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LAKEWOOD HILLS #2 LT 20A-1
Lokcwood Hill Lo1' 20A- ! #015-134-96 Municipality of Anchorage Development Services Department u^-:.. Building Safety Division -' 00* On-Site Water & Wastewater Program, 4700 South Bragaw St. ; A E - v P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SWO10352 PID Number: 015-134-96 Name: MIKE SHARROCK Wastewater System: ■ New El Upgrade Y Address: 10001 HILLSIDE DRIVE * ANCHORAGE, AK 99516 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 244-5085 6 ■Deep Trench ❑Shallow Trench ❑Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: 0.8 GPD/Sq. Ft Total Depth from original grade: 10.25-10.46Ft. Block: Lot: Subdivision: Depth to pipe bottom from original grade: Grovel depth beneath pipe: — 20A-1 LAKEWOOD HILLS #2 2.22-2.43 Ft 8.03 F, Township: Range: Section: Fill added above original grade: Gravel length: — — — SEE DWG. Ft 72 Ft WELL: ■ New El Grovel width: 2.5 Number of llnea: Distance between linea: — Ft.1 Ft Classification (Private, A B,C): Total Depth: Cased To: 1 Total absorption area: Pipe material: D 3034/ F-810 PRIVATE 256 Ft 256 Ft. 1 156 SQ. Ft Driller. Date Drilled: Static Water Level: 1 Installer. SANDER & SANDERS Date installed: 10/4-31/2001 HEFTY DRILLING 9 17 01 234 Ft Yield: Pump Set At: Casing Height Above Ground, TANK 3.5 GPM UNKNOWN Ft 1.5+ Ft SEPARATION DISTANCES ■ Septic ❑ Holding ❑ S.T.E.P. ❑ Other To Septic Absorption Lift Holding Public/Private Manufacturor. ANCHORAGE TANK Capacity in gallons: 2000 From Tank Feld Station Tank Sewer Lines Well 100'+ 100'+ — — 25'+ Material: STEEL Number of compartments: 2 Surface Water 100'+ 100'+ — — — LIFT STATION Lot Line 5'+ 10'+ — — — Size in gallons: Manufacturer. Pump on' level at: at: High water alarm at Foundation 5'+ 10'+ — — — =at:* Pump Make ode1: Electrical Inspections performed by. Curtain Drain NONE KNOWN BENCH MARK Remarks: Location and Description: TOP OF FOOTING BETWEEN GARAGE DOORS Assumed Elevation: 125.13 FL ENGINEER'S SEAL o40Q�QO� Inspections performed by: AKWWC, INC. Dates: 1st 10/4/2001 :.....gTH -P�ODD Q 2nd 10/5/2001 . • 3rd 10/31/2001 �•.�leff y G rnes .= Q QO � 0�@ ca�7953 - • mp Development Se icesDepartment Approval �'s c°O Reviewed by: Date: /0` 1 �4 dprofessio��o and approved (Rev. 12/01) I OQQO�O�p� J I V v NUMBER: PARCEL INUMBER:SWO10352 AS -BUILT DRAWI�G 015-134-96 I / I � A B Via• • :ear NEW 2000 GALLON / SEPTIC TANK N DBL1 I f r 155 o T2 l ITM#, dra- `NEW DRAINFIELD) I DATE: 8/20/2002 DRAWN BY: ALASKA WATER & WASTEWATERS J.L.M. - CONSULTANTS, INC. - SCALE: 6901 DEBARR ROAD, SUITE 28 ' ANCHORAGE. AK 99504 ' PHONE (907)337-6179 ' FAX (907)338-3246 PREPARED FOR: PHONE NUMBER: PAGE NUMBER: MIKE SHARROCK (907) 244-5085 2 OF 3 LEGAL DESCRIPTION: LAKEWOOD HILLS SUBDIVISION #2; LOT 20A-1 TYPE OF WORK: AS -BUILT OF NEW WELL AND SEPTIC SYSTEM ST1 44.87 14.35 ST2 58.84 18.16 DBL1 63.23 20.85 DBL2 64.58 21.91 C01 1 67.74 69.07 CO2 100.38 99.73 MT1 98.47 98.88 CO3 107.90 137.47 MT2 106.75 136.17 I _ _ PERMIT NUMBER: AS -BUILT DRAWING PARCELID NUMBER: SW010352 015-11 34-20 FINAL GRADE = 126.70-127.21 5fl 5f2 TOP OF TANK AT TOP OF TANK AT OUTLET = 122.33 INLET = 122.37 INVERT OF BUNG AT INLET = 121.93 NSW 2000 CALON 5�FTIC MW Mf CO FILTER FABRI RELATIVE BOTTOM OF TEST HOLE = 82.62 (DRY) --7 BOTTOM OFA TRENCH = 90.16 (AVG.) (VERT OF BUNG AT OUTLET = 121.51 GRADE = 101.82-102.30 ORIGINAL GRADE = 100.62-100.41 INVERT OF PIPE = 98.19 (AVG.) DATE: 8/20/2002 f .. DRAWN BY: ALASKA. WATER & WASTEWATER J.L.M. scALE: � = CONSULTANTS, INC. e - - ,6901 DEBARR ROAD, SUITE 2B ' ANCHORAGE. AK 99504 ' PHONE (907)337-6179 'VFAX (907)338-3246 N.T.S. PREPARED FOR: PHONE NUMBER: PAGE NUMBER: MIKE SHARROCK (907) 244-5085 3 OF 3 LEGAL DESCRIPTION: LAKEWOOD HILLS SUBDIVISION #2; LOT 20A-1 TYPE OF WORK: PROFILE AS—BUILT OF SEPTIC SYSTEM f —7953 nes. m� • . , ' tic°G 0 ,���pr0 f essi01il P.01 HEM