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Home My WebLink AboutLAKEWOOD HILLS #2 LT 21CLokewood Hill Lo1' 21¢ #015-134 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ,~*~/'c~qo~¢,,~-- PIDNumber: O~- 13u/- ~'z.. Name: ~ Wastewater System: [] New [] Upgrade Address: le ~ ¢ ILk¢l>~ ~lF¢ ABSORPTION FIELD Phone: No. of Bedrooms; ~ ~ Deep Trench ~ ShaHowTrench ~ Bed ~Mound ~ Other L E G A L D E S C R I P T I O N so, .,~i,.: Tot,~ ~¢, f,o. o,~a~ gr~.: ~ ¢ ~ GPD/Sq. Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township: I Range: I Section: Fill added above original grade: Gravel length: I I WELL: ~New ~ Upgrade Gravel width: l ~ Ft.' Number of lines:~ Dislance belweenlines:~ Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Driller: Date Drilled: Static Waler Level: Installer: Date i~stalled: / . J A GPM D~ Ft. ~ Ft. SEPARATION DISTANCES U Septic U Holding ~S.T,E.P. To Septic Absorption Lift Holding Public/PrivateManufacturer: Capacity in gallons: From Tank Field Station Tank S .... Lines /~¢ ~/¢ Material: Surface w~t~ N o ~I ~ LIFT STATION Lot Size in gallons: Manufscture~ Foundation ~ ~ ~ ~ "Pump on"~level at: "Pump off"~level~ at: High water~ ~alarm at: CUrtain P.~ Make & Model Electrical Inspections performed by: Drain N 0 Nl~ ~¢ Remarks: BENCH MARK As*umeO [levation:]~ ~, ENGINEER'S SEAL Inspections performed by: ~ Dates: 1st 2nd Department of Heal~an~uman~~ Services approval Reviewed and approved by: ~¢ Date: Well 25 0 25 ,50 75 100 SCALE; i" -- 50 FL SWING TIES: BO 13.3 FT CD 20 AE 31.3 BE 12.3 ,4F 25 BF 36.3 1250 6ol. STEP 125 150 TOBBEN SPURKLAND P.E. II 203 W 15TH. AVENUE ANOH. AK. 99501 (?07) LOT 21C LAKEWOOD HILLS 10501 HILLSIDE DNIVE PHYLLIS BOOTH SEPTIC SYSTEM ASBUILT DATE: NOZ 7, 1994 SHEET: 2/3 GRID: 2540 45 ~ ! -1//4 PVC with liS" holes at 19" Clean Out( 0 0 Monifors oI SECtiON A-A 6" Halfpipe 1-I~ PVC Holes Po/Ming Up Monitor Iht Filter Sand Monitor No Perforations 5 FI, of Cover ............ ~-... ---.x.-- -- '" IF' I % %. '%. %,, "~//"~./~ .. / .,, '~.. %. "L.~ ~- ~ / 97.2 ~ "~ ~ ~'~ K'~ I-1/4" /J X 1250 gal STEP tank Mirafi 140 ~ ~ ~ 6round Water 4 fee~ belo~ surface BENCH 2.5' "Filler" Sand / ~D[TDM SIDING NE CD~NER A22UHE9 ELE~ 100,00 FT r. 88 TOBBEN SPURKLAND P.E. 203 W 15TH. AVENUE ANCH AK. 99501 (~)0;()' 279-5916 LOT 21C LAKEt OOD HILLS PHYLLIS BOOTH 10501 HILLSIDE DRIVE II SEPtiC SYSTEM ASBUILT DATE: NOV. 7, 1994 SHEET: 5J5 GRID: 2540 LOCATION OF'WEI~L ..... . .... - .. ,~i~.r : .~.~h. , .o.o,"~. 'ti .u..r~,o. '"" '""' " '"' ' ~z~¢_~ --c ,. .~,,. . [/[OCATIONISK~CH: , WELL OWNER~ ,. , .... DEPTHS M~SURED F~0M:~caslng T¢~ ~tound su~8~o' WELL DEPTH: DATE OF COMPL~ION ' De~th of holet ~ ~/ ft 80REH.OLE DATA; De,th Depth =f =aCne--fl ~/ /. / ~ Material Type and Color , , Prom To -' ' D~H T0 STATIC WATER L~ELt .~~. i~ , g ~ ~ft below ~ top of ~aslng D ground ouda~o . -~' ' / / M~HOD OF D~ILU~O~ ~[r rotary B cable ~ool ~ , I - (~ ~ / USE OF WELL: ~domostlo O Irrigation 0 m~nltor :~ ~ ; // WELL ~TAKE OPTING TYPE: ~open end O scteoned / . -- , ,C,U~ TYPE: ~. /~ G~VEL PA~ TYPE: '~. Volume used:. , ' ,, D~'pth to top': ', ~. GROUT TYPE: Volume: , , Dap:h; trom ' l~to ft D~ELOPM~T M~HODt Dura:lorn ,, ¢/~' , : PUMPWe L~EL AND ..i ~ ' ft,a.fter ~ ";. ~pumpina /~ PUMP ~TAKE DEPTH:, ft Horsepower: ~LL DISlNFE~ED UPON'C0MPL~ION7 0 Y? O,NO ' I ~. ,,..,, -.',.