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HomeMy WebLinkAboutSAND LAKE #2 BLK 1 LT 19Sand Lake #2 Block 1 Lot 19 #011-132-06 Municipality of Anchorage i �a i` Development Services Department O Building Safety Divislon On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.ci.anchorage.ak.us (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT o .m,f NNimher S W /•110 '1 q PID Number: O 11 ' 13X - d Name Ae niil3ifi Wastewater System: ❑ New ® Upgrade Address. D51� „ ,• �} Rae+ ABSORPTION FIELD Phone:Number ?b i of eadrootiu' ❑Deep Trench .Shallow Trench OBed ❑ Mound DOther Soil Rating: Total Depth from original grade 4 5v5 LEGAL DESCRIPTION G IF FIS Block: �s Lot: vp L Subdivision: `L fs % Depth to pipe bottom from o iginal grade: Gravel depth beneath pipe: Ft. Ft . .+•G'lYl Township' '. io¢ Section: original gra added above ograde: Gravel Length i2 Ft.Fl. Gravel width: Number of lines: Distance between ^.es. Well:�^ �d ElNew ❑ Upgrade 5 Ft. I — Fl. Classification (Priv ta, S' C): Total Depth: Cased to: Total absorodon area: Pipe Matelot'. p� ®w yy IO Flo SvliE DUL6 —W PVC. Ft. FL Driller. Date DdIIei Static Water Level: Installer. Date Installed: A+- -7/1 ZOOL Ft. Yield', Pump Set at: Casing Height Above Ground: !� TANK GPM Ft. Ft. SEPARATION DISTANCES ❑ septic ❑ Holding ❑ S.T e P. 90ther: To Septic Absorption Lift Holding Publidarivat Manufacturer. giOC.iCLC capacity IIQOb cal./ From Tank Field Station an sewer Line Material: Number of Compartments'. �y'� Well IV IV p/��,n/� wo a (�, 100 /y� )V yA, � " • FF I$ERG1A55 g Surface Water N.O. Y0. „. LIFT STATION 31 i' N A stze 11004) GalManufacturer 9i0CW. LG Lot Line -Pump on level aC 'Pump off levelat:High water alarm ac. 45 r Foundation 5'T� 5gI A f Jy 2Z in. i`7 in. 'n. n, Curtain Drain N,V c N. (7s w' f Y s I� i A i • Pump Make & Model Electrical Inspect' n_s\performed by: �%�' 7�� C. _(_ �i /CLI Oeckr Li..,.. Remarks: BENCH MARK - Location and Description: G Assumed Elevation: app Ft. cny''o ial story { Inspections performed by: af, 70ur�7 _ G Dates 1aljq4 2ntlY Development Services Department Approval Reviewed and approved by: Date: Date: q'6G–C7� (Rrr. I zroo> --(,E'MXW.- - 4 1CH ABAARK)NEDCK 5 120 I I I I �„ EXIST 1250 CAL SEPTIC TANK CED WnH &OCYCLE Well DOUBLE CLEA 6 19 1N$rAam W Gp� I ti 0 D PHONE 18 NEW RELD 1NSTALLM W PED£ST 5 FT WIDE 4 12 FT LONG , �... I 5 FT DEEP 3 FT BEDROOMS 2 RApwkAREA. 2x 150/4= 75 sq. H FACT ..� 0.58 17 LfNGTN.• 75x x58/4= 8,7 TT 1 I I I I I 1 8 I 49 ...... ...... ......... ::.... I �......... ...... .TOBBEN SP LAND mr No. E-22252014'�. 60 80 120 S...... TOBBEN SPURKLAND P.E. OT 19, BLOC , !S�_Ag LAKE SID SEPTIC SYSTEM ASBU/LT 203 W TH AVENUE (NCH. ERMA MCMILLAN DATE SEPTEMBER 14, 2004 : 907 277X 99501 9-3918 8058 fNDlCOT STREET SHEET. 2/3 GRID2214 PERMIT #SW040XXX PID # 011-132-06 SLK01192.DWG 4' AGWT17R ASTM 3034 GRADE TO FAIN BACK FILL £LEVATMW = 95.2 ' 6' MIN 24' MAX 4 3' Q M �o 0 I Ln FOAVDDATIOV CLEAN O/T SLOPE FINISIED GRADE AWAY FRWV TO' DV ALL DIRECTIONS z O DISCHARGE ., P 4' PVC INFLUENT O PRIMARY CHANBER ® AERATION CHANGER m CLARIFIER ®DISCHARGE CHANGER �BOTT�I OF TAW STANDARD 5—WIDE TRENCH ° t --8-p' 1�V�BLJIkBGARV INSIKAT7�J '^� 4' SAND/GRAVfL NTS ELEVATMV = 921' LEVELING CDURSf, CON4'ACTED INSTALLATILIN 1. EXCAVATE A 10' x 10' x 10' DEEP MXE MR BDKYCLE SYSTEM. 2. PLACE A AIN" O' 4' SAND W7 ERA VEL FO? -LEVELING CwRS£ IN THE BDTTDN Dr TAE' EXCAVATION COWACT AS ROUND' .... 3 PLACE 4 SFE£TS OF 2' x 8' x 2' BIWCT &RIAL RIGID DULEAMN ON TDP DF COWACTED LEVELING CDURSE TD PROTECT BDTTOV DF FDkMASS TAO. TAKE EXTRA CARE TO ASSIff THAT INSULA MY CMSE IS LEVEL WYS IN ALL BMWI..._ .. . A BACKFILL AROIAVD TAW LF TO DNVERT DF 4' MULE T AND 1-1/4' £FFLB:NT LINES WITH FREE-FLOWING NSF MATERIAL FXE OF LARGE STONES Oe BOB.D£RS. SAND/GRAVEL BACKFILL NWri7R TUBE CAP M DOUBLE CLEAAIDUTS p J INSTALLED v 1-1/4'. SMILE 40 PVC W/ i=hMU30' p ' ' p 2-1/2' MIAVS SEWER ROCK TOWN SPURKLAND P.E. I (LOT 19, BLOCK_ I SAND LAKE 12 I ( SEPTIC SYSTEM ASBUKT 203 W 15TH. AVENUE 8056 ENDICOT STREET DATE.•SEPTEMBER 14, 2004 ANCH. AK. 99501 ERMA MACMILLAN SHEET • 3/3 GRID: 2224 (907) 279-3916 PERMIT # SV049XXX PID #011-132-06 SLK01193BVG fi Yk Page t of t INSPECTION REPORT MUNICIPALITY OF ANCHORAGE, -- BUILDING SAFETY DIVISION 4700 SOUTH BRAGAW STREET, ANCHORAGE, ALASKA INSPECTIONS: Voice. (907) 343-8300 Fax: (907) 249-7777 RWORM47TON.