DRILLING WATER ELL, RECORD M'te OF ALASXA 3S40 AKUJA DRIVE I AN.CHOROE, AK 99516 DEPASITMENT Or NXILIFIAL. RE-SyVRES (907) W,-0593 Division of Goolog to) Ek Goophyalcol Surveys Drilling Permit N Li 0 LOCATION or WELL (PI-4 comvtofo olfhmr to, lb or ic.) A. 0. L N:. saroUohzbdlvlvlott Lot Block lb, 'A 41 (1. Sstflon No. Townfthlpli Banco, 'FEl marldlon ��kl%'JLVJ-, . t H i of— of—af W(j DISTANCE AND DIRECTION FROM ROAD S INTERSECTION3. OWNER OF WELL'Th" INTERSECTIONS Aa V Y, t) SIr#9l Address and Area Of Well Location 2. WELL LOG Feel below Su r (cc* A. WELL DEPTI-ft UlAol) UATSQF to, mr"�'-VI'DN Molartal TypooD llom ff. 0. OCoblo tool polory C) Driven ODug L1 0 Bored 0 Other t 7. USE: Domestic, 0 P Will 4upply 0 In'du*sIfY C] Irrigation ❑ R�cholv 0 Cd ! mmoricol 0 Yost Well C] 0114f. $.0 S G 0 Threaded A� Welded S q- dlom-mift. to It. 001h , weight i lbs./ft. S diem. In, 10 '—It. Depth Stickup— 11, FF I 9: FIN18H OF WELL- — Typo: 6 P t�OlameUn Slot/Mesh Size;. Lling1hi- 11 CA Sol blilwwk ff. and Ck it A 0iickfillfrig )rov$l pdtk 10. STATIC WATER LEVE( Above or ❑O'Billow leAd'sy Dal* Equipment used: It-PUMPING LEVEL koglow land & Irfatf CAO YIELD I (I, alter pumping I ff. offer h 6. PUMPIAQ IZIGROUIING Well Grouted. Yet C] No Material*. 011act Cement 'Other, ---------- 13, PUMPI (if ovallohlo) HP 7— Length of Otop Pipe 11. capacity 0. P. m. 0 sub.. 0 jot❑ Almiricol E) of ' j. P Ill- WAYCR WELL CONTRACTOR'S CERTIFICATION: Wolof Temperature _9 Ir O-C • Thli; well wag drilled Older OnY Jurizalollon and this ropofl Ii Ilub 1, 1,,* boil of my �AO-Iodjm omd belief; lbri-O but ni, i No.0 Contrast License NumDK A u , 0.1f out# rar- Oz-WWR (11/01) COPY 0131fibUllon: WHITC-Stolo OGGS' CANARY- Cuslornor JAN -29-02 06:33 PM GOLDEN NORTH CONST 9073463323 P.01 HEFTY DRILLING STATE OF ALASKA 3540 AKULA DRIVE DEPARTMENT OF NATURAL RESOURCES ANCHORAGE, ALASKA -99516 MINING, LAND. WATER 11NID1101.10GIC SURVEY WATER WELL LOG (907) 345-0593 Drilline Started: q / I�4 /•Q_,(, Completed: ,q -/j -7—/!!2L ('ity/Ilnrough: _Subdivision/USS: 111nck Lot O Properly or vnc & dross: p N� Q A- Mcridian, f0\Vp$ltlp Range SCctn)11 11 Or 'A Of V4 Or 1�4 Lot: N Long: W NAC!: 27 OR 83 Elevation: , BOREHOLE DATA: (frt w1!rotmd surface) Depth Drilling method. - Air rotary, 0 Cable tool, Other Material: 'type, Color & wetness I Fes)� � ° Well use: -1 Public supply, Domestic, fl Other Depth of hole:., ft, Catling stickup: V r � „ tt Casing types. Z°��� Thicknes., _ inches Casing diameter: inches Casing depth ft ._ Liner t.ypc: Diameter: holies Depth: ft Static water (1'rom 11)11 4 un "�y 0, V o. �., Pumping level & yield: feet after lours at gpm Recovery rate: gpm, Method of testing: C�— ! )ci +N d (i t� Development method: Duration: ' rr-�.Cl well intake opening type: •f4 Open end, n Open hole ro,v¢.(.. 0 Screened; Stmt: ft, Stopped ft Screen type: Slothilesh size 1. i Perforated;Start: ft, Stopped ft Start: it, Stopped ft '��. cl ... ^ `� Note: J Grout type: ��.n�o.r�� volume Depth; From ti, to _tt Pump intake depth: ft Pump size hp, Brand name: Was well disinfected upon completion? /5q Yes, ONo Method of disinfection: ha U.z L U Driller comments/ disclaimers: Well Driller Name•A (J�tIVA` --s t4.4. e, < �• Company Name: HEF DRILLING Mailing Address: _„_ 40 AAKl LA DRIVE City: ANCHORAGE St ALASKA Zip; 99516 Phone Number :\ 907 5- 9 Drillers Signature: o AA() kSi�c (Q (� ' _ <' _- a. V,\1 Na u _ )-t:k ve L k-, 3,5b Stale In\% rrquircc th:n a oq- •.1 0m. "'Al h•;; f•.• .cnl 1" 11-v `•talc vr.\lar.l..r within •1� llii�9. i,a3t, are (AK statutes 38.05.02().,18.05.0-45. 41.0x.020, 46 15.020 and AK regulations I I AAC 93.140). DEPARTMENT Of NAT(IRAL RESOURCPS Mining, I,nnd & Water Hydrologic Survey 550 W 711, Ave., Suite 900A Anchorage, AK 99501-3577 Telephone (907) 269-809 !tad FAX (907) 562-1384 Within the City of Anchorage, it is required that a copy of the well lug be sent to the appropriate city office within 60 days and that another copy of the well log he sent to the well/property owner within 30 days. Permit Number: Date of issue: /_ /-.