~'r~/,,-..~ ......... r ...r,.~, ..,.,-', ,v,~,,,,~ .... ;~,~.,~ ,~,. DI,.V.I~JON :_.,....MIJ G'& WATER' MGMT ;4 '~',,,'''' ":"'"";'. ....."~" .,;........ · . , """','~,;~,,~4... ,,.:, ~,:'";,... . ~,~,i::.'.:,,,, W~,tE, W,E,~L'"~O"~',.: , ...' . . ".' ., :.,ti,; I CONTRACTOR INFORMATI~N: REMARKS: /,,¢',: · .¢/.. '_ 2'/,_' .,,~c ~.. .... ,, , :,, PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE ~ I(l~l~l(,L ~'~ I'. ~o p~ DEPONENT OF HEALTH ~ H~ SERVICES ~ ~ ~/~ ~.0. ~ox ~9~6~0, 8~ ,,~,, s~, ~00~ ~0~ ' ~//~ ~ ~c~o~sz, ~nas~ 99~9-6650 ~ ~1~ '~ PERMIT NI3MBER:SW940352 DESIGN ENGINEER:TOBBEN SPURKLAND, OWNER NAME:BOOTH PHYLLIS J OWNER ADDRESS:10301 HILLSIDE DR ANCHORAGE, AK DATE ISSUED: 9/20/94 P.E. EXPIRATION DATE: 9/20/95 PARCEL ID:01513492 LEGAL DESCRIPTION: LAKEWOOD HILLS ~2 LT 21C LOT SIZE: 46102 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (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) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: Ao OPENED AND CLOSED ON THE SAME DAY Bo COVERED, SEALED AND HEATED TO PREVENT FREEZING 5o THE FOLLOWING SPECIAL PROVISIONS. RECEIVED BY: ISSUED BY: - / DATE: DATE: T.SPURKLAND P.E. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 21C LAKEWOOD HILLS PHYLLIS BOOTH Groundwater at 4 Ft Use Mound with filter sand Soil Rating. From test June 28, 1994 1.5 min/in = 0.7 gal / sq. ft. No. of Bedrooms 3 Required Area per Bedroom: 150/.7 =214sq.ft.. Total area required: 3 x 214 = 643 sq. ft. SYSTEM CONFIGURATION MOUND TOTAL LENGTH 43 FT. TOTAL ~WIDTH 15 FT. TOTAL DEPTH 2 FT. FILTERSAND 2.5 FT LAKE OTIS GRAVEL ROCK DEPTH .5 FT. COVER 3 FT. STEP TANK 1250 GAL. The installation of this septic system will not prevent wells from be installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. Septic System Design Lot 21 C Lakewood Hills LZYf Vacon$ LOT ~ LI~T LOT 5 + Well ~J ££ALE: /* !OOFT, TOBBEN SPURKLAND P.E. Il II 205 W 15TH. AVENUE ANCH. AK. 99,501 fgD7) 279-.~?16 LOT 21C LAKEWOOD HILLS 10301 HILLSIDE DRIVE PHYLLIS BOOTH J J SEPTIC SYSTEM DESIGN DATE: AUGUST 25, 1994 SHEET: I/5 GRID: 2540 _.N .stho/e #7 c°S ,50 7.5 100 125 150 SCALE: l" ~ ,50 FL note //2 I I I note #i I I P;.'imory Ab~option ?i~la' I 6o[, gTEP I I + Testl~o TOBBEN SPURKLAND P.E. J J II 203 W 15TFI. AVENUE ANCH. AK. ggs01 (907~ 279-3916 LOT 21C LAKEWOOD HILLS 10301 HILLSIDE DRIVE PHYLLIS BOOTH J J SEPTIC SYSTEM DESIGN DATE: AUGUST 25, 19.94 SHEET: 2/3 GRID: 2540 ~ A Cleon Out( ! -1/4 PVC with 1~8" holes at 19" 0 0 I~onltors ~-- A 6" Holfpipe 1-I/4 PVC Holes Pointing Up / ': SECtiON A-A ~., ,;~ ,,, :,:. Bonffor Int Fi#er Sond ~ k <',' <~?,' .. "' I ........... -.....,~..... -. ... ....-.I , ~1 ~';. ~,. .'~.. -%//~.//'%.~/%. '%. ~.. '%. ~ ~ / ~ ~ Ground ~oter 1250 gal STEP tonk 140 4 feet belo~ surface 2.~' "Fiffer' Sond ' TOBBEN SPURKLAND P.E. II 205 W 157H. AVENUE II AK. 99501 LOT 21C LAKEWOOD HILLS PHYLLIS BOOTH lOJOf HILLSIDE DRIVE SEPtiC SYSTEM DESIGN DATE: AUGUST 29, 1994 SHEET: 5/J GRID: 2540 , Jul 11.199~ 05:25PM FROrl 6[LFIL[AIq EtqG[IqEERING. fN TO $~3~453 P. 86 GmFILIAN EN INmUN & ;? EIWIRONMF. NTAL TESTING, INC. ~.:-.::"' ,.',. Professional Environmental Consultants 2605 l~nali Sifct:l. '4ui1¢ 2U] · A.qchorag¢, Alaska 99503-2749 Tel: (90'7) 277-2021 · Fax: (907) 274-8683 PERCOLATION TEST NO. 1 FOR TEST HOLE NO. 3 PROJECT NAME: Lot 21C Lakewood Hills Presoak Performed By: NA Perc Test Performed By: Tony Jackson Hole Diameter 8 inch Test Run Between PROJECT NO.: 94016 Date: NA Time: NA Date: 6/28/94 Time: 1:00 3.0 Feet and 3.5 Feet START STOP TIME MEASUREMENT MEASUREMENT WATE~ PERC REMARKS TIME TIME INTERVAl. {INCHES) (INCHES) DROP RATE (rnin) (START RUN) {END OF RUN) (INCHES) MIN/1NCH 1:13:08 1:19:30 6.49 41 ~/4 47~1, 6 1.08 1:22:08 1:30:00 7.99 41 ~/.