• (907) 3433/-�7j9r6y2 0 / NAME: �sz�Lt( iv�LL MWY'N6tWR: a` p0 DAM ADDRESS: 2) �� �% )G G) PHONE #1: PHONE #2: LOT. /I o cB OeK.j � / SUBDIMION. SG ti19 L an�� �i 2 COMMENTS: SCT TYPE OF #i: #2: #3: INSPECTION. No non,=plianw obem d. [] Do not w,=,d mWro•i:mpoctcd. ] C O appnmd- Cmmotia aeaotrtial m acphuwd below. F7 Will re-vaatmne at neat impootion. ] C.0 a approval (Qo mta bclaw). C011716t1ENTS: Reinspecti=7 Q DATE. ONS ARE MADE, PLEASE CALL FOR INSPECTTON DO NOT REMOVE THIS NOTICE MUNICIPALITY OF ANCHORAGE Development Services Department 1 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 PERMIT Initial Date Issued: Sep 01, 2004 Expiration Date: Sep 01, 2005 Permit Number: SW040369 Parcel ID: 011-132-06 Legal Description: -%A ......._ .. Design Engineer: 0007 Tobben Spurkland, PE Site Address: 008056 ENDICOTT ST Owner Name: ERMA MACMILLAN Lot Size: 6750 SQ. FT. Owner Address: 8056 ENDICOTT Total Bedrooms: 2 Permit Bedrooms: 2 ANCHORAGE, AK 99502-4127 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 'T11'?10q Received By: Issued By: A/c7g: %F2{Vcr/ LE�lFTh Wj�c Be- /2Ea„cEn #71vj:> 7 -RC -VC,-,, P£Pry A✓E To RRE 9 Co vs T�sF/^�yJ. G v7 Z/n/E (�JR1VEp� I�.11�(-. !3E ��Q✓EST��, Date: 6?1t 1 a y Date: 4 Municipality of Anchorage '�E B4i Development Services Department =o- Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907)343-7904 ON-SITE SEWERIWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. d i �— `� _C �, Permit Number SW Property owner(s) PWA WAC W I L_LA-N Day phone Jib -45-3,6 Mailing address (1) Mailing address (2) Zip Code q S 4 Z Legal description (Lot, Block & Sub'd.) l.0 4 Ig D' L S Ga.+4'.'/ "&r Legal description (Section, Township & Range) Lot Size (Q�1���_Acresq.Ft. Number of Bedrooms i THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well / Water Storage ❑ Sewer Upgrade Lid 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. (Signature of property owner or Date of Payment: Date of Payment: Receipt Number: 32 qtr Receipt Number: (Rev. 12/00) 7I`oMIPTC=AND P.E. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907)279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 19, BLOCK 1 SAND LAKE #2 68056 ENDICOTT Municipality of Anchorage July 15, 2004 Development Services Department Building Safety Division On Site Water and waste Water Program 4700 South Bragaw Street Anchorage, Alaska 99519-650 We are submitting an application for the upgrade of the septic system for this lot. The existing system failed an adequacy inspection and require replacement. This submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable test holes are also enclosed. Due to the limited space available, a BioCycle unit has been selected.Yn No groundwater or impervious layer to 12 ft. Use Standard 5 -Wide BioCycle Soil Rating. From Testhole 7-22-04. <1 min/in = 4 gal per sq.ft/day No. of Bedrooms 2 Required Area : 2x 15014 =75 sq.ft. Rock Depth 3 feet Reduction Factor: 0.58 Minimum Length: 75 x.58/5 = 8.7 ft SYSTEM CONFIGURATION BIOCYCLE STANDARD 5 -WIDE BED TOTAL LENGTH 15FT TOTAL WIDTH 5 FT TOTAL DEPTH 5 FT ROCK DEPTH 3 FT INSULATION 2" COVER 2 FT The installation of this septic system will not prevent wells from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. rGj',r• •�1 49th * '•N! i z r TO••EN •SPURKLAND f'•; No. CE -2)225 J� k4l Of 50 0 50 100 150 200 250 300 SCALE 1' = 100 FT, TOWN SPURKLAND P.E. I ILOT 19, BLOCK 1, SAND LAKE SID I I SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE ERMA MCM/CLAN DATE: AUG. 3, 1004 ANCH. AK. 99501 SHEET 1/3 GRID: 2214 (907) 279-3916 8056 ENDICOT STREET PERMIT #SV040XXX PID # 011-132-06 SLK01181.DV6 I I —4-1 5 120 I 6 15 1 ,PCF" EX/ST. TRENCH nrro — — - 8 FT OF ROCK / I I 50 DAL SEPTIC TANK WN CYCLE Well 1 � W 1 -OL 0 NER A NE %f 1 B NEW D REE W J 5 F' WIDE15 FT GOND I �,. 5 fT DEEP 3 FT U I Wel '(2 ��**!�Suit% 17 1 !(E,....... ,•�1� I P 49th 20 a 910 40 66 - - 00 120 SCALD I' = 40 FT I I I 8 I TOBBEN SPURKLAND P.E.OT 19, BLOCK 1, SAND LAKE SID SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE ERMA MCMILLAN DATE. JULY 12, 2004 ANCH. AK. 99501 SHEET,• 1/6 2224 907 279-3916 8056 ENDICOT STREET PERMIT#SW040XXX PID # 011-132-06 SLK011920V✓5 FLADJDDATION CLEAN OUT 4' MONITOR ASTM 3034 GRAD TO BRAIN I SLOPE FINISHED GRADE AWAY fRDK TOP IN ALL DIRECTIONS 6 MIN GE07EMLE 8' INSULA 04' MAX BACK FILL p.-1 PVC DISCHARGE e• SEWER R[A:K 7 4' PVC INFLUENT MIFA/S f 4 of ® o O PPRIMARY.CHAMBER ® AERATION CHAMBER 3'" ® CLARIFIER GBISCHARl,ECHAMBER � Q BOrrGM LF rANK 15 _ ................: ............... BLUEBOARD INSaAT10N STANDARD 5 -WIDE TRENCH -8'-a 4• SAND/GRAVEL NTS LEVELING COURSE, COMPACTED INSTALLATION 1. EXCAVATE A 10' x 10' x 10' DEEP HOLE FOR BILICYCLE SYSTEM R. PLACE A MININN OF 4' SAW OR GRAVEL FOR LEVELING Ca*SE IN THE BOTTOM DF THE EXCAVATION ;... COMPACT AS REOUIREA _.. _. .. __ .. 3 PLACE 4 SHEETS OF 2' x 8' x F'. DIRECT BIh?IAL RIGID INSULATION LIN TOP OF COMPACTED LEVELING COURSE TO PROTECT BUTTON OF FIBERGLASS TANK TAKE EXTRA CARE TD ASSURE THAT INSLKAIM COURSE IS LEVEL IN ALL DIR£CTMYS _. 4. BACKFILL AROUND TANK UP TO INVERT LIF 4' iwLt :NT AND 1-1/4' EFFLUENT LINES WITH FREE-FLOWING NSF MATERIAL FREE DF LARGE STONES LAR BDLEDERS SAND/GRAVEL BACKFILL MLINITDR TUBE CAP END /�f�111111/11LLL/////// 1-1/4' SCHEDULE 40 PVC W/ 1/8' HOLES P 30' O O o 4 mm y NWIT17R TUBE 2-1/2' MINUS SEWER ROCK ece am TOBBEN SPURKLAND P.E. LOT 19, BLOCK 1 SAND LAKE 12 SEPTIC SYSTEM SCHEMATIC 203 W 15TH. AVENUE 8056 £NDICC STREET DATE: AUG. 2, 2004 ANCH. AK. 99501 ERMA MACMILLAN SHEET 3/3 GRID: 2224 907 279-3916 PERMIT # SV040XXX PID #011-132-06 SLKO119aDVG Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P,O. Box 196650 Anchorage, AK 99519-6650 vnvw ci anchoraoe.ak.us (907) 3437904 T Soils Log - Percolation Test Per`orrned For: `' .