•�__.__ Parcel Identification Number: Is well located at wDroved permit location'? 0 Yes or n No • ro Z by JOCt MA0,*0900 N 'I" tp cD C; — — — — — — — — — — — — — — — — — — — — — — .6'1-L M,.00.*0.00 N ap 3AIN0 30IS-nlH z t< t1i 0•1 U) cq ul wj c" F r 0 .j 0 0 3: ui • ro Z by JOCt MA0,*0900 N 'I" tp cD C; — — — — — — — — — — — — — — — — — — — — — — .6'1-L M,.00.*0.00 N ap 3AIN0 30IS-nlH AUG -20-02 03:19 PM GOLDEN NORTH CONST 9073463323 lb•0 m ° 1� N �,, • • 'f e °o a O3 Qt zU-® � • O o C ® (yJ = e e I o a ANAN J bIZ 'f+1 M-004040 N oz z o =�9 z /jt3 S2 zg18, zo $ O w W Z� w �M w �wSw$ u =Law La Z 000m z xw r Z N _ N Z N no Z .7::)00 m -N w a#= N � U 9 cd i 9 P. 03 1 0.5' -- 4 / Leo _�-: o a r, MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Permit Number: SWO10352 Legal Description: LAKEWOOD HILLS #2 LT 20A-1 Design Engineer: 0041 AK Water & Wastewater Consultant Owner Name: Mike Sharrock Owner Address: 10001 Hillside Dr. Anchorage , AK 99516 - Date Issued: Sep 04, 2001 Expiration Date: Sep 04, 2002 Parcel ID: 015-134-96 Site Address: Lot Size: 67555 SQ. FT. Total Bedrooms: 6 Permit Bedrooms: 6 This permit is for the construction of: ❑� Disposal Field F,-/] Septic Tank Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. Private Well ❑ Water Storage 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Date: 6/ Issued By: t / GlAtW / - 7 Z�o-� Date: Y —4 —(// Municipality of Anchorage • eitifi{ilIliilli rt Development Services Department Building Safety Division SAFETY On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 0/,5— r �L�- 7 k Permit Number Property owner(s) MIKE SHARROCK Day phone 244-5085 Mailing address (1) 10001 HILLSIDE DRIVE * ANCHORAGE. AK Mailing address (2) Zip Code 99516 Legal description (Lot, Block & Sub'd.) LAKEWOOD HILLS SUBDIVISION #2: LOT 20A: I Legal description (Section, Township & Range) Lot Size -6-7= Acres/Sq.Ft. Number of Bedrooms 6 THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ■ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. ALASKA WATER & WASTEWATER CONSULTANTS, INC. Permit Fees: r� Date of Payment: g Iq C� 1 I Receipt Number: 90(11- c? Waiver Fees: Date of Payment: Receipt Number: zu�. CONSULTANTS, INC_ na„ August 14, 2001 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Proposed Well and Septic System for Lot 20A, Lakewood Hills Subdivision #2 To whom it may concern: The proposed 6 bedroom house will be served by a private well and septic system. Test holes were excavated on the property in the area of the septic system. The septic system will be designed around the 30 foot radii of these test holes. We are proposing that a new 2000 gallon septic tank and a deep trench type drainfield be installed. The proposed well location is shown on the site plan and design drawings. Comments regarding the design are summarized as follows: 1. SOILS: See the attached log which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that due to the overall appearance of the soils, an application rate of 1.2 gallons/day/ft2 should be used. 2. TRENCH DESIGN: a. Percolation Rate: <l, 3.5, 10 minutes/inch b. Allowable Application Rate: 0.8 gallons/day/ft2 c. Number of Bedrooms: 6 d. Design Flow: 900 gallons per day e. Minimum Absorption Area: 1125 ft 2 f. Total Depth: 11 feet (max.) g. Effective Depth: 8 feet h. Width: 2.5 feet i. Reduction Factor: N/A j. Minimum Length: 72 feet k. Effective absorption area = 1152 ft2 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com 4. TOPOGRAPHY: As can be seen on the attached topography site plan, the average topography of this property is a 20 to 25 percent slope running from approximately north/northwest to south/southeast; in short, there are no slope concerns. The trench is to be installed parallel to slope contours. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your asgi stance_ .E., M.S. NOTE: Attached is a site plan drawing, a design drawing, a topography site plan, a soils log, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com i Lul S 1/2, SW 1/4, NW 1/4, SECTION 13, T12N, R3W c1lJ\// J -------�----------- I I R' \ If I / I HAMPTON HILLS S/D #1; It I LOT 1, BLOCK 3, PROPOSED 6 BEDROOM I I I I I _ _ _ �` .`i4•; / I EXISTING / HOUSE I I o 1 ;.•:� 6 BEDROOM / HOUSE / I '+;.;; / ;; , •: • EXISTING SEPTIC SYSTEM WELL AND SEPTIC ON EAST SIDE OF PROPERTY I NO ENCROACHMENT CONCERNS I HAMPTON HILLS S/D #1; LOT 2, BLOCK 3, PROPOSED SEPTIC SYSTEM (SEE DESIGN I PAGE 2 OF 2 -- I I i I ALTERNATE SITE I I I I I I �� I PROPOSED NEW LOT LINE I HAMPTON HILLS S/D #1; \ LOT 3, BLOCK 3, i �LAKEWOOD HILLS S/D #2; WELL R4DjUS ' I I I `-VACANT LOT 21A, I I I I I I - — - — ----- DATE::�:a,�� 8/ 10/2001 . Com• ..G;;. �l DRAWN BY: C.J.G. _. ALASKA WXrER & WASTE WATER CONSULTANTS, INC.= I DEBARR ROAD, SUITE 2B •ANCHORAGE, AK 99504 •PHONE (907)337-6179 FAX (907)338-3246 �::' (l�+ri 7V .. I4r ��y�`� :� '•!rl4l') :• 9.T ``� '. *�+01' ,i....:.. .. ....:....i% vA 1, vn ,• . ..••••. SCALE: as a 1 = 100 PREPARED FOR PHONE NUMBER: PREP PAGE NUMBER: MIKE SHARROCK 244-5085 1 OF 2ori:• •. a yr ,, re or, ess; �v P CEJ 7953 ; Y J'�;9�r��•'•:•.••`•••.. LEGAL DESCRIPTION: LAKEWOOD HILLS SUBDIVISION #2; LOT 20A, ••' cNtit %" k a°\a�°rofessio��� 1:SITE TYPE OF WORK: PLAN FOR PROPOSED WELL LOCATION AND SEPTIC SYSTEM �'��.,,,�,� PROPOSED 1 I WELL q 6 6E VSE— — INSTALL FOUNDATIONYO CLEANOUT � • ,. W I 1- ° EXISTING I PROP SED 200 GALLON SEPTIC SEP�!: ,' I SYSTEM N I ti- DOUBLE C/0 0 I _ MT. ALTERNATE SITE I I LOT UNE PROPOSED NEW DRAINFIELD. EXCAVATE A THAT IS FEET DE PTRENCH MAXIMU BY 2.511 FEET WIDE AND 72 FEET LONG. ADD 8 FEET OF CLEAN, WASHED SEWER DRAINROCK. INSTALL — IE TANK IS TO BE 5'+ FROM FOUNDATION TRENCH PARALLEL TO SLOPE I / IE TANK IS TO BE 5'+ FROM DRAINFIELD CONTOURS / IE TANK IS TO BE 5'+ FROM LOT LINE IE DRAINFIELD IS TO BE 10'+ FROM FOUNDATION y \ IE DRAINZI-D IS TO BE 5'+ FROM TANK IE DRAINFIELD IS TO BE 10'+ FROM LOT LINE DATE: p60Q0 8/14/2001o F 00 00 DRAWN BY- CJ Y: ap .•, // �Sl�oo ALASKA WATER & WASTEWATER SCALE: • • G • oQ _ y_� •'-•:y*�0 CONSULTANTS, INC. Di ; — ' ...............�� 6901 DEBARR ROAD, SUITE 2B 1 50 �1........ � ANCHORAGE, AK 99504' PHONE (907)337-6179 `FAX (907)338-3246 — D PREPARED FOR: PHONE NUMBER: PAGE NUMBER: MIKE SHARROCK (907) 244-5085 2 OF 2 •••tee re ••�•'•rnes ••�••• D O =, �effre A. Gayness;• m LEGAL DESCRIPTION: oOQ 9L �'•,•� CSE -7953 c�QQQ LAKEWOOD HILLS SUBDIVISION #2; LOT 20A, 00 f ,. TYPE OF WORK: 440edoo�v DESIGN OF PROPOSED WELL LOCATION AND SEPTIC SYSTEM �°rofessiono �DOpppopo o I X40 A ]L ASKA 'WATER & WASTEWATER CONSULTANTS, INC. ._. �..m* •••� lH o 6901 DEBARR ROAD, SUITE 2B °ANCHORAGE, AK. 99504 °PHONE: (907)337-6179 °FAX: (907)338-3246 • WEBSRE: akwwc.rnm � SOIL LOG - PERCOLATION TEST ,,; „•1 • ...•,••„ LEGAL DESCRIPTION: LAKEWOOD HILLS #2, LOT 20A-1 (PROPOSED) DO e fr y . Garness,. ` PERFORMED FOR: DATE: 44 E••7953 �Q MIKE SHARROCK 5-30-01 J �c°Q DEPTH (feet) ORG �44�0 rofessioao"�o TEST HOLE #1 00000 1 (PAGE 1 OF 2) GM SOIL CLASSIFICATIONS 2_1 ,p �p pip ; GW ORG 3G P T11 17111 ML ,oso°oo SW/GW I FSI I I ti GM CL ° o°p°o° c /v/, GC I ,_I OL o" SW I I-I I I MH Q• 0:4` o n 0001, c 5 .11�')�1 °° O� SP CH t. n ?i .Q.