 1 µ CRUSH AND BUR TANKS) ON SITE :_ _ _ _ _ _ --——————————— — ---Ft ----- (E,�..... I I ��,`p,•,..... • �;•' I•; �� off; III A r 49th) i......... .................... TOB N PlX2KLAND I I �� r • No. E-2225 .� I I I I well I I I i I i TOBB£N SPURKLAND P.E. LOT 1 BLOCK 3 SOUTH LAKEIPOOD HILLS SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE DATE. AUG 3 o 25 so n lm M5 15O .� SC4LFr.L.r.50 ,ET. � _ Well 1 1 ANCH. AK. 99501 10901 ROCKRIDGE DRIVE , 2001 907 279-3916 CARLA T18BETTS SHEET. 2/3 GRID: 2638 PERMIT # SVOIOXXX PID # 015-151-14 SLVH3012DVG Standard Trench, 2' Vide 75' Long 11' Deep 7.0' Sewer rock 4' Cover �'il_/LI1OUArim Sit t 7.0 ft of Septic Rock Effective -00do 0 _ 0 o " 0 1250 gal Sept/c tank o c a c a V a 3 a O C � 3 Monitor NO SCALE .oj.,.•• L9� 49th '} SPURKLAND CE -2225 . 1250 gat septic tank 9 I ,03 V1 hAveRrvU r.c. I I LOT I BK 3 SOUTH LA1flI00D HILLS I I SEPTIC SYSTEM SCHEMATIC I An orage Ave 10901 ROCKRIDG£ DRIVE AUG. 7, 2001 Anchorage Ak 99501 DATE, CARLA TOAVM SHEET, 3/3 GRID, P63R PERMIT / SW0l00XX PARCEL ID / 015-151-14 SLWH3013.DWG I H a ! Municipality of Anchorage Development Services Department Building Safety Division 0 On -Site Water and Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 vnnv ci anthoraae.ek.us (907) 543-7904 Performed For: Legal Description: Depth 1- 13- 14- 17- 18- 19- 2o -L, COMMENTS 3-14-1719- 19- 2o- COMMENTS Soils Log - Percolation Test _C'et I l k 1 t bb pis 1 eDate 1 1;6K1 S,,u A J, -,Lµ u-rr,(Township, Range, Section: 4:115 S P+ r. � Sortt�CP MLI - M !w He wL e> -V Nele- WAS GROUND WATER ENCOUNTERED? No a IF YES, AT WHAT DEPTH? L O Depth to Water After p Monitoring? Day E Date: SJ O rian Reading Date Gross Time Net Time Depth to Water Net Drop SO I -'r II lib/O 1 v '/z- lt1r III �};10 o.zr;n 8 a� aq 11 r!b 4-, tj 30 r-113 ( 3 b;lu 3D for163" PERCOLATION RATE a -& (it+/ ) rcm, n�r�c LZ TEST RUN BETWEEN % FT AND 03 FT PERFORMED BY: I . S 1 CERTIFY THAT THIS TESI WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 8 O .-r." 4+ 7 - Municipality Municipality of Anchorage Development Services Department a Building Safety Division r y� On -Site Water and Wastewater Program 4700 South Bragaw SL �+ P.O. Box 196650 Anchorage, AK 99519.6650 www cIanchorage ak us (907) 343-7904 //�� Soils Log - Percolation Test Performed For: eo-4'� h t 'CID! 1Date Perk Legal Description: tv�/13K3 Jor•'�-Iti af-D•1'<w1D��Township, Range, Section: i•I-� II SII I I I Ti— Depth 13- 14- 15- 1 7- 19- 612-6ANIC S' SaMA41 01Z C4 -- µL P', i 1'o H 0 F 14OL< COMMENTS WAS GROUND WATER ENCOUNTERED? _ 0 S IF YES. AT WHAT DEPTH? L O Depth to Water After P Monitoring? E Date: 1 ` '. v- •.(ENGINEER'S EAL)�\ 'h:• •°ems T �n •, C.-2223 •.' V r Teed: -7/Z 6 /V / Site Plan L Reading Date Gross Time Net Time t- I'7 6 S oI1• a � av to / 3 ; 4 �- �"II'Iz JRFic :4 33-b;lZ 3D PERCOLATION RATE 127 1"""^ef""'"r TEST RUN BETWEEN -7FT AND h FT PERFORMED BY: �� I / CERTIFY THAT THIS TEST !A PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: g MUNICIPALITY OF ANCHORAGE DE aTMENT OF HEALTH AND HUMAN SEM..,ES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT DISTANCES TO 70 SEPTIC ABSORPTION — ndarnaa -,.. FROM WELL pave W/,r��r _F��vtcc�f��i.� ) TANK FIELD Phones) Permit No. No. of Be too s J WELL ' U J +{ L7�hra-2a�—— _ LEGAL DESCRIPTION Lot —/ Black Subdfiws,on q ' , Tavmship, Range. Sor,r.h �� . G. % %_% �. %i -.Zs LL's TANKS ❑ SEPTIC ❑ HOLDING ManLit,aCl Llt II capacity in gallons Mmenal —-- No. of Cornpartments rvP>� or SYSTEM -- ❑ TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from Toiol depth Fom original grade or,oal grace Fill added above ongrnzl grade Gravel depth beneath pipe FT Gravel length Gravel width __ _ FT_ Total absorption area D,Manco botwecn lines SQ FT Number oI lines Son efmg Pipe malenal ___ ___ SQ FT Installer Date Installed WELLS PRIVATE ❑ OTHER (Identity) Classdicaulonn (ASTC) Total Depth W=ed to FT Installer Date Inslallutl. AIT>ikI f;, i in i t tri t_ !2 AY -1 REMARKS: LOT LINEJ- FOUNDATION n AS -BUILT DIAGRAM (Show location of well. septic system. property Imes, fom:dal dnveway. water borLes. ole I beans /I/� f/ U Inspections Performed by. Date.r�� n __ celiily Thal this inspection was perlormed according to all Municipal and 9 ale guidelines in ellect on this date: —/�—� �Z---_ Health Doparhitont Approval: """"`' - _ _ Date: -2 � -9 D 7 u ENGINEER'S SEAL a° A\ �• •deo/,o>/oa e4 c i fr4�rYY s oL�'i No, 2225-q °Roe. u u WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological & Geophysical Surveys Drilling Permit No. LOCATION OF WELL (Pica.. complete either to, to or le.) A.D.L. No. la. Borough SubB8C ivvisiop "., Fot Block Ib. /4glrs. Section No. Township IN E) Range E❑ Meridian '.� F`u'ry/l"y�flr '.- Icof . DISTANCE AND DIRECITION DISTANCE, FjtOM ROOD INTERSEFTIONS ) 3. OWNER OF WELL �J ./,/ �) l Address: Street Address and Area of Well Location 2. WELL LOG Feet Below 4. WELL DEPTH: (llnall 5. DATE OF COMPLETION Surface.,'- ), v`i=. — Y:L 4 Material Type Top Bottom -/ t 6. ❑ Cable fool y�' Rotary ❑ Driven ❑ Dug i..J ❑Auger ❑Jetted C) Gored ❑Other: f 4 7. USE: Domestic ❑ Public Supply ❑ Industry 1 ' ) J..r. ry ❑ Irrigation ❑ Recharge ❑ commerical - - , {V�, 1'6" j, 1. ❑ Test Well ❑ Other: n — 8. CASING: ❑'rhroado(d is Welded /u ` f! 7f I. Depth Weight tbs./ ft. diam. F In. to `(/-N(.'//41 ... •.' ')/)•,i �L. �. I J._d f" diam. in. toft. Depth Stickup ft. 9. FINISH OF WELL: f' Type:I-=1 ,rifll. Diameter: -- Slot Mu'eh Size: Length:__ "411 -MORAL Set between fland ft. — PRO Q Backfilling _—— Gravel pack F98 10. STATIC WATER LEVEL: ;'Y fl. E]Above or W Below land surface Date Equipment used:=:,. _.•=.t'�yj�_ II . PUMPING LEVEL below land surface and YIELD /7—t-1. after hn. Pumping ,i g. P. m. % ft. after hire. pumping g.p.m. ,i/ � 12.GROUTIN'G" VYell Grouled: l=� Voa ❑ No f/ I J 4 4. it Metairie l:❑ Neat Cement ❑ Other: �I1� /�1, 13. PUMP: (if available) HP n`!^' "' - Length of Drop Pipe it, capacity _g. P.m" ❑ Sulam. ❑ Jet ❑ Cenlrificol ❑ Other 14. REMARKS: 16. WATER WELL CONTRACTORS CERTIFICATION: 15. Water Temperature ❑ F ❑ C This wall was :1611 under py jurisdiclion apt this report is true to the best of my knowledge and belief; 1, lis. _ ✓/--=1--Cc t rlRegistered Business rf ome Cc Number �lt Address:— Signed: 1 ,� � 1.. Dale Authorized Repres%r(taliva Form 02-WWR (11/81) Copy Distribution: WHITE-Sfote OGGS, I'INK-Driller, CANARY -Customer 1-11 1 All A I � 1: �1 J ; "0" �� AM C � I I " I FT IN W E�.. DEPAhoTMB1T OF HK AL I)ND ENVIRONMENTAL F1 �OTECTION 825 L S|REEl' ANCHO�AGE 'AK 950� 264-1720 PERMll NO: G7O022 00l�: 1,3SI-IEUs 02/1 D7 APPLICANTI� AND FN[ER1TSK3 ALPIHF: DRlLLING HPDRESS� P"o, �OX 11�49� �NCHORA[�E, AK 9�5l1 CON[4�T PUUNE: 3�5-0��2 L[GAL DESCpIP: SUBDIVISION: S. LAKEWOOD MILLS LOT: 1 BLOCK: 3 SEISTIDN: 25 TOWNSHIP: T12N RANnE:: R:�!;lq LOT ClZE: 1.�5A {SQ.F[. OR ACR�S) I certify that: 1. l am familiar with thp requirements for on-site sewers and wells as set [orth by the Municipality of Anchorage (MOM and the State of Waska" W. 1 will instali Lhe system in acco,dance with all MOA codes and regulations,, and in compliance with the design criteria of this permit., S. I will adhere Lo all UOA and State of Alaska requirements for the met back distances Irnm any ex1sting well, wastewater disposal system or public spweraqe system on this or lany oidjacunt or nearby lot. �IGM5D DATE: __... APPLICAMT: AND T!::RP�l��q ALPT�E gRILLING ISSUED 8Y DATE: ML ANCHORAGE E ENVIRONMEN SERVICES DIVSON FEB 9199% RECEIVE' - 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 PHONE (� ❑ NSE' W L}!-/_S FJm�IIB'CIPCRADE MAILING ADDRESSiVh`� LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS 11 Wel Absorption area Dwelling PERMIT NO. 3 �i Y DISTANCE TO: O L -- H Z Manufacturer G //�� Material No. of compartments w El 0 B O l.l.