~ 47~14 6 1.33 1:32:30 1:42:15 9.5 41 ~/~ 47~/. 8 1.58 1:45:00 1:50:00 5.0 41 vi. 45'14 4 1:53:30 1:59:00 5.5 41 ~1~ 45~4/~e 4~°/~e 1.19 2.:00:30 2:05:20 7.83 41 ~Slf, 47~/a 5ah, 1.81 SOIL PROFILE See TM#3 5-I0-94 Percolation Rate = 1.5 Recommended Soil Absorption Rating = LOCATION MAP See At~ached Test Hole Location Map Minutes per Inch 125 sf/bedroom for trench Reviewed by: PERCTEST.GEI C.I~: 2_-',PM FROM GILF[L[AH EHG[MEEF'[NG, U,I TO 563:B453 GILFILIAN ENGINEERING & ENVIRONMENTAL TESTING, INC. Professional Environmental Consultants 2605 Den. ali Strr~. Suite 203 · Anchorage, Alaska 99503-2749 Tel: (907) 277.2021 · Faa: (907) 274--8683 PERCOLATION TEST NO. 2 FOR TEST HOLE NO. 4 PROJECT NAME: Presoak Performed By: Perc Test Performed By: Hole Diameter 8 inch Lot 21C Lakewood Hills PROJECT NO.: 94016 NA Date: NA Time: NA Tony Jackson Date: 6/28/94 Time: 1:00 Test Run Between 2.0 Feet and 2.5 Feet START STOP TIME MEASUREMENT MEASUREMENT WATER PERC REMARKS TIME TIME INTERVAL (INCHES) {INCHESI DROP RATE {mln) [START RUN) {END OF RUN) {INCHES) MIN/INCH :06:25 1:13:25 7 61 ~1~, 66~a/~, 5 1.40 :16:00 1 ;Z3;OO 7 92 66111~ 4.44 1.58 :25:40 1:32:40 7 62 657/~, 4.44 1.58 :36:50 1:43:50 7 62 66a/T~ 4.38 1.60 :45:45 1:52:45 7 62 66~/~e 4.31 1.62 8.25 62 67~h, 5.06 1.63 SOIL PROFILE See TM#4 5-10-94 Percolation Rate = 1.6 Recommended Soil Absorption. Rating LOCATION MAP See Attached Test Hole Location Map Minutes per Inch = 125 sf/bedroom for trench Reviewed by: Date: PERCTEST.GEi .Tul 11, 1'-794 ~35:24F'M FROI'I GILFIL[~I'I EHGIHEEI~ii'.IG. [t-I '0 TH--1 PERC- 1 I I I.. LOT 2 1 I t- N 89'5,3'59" E 279.67' TH-.3 PERC-1 PERC-2 LOT B ~20' UTILITY ESMT. N 89'53'59" E 21 C -176' ~141' ~02' ! TH- 1 10' UTILITY ESMT. I I -'-t 279.67' LOT 21 D I I I TEST LOCATION and I.D. No. PERCOLATION TEST LOCATION LOT 21C LAKEWOOD HILLS - TESTHOLE LOCATION MAP SCALE: GILFILIAN ENGINEERING & ENVIRONMENTAL TESTING, INC. 2605 Oenali St., Suite 203, Anchorage, Alaska 99505-2749 1"= 50' DATE: 7/11/94 GEl PROJECT NO. 94016 FROM GILFILIAH ENGINEERING, IN P. 88 TESTHOLE No. 4 LOT 21C LAKEWOOD HILLS - TEST HOLES GILFILIAN ENGINEERING & ENVIRONMENTAL TESTING, INC. 2605 Oenali St., Suite 203, Anchorage, Alaska 99505-2749 SCALE: N.T.S. DATE: 7/11/94 GEl PROJECT NO. 94016 PERFORMED FOR: LEGAL DESCRIPTION: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Range, Section: (FEET) 1 2 3 4 5 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS S,~--~- SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? P E I ,a~I Depth to Water Alter i'i% _., Monitoring? ~ Dale: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE I, ~ (minutes/inch) PERC HOLE DIAMETER . TEST RUN BETWEEN ~...3' FTAND ~'~'"'" FT PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85} 5 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 2 3 4 5 6 7 8 9 10 11 121 ~3 14 17 19 20 COMMENTS NO Township, Range, Section: SLOPE I I WASGROUND WATER ENCOUNTERED? s L IF YES, AT WHAT O DEPTH? p E Depth lo Wal~r After [¢,onilori~g? .0ate: SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~'> ~,¢'(~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 1 __ FTAND '~ /2' FT PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCEWITHALLSTATEANDMUNICIPALGUIDELINESINEFFECTONTHISDAi'E. DATE: 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG B PERCOLATION TEST PERFORMED FOR: LEGAL OESCR,.T,ON: Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? P Depth lo Water AIler Monitoring? Dale: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE 5 bO (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN __ FT AND -- FT PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4- 5- 6- 7 8 9- 10- 11 12 13 14 15 16 17 18 19 20 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST e- EN )N ER'S ~' ~t,~ ~, ~ .. · ~, SATE PERFORM~'/~/~O~~ Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT 0 DEPTH? P E Depth to Water After Moniloring? Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN FT AND FT COMMENTS PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72~008 (Rev. 4/85) -TH~) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L~ OL DEPTH? P E 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O SLOPE SITE PLAN Depth to Waler After) Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN __ FT AND FT COMMENTS PE,,OR.EOBV= , CE,T,,VT.ATT.,ST,STWAS,E""OR'EO'" 72-008 (Rev. 4185) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9- Township, Range, Section: SLOPE SITE PLAN 10- 11 12 13 14 15- 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? S If YES, AT WHAT q..~ DEPTH? P E Depth to Water After/ ~ /~,y Monitoring? ,,'~J.~ ~ ~ Date: U Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN __ FT AND -- FT COMMENTS PERFORMED BY: ~,'¢°[~'~ I ~ ~ , CERTIFY THAT THIS TEST WAS PERFORMED IN AOOORDANCEW.THALLSTATEANDM .,O.PA U,OE'NES'"EFFEOTONT"'SOATE- DATE: --%"--'¢ 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMEI LEGAL DESCRIPTION: 1 2 3 § Township, Range, Section: SLOPE SITE PLAN I I 10 11 12 13 14 15 16 17 18 19 2O WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth lo Water Alte/' Gross Net Depth to Net Reading Date Time Time Water Drop ; ~o:,,-o 7, 87 ~17'/¥ [; ~ 2.~ 5o ~ MI I '..~g'-.?~= -- t']lq'q PERCOLATION RATE f""-~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN Z FT AND 3, ~ FT COMMENTS ACOORDANOE W,T. A'L ST^TE AND MUN'O'P^' GU'~EL'NES 'N """EOT ON TH'S DATE- DATE: 72-008 (Rev. 4/85) T~uq Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST L~.o_,.,...-~,,,~? P,; tl~ ~',t4- tq L_ 2 6 8 DATE Township, Range, Section: SLOPE SITE PLAN I 10 11 12 13 14- 15- 16- 17- 18- 19- 20- COMMENTS WAS GROUND WATER 7 ENCOUNTERED? S IF YES, AT WHAT ~ DEPTH? '~' ~ P E Depth to Water After/ ~"/i;?-..~ / Monitoring? ~.~. ~,- ~4_ Date: kd' Gross Net Depth to Net Reading Date Time Time Water Drop ~!~. ~.'o~,: ~,,* - 6t '~'~,,, PERCOLATION RATE TEST RUN _~ ETWE[E~, . (minutes/inch) PERC HOLE DIAMETER FTAND ~,'~,~"~ FT (;~,....~ ~"~ PERFORMED BY: I ~)~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN AOCORDANCE W,T. ALL STATEAND M~.'C'"AL ~'DEL'"ES'" EP~EOT O" TH'S DA-* DATE: 72-008 (Rev. 4/85) Municipality of Anchorage Development Sentices Department Bulldlng Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 A~chorage, AK 99519-6650 www.d.anchorage.ak, us (9{)7) 343-7904 CERTIFICATE OF HEALTH ,UTHORITY ,b, PPROVAL FOR SINGLE FAHILY DWELLING Parcel I.D. 015-13,4-92 1. GENERAL INFORMATION Exp{retion Date: /- "Completelegaldescripflon LAKEWOOD HILLS SUBDIV1SON ~2; LOT 21C,' Location (site address or directions) 10.301 HILLSIDE DRIVE * ANCHORAGE, AK 99507 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address BRADLEY S. BOOTH Dayphone 274--5817 1210 'U" STREET APT ~3 '~ ANCHORAGE, AK 99501 Day phone CONNIE GOODALL w/ DYNAMIC PROPERTIES Day phone 31'11 'C" STREET * ANCHORAGE, AK 99503 261-7656 Unless othen~ise requested, HAA will be held by DSD for plckup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Indtvldual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an Independent professional civil engineer registered In the State of,Naska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from th6 date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Ce~ficates may be reissued fora period cf up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER ~ AS ce~'fied by my seal affixed hereto and as of the validation date sho~vn below, I verify that my investigation, based on procedures outlined in the Health Autho6ty 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 ve6fy that based on the infon'natlon 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone Address 6901DEBARR ROAD, SUITE 2B * ANCHORAGE. AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 537-6179 Engineer's Comments: In conducb'ng this evaluation, AWWC, Inc. attempted to provide e thorough, conscientious engineetfng analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the t/me of the test, end separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate durfng the year, and the water usage of the family being served by the system. These conditions are outside the contrel of the eveluator of the system. Satisfactory test results do not guarantee f~ture perfon'nance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not previde any waEanty or futura estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal dght whatsoever. ' 5. DSD SIGNATURE J Approved for '~ bedrooms. Disapproved. Conditional approval for .__ bedrooms, with the ~owing stipulations: .,f¢{(lh'?o¥,r,, ........ WATERAND . ¢ Attachments: HAA Checklist Septic System Advisory Well Flow Advisory '. PROGRAM ...' Manitenance Agreements /~J]/~ ~ } ~ I ) H'" Supplemen~l Engineer's Reort Other Original Certificate Date: Legal Oe$cflption: A. WELL DATA Well t~pe.~v^~ Municipality of Anchorage Development Services Department On-S~ W~e~r & W~tewter PmB~m P.O. Box 196650 AnC~o AK gg51g-6650 ~w~w.d.mtcl~x~e~cu~ HEALTH AUTHORITY APPROVAL CHECKLIST LAKEWOOD HILLS S/O 42; LOT 21C, Parcel ID: Data completed Totaldepth 251 It. Data of test StaUc water level Well production WATER SAMPLE RESULTS: If A, B, or C provide PWSII:~ N/A 11/18/94 Sanitary seal (Y/N) YES Casedto 251 ft. FROM WELL LOG 11/18/94 109 .It. g.p.m. 12 015-134-92 YES YES 12+ Coliform .(~ colonies/100 mi. Data of =ampio: lO I B. SEPTIC/HOLDING TANK DATA we, Log (Y/N) Wires pmpedy protactad (Y/N) Casing height (above ground) AT INSPECTION 7/20/01 158 5.4 g.p.m. Nitrate ~__.