`,; GM/ML msc SM/,i OH t. 1 6-1 11`(1 I I I L� 7 °ao©oho °7 O°O°E co ®Q°00 8 J°C fl°fl°a pfl ° fl°0© :gip i�Jo.. g uoc�c°� o=V SP °� ©°D°= SITE PLAN gp° O 'p'o'p °pfl °o°p°oca aoo°oo 12 0; p odocp GW/SW 13—,,:q ;,;: o oo°oo 14 =:o' :b;`: �000000 OC3°43°Cfl SPUZI 18°a f° B.O.H. 19PERCOLATION RATE 3.5 (MIN./INCH) PERC. HOLE DIA. 6" (INCHES) TEST RUN BETWEEN 2.0 FT. AND 2.5 FT. 20 COMMENTS: PERC—HOLE WAS PRE—SOAKED FOR 4+ HOURS PERFORMED BY ALASKA WATER & WASTEWATER I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS �ERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: It Z /01 DEPTH TO DATE GROUNDWATER DRY 5Z30/01 DATE READING CLOCK TIME NET TIME (MINUTES) DRY 6 1 01 DRY 6/8 01 12:46 — DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 6/1/2001 1 12:46 — 6" — 2 12:56 10 MIN. 2" 4" 3 12:56 — 6" — 4 1:06 10 MIN. 2 1 /2" 3 1 /2" 5 1:06 — 6" — 6 1:16 10 MIN. 2 3/4" 3 1 /4" 7 1:16 — 6" — 8 1:26 10 MIN. 3" 3" 9 1:26 — 6" — 10 1:36 10 MIN. 3 1 /8" 2 7/8" 11 1:36 — 6" — _ 12 1:46 10 MIN. 3 1/8" 2 7/8" ALASKA WATER & WASTEWATER CONSULTANTS, INC. 6901 DEBARR ROAD, SUFE 2B • ANCHORAGE, AK. 99504 • PHONE 907 337-6179 • FAX: 907 338-3246 • WEBSRE: akwwc.com SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: LAKEWOOD HILLS #2; LOT 20A-1 (PROPOSED) PERFORMED FOR: MIKE SHARROCK DATE: 5/30/01 DEPTH (feet) TEST HOLE #1 1 (PAGE 2 OF 2) SOIL CLASSIFICATIONS 2 3- 4- 5- 0 45O 6 LLU 7 V) g 8 9 U J_ O U) 10 0' O 11 cV LL - 12 O 13 w C� Q 14 a— w 15 V) 16- 17- 18- 19- 20-- COMMENTS: 617181920COMMENTS: GW ORG G P IT ML GM CL GC OL a0000� SW I I MH Don°oDo°c 7v n�f 000 t SP SM OH SC DEPTH TO GROUNDWATER DATE (MIN./INCH) PERC. HOLE DIA. 6" (INCHES) SEE PAGE 1 OF 2 8.5 FT. AND 9.0 FT. IN EFFECT DATE READING CLOCK NET TIME WATER LEVEL NET DROP TIME (MINUTES) READING (INCHES) 6/1/2001 SOIL ABSORBED WATER AS FAST AS IT WAS ADDED. PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6" (INCHES) TEST RUN BETWEEN 8.5 FT. AND 9.0 FT. PERFORMED BY ALASKA WATER & WASTEWATER I, JEFFREY A. GARNESS, CERTIFY THAT THIS IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: L PERFORMED AT ,ASKA WATER & WASTEWATER CONSULTANTS, INC. - 6901 DEBARR ROAD, SUFFE 2B • ANCHORAGE, AK. 99504 " PHONE (907)337-6179 * FAX: (907)338-3246 * WEBSRE: akwwc.com SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: LAKEWOOD HILLS #2, LOT 20A-1 (PROPOSED) PERFORMED FOR: MIKE SHARROCK DATE: 5-30-01 DEPTH ORG (feet) TEST HOLE #2 1 I PAGE 1 OF 2) 2 0: GW GP GM GC SW SP SM SC T 171 I I /%//Z II oo° Gw eiII I I mop°°-oQ� >i P ✓���� 13 ©o®p�a4 — 4 .° 2 5 6 7 8 9 10 GM/ML I SW/GW nq`^oo p 12 DATE GW GP GM GC SW SP SM SC T 171 I I /%//Z II oo° 6/1/01 eiII I I mop°°-oQ� >i P ✓���� 13 ©o®p�a4 — 2 1:15 30 MIN. 3" 3" 3 OfJC p°Qp — 6" — 4 1:45 30 MIN. 3" 3" SP 1:45 — 6" — ao°®°mo 6 2:15 30 MIN. 17 3" 18 B.O.H 19- 20— COMMENTS: 920COMMENTS; SOIL CLASSIFICATIONS DATE GW GP GM GC SW SP SM SC T 171 I I /%//Z II ORG ML CL OL MH CH OH 6/1/01 eiII I I mop°°-oQ� >i P ✓���� � �%,� v��s — DEPTH TO GROUNDWATER DATE DRY 5/30/01 DRY 6/1/01 DRY 6/8/01 12:45 — SITE PLAN 1'-100' DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 6/1/2001 1 12:45 — 6" — 2 1:15 30 MIN. 3" 3" 3 1:15 — 6" — 4 1:45 30 MIN. 3" 3" 5 1:45 — 6" — 6 2:15 30 MIN. 3" 3" PERCOLATION RATE 10, (MIN./INCH) PERC. HOLE DIA. 6" (INCHES) TEST RUN BETWEEN 5.0 FT. AND 5.5 FT. PERC—HOLE WAS PRE—SOAKED FOR 4+ HOURS PERFORMED BY ALASKA WATER & WASTEWATER I, JEFFREY A. GARNESS, CERTIFY THAT THIS VIAS /PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: ! l "I ,Qo0600�� 0 ol G AZ.ASKA WATER & WASTEWATER oo ) 0 IT •:� �� •a. - CONSULTANTS, INC. 6901 DEBARR ROAD, SWE 2B • ANCHORAGE. AK. 99504 • PHONE: 907 337-6179 • FAX: (907)33B-3246 • WEBSITE: ckwwc.com SOIL LOG - PERCOLATION TEST Nov•••••••: •. •• LEGAL DESCRIPTION: LAKEWOOD HILLS #2; LOT 20A-1 (PROPOSED) O� •. e r IA. Gayness; D Q 9. E-7953 0' p PERFORMED FOR. MIKE SHARROCK DATE: 5/30/01 s� •. •�cpO DEPTH 4�44oa p • • ...... •�Q\ Foo O0000��� (feet) TEST HOLE #2 O 1 (PAGE 2 OF 2) SOIL CLASSIFICATIONS 2 d' GW ORG GP ML 4 / GC OL SW (� MH o n ccc 5— n°�aE SP % CH o ��R � SM 7//—/7� OH \ 6 a SC U LL - 7— L7 V) GROUNDWATER DATE 8 U V) SEE PAGE 1 OF 2 9 J O V) 10 ry ow DATE READING CLOCK NET TIME WATER LEVEL NET DROP 11 N TIME (MINUTES) READING (INCHES) 12 O 6/1/2001 13 w U Q 14 O_ w SOIL ABSORBED WATER AS FAST AS IT WAS ADDED. 