� � a9fl ft L- 1' � a _L/ l`v,a Date.p .ecal Description, L- i 14 F-2 � � SLt ��Township, Range, Section: ir.oYtiC,/VNriS r,2 ,-#o v✓( 04 l40le- WAS UNDNIATE VCC R o 5 IF YES. AT WHAT DEPTH? 0 DeplS to Water After p Monitoring? "-'!""— E Date: PERCOLATION PATE tn"Ieshcl) lzl� nv__i cr. TEST RU'! 9cT`NE"cil - F -i AND FT PE?F`,I°D BY. t�.W� I. C=RTIF`f T4?T T' -"S OR'c5 °E'.=OR'A EO IN ACCORDANCE WIT ALL S�h�E AND M1'U`IICIPAL GUIDEUNES VI EFFECT ON TIHIS DATE DATE' ,(� y 72-013 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE ® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE XNEW G` -V`'3 y L` i Fd�.Ii' - 'yF'a--[:r7Lws ❑UPGRADE MAILING ADDRESS LEGAL DESCRIPTION L -0 "-F 1 s Vii- 5A LIU6 LL I'TE i' iii LOCATION _ NO.OFBEDROOMS # co f r— � A LU Well Absorption ares DISTANCE TO: � { Dwelling _ �na'C'LOzise PERMIT NO. �^ r) (j S % FZ h H Q nufacturer, �i .� F Material � No. of compartments . capacity in gallons Inside length •'X_ - IF HOMEMADE.: Width Liquid depth q P t2 ®�Z Z DISTANCE TO: Well Dwelling PERMIT NO. Manufacturer Material Liquid capacity in gallons ° �=TNo. STANCE TO: Well d Fourlda wn Nearest lot li a PER,p�IT NO. Z w f lines Length of each line Total length,of lines Trench width l J § Distance b tw en lines a 1 i t 5 l>v S 3 �. inches ae[ Top of tile to finish grade t j F Material beneath tile C Total effective absor pion area Lu Length Width Depth PERMIT NO. 0 Qh w a Type of crib Crib diameter - Crib depth Total effective absorption area rn DISTANCE TO: Well Building foundation Nearest lot line _j Cla T I U a t tc Depth Driller Distance to lot line PERMIT NO. w DISTANCE TO: Building foundation Sewer line I / Septic tank /© Absorption area(s) OTHER Ll I PIPE MATERIALS e SOIL TEST RATING I _v i 0 i> s INSTALLER f 1 REMARKS L i'A , Ya b'_`='7 ✓t 1 s 3' W � r /%4✓y Gi, i�iiOA.-. {J 1i :�/L t13A✓�.`�: /d/i-". °:fit`;E/.'r'A�Lt. LYUH ALI CA TEC ILL10 t _ i) i21 r O r APPROVED DATE LEGAL n'e 72-013 (Rev. 3/78) Date Drilled s 0-11-86 Static Water Level 3 et feet Draw Down ,N14A _ feet Tv,-ne�MMateri al =lled s 0 feet to 12 Seed 12 feat to �Q Sa^dy clay ya feet to ori Sa^c?, w/=1w x '90 feet to 103 Black sand 11j2 ti -jet til' 140CreysandsCIOV • .i 160 feet to 280 Very wet 180 feet to 223 flay 223 feet Gravel w/water Hefty Drilling S.R.A. Box 1553 H Anchorage , Alaska tot 19 k3k4 1 Sand Lake Subd. #2 Gallons Per Minute Total Feet of Casing 223 u J e ~ ' � ji� �PJ C7, H-1 ^ .^ DEPARTMENT OF HEALTH AND ENVIRONMENTAL pROTECTION Alt 825 L STREET, ANCHORAGE, AK 99501 � PERMIT NO: 840790 DATE ISSUED: 09/17/g4 APPLICANT: . KEVIN KEIFER ADDRESS: P.O.BOX 695 ANCHORAGE, Al.-.-. 99510 CONTACT PHONE: 243~0160 � LEGAL DESCRIP: SUBDIVISION: SAND LAKE #2 LOT: 19BLOCK: 1 SECTION: 10 TOWNSHIP: 12N RANGE: 4W LOT SIZE: 8000 (SQ.FT. OR ACRES) MAX BEDROOMS: 2 Listed below are the options available'tx i you �n designing your septic system. Choose the option that best fits your site. ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certify that: 1. I amJamiliar with the requirements for, on-site sewers and wells as set forth by the Municipalityo� Anchorage (MOA> and the State o� Alaska 2, I will install the system in accordance with all MOA codes and regul^tions and in compliance with the design criteria of this permit. ~ ' 3. I will adhere to all HOA and State o{ Alaska requirements for the set back distances from any existing well. wastewater disposal system or public sewerage system on this or anyadjacent ornearby lot. 4. I understand that this permit is valid for a maximum of 2 bedrooms and any enlargement will requirean additional permit" IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY .OA BUILDING CODES THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE ~^BTA^~ED; .2) AS�'"uILTS WILLNOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTIONREP~'`' '` ; AND (3) TI -IE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED DATE: APPLICANT: KEVIN���IFER �ATE: ^r FEE ply K�F.-H r -_r E-17 T3 IV3~ �������K� DEPTH TO PIPE BOTTOM (FT.) 4.O 4.0 ' 11° O GRAVEL DEPTH (FT ) . 8 O . 0.5 3 5 TOTAL DEPTH (FT ) . 