~JL Other becteda ~ Collected by: AWWC, ~NC. in. colonies/100 mi. Tank Tybe/Matadal S.T.E.P./STEEL Data Installed 11/3-7/94 Tank size 125o gal. Number of Compa~menta 2 Cleanouts (y/N) YES FoundaUon deanout (Y/N) YES Depression aver tank (Y/N) NO High watar alarm (Y/N) YES Data of pumping 7/2.3/01 Pumper A+ HOME / SERVICES C. ABSORPTION FIELD DATA Data Installed ~ ~/3-7/94 Soft rating (~lor ~/Ixlrm) 0,7 System type BED Length 43 ~ Width 15 ft. Grovel below pipe 0.5 ft. Totaldepth &ST ff. Eff. ebsorptionerea 64.5 ft' MonJtoringtube YES Depression over fleld. NO Dataofacioquacytast 7/20/01 Results(Pass/Fell) PASS For .3 bedrooms Fluicldepthinab$0rptionfleldbeforotast 0 In. Wataredded1856gal. Newdepth 0 in. Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p,d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give data - O. UFT STATION Date installed 11/5/94 'Pump on' level at 42 in. Datum BOTTOM OF TANK E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Size In gallons 1250 "Pump off' level at 58 in. Cycles tested. 5 Septic tankalft station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer/septic sen/Ice line 25'+ Manhole/Access (Y/N) YES High water alarm level at 44 in. Meets alarm & circuit requirements? YES On adjacent lots 100'+ On adjacent lots ~ 00% Public sewer manhole/deanout Holding tank N/A N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5' Property line §% Water main N/A Water esndce line 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10' + Building foundation 10' + Water service line 1 o' + Surface water 100' + Curtain drain NONE KNOWN Wells on adjacent lots ; 00'+ Absorption field 5'+ Surface water ~ 00' + Water main N/A Driveway, perking/vehicle storage F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections end revfew of Municipal records that the above systems ere In conformance with MOA HAA guldellnes in effect on this date. Engineer's Pdn,ted Ne~me Date ID/Dello, JEFFREY A. GARNESS , / HAA Fee $ Date of Payment Receipt Number (ear. 12mo) Waiver Fee $ Date of Payment Receipt Number OCT-09-OI 15:38 FiEi~T&E EflVli~/~NTAL IRV 9075515~01 T-519 P.02/03 Fog4z ,~t~__" ~&E Environmental ~wices Inc. 1016785001 AK Water & Wastewattr Consultants l~c. Lakewood llilh//2 Lot 21C Lakcwood Hills//2 Lot 21C Drinking Water Client POW printed Date/Time 10/09/2001 14:11 Collected Date/Time 10/04/2001 13:00 Received Date/Time 10/04/2001 14:40 gample Re~arkS: Nittatc-N 3.95 0.500 m~t. EPA 300.0 SCL M:L c ~:ob:Lo'l og'/ ~.aborat:o~/ Tolal CoB fo~n col/100mL SM18 9222B (<Il KAP ' MUNICIPALITYOFANCHORAGE ;' ' ' DEPARTMENT OF HEALTH & HuMA~'S~iViCi:S: 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. # OI-~' I'~L~-- 1. GENERAL INFORMATION complete legal description Location (site address or directions) ProPerty owner Mailing address Lending agency Mailing address Agent Address Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: lng to the legality and status of system. " 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer If community well system, provide written confirmation from State ADEC attest- · :~,, t j · -.:, 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 ~1 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water suPply and/or wastewater disposal system is in compliance .with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature DHHS SIGNATURE Approved for -~ Disapproved. Conditional approval for Phone bedrooms. bedrooms, with the following stipulations: Additional Comments Date//-- :' ' '~,~he MuniciPality of~.