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Home My WebLink AboutSAND LAKE #2 BLK 2 LT 214c),k-mmt*4 3-0L1 DEPT. OF ENVIRONMENTAL CONSERVATION DIVISION OF ENVIRONMENTAL HEALTH DRINKING WATER and WASTEWATER PROGRAM 555 CORDOVA STREET ANCHORAGE, AK 99501 http://Www.state.ak.us/dee/home/htm Robert C. Cowan, P.E.. S & S Engineering 17034 North Eagle River Loop, Suite 204 Eagle River, Alaska 99577 TONY KNOWLES, GOVERNOR Telephone: (907) 269-7696 Fax: (907) 269-7650 March 29, 2002 Subject: Lot 21, Block 2, Sand Lake Subdivision, 92;Wastewater Disposal System Waiver Request from Existing Class C Public Water System Source Well; Review Dear Mr. Cowan: This is response to your letter received in this office on March 14, 2002 in which you requested the Department to grant two separation distance waivers. The separation distances to be.waived are between the proposed wastewater treatment and disposal system to ne located on. Lot.20, Block 2, Sand Lake Subdivision, Y#2 and one Class C pub]. c water syste n source well located on Lot 21, Block 2., Sand Lake Subdivision, #2_ I have completed my review of the files covering this subdivision and th submitted information. Based on this reuiew,_I:beiieve that the requested waivers are reasonable. As noted above, you have requested the Department to grant two separationdistance waivers between the proposed wastewater treatment and disposal system and one Class C public water system source well. Due to the continued low nitrate levels, lack of bacteria, and the great depth of the source wells in the area, the two waiver requests are reasonable. Therefore, in accordance with the Wastewater Disposal Regulations [18 AAC 721, the following waivers are granted: • The horizontal separation distance between the Class C public water system source well located on Lot 21, Block 2, Sand Lake Subdivision, #2 and the proposed septic tank located on Lot 20, Block 2, Sand Lake Subdivision, 92, serving a single family home has been waived from 150 feet to 100 feet. • The horizontal separation distance between the Class C public water system source well located on Lot 21; Block 2, Sand Lake Subdivision, 42 and the proposed drainfield located on Lot 20, Block 2, Sand Lake Subdivision, #2, serving a single family home has been waived from 150 feet to 90 feet. The above noted distances were taken from your submittal. If the proposed wastewater disposal system located on Lot 20, Block 2, Sand Lake Subdivision 42 fails or needs to be upgraded, this waiver becomes invalid. If the new system fails, additional treatment to the waste stream will be required. Robert C. Cowan Page 2 03/28/02 These waivers do not imply the granting of any additional authorizations, nor obligate any local, state, or federal regulatory body to grant required authorizations. In future waiver requests, please use the waiver checklist that can be found in the Department's publication entitled: "Plan Approval Checklist for Engineering Plans, Wastewater Treatment and Disposal, 18 AAC 72". Thank you for your cooperation with this office. If you have any questions, please do not hesitate to contact me. Sin rely, Ozem�� Keven K Kleweno, P.E. Environmental Engineer Cc: Jim Cross, P.E., MOA 72-013 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE d 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 NEW Csv. �: �,.�t ,�. "� ❑ UPGRADE MAILING ADDRESS 9 Bea r � LEGAL DESCRIPTION �S 2 _ LOCATION /... yJ r & —7777// NO. OF BEDROOMS o DISTANCE TO: Well ,`, bsorption a/ rea f (� 1 Dwelling PERMIT NO. �.y a. Q Manufacturer - , Material Aed No. of compartments ,.7 to N Liq. capacity in gallons —J bori IF HOMEMADE: Inside length � Width Liquid depth OJ 0 z DISTANCE TO: Well Dwelling PERMIT NO. 02 F Manufacturer Material Liquid capacity in gallons O W = DISTANCE TO: Well ` 6 80/#40 Foundation Nearest lot line PERMIT NO.�� 637 J Z w ~ No. of lines Length of each line _ j Total length of lines % Trench width Distance between lines Imo. O Top of tile to finish grade Material beneath tile inches Tot I effective s tion area e 6 inches �'S % -f�. Lu Length Width Depth PERMIT NO. C7 i F wa LU Type of crib Crib diameter Crib depth Total effective absorption area Cn DISTANCE TO: Well Building foundation Nearest lot line .j J Class Depth Driller Distance to lot line PERMIT NO. LU DISTANCE TO: Building foundation Sewer line Septic tank Absorption areas) OTHER PIPE M TERIALS C SOIL TES RATING INSTALLER , x 3. REMARKS P�av r r �yiz b' totl Z APPROVED DATE LEGAL ITA,V nrl l mbe,