12.0 4 5 ` 7 5 GRAVEL WIDTH (FT.) 2,5 ^ 15. ~O � 5"0 GRAVEL LENGTH (FT.) 19.0 33.O 33^0 GRAVEL VOLUME (CU.YDS.) 15.0 16'� 24^5 TANK SIZE (GALS) 1,000^O ** 1,000.O ** ^ ' 1,000�O ** SOIL RATING (SQ FT /BR> ^ , 150 150 150 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certify that: 1. I amJamiliar with the requirements for, on-site sewers and wells as set forth by the Municipalityo� Anchorage (MOA> and the State o� Alaska 2, I will install the system in accordance with all MOA codes and regul^tions and in compliance with the design criteria of this permit. ~ ' 3. I will adhere to all HOA and State o{ Alaska requirements for the set back distances from any existing well. wastewater disposal system or public sewerage system on this or anyadjacent ornearby lot. 4. I understand that this permit is valid for a maximum of 2 bedrooms and any enlargement will requirean additional permit" IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY .OA BUILDING CODES THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE ~^BTA^~ED; .2) AS�'"uILTS WILLNOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTIONREP~'`' '` ; AND (3) TI -IE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED DATE: APPLICANT: KEVIN���IFER �ATE: tSOILS LOG MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION 825 L. Street, Anchorage, Alaska 99501 264-4720 TEST - SOILS LOG — PERCOLATION TEST PERFORMED FOR: A 10-s' & (hd4S+jt'PS' DATE PERFORMED:_ 1011 I� � LEGAL DESCRIPTION:_ a.r\J L, (fin 0- 2 ,j laqc I Lo r L `l -7Ff EPIF SLOPE SITF PI AN - — ( EST OL or Wti[ So; I 1 2 3 4 5 6 7 8 9 ~ 10 11 12 13 14 15 •i. 16 17 18 19 20 •rF4 I COMMENTS -/14ea�"i?�e� I b I[Lk- Co0.r$P Io-�eU 0./I,K ton 'A'I0 laryerS V r 5 " I II "k (e IS-DC%(4 l •1b / 6 u E WAS GROUND WATER S ENCOUNTERED? L 0 P IF YES, AT WHAT E DEPTH? Rea Date Gross Time Net Time Depth to Net Water Drop 2s(A 4L PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT 1--S V"S'Iru/(y & /S—C> rt `241 PERFORMEDBY:2o�/Y/01 ST�oZ�SY' g _CERTIFIEDBY: 72-008 (6/79) DATE: / 6 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section U(�&Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 011-132-06 Expiration Date_ 1. GENERAL INFORMATION -Complete-legal-description- --SAND LAKE #2 BLOCK 1, LOT 19 -- - - --- --- - - - - - - - Location (site address) 8056 ENDICOTT STREET, ANCHORAGE, AK 99503 Current property owner(s) WELLS FARGO BAN Mailing address Real estate agent 6200 PARK AVENUE, DES MOINES, IA 50321 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone Day phone 3. NUMBER OF BEDROOMS: 2 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $_95-0.00 Waiver Fee $ I `C)w q Date of Payment t - 1 Date of Payment Receipt Number (9 2Q Q Receipt Number COSA # 05C/19 1,500 Waiver # aeP1ax\. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377 Address 4661 NATRONA AVENUE, ANCHORAGE, AK 99516 Engineer's Printed Name MICHAEL N. ANDERSON, PE Date 10/18/2019 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and besttindustry practices / methods.—The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by FWf.S and Anderson Construction & Engineering. 6. DSD SIGNATURE System #1 Approved for 2- bedrooms System #2 Approved for bedrooms Disapproved IT AL4 \ Cc 9189 a Conditional approval for bedrooms, with the following stipulations: Original Certificate D 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 1><7 Well Flow Advisory Other COSA Checklist blue sheet Legal Description: SAND LAKE #2 BLOCK 1 LOT 19 Parcel ID: 011-132-06 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ® Well log is filed with Onsite (or attached) Water storage tank volume NA gallons Date drilled 9/11/1984 Well disinfected for coliform test? ❑ Yes ® No Total de th 223 ft p Coliform bacteria is Negative Cased to 223 ft Nitrate mg/L ® Nitrate less than MRL (ND) ® Sanitary seal is functioning correctly Arsenic 43.2 ug/LE] Arsenic less than MRL (ND) ® Wires are properly protected Casing height (above ground) 24+ in. Collected b Y Date of flow test for COSA 10/7/2019 Static water level at beginning of test 105 ft. Date of Sample 10/7/19 Well production at time of test 4.8+ gpm Comments B. TANK DATA — 9/10/04 - 1600 GAL Age of tank(s) 15 years Tank type/material BIOCYCLE / FIBERGLASS Measured operating fluid level in septic tank SEE MAINT. ® Standpipes/foundation cleanout per record drawing Date of pumping 10/21/19 MAINT. D. ABSORPTION FIELD DATA Which system tested (date installed) 9/10/2004 ® ALL standpipes present per record drawing Total measured depth from grade 6 ft (max) Measured depth to pipe invert from grade ft (min) ® N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective ® Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist copy 4.docx C. LIFT STATION ® Required maintenance completed Age of lift station 15 years Lift station material FIBERGLASS Comments: Adequacy test date 10/7/2019 Results ® Pass For 2. bedrooms Fluid depth prior to test 0 in Water added 360 gal New depth 7 in Elapsed time 60 min Final fluid depth 0 in Absorption rate 300+ gpd Any rejuvenation treatment (past 12 months) N If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' If absorption field is under driveway comment below Property Line > 10' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes — if No ft Yes ._if -No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lotto: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® 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' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No *3 ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *WAIVER WR040063 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. COSA Checklist copy 4.docx n DEVELOPMENT SERVICES DEPARTMENT ( j On -Site water and wastewater Section www.muni.org/onsite rsenic vlsory Certificate of On -Site Systems Approval # OSC191500 Subdivision: Sand Lake #2, Block 1, Lot 19 A water sample revealed an arsenic concentration of 43.2 micrograms per liter (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/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. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. '011 � ��� � � �Mail[ng'�ldcai"ress P��O Sok 1.9���50 ��pnch�rage, q�ask�a 9:9519 6650 f un� argue" ,.:�,...'�. r, :,..;„R�:., .+'s'r..2, .:.-e:.✓7.,.m...,z�.f�. z.� ._ :��`+.sa...#.?.�s,''` s ,.... a"sr.4a k,�.i�.r .�u,.^,�.+�r�*�;�iro�1�' MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and -- - -entered into as of this --Q- Day -of -i I; - of 20JLq-- --, by -and -between — - JOSHWA JA/%- 1-S $ rn/j rL herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchora¢e Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as L t-: located at (legal description) YQ 6 6-�x/ Di co `i S 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $100 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/1812018) Pagel of 3 Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. gt� Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new _ Certificate of OnSite Systems Approval: Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. L� Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severabilitv. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER: By: d.l�G�—i%� (signature) Date: J 0.S H 4,,+ J S An .+l L (print name) STATE -OF ALASKA - - - -- - - - - - - - - - ) ss. THIRD JUDICIAL DISTRICT ) The foregoin strument was acknowledged before m 2 e this -2-i-day of &to 20, by NOTARY PUBLIC OR ALASKA My Commission expires:�pTgR. MUNICIPALITY: By: (signature) (print name) 080G�?:' N Date: Title: (rev. 05/18/2018) Page 3 of 3 3705 Arctic Blvd #313 > b na E-Allaska Anchorage AK 99503 AVv , c: 1tr`/[ �4t.r TxGb igr, Email: crbioalc@gmail.com (907)274-0314 vth Quarter Inspection Report 201� Homeowner Info Customer Name: Tim Kelly Address: 8056 Endicott St. Anchorage AK 99502 Tank#: 183 Install Date: Aug -2008 Area Eastside -Westside Initial Inspection: Alarms Tested: Air FO High Water O Battery Tested: Yes I I No I I N/A (Please make sure alarm is on "normal", not "mute") Does system have a septic tank ? No 11V I Yes ❑ (Recommend pumping tank every 2 years) Is System Lid Locked? Lid hardware in working order? Is there any noticeable odor? Yes 171 Repaired ❑ Yes 171 Repaired ❑ Strong ❑ Mild F-] None Z System Inspection Parcel I.D. 011-132-06 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: / — '�') ( l I Complete legal description SAND LAKE #2 BLK 1 LT 19 Location (site address) 8056 ENDICOTT ST ANCHORAGE AK Current Property owner(s) MATT METCALF Mailing address Real Estate Agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 2 4. TYPE OF WATER SUPPLY: Individual Well lX Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL Individual F1 Holding Tank ❑ Community ❑ Public Sewer ❑ WaiverNariance request for: NONE Distance: --- Received COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ gQc) Date of Payment 16113-/43 Receipt Number An by r COSA # (�SCl3151 Date: Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm SPURKLAND ENGINEERING Address 203 W. 25TH AVE.,STE.202A, ANCHORAGE, AK 99501 Engineer's Printed Name LARS SPURKLAND 6. DSD SI NATURE System #1 Approved for � bedrooms System #2 Approved for bedrooms Disapproved Phone 279-3916 DateyffO/1414 10 � pR0(fS�rSC;�•, Conditional approval for bedrooms, with the following stipulations: By: l r Original Certificate Date: /0 -_2 1- 13 Thelliia icirf ity f orage 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory_ Well Flow Advisory Other COSA blue sheet 5 .. - If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: SAND LAKE #2 131 L19 A. WELL DATA WellPRIVATE type If A, B. or C provide PWSI D # Date completed 9/11/84 Sanitary seal (Y/N) Y Total depth 223 ft. Cased to 223 ft. FROM WELL LOG Date of test 9/11/84 Static water level 135 ff Well production 15 g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate ND mg/L Arsenic 46.7 ug/L Date of sample: 10/2/13 B. SEPTIC/HOLDING TANK DATA Parcel ID: 011-132-06 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 24+ in. AT INSPECTION 10/2/13 M 6.2 ft. 42 Collected by: ANSON MOXNESS Tank Type/Material BIOCYCLE/FIBERGLASS Date installed 9/10/04 Tank size 1600 gal. Number of Compartments 4 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y Date of pumping '-- Pumper •vF>..c. (� I, ct wr 13i (y [c .AK C. ABSORPTION FIELD DATA Date installed 9/10/40 Soil rating (g.p.d./f:2 or ft2/bdrm) 1.2 System type 5-WDE Length 12 ft. Width 5 ft. Gravel below pipe 3 ft. Total depth 5'5 ft. Eff. absorption area 103 ft2 Monitoring tube Y Depression over field N Date of adequacy test 10/2/03 Results (Pass/Fail) PASS For bedrooms Fluid depth in absorption field before test 2 in. Water added 300 gal. New depth 3 in. Elapsed Time: 20 min. Final fluid depth 2 in. Absorption rate >= 300 9 p d Any rejuvenation treatment (past 12 mo.) (YIN & type) NO Ifes, y give date D. LIFT STATION Date installed 9110104 "Pump on" level at 22 Datum BOTTOM Size in gallons 1600 in. "Pump off' level at 15 Cycles tested 2 E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot 100'+ Public sewer main NA 100'+ Sewer /septic service line 25'+ Animal containment areas 50+ in. Manhole/Access (Y/N) Y High water alarm level at 45 Meets alarm & circuit requirements? Y On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout NA Holding tank NA Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 56 Property line 11' Water main NA Water service line10+ Wells on adjacent lots100+ ABSORPTION FIELD ON LOT TO: Property line 3" Building foundation 10'+ Water Service line 10+ Surface water 100'+ Curtain drain N.O. Wells on adjacent lots 100'+ F. COMMENTS *WAIVER WR040063 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 LARS SPURKLAND Date 10/14/13 COSA brown sheet 10-10-12.doc Absorption field 5 Surface water 100+ Water main N/A Driveway, parking/vehicle storage 50'+ in. 4� 00 LA E. SPURKL1' pp Municipality of Anchorage Community Development Department Development Services Division s On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # 131541 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 19 of Sand Lake #2 Subdivision. This inspection revealed an arsenic concentration of 46.7 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/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. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.or /og nsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. b. 5. Municipality of Anchorage I� Development Services Department Building Safety Division = On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.. Oil- 132-0(P COSA# Expiration Date: In — G — Oro 1. GENERAL INFORMATION Complete legal description _&jnA Lc ke-t2 gltc li Lol 19 Location (site address) $05to Enj ico* SF -ted' Current Property owner(s) Tamea LAW Day phone Y40_0164 Mailing address Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Z- 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Z Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of 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 Onsite 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 sample results. (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 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 5pyr•hIand £n9;neer;n4 Phone 279-391(0 Address 203 u/. 104 -ID3 AA Ie%mn. _ Ak 99rn1 Engineer's Printed Name Tobloen SD:ie-W&J, v Date Co -to -Ota EOF104 s' TCB EN SPURKLAN j 5. DSD SIGNATURE �/ �'•, f CE 2225 �. ✓ Approved for .2- bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other (R. 11105) Original Certificate Date: -7-6-06- (R. 7-6-D1n Municipality of Anchorage Development Services Department Building Safety Division on -Ste Water & Wastewater Program 4700 Bragaw Street P.O. Box 196850 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 3437904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: sarA :.O'V�e' 2. (3k 1 Lc 19 _ Parcel ID: 011-1n.:=010 A. WELL DATA v Well type A If A. B, or C provide PWSID # Well Log (YIN) 7 = Date completed _J_JI- $y Sanitary seal (YIN) Y area property Pry (YIN) 4_ Total depth 713 ft. Cased to Z3�ft. Casing height (above ground) �_in. FROM WELL LOG AT INSPECTION Date of test 9 - l I - 8Y 8-13-04 Static water level 135 IL 1 O1— ft. Well production l S g.p.m. 8 g.P.m. WATER SAMPLE RESULTS: D L Other bacteria oolonies/100 mL Coliform �_ooloniesJ100 ml Nitrate I� n+91 1 1 ` Arsenic: y �Z �I Date of sample: 15 oto Collected by: LAC4 SP ur tWand B. SEPTICIHOLDING TANK DATA Tank Type/Matarial Fok+i5 / BnC��I� Date installed 9 !o Oy Tank size 1 00 gal. Numb of Compartrnenb Cleanoub (YIN) ` Foundation cleanout (YIN) Y Depression over tank (YIN) Al High water alarm (YIN) .y_ Date'ot pumping Z3 Pumper AlarK laviA FFM_ liw. C. ABSORPTION FIELD DATA Date installed AteO Soil rating (g.p.d.W or felbdrm)1-Z System type 5- WIDE Length Width �J ft. Gravel below Pipe __3_ ft. Total'depth 5 ft. Eff absorptbn area Jq Monitoring Wbe Depression over field N Date of adequacy test _&L% Results (PasslFail) — For = bedrooms Fluid depth in absorption field before test in. Water added — gal. New depth in. Elapsed Time: ' min. Final fluid depth - in. Absorption rate >= " g.P.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed 9fo 0 'Pump on" level at !)1 in. Datum gJc-W% E. SEPARATION DISTANCES Size in gallons (WO ManholelAocess (Y/N) I 'Pump ofr level at J�L in. High water alarm level at 45 in. Cycles tested _ Y_ Meets alarm & dreuit requirements? Y SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot M r Absorption field on lot toot Public sewer main AtJA r Sewer /septic service line ;1150 Animal containment areas > tool On adjacent kits too t On adjacent lots 100 Public sewer manhole/cleanout NLA_ Holding tank _NIA Manurelanimal excrete storage areas (� r SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation S4r pProperty line I� r Absorption field 5 r Water main N A Water service One 50 r Surface water N, D . Wells on adjacent lots [Do, SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 3 r Building foundation _ i 2 Sr Water main _ Nl Q r Water Service line > 50 Surface water NO, Driveway, pararg/ehide srg> SOr Curtain drain At. 0, Wells on adjacent lots F. COMMENTS: G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Date6/0(p COSA Fee s V30 yam' Date of Payment 6A -5Z06 Receipt Number 002150 (Rev. 1 IM) Waiver Fee $ Date of Payment Receipt Number E2 Municipality of Anchorage •�-'�1 Development Services Department �<<� Building Safety Division ' On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # 060264 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 19 of Sand Lake #2 Subdivision. This inspection revealed an arsenic concentration of 44.2 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/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. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.or /og nsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. 7 I L � (n 0 D D 0 N Z W r r- 0 0 m 0 V/ r c it l o m n 30sp S.ZR,C�i 0 isI O ji Ali 0�.� OA 2 ^Du0 e4� ��Rz a3.4IND Ro�^.s, o4e -gm Fx 3>^ z e A 00n 3vuZ� RiSo YO`,1I-� o^ goe �s: z +n 'gIl 30°j 95 gs e 2 w+ 6.6 ' = x o o a «� v moi Noi�rSim � m a N © Z o y r I O = m -1 C I G m O z �Ov r O W W O II co Ci Ln co i m 00'09 3 „ r—x— O N 6.6 ' = x o o g� z v N1..5 9'01 N i 10.4 a 10.4 r—x— 5IS �gRaoRT i l.0 3NI73AV3 •' � — 2 C 00.09 M „00,90.00 N I I 332JiS 110DIaN3 W 0 0 W O N 00 I� ,C r I O = m -1 v O 5IS �gRaoRT i l.0 3NI73AV3 •' � — 2 C 00.09 M „00,90.00 N I I 332JiS 110DIaN3 W 0 0 W O Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci-anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel 1. D. ®t1-- I3a--0tt T S gk1j, HAA# Expiration Date: 1. GENERALINF,QRMATION Complete legal, description Location`(siteaddressordirections) f Current Property owner(sy �r testa �r ; ��afy, Day phone _&2�0-- 9-41 fea I Mailing ,address Lending agency Day phone Mailing address Real Estate Agent RauAfa i-laxia 16yy"O[j,rk,;,Cpayphona Mailing Address 61-1 V1, i �L W-, Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: _'L 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site - [� Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may, be reissued with new water sample results. (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 as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm 010104-" 1 �nU r�:Aa -+ktp, 7 � Phone -7 1 � Address AD h i, 125- I -e, i:� zvrtl Engineer's Printed Name 5. DSD SIGNATURE Approved for _ Disapproved. bedrooms. Date X Conditional approval for 2 bedrooms, with the following stipulations: At the time of title transfer the new property owner shall sign the attanbed maintenance agreement which shall be rpturn'a to this offire before an unconditional approval is issued. Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: C s� / j'0&47( Original Certificate Date: (Rev. 01M) ivivaa Nvelop (1n..Ci on => �colomes/100 m1 Nitrate ft. . 0I Ancnorage !lces Department a ty Division ` sfewaterProgram SA " Brag`" a�ri'M s)rage!AK 99519'=6650 wage ak us 3 r s I Ila Well b Wires properly mg.A. Other batter ies/100 ml. Pumper soil rating (g.p.d./ft2'or ft2/bdrm) Z System type "e",MT ceg^+xrgow5-ss Mmmts,;vs+a`r eg KN..y neauiw �r aw"i ani f e116"be(`ore lest '_fin. Water added_ gal. 3s5s'%w a Final fluid, depth in. Absorption rate >= If A, on => �colomes/100 m1 Nitrate ft. . 0I Ancnorage !lces Department a ty Division ` sfewaterProgram SA " Brag`" a�ri'M s)rage!AK 99519'=6650 wage ak us 3 r s I Ila Well b Wires properly mg.A. Other batter ies/100 ml. Pumper soil rating (g.p.d./ft2'or ft2/bdrm) Z System type "e",MT ceg^+xrgow5-ss Mmmts,;vs+a`r eg KN..y neauiw �r aw"i ani f e116"be(`ore lest '_fin. Water added_ gal. 3s5s'%w a Final fluid, depth in. Absorption rate >= D. LIFT STATION Date installed L iv)ICq Size in 1 b 0,P Manhole/Access (Y/N) gallons "Pump on" level at in. "Pump off" level at 15' in. High water alarm level at #!5— in. Datum f�x— 44c-v,, Cycles tested � Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM W ELL ON LOT TO Septic tank/lift station on lot 10Dj On adjacent lots 1001 Absorption field on lot 10nF On adjacent lots i0o r ^ Public sewer main NJA Public sewer manhole/cleanout A r Sewer /septic service line 50; Holding tank YZA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: e Building foundation 15 (o' Property line 1 Absorption field Water main &A Water service line 7 50' Surface water evio Wells on adjacent lots ©D f SEPARATION' DISTANCE FROM ABSORPTION FIELD ON LOTTO., Property line �1 Building foundation > ZS Water main A Water Service line } Surface water .0 Driveway, parking/vehicle storage i $O Curtain drain /i h Wells