15 16 17 18 19 PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6" (INCHES) TEST RUN BETWEEN 8.0 FT. AND 8.5 FT. 20 COMMENTS: PERFORMED BY ALASKA WATER & WASTEWATER I, JEFFREY A. GARNESS, CERTIFY THAT THISAS PERFORMED lV IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: /. /U► ///// I I f II III/ / I III( 11 V/// / / I i ............. 9 HAM ISTING PRO SEPTIC (SEE DESIGN OSED EW 1-51 LOT UN Ov 6901 DEBARR ROAD, SUl- PREPARED FOR MIKE SHAR;,,141'jn LEGAL DESCRIPTION: LAKEWOOD TYPE OF WORK:L�W LVA N SITE P _Z _11!f ATION AND SEPTIC It -�Avaiamimj / I III( 11 V/// / / I i Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Braaaw Street CERTIFICATE FOR A P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.Org/onsite (907) 343-7904 OF 0N-SITE SYSTEMS SINGLE FAHILY APPROVAL DWELLING Parcel I.D. 01515496 1. GENERAL INFORMATION COSA# O¢.~ ~'.. Expiration Date: Complete legal description LAKEWOOD HILLS,2, LOT 20A-1 Location (site address) 10101 HILLSIDE DRIVE *ANCHORAGE, AK 99507 Current Property owner(s) MICHAEL SHARROCK · Day phone C/O AGENT Mailing address 10101 HILLSIDE DRIVE *ANCHORAGE, AK 99507 Lending agency Day phone Mailing address Real Estate Agent Maliing address JIM MURPHY W/ DYNAMIC Day phone 5111 C STREET *ANCHORAGE, AK 99505 720-7999 unless ~therwise'?equested, COSA will be held by DSD for pickup. 2. NUMBER'OF BEDROOMS: 6 3. TYPEOFWATER SUPPLY: Individual 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 On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional ciVil engineer registered in the State of Alaska. Certificates of On-Site Systems 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 COSAs upon request to homeowners. Certificates of On-Site Systems. Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT ~OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and ,~ o, the va, da,ia,, u,~L= o,,,,wJ, b=,~,w, I .... ;~, ,u., 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, t 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 GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * .ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date '5. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering 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 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, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of 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. GEG, LTD. can therefore not provide any warranty or future 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 &this report by any · other person or party is not authorized, nor will it confer any legal dght whatsoever. DSD SIGNATURE ~ Approved for bedrooms. Disapproved. Conditional approval for : WATERAND .. ~ [ WASTEWATER : ~ '~ t PROGRAM : .,~ bedrooms, with the following stipulations: ~. <~.'.. ..' '.~'-'~ Attachments: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 11/05) Arsenic Advisory. Maintenance Agreements Supplemental Engineer's Report Other ~(J"~ Original Certificate Date: Bi Municipality of Anchorage Development Se ices Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O, Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF 0N-SITE SYSTEMS ,PPEOVAL Legal Description: WELL DATA Well type PRIVATE Date completed Total depth 256 Date of test Static water level Well production LAKEW00D HILLS#2, LOT 20A-1 9/17/01 ff. If A, B, or C provide PWSID# Sanitary seal (Y/N) YES Cased to 256 ft. FROM WELL LOG 9/17/01 234 ft. 3.5 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Arsenic: ND ug./L. SEPTIC/HOLDING TANK DATA Tank Type/Material . SEPTIC/STEEL Tank size 2000 gal. Number of Compartments CHECKLIST Parcel ID: 01515496 Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 5/17/2010 246 fi. 5.03 g.p.m. YES Nitrate 6.57 mg./L. Other bacteria __ Date of sample: 9/2/10 Coll'ected by: YES 18+ in. 0 colonies/100 mi. GEG Ltd. Date installed 10/4-31/01 Cleanouts (Y/N) YES High water alarm (Y/N) N/A UCDONALDS PUMPING