HomeMy WebLinkAboutSAND LAKE #2 BLK 2 LT 3and Lake #2
Block 2
Lot 3
#011-133-46
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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
I ANEW
Iklc U C.ib.� i E. 770—..
�.3 Jc,
❑ UPGRADE
MAI LING ADD SS
LEGAL DESCRIPTION
LOCATION -`
NO. OF BEYOMS
Well /O,'
Absorption area
Dwelling
PERMIT NO.
DISTANCE TO:
��,,.7d,-i;�,,,�
v
�Y
wQ
Manufaciurer6���.
Material /
No. of compartments
Liq. capacity gallons
IF HOMEMADE:
Inside length
Width
Liquiddepth
0 Y
DISTANCE TO:
Well
Dwelling
PERMIT NO.
J
Z 'q
O z
S h
Manufacturer -
Material
Liquid capacity in gallons
O
Well
Foundation
NearestJoline
PERMIT NO.
w y
DISTANCE TO:
Lu LL z
No. of lines
Length of each line
Total length of lines
Trench width
Distance between lines
P Z w
7Z inches
FTop
finish
Material beneath tile
Total effective absorption area
of tile to grade I
_�
p
% inches
6 /
Length
Width
Depth
PERMIT NO.
Lu
Q F
Type of crib
Crib diameter
Crib depth
Total effective absorption area
w 1
W
Well
Building foundation
Nearest lot line
DISTANCE TO:
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
W
3:
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
P/25h-
SOI L TEST RATING
INSTALLER
( 0
REMARKS
/ >
40
r i Z,rtee
A,e-1 re,-4 r,/ 4 ,0C— /o —16 -y,F/ 'V n" ✓
SYsA,f aFFre
APPROVED DATE LEGAL
/0 -30i
72-013 (Rev. 3/78)
r-1 U r-4 T_ ® z I If =9 - I "T ll� CH F-7 A --r 1"-4 u_ L --f u--® IF=' F: -g e_.=a E--
DEPARTMENT' HEAL"fH AND ENV IFaOP•dt'1El'-FrAI_ '--N.JTECTIOhl
L l -FEET, ANCHORAGE:, Ak:. 99...-._1:1
r
4-4720
PEF' '1I l NO. -3J_ki t'58 .'
APPLICANT HULTOUIS:T' C:ON TRUC:TIOP-,! 37.221 'T'At,IAGA CIRC LE 2-1:3--11.19
L..00AT'ION SEAVIEW
LEGAL L 3 B 2� ,Ht'dD LAKE ##2 LOT' SIZE 675f.,, SQUARE FEET'
T'r'PE'. OF _OIL. AB'.=;ORP-f'iOtd '.-;' ST`EM T'RENC:H
t'1A,l:It'1Ut'1 NUMBER OF F3ECiF:OOt'I_ = _ SOIL RATING SQ FT `Bl:?- :12
THE REQUIRED SIZE OF -T"HE `-OII_. ABSORP'f'IOP-d SYSTEM IS:
CA IF= F* `F_."= = 1 9— II=_ P -A C:i -T' g --H — __ . Y-. Ca" F" F::9 e° � 1_. 6w -d E-.. F"—r' l--1 =- W-
TI -•IE LENGTH DIMEP-dSION IS THE LENGTH j::IP-d FEET') OF THE TRENl.-:H OR DF'AINFIELD.
THE DEPTH OF A TRENCH OR PIT' is rHE DISTANCE STANCE BETbdEEN T'HE SURFACE OF THE
GROUND AND 'CHE BOT-l'OP1 OF THE EXCAVATION IN FEET).
]"HERE IS NO SET' WIDTH FCR TREP•dCHES.
T'HE GRAVEL DEPTH i'=, THE t'IINIMUN DEPTH OF GRAVEL_ BETWEEtd THE OUTFALL F`IF'E
AND T'HE BOTTOM OF THE. Er'C:A'v'A'TION (IN FEET).