&G Jib O Fa. _ cj�— _ to Liq. rapacity in gallo s Inside length Width Liquid depth IF OMEMADE--—� DISTANCE TO: Well Dwelling PERMIT NO. a 2'1 Manufacturer Mate ia) Lquid capacity —ingaii—ons— O wy Well DISTANCE TO: Foundation Nearest lot line PERMIT NO. J lL Z No, of lines Length of each line Tola length of lines Trench width Distance between lines _:7 inches aFes- Top of tile to finish grade �j—� Material beneath We Total effective absorption area inches I- ) J-J .Z Length Width Depth PERMIT NO. to 7— Q H Type of crib Crib diameter Crib depth Total effective absorption area to Lu DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. J DISTANCE "f0: Building foundation _— Sewer line Septic nk ta Absorption area(s) OTHER ��-- PIPE MATERIALS 1303 �S _ SOIL TEST RATING a1 E) Z INSTALLER REMARKS 5-06 ed. TLVA LEGAL --- — ej APPROVED DATE � I 72-013 (Rev. 3/78) 'NICIPALITY OF ANCHORAGE Department o.. Health and Environmental :otection CVS 825 L Street, Anchorage, AK. 99501 264-4720 U3t-{0 # HANDWRITTEN PERMIT # # # �`)fJ L`��. WELL AND/OR ON-SITE SEWER PERMIT r-nt4J. �i9Sd7 Applicant: �_�' Mailing Address: � )5 ,e i% f-35 Location: 6, Phone Number: --��Legal Description: Type of Soil Absorption System Is: Trench: //' Drainfield: _ - Seepage Bed: Holding Tank: Maximum Number of Bedrooms: _Z/_ Soil Rating(sq.ft/br) '-J /0 The Required Size of the Soil Absorption System Is: >f DEPTH �_ LENGTH r /0 GRAVEL DEPTH _ WIDTH — The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ X50 0 _ GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. # TWO(2) INSPECTIONS ARE REQUIRED ' Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 1 I certify that: (1) 1 am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 1 bedrooms. Signed: Issued by: IdllLd�_ Applicant e Date: — SWP/024 (1/81) ,1 a cCe - 61. SOILS LOG MUNICIPALITY OF ANCHORAGE +. l DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION / 1 PERCOLATION TEST \� �I 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TESL PERFORMED FOR: GlD""e_5 b-4jt- /C-G / / ) DATE � PERFORMED: •1i /,3 •-jam_ LEGAL DESCRIPTION: .0 % i) P� r�6U 6�2[C:cl. J_0 3� 'lywlS' '6_4 al . DEPTH / SLOPE SITE PLAN (FEET) :JlM CN2✓P..I s//•J I�'i 2 3 4 5 6 7 8 9 10 12 13 14 15 16 17 18 19 20 1/ H IN 0 WAS GROUND WATER •�'S S ENCOUNTERED? I- 0 P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop 44 /Z.� 1 /� 3,-, 2- �Ny 51 /ail /o 0,03 45 PERCOLATION RATE _r1Z__(minutes/inch) TEST RUN BETWEEN _Je4�_ FT AND FT .n -L_ /.. . / �L PERFORMED BY: _CERTIFIED BY: 72.008 (6/79) -DATE: S � /Y' __ / ALASKA RUIRM611TAL COnTROL SCRUIUS) Inc. Cngineerinq & Enuironmental Studies MUNICIPALITY OF ANCHORAGE __- DEPT. Of- HEALTH & ENVIRONMENTAL P::OTECTION MAY 8 1981 JAMES KENDRICK SRA BOX 26 L ANCHORAGE AK 99507 MAY 'i 1. 1981 RECEIVED SELLER — JAMES KENDRICK SUBDIVISION—SOUTH LAKEWOOD HILL $1 BIOCK-3 LOT -1 THE TYPE OF ABSORPTION SYSTEM IS A PIT WITH AN AREA OF 600 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 10 GALLONS OF WATER PER DAY, THE SOILS RATING OF THE SYSTEM AT ODNSTRUCTION WAS 208 AND NOW IS >300 SQFT PER BEDROOM. BASED UPON THE `.GEST DATA THE SYSTEM IS NOT ACCEPTABLE FOR A H014E OF 4 BEDROOMS. THE SEPTIC TANK WAS PUMPED ON 4-2.3-81 . 4r "Irzw) Y499ro1�K w� C. U04 1. 9201-0 1220 West 25th Auenue • Anchorage, Alaska 99503 • 907) 276-1361 154,)# ("Co a V.cro JD 19 G!`=ATER ANCHORAGE AREA BORON ,H HEALTH DEPARTMENT NO 799 327 EAGLE ST. ANCHORAGE, ALASKA 99501 2/9.2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING„/AL'l '7 J�� O NAME �«��"'��`y/�«�� `- —ADDRESS % I) HONE � / v l LOCATION �)�lflfJ`lE�✓ iE-G7 LEGAL DESCRIPTION �l-�y.Lj� ��10jr,'1') SEPTIC TANK: NUMBER F DISTANCE FROM WELL _�C`I MATERIAL=/-``"� ""�� COMPARTMENTS��- P ' ��/7C'--5/l-1-/�- W, ////ov[5)hh� LIQUID LIQUID CAPACITY-///'/)() GALLONS. INSIDE LENGTH —INSIDE WIDTH— _DEPTH - SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS --/OUTSIDE DIAMETER— OR WIDTH_z , LENGTH DEPTH LINING MATERIALL?L �1�� .DISTANCE FROM WELL , BUILDING FOUNDATION i NEAREST LOT LINE w Ci �� / TOTAL EFFECTIVE ABSORPTION AREA (WALT. AREA)_ /e�O SQ. FT. TILE DRAIN FIELD: _ TOTAL LENGTH DISTANCE FROM WELL - - _, FOUNDATIOI4 , NEAREST LOT LINE OF LINES. NUMBER OF LINES DISTANCE BETWEEN LINES—TRENCH WIDTH N. TOTAL EFFECTIVE ABSORPTIOIy4 REA SQ. FT. LENGTH OF EACH LIN\' - -�G — DEPTH: TOP OF TILE TO FINISH GRADE —DEPTH OF FILTER MATERIAL BENEATH TILE _IN. ABOVE TILE—. WELL: DISTANCE FROM __ WATER TYPFi'!%(jl //4" , DEPTH ,BUILDING FOUNDATION.— SAMPLE - NEAREST NEAREST SEPTIC;- /, SEEPAGE / OTHER LOT LINE SEWER LINE—, TANK 1j'122 SYSTEMIY CESSPOOL _, SOURCES_. DIAGRAM OF SYSTEM DISTANCES: /iii? t/Fw I��//11/LIC`/c' S>fliC=S DATE / ( -/ / GREAt I ER ANCHORAGE AREA BCI -.-.)UGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. I_LJ� 3500 TUDOR ROAD POUCH 6.650 ANCHORAGE, ALASKA 99502 j 1 �I II TELEPHONE 279-8686 X11 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT NAME OF APPLICANT 'J % MAILING ADDRESSG z'//y�— PHONE INSTALLATION LOCATION LEGAL DESCRIPTION �/2Z r' "z�L INSTALLATION OF: SEPTIC TANK _SEEPAGE PI'T °-', [DRAIN FIELD � OTHER _L , TYPE AND SIZE OF FACILITY TO BE SERVED r FINANCED THROUGH — TO BE INSTALLED BY— _ ` t SOIL TEST RESULTS _JL}/l j1 /%�NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE L ` TYPE . MINIMUM DISTANCES, REQUIREMENTS _ r FOUNDATION TO SEPTIC TANK _ FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK '�5' , SEEPAGE PIT c'z-��—. DRAIN FIELD TO NEAREST LOT LINE. DRAIN FIELD SEEPAGE AREA SIZE. 5 n "Z-� - TYPE Gid'- C''/lL'i iii' <✓.✓l WELL TO SEPTIC TANK �5 SEEPAGE PIT -f DRAIN FIELD -! ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT G DRAIN FIELD SEPTIC TANK, .��`.o SEEPAGE PITL, DRAIN FIELD TO RIVER, LAKE. STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION, HEALTH AUTHORITY OR LICENSED DESIGNER DIAGRAM OF SYSTEM z%e' -s- I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE :7//11% I -Z APPLICANT'S SIGNATURE C REATER ANCHORAGE AREA I )UMI HEALTH DEPARTMENT 327 EAGLE, STREET ANCHORAGE, ALASKA 99501 Performed For Zl -UL _ALL s Date PerformedGF.ga]. Description t hot lock This F'crm Reports at Sat' hr. a, lon`�.Lb.�./.2.... li.fld ! ry i ercolat .on CASA: Depth Feet Soil Char.;:::aeri.stics Location Skater ---:j v�/ o/ie p�erOn/s ..�� cn c //ie �r]'a//2 i)t]/urr o' / LVY Ae /5, 7,11C" Un] 'ox /rri]l/y We// 6M 0/ the o/hep U Il S"'ChrY]tvl/' Lvq/ iYjOdePG/e, Was Ground 'Water Encountered? proposed Dept; Of Tnsta.tl<3t: oni..,,,p,ge tt i Drain Field 01.eYw "] Depth To Bottom 0 =Pit :;r TrenCh�� xz_._._ci/ .1 a s=%%i,./;,. %lea•.: Y.e. Tess performed By'n..._..,....,„,v„,�,.,.._..�._,>..,..�.�,....e,..�d.,,,.w�,,.,..M..>.n,..�.......................... Dat:<t Certified ByI��/ ;� Date f' s_ f^.�.•._ 1��I�UMUP UTY OF A HCH ORA GIE Development Services Department a =-% Phone- 907-343-7904 On -Site Water & Wastewater Section '-- Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-151-14 1. GENERAL INFORMATION Expiration Date: _M aAJ'-\ i I v o Complete legal description South Lakewood Hills #1 B3 L1 Location (site address) 10901 Rockridge Dr, Anchorage, AK 99516 Current property owner(s) Kimberly Hoeppner Day phone Mailing address 10901 Rockridge Dr, Anchorage, AK 99516 Real estate agent Nell Godfrey Wall 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone (907)727-6355 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Q Private Septic Fmil Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5 Date of Payment 11 a 0 2 Receipt Number 0 b 33 o.D COSA#_05GZN 167 Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge.that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. (M.J.) 6. DSD SIGNATURE System #1 Approved for 4 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for CAimo I "cr - y� L+ iw vy1 10r-1 V aJ2 C -0m Y w71V vt we 1l c Date 11/11/21 rte OF 4,( d � �0 . ... �� •.• Benjar'nt'nSchiller .•:4 V(KTF1292 9�D 11/11%21 �� pROFESSIO�P .�. bedrooms, with the following stipulations: SISd 6- I oc.14-ci �- (ea &A o f JeQ SL20-11 a oo J lM a. OF r(61riri %Af ATER AND m' o WAST`=v'AT w-' J O.^ J / _fJeJ FST SERN�G,,� Original Certificate Date:_1 Z 202 i The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory Other i ave Q:!VJ o r� X By: OF r(61riri %Af ATER AND m' o WAST`=v'AT w-' J O.^ J / _fJeJ FST SERN�G,,� Original Certificate Date:_1 Z 202 i The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory Other i ave Q:!VJ o r� X COSA Checklist yellow sheet COSA Checklist Legal Description: Parcel ID: If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test?Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA ______________________ Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: South Lakewood Hills #1 Block 3 Lot 1 015-151-14 ■6.6+ 2/15/1987 124 ■ 124 0.698■ ■ 31 Forge Engineering 11/8/21 93 11/2/21 20 Septic/Steel 49 ■ 8/31/21 Around The Clock Pumping LLC Deep Trench 8/26/01 11/8/21 ■4 13.2 37 8.2 784 57 ■ 1440 5 38 >600 ✔ COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to:(Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’Yes if No ft Absorption Field on Lot > 100’Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’Yes if No ft Holding Tank > 100’Yes if No ft Animal Containment > 50’Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft From Septic/Holding Tank on Lot to:(Please enter distances if less than required) Building Foundations > 10’Yes if No ft Property Line > 5’Yes if No ft Absorption Field > 5’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to:(Please enter distances if less than required) Building Foundation > 10’Yes if No ft Property Line > 10’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft F. ENGINEER’S 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 COSA guidelines in effect on this date. 11/29/21 ✔✔ ✔ ✔ ✔ ✔ ✔ 30** ✔✔** ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ **Waiver# OSV151004. Horse barn located on property, any animal waste is to be removed on a daily basis. ✔ MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904 On‐Site Water and Wastewater Section Fax: 343‐7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Septic Tank Advisory Certificate of On‐Site Systems Approval # OSC211675 Subdivision: South Lakewood Hills #1 Block:3, Lot: 1 The septic tank for this property is 20 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $7,000 to $11,000. This advisory must be attached to all copies of the subject Certificate of On‐Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. r ---------- ------WOODMONT -DRIVE --- Q r'h'AIiEI ", pRiVFy l(� I • ` '- CNC O i p��FTF Q �yAY Z I • 108.1 • • SHED 10' UTILITY EASEMENT N 89 59' W 220.00 49 TH `9 OBD THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY ' O CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND I5 9 f SHANE A. HOLT OO NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. LS -6914 yj�O EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN OQ4a d o HEREON ( UNLESS INDICATED) �prO fes siona� �Qo NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE �O�000p�� PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. AS -BUILT SURVEY 1" =30' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 1, BLOCK 3, SOUTH LAKEWOOD HILLS SUB. IST ADD -N. 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 _16 TH DAY OF NOVEMBER , 2021. HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99515 5708, FB 56-54, 168-54,219-31 345-5513 • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 015-151-14 Expiration Date: 6 d 1. GENERAL INFORMATION Block 3, Lot 1 Complete legal description South Lakewood Hills #1, Location (site address) 10901 Rockridge Drive Anchorage, AK 99516 Current Property owners) Richard & Stacey Minkler Day phone 947-0142 Mailing address 10901 Rockridge Drive Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: Q Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Four 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5 Z 6 64 Waiver Fee $ Date of Payment z �Z 6�� j Date of Payment Receipt Number is�� 6? Receipt Number COSA # CSG 15166 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Phone Date 522-7773 •A4'H#t .fir �:;�`°•'rE 6. DSD SIGNATURE 1V •.. r, 3`....`............. System #1 Approved for bedroomst�� f o 438 ERSON -' System #2 Approved for _ bedrooms `g Fj°. _-2•t 4 (rf/• ••eae N° �. Disapproved ,!�®w�QoS ®g�Q•® Conditional approval for bedrooms, with the following stipulations: By: (/r7 . ' Original Certificate Date:_�}%1 The ici/0/neo Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet � c If more than 1 -septic system is on the lot: COSA Checklist # of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: South Lakewood Hills #1, Block 3, Lot 1 A. WELL DATA Parcel ID: 015-151-14 Well type Private If A, B, or C provide PWSID # Well Log (YIN) Y Date completed 2/15/87 Sanitary seal (YIN) Y Wires properly protected (YIN) Y Total depth 124 ft. Cased to 124 ft. Casing height (above ground) >12 in. FROM WELL LOG AT INSPECTION Date of test 2/15/87 2/12/15 Static water level 88 ft. Well production 9 g p m WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 7.51 mg/L Arsenic ND ug/L Date of sample: 2/2/15 B. SEPTIC/HOLDING TANK DATA 87 ft. 6.0 g.p.m. Collected by: Anderson Engrg. Tank Type/Material Septic/Steel Date installed 1971/1981 Tank size ' 0001500 gal. Number of Compartments 1/1 Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN) N Date of pumping 8/1/14 Pumper Around the Clock Pumping C. ABSORPTION FIELD DATA 5/28/81 z 210 SFMDRM Deep Trench Date installed Soil rating (g.p.d./ft or f[�/bdrm) System type Length 77 ft. Width 3 ft. Gravel below pipe 8 ft. Total depth 12 ft. Eff. absorption area 1,232 ft, Monitoring tube Y Depression over field N Date of adequacy test 2/12/15 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 630 gal. New depth 1 in. Elapsed Time: 1,440 min. Final fluid depth 0 in. Absorption rate >= 600 g p d Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum No Add On Manhole - Gravity Flow to Absorption Trench. Size in gallons in. "Pump off' level at Cycles tested Manhole/Access (Y/N) _ in. High water alarm level at Meets alarm & circuit requirements? E. SEPARATION DISTANCES OF WELL ON LOT TO: �� .S� Septic tank/lift station on lot >1 00' On adjacent lots >1 00' Absorption field on lot >1 00' On adjacent lots >1 00' Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line >25' Holding tank N/A Animal containment areas 30,** Manure/animal excrete storage areas >1 001** SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5r Property line >5' Water main >1 0Water service line >10' Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >10, Building foundation >10' Water Service line >10' Surface water >100' Curtain drain None Noted Wells on adjacent lots >100' Absorption field >5' Surface water >100' Water main N/A Driveway, parking/vehicle storage >10, in. F. COMMENTS "Horse Barn located on property. Animal waste mucst be removed from the property on a daily basis. G. ENGINEER'S CERTIFICATION OF �� .S� I certify that I have determined through field inspections and '••'• �n p review of Municipal records that the above systems are in 4g TH; ,\ conformance with MOA COSA guidelines in effect on this date. 00.1.... Engineer's Printed Name Michael E. Anderson, P.E. %••••.. ..... 4 m : MICHAEL E. ANDERSON = s 2/26/2015 Date �� ice'. CE -4381 � '1�' ••.Z -Ll - !�.•��® COSA brown sheet 10-10-12.doc Municipality of Anchorage Community Development Department Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 151068 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 3, Lot 1 of South Lakewood Hills 91 subdivision. This inspection revealed a nitrate concentration of 7.51 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Pact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. ➢pZxmZ�y <�mmm�zm af..Zn�HT z ZC mNA 4l H (IZN�w3 NZ�rOUm➢ OQmNN,mO ZAU pTZ ypp Z O Or7 ~n�ONO ZO>�mr��H yO ➢ y v~n Zon A �ZZ �c NrM mOv� ;�N 9Zn0 vm� Ayo �mn zc�z Nm A N o muo� y m3..Cy y AMNo N m O m O N z C T N E m yTOm n NA7 O O mOa� O SND A Zm3� tai A O m ? y 3 irNO m fzzs o of U➢ Z 2 ROCK RIDGE DRIVE N 00 05' W 160.00 m fill p I I m .�I o I o sl. I �I o aps' m I o as c t n i m ' c c ago i 51, 5 O� ------------ ---------------- ----------------- IIS o m �'i � \+�.�n•��i Sim J C9F � PgF_T/NO Eq ___ n ---------------- N 00 05' W 160.00 I Om H < D D X = H z zH H m V I n O m V H S < 0 1 v w 0 3 D O O m> w H H v n m S m H m A D m A m 0 2 r < x D H v D Z Z i 0 G m M" m z V z z G D D w r m z o a o o w " •• VI . H N ocDM mn HH <—In A 2 H m y • H N O VI H w y D r 2 r m m H V w n mm r. H z O D nz� o D D n x n m 0 K o m H = y Al n ziD ml No < N H xFC z= nim m TI m � m Nz N 2 ROCK RIDGE DRIVE N 00 05' W 160.00 m fill p I I m .�I o I o sl. I �I o aps' m I o as c t n i m ' c c ago i 51, 5 O� ------------ ---------------- ----------------- IIS o m �'i � \+�.�n•��i Sim J C9F � PgF_T/NO Eq ___ n ---------------- N 00 05' W 160.00 I ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 FAX February 26, 2015 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 1, Block Block 3, South Lakewood Hills Subdivision No. 1 Waiver Animal Containment Area to Well Dear Onsite Services Engineer: A horse stable on this lot is located 30' from the existing well on the lot. The stable is currently vacant, but may be used in the future. A waiver is therefore required to allow the stable to remain in its current location. All animal wastes will be collected daily and removed from the site and properly disposed. No animal excrete is or will be stored within 100' of the well. We therefore recommend a waiver be allowed for the stable to be within 30' of the well. Sincerely, Michael E. Anderson, P.E. , L_ ' I ,95 .'. 49th „ s•, MICHAEL E. ANDERSON '-_ Nn CE -4361 Engineer: Legal: Waiver not Submitted With COSA or Permit >(LI -14 Laic: v.,L,u 141�LS Wit, PID: %.S - r �; 1 —I q Waiver Requested: Rush? Yes No Y�- w Waiver Fee: Rush Fee: —6 Date of Payment: 2 ` Z i " /5 Receipt Number: 63(,oG S Waiver Number: 05V t--,) l �o�f MOA Employee Reviewing Submittal 1 Distance: -3e Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program 17au I]C.,S' Department **** VARIANCE/WAIVER REVIEW **** Waiver#: osv151004 COSA#: osc151068 Permit#: PID#: 015-151-14 Legal Description: South Lakewood Hills #1 B-3 L-1 Engineer: Anderson Engineering Applicant: Richard & Stacey Minkler Your request for a waiver of the required 100 feet horizontal separation from the animal containment area to the private well has been approved. The approved separation distance is 30.0 feet. This waiver approval applies to the existing animal containment area only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this ► OMPIA ❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. ............................................................................... Waiver is Granted: X Waiver is not Granted: i Date: � �l� J� Approved by: I_ Of R 'ewer ...........................................G..�%.�.. .....................� Municipality of Anchorage Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ek.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY FOR A SINGLE FAMILY DWELLING Parcel I.D. O 15 — 16 I - LL 1. GENERAL INFORMATION HAA #_ Expiration Date: I I -'9 0- O t Complete legal description 1 67 l . 1Pk31 SOOTH I—AVF- tt/00D 4ILL—S Location (site address or directions) 10 q0 I TZO LK tZl D L, E t2 t Current Property owner(s) a 0•1.A t % l= TTSDay phone Mailing address Lending agency Mailing address Day phone Real Estate Agent Ii i -S 5 S t✓i r< 5 ✓�-b4dt Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. The Municipality of Anchorage Development Services Department (DSD) 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) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. 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 then 30 days old. (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 encineer's work. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site [� Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) 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) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. 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 then 30 days old. (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 encineer's 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 Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm t-0bbec1 S'n✓rltlaH� �- Address go - 14 20 3 Engineer's Printed Name I n bbe h S'r�vrV lc(H� 5. DSD SIGNATURE _►C Approved for _� bedrooms. Disapproved. Conditional approval for C Phone' ig j9-35/ b Date s-/Zq /O / sf�...1.� ,',, ;,..........« . A STAMP Tot Sgaddand k'�r K 3: Es5':i p bedrooms, with the following stipulations: Additional Comments I Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date: (P". 12EG) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water S Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.d.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L.CT I . S K -A, So U ur L..Gr wft Jv it -'11 S-*% Parcel ID: O / 5 — 15 1— I � A. WELL DATA Well type R If A, B, or C provide PWSID # Date completed *--/ —$ ]San" seal (YIN) Total depth IA±ft.. Cased to jAift. FROM WELL LOG Date of test Q2 —/6— 8 �7 Static water level 8 $ ft. Well production R 9•p•rn• WATER SAMPLE RESULTS: Coliform colonies/100mi. Nitrate _UD�mg.A. Well Log (YIN) Wires properly protected (Y/N) Casing height (above ground) Qin. AT INSPECTION LI -5- o I q1 ft. 15 7— g.p.m. Other bacteria _ I colonies/100 ml. Date of sample: -aZ 3—d I Collected by: lr S B. SEPTICIHOLDING TANK DATA / Tank Type/Material S ! Ej^ 1 _- Date installed Tank size 14A �O gal. Number of Compartments Cleanouts (Y/N) y Foundation cleanout (YtN) Depression over tank CON) High water alarm (Y/N) Date of pumping NA Pumper YZ& C. ABSORPTION FIELD DATA Date installed B -[7r Soil rating (g.p.d.MF aNlZlbd i System type I Abf e-4 Length 1ft. Width ft. Gravel below pipe _(& ft. Total depth ft. Eff. absorption area JRZOW Monitoring tubeT4/ Depression over field IVA� Date of adequacy test Results (Pass/Fail) L-/�� For -y—bedrooms Fluid depth in absorption field before test / in. Water added!/gal. New depth �n. Elapsed Time: V/min. Final fluid depth Zin. Absorption rate >= L -"l g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) ✓bsIf yes, give date a D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at _ in. "Pump Datum E. SEPARATION DISTANCES at _ in. High water alarm level at in. tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 10-71 Absorption field on lot IW Public sewer main MIA Sewer /septic service line i �5 D On adjacent lots " p 1 0 0 4 On adjacent lots 7 1 t-0 Public sewer manhole%leanout N`/4 Holding tank , N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Y(O r Property line __U5 1 Absorption field Jr Water main �/A Water service line >1012 Surface water N ( O Wells on adjacent lots > 1047 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 13 Building foundation 30 Water main N/.4 Water Service line Z .Z b_ Surface water 1`4 10 Driveway, parking/vehide storage z 0 t Curtain drain N 10 Wells on adjacent lots >/" F. 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 l OYJh-! N >DVy k 1*a 1e Date HAA Fee $ 36tA Date of Payment �/¢ 4 `m / l Receipt Number (Rev. ivao) Waiver Fee $ Date of Payment Receipt Number ALIO -27-31 .12:40 . FROLI-CTIE ENVIRMIX117AL SRV ALWAVAe" ME Environmental Sarvlcea Ina. CMERef.M 1013574001 nont Name Tobben Spurkland P.E. Project Namely 10901 Rockridge atat Sample ID 10901 Rocktidge Matrix Drinking Water Ordered By PWSID 0 OCTSE15301 T-339 P.02/C3 F-277 Cheat POM Printed Datelfime Collected DataITlme Received Date/time Technical Director Pre -Paid ColWN03 0826MOI 16:09 08232001 9:13 06232001 9:40 Stephen C. Ede IF KIerobic3eQ7LAbnratery Total Coliform 1011. No Coli coVI0OmL 5 7189222[1 (<I) 0823101 SKW Allowable Prep Analysis Pmrreta Reeulu PQL Units Method Limits Date Dau Tait Vatara Davartmant Nitmtc•N 0.500 U 0.500 mWL EPA 300.0 (<10) 0823.101 SCL KIerobic3eQ7LAbnratery Total Coliform 1011. No Coli coVI0OmL 5 7189222[1 (<I) 0823101 SKW 79 MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section YYY P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# `2- �5 - IL__ HAA# "�q if 0gkA — 1. GENERAL INFORMATION Complete legal description L -c 1 . -5K 5 sou IJA L �'° �II--, Location (site address or directions) O n /'Property owner Day phone _ i .56 6 t - Mailing address --- -- ------ Lending agency --- -- Day phone Mailing address -- —= Agent— I er r -I iii �a, �� (iI= i�+ ay phone 'St -3- 55r— Address- Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4-1 3. TYPE OF WATER SUPPLY: Individual well _ 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 V Holding tank Community on-site Public sewer NOTE: If corn munity wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev. 1/91) Front 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 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 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 L �� Spu'rl,c.lA"'d �t-�. Phone 979-39/� Address AD 3 1-t/ / 6-A-4 P� Z -O Engineer's signature 6. DHH6 SIGNATURE Approved for FO VR bedrooms. 0 Disapproved. Conditional approval for Additional Comments Date 9/3%49 bedrooms, with the following stipulations: &/"X ._� Z / . Date 0/_ J 6 - q cl U ITI C 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 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. 12025(RW.1M) Back MOAM21 RECEIVED Municipality of Anchorage SEP 15 ($9 DEPARTMENT OF HEALTH & HUMAN SERVICES MUNICIPALITY OF A C* -D) Environmental Services DivisionIRONM ENTALSERVI N V 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 943-4744 Health Authority Approval Checklist Legal Description: _iLAl , 31, 3 S,, j Q1.,) ..j ro,Yw� �4, ((s Parcel LD.:_ 016— A. WELL DATA Well type _—_ If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) — Date completed nQ, MT -, 7 Total depth -_I —_ Cased to I o'I=Y —Casing height (above ground) Zo Sanitary seal (Y/N) FROM WELL LOG Date of test r�! / b '0 .' Static water level is Well production---9-P.M. WATER SAMPLE RESULTS: Wires properly protected (Y/N) AT INSPECTION C/.g..il? L'_�---g.p.m Coliform _ Nitrate _—td_. D_I =_ Other bacteria _ Date of sample: _ 9 �4lQ9 _ Collected by: _ 77s _--_ B. SEPTIC/HOLDING TANK DATA Date installedI `i71 /1ALTank sire AOr5� Number of Compartments L Cleanouts (Y/N)--Y-- Foundation Y/N)_ _ Foundation cleanout (Y/N) Depression (Y/N) �� _ High water alarm (Y/N) Date of Pumping _ "13--_ Pumper_Ly C. ABSORPTION FIELD DATA Date installed 8 _ Soli rating (g,p.d./ft2 or ftz/bdrm) _ 1) _ System type �C�_ Length _ 71 —Width _ —_ Gravel thickness below pipe 12 _Total depth Effective absorption area /��_ Monitoring Tube present (Y/N)4_ Depression over field (Y/N) N) _ Date of adequacy test _ 4�`I —_ Results (Pass/Fail) _ T -- For e --bedrooms Fluid depth in absorption field before test (in.);_ (� _ Immediately after 7Z-Ogal. water added (in.): Fluid depth _ %A— (ins) Minutes later:. 3 1� r5 _ Absorption rate = -->— 6.6 /_-g.p.d. Peroxide treatment (past 12 months) (YIN) __ h) If yes, give date __ v 72.026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N)ump on" level at* "Pump off" level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 109 On adjacent lots t !9 Ca Absorption field on lot L tL 1 On adjacent lots 7 a v 14 Public sewer main N //� Public sewer manhole/cleanout Sewer /septic service line 1>46' Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 14 6 Property line > 5r�) Absorption field 7 Water main/service line >,2 _Surface water/drainage 1� D Wells on adjacent lots ? t O c SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line > 16 Building foundation 3 L9S Water main/service line 7 Surface water N O Driveway, parking/vehicle storage area Curtain drain ��' U Wells on adjacent lots i lD 7 F. ENGINEER'S CERTIFICATION I certify that i have determined thru field inspections and review of Municipal records,that the above skstem8 are in conformance with MDA HAA guidelines in effect on this date. Signature Engineer's Name I e lo(o•to u ✓ Lt l a� r �X Date 9/1 :5/q HAA Fee $ �x�D' l0 Waiver Fee $ Date of Date of Payment � Payment Receipt Number ' J ( Receipt Number 72-026 (Rev. 3/96)* SEP -15-99 09:29 FROM -CTE ENVIRONMENTAL AM C'1'&E Environmental Services Inc. CT&E Ref.# Client Name Project Name/# Client Sample W matrix Ordered By FWSlp Pa,zmeter 994840001 Tobben Spurkiand P.E. I13 South L *ew00d Hills 1/3 South i akewoW gulls Drinking Water Resulxs_ 111 5615301 T-909 P.02/03 F-239 Client PO# ple-PaidColis/NW PrintedDatcYltme 09/14/9916:09 Collected Mte/Time 09/10/99 11:40 Received Date/Tltne 09/10/99 14:15 TechWcal Director: Stephen C. flde Released ALLoaaiAO Prep Arta L y5 is POL Unitsr Method J omir5 Date --_- Date _ ll)t Total Gatirarm 0 Cot/100m1 51118 92228 09/{d/94 KAP Nitrate -g 0.840 0.500 me/L. EPA 300.0 10 max 09/10199 09/10/99 M MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES. Awmil Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # O HAA #G GENERAL INFORMATION Complete legal description �•' i I l�T S LZ, �- �u i� �• Location (site address or directions) Y_A UX p D Property owner (20-NA� V) Lax-�-L4-1l . Day phone Mailing address R.ox 3 1 q7_5I�p(JL %�- Lending agency�Czw_�-mac' �+ Day phone Mailing address— L+-,, L 3(✓ cK Agent —fir Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 1-i 3. TYPE OF WATER SUPPLY: / Individual well v Community well Public water NOTE: If community well system, provide written confirmation ing to the legality and status of system. 4. TYPE: OF WASTEWATER DISPOSAL: /' Individual on-site 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(Rw. 1/91) front MOA 921 m 1 � a n Z n ra: D --I CP mCn D zo z n r 1 � cin " G from State ADEtest- z NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rw. 1/91) front MOA 921 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 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 Address Engineer's signature EM 6. DHIiS SIGNATURE Approved for bedrooms. M Disapproved. Conditional approval for Additional Comments _— Date [ bedrooms, with the following stipulations: 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 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. 72-025(Bay.1191) Back MOA921 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:�, �r I�eei V 1p��_ Parcel I.D. 5;W135;W13Iit—n,l.�..c J_06� 0) tilltl_5 A. Well Data Well type _K__If A, B, or C, attach ADEC letter. ADEC water system number. Log present (Y/N) Date completed J' '/ f , 9 d_Driller _ 1tpi 0 Total depth ___�__Cased to ___L2 -A_ --Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) �FROM WELL LOG Date of test Static water level Well flow _ q _g.p.m. Pump levell SEPARATION DISTANCES FROM WELL TO AT INSPECTION c- r.rl m b i r 1� P. - cn m o y T 0 Septic/holding tank on lot _�6 Lo�') ; On adjacent lots , i 0-9 z Absorption field on lot - l r� _; On adjacent lots _ �i / 0 —_ Public sewer main Public sewer manhole/cleanout V_Zq- ( _ Sewer service line _ Petroleum tank ___l y- 6P' _ WATER SAMPLE RESULTS: � � � Coliform CL✓,,_ // Nitrate Lcu--- —Other bacteria _ Date of samp�le:��_____Collected by: �T 7 �> B. SEPTIC/HOL.DING TANK DATA Date installed 1 G i L_Tank size 1. 