~'r~chorage Department of Health and Human Services (DHHS) issues Health Authority ,, ;Approval ~'ert f cates based only upon the representations given in paragraph 5 above by an independent Profess!anal engineer registered m the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-0'25 (Re~, 1/91) Back MOA ~1 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lc'f.~-{(_~ .~ouT~, LA~-¢,~c~ 14~t.L~ Parcel I.D. A. Well Data Well type '~. Log present (Y/N) ~ Total depth ~q-'~ / Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed II, 1~ -q. ~{ Driller /~ L~IN t.~ Cased to ~- ~ I Casing height ~f. I Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot [ Public sewer main Sewer service line AT INSPECTION g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: ~,..~ Other bacteria Collected by: '~'. ~ B. SEPTIC/HOLDING TANK DATA Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size ~ ~E) Compartments ~-- Foundation cleanout (Y/N) "// Depression (Y/N) ?/ Alarm tested (Y/N) .'2/ Pumper N/'A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I ~ ~-- On adjacent lots To property line ~-~ Absorption field Surface water/drainage ~ o /fl ~- Foundation Water main/service line 72-o25 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) ~/ High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) "/ Manufacturer ,~ Manhole/Access (Y/N) "Pump off" Level Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot I L~ O On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed "I ¢ lq ~ Length L{ ~.~ Width Soil rating (GPD/F¢) 0. Gravel thickness System type Total depth Total absorption area ~, ~ Cleanout present (Y/N) Date of adequacy test ~ Results (pass/fail) Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Depression over field (Y/N) for After test If yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Sudace water Curtain drain On adjacent lots '~' / L,~:) Property line To existing or abandoned system on lot F'-////,~ Cutbank .~ ~-O Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to afl MOA and HAA guidefines in effect on the date of this inspection. HAA FeeS ¢00 "(,/0 Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number CT&E Ref.~ Client Sample ID Matrix Commercial Testing & Engineering Co. Environmental Laboratory Services 94. 6197-1 LABORATORY ANALYSIS REPORT L21c ~EWOOD HZLLS WATER Client Name' TOBBEN SPURKLAlVD, P.E. WORK Order Ordered By Printed Date Project Name Collected Date Projeot~ Received Date PWSID UA 11484 12/27/94 @ 16:11 hrs. 12/19/94 @ 12:30 hrs. 12/19/94 @ 15:05 hrs. Technical Director STEPHEN C. EDE ReleasedBy Sample Remarks: SAMPLE COLLECTED BY: T.S. QC Allowable Ext. A~al Parameter Results Qual Units Method Limits Date Date Init Nitrate-N 4.2 mg/L EPA 300.0 ION 12/21/94 CMR * See Special Instructions Above UA = Unavailable ** See Sample Remarks J~ove NA = Not Analyzed 9~U = Undetected, Reported value is the practical quantification limit. LT = Less Than ~:~D = Secondary dilution. GT = Greater Than 5633 B Street, Anchorage, AK 99518-1 600 -- Tel: (907) 562-2343 Fax: (907) 561-5301