F: -"EE IC: 0-3 T F"c' F Eu C-- F' -Y" I C, -I- F-- # Ir -•E "_. 1 2: JE--,
�� d - u^�� u»u u = u u� � R d� 1- u: a I "I °_•
PERMIT APPLICANT- HAS -FHE RE'=;POP•,lS I B I l_ I TY TC) INFORM THIS L•lEF'ARTt'1Et•,IT DURING T'HE
INE."I"ALLATION It•d' PE:C:'TIOP•S OF ANY WELLS ADJAC:EP•-IT TO THIS F'ROPERT''r APID THE
NUMBER OF RESIDENCE_; THAT l"HE WELL HILL SERVE.
-7^ 14 CC e e -Jr rA J f�--" _ �_..: 'VG 1 cn j° -A g'_"@ FZ � �'^=' _ N -�R A.._.9 _- d-° = lF IE- -,..__ �.._._.
BACKFILLING CSF' ANY SYSTEM I.4I l HOi_1T FINAL INSPF_C:TION ANC, APPROVAL BY n- i .
DEPARTMENT- WILL BE SUBJECT TO PRO ,EC(JT I Or --l.
11INIPlUM DISTANCE BET'WEEP•d A WELL. AND AP+i'r Ohl :ITE SEWAGE DISPOSAL_ SYSTEM IS
:1.00 FEET' FOR A PRIVATE WELL OR 150 'TO 200 FEET' FROM A PUBLIC WELL DEPENE)ING
UPON THE TYPE OF PUBLIC: I dEL.L.
t'1 I P• U U.. M DISTANCE FROM A PRIVATE IdELL TO A PRI VAT"E SEWER LINE. IS 25 FEET FIND
T'O A COt'it'U_ N I "re SEWER LINE IS 75 FEET.
WELL. LOGS ARE REQUIRED AND MUST BE RETURNEE? TO THE DEPARTMEtdl'" WITHIN ":0 DAY
OF THE WELL COMPLE'T I � N.
Cil"HER REI_!LIIREMENTS MAY APPLY. SPECIF'ICAT'IONS AND C:ONST'RUCT'IOP•d DIAGRAMS FIRE.
AVAILABLE TO IP•dSURE PROPER Itd=-FALLATI[:N.
-1 T- '" ° :1 � ^-'" F "_M" 1- C_ IE_ -_
I CERTIFY THAT
:1 : I AM FAMILIAR WITH THE RECO I REI''1E611'S FOR Ohl --SITE SEWERS AND I.dEL.L'E As SEl'
FCR -!-H B',' l"F-IE MUY-d I C I PAL I T'Y OF AkICHORR E.
2: i WILL i t•,is,r-ALL -I"HE S'r ;TEM IN ACCOR%:,Ht-,!CE 1,11"M T'HE CODEC.;.
_.: i UNDERsT—AND 'T'HAT' THE or -4- SITE SEWER SYSTEM MAY F•;F:QI_IIR,E ENLARGEI'1EP•T' IF T'HE
RE--;IDF_t•di;E IS REMODELED TO INCLUDE MORE THAN BEDROO11S.
APPLICANT* HI._ILT'G!LII'=T CONSTRUCTION Lj IQ �clf, Ii1Qc/
I:ESUEC: V4. 0
MUNICIPALITY OF ANCHORAGE,--,
Department' Health and Environmenta_ ,rotection
825 L Street, Anchorage, AK. 99501
264-4720
# # # HANDWRITTEN PERMIT # # #
WELL AND2 ON-SITE SEWER PERMIT
Applicant: Mailing Address: -73�i� r CLv e_a A
Location: A_0_V_r Phone Number: 3 3 3_M9
Legal Description: L � -_9L( Z ' LL S/Q Lot Size: (0
Type of Soil Absorption System Is:
Trench: _� Drainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:
DEPTH I LENGTH _ GRAVEL DEPTH -- WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE _ 16060 GALLONS # #
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* # * TWO(2) INSPECTIONS ARE REQUIRED # # #
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 3 1
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that 3 be rooms.