0-00 • t c� _Compartments Cleanouts (Y/N) _ //-Foundation cleanout (Y/N) High water alarm (Y/N) /�� Date of pumping 6 / g _6 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: tested (Y/N) 1-1. ----ILS LL e (Y/N) _�_4 Well(s) on lot _ I C13 On adjacent lots > / &-o __Foundation _ 7 `� To property line > 5o Absorption field_7 __Water main/service line Surface water/drainage — 1 0 72-026(3W)• Frwt CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) Manufacturer Manhole/Access (Y/N) "Pump on" level at "Pump off' Level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots Surface water Date installed Soil rating (GPD/Ft2) to _System type 2 e,4,4 Ci Filfd( V4AZ 21 a qa Length Z � Width Gravel thickness r dept q4!?i-ire �wlI TS fill Total absorption area 3 Cleanout presen (Y1fJ)01 Total field (Y/N) Date of adequacy test. Results (pass/fail) for 7 Bedrooms Water level in absorption field before test d r!�l TO Id, 5 After test circ/ Peroxide treatment (past 12 months) (Y/N) _ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot o� On adjacent lots l U -c> Property line ! L7 To building foundation To existing or abandoned system on lot f On adjacent lots > 'n l� Cutbank N l7 W e. Water main/service line Surface water ,A1� o m e Driveway, parking/vehicle storage area '36 Curtain drain ` Y o E. ENGINEER'S CERTIFICATION / certify that l have checked, Signa Engin Date verified, or conformed to all MOA and HAA guidelines in effect oh the:datdvhth{'s inspection. on," 1,jY F i HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number 'r. S]'URKLAND P.E. 203 W EST 157.11. AVENUE SUITE 203 ANCHORAGE, ALASKA 99501 (907)279-3916 Fax (907)-276-6013 Robbie Robertson Municipality of Anchorage Department of Health and Hunan Services On -Site Service Section 820 L Street Anchorage, Alaska 99501 Subject: HAA Lot 1, Block 3, South Lakewood Hills Gentlemen; June 30, 1995 RECEIVED JUL 51995 Municipality of Anchorage Dept. Health & Human Services This afternoon the top of the rock was exposed and a 2 -inch probe pushed into the rock until change in resistance was noticed. The rockdepth was found to be 6 feet with liquid surface 2.5 feet below distribution pipe invert. It was also observed that the two original cribs were connected to the septic tanks. The cribs are 10 feet total depth with a liquid level id 24 inches. Based on this observation the total absorption area for this system is 12 x 77 = 924 sq. ft for the trench plus what ever the cribs contribute. The soil rating is 210 per Muni record. The required absorption area for a four bedroom house is 840. The trench itself satisfy this requirement. Please issue the HAA. C' 7. 1'onr'$ c 1 rS (Y1 e Tobben Spurkland P E g AGO J Ja b: `i �'q,11 'T. spuF ;LAND P.E. RECEIVED 203 WEST 15TH. AVENUE SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Robbie Robertson Municipality of Anchorage Department of Health and Human Services On -Site Service Section 820 L Street Anchorage, Alaska 99501 Subject: HAA Lot 1, Block 3, South Lakewood Hills C - Gentlemen; dUN 2 7 1995 Municipality of Anchorage Dept. Health & Human Services June 26, 1995 Per your verbal request I attempted to establish the total rock depth in the trench this afternoon. I treasured the total depth of the monitor to be 128 inches. At 80 inches I could see a displaced pipe joint and sewer rock. A perforated pipe could be seen extending for 4 feet past the pipe joint. The elevation of this pipejoint does not match the elevation of the cleanout at the beginning of the trench. I suggest to bring in a backhoe and excavate to the top of the wench , a probe can then be driven through the gravel to the in situ soil under the trench. It can be expected that the trench it at least partially full of effluent. Excavating through the rock is not recommended. 1� Yours 0, r,'purkland Tobbe P.E. fit � t 1 + T ation'(site address or direct ing address l O 4 01 Jing agency �on4 A.4 a.,..... 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 courtesyto purchasers of homes and their lending institution a in orderto satisfy certain federal and state requirements. Employeesof DHHSdo 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. ;i 72-M(Rev.1/81) Back MOAM21 _.. ._.....�..-nom 5. `STATEMENT OF INSPECTION BY ENGINEER�� u.� As certified by my seal affixed hereto and as,of the,validation date shown below, I verify that my r ., investigation of this Health' Authority Approval application shows that the on-site water supply kh ' and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. If ritherverify 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 ofFirm 1 ob�reK ~SpyrkLa,v 17 L Phone%l-3if(� , Address ad 3 r -V 15 i K A0 3 r, ' Engineer's signature TI` ' Date ) � 3 ° is •t% ', e•' 1. 4 s ^ da , 6. DHHS, SIGNATURE Approved for q' bedrooms. Disapproved. ' g st ipulations. Conditional approval for bedrooms, following the with n. Additional Comments BYC �t�t (TN Date l`� c* 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 courtesyto purchasers of homes and their lending institution a in orderto satisfy certain federal and state requirements. Employeesof DHHSdo 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. ;i 72-M(Rev.1/81) Back MOAM21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: iAA 3 SIoJ L- Parcel I.D. A. Well Data 0 Well type _ _P1_ If A, B, or C, attach ADEC letter. ADEC water system number t�!ZA Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump levell Date completed 4-'/5- 0 _Driller A I pI,ti ' Cased to FROM WELL LOG v2'/!;-- 8 7 a F3 SEPARATION DISTANCES FROM WELL TO: Casing height Wires properly protected (Y/N) AT INSPECTION .?,o it 1 �L U..i i�nGpALITY OF ANChIORAGE 9 D ENI IRONMENTAL SERVICES DIVISION Pp,i,,8 1994 q Septic/holding tank on lot 10 E3 ; On adjacent lots i /Lt, -0 Absorption field on lot I b_ 1 ; On adjacent lots i Public sewer main—Public sewer manhole/cleanout Sewer service line ------ 25 Petroleum tank E WATER SAMPLE RESULTS: n , Coliform Nitrate _ �o Other bacteria Date of sample: _ 3D Collected by: S B. SEPTIC/HOLDING TANK DATA Date installed/`71 e 19%1 f 199 -Tank size /0&0 t6o-O _Compartments__ Cleanouts (Y/N) Foundation cleanout (Y/N) Depression (Y/N) _ N1 High water alarm (Y/N)//A Alarm tested (Y/N) Date of pumping A L.e M 93 Pumper {�d e ✓ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot d n [5 On adjacent lots � /e:5-0 Foundation) To property line _:� 50 /Absorption field Surface water/drainage N 10 Water main/service line O 72-026(8/03)* From CONTINUED ON BACK PAGE C. LIFT STATIONN fI / Ak Date installed Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pump off' Level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots Cycles tested Surface water Date installed Soil rating (GPD/Ft2) 02 1 System type I ✓2 SNC! F F C1211i Length '7 7 Width 2 Gravel thickness Total depth in + Total absorption area l.� 3 Z Cleanout present (Y/N) i Depression over field (Y/N) N fi Date of adequacy test 330 ('9 `/ Results (pass/fail) 7 for /// Bedrooms Water level in absorption field before test aE r )l After test 1__/ r �2 Peroxide treatment (past 12 months) (Y/N) N1 If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot j X I On adjacent lots > /U D Property line To building foundation t`54!5 To existing or abandoned system on lot On adjacent lots i 3 U Cutbank N u >1 - Water main/service line Surface water 1\/10 K Driveway, parking/vehicle storage area Curtain drain t,�' b E. ENGINEER'S CERTIFICATION 3 to I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. HAA Fee $ / Waiver Fee $ Date of Payment 7 -8- 9 Date of Payment Receipt Number �� 8 Receipt Number 72-026 (3/93)' Back MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OI° INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) dor 1, �� _s��l� _yG, ,,��; S ov/ SiFC ;23I i Io2NLe3'X Location (address or directions) "�/1,qc� jLor TZIQ A 1! (b) Property Owner vein. •Llbusi4 Telephone: Home Business Mailing Address 0 (c) Lending Institution For.a.tn.an F-rN - —r-,• r'aes_ P Tele hone Mailing Address (d) Real Estate Company and Agent a -Y /J i�x ✓ -c lie""" Address �Z��'.n roe ✓ a _ Telephone (e) Mail the HAA to the following address: or: Check here tee, if hold for pick up. List contact person and day phone number below. 