Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
HomeMy WebLinkAboutLAKE O THE HILLS BLK 4 LT 2Lake O' The
Hills
Lot --2
Block 4
#015-331-10
Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 1
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP151229 PID Number: 015 331 10
Dwelling: ❑■ Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑■ Upgrade
Name:
GARY JONES
ABSORPTION FIELD
❑ Deep Trench ❑Shallow Trench El Bed E] Mound
Address
6700ROCK RIDGE
❑ Other
Phone
Number of Bedrooms
Soil Rating
depth from original grade
7
JTotal
-- GPD/SF
-- Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
-- Ft.
Gravel depth beneath pipe
-- Ft.
Subdivision Block Lot
LAKE O' THE HILLS 4 2
Fill added above original grade
Ft.
Gravel length
-- Ft.
Township Range Section
Gravel width
-- Ft.
Beds: Number of Lines
--
Distance between lines
-- Ft.
SEPARATION
DISTANCES
To
From
Septic
Tank
Absorption
Field
Lift Station
Holding
Tank
Sewer
Line
Total absorption area
__ Ft
Number of trenches
--
Dist. between trenches
-- Ft.
Well
+100
--
__
__
__
TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
ANCHORAGE
Capacity
12000 Gal.
Surface Water
+100
--
__
__
NA
Material
STEEL
Number of compartments
2
Lot Line
+5
--
--
--
Foundation
+10
--
__
__
LIFT STATION
Manufacturer
__
Capacity
__ Gal.
Curtain Drain
__
__
__
__
Remarks OLD TANK DISPOSED OF PER MOA
Pump on level at
-- in.
Pump off level at
-- in.
High water alarm at
-- in.
REQUIREMENTS
TANK REPLACEMENT ONLY
Pump make and model
Electrical Inspections performed by
Installer
GUARANTEED SERVICES
PIPE MATERIAL House to tank 3034 drainfield Tank to
3034
Drainfield UNK CO/MT 3034
Inspector CHARLES BALZARINI
BENCH MARK (Assumed elevation) 100 ft
Inspection 15' 9/3/15
dates: "d
2
3d 4th
Location and description
SW CORNER OF HOUSE
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Conditional Approval: Date
Engineer's Stamp
X11
C f A��lll
����'�`.•'''�'' .tQ,��)
TH
..... _
Ir i;HARLES G BALZARIW .
Z<IN •, CE-13854 .•
!`�lF ' • .9'1818 • •�� w
Aw
FESSI`
1
Approved Date % X019
Inspection Repo rt_9-1-12.doc
ALTERNATE SEPTIC RESERVE
SITE, REQUIRES SOILS
EXPLORATION. AND LIFT
STATION.
\1
�SWING TIES
A| B -- --
i C 21.5' 50.1
FOUNDATION
CLEANOUT
LEANOUT
SW HOUSE CORNER I
APPROXCR|B
LOCATION
�
OA
2000 GAL
STEEL SEPTIC
/
WELL
�
CLEANOUT-,,
OS.5/
NEW TANK
-SCALE: 1^=
FINISHED
GRADE
|
� |
EXISTING 2.5'X50'
�\TRENCH VW5'
EFFECTIVE DEPTH.
_----_.i�
SCHEMATIC ELEVATION - SCALE: NTS
LEGAL DESCRIPTION: LAKE O'THE HILLS BLOCK 4 LOT 2
C&M ENGINEERING SERVICES OWNER:GARYJONES DATE:9/05/18 REV:O I DRAWN: CB REF:
907-854-5558
INSPECTION REPORT FIGURE
IV y
SCHEMATIC ELEVATION - SCALE: NTS
LEGAL DESCRIPTION: LAKE O'THE HILLS BLOCK 4 LOT 2
C&M ENGINEERING SERVICES OWNER:GARYJONES DATE:9/05/18 REV:O I DRAWN: CB REF:
907-854-5558
INSPECTION REPORT FIGURE
On -Site Water and/or Wastewater System
Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number:
OSP151229
Tax Code Number:
01533110000
Work Type:
SepticTank Upgrade
Permit Effective Dates: July 30, 2015 to July 29, 2016
Design Engineer:
C&M ENGINEERING SERVICES
Subdivision:
LAKE O THE HILLS
Site Legal Address: LAKE O THE HILLS BILK 4 LT 2 G:2639
Owner/Address: HILTWEIN WENDI J &
FLAHERTY COLIN M 10175 N ELSIE LANE PRESCOTT VALLEY AZ 863150000
Site Mailing Address: 6700 ROCKRIDGE DR, Anchorage
This permit is for the construction of:
N Disposal Field Y Septic Tank N Holding Tank
Lot Size in Sq Ft: 63844
Total Bedrooms: 7
N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued By:
MUNICIPALITY OF
Community Development Department
Development Services Division -
On -Site Water & Wastewater Program
r
ON-SITE SEWERIWELL PERMIT APPLICA
Parcel I.D. 015 331 10
Property owner(
Mailing address
Site address f
Phone: 907-343-7904
F i,;--�3-7997
JUL 16 2015
Legal description (Sub'd., Block & Lot) G-AkE (9 ! 4
Legal description (Township, Range & Section)
Lot Size 63, Q q Sq. Ft. Number of Bedrooms
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF)
sa
Septic Tank
®
Upgrade ®
(w/wo ADU)
Tank
❑
Renewal ❑
Duplex (D)
ElHolding
Multiple Dwellings
❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
NOi✓,e Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
owner or authorized agent)
.#VQ
Permit/Rush Fees: $ 21 + `Waiver Fees: _
Date of Payment:Date of Payment:
Receipt Number: 035:V4G 190633 Receipt Number:
Permit No. 05Q 161 22A Waiver No.
Permit App9-1-12.doc
C&M ENGINEERING SERVICES
Ph: 907-854-5558
Municipality of Anchorage
Onsite Water & Wastewater Program
4700 Elmore Rd Anchorage, Ak 99507
RE: Proposed Septic System Modification for Lake O' The Hills Block 4 Lot 2
Dear Reviewer,
The above referenced property is currently served by a 4 bedroom septic system. With a diverter valve
connecting an additional 4 bedroom system, and an older crib.
The Home has recently been sold, and received a COSA in July 2015. The new owner would like to
upgrade to a 7 bedroom system. We are requesting approval to upgrade to a 7 bedroom system.
The proposed design for this upgrade includes a new septic tank sized for 7 bedrooms, and makes use of
both of the existing trenches. The crib will be connected as well, however the capacity of the crib is not
considered for the purpose of the design.
In addition to the proposed upgrade, we are showing two reserve systems on the lot. The first reserve
system, is the existing bed that would require the use of a category III AWWTS to be suitable for a 7
bedroom home. The second reserve site, shown in the Northwest of the property, is a double deep trench
configuration that would likely require a lift station. This may be a better location for a reserve system, but
a soils investigation has not been conducted at this location to support the design. The second reserve
system is not a "designed" component of this submittal, but is included to identify a probable future
reserve site.
Installation of the proposed system will not negatively impact adjacent lots. Drainage is not a major
consideration in this design due to the large size of the lots.
Included with this letter is a permit application, plans, specifications, and calculations.
Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854-
5558 or by email cgbalzarini(o)gmail.com with any questions or concerns.
Sincerely,
Charle Balzarini, PE
C&M ENGINEERING SERVICES
Ph: 907-854-5558
SPECIFICATIONS FOR ONSITE SEPTIC SYSTEM - MOA CERT ff
LEGAL: Lake O' The Hills Block 4 Lot 2
s= 4 T �0®
July, 2015°'
*o
A. GENERAL.:." ...®
7faareni Q®
1. The septic design is for a 7 bedroom, residence only. �s¢�r®®
2. The site plan and drawings shall be a part of this specification.
3. The Wastewater system shall be installed by a certified installer in accordance with
moa requirements. All materials and workmanship shall meet the Anchorage
Department of Health and State Department of Environmental Conservation
requirements.
4. All excavations and depths are advisory and are to be verified in the field by the
contractor to meet Municipality of Anchorage, Department of Environment of
Conservation requirements.
5. It is the responsibility of the owner to obtain all necessary permits or easements and
to locate any adjacent multi -family wells. A licensed surveyor should locate all
nearby lot lines, easements, exact 100' radius from the existing and neighboring on-
site wells, and any nearby surface water.
6. The excavation is to be exactly in the area shown on the site plan, any deviation
requires engineer approval.
7. The contractor shall provide the engineer with adequate notice to perform
inspections.
8. Sewer Pipe shall be ASTM 3034, pvc. Insulate the sewer line if it passes under the
driveway or parking area, with a minimum of 2" extruded board insulation, rated for
burial, and on the moa approved list.
B. SEPTIC TANK
1. Septic tank shall be a fiberglass or steel, 2000 -gallon tank capacity of MOA
approved construction. Installed to meet MOA requirements.
2. Install a foundation cleanout within 5' of the foundation.
3. Install 2 after tank cleanouts between the tank and drain field.
4. A combination of soil and 2" minimum of insulation shall be placed over the tank, to
prevent ponding and promote drainage. The insulation shall be rated for burial and
meet moa requirements.
C&M ENGINEERING SERVICES
907-854-5558
11111600W Septic Design Calculations
Residence: Lake O' The Hills Block 4 Lot 2
system type: Conventional
type: Deep Trench
Application Rate(1996 system) 0.8 gpd/sqft
Application Rate(1984system) 125 sgft/br
required absorption area 1093.75 sqft
Tank:2000 gallon
Existing 1984 Drainfield : 2.5'x50'x5' W'xL'xD' trench
Existing 1996 Drainfield: 2'x57'x6.5' W'xL'xD' trench
Total effective absorption area: 1241 sqft
Calc By: CGB Date: 7/13/2015
+++( OF 441
+,gyp,.••....., q� 0�
9 i4
:• ass. .,
number of bedrooms
7
br
Water usage/bedroom
150
gpd/br
Water Usage
1050
gpd
Percolation Rate
varies
min/inch
Test Hole Depth
18
ft bgs
system type: Conventional
type: Deep Trench
Application Rate(1996 system) 0.8 gpd/sqft
Application Rate(1984system) 125 sgft/br
required absorption area 1093.75 sqft
Tank:2000 gallon
Existing 1984 Drainfield : 2.5'x50'x5' W'xL'xD' trench
Existing 1996 Drainfield: 2'x57'x6.5' W'xL'xD' trench
Total effective absorption area: 1241 sqft
Calc By: CGB Date: 7/13/2015
+++( OF 441
+,gyp,.••....., q� 0�
9 i4
:• ass. .,
C&M ENGINEERING SERVICES
907-854-5558
Reserve Septic Design Calculations
Residence: Lake O' The Hills Block 4 Lot 2
Calc By: CGB Date: 7/29/2015
EXISTING 2'x57' —
TRENCH W/6.5'
EFFECTIVE DEPTH.
752 SOFT
NEW 50/50 FLOW
SPLITTER
LOT 1
LEGEND
0 CLEANOUT
rm IT, WzIN1101 tiumq
® TEST HOLE
0.5% SLOPE INDICATOR
ROCKRIDGE ROAD j��P•' '9+)
i *: 7H
ALTERNATE SEPTIC RESERVE • •' •'
SITE, REQUIRES SOILS
EXPLORATION. AND LIFT �Z • • ARLES G BALZARINi
STATION. �r PF'• C _13a.
PLACE -6" FLL
5— TO PREVENT PONDING ,II;F�pROFESSIONA ��
�\ NEAR CLEANOUT
APPROX idR16-� EXISTING 2.5'x50'
2% LOCATION TRENCH W/ 5'
EXISTINGt``. EFFECTIVE DEPTH.
i2 l � DIVERTER'•. 10% 500 SOFT
I \ r USE OLD BED AS RESERVE
SITE. WILL REQUIRE USE
\ OF CAT III AWWTS. BED IS
\\ 12x47x3' EFF. PER 1974 INSP.
\\\ a REPORT
p
ABANDON/DISPOSE
TP1 yl° , \ f� OF EXIST. TANK PER
PANONE, \ MOA REQUIREMENTS
19961 \\
I � �
i
NEW 2000 GAL SINGLE FAMILY
I I / STEEL SEPTIC DWELLING
TANK. j�rl `WAS+
RSG I - °. -.::_ •.' .'
=L4 RADIUS I � - _ ; ::�•::;:' •
I W LL
F I ....'..:.':
LU
/ 1 DRIVEWAY
Lu
U)
I APP ROX TOP
<:.,..