Signed: A414 Issued by:
Applicant
Date: ��—
SWP/024(1/81)
AK SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION' PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264.4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: Nu Y. `tet V l.s-t / DATE PERFORMED: -7
LEGAL DESCRIPTION: ��� `L' V Gk Z `Jb.N ►-AKE 5 V �3 a V 5 O
SLOPE SITE PLAN
ITTER -T-6 e ate, F—F—ImsI'-j
I I I
2
iia �•\' vr.,{ �.�.'� Oe°
�}
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
4
5
r�
6-
7
,
8
a
9
10
Sp CSW
11
12
� T
13-
314
I
14-
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15
16
17-
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_,l l�ada(e aN'•GeV'!Na r1L5,a���
18-
19
8 19
J!
[f� a Ralph Vij. jOf:
6!ae Na. 145E .'ra
we
COMMENTS
ow
WAS GROUND WATERS l A L
ENCOUNTERED? O
P
E
IF YES, AT WHAT
DEPTH?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE IminuteshncW
TEST RUN BETWEEN FT AND FT
PERFORMED BY: CONTQAC i I wt. FN G I hIL ees CERTIFIED BY: SZAL.91-1 .SOk F-L1Nc DATE: 1- Z t -'I& ti
»_nnn rFnni
1
CONSTRUCTION AND OPERATION CERTIFICATE
ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION
PUBLIC WATER SYSTEM
APPROVAL TO CONSTRUCT
Plans for the construction of E' ii) r/1 P> > i ✓ I()) lo C. <
public water system located
in t i r &r C 7Frf L , Alaska, submitted in accordance with 18 AAC 80.100
•A
by-
L,4/L -( have been reviewed and are
approved.
❑ conditionally approved (see attached conditions).
g TITLE DATE
If construction has not started within two years of the approval date, this certificate is void and new
plans and specifications must be submitted for review and approval before construction.
02,x.
Date
APPROVED CHANGE ORDERS
Change (contract order no.
or descriptive reference)
Approved by
o,1.
The "APPROVAL TO OPERATE" section must be completed before any water is made available to
the public.
APPROVAL TO OPERATE
The construction of the
public
water system was completed on (date). The system is hereby
granted interim approval to operate for 90 days following the completion date.
BY - TITLE - DATE
As -built plans submitted during the interim approval period, or an inspection by the Department has
confirmed the system was constructed according to the approved plans. The system is hereby granted
final approval to operate.
BY
TITLE
DATE
Engineering Report
Water System
for
Lots 1 thru 6 Block 2
Sand Lake Subd.,
(all lots single family dwellings)
Water Source
OF.q��`99�
aY Gj •° °o. �- ��
Ralph B. Joketo
'r NO. 1995-E
G`IC'S�C''O•o...°oma<+' +Y���
Well #1 located on lot 6 to serve lot 5 and lot 6. Well is 6" steel casing 408
feet deep with a static water level of 112 feet. Test pumped at 20 GPM.
Well #2 is located on. lot 3 and is proposed to serve lot 1,2,3, & 4. Well is
6" steel casing 410 feet deep with a static water level of: 118 feet. Test pumped
at 30 GPM.
Wells shall be installed with a pitless adapter at a minimum depth of 10 feet.
An approved water tight sanitary seal shall be installed on the well. The top
of the well casing shall extend a minimum of 12" above ground with drainage sloped
away from the well for a minimum of 10'. Due to the depth of the well and soils
conditions, the well casing should not require grouting.
Also due to the conditions noted above, it is proposed that the protective radius
for this well be reduced from 150' to 100' required to on—site sewer systems.
Water Distribution
Proposed distribution system shall comply with AWWA standards. Pipe shall be
type K copper with sizes as indicated on attached sketch. Pipe shall be buried
a minimum of 10 feet. All underground splices shall be flare fittings.