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms . 3. WATER SUPPLY Individual Well Commu ity,2 Public[] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community CI Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (Rev 8/861 From 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation of this He'alt f Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequatii 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 Municipal and State codes, ordinances, and regulations in effect on the date of this inspe tion. n Name of Firm `� �(.�d µG Telephone P -7q -M 16 Address Date �.. N 22257+?a - JUPIf. 25. [971 DHHS APPROVAL Approved for Fn C4 bedrooms by Approved t� Disapproved Conditional _- ]'arms of Conditional Approval CAUTION Seal Date 2 --2_� -a-?- 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 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. Page 2 of 2 72-025 raev 8/861 Beck MUNICIPALITY OF ANC, 4GE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) 1987 CHECKLIST - FEBRUARY 1984 { / [ N p� 264-4720 R E C E I U L Legal Description: �- ' ` `s no nl' LAV,M A. WELL DATA well t`;-, (yu I. I f. Well Classification —ham �' If A. B, C, D.E.C. Approved (Y/N) N�ih Well Log Present (Y/N)— N _ Date Completed 1 q bo,,c Yield Total Depth _ 4j — Cased to e�� f Depth of Grouting Static Water Level P, IPump Set At 1/c Casing Height Above Ground Sanitary Seal on Casing (Y/N) N 4% crl'in�� Electrical Wiring in Conduit (Y/N) t� __ Depression Around Wellhead (Y/N) r Separation Distances from Well: To Septic/Holding 'Tank on Lot — ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot _; On Adjoining Lots To Nearest Public Sewer Line--N_0NE _ To Nearest Public Sewer Cleanout/Manhole l: To Nearest Sewer Service Line on Lot e> Water Sample Collected by Date 1/2, �� g Water Sample Test Results _— C B. SEPTIC/HOLDING TANK DATA Date Installed Size No. of Compartments Standpipes (Y/N) _ — Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) ---� Date Last Pumped _JA& / Pumping/Maintenance Contract on File (Y/N) 1'7/Ar ; for N/A Holding Tank High -Water Alarm (Y/N) hVATemporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well ' ra To Building Foundation To Property Line __>' �U To Disposal Field To Water Main/Service Line __ To Stream, Pond, Lake, or Major Drainage Course t\4c>NLE- Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata D Type of System Design d Jes-N& Date Installed b~- Z9 --d L Length of Field 77 Width of Field 3( I Depth of Field 1004 .t Gravel Bed Thickness 64 `/ Square Feet of Absorption Area �2Ja Standpipes Present (Y/N) 7 Depression over Field (Y/N) Date of Last Adequacy Test tI 7�(. %-Z Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation JU Lot 2CJ To Water Main/Service Line 7R> To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments * grrn' To Property Line To Existing or Abandoned System on On Adjoining Lots 7 Vo To Cutbank (if present) /YU/><,;—"=' D. LIFT STATION N0h1 Date Installed Size in Gallons "Pump On" Level at High Vyater Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access(Y/N) "Pump Off' Level at " Check Permitted Bedroom Rating Against HAA Request " Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify t I In ecked, verified conformed to allM A an HAA guidelines in effect on the date of this inspection. Signed Date Company / �/ MOA No. Receipt No. Il%00 ( 01Z b" Date of Payment /-40 — n Amount: $ Md ti O Page 2 of 2 72-026 (1 1Y84) 00 0, .. j:4 P o, z225—e .'� r..t'•`. JUNE 25. 1971 ' dyd_ Engineer's Seal 203 () C G V)r, 2UV lj.nm G Abq PQ2Q 2 ANCHORAGE, ALASKAI 99501 CONSULTING ENGINEER l"ELEPHONE: (907) 279-3916 S E P T I C LEGAL: LOCATION: OWNER: RESIDENCE: WELL: S Y S T E M A D E Q U A C Y T E S T LOT 1, BLOCK 3, SOUTH LAKEWOOD HILLS 10901 ROCKRIDGE AHFC SINGLE FAMILY, FOUR BEDROOMS PRIVATE, ON SITE SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: TANK: 1000 + 500 GAL. ABSORPTION SYSTEM: TRENCH ABSORPTION AREA: 12.32 SQ. SOIL RATING: 210 INSTALLATION DATE: MAY 1.981 DATE OF PUMPING: JANUARY 26, 1987 DATE OF TEST: JANUARY 26-29, 1987 fIF At 'akk�'C FJT ti•• 2225-E cc 7PI'. •LINE 25, 1911 iy TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. 500 GAL TANK WAS FOUND WITH 5.5 FEET OF COVER AND 41 INCHES OF LIQUID. 1000 GAL TANK WAS FOUND WITH 4 FEET OF COVER AND 49 INCHES OF LIQUID. TRENCH CLEAN OUT WAS 6.5 FEET DEEP AND HAD 2 INCHES OF LIQUID. TRENCH SUMP WAS 11 FEET DEEP AND DRY. ORIGINAL CRIB WAS 10 FEET DEEP AND DRY. ON JANUARY 26 2000 GALLONS OF CLEAN WATER WAS ADDED TO THE TRENCH. 1000 GALLONS WERE ADDED TO THE CLEANOUT BETWEEN TANK AND TRENCH. THIS CAUSED THE WATERLEVEL IN THE TANK TO RISE 1 INCH. NO WATER WAS OBSERVED IN THE TRENCH SUMP. 12 INCHES OF WATER WAS MEASURED IN THE ORIGINAL CRIB. THEN 1000 GALLONS WERE ADDED TO THE TRENCH SUMP. THE WATER LEVELS IN THE TANK AND CRIB DID NOT CHANGE, AND IMMEDIATELY AFTER DUMPING 14 INCHES OF WATER WAS MEASURED IN THE SUMP. ON THE 29TH. SYSTEM WAS MEASURED AGAIN. BOTH CRIB AND SUMP WERE DRY. 350 GALLONS OF WATER WAS ADDED TO THE SUMP. WATER DEPTH WAS MONITORED DURING THE ADDITION OF THIS WATER VOLUME. AFTER ADDING THE WATER THE TOTAL DEPTH WAS 13 INCHES. AFTER 3.5 HOURS THE LEVEL WAS MEASURED AGAIN AND FOUND TO BE 6 INCHES. AFTER 19 HOURS THE SUMP WAS DRY. TEST RESULT: THIS SYSTEM MEETS THE CODE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any esti-mate of how long the system will continue to meet the operational requi- rements of the Municipality and State. 1 "C" SUITE 203 U oO �UV L��..%G3G3.�G��U`�D9 po�a 2A CHORAGE,EALASKA 99501 CONSULTING ENGINEER TELEPHONE: 19071279-3916 R E S I D E N T I A L W E L L I N S P E C T 1 O N -- — — — — — — — — — — — — — — — — — — — — — — — — LEGAL: LOT 1, BLOCK 3, SOUTH LAKEWOODS Z1J,' Se -z LOCATION: 10901 ROCKRIDGE OWNER: AHFC ;sY. 49 1. •�' 7/ ®,• ... ... .� TYPE OF WELL: SINGLE FAMILY �• ti..�• 2225-E •• WELL LOG AVAILABLE: NO rP %` , J NE 2b. 1971 INSTALLATION REQUIREMENTS MET: NO. MUNICIPAL REC&RD.S•,1SA001S WELL TO BE LOCATED AT THE NORTHEAST CORNER OF THE HOUSE WITH THE PROPER DISTANCES TO THE SEPTIC SYSTEM. DURING INSPECTION IS WAS FOUND THAT THE WELL CASING AT THIS LOCATION WAS A FAKE APPROXIMATELY 4 FEET DEEP. THE ACTUAL WELL WAS FOUND ON THE SOUTH SIDE OF THE HOUSE AT A DISTANCE OF 46 FEET FROM THE SEPTIC TANK AND 64 FEET FROM THE BEGINNING OF THE TRENCH. TOP OF WELL WAS 3-6 INCHES BELOW GROUND SURFACE AND WITH A WELL CAP ONLY. WELL YIELD 4 GALLONS PER MINUTE AT MAX DRAWDOWN PUMP YIELD: 5.5 GALLONS PER MINUTE DATE OF INSPECTION: JANUARY 29, 1987 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE WHILE THE DRAWDOWN WAS MONITORED WITH AN ACOUSTIC PROBE. THE WELL WAS PUMPED TILL THE DRAWDOWN STABILIZED. STATIC WATER LEVEL WAS FOUND AT 81 FEET BELOW TOP OF CASING. ATTER 20 MINUTES OF PUMPING THE WATER LEVEL WAS AT 96 FEET AND THE PUMP WAS DRAWING AIR. WELL WAS RUN FOR AN ADDITIONAL 60 MINUTES ANT A RATE OF 4.5 GALLONS PER MINUTE. WATER LEVEL REMAINED AT 96 FEET. TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON JANUARY 30, 1987. TEST WAS NEGATIVE. TEST RESULT: `PHIS WELL DOES NOT MEET THE INSTALLATION REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hour.s.This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. unlclpaaity of Anchorage February 2, 1987 P.O. k 196650 ANCHORAGE, ALASKA 99519-6650 (907)264-4111 TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES Tobben Spurkland, P.E. 203 West 15th Avenue, C Suite 203 Anchorage, Alaska 99501 Subject: Health Authority Approval Application, Lot 1 Block 3 South Lakewood Hills Subdivision Dear Mr. Spurkland: This Department cannot issue a Health Authority Approval for the subject lot. Your application indicates that the well is located too close to the septic system. A separation distance of 100 feet is required between a septic system and well. In order to gain approval of the sewer and water facilities on this lot, the well and/or septic system must be relocated to meet this separation requirement. Proper abandonment of the well will be required if it is relocated. If you have questions regarding this matter please contact me at 264-4744. Sincerely, sQ • �oi-gym, Steen S. Morris Civil Engineer On-site Services Ale.a.v wall �, rll�� 2-e5-�� , e J'a -- --_ INSPECTION INSPECTION APPOINTMENTS DATE RECEIVED cotyt,-1-t TIME TIME TIME DATE DATE DATE 6. TYPE OFRESIDENCE NUMBEROF)BEDROOMS UI SINGLE FAMILY INSPECTOR INSPECTOR INSPECTM —__ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION . 825 L Street - Anchorage, Alaska 99501 d 1 ENVIRONMENTAL SANITATION DIVISION Telephone 264.4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNIiR - PHONE— UJO 5A7r, _S K. 1;�n�t�n, 6. SEWAGE- DISPOSAL SYSTEM C INDIVIDLIAL/ON-SITE** MAILING ADDRESS Fff}yq&- hjC11Y71c PROPERTY RESIDENT (If different from above) - PHONE v--_—_� 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE --— MAILING ADDRESS 4. REALTOR/AGENT —i PHONE C,00D .AA)[7E-12 MAILINGADDRESS _ 141), A).:L5~HA04, 4t3�sf�c1302466� ./91 L 5 K 4 C)ei�o3—�� fi: LEGAL DESCRIPTION - 1-0T l 8.ko ' L 3 50o i fi Lj4KE-WDOD h-1 LL5 1116 STREET LOCATION C8fl7LW6A) ilRE T+171ONa Sco'P.L "J S`JW 6T . O'M ALLEY/ kbej1 R 0Ro, 4 D -- .? 9095E 0A) del 1 oN Roc.eR ) 6. TYPE OFRESIDENCE NUMBEROF)BEDROOMS UI SINGLE FAMILY ❑ One Ltl/Four ❑ Other,__ ❑ Two El Five ❑ MULTIPLE FAMILY ---- ❑ Three ❑ Six 7. WATERSUPPLY— ----- �— * LK INDIVIDUAL* ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well _ E:1 PUB LIC UTILITY depth (attach log if available.) /RSO 6. SEWAGE- DISPOSAL SYSTEM C INDIVIDLIAL/ON-SITE** 't 7 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLICUTILITY NOTE: THE! INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 45- AD . 72-010 (Rev. 6/70) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED —7 --� INSTALLER ❑Septic Tank or ❑ Holding Tank Size: je�00 If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL c 4. DISTANCES WELL T0: Septic/Holding Tank Absorption AVea Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS B�- APPROVED FOR BEDROO ❑ CONDITIONAL APPROV L (letter mu t ccompany certificate) ❑ DISAPPROVED , DATE BY e ( KAP 72-010 (Rev. 6/79) -rime APPLI( W FILLS OUT UPPER Hk ONLY Properly O-ner Gerald and .lane Brtmell Phone Time n I /I SRA- 2G Mailing Address Anchorage, Alaska zip Code 99507 359-5248 Buyer Stephen G. Fussell and Sandaa D'P.ntrement Date /'\ P.O. Banc 635 Address Chuaiak, Alaska zip Code 99567-9999 Lending Institution Rainier Corp . Phone 4797 Business Park Blvd. Inspector Address Anchorage, Alaska zip Code 99503 279-0665 Realty Co. & Agent I)ynalnic Realty, Inc„ Phone Doris Timperley, Assoc. Broker c�J) Address 501 W. No. Lights Blvd. Anchorage, Ak Zip Code 99503 279-7611 Legal Description Lot 1, Block 3, SoUth Lakewood hills dk 1 Street Location Roizkridge andWe a�mont Anchorage, Alaska Type of Residence C7} Single Family �j Multiple Family No. of Bedrooms 4 — ❑ Other _ Water Supply (Gk) APPROVED 13EDRO�� L-Vindividual n I �_ I I L]ti�i • ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. ❑ Community ( \.)CONDITIONAL APPROVAL' DDATE � '_� _�_ For wells drilled prior to that date, give well depth (attach log If available). ❑ Public Utility Sewer Disposal / ' ,,� / 12,✓�z`ta 1�/� CM(ndivldual Year Individual Installed:_Lq7(- S. ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank Sells Rating Date Sewer Installed NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. -rime Time Time n I /I Time Date Date Date /'\ Date Inspector Inspector Inspector Inspect r c�J) 1 Field Notes: MUNICIPALITY OF ANCHORAGE DFnT C' ' - I r' F. ),-''TI0N RECE IM (Gk) APPROVED 13EDRO�� CONDITIONS OF APPROVAL ( ) DISAPPROVED 1' ( \.)CONDITIONAL APPROVAL' DDATE � '_� _�_ �p -5vx)... , �% ' !/ ,C �.: �t/`l.1 ,•><�i'.-r 2� .-�� I � �, G� G '-t_ C e; 13Y J i Sells Rating Date Sewer Installed Well To Absorption Area / ), `•`� Well Log Received �•' S ( Well to Tank •J -; r `/ Septic Tank Size 1,5-2)0 72023131321 February 10, 1903 Gerald and Jane Brune.11 SRA- 2G Anchorage, AK 99507 Subject: Lot: I Block 3 South Lakewood Hills 41 Approval for the individual sewer and water facilities cannot be granted until the following items, have been complotcal \� The water, analysis report needs to be submitted to this 1 office from the Chem Lab, 5633 B Street, for our review. ° The depression over the sewer system will need to be filled so that surface water Brains away from the sewer system. ° Conditional approval can be given if monies are escrowed for backfill in the Spring. Please notify this Department for a roin8pection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, Jim Roberts Associate Hnvironmenttal Specialist: JT2E34/p/S[t.l. 72-014 (3/78) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION Environmental Sanitation Division F 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 CERTIFICATE OF INSPECTION SEWER AND WATER FACILITIES 1. PROPERTY OWNER James K. Kendrick MAILING ADDRESS Star Route A Box 26L 99507 2. LEGAL DESCRIPTION ' .Lot 1 Block 3 South Lakewood.Hills Subdivision 3. TYPE DWELLING :�3 SINGLE FAMILY RESIDENCE O OTHER (Describe) EA MULTIPLE FAMILY RESIDENCE 4. WATER SUPPLY iKZ INDIVIDUAL O COMMUNITY/PUBLIC 5. SEWAGE DISPOSAL IE3 INDIVIDUAL/ON-SITE [::] PUBLICUTILITY O HOLDING TANK (Maintenance Required) X3 APPROVEDFOR four BEDROOMS (See Attached) O CONDITIONAL APPROVAL O DISAPPROVED DATE BY (TITLE) - June 17, 1 81 �rhi �� r 72-014 (3/78) y B20 "L" ST I- QI` y ITMO OkAGE, ALASKA 90501 Or (007) 264-4111 G60RCPi4 SULLIVAN, j� MAvon DL'PAR FMINA OF I IrALTu AND FNVIRONMCNl711_ PROI [C HWO May 13, 153:1. James K. Kendrick Star Route A Box 26h Anchorage, Alaska 99507 Subject: Lot l Block 3 South Lakewood Hills Subd.i-vision 41 The adequacy Lest performed on the existing sewer system has failed, Therefore, an upgrade will be necessary prior to any approval.. The upgrade will include seventy(70) feet of leaching line. with six(6) feet of screened gravel backfill.. A 500 gallon septic tank needs to be installed 10 the existing 1,000 gallon tank. Prior to any construction a permit needs to be obtained from this office. A $20.00 permit fee is required at the time of application. If there are any further questions, please call this office at 264-4720. Sincerely, Robei:t. 0 Pratt, R.S. Associate Speci_al.is:; RCP/.ljw cc& Gold Panner Investments 1401. West 25t:h. Avenue 43 99503 100 v .j" y` Y �i�{.lq �' ; l a.` •] �C I 1 it ,'` 825 "t" STREET ANCHORAGE, AI -A.` KA 901501 0707) 264-11111 GEORGE A SUI_HVAN, MAY011 DrPAR i MI N7 OF I1EACi H AND FNVIRON IEN'f,11_ PRO'fCCTION April 23, 1981. James K. Kendr:i.ck. Star Route A Loi; 261, Anchorage, Alaska 99507 Subject: Lot 1. Block 3 South Lakewood Hills Subdivision Al Approval for the :ind.i.v.idual sewer and water facilities cannot be granted until the following items have been completed: (1.) The water analysis .repo7:t needs to be delivered to this oVi.ce from the Chem Lab, 5633 p Street, for our review. Y(2) The septic tank pumped with a receipt submitted to this office. 3) 1ln adequacy test need to be performed on the existing loathing area This test will determine if the system k -Vis adequate according to National Standards, A listing of private firms performing the test is enclosed. This report needs to be submitted to this office for our review. (4) The application shows the number of bedrooms exceeds the number the sewer system was originally designed for. A 500 gallon septic tank needs to be installed to the existing sewer system. prior: to any upgrade, a permit needs to be issued by this department. if there are any further questions, please call this office at. 268-972.0. Sincerely, Robert C. Pratt:, R.S. Associate Spec.i_al.:i.st. RCP/ljw