on adjacent lots >1001 F. COMMENTS G. ENGINEER'S CERTIFICATION ' °®010 I certify that I have determined through field inspections and °� = in review of Municipal records that the above systems are t. a a eayasr..am;s+xo c,.. conformance with MOA NAA guidelines in effect on this date. �0 Engineer's Printed Name I r VU <-N Date 5e. a 1 0 � "� • ��" ry W . _... HAA Fee $ � Lo7 E Waiver Fee $SN Payment h Lod �H o Date of y Date of Payment l Receipt Number 0 J j J zo(o Receipt Number , (Rev. 1901) m. i Municipality of Anchorage. ) W__ P.O. Bar 196600 • Anchorage llaska 99,,519 6650 • "re,lephone (907) 343-8301 • I'a-e (907) 343-5200 4700 Bragaw Strut • Anchorage, Alaska 99507 unxw.muni.org Mayor Mark Begich Building Safety Division 16 September 04 Tobben Spurkland, P.E. 203 W. 15`h #203 Anchorage, AK 99501 Subject: Waiver Request for Sand Lake #2 Block 1 Lot 19 Waiver Request #WR040063 Parcel ID 4011-132-06 Dear Mr. Spurkland: Your request for a waiver of the required 10 feet from the Absorption Field to the Property Line is approved. The approved separation distance is 3 feet. This waiver approval applies to the existing Absorption Field to Property Line separations only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding thiswaiver, please call our office at 343-7904. Sincerely, Jeff Poet Engineering Tech On -Site Water & Wastewater Program Community, Security, Prosperity AFiEr MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date (� ' -z' 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) SAN —�, I_nY--cn 2 6Loa, I Lor 1c( 5rdc 10-1(2 N iZ3 Location (address or directions) EIJvt Co Ti NEAR 6b"l' (b) Applicant Name AE U I IJ K l I HcC (Z, Telephone: Home 3,56 3 -58+ Business 2� 4" 73 Applicant Address PO B c, -f 6 q 3 A N c H A Ic g q 5 i O (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 5-33044 2. TYPE OF RESIDENCE Single -Family `�, Multi -Family ❑ Number of Bedrooms a Other 3. WATER SUPPLY Individual Well* Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/e4) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND `INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval 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 14 C S Telephone 5-0/1 Address /2 -OO k) 5 3 A /uc N e 2 n G 2E A Ln S /c /9 X 1 5-0 3 Date _)I ` -z6—,?r go 00 ou®e ®ooca°s'a" <'a E90 oa.ee (` , ler C. Reid, !r. ,°`gineer's Seal �� Bo o. 2251E o �c a` F',ROFE5`a1� , 6. DHEP APPROVAL Approved for bedrooms b ats ApprovedDisapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) !� MMCIPAM OF ANOiMeE MUNICIPALITY OF ANCHORAGE (MOA1 DEPT, Of REALM 4 HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECtION CHECKLIST- FEBRUARY 1984 viv 2 7 �, 264-4720 Legal Description: SANS I_A t✓E J?f C mfC(�'�r�� 1� cc 10 7 12 N (z 3 y {.��T�. A. WELL DATA Well Classification J " M eS +6� If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y ) Date Completed q-tiB 4 Yield is C (' M Total Depth 2 2-'2> Cased to 22-3 Depth of Grouting Static Water Level 13 $ Pump Set At — Casing Height Above Ground 3 Sanitary Seal on Casing ON) Electrical Wiring in Conduit O/N) Depression Around Wellhead (Y/(y Separation Distances from Well: To Septic/Holding Tank on Lot 104 ; On Adjoining Lots ( 100 To Nearest Edge of Absorption Field on Lot { 1 1 ; On Adjoining Lots GT too To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot GT ZS Water Sample Collected by '00-` ; Date Water Sample Test Results s a fi Comments B. SEPTIC/HOLDING TANK DATA Date Installed Zo 84 Size 1 ZS 2 No. of Compartments -1- Standpipes Standpipes (?N) Air -tight Caps Y V) Foundation CleanoutoYN) Depression over Tank (Y/O Date Last Pumped 2* Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well 10 4 To Building Foundation S S To Property Line 19 To Disposal Field 2 To Water Main/Service Line 10 To Stream, Pond, Lake, or Major Drainage Course CT 100 Comments �'� 5R_ �ds 6&-n Page 1 of 2 72-026(11/84) �RN7> (—A KE z BL0uv- i n C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ( 50 Type of System Design -T 1Z C- t") ` 'Date:lnstalled 12-018 Length of Field I ci' Width of Field Depth of Field Z Gravel Bed Thickness 8 Square Feet of Absorption Area 3 12' Standpipes Present 6YJ Depression over Field (Y/ l)- Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well I I i To Property Line LO To Building Foundation To Existing or Abandoned System on Lot ; On Adjoining Lots 61 3 0 To Water Main/Service Line GT t o To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course C, T- 100 To Driveway, Parking Area, or Vehicle Storage Area GT 570 Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level al (Y/N) Pumping-CgE4e.,during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that ve check e verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed �// �6 Date2SP Company A 6C MOA No. ST Receipt No. Q ( 3 (p Date of Payment Amount: $ (�jc9D°Gt rq t Sad dna �.koasa+ .• 6) L Y G. Reid. r. 1 No. 2251 l:tl.;-4 Page 2 of 2 PROFESS�b� 72-026 (11/84) ®�®��°