Water Pumps
We 11 #1:
Using a depth of 300' to the pump and an assumed drawdown of 200 feet total
head loss is as follows:
he= 200'
hf=375 L.F. of 1" pipe= 47'
20 psi minimum discharge pressure= 46'
Total head loss= 293'
Nak demand for 2 dwelling units is 840 GPH. Use 12 H.P. pump. (Pioneer submersible
Model A-18 or equivalent) (See attached performance curves)
cell/ �2
Using a depth of 300' to the pump and an assumed drawdown of 200 feet total.
head loss is as follows:
he= 200'
hf=425 L.F. of 1" pipe= 103'
20 psi minimum discharge pressure= 46'
Total head loss= 349'
Peak demand for 4 dwelling units is 1260 GPU. Use 3 U.P. pump (Pioneer. submersible
Model A-35 or equivalent)
Water Storage
Water storage shall be accomplished with a diaphram type storage tank (42 gallon
capacity) in each dwelling unit. Tanks shall be precharged to 20 psi and will
preclude the necessity of air volume control. Shut—off valves will be located
in each dwelling unit served.
i
L.5,
\ Municipality of Anchorage
• -- Development Services Department
Building Safety Division =
Onsite 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. loll- 133- �(ei COSA# oj,ow5
Expiration Date: IQ f R- O G
1. 'GENERAL INFORMATION
Complete legal description Lot 3 BIoe_k 2 &J U6 VZ
Location (site address) 8031 Seavle,�7 Stree.�
Current Property owner(s) M iclr , NmMeA. Day phone I 5— 9310
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: 3
3. TYPE OF WATER SUPPLY:
Individual Well ❑
Individual Water Storage ❑
Community Class C Well 19
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 Onsite 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 OnSfte 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 Onsite 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 Finn
Address
Engineer
5. DSD SIGNATURE
Approved for _3 bedrooms.
Disapproved.
Phone 249-3916
Date 1310 t,
-- ��.QF A(,gsl1i
001 JJ
10. r.49TH i..�
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I.ARS . SPUR KLAND: j
J��i �o��/l�3Ro�.•���s
l� �OF SsioN�_
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
(R«. IM)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: %" 12-06
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Sita Water & Wastewater Program '
4700 Bragaw Street
P.O. Box 196850
Anchorage, AK 9951943650
www.muni.org/onsite
(907) 343.7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: S and L4ke " 2 &A 3 Block 2 Parcel ID: O 11— 13 3 — 4 G
A. WELL DATA
Well type
Date completed =
Total depth ft.
Date of test
Static water level
If A, K or C provide PWSID #
Sanitary seal (Y/N) _
Cased to — R
FROM WELL LOG
ft.
Well Log (Y/N) '—
Wires property protected (YM)
Casing height (above ground) — in
AT INSPECTION
R
Well production g.p.m. — 9—
p.m-WATER SAMPLE RESULTS:
Coliform _0od7 ies/100 mL Nitrate N� mg/L Other bacteria colonies/100 mL
Arsenic: I !tel ylgllDate of sample: Ofo Collected by: Lori; S,eirklAnj
B. SEPTICfHOLDING TANK DATA
Tank TypelMatenal &car / S>fet:� Date installed i0 `
Tank size _1000 gal. Number of Compartment Ciearmuts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (YIN) Al N
L High water alarm (Y/N)
Date of pumping b'� Pumper Rotor- Roo Ft,
C. ABSORPTION FIELD DATA
I
Date installed) Soil rating (g.p.d.fie ft=/bd 125 System type Deep Trerw_�,
Length 3Y R Width t e ft. Gravel below pipe (o ft.
Total depth —LO—ft Eft. absorption arealct Monitoring tube yDepression over field
Date of adequacy test 0(o Result (Pass/Fail) }155 For 3 bedrooms
Fluid depth in absorption field before lest in. Water added X00 gal. New depth 2 9 in.
Elapsed rune: 015 min. Final fluid depth _Q n. Absorption rate >= 150 g.p.d.
Any rejuvenation treatment(past 12 mo.) (YM & type) &/0"d kp0c✓11If yes. give date —
D. LIFT STATION
Data installed
.Pump on, leve _ in.
Datum
E. SEPARATION DISTANCES
Size in gallons Manhole/Access (YIN)
'Pump ofr _ in. High water alarm in.