Foundation bleanout (Y/N) YES. Depression over tank (Y/N) NO Date of pumping 5/20/2010 Pumper. ABSORPTION FIELD DATA I*B~LOW EXISTING GRADEJ Date installed 10/4-31/.01 . Soil rating (g.p.d./ft2o~ 0.8 Length 72 .ft. Width 2.5 ft. Totaldepth '11,67 ft. Eff. absorption area1156 ft2 Monitoring tube YES Date of adequacy test *'5/18/2010 Results (Pass/Fail) PASS Fluid depth in absorption field before test DRY in. Water added 1000gal. Elapsed Time: 155 min. Final fluid depth DRY in. Absorption rate >-- Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date **PRESOAKED 2000 GALLONS OF LIQUID ON 5/17/2010 System type DEEP TRENCH Gravel below pipe 8.03 ft. Depression over field NO For 6 bedrooms New depth 4- in. 900+ g.p.d. D. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCEs Size in gallons Manhole/Access ~ ~ High water alarm level at Cycles tested. Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: 100'+ Septic tank/lift station on lot Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas. 50'+ .in. On a'djacent lots. 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas N/A 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service line 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Absorption field 5'+ Surface water 100'4- Property line 10'+ Building foundation. 10'+ Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ COMMENTS Water main N/A Driveway, parking/vehicle storage 10'+ 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. Engineer, s Printed Name JEFFREY A. GARNESS Date q/IS/lO COSA Fee $ Date of Payment. Receipt Number. (Rev. 11/05) Waiver Fee $ Date of Payment. Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmorc Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On-Site Systems Approval # 101058 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 20A-1 of Lakewood Hills #2 subdivision. This inspection revealed a nitrate concentration of 6.57 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. · ,'. Municipa!ity.of Anchorage : Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni,org/onsite (907) 343-7904 C._.ERTIFICATE OF ON-SITE SYSTEHS APPROVAL FOR A SINGL 'FAHILY DWELLING Parcel I.D. 01513496 1. GENERAL INFORMATION COSA# Expiration Date: Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address LAKEWOOD HILLS#21 LOT 20A-1 10101 HILLSIDE DRIVE *ANCHORAGE, AK 99507 MICHAEL SHARROCK Day phone 10101 HILLSIDE DRIVE *ANCHORAGE~ AK 99507 Day phone C/O AGENT ANDREA GRIBBIN W/ PRUDENT~L Day phone 223-~824 3801CENTERPOINT DRIVE #200 *ANCHORAGE~ AK 99503 Un~ssotherwise~queste~ COSA w~beheldbyDSD ~rpNkup. 2. NUMBER OFBEDROOMS: 6 3, TYPE OF WATER SUPPLY: Individual 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 On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems 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 COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION'BY ENGINEER As ca,tried by my seal a~xed 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 bedreoms and type of structure indicated herein. I further vedfy 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 CARNESS ENGINEERING CROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE. AK 99507 Engineer's Printed Name JEFFREY A. CARNESS, P.E. Phone 337-6179 Date Engineer's Comments: In conducting this evaluation,. GEG, LtD. attempted to provide a thorough, ' conscientious engineenng analys~s of Zhe system In accordance with ADEC and MOA ~ OF m t( '~ DSD Gutdelines& Regulations. The reported results described the performance of the ~.,_/~,'~.. .......... '~. sys,em the cond, ons encoun,ared a, the time o, ,o,t, sepa tion " -- di~ances rneasured to raadi/y ldentifiabla features. The eperational life of al/ welts and septic systems depend on the Iocal soils condition, groundwater levels that may I 8' '-" :"~" '~' .l/lc.....' \..."...