\ OF SLOPE
F- LOT 2 +, .
FENCE •�_` �:. ;.
APPROX TOE
\ OF SLOPE
L----------------------
10' UTILITY EASEMENT
NOTES:
LOT 3
LOT 3A 1. THE PROPOSED SEPTIC SYSTEM IS GREATER THAN:
100' FROM ANY PRIVATE WELLS
200' FROM ANY PUBLIC WELLS
100' FROM ANY SURFACE WATER
C&M ENGINEERING SERVICES
907-854-5558
LEGAL DESCRIPTION: LAKE O' THE HILLS BLOCK 4, LOT 2
OWNER: GARY JONES DATE: 07/15/15 1 REV: 0 DRAWN: CB I REF:
SITE PLAN
,-SAL
LIAR 13 20 13
susifii'7
IdARid4..
Inspection Report_1-1-1 .d
Municipality of Anchorage
Community
Development Department Page 1 of 3
On -Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519.6650 • http:#www.muni.org/onsite • (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSPI41442
PID Number: 015-331-10 ❑ New ❑✓ Upgrade
Name:
Wendi Hiltwein & Colin Flaherty
ABSORPTION FIELD
❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
6700 Rockridge Drive
❑ Other
Phone
Number of Bedrooms
Soil Rating.
Total depth from original grade
4
GPD/SF
- Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision
Block Lot
LAKE O THE HILLS
4 2
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range
Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
I Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Lift Station
Tank
Line
Ftp
I NAFt.
Well
100+
100+
N/A
N/A
NIA
TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank
Capacity
1250G,1.
Surface Water
100+
100+
NA
N/A
Matedal
Steel
Number of compartments
2
-
Lot Line
88.4
11.4
NA
N/A
NA
Foundation
17.6
27.3
NA
N/A
LIFT STATION
Manufacturer
Capacity
Gal.
Curtain Drain
50+
50+
NA
NIA
Pump on level at
Pump off level at
High water alarm at
Remarks Tank Install Only
in.
in.
in.
Pump make and model
Electrical Inspections performed by
to
PIPE MATERIAL House to tank 3034 Tdrainfield n eld 3034
Installer
A Plus Home Services
Drainfield 3034 CorMT 3034
Inspector Pannone Engineering Services
BENCHMARK (Assumed elevation) 100ft
Insp
15 10/13/14
Location and description
2nd
dates:
SW Corner of House
3r° 4M
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
OF, A(, -k'k,
Conditional Approval:
Date
'f'9r
en f. �anr ome
�r StevAW
Approved
Date 1.5r^�yqp
Inspection Report_1-1-1 .d
I
SEPTIC AREA (E)
ROCKRIDGE ROAD
DRAIN FIELD (E)
F�
/
SEPTIC AREA (E) RIB -7 I /
FC3
A LOCH OF
oco ABANDONED BED
BV T2 TI M --M _M
FC2 1 94.9 1 73.8 1 149.3
CRIB 70.3 49.9 129.4
DV 51.5 29.6
S6,
2
NOTES: PANNONE ENG SVC, LLC
RECORD DRAWING P.O, BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
LAKE 0 THE HILLS, BLOCK 4, LOT 2
WENDI HELTWEIN & COLLIN FLAHERTY
6700 ROCKRIDGE DRIVE
PLAN ANCHORAGE, AK 99516
WELL (E)
w�— w� W/
I
3
1
3
SEPTIC AREA (E)
NEW 12509
SEFBOTANK
CE 8149
PROFILE
1"=50'
P.I.D. NO
015-331-10
PERMIT NO
$� OSP141442
Sheet
1 OF 1
MI�
I
• �/'
%
DRAIN FIELD (E)
A
8
Fc l
12508 SEPTIC TANK
^\ 101
O1\
DECOMMISSIONED PER CODE
INSTALLED NEW 12508 SEPTIC TANK
1I
WITH DCO AND DV
vc 4BR
4
('
HOUSE
(E)�LL
(E)
WELL (E)
/
A
B C
FC
35.5 49.5 \
T1
45.9
19.8
T2
49.6.
26.2 \
DCO
50.7
28.1
FC1
58.3
29.1 92.3
\
M1
74.4
50.1 124.2
W�
FC2 1 94.9 1 73.8 1 149.3
CRIB 70.3 49.9 129.4
DV 51.5 29.6
S6,
2
NOTES: PANNONE ENG SVC, LLC
RECORD DRAWING P.O, BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
LAKE 0 THE HILLS, BLOCK 4, LOT 2
WENDI HELTWEIN & COLLIN FLAHERTY
6700 ROCKRIDGE DRIVE
PLAN ANCHORAGE, AK 99516
WELL (E)
w�— w� W/
I
3
1
3
SEPTIC AREA (E)
NEW 12509
SEFBOTANK
CE 8149
PROFILE
1"=50'
P.I.D. NO
015-331-10
PERMIT NO
$� OSP141442
Sheet
1 OF 1
Permit Number:
Tax Code Number:
On -Site Water and/or Wastewater System
Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
OSP141442
01533110000
Work Type: SepticTank Upgrade
Permit Effective Dates: October 13, 2014 to October 13, 2015
Design Engineer: PANNONE ENGINEERING SERVICE
Subdivision: LAKE O THE HILLS
Site Legal Address: LAKE O THE HILLS BLK 4 LT 2 G:2639
Owner/Address: HILTWEIN WEND] J &
FLAHERTY COLIN M 6700 ROCKRIDGE DR ANCHORAGE AK 995161898
Site Mailing Address: 6700 ROCKRIDGE DR, Anchorage
This permit is for the construction of:
Lot Size in Sq Ft:
Total Bedrooms:
63844
N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
1. The Inspection Report is to show all parts of the existing absorption systems.
2. The Inspection Report is to show the correct size of the (e) crib.
Received
Issued By
By: 0/j�// Date: tV l
Date: /D �: �
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division QD Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
33l
Parcel I.D. 0150-10
Property owner(s) Wendi Heltwein & Collin Flaherty Day phone
Mailing address 6700 Rockridge Drive, Anchorage, AK 99516
Site address 6700 Rockridge Drive
Legal description (Sub'd., Block & Lot) Lake O The Hills, Block 4, Lot 2
Legal description (Township, Range & Section)
Lot Size 63,844 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
(® all that apply)
Absorption Field [
Septic Tank
❑x
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
APPLICATION IS AN:
Initial ❑
Upgrade ❑X
TYPE OF DWELLING:
Single Family (SF)
(w/wo ADU)
Duplex (D)
Renewal ❑ V
Multiple Dwellings
f�T'Al (SF and/or D)
OCT 0 1 2014
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or
Permit/Rush Fees: 215. Waiver Fees: _
Date of Payment: to I 2 -fig _( Date of Payment:
Receipt Number: 0 11 45L Receipt Number:
Permit No. (%pIL{tL442- Waiver No.
Permit App_;;- :- :'-._c
IN
e
Pannone Engineering Services uc
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steveraoanengak com
October 1, 2014
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road
Anchorage, Alaska 99519
Subject: Lake O The Hills, Block 4, Lot 2
Emergency Septic Tank Replacement Permit Request
Ladies and Gentlemen:
I am writing to request that a permit to install a new 1250 gallon septic tank be issued for this lot.
The proposed system will serve an existing four-bedroom house. Currently the lot is developed.
The existing septic system was designed and installed for four bedrooms, and the existing drain
field is operating adequately. The baffle in the existing 1250 gallon septic tank has failed,
allowing solids to flow through to the outlet, blocking the pipe. The existing tank will be
abandoned per code. This lot and the surrounding lots are served by private wells. There are no
wells within 100' of this system.
1. Upgrade Tank Design.
a. See Sheet 1 of 1 of the plan set
2. Surface Water: There is no surface water within 100 feet of the proposed system. The
Proposed systems will maintain at least 100 feet from all surface water and drainage ditches.
3. Topography: The area around lot 2 generally slopes from south to nouth. The proposed
installation will be located in the central portion of the lot, behind the house, and next to the
existing septic tank and absorption system.
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 1/2 East Manor Ave, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
Page 2 of 2
The proposed installation will not affect the future development of the surrounding or existing
lots. If you have any questions or concerns, please contact me at 272-8218.
Sincerely,
Steven R. Pannone, P.E.
Owner/Civil Engineer
Attachments:
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 1/2 East Manor Ave, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
I
SEPTIC AREA (E)
ROCKRIDGE ROAD \
DRAIN FIELD (E)
SEPTIC AREA (E)
M
1q—iAte,
DRAIN FIELD (E)
12SOg SEPTIC TANK (E) COLLAPSING ^ 1 00.3
DECOMMISSION PER CODE LJ
INSTALL 125.0g SEPTIC TANK (P)
WITH DCO AND DV 4BR
1� HOUSE
(E)
ELL (E) �� \
WELL
N�—W—�w� \
WELL (E)
oP W I
WS \N
NOTES. PANNONE ENG SVC, LLC
TANK REPLACE P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
LAKE 0 THE HILLS, BLOCK 4, LOT 2
WENDI HELTWEIN & COLLIN FLAHERTY
6700 ROCKRIDGE DRIVE
PLAN ANCHORAGE, AK 99516
10/1/14
"' P.LD. NO
015-331-10
Steven Rannone % PERMIT N0.
P�•. CE 8149 .. `�% OSpXXXXXX
sf,_r
(`ll`�,Sheet
OFESSIONP��"
h�.� 1 of 1
Municipality of Anchorage Page of
DEPARTMENTOF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number.gi (zZ4 PID Number: 015 -33 ! - / O
Name:II
Wastewater System: ❑ New Upgrade
—190W r MS
Address:
ABSORPTION FIELD
n a)cYT2t a
Phone:
No. of Bedrooms:
Deep Trench ❑ Shallow Trench ❑ Bed O Mound ❑ Other
Soil Rating:
Total from original grade:
LEGAL DESCRIPTION
O•f3 GPD/Sq. Ft.
/3.(.& a -"r77 19.1
Lot: Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
Z Lf GAE& D D }{raS
:7, -rb I1.$' Ft.
6 = Ft.
Township:
Range: —rac�
Fill added above original grade:
Gravel length:
r
— v — Ft.
Ft.
Gravel width:
Number of lines:
Distance`etween lines:
WELLEl ❑Upgrade
•
2 m Ft.
I
Ft.
Classification (Private, A,B,C):
Total Depth:
Cased To:
Total absorption area:
Pipe material:
Ft.
I Ft.
'�.SZ SO. Ft.
-5®3 e4 FBSC
Driller.
Date Drilled:
Static Water Level:
Installer:
Date installed:
Ft.
Millkis. A 6l--�ta2sar✓
Yield:
Pump Set at:Casing
Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION
DISTANCES
Septic ❑ Holding ❑ S.T.E.P.
To
Septic
Absorption
Lift Holding ublic/Private
manufacturer:
Capacity In gallons:
From
Tank
Field
Station Tank Sewer Lines
(i[".ST
/ 4`
N((A �rA
Material:
Number of Compartments:
Well'
),S
/oo
.Sv
Surface
LIFT STATION
/ct�-r
WateLot
/00r
Size in gallons:
Manufacturer:
Line
R$'
,
So
"Pump on" level at:
"Pu evel at:
High water alarm at:
Foundation
I'S
2 R
Curtain�
Pump Ma el
Electrical Inspections performed by:
Drain
BENCH MARK
Remarks: S—,st-L-rh �.yT [L L
Location and Description:
•
'/
(5, AQA6, X "'Aoo2 STeP S.c.v• 5 E 2P
L LL Sot ty sr r NT
Scor `� Lall I c7t2t
G7P�rR✓.��! t`G.
Assumed Elevation:
Ft
EN S
yp. yyCe .� `!SEAL
4�
/,kq 9
�N / 6
Inspections performed by: �• .VONT` ta_Dates: 1s t
2nd
. .,,..
R. Ponn®na -
Heal h u ervices approval
�5Stevan
`n
Department of and
Reviewed and approved b . Dater_:.
72-013 (Rev. 9/91) MOA 25 V
No well or septic systems
within 200 feet.
Undeveloped.
C.O:
A
B
T1
15,8'
44.7'
T2
20.3'
46.6'
By
21.1'
46.9'
C1
22.1'
47.4'
c2
22.6'
47.6"
C3
29:1'
59.1'
MT
50:2'
75.2'
C4
73.8'
95.6'
49TH
R.
49
AS -BUILT
WASTEWATER ABSORPTION SYSTEM
Lot 2, Block 4 Lake O'the Hills
Rack Ridge Drive
No well or septic systems
within 200 feet:
RECEIVED
OCT 231996
Municipality of Anch
Dept. Health & Human 7
DESIGN:
Soils = 0,8 CBS sf/br)
4 Bedroom House
752 sf required
/P.6' effective, 10' total depth
(� Sq, 60 L.F. 2' wide
WO sf total absorption
Ms. Laverne Hodge
6700 Rock Ridge
Anchorage, AK 99516
stic systems
t of proper
Welt 150 feet from
exist, well on lot -2.
i
STEVEN R. PANNONE, P.E.
P. 0, BOX 142025
ANCHORAGE, ALASKA 99514
AS -BUILT
No well or septic systems
within 200 feet.
Undeveloped.
CA.
A
B
TS
15.8'
44.7'
T2
20.3'
46.6'
C2
21.1'
46,9'
CS
22.1'
47.4'
DV
22.6'
47.6'
C3
29.1'
59.1'
MT
502'
75.2'
C4
73.8'
95.6'
11-19-96
R. Panni
CE 8148
AS -BUILT
WASTEWATER ABSORPTION SYSTEM
Lot 2, Block 4 Lake O'the Hilts
Rock Ridge Drive
No weft or septic systems
within 200 feet.
Z/-3
ptlC systems
!t of oronert%
DESIGN:
Solis = 0.8 C1B8 sflbr)
Well 150 feet from
exist. welt on tots 2.
4 Bedroom House
752 sf required
••--
6,6' effective, 13' total
depth
57 L.F. 2' wide
�}
57
752 sf total absorptlon
2
.....f
•
•
PREPARED
FOR,
STEVEN R. PANNONE, P.E.
Ms. Laverne
Hodge
P. O, BOX 142025
1
At
;mss
6700 Rock Ridge
ANCHORAGE, ALASKA 99514
Anchorage,
AK 99516
„l„ �, 4 ^
AS-BUILTDETAILS
WASTEWATER ABSORPTION SYSTEM
Lot 2 Block 4 Lake ❑'the Hills S/D
Z
H
U
W
0
•�p.
a
a
n
'
+m'o
u�
e
r#a m
Imo
Com
x LS
LO0
(m,p&
LL
Cpm
�,
y�
ROjy
C
m
�'LYtl
RmpUy
ILLM
a fe
m] m
IO
�uu'
m9mo�
cas
.^.mvr
mLL
msvav
lV
Y
Z
H
U
W
0
•�p.
a
r
'
+m'o
ai
e
r#a m
Imo
Com
x LS
LO0
(m,p&
L4 CxL
Cpm
H�GDO
ROjy
U-p� y
m
�'LYtl
RmpUy
maw
LGE3
a fe
m] m
Qi't=L
uma
�uu'
m9mo�
cas
.^.mvr
mLL
msvav
.571
49R ils�
n""; Revised 11-19-96 KEPREPARED FORS
renR. Pannaner +
«
+ Ms. Laverne Hodge
No.CE 8149 6700 Rock Rldge
�t,,..? lam` Anchorage, AK 99516
ti
v
0
N
inawno c
3Hn1 smiNew
b
O
N
inoNv3�a c
8AIDA MJ11rd
1nilw3l]
Ino w3ln
IrMNV3M
ln@w31n
NaUVQWMA
RECHVED
DEC o2 199G
mulr C-pci-iy :jj At .Cnu'1
Dept. Health & Human Se
m o
M
a m
a .r
N
0
a
STEVEN R. PANNONE, P.E.
P. O. BOX 142025
ANCHORAGE, ALASKA 99514
274-0308 272-8218 FAX
%TQ 7-22-96
FIT Tn creic AS -BUILT
PAGE 1 OF
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW960129
DESIGN ENGINEER:STEVEN R. PANNONE
OWNER NAME:WILLIAMS THOMAS H JR & NANCY B
OWNER ADDRESS:6700 ROCK RIDGE DR
ANCHORAGE, ALASKA 99516
PARCEL ID:01533110
LEGAL DESCRIPTION:
LAKE O THE HILLS BLK 4 LT 2
LOT SIZE: 63844 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
DATE ISSUED: 6/20/96
EXPIRATION DATE: 6/20/97
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY
DATE: &-?a- ¢b
1
Steven R. Pannone, P.E.
Consulting Engineer
June 5, 1996
Municipality of Anchorage
Dept. of Health & Human Services
On -Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519
Subject: Lot 2, Block 4 Lake O' the Hills S/D
Request for Septic System Up -grade Permit
Attn: Mr. James Cross, P.E.
Dear Mr. Cross:
P.O. Box 142025
Anchorage, Alaska 99514
(907)272-8218
I reinvestigated the soil absorption system at the above referenced lot this spring. The system laterals were
found to be installed level. Fluid levels in the existing crib and deep trench were also found to be higher.
Therefore I request that a permit be issued to up -grade this system per the attached engineering design.
A soils investigation was conducted on May 24, 1996. The soils were found to be poorly graded gravels to
well graded sands. A peculation test was conducted and the soils percolated at 8 minutes per inch. See
attached soils log and peculation test. No water was encountered during the test or after seven days.
A deep trench system will be installed adjacent to the existing system, yet maintaining a separation of 10 feet
from the existing crib. A Zabel Z2000D flow director will be installed just downstream from the tank. It will
be used to divert the flow between the new drain field and the existing fields. The existing septic tank will be
inspected. If the tank is found competent, it will be reused. It will be replaced if the tank is found
incompetent.
There are no wells within 200 feet of the proposed location on neighboring lots. The well serving lot 2 is
located greater than 100 feet from the proposed location. Additionally, there are no septic systems within
100 feet of the proposed installation. The system will be placed greater than 50 feet from the bluff located on
the east edge of the lot. The surrounding are will not be affected by this system.
Please contact me if you have any questions.
Sincerely,
Y $�
Aw
even R. Pannone, P.E.
Civil Engineer°"eY
{ N�'$� EiaveR R. Pain.na
CE CAWORK\2-4LO11.003 f«� a )I
No well morseptic systems
.,thin 200 feet.
Undeveloped.
-ms's••-
3
49TH
12
8149
DESIGN DETAILS
WASTEWATER ABSORPTION SYSTEM
Lot 2, Block 4 Lake O'the Hills
Rock Ridge Drive
No well or septic systems
within 200 feet.
,eptic systensl
let.
DESIGN
DESIGN,
Solis = 0.8 (188 sf/br)
4 Bedroom House
Weil 130 feet from
exist. wait on lois
\
752 sF required
6' effective, 10' total
depth
65 L.F. 2' wide
>}
2 ss
,
780 sf total absorption
i
PREPARED
FOR,
STEVEN R. PANNONE, P.E.
All
Ms. Laverne
HodgeAs
P. ❑. BOX 142025
'Ar
6700AnchRockR
ANCHORAGE, ALASKA 99514
Kg 99516
DESIGN
DESIGN
DETAILS
WASTEWATER
ABSORPTION SYSTEM
Lot 2 Block
4 Lake O'the HIL(s S/D
1nwm3m Elm
n
s
6
g
1
u
e�° &
v
m$ �
y a
L7
301 8MDUN
UZb
e°°ene°e
MOORS
Z
W
o°^°
U
R
W
W
J
W
P• N
IfMNtl3'M
El
D_
s
L o
YEb
d"
b
�yb
Et4
V]
d
Lim
y
ObO
4
MLytl
tlbC14
sa3
o
HOW=
ma H
y u o y
1nONtl319
scar
hmki+
3
1nmum
.j d
LrENV313 28 L
`�
� ,lei
♦��E
411C;G%ae�....... ...... `
��
JfMNV313
AV 9 4•
�B
NDI1YQNnEU
s 492i
..mL..u..............................h.....,
..................................may
•"'?' (f
R. Pannone.°7s
PREPARED FOR
STEVEN R. PANNONE,
P.E.
{ cSteven
{ G) .• i
♦ •., No. CE 8149 ��
Laverne Hodge
P. ❑, BOX 142025
,!j`,`'•QboboS.��'
67
6700 Rock Ridge
Anchorage, AK 99516
ANCHORAGE, ALASKA
99514
:'�ps�
72-8218
A 74526
FAX
962DEi
DESIGN
T
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: DATE
LEGAL DESCRIPTION: GOT ZZ 41 LA00 TBB h1fleS 5&TOWnsnip, Hange, Section:
—DE —PT-HSLOPE SITE PLAN
(FEET)
OCL
2
3 St -1
4-
5
6
7
Cvp
8
sw
9-
1011 10-
11
12-
13-
14-
15-
16-
17
21314151617
18
"PP tf
19-
20
COMMENTS T� UJJo s -V-�Q t2SoA k LO
WAS GROUND WATER
ENCOUNTERED? NO
S
IF YES, AT WHAT O
DEPTH? P
E
Depth to Water After
Monitoring) Date: S -31-96
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
-201-96 Qe
13LIvz
1/i
1?-/ q
S/M
3/
17,21
Z
3/
1 ? Z3
z
i/
t
t?25
2
CV
1?z
Z
CPV
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER 6 r
TEST RUN BETWEEN F7 AND _R FT
PERFORMED BY: S`QQ1 A.vNoNC$ � CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85) -
4 V
• Munielpt 0. ty of Anehor ge
Department of Health and Human Services
825 " L' Street
Rick Nlystrom, 9
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
December 9, 1996
Steven R. Pannone, P.E.
PO Box 142025
Anchorage, Alaska 99514
Subject: Waiver Request for Lot 2 Block 4 Lake O' The Hills Subdivision
Waiver Request #WR960047, PID #015-331-10, HA950539
Dear Mr. Pannone:
Your request for a waiver of the required 100 foot horizontal separation of an on-site
wastewater disposal system to a private well has been approved. The approved separation
distance is 95 feet from a private well to the septic tank on property.
This waiver approval applies to the existing on-site wastewater disposal system to well
separation only. Any future upgrade to either will require all separation distances be met
or another approval from this department.
If there are any further questions or concerns regarding this waiver, please call our office
at 343-4744.
incerely, n
1
G'v1�i'ly�
ames P. Williams
'l Civil Engineer
On-site Services
JPW/1jm;Williams
* s .MUNICIPALITY OF ANCHORAGE•
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR# WR960047 PID# 015-331-10 HA# HA950539 Permit #
Date Received: September 4, 1996
Legal Description: Lot 2 Block 4 Lake O'The Hills Subdivision
Engineer: Steven R. Pannone, P.E.
PO Bos 142025 Anchorage, Alaska 99514
Applicant: Thomas Williams
Waiver Requested: Private well to on-site septic tank of 95 feet
Criteria: 1. Geology:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
2. Special Conditions:
3. Other:
Points:
6,
jLc
i.3
ly-Y
Waiver is Granted: Waiver is NOT Granted:
List Conditions or Reasons for above: L", �c ��41
.
Rec #: #02302/2135 Amount: $ 625.00 Date Paid: -Sept 4, 1996
L
7 -ME ll/LAS
Uvf}Zfz� l•L; TAt3�c i�njP71 (J 10 � &
wia(c Lot -
160 '410
�`Rt2�N�kt- �APdi7[aN;'
Steven R. Pannone, P.E.
P.O. Box 142025
Consulting Engineer Anchorage, Alaska 99514
(907)272-8218
September 2, 1996
Municipality of Anchorage
Dept. of Health & Human Services
On -Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519
Subject: Lot 2, Block 4 Lake O' the Hills S/D
Request for well to Tank Waiver
Attn: Mr. James Cross, P.E.
Dear Mr. Cross:
I am writing to request a waiver be granted between the well and septic tank at the above property. A waiver
should be issued for the following reasons;
- The distance from the tank to the well is measured to be 95 feet.
- This tank was installed in 1984. Since that time, there has been no instances of bacteria in the drinking
water. The nitrate count is measured at 3.8 mg/l on November 19, 1995. There was no bacteria present.
- A new system was installed in June of 1996. The tank was inspected and found competent.
- The depth from the bottom of the tank to the well static water is 30 feet.
- The soils are silty sand to silty gravels.
- The water table gradient from the tank to the well is approximately 10 to 20 percent uphill. The water table
generally flows to the Northwest, and the tank is located Northwest of the well.
Using the accepted method of scoring the above items as issued by ADEC, this well scores between 16 and
25, which indicated the well is almost sure to be free from any form of contamination from household
sewage. Therefore, I would request that a waiver be granted.
Please contact me if you have any questions.
Sincerely,
Steven R. Pannone, P.E.
Civil Engineer
C:\WORK�2-41,011.004
' 8'� 'n R. Fannrnia
jr,; k
a,,..
�"VV i
Steven R. Pannone, P.E.
Consulting Engineer
September 2, 1996
Municipality of Anchorage
Dept. of Health & Human Services
On -Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519
Subject: Lot 2, Block 4 Lake O' the Hills S/D
Request for well to Tank Waiver
Attn: Mr. James Cross, P.E.
Dear Mr. Cross:
P.O. Box 142025
Anchorage, Alaska 99514
(907)272-8218
RECEIVE®
SEP 6 1996
Municipallty 01 ABn Services
Dept. Health & Hum
I am writing to request a waiver be granted between the well and septic tank at the above property. A waiver
should be issued for the following reasons;
- The distance from the tank to the well is measured to be 97.7' feet.
- This tank was installed in July of 1996. The existing task was located closer to the existing well. Moving
this tank improved the situation.
- The depth from the bottom of the tank to the well static water is 75 feet.
- The soils are well graded sands and gravels with a rating of 125 sf/br..
- The water table gradient from the tank to the well is approximately 10 to 20 percent uphill. The water table
generally flows to the West, and the tank is located Southeast of the well.
Using the accepted method of scoring the above items as issued by ADEC, this well scores between 16 and
25, which indicated the well is almost sure to be free from any form of contamination from household
sewage. Therefore, I would request that a waiver be granted.
Please contact me if you have any questions.
Sincerely,
Steven R. Pannone, P.E.
Civil Engineer
C:kwORxu 1-2wn,rbtt.002
RECEIVED
OCT 23 1996
u i ity of Anchorage
.Steven R. Pannone, P.E. P � ���, &Human service
Consulting Engineer Anchorage, Alaska, 99514
(907)272-8218
October 13, 1996
Municipality of Anchorage
Dept. of Health & Human Services
On -Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519
Attn.: Mr. Jim Williams
Subject: Lot 2, Block 4 Lake O' The Ilius
Septic tank to well waiver
Dear Mr. Williams;
You requested additional information on how the points were derived requesting a waiver for the above
property. Attached is a site plan showing the adjacent properties, general site topography and approximate
location of wells and on-site soil absorption system on each lot.
Lot 2 is approximately 1 '/2 acres. The lot slopes gradually from the north to the south, with the southwest
corner dropping off to an undeveloped forest. The well is situated in front of the garage. It was located in a
pit, but was extended to meet MOA Health Authority Guidelines. The seepage trench is located along the
northwest boundary of the property, approximately fifty feet east of the western property line and located
approximately 102 feet from the well serving this lot and approximately 250 feet from the neighboring well to
the west and 200 feet from the neighboring well to the southeast. The soil absorption system was installed in
June 1996. The original septic tank clean-out was measured to 97.76' from the existing well. The integrity
of the tank was confirmed during the new soil absorption system installation in June of 1996. The sewer
systems and well on the west side of Lot 2 is similarly situated, but with the well located on the west side of
the lot and the septic on the eastern portion of the lot.
The exact date of drilling the well is unknown; we found that it is cased to over 40 feet and that the static
water level was 34.5 feet below ground level. Well logs for the adjacent lots cannot be found in the records
maintained by your office. It is assumed that the wells were drilled by the same company during the same
time frame. A well flow test showed the static water lowered eight feet while flowing at approximately 4.5
G.P.M. An adequacy Investigation conducted in December of 1995 indicated that there was no bacteria and
minimal nitrates (3.8 mg/1) in the drinking water. Ground water flows generally from the east to the west.
I conducted a soils investigation for a new system in May of 1996, The soils on Lot 2 were logged to be
poorly graded gravels and sands to a depth of 18 feet. No water was encountered in this test hole. It can be
assumed that the soils are similar on the adjacent lots.
Mr. Jim Williams 0 C T 23 199G
October 13, 1996
Page 2 Municipality of Anchorage
Dept. Health & Human Services
As outlined under 18 AAC 80.020 and 18 AAC 72.021(a), I have calculated the following points:
Distance from sewer system bottom to groundwater
4.5
Soil absorption below sewage system
2.0
Soil permeability below the system
1.0
Water table gradient
6,0
Horizontal separation
2.8
Total Points
16.3
16-25 Almost sure to be free from any form of contamination from household sewage.
In my opinion, this waiver request meets the above criteria for approval and does not constitute risk to
health. The soil absorption system is located greater than 100 feet from the well, and the septic tank has been
in continuous operation since 1974 without any contamination of the well. I hope the above information will
assist you in determining that the waiver should be granted. If you have any questions or concerns, please
contact me.
Sincerely,
CA)VORK 2 4LOn.005
Steven R. Pannone, P.E.6�Ce
l h.
Civil Engineer
Attachments`
CA)VORK 2 4LOn.005
Steven R. Pannone, P.E.
P. O. Box 142025
Consulting Fngineer Anchorage, Alaska, 99514
(907)272-8218
November 19, 1996
Municipality of Anchorage
Dept. of Health & Human Services
On -Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519
Attn.: Mr. Jim Williams
Subject: Lot 2, Block 4 Lake O' The Hills
Drain Field Separation
Dear Mr. Williams;
During the development of the as -built drawings for this lot, it was discovered that the new drain field was
installed closer than the required "twice the effective depth" to the existing crib. From as -built information
gathered from your files, field measurement and observations, I estimate the distance between the new and
existing field to be approximately six feet. I request the distance requirement be waived to six feet for the
following reasons:
► During the as -built survey, I took an elevation of the top of the crib clean-out to establish a
relationship between the new and existing systems. The bottom of the new trench is 0.9 feet lower
than the bottom of the existing crib. While the top of the new trench is 0.3 feet lower than to top of
the crib.
► The soils encountered in the new system area were classified as poorly graded gravel to well graded
sands that percolated at eight minutes per inch. The existing crib's soils report indicated the soils
were rated for better than 125 square feet per bedroom (SW -GW).
► During construction of the new field, no moisture of any kind was encountered. The crib was still in
operation and full serving the house which was occupied by six adults. This indicates that the liquid is
being absorbed at a rate great enough that fluid will not affect the operation of the new system and
vise -a -versa.
► The exact location of the crib walls in relation to the clean-out is not known. The location shown on
the as -built drawing is a best guess relationship. The exact position can only be determined by
excavating the crib.
Steven R. Pannone, P.E.
Consulting Engineer
Mr. Jim Williams
November 19, 1996
Page 2
P. O. Box 142025
Anchorage, Alaska, 99514
(907)272-8218
Liquid in sandy or gravely soils will tend to absorb at steep angle. Assuming an absorption angle of
45 degrees below horizontal, the six foot separation would be adequate for the estimated six foot
distance.
The area encroached by the new trench is limited to a fifteen foot length along the trench. All other
areas of the trench and crib meet the separation requirements.
In conclusion, the Department's granting a separation waiver between these two systems will not affect the
operation of the systems, cause health dangers or in any way be detrimental to the overall function of the soil
absorption systems.
Please contact me if you have any questions.
Sincerely,
St— even R. Pannone,
Civil Engineer
CAWORK\2-4LOH.006
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
C
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 2644720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE
EINE
����//�� J
c•01•.�W�-L_L--��d IICE YZ AL,k L014 irLE co
KUPGRADE
MAILING ADDRESS
3/0)- C
LEGAL DESCRIPTION
t,o i 20 6 u �4 C> I—/ r�L�
LOCATION
NO. OF BEDROOMS
Well
Absorption area
Dwelling
PERMIT NO.
O
DISTANCE TO:
([Xj
_Y
i z
Manufacturer /�' (
Material
No. of compartments
y
Liq. �!acity in gallons
I IF HOMEMADO
Inside length
Width
Liquid depth
0 se
DISTANCE TO:
Well L'[
Dwelling t _
PERMIT NO.
SFa-
Manufacturer
Material
Liquid capacity in gallons
d
w=
DISTANCE TO:
Well
/ LL)
l
Foundation
Ll0
Nearest lot line
1-
PERM IT fsJ O.
y O 30(6
J w z
No. of lies
Length of each line
Total length of lines
Trench width
Distance between lines
Zw
—¢
�i7
30 inches
� F
Top of rile to finish grade
Material beneath rile
Total effective absorption area
O
%
&0 inches
� OU
J
Length
Width
Depth
PERMIT NO.
W
0
i I—
Type of crib
Crib diameter
Crib depth
Total effective absorption area
wa
W
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
W
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
_
SOI L TEST RATING
INSTALLER
REMARKS
J6—
0
10 A
L A
L
wti wt .. i aV
7 fit' %�e LS s e ca
r
2225aE.•`.`®® MUNICU
INP 7�1 C171
k EALT
• ,•mil PT. OF
�/� �`••.
4 &
.°��: � ENVIRONMEN
A•
PRC
TEQ ION
APPROVED DATE LEGAL
(RF
L/i t'/ In U i -)-A�
72-013 (Rev. 3/78)
APPLICANT: TOBB I N SPS �R.KLAND
ADDRESS: : 203 W. 15TH
ANCHORAGE: AK 99501
CONTACT PHONE: 279-3916
LEGAL DESCRIP: SUBDIVISION: LAKE O THE HILLS LOT: 2 BLOCK: 4
SECTION: 23 TOWNSHIP: 12N RANGE: 3W
LOT SIZE: 30000 (SQ. FT. OR ACRES)
CERTIFY THAT:
1. I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA.
2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS,
AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT.
3. I WILL ADHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK
DISTANCES FROM ANY EXISTING WELL: WASTEWATER DISPOSAL SYSTEM OR PUBLIC
SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT.
IF A LIFT STATION IS INSTALLED IN AN,AREA COVERED BY MOA BUILDING CODES:
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED: (2) AS -GUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT: AND (3) THE
ELECTRICAL WORE: MUST BE DONE BY A LICENSED ELECTRICIAN.
SIGNED DATE:/?/�L/
APPLICANT: TOBBIN URVLAND
ISSUED BYDATE:
---------
M?,1NICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH
AND ENVIRONMENTAL PROTECTION
825 L STREET,
ANCHORAGE,
AK 95501
264-4720
EDP-4-�S I -IF F=
SEWER
PERM I i"
PERMIT NO: 240306 UPGRADE
DATE ISSUED: 05/07/84
APPLICANT: TOBB I N SPS �R.KLAND
ADDRESS: : 203 W. 15TH
ANCHORAGE: AK 99501
CONTACT PHONE: 279-3916
LEGAL DESCRIP: SUBDIVISION: LAKE O THE HILLS LOT: 2 BLOCK: 4
SECTION: 23 TOWNSHIP: 12N RANGE: 3W
LOT SIZE: 30000 (SQ. FT. OR ACRES)
CERTIFY THAT:
1. I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA.
2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS,
AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT.
3. I WILL ADHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK
DISTANCES FROM ANY EXISTING WELL: WASTEWATER DISPOSAL SYSTEM OR PUBLIC
SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT.
IF A LIFT STATION IS INSTALLED IN AN,AREA COVERED BY MOA BUILDING CODES:
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED: (2) AS -GUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT: AND (3) THE
ELECTRICAL WORE: MUST BE DONE BY A LICENSED ELECTRICIAN.
SIGNED DATE:/?/�L/
APPLICANT: TOBBIN URVLAND
ISSUED BYDATE:
---------
G Q GRE*R ANCHORAGE AREA BOUGH
t �� Department of Environmental Quality
3330 C Street
' Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME iaS PZy r0215f MAILING ADDRESS Sg�
72 ii7
PHONE!itf -'
(161
LOCATION LEGAL DESCRIPTION
2
ke
/A''REST
ADDITIONAL ABSORPTION / 2 x 9-Z v✓uinu
SEPTIC TANK:
DISTANCE /��, J NUMBER OF
FROM WELL/, MANUFACTURER- ✓-C-0 V- MATERIAL S��-e / COMPARTMENTS I
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY )�2-S O GALLONS.
SEEPAGE PIT:
/ 9 X /LT K 91< 9n /7 K Z $
NUMBER OF PITS DIAMETER
/
OR WIDTH_, LENGTH_, DEPTH -
LINING MATERIALZCQ-n_- �i nc: CRIB SIZE:
DIAMETER —DEPTH k DISTANCE FROM: WELL
TOTAL TIVE
BUILDING FOUNDATION ZS NE LOT LINE ABSORPTION RPTIONC�A['REA (WALL AREA) "- n& SQ. FT.
/A''REST
ADDITIONAL ABSORPTION / 2 x 9-Z v✓uinu
P a'✓ea tt' 3QUI �W P�
%�l�S eL�ri q�S
3Q � SCJ � /7TG€'JSri✓fit-ion Gr/�cc !(7fRl �J'OI�fiE
WELL:
TYPE PVi0l fe CONSTRUCTION
DEPTH DISTANCE FROM:
BUILDING NEAREST
NEAREST SEPTIC SEEPAGE
FOUNDATION—,LOT LINE—,SEWER
LINE TANK—,SYSTEM ,
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED
REMARKS)9,41Q'l
DISTANCES: 14✓ //��,, -J 4
DIAGRAM OF SYSTEM
2�fi :' t
•
INSTALLED BY: A2 Z LOCI
TVGn$iif lei
,/
PIPE MATERIAL: Cu5 I✓0,4 qNc(
` rY2 n S; �P
�` ecl/m S nJc%P Z,
LOT SLOPE:
WQ�i
- ClVyin 4i Y)e
REMARKS:
`7/3 7o-fi ab -go otic 1.
DATE 5-ZZ-'�/
APPROVE
.A. A. B.
Form No. EQ -031
GREATER ANCHORAGE AREA BOROUGH
d` b DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO.
& 3330-C"STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
qa4 .A.
SEWAGJE� DISPOSAL SYSTEM - APPLICATION AND PERMIT
NAME OF APPLICANT "" L� MAILING ADDRESS � `- ' 3 l
PHONE
INSTALLATION LOCATION %
LEGAL DESCRIPTION '^ Z' rt kQ
INSTALLATION OF: SEPTIC TANK SEEPAGE PT 4./ DRAINriFIELD OTHER _
TYPE AND SIZE OF FACILITY TO BE SERVED -5; /� (it--v'L
FINANCED THROUGH
SOIL TEST RESULTS
COMPLETION DATE ANTICIPATED
PO BE INSTALLED BY
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION,
SEPTIC TANK SIZE / ?— ® TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT 2 0 , DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK , SEEPAGE PIT DRAIN FIELD
TO NEAREST LOT LINE. /^
WELL TO SEPTIC TANK .� SEEPAGE PIT Z e
DRAIN FIELD ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEEPAGE PIT
SEPTIC TANK, t�% SEEPAGE PIT �, 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.
G.A.A.S.
OR
LICENSED DESIGNER
I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
DATE � - 7 � -TV- APPLICANT'S SIGNATURE
FORM NO. EQ -016
SIZE TYPE
DIAGRAM OF SYSTEM
AREA
�/�/BOROUGH ORDINANCE NO. 26-68 AND THAT THE ABOVE
V %f-'�
-.
FJ-
-_
- -�- --
IIIIII
I--
_ _
- -
--
3
--T 17 .
AREA
�/�/BOROUGH ORDINANCE NO. 26-68 AND THAT THE ABOVE
V %f-'�
G'I�PER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 °C" Street
{ Anchorage, Alaska 9g5O3
Perf,-�ed for
;egg' :iescript'oa'n,- v T
This 'arm reports: Soils logog
Deptr.
Feet
1 _ -- --
_//�� Date performed 5
NLe6Y — --
ercolatiT;
;Jas ground water encountered? X10 If yes, at what depth?
treading
Date
Gross Time
Net Time
Depth co H2O
Net Drof,j
}
I
I I
—77
;Jas ground water encountered? X10 If yes, at what depth?
treading
Date
Gross Time
Net Time
Depth co H2O
Net Drof,j
I I
• �-' �•� , �. Y 1 411 I U LC
Prcpn,;e� installation
Perfc
III 1 tll! t. t;
See[,a�le P -ii: _ Drain Field
""ottom yf pito t,cr��,
MUNICIPALITY OF ANCHORAGE
Development Services Department=1 Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel 1. D. 015 331 10
1. GENERAL INFORMATION
Expiration Date:
Complete legal description Lake O the Hills 134 L2
Location (site address) 6700 RockRidge
Current property owner(s) Ones Day phone
Mailing address
Real estate agent Day phone
2. TYPE OF DWELLING:
❑ Single Family (w/ADU)
F-_1 Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 7
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
0
Private Septic
0
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: NONE Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ J 50 Waiver Fee $
Date of Payment Date of Payment
Receipt Number 060 G 3b Receipt Number
COSA # OSC 211 5 50 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.
Name of Firm C&M ENGINEERING Phone 8545558
Address 20182 TULWAR
Engineer's Printed Name CHARLES BALZARINI Date 9/8/21
OF Al_g,�l
,*.-49TH*
6. DSD SIGNATURE •• ..••• ••••••
System #1 Approved for bedrooms CHARLES G BALZARIUI j
System #2 Approved for bedrooms ��F���. CE -13854
Disapproved ��l%PROFESSO����
Conditional approval for bedrooms, with the following stipulations:
By: Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description: LAKE O THE HILLS BLOCK 4 LOT 2
If more than 1 septic system on lot: COSA Checklist # 1 of 1
A. WELL DATA
-i Well log is filed with Onsite (or attached)
Date drilled LINK
Total depth LINK ft
Cased to UNK ft
❑ Sanitary seal is functioning correctly
OR Wires are properly protected
Casing height (above ground) +12 in.
Date of flow test for COSA 9/14/21
Parcel ID: 015 331 10
Structure served by this system 1
Well production at time of test +5.4 gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate 3.89 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by C.Balzarini
Date of Sample 9/20/21
Static water level at beginning of test 34 ft.
Comments WELL DREW DOWN TO 56' BTC DURING SUSTAINED PUMPING AND STABILIZED
B. TANK DATA
Age of tank(s) 7 years
Tank type/material SEPTIC STEEL
Measured operating fluid level in septic tank 50
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 9/21/21
D. ABSORPTION FIELD DATA Trench
Which system tested (date installed) 1990
❑ ALL standpipes present per record drawing
Total measured depth from grade 15.5 ft (max)
Measured depth to pipe invert from grade 3 ft (min)
❑ N/A – pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 9/14/21
Results IDPass For 7
Fluid depth prior to test 3
Water added 1050 gal
New depth 5 in
Elapsed time 1440 min
Final fluid depth 3
❑ Code -required soil cover over field —
rt
F-1 System presoaked Absorption rate 1050 gpd
bedrooms
in
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NA
date of test)
Gallons introduced gallons If yes, enter date NA
Comments/Deficiencies: DEBRIS AND ROCKS REMOVED FROM STANDPIPES.
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
Community Sewer Manhole/Cleanout > 100'
17 Yes
if No
ft
2 Yes
if No ft
Neighboring Tank > 100' [✓ Yes
if No
ft
Private Sewer/Septic Line > 25' 0 Yes
if No ft
Absorption Field on Lot > 100' E✓ Yes
if No
ft
Holding Tank > 100' n✓ Yes
if No ft
Neighboring Absorption Fields > 100'
Yes
if No
Animal Containment > 50' ❑✓ Yes
if No ft
✓� Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' MYes
if No
ft
P/1 Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ❑ Yes if No +5 ft Surface Water > 100' Yes if No ft
Property Line > 5'
✓�
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
0✓
Yes
if No
ft
Private Wells > 100' ❑✓ Yes if No ft
Water Main > 10'✓�
Yes
if No
ft
Community Wells > 200'✓Q Yes if No ft
Water Service Line > 10'
[✓
Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' El Yes if No ft If absorption field is under driveway comment below
Property Line > 10'
0✓
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'✓Q
Yes
if No
ft
Private Wells > 100' El Yes if No
Water Service Line > 10'
Yes
if No
ft
Community Wells > 200' 0 Yes if No
Surface Water > 100'✓71
Yes
if No
ft
F. ENGINEER'S COMMENTS
Pipes were full of debris and toys; removed. Verified no obstructions between tank/splitter.
Engineer verified all standpipes shown on record drawings were present.
East trench had 50" standing water, test run in west trench.
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. 9/18/21
COSA Checklist yellow sheet
of At
TH
... _�.. '
• CHARLES G BALZ
�'c`G' •. CE -13854 .• �`�
�FOPROFESSIONP
���aaao�►-
ft
ft
eiE?�BG
Municipality of Anchorage-
On -Site Water and Wastewater Program
(907) 343-7904 s a r e r x
Certificate of On -Site Systems Approval
Parcel I.D. 015-331-10 Expiration Date:
1. GENERAL INFORMATION
Complete legal description Lake 0' the Hills, Block 4, Lot 2
Location (site address) 6700 ROckridge Rd.
Current Property,owner(s) Wendi Hltwein & Colin Flaherty Day phone
Mailing address 6700 Rockridge Rd. Anchorage, AK 99516
Real Estate Agent Day phone
2. TYPE OF DWELLING:
El Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
individual Well
Fx]
Individual
EJ
IndlvidualWaterStorage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance
COSA to be released to the engineer, unless otherwise requested by the engineer
COSA Fee $ - lJ�') Waiver Fee $
Date of Payment tP �I l�j r� a, Date of Payment
Receipt Number D II03G Receipt Number
COSA # OSCIrJI3 Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation dateshownbelow, 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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test,
and separation distances measured toreadily identifiable features. The operational life of all wells .and septic systems depend an the local soil
condition, ground water levels that may fluctuate during theyear, and the water usage ofthe family being served by the system. These conditions
are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty
for future :performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 6/2/2015
6. DSD SI NATURE
77 System #1 Approved for bedrooms
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
Slsven' �`�`(�onnorie
CE -8149 _• ;
bedrooms, with the following stipulations:
By: r r Original Certificate Date:
The i l icipol' of An ge Development Services Division (DSD) issues :Certificates of On Site Systems Approval (COSA) based :only -
upon the r resentations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska The Municipality
Of Anchorage isnot 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
COSAbluesheet'f , c
:, a
If more than 1 septic system is on the lot:
COSA Checklist # + of
Structure served by this system i
Certificate of On -Site Systems Approval Checklist
Legal Description: Lake O' the Hills, Block 4, Lot 2 Parcel ID: 015-331-10
A. WELL DATA 4-1
Well type Private If A, B, or C provide PWSID # Well Log (Y/N) 1: U
Date completed
�� Sanitary seal (Y/Nf Y Wires properly protected (Y/N) Y
Total depth ft. Cased to a✓ft. Casing height (above ground) 18+ in.
FROM WELL LOG
Date of test 4
Static water level ft.
Well production g.p.m.
WATER SAMPLE RESULTS:
Coliform N colonies/100 mL Nitrate �,3� mg/L
Arsenic N ug/L Date of sample: 6/2/2015 -
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Tank size 1,250 gal. Number of Compartments 2
Foundation cleanout (Y/N)
Date of pumping New
Y
Depression over tank (Y/N) N
Pumper N/A
5''AA(/9°
C. ABSORPTION FIELD DA
t�IA I f dt6q
AT INSPECTION
8/29/2014
36
ft.
4.3+ g:p.m.
Collected by: PES
Date installed 10/13/2014
Cleanouts(Y/N)
Y
High water alarm (YM) N
Date installe Soil rating (g.p.d./ft2 orft/z�/bdrm) 125 SF/BR System type Deep Trench
Length 50/3
q ft. Width 2.5 �` i ft. Gravel below pipe 5 � ft.
Total depth 12 ,� ft. • Eff. absorption area 500 fe Monitoring tube Y Depression over feld N
Date of adequacy test 8/29/2014 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 0/ b in. Water added 602 gal. New depth 30 3 min.
Elapsed Time: 440 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 1.2 mo.) (Y/N & type) NO If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off" level at in. High water alarm level at in:
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO
Septic tank/lift station on lot 100+
Absorption field on lot 100+
Public sewer main 75+
Sewer /septic service line 25+
Animal containment areas 50+
On adjacent lots 100+
On adjacent lots 100+
Public sewer manhole/cleanout 100+
Holding tank . 100+
Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+
Water main 10+ Water service line 10+
Wells on adjacent lots 100+
ABSORPTION FIELD_ ON LOT TO:
Property line 10+. i Building foundation 10+
Water Service line 10+ Surface water 100+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 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.
Engineer's Printed Name Steven R. Pannone
Date
COSA canary sheet 2f-15.doc
6/2/2015
Absorption field 5+
Surface water 100+
Water main 10+
Driveway, parking/,vehicle storage 10+
ROCKRIDGE DRIVE
LO
N
�n
N
I hereby certify that an accurate survey of the following described
property:
LAKE 0' THE HILLS SUBDIVISION (72-236)
LOT 2, BLOCK 4
was made on November 14. 2014 and that the improvements
situated thereon are within the property lines and do not overlap or
encroach on the property lying adjacent thereto, that no
improvements on the property lying adjacent thereto encroach on
the premises in question and that there are no roadways,
transmission lines or other visible easements on said property except
as indicated hereon. Easements other than those shown on the
record plat may not appear on this drawing.
Anchorage Alaska, this 19th day of June 2015.
3
SCALE : 1" = 30'
0' 15' 30' 60'
o c5
MUNICIPALITY OF ANCHORAGE
• ''° DEPARTMENT OF HEALTH & HUMAN SERVICES M
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
(907)343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY DWELLING
Parcel l.D.# 015-331-10 HAA# xl&zG og'12
1. GENERAL INFORMATION
Complete legal description LAKE 0' THE HILLS SUBDIVISION: LOT 2. BLOCK 4
Location (site address or directions) 6700 ROCKRIDGE
Property owner ANGEL FITHEN Day phone X907) 346-4255
Mailing address 6700 ROCKRIDGE, ANCHORAGE, AK 99516
Lending agency
Mailing address
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well xxx
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 xxx
Holding Tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
ing to the legality and status of system.
72-025 (Rev. 1191) Front MOA #21 Computer version
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. 1 further verify that basep?-d yn the information obtained from the Municipality of
Anchorage files and from my investigation and instion, the on-site water supply and/or wastewater
disposal system is in compliance with all Municip nd State codes, ordinances, and regulations in effect
on the date of this inspection. _ ' ;
Name of Firm
Engineer's
Phone (907) 337-6179
In conducting this evaluation, AWWC, ICO',
'. ff ' pted tooprbvide a thorough, conscientious engineering analysis of the
system in accordance with ADEC and O , D HS Guidelines & Regulations. The reported results described the
performance of the system under the conditions encountered at the time of the test, and separation distances
measured to readily identifiable features. The operational life of all wells and septic systems depend
on the local soils condition, ground water 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 the system. Satisfactory test results do not guarantee future performance
of the system, nor do they guarantee that there are no hidden defects or encroachments.t�S���r
AWWC, Inc. can therefore not provide any warranty for future estimate of how long the ��*� • 4 �*
system will continue to meet the operational requirements of the ADEC or MOA DHHS. .......... > • • . • .. • .. • .. ; • .
The content of this report is for the sole benefit of the owner listed above. Any '
reliance upon or use of this report by any other person or party is not authorized, . ... ...
nor will it confer any legal right whatsoever.P .J ffr A. s's G
QA " 7953 '
6. DHHS SIGNATURE
_Jef::�' Approved for L� bedrooms
Disapproved
Conditional approval for
EXTROTeR
J
ed
bedrooms, with the following stipulations:
Date 15 " 0
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 (Rev. 1191) Back MOA #21 Computer Version
Municipality of Anchorage ,,te�tt L E I V t V
DEPARTMENT OF HEALTH & HUMAN SERVICE
Environments! Services Division
625 V Street, Rm 502 Anchorage, Alaska 99501 (907) 343.4AWG 03 2000
MUNICIPALITY OF ANCHORAGE
--1"rNITALSERVICFS PIN
Health Authority Approval Cheddist
Legal Description: LAKE 0' THE HILLS S/D; LOT 2, BLOCK 4 Parcel I.D.: 015-331-10
A. WELL DATA
Well Type PRIVATE If A. B, or C, attach ADEC leiter. ADEC Water system number N/A
Log present (YM) N Date completed UNKNOWN
Total depth 56'+ Cased to 40'+ Ging height (above ground) 180+
Sanitary seal (YIN) YES Wires properly protected (YM) YES
FROM 1995 HEALTH AUTHORITY
Data of tent 11-13-95
Stalk water level 34.5'
Well production 4.5 g.p.m.
AT INSPECTION
7/5/2000
40'
5.6 g.p.m.
WATER SAMPLE RESULTS:
Gt�(Ly eh(oren
Coliform Nitrate q,01? mq ZL Other bacteria A -
Date of sample: 7/a y 7�a7 Collected by: A.W.W.C., INC.
B. SEPTICIHOLDING TD A
�.ha227
Date installed — Tank size 1250 Number of Compartments 2 Cleanouts (YIN) YES
Foundation cleanout (YM) YES Depression (YIN) NO High water alarm (YM) N/A
Dade of Pumping 7/5/2000 Pumper OLD MCDONALD'S
C. ABSORPTION FIELD DATA
Deft Installed 6/29/96 Soil rating (g.p.dM orft2lbdrn) 0.8 System type DEEP TRENCH
Length 57' Width 2' Gravel thickness below pipe 6.6' Total depth 13.6' — 18.1'
Effective absorption area 752 SO FT Monitoring Tube present (YM) YES Depression over field (YM) NO
Date of adequacy lest 7/5/2000 Rmb (PassfFall) PASS For 4 Bedrooms
Fluid depth in absorption field before lest (tn.); 48.5" Immediately after 898 9nt, water added (in.): 68.5"
Fluid depth 63" (iris) Minutes later: 30 Absorption rate = 600+ GPD
Pem)dde treatment (past 12 morribe) (YIN) NONE KNOWN U yes, give date -----
72.028 (Rev. 3196r Cw0uW Vardon
D. LIFT STATION
Date installed Size
ManholafAcoess
High water alarm
*Datum
at*
E. SEPARATION INSTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO: *WR#960047
F.
"Pump ofP level at*
Septic/holding tank on lot *95' On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main NSA Public sewer menhoWcleancut N/A
Sewerlseptic service line 25'+ Uft station N/A
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Foundation 5'+
Property line 5'+
Absorption field
5'+
Water mainlservica line 10'+
Surface wateddrainage 100'+
Wells on adjacent lots
100 �+
SEPARATION DISTANCES FROM ABSORPTION
FIELD ON LOT TO:
Property line 10'+
Building foundation 10'+
Water malMservice line
10'+
Surface water 100'+ Driveway, paridngfvehicle storage area
10'+
/.
Curtail drain NONE KNOWN Welk on
Engineer's
HAA Fee S 3 6'o r 0
Data of Payment 19-3' erD
Receipt Number (eg7�}
72-028 (Rev. =r Computer Vemlon
Waiver Fee
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE A
• DEPARTMENT OF HEALTH & HUMAN SERVICES y- t
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..# C;iS` - 33 -/b
1. GENERAL INFORMATION
H A A # -\Q_A
Complete legal description L 0'-C .Z ., i CC is t( 16A Ic4: c-' < Nc- IH, ti.S
Location (site address or directions) & Fe c; -7 0Ck 1-2i-y,e-
Property owner Day phone 3u6 -932 -1 -
Mailing address L 7 cc- 'R c IL V_� t�-A'L , dl riaif 'k l ') X75/ C,.
Lending agency
Mailing address.
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
q
Day phone
Day phone
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 }c
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev, 1/91) Front MOA 021
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 furtherverifythat 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 � ��� tic7�c 0-N(, Syc Phone -29"2-2 21
Address V�>c>K /u�o`'s 0"Ir14-j t`>16 :�D -,)S/el
Engineer's signature— Date `�- `�
Ql�-Q</L;,�,-c��L LhSL C�i=Co N�IT7vtJ iAL �:�-.�11�. .-.,: evva:'�
L
6. DHHS SIGNATURE _
Approved for Buz bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
7MZ (Re ,1/91) Back MOA q l
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES R F C F i V
Environmental Services Division
825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 0219966
DEC
murs'G' pw'.' s .a:,t;norage
Health Authority Approval Checklist Dept. Heaith & Human Services
Legal Description: LZ , 13 4 L A Kt-- C "rjlra 0 r tis Parcel LD.: C) LS — 33 t — i o
A. WELL DATA
Well tvpe�R t JA—rrf If A. B. or C. attach ADEC letter. ADEC water system number
Log present (YIN) tV Date completed 0N14,00u/ ,
Total depth u p)"uw vr.i Cased to �(o+ Casing height (above ground) 21 e
Sanitary seal (Y/N)
Wj
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Wires properly protected (Y/N) Y
AT INSPECTION
r1- t3-gs
3 u r(z
g.p.m. `('S g.p.m.
Coliform
— c7 — Nitrate
3
Other bacteria —�
tzczG�0 r
Width
Z` Gravel thickness below pipe • 6
Date of sample:
I1 l r" -4S T- ;i, — At
Collected by:
5� (2-J��1 v ✓aN
B. SEPTIC/HOLDING TANK DATA
Date installed -S-/-z z /-7 a Tank size 1'2,5u Number of Compartments Cleanouts (Y/N) '(
Foundation cleanout (Y/N) `C Depression (Y/N) V High water alarm (Y/N)
Date of Pumping 1 !- f L- FS Pumper N" t rA(l,,
C. ABSORPTION FIELD DATA
Date installed
6 - Z4-46
Soil rating (g.p.d./ft' or ftZ/bdrm)y . (3
Svstem type -L) --r-
Length Sys
Width
Z` Gravel thickness below pipe • 6
Total depth
Effective absorption area Monitoring Tube present(Y/N) Y Depression over field (Y/N) ✓"
* S,.zca A--,rp.-rViaD os-c� rA
Date of adequacy test 111? -'?116 Results (Pass/Fail) C�fa gS_ For 41 bedrooms
Fluid depth in absorption field before test (in.); /6 " Immediately afterr gal, water added (in.): ! Y %4
Fluid depth 16 " (ins.) Minutes later: ' 4 u D Absorption rate = <- u.SD a.P d.
Peroxide treatment (past 12 months) (Y/N) NO If yes, give date �—�
D. LIFT STATION
Date installed
Maiiliole/Access (YM)
High water ala�l at*
tested
E. SEPARATION DISTANCES
Size
on" level at* "Pump off' level at*
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Se=C 1-r ,A( 0 'm
Septic/holding tank on lo[ 2 `�(5n adjacent lots
Absorption field on lot 1 D 2 ; On adjacent lots (BD T
Public sewer main Public sewer manhole/cleanout / M
Sewer /septic service line Lift station �(
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation lS Property line qS Absorption field Z S
Water main/service line /001' . Surface water/drainage 100-t- Wells on adjacent lots /tr _r
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation c< < Water main/service lined /00+
Surface water /all f
Driveway, parking/vehicle storage area �S
Curtain drain N (CA Wells on adjacent lots 0o Property line
F. ENGINEER'S CERTIFICATION
I certify that 1 have determined thru field inspections and review of Municipal records Yhgt ihe;Ab$fte,• stems are
in conformance with MOA HAA guidelines in effect on this date.
Siguatum
e
Engineer's Name 5 i fat c� N re s
4
$ ,, Fzar
noe
Date l2 4 i� 41
CE �t1'p9
E '• T. �.
HAA Fee $ Waiver Fee $
Date of Payment Date of Payment
Receipt Number Receipt Number
Rev. 8/95 OSS: haa.wk.doc
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES —
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # HAA #
1. GENERAL INFORMATION
Complete legal description Lo-- Z BLC, C1/- 44 c(A).ce o'-rJle1-f)Lcs 5/n
Location (site address or directions) 67-c>o RaocK 2 ibc, p -
Property owner ravee� e..)E K. 9 oho e. Day phone
Mailing address I . o •7$oSc. A A) clt Q % 99 5' 416 S-3
Lending agency
Mailing address.
Agent
Address
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: AL Ll
3. TYPE OF WATER SUPPLY:
. _:. 1ll4il YYtFitj i7E
Individual well
Community well
Public water
1 _
NOTE: If community well system, provide written confirmation from State,!AP�C attest -1
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site - k
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(11ev.1/91) Front MOA#21
5.
6.
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 Sv c Phone
Address
Engineer's
DHHS SIGNATURE
At
Approved for
bedrooms.
Date //' 2-0' 4s
stavrn R. Panncae
CE -8149
ti 'IS// Z O '}
r
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
sc�Gv✓L O eouER Tff� ��aF /�ccbntNT
vti,—'e'_
r
7 I
i'Ksoas
Date
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 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.
72-M(Rw.1/91) Beck MOAM21
Municipality of Anchorage C F I�[ V E D
DEPARTMENT OF HEALTH & HUMAN SERVIC
Environmental Services Division
825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343W44 1995 44
Municipality of Anchorage
Dept. Health & Human Services
Health Authority Approval Checklist
Legal Description: L2,—B4 Parcel LD.:
A. WELL DATA
Well type— ,UA-Te—r If A, B. or C, attach ADEC letter. ADEC water system number
Log present (Y/N) r( Date completed 01-4 kA.)c k V'J
Total depth 0 /j Cased to G1 t7 *t
Casing height (above ground)
..>
Sanitary seal (Y/N) ( Wiresro erl
p p y protected (Y/N)
FROM WELL LOG AT INSPECTION
_twx
Date of test I _ 4 _ c? S
Static water level 3 y ��2 .(Lr
Wellroduction
P g.p.m. �-I • S
g.p.m.
WATER SAMPLE RESULTS:
Coliform —0— Nitrate 3.44 Other bacteria —0 —
14
Date of sample: Collected by: 5.IQCPA„)„0o„0e
B. SEPTIC/HOLDING TANK DATA
Date installed Cvl R y Tank size 12 Sa Number of Compartments 2 Cleanouts (Y/N)
v
Foundation cleanout (YIN) C Depression (Y/N) 1`E High water alarm (Y/N) ^ A
DateofPumping_Pumper 1,0-7-igtAA;D
C. ABSORPTION FIELD DATA
? &v-5 cmtv1(
Date installed 6 /�3 y Soil rating (g.p.d./ft2 or fr'/bdrm) / ZS- System type "1� k
- .
CMIG gym, �, r83.7,rX- .*
Length So Width 3o ` Gravel thickness below pipe S'04 Total depth /
Effective absorption area Sop Monitoring Tube present(Y/N) Depression over field (Y/N) t4
Date of adequacy test /(— t qb Results (Pass/Fail) Wass Forbedrooms
53 3/a
Fluid depth in absorption field before test (in.); &a33/q Immediately after boo gal. water added (in.):
5331y
Fluid depth 63-Yq (ins.) Minutes later: 141140 Absorption rate 00 } g.p.d.
Peroxide treatment (past 12 months) (Y/N) .N O If yes, give date
0
D. LIFT STATION N /
Date installed r/
Manhole/Access (Y/N)
High water alarm level
E. SEPARATION DISTANCES
Size in gallons
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
0
"Pump off' level at*
Septic/holding tank on lot / (� �/ (-rtANtr roSTAu POn ad ac nt lots /00
Absorption field on lot / 3 -7 ; On adjacent lots / 00 r
Public sewer main ^�/A
Public sewer matthole/cleanout N(A
Sewer /septic service line ?S + Lift station N/fA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation / 4" Property line 25-t Absorption field 3 4
Water main/service line `TO ' Surface water/drainage /cvo T Wells on adjacent lots / U O f
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
i
Building foundation 3 q Water main/service line
/c; 0 -k--
Surface
Surface water /Do Driveway, parking/vehicle storage area 10 O
tF T
Curtain drain so Wells on adjacent lots / Oct Property line / b
F. ENGINEER'S CERTIFICATION 4:
I certiJv that I have determined thru field inspections and review of Municipal rec i(s t the above SjaS't�rt e
in conformance with MDA NAA guidelines in effect on this date.
lJ �OM im u..yina. iSrv9.'�Si
Signature
-s n,
Engineer's Name 5 TSV e.r—) t tn. &z
Date /I— zeo— 4,T
HAA Fee $ ?nc,
Date of Pavment i 1-a 1- q6
Receipt Number " C)�'A $M I rI1 Y , S
Rev. 8/95 OSS: haa.wk.doc
Waiver Fee $ _
Date of Payment
Receipt Number
ph`OF�
Steven R. Pannone, P.E.
P.O. Box 142025
Consulting Engineer Anchorage, Alaska 99514
(907)272-8218
December 14, 1995
Municipality of Anchorage
Dept. of Health & Human Services
On -Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519
Subject: Lot 2, Block 4 Lake O' the Hills S/D
Request for Conditional Health Authority Approval
Attn: Mr. James Cross, P.E.
Dear Mr. Cross:
I am confidant that a replacement system for the above lot can be installed. The replacement system will be
located west of the existing seepage crib approximately twelve feet away. I reviewed the design files for the
original system. A test hole was excavated and soil rated in 1974. See the attached soils log. A portion of the
new system will be installed within the 30 radius of this test hole. Furthermore, a test hole will be excavated
and the soils verified if a new system need to be installed. Drainage is positive away from the proposed
location to the east and south west. The new system will not affect surrounding properties. The nearest
property that could be affected is to the northwest and it's septic system and well is located approximately
200 feet away.
A new trench would be located in soils identified as SW (Well Graded Sands) that have an application rate of
125 SF/BR. The existing house is a four bedroom structure. The required area for absorption is (125 sf/br X
4 br) is 500 S.F. A deep trench is best suited for this property. It would have an effective depth of 5 feet (10
sf/11) and be a minimum of 50 feet long for a total of 500 sf of absorption area. The total depth will be eight
to ten feet deep. See attached Preliminary Design Details. rr
Fund have been escrowed to cover the cost of installation.
Please contact me if you have any questions.
Sincerely,
teven R. Pannone, P.E.
Civil Engineer
t�
M
0
•
0
r"
AralJ. o©
eAe•-BuIII "
1 hereby 0er►Ity that a survey of the followtnq deeorlbed property
L r t e,4 e� c�'rNe tyros
�• ) was made an.
_and that the jmprovements situated thereon are -
wlihln the properly lines and do'not overlap or enoreoah on 60 properly adjacent
thereto0that no improvements 00 property lying adjacent thereto encroach on the
premises In Question and that there ore no roadways, transmission lines or other
visible easements on sold property except as Indicated hereon,
Dated of Anchorage, Alaska, this day ofren
CONTRACTING ENGINEERS @ ASSOC.
212 E, International Airport Rood
Anchorap0, Alaska 99502
Phone: 2TO.3TT3
10 'd
0
i So,
tE OF ( %
�'• EE
r....:.......9 t�.�f•.... .
Donald O. Sourl'ar
.NO, 2233.8 J f .
pAOFESSIQIin
SEAL
SZIOI flH1 56 -tit -03Q
Steven R. Pannone, P.E.
P.O. Box 142025
Consulting Engineer Anchorage, Alaska 99514
(907)272-8218
December 14, 1995
Municipality of Anchorage
Dept. of Health & Human Services
On -Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519
Subject: Lot 2, Block 4 Lake O' the Hills SID
Request for Conditional Health Authority Approval
Attn: Mr. James P. Williams
Dear Mr. Williams:
I conducted a Health Authority inspection at the above property on November 18, 1995. The initial
inspection showed that there was 63.75 inches of fluid in a deep trench with five feet of effective depth and
53 inches of fluid in a crib with six feet of effective depth. I added 600 gallons to the crib and monitored the
fluid levels in the crib and deep trench for twenty four hours. Fluid levels rose with the addition of water and
returned to the original levels by the end of the test period. It is my opinion that this system is performing
adequately.
During the MOA review process, you have indicated that this system is operating in a surcharges manor, I.E.
the fluid is being absorbed above the distribution lateral. A Health Authority Approval will not be issued with
the system operating in this manner.
i
Our discussions have focused on the point that this deep trench does not
to be level. According to the
approved as -built, it must be assumed that it is level. In addition, the fluid levels in the crib—did not exceed the
as -built effective depth. A Health Authority Approval would be issued if the levelness of the deep trench
lateral was verified or the adequacy of the crib was determined.
On December 13, 1995 I hired a backhoe to excavate down to the distribution laterals to verify or disprove
the levelness of the lateral and install a valve on the line to the deep trench so the crib could be tested for
adequacy. Frost was encountered down to a depth of 2.5 to 3 feet. One of the teeth on the bucket was
damaged trying to excavate into the frost. We terminated our attempt to verify the elevation of the laterals.
Mr. Tim Williams
December 14, 1995
Page 2
Therefore, I request a Conditional Health Authority Approval be issued for this property. An Unconditional
Approval will be sought in the spring, May or June, when the ground thaws. The existing system will be
verified and tested to be adequate at that time. Full documentation will be provided to your department
showing adequacy of the system. Funds will be set aside in escrow to install a replacement system in the
event that the existing system does not prove to be adequate. See attached Preliminary site plan for the
replacement system. There should be no chance of health danger from effluent. There are three systems on
this property, each one sized to handle four bedroom. The existing crib is roughly 28 by 17 by six feet deep,
There is the fifty foot long by five foot deep trench, and there is a 42 by 12 by 3 foot deep bed. In addition,
six hundred gallons of water was added to this system with no backing up into the septic tank or flowing over
the ground.
Please contact me if you have any questions.
Sin
Steven R. Pannone, P.E.
Civil Engineer
sso.a � a. Pa:.ncna
CE . 81 ,19
t�$.�/ih.�.�•ti� V �f
Steven R. Pannone, P.E.
P.O. Box 142025
Consulting Engineer Anchorage, Alaska 99514
(907)272-8218
SEPTIC SYSTEM ADEQUACY TEST
Legal:
Location:
Owner:
Septic System:
Date of Pumping:
Date of Test:
Lot 2, Block 4 Lake o' the Hills Subdivision
6700 Rock Ridge
Ms. Laverne Hodge
From Municipal Records•
Tank: 1250 gallon
Absorption System:
Absorption Area:
Soil Rating:
Installation Date:
Deep Trench/crib
500 s.f.
125 sf/Bedroom
June 2, 1984
November 17, 1995, Northland Pumping,
November 18, 1995
FA �q Steven R. Pannone Icy
c, y CE 8149m r
w
Test Procedure: System was inspected and measured. Liquid depth was measured to be 63.75 inches in the field monitor
tube and 53.75 inches in the crib. The field total depth was measured to be 160 inches, and the crib total depth was
183.75 inches. Black gritty material was observed in the fluid of the field monitor tube. The owner mentioned she has
used Isaacs Honey Wagon in the past to pump her tank. It appears that the system was installed with a deeper effective
depth than was noted on the as -built inspection sheet, or not installed level. The as -built inspection indicates that there is
60 inches of effective depth. Fluid was measured to be 63.75 inches deep in the fields monitor tube. That indicates that
the operating level is above the new systems perforated pipe at the monitor tube.
Water was added to the system at a constant rate of 4.5 G.P.M. The water levels in the tank, field monitor tube and crib
monitor tube were monitored. A total of 600 Gallons of water was added. During the test the fluid level rose 13 inches in
the field, and seven inches in the crib. The fluid levels rose to the same level. No rise was noted in the tank.
The infiltration rate was monitored for 24 hours. During this period, a total of 600 Gallons were absorbed. Fluid levels in
the crib and trench system returned to the before test levels. By extending the observed infiltration rate a total absorption
rate 600 Gallons per day was arrived at.
TESTS RESULTS: This system meets the code requirements of the Municipality of Anchorage for a 4 bedroom
single family residence. The well produces 4.5 G.P.M., and the soil absorption system accepted
600 G.P.D. of fluid. It appears that this system is not installed level and is operating in the last
15 to 25 percent of its life.
The operational life of all septic systems depend on the local soil condition, ground water 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 system. We can therefore not give any estimate of how long the system will continue to meet the
operational requirements of the Municipality and State.
Time
APPLKVT FILLS OUT UPPER MA ONLY
Time
Property Owner
John R. & Edie Creek
Date
ne
' Mailing Address
SRA Box 7B Anchorage,
AK Zip Code 99507
F349-8253
Buyer
Field Notes:
Address
)DISAPPROVED The system must undergo normal occupancy use for at least
Zip Code
DATE .�2 that period (on or around the end of March). If it is
Lending Institution
BY: consider releasing approval of this system.
6Z, ��e;/L r --o ,.�'C. <_.614c Q.LrX :.74—
Phone
Address
Soils Rating
Zip Code
Well To Absorption Area
Realty Co. & Agent
Coldwell Banker Jack Shite
Company — Elliot Lawson
Phone
Address
3201 "C" Street Suite 100
Anchora a AK Zip Code 99503
277-1553
Legal Description
Lot 2, Block 4, Lake O'the
hills Subdivision
Street Location
6700 Rockridge Drive
Type of Residence
IX Single Family
❑ Multiple Family
No. of Bedrooms 3
❑ Other
Water Supply
Ck Individual
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
❑ Community
For wells drilled prior to that date, give well depth (attach log if
available).
❑ Public Utility
Sewer Disposal
XD Individual
Year Individual Installed:
❑ Public Utility
When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
Field Notes:
( •.) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL
)DISAPPROVED The system must undergo normal occupancy use for at least
CONDITI NALAPPROVAL' six months and will need to have an adequacy test after
DATE .�2 that period (on or around the end of March). If it is
working satisfactory at that time then this department can
BY: consider releasing approval of this system.
6Z, ��e;/L r --o ,.�'C. <_.614c Q.LrX :.74—
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well Log Received
Well to Tank
Septic Tank Size
2-023131821
•
40 �a MANIAa oDO pato
CONSULTING ENGINEER
John Creek
SRA Box 7B
Anchorage, AK
LEGAL:
LOCATION:
OWNER:
RESIDENCE
WATER:
99507
March 29, 1983
SEWER ADEQUACY TEST
0
203 W. 15th AVE "C" SUITE 203
ANCHORAGE, ALASKA 99501
TELEPHONE: (907) 2793916
Lot 2, Block 4, Lake O'The Hills
On Rockridge
John Creek
Four-bedroom, single family
Onsite well
MUNICIPALITY OF ANCHORAGE
DEPT. OF H`.�.LTN •:
ENVIRONI�LNTAL P/�ROTECTION
Mpg 3 0 ens +a
RECEIV ED
SEWER: From Municipal Records:
Tank - 1250 gallon Greer Steel, one compartment
Absorption System - 6 feet diameter, concrete ring,
6 feet deep and seepage bed 12 x 42 feet
Absorption Area - Crib = 606
Bed = 307
Soil Rating - 125
Installation Date - May 1974
DATE OF TEST: March 28 and 29, 1983
TEST PROCEDURE: System was inspected on February 16, 1983, and found
surcharged. On March 8 the tank was pumped and the
crib treated with hydrogen peroxide. On March 28 the
"Tobben Spurkland P.E. 0 •
crib was filled with water at a steady rate of 5 gallons
per minute. The following measurements of the liquid
depths were as follows:
Time
Depth
Volume
0
40
--
10
4321
50
20
47
100
30
49
150
45
5321
225
60
57
300
75
61
375
90
64
450
105
68
525
120
71
600
(10.00 p.m.)
Tank depth
52"
2.00 p.m.
60
225
9.00 a.m.
46
500+
TEST RESULTS: This system accepted 600 gallons in a time period of two
hours without showing signs of overloading. During
the next four hours 225 gallons were absorbed. Ex-
tended to a 24 hour period, this is equivalent to 1350
gallons per day. After 23 hours, less than 100 gallons
remained in the system. Based on the absorption rate
of the first four hours this system meets the Municipal
Code Requirements.
*: A972
•
11
U O °° �a 60"A 3IAML7 PAA AN HORAGE,V ALASKAIT203
99501
1CONSULTING ENGINEER TELEPHONE: (907) 279-3916
Elliot Lawson MPNIcro(itry OF ANCHCRA36ptember 6, 1983
ENVIk;1r?��.�-'"•`,ctrl 2
Coldwell Banker Jack White Co. �� PkOT'C TION
3201 "C" Street
Anchorage, Alaska 99503
kECEIVED
Subject: Creek Property, Lot 2, Block 4 Lake Of The Hill
Gentlemen:
Per your request I performed a follow up adequacy test
on the septic system on subject property.
The residence has been vacant since May and the system
has rested during this period. In order to saturate the soil
around the system a surcharge of liquid, approximately 700 gal,
was dumped in the crib on August 30, 1983.
24 hours later this water had been absorbed by the system.
On September 2, 1983,-I again surcharged the system with
approximately 750 gal. of liquid. Within 7 hours 450 gal had ben
absorbed. After 22 hours ,nly 100 gal. remained in the crib. The
s -y -stem had absorbed 650 jal. At this time this system meets the
Municipal Requirements.
During the test I noticed that the wellcap had been
disconnected from the wellcaseing. The well extension installed
previously was olnly attached with a clamp. This is not satisfactory.
The extension must be welded to the casing. The present condition
is a health hazard and must be rectified.
Yours
Spurkland PE.
_
OAlaos
'�p✓0` . • 1�.
h: 9pt1
*:49?H ';*
. ... .... ....
2225-
a�• J NE25,1971 :4;r
Wjp lft►L, e, �;310 RL- - .LlIs fo,•
MUNICIPALITY
OF ANCH RAGE
- MUNICIPALITY OF ANCHORAGE
DEPT. C .�
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTkWJRONPy,E . ON
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION
17•
I L8 13 izyr(J
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL
R C l/.�. E 1 � � D
FACILITIES
WATER AND SEWER
SINGLE FAMILY
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER
❑ Two ❑ Five
PHONED
Merrill Lynch Relocation Mgt. (Pratt)
7. WATER SUPPLY
MAILING ADDRESS
❑ COMMUNITY A`�T
PROPERTY RESIDENT Ilf different from above)
❑ PUBLIC UTILITY
PHONE
Vacant
INDIVIDUAL/ON-SITE**
2. BUYER
E-1
PHONE
Not yet sold
by this Department.
MAILING ADDRESS
NOTE: THE INSPECTIONEE NA U.ACCOMPANY
3. LENDING INSTITUTION
PHONE
N/A
MAILING ADDRESS
4. REALTOR/AGENT
PHONE
Jack White Company.... Attn: Elliot Lawson
D77-1553
MAILING ADDRESS
3201 C Street, Anchorage, AK 99503
5. LEGAL DESCRIPTION
Lot 2, Block
4, Lake O'Hills Subdivision
STREET LOCATION
SRA Box 28....
Rockridge Road
6. TYPE OF RESIDENCE
NUMBER Or BEDROOMS
SINGLE FAMILY
❑ One ❑ Four ❑ Other
❑ Two ❑ Five
❑ MULTIPLE FAMILY
'� Three ❑ Six
7. WATER SUPPLY
INDIVIDUAL* P�IP� -j* ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY A`�T
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE**
**If individual/on-site, give installation dated,
E-1
If system is over two (2) years old an adequacy test is required
PUBLIC UTILITY
by this Department.
NOTE: THE INSPECTIONEE NA U.ACCOMPANY
EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Co r i1 �L2�e rny0�r
_.1 `r
- THIS SIDE FOR OFFICIAL USE ONLY 4
INSPECTION APPOINTMENTS
DATE RECEIVED
TIME
TIME
TIME
DATE
DATE
DATE
INSPECTOR
INSPECTOR
INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE
❑ SINGLEFAMILY
❑ 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
DATE INSTALLED
INSTALLER
❑Septic Tank or ❑Holding Tank
Size: If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL T0:
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
tl--APPROVEDFOR It BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompan certificate)
❑ DISAPPROVED
DATE
BY (Title)
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
41M CONSULTANTS. INC. 542-0 COHUOVA Y ¢OX 608] H .iNCHORgG `c. ALA.�'iKq 9954: 8 VH. 90] -2]9 -OE 83 • TLX. CAO -21360
u niE R S' T'A�YY
= R.S�LRsApril 1, 1980 R&hI ��yyNCC6IEP,�Yj@bf4HORA(9
i NVIRON vi[ _LTION'
Jack White
3201 "C" St.
Anchorage, Alaska
Attention: Elliott Lawson
ANR 10
RECEIVLL)
Re: Adequacy Test on Existing Sanitary Sewer System; Lot 2, Block 4, Lake
of the Hills Subdivision, Anchorage, Alaska
Dear Mr. Lawson:
Per your request of March 14, 1980, we conducted a test of the sanitary sewer
system on the above described property.
During this test the liquid level in the septic tank was monitored as water
was added to the system. The measurements are summarized in the following
table:
The meter used during the test was a Rockwell 5/8" standard water meter which
had previously been calibrated by R&M Consultants, Inc.
ANCHORAGE �AINB AiY KS ]U NEgU VALUk2 Wg51L LA
Liquid Level Below Top
Total Gallons
Time
of Standpipe
Added
2:45
5.60'
0
2:50
5.63'
30
3:06
5.57'
70
3:11
5.53'
120
3:21
5.45'
170
3:30
5.40'
220
3:36
5.64'
220
The meter used during the test was a Rockwell 5/8" standard water meter which
had previously been calibrated by R&M Consultants, Inc.
ANCHORAGE �AINB AiY KS ]U NEgU VALUk2 Wg51L LA
April 1, 1980 • •
Jack White
Page -2-
I£ the 4 bedroom residence on the property is to house 8 people, the average
load on the system can be expected to be 600 gallons per day or 0.42 gallons
per minute. During the test, the system accepted 220 gallons in 51 minutes.
This indicates an average effluent acceptance rate of approximately 4.31
gallons per minute at the time of the test.
We can therefore conclude that the system is disposing of effluent at an
adequate rate for a 4 bedroom residence.
We appreciate this opportunity to be of service to you. Please contact us if
you have any questions concerning this test or if we can be of additional
service.
Very truly yours,
R&M CONSULTANTS, INC.
Janice Cecere
Project Manager
JC/dj/AT&SI-H
=' �v1
i._.. �.—..�S Vi. J:�1J ice, INv. 0023 CJ ftOGVrI 3 FJOX aOHJ '.9 ANC'H Ofl AG G, TLASKA 9)562 y PH. 'JO7-219-01105 8 !LX. 0J025350
-NGIN EGtiS
1H`FYG April 1, 1980 R&M No. 051001-9
Jack White
3201 "C" St.
Anchorage, Alaska
Attention: Elliott Lawson
Re: Adequacy Test on Existing Sanitary Sewer System; Lot 2, Block 4, Lake of
the Hills Subdivision, Anchorage, Alaska. For Services Rendered through
April 1, 1980.
Dear Mr. Lawson:
The following is our invoice for professional services rendered on the"above
referenced project.
Professional Services
Fixed Fee
Invoice No.051001-9
Total Invoice No. 9
$300.00
$300.00
Please note our invoice number on your remittance. Should you have any
questions concerning this invoice, please contact me or the Project Manager,
Ms. Janice Cecere.
Thank you,
R&M CONSULTANTS, INC.
C. J. arisena
Anchorage Office Manager
CJP/dj/I5-Z
4 1,—."11 1111"1 '1PL'_J E'r —1511-1
L
Time
APPLIq&T FILLS OUT UPPER HAIMNLY
Property owner
John R. & Edie Creek Phone
Mailing Address349
iftragia, AK 99507Zip Code _
8292
Buyer
Address
Zip Code
Lending Institution
Phone
Address
Zip Code
Date
Realty Co.& Agent
Coidwell Banker Jack White Company - Elliot Lawson
Phone
Address 3201
"C"St-. Suite 100, Anchl AK Zip Code 99503
277-1553
Legal Description
Lot gs Blau a, Lake O'the Hi11s Sub.
Street Location 6700
Rol Drive
Type of Residence
_
0 Single Family
❑ Multiple Family
No. of Bedrooms A-
❑ Other
Water Supply
`y
RECEIVED
Individual
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
Community
For wells drilled prior to that date, give well depth (attach log if available).
❑ Public Utility
( J jPI1jP:1V'D OMS
)A0 ED
Sewer Disposal
APPROVAL'Ll
[X Individual
r� ��( ./,� Year Individual Installed:
�f��Lf Gli uL
❑ Public Ulllit Y
❑ Holding Tank
c�°CC°F
��When Connected to Public Utility:
`kl<e 'f.<...
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST B FORE PROCESSING CAN BE INITIATED.
L
Time
TimeTime
Time
Date
Date
Date
Date
� - l (�1-i- L S
Inspector
Inspector
Inspector
Inspector , \
Field Notes:—{�—
— �..J
`
DEPT. HFLTH i;
ENVIRONf.1ENTHL PROTECTION
Aa
`y
RECEIVED
( J jPI1jP:1V'D OMS
)A0 ED
'CONDITIONS OF APPROVAL
o.--NDITIONA
APPROVAL'Ll
C
fn ..,`:1�1.�;�.�
/
i
DATE —I
_¢°53
`kl<e 'f.<...
p,v•-;: !.,
BY:
�- 'w.t C
r
Solis Rating
Installed
Well To Absorption Area
Well Log Received
LDatower
Well to Tank
Septic Tank Size
2 023 wi&2r
1
I I
4