CyclesMeeh alarm 6 regriremeMs9
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/ ift station on lot 100'+- *41
Absorption field an lot 1001+ f
Public sewer main N/ A
—r
Sewer /Septic service One 101+
Animal containment areas
On adjacent kris ) 00'4-
On
0rrOn adjacent kits 1i�O�t
Public sewer menhoWdeanout N
JA
Holding tank /VSA
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 20 Property line IOr+ Absorption field S
Water main IV Water service One Z51 + Surface water N O
Wells on adjacent kris I OD rt
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property Ona 16,S Building foundation 101+ Water main --V /A
Water Service line 2S l+ Surface water N.D. Dray, + 25 r
Curtain drain Al. d• Wells on adjacentlots 100 r +
G. ENGINEER'S CERTIFICATION
/ cat* that I have determined thnwgh field inspect/ons and
review of Mur*VW records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Lm S."o :1
Date ' II;10(o
(Rev. 119)5)
Waiver Fee i
Date of Payment
Receipt Number
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I hereby certify that I have surveyed the following described prcperty: a/ 3 , L or- K 2
and that no encroachnents exist except as indicated.
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It !s the responsibility of the Omer to determine the existence of any easements, d,`Q-; • •.s,�0�
cove -ants, or restrictions which do not appear on the recorded subdivision plat.Uj;' 9TH OQ
Ender no circ nstances should any data hereon be used for construction or for �� is
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Anchorage, Alaska 99502220 Briarwood Street LT
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Phone (907)349-2407
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I hereby certify that I have surveyed the following described prcperty: a/ 3 , L or- K 2
and that no encroachnents exist except as indicated.
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It !s the responsibility of the Omer to determine the existence of any easements, d,`Q-; • •.s,�0�
cove -ants, or restrictions which do not appear on the recorded subdivision plat.Uj;' 9TH OQ
Ender no circ nstances should any data hereon be used for construction or for �� is
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Anchorage, Alaska 99502220 Briarwood Street LT
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Phone (907)349-2407
Municipality of Anchorage ,.� r
.�
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 # 060305
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 2, Lot 3 of
Sand Lake #2 Subdivision. This inspection revealed an arsenic concentration
of 49.1 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.org/onsite) or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
Or
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 F&L/_ia�5—
r
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision,/section, township, range)
k ®% 3 &'q C/<
Location (address or directions)
S:?Gtll;e £ SC7
(b) Applicant Name J-, k)+S r`L 4a Telephone: Home Business c__y3_ 9a'�
Applicant Address :;LD/ Ly Sgt SGcti/2
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; Other (explain);
(d) I
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
2. TYPE OF RESIDENCE
Single -Family lA Multi -Family ❑ Other
Number of Bedrooms
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.
6
sa"d Ladle
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
Ascertified by my seal Mixed hereto and as of the validation date shown below, I verify that my investigation of this Health
AuthorityApproval 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 4- C Telephone
Address ^
Bate
s. DHEP APPIa2
11
Approved for _bed
Approved _"� Disapproved
Terms of Conditional Approval
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Date
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 ceRificate Is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineers work.
Page 2 of 2
a
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MUNt�, E8V 0A
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9
A. WELL DATA(
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
'% /2/✓ kJ/_80
1 �
Well Classification ..bT✓yi �VrLltk t =k If A, B/. C.1D.E.iC. Apprrov�e�N) dO
Well Log Present (Y/ ) � Date Completed l� Imo" Yield _
Total Depthased to Depth of Grouting
Static Water Level _>Ar^ Pump Set At
Casing Height Above Ground �1, Sanitary Seal on Casing (Y/N) —
Electrical Wiring in Conduit (Y/N) 7" Depression Around Wellhead (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot `Da ® ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot � 6) ; On Adjoining Lots //(o
Ai
To Nearest Public Sewer Line AfL To Nearest Public Sewer
Cleanout/Manhole To Nearest Sewer Service Line on Lot
Water Sample Collected by Date
Water Sample Test Results 5f+'1-15F/KTZ7RY
Comment "` iiUCtd't
c 2.
d WGN��-o
B. SEPTIC/HOLDING TANK DATA ;
Ii :h
Date Installed �� �� `/( Size OCD No. of Compartments
2
Standpipes (Y N) Air -tight Cap (Y ) Foundation Cleanou66YA,
Depression over Tank (YN�) Date Last Pumped_/�� l �J
Pumping/Maintenance Contract on File (Y/N) A/W ; for /1/•i
Holding Tank High -Water Alarm (Y/N) ZdlTemporary Holding Tank Permit (Y/N) _
Separation Distances from Septic/Holding Tank:
To Water -Supply Well 10 M1 '
To Property Line
To Water Main/Service Line .
Course i () 0
i
Comments
Page 1 of 2
72-026(11/84)
r�
To Building Foundation jet
i
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
V
Soils Rating in Absorption Strata / Type of System Design
Date Installed D ��'� Length of Field��
i
Width of Field Depth of Field
�i
Gravel Bed Thickness r
Square Feet of Absorption Area 1 �gy" f Standpipes Presen (Y N)
Depression over Field (YO Date of Last Adequacy Test /
Results of Last Adequacy Test !/ "L
Separation Distance from Absorption Field:
To Water -Supply Well /4,
i
To Building Foundation
Lot A�
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
i p
Commentszt'%rze-
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
To Property Line
; On Adjoining Lots
61
To Existing or Abandoned System on
.-*2 / r.Xi
To Cutbank (if present) e G
dp / "-t`
(Y
at
Vent(Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
certify that Ira. f checked, erified, or conformed to all M A a d HAA guidelines in effect on the date of this inspection.
Signed Date g
Company MOA No.� �� 7 A ®®FAl, 4
61i
Receipt No. ���J \ ���lio•,000..9ses®°�
e• a •9
Date of Payment 45 I�7��' . VV •' 900oe
Amount: $ �e••;a F"s° a�
Page 2 of 2
72-026 (11/84)
w
® cr m lero C. Reid, Jr. e s
2251-E
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ALASKA RUIROWnTAL COOK SRUS, InC.
Engineering & 6nuironmental Studies
ALASKA HOME EQUITY SHARE
701 E. 58TH SUITE K
ANCHORAGE ALASKA
99504
JULY 16 1985
SELLER—JOYCE ALASKA HOME EQUITY SHARE
701 E. 58TH SUITE K
ANCHORAGE ALASKA
99504
LEGAL:SANDLAKE #2 BLOCK 2 LOT 3
ADEQUACY TEST FOR SEWER SYSTEM
ADEQUACY TEST DATE—JULY 1 1985
THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 408 SQFT.
THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 672 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
3 BEDROOM HOME.
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR
THIS 3 BEDROOM HOUSE.
THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON 10/11/84 .
fl O a
$• 4j� 3 i .V
^stiff J e8var•,•soca zanz`.,acaceo ; a � �
G Ler C. Reid,
1200 West 33rd Auenue, Suite B • Anchorage, Alaska 99503 • (907) 561-5040
CONSTRUCTION AND OPERATION CERTIFICATE
ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION
PUBLIC WATER SYSTEM
APPROVAL TO CONSTRUCT
Plans for the construction of S 4Y LIKE KE s(4131l_( V1 S 1oK) ::;#Z 91 e k L
Lptc 1 7 a CI G SS lP" (%`LZE F A- — 10 14� public water system located
in lfV1 C L 0 r CA- e ._ AL , Alaska, submitted in accordance with 18 AAC 80.100
by 00vt4N-ccc ik S NS IWCC✓S — have been reviewed and are
X approved.
❑ conditionally approved (see attached conditions).
ilJt ��d —l?I) IY U MAPk11Yf ESP 1 N@tY DAT
If construction has not started within two years of the approval date, this certificate is void and new
plans and specifications must be submitted for review and approval before construction.
APPROVED CHANGE ORDERS
Change (contract order no. Approved by Date
or descriptive reference)
The "APPROVAL TO OPERATE" section must be completed before any water is made available to
the public.
APPROVAL TO OPERATE r
The construction of the ! aO % C St/%��J� �O c �C z Leif s r— 7 public
water system was completed on (date). The system is hereby
gran d interim approval to opera for 90 days
following the completion date. Tl
f— 1/1//1YO14�liPt1�Q(CNn 1Nef li � o
E DATE
As -built plans submitted during the interim approval period, or an inspection by the Department has
confirmed the system was constructed according to the approved plans. The system is hereby granted
final pproval to operate.
7
f
TITLE ^� DATE
- -
DATE RECEIVED
INSPECTION APPOINTMENTS
!T
TIME
TIME
TIME
DATE
DATE
DATE
INSPECTOR
INSPECTOR
INSPECTOR
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIp�t� DEPT. OF HEALTH &
825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION
•
NOV 9 1981
ENVIRONMENTAL SANITATION DIVISION
Telephone 264.4720
RR
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER;QT11/4D
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTYOWNER `
PHONE
��" _�� C
5
rr Cl
MAILING ADDRESS
?3 ),eC ( r
PROPERTY RESIDENT (If different from abode)
PHONE
t +
2. BUYER
PHONE
�
MAILING ADDRESS
3. LENDING INSTITUTION
PHONE
7 �!
MAILING ADDRESS
� r
4. REALTOR/AGENT
PHONE
1
�—
MAILING ADDRESS y�
t7 (P1n f
/ C PCt,I er
5. LEGAL D RIPTION
�G�S
s 32
!T
STREET LOCATION
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS
EJ One ED Four EJ Other
SINGLE FAMILY
❑ Two ❑ Five
❑ MULTIPLE FAMILY
�0 Three ❑ Six
7. WATER SUPPLY
❑ INDIVIDUAL* c��
* A TACH WELL LOG. A well log is required for all wells drilled
;- COMMUNITY G\�
si -ce June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTI L TY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
® INDIVIDUAL/ON-SITE**
F1 YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUSTACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
3+4 aw'� 6AL Son/eat �/ f/1e Glen 6T IGS
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
NUMBER OF BEDROOMS
❑ SINGLE FAMILY
❑ ONE ❑ THREE ❑ FIVE
❑ OTHER
❑ MULTIPLE FAMILY
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
PERMIT NUMBER
❑ INDIVIDUAL
DEPTH OF WELL
❑ COMMUNITY
DATE DRILLED
❑ PUBLIC UTILITY
LOG RECEIVED
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
PERMIT NUMBER
❑INDIVIDUAL/ON -SITE
DATE INSTALLED
❑PUBLIC UTILITY
Connection Verified
INSTALLER
❑Septic Tank or ❑ Holding Tank
SOILS RATING
Size: If Tank is homemade
give dimensions:
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
-MATERIAL
4. DISTANCES
Septic/Holding Tank
Absorption Area
or Line
Nearest Lot Line
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
3
❑ APPROVED FOR
BEDROOMS
CONDITIONAL APPROVAL
(letter must accompany certificate)
❑ DISAPPROVED
DATE
1
BY
!
72-010 (Rev. 6/79)
PENINSULA
ENGINEERING
2820 'C' Street, Suite #3
Anchorage, Alaska 99503
276-4855
November 19, 1981
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
I= 1 9 1981
RECEIVED
Dave Hultquist
7324 Tanaga Circle
Anchorage, Alaska 99504
Re: Lots 1, 2, 3, 4, 5 & 6, Block 2, Sand Lake Subdivision #2
Site Inspection
Dear Mr. Hultquist:
Inspection was made today to investigate the septic system installation
and the well construction on the above lots as requested by Robert
Pratt of the Municipality of Anchorage in his letter of November
17, 1981.
(1) All standpipies from the sewer system have been installed and
capped in accordance with Municipal standards.
(2) The two wells are at least 12'' above finish grade and are sealed
and installed in accordance with Municipal Standards.
(3) All six septic systems appeared to be installed adequately with
no visible depressions over the tank or leaching area, except
as follows:
(a) Lot 4 Block 2 has some subsidence above the septic tank
area.
(b) Lot 3 Block 2 has small amount of subsidence around the
cleanout, 2 feet from building wall.
These don't appear to be serious problems, however, they should be
corrected.
Sincerely,
Wayne tl�nderson
WH:zc—p
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_�dovember 17, 1981.
Wayne Henderson
Peninsula Engineering
2820 C Street, Suite 3
Anchorage, Alaska 99503
Subject: Lots 1, 2, 3, 4, 5, 6 Block 2
Sand Lake Subdivision lk2
Information submitted in your letter_- of '�Jovember 12, 1981 is
satisfactory regarding the water well serving the above
subject property. However, we will need the following
additional. information:
(1) After final_ grading, were the standpipes to the sewer
systems in place and above ground level?
(2) Was there any depression over the sewer systems; leaching
area and septic Lank?
(3) Does the construction of the water wells meet Municipal
of Anchorage and State of Alaska regulations?
The additional information submitted to this office will. need
to be stamped by an engineer on a original copy.
I.f there are any further questions, please call this office
at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
cc: Dave Hultquist
7324 Tanaga Circle
Anchorage 99504
825 "1
ANCllOIRIGr,A1.ASKA:)9',01
1
(901)21A/11'1I
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OHGI ill JUI i_!VAN,
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Y?ltYCiR
[MIA i 1101-N 1 01- 111 -AI l iI ANN) I niVllilii-;."i ;.I ir.l_ Plli;I i - 1l(.)N
_�dovember 17, 1981.
Wayne Henderson
Peninsula Engineering
2820 C Street, Suite 3
Anchorage, Alaska 99503
Subject: Lots 1, 2, 3, 4, 5, 6 Block 2
Sand Lake Subdivision lk2
Information submitted in your letter_- of '�Jovember 12, 1981 is
satisfactory regarding the water well serving the above
subject property. However, we will need the following
additional. information:
(1) After final_ grading, were the standpipes to the sewer
systems in place and above ground level?
(2) Was there any depression over the sewer systems; leaching
area and septic Lank?
(3) Does the construction of the water wells meet Municipal
of Anchorage and State of Alaska regulations?
The additional information submitted to this office will. need
to be stamped by an engineer on a original copy.
I.f there are any further questions, please call this office
at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
cc: Dave Hultquist
7324 Tanaga Circle
Anchorage 99504
7324 Tanaga Circle
Anchorage, Alaska 99504
Re: Lots 1, 2, 3, 41 5 & 6, Block 2, Sand Lake Subdivision #2
Water Sample and Analysis
Dear Mr. Holquist:
This letter is to verify that I performed the water sampling and
had the water tested in accordance with Municipal standards. The
results of the lab analysis are satisfactory as shown on the
attached lab report from Chemical & Geological Laboratories.
One sample was taken directly from the well located on Lot 3,
Block 2, which services lots 1, 2 3, & 4 of block 2. The second
sample was taken directly from the well on lot 6 which services lots
5 and 6 of Block 2 in this subdivision.
If I can be of any further service, please do not hesitate to call
on me.
Sincere y, J
Wayne H nderson, P.E.
WH:sa
Attachments: Lab Analysis
44 9V-1
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2820 "C" street, Suite #3, Anchorage, Al.aqjka 99503
�/6-4855
** Check Permitted Bedroom Rating Against HAA Request **
I certify that Ira, f checked, erified, or conformed toall M A arfd HAA guidelines in effect on the date of this inspection.
Signed Date gs
Company�f� MOA No. $� C� Aa�®®®���
Receipt NoYr
.°®coo
Date of Payment
Amount: $ ve••�® al
Page 2 of 2
72-026 (11/84)
Lero C.
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November 12, 1981
PENINSULA
ENGINEERING
Dave Holquist'
7324 Tanaga Circle
Anchorage, Alaska 99504
Re: Lots 1, 2, 3, 4, 5 & 6, Block 2, Sand Lake Subdivision #2
Water Sample and Analysis
Dear Mr. Holquist:
This letter is to verify that I performed the water sampling and
had the water tested in accordance with Municipal standards. The
results of the lab analysis are satisfactory as shown on the
attached lab report from Chemical & Geological Laboratories.
One sample was taken directly from the well located on Lot 3,
Block 2, which services lots 1, 2 3, & 4 of block 2. The second
sample was taken directly from the well on lot 6 which services lots
5 and 6 of Block 2 in this subdivision.
If I can be of any further service, please do not hesitate to call
on me.
Sincere y,
Wayne H nderson, P.E.
WH:sa
Attachments: Lab Analysis
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2820 "C" street, Suite #3, Anchorage, Al.a$ka 99503
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