~. fluctuate durtng the year, and the water usage of the family being served by the system. ~ ~ t These conditions are outside the control of the evatuator of the system. Satisfactory test ~)~... . '~. ' i l~. 1~ ...... .)..:... results do not guarantee lucre performance of the system, nor do they guarantee that ~:.Je~fle//- ~or~..s.... ~ · there are no bidden defects or encroachments. GEG, LTD. can therefore t?ot provide vO~,p,. "'11 ~-,~'~:. operational requirements of the ADEC or MOA DSD. The content of this report is for ' ~_ee', ~ ' ~";"_', ~'~ the sole benefit of the owner listed above. Any reliance upon or use oft his repot1 by any "~ ~.,of~ ~[~ ~. ( ~ otherpersonorpartylsnotauthodzed, norwillltconferanylegal#ghtwhatsoever. , ~ ,~%[~ _ ... ON-SITE ~ Approved for ~:) bedrooms. ~: WATERAND : -_ . WASTEWATER . . Disapproved. ' PROGRAM o.' Conditional approval for __ bedrooms, w~th the fllow~ng sbpulations: :',,~-,~,, '... .. o · Attachments: CaSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report' Other Odginal Certificate Date: Municipality of Anchorage Development Services Department Building Safety D~vision On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage. AK 99519-6650 www.munl.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS ,b, PPROVAL CHECKLIST Legal Description: A. WELL DATA Well type pRIVATE Date completed 9/17/01 LAKE'WOOD HILLS,2t LOT 20A-1 Total depth 256 ft. IfA. B. or C provide PWSID# N/A Sanitary seal (Y/NI. YES Cased to 256 ft. FROM WELL LOG Date of test 9/17/01 Static water level 234 ft. Well production 3.5 g.p.m. WATER SAMPLE RESULTS: Coliform ~"~) colonies/100 mi. Arsenic: ~ ug./L. SEPTIC/HOLDING TANK DATA NitrateQ,,~'C ~ mg./L Date of sample: 5/18/2010 Tank Type/Material Tank size' 2000 gal. FoUndation cleanout (Y/N) YES Date of pumping 5/20/2010 ABSORPTION FIELD DATA Date installed lo/4-31/ol Length 72 ff. SEPTIC/STEEL Number of Compartments 2 Depression over tank (Y/N) NO Pumper. - ~B[LOW EXISTING CP, ADEI Soil rating (g.p.d.lft~oG 0.8 Width 2.5 ft. Parcel ID: 01513496 Well Log (Y/N} Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 5/17/2010 246 ft. 5.03 g.p.m. YES YES 18+ .in. Other bacteria (~) coloniesll00 mi. Collected by: GEG Ltd. Date installed 10/4-31/01 Cleanouts (Y)N) YES High water alarm (Y/N) N/A MCDONALDS ' PUMPING System type DEEP TRENCH Gravel below pipe 8.03 ft. Totaldepth '11.67 ft. Eff. absorption area1156 ft~ Monitoring tube YES Depression over field NO Date of ac~equacy test *'5/18/2010 Results (Pass/Fail) PASS For 6 bedrooms Fluid depth in absorption field before test DRY in. Water added 1000gal. New depth 4 in. Elapsed Time: 155 min. Final fluid depth DRY In. Absorption rate >= 900+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YiN & type) NONE KNOWN If yes. give date - · *PRESOAKED 2000 GALLONS OF LIQUID ON 5/t7/2010 D. LIFT STATION Date installed, Size in gallons ~ ~ "Pump ~igh water alarm level at__ .in. Da.._~F~tu~ ~ C~ets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas, 50'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service line. 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Water service line 10'+ Curtain drain NONE KNOWN F. COMMENTS Building foundation 10'+ Surface water 100'+ We/Is on adjacent lots 100'+ Absorption field 5'+ Surface water. 100'+ Water main N/A Driveway, parking/vehicle storage 10'+ 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. Engineer's Printed Name JEFFREY A. CARNESS Date ~"/~-"~/I ~ COSA Fee $ Date of Payment Receipt Number (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On-Site Systems Approval # 101058 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 20A-I of Lakewood Hills #2 subdivision. This inspection revealed a nitrate concentration of 6.69 milligrams per liter (rog/L) was reported for the property's well water sample. The Environmental Protection Agency {EPA) has established a maximum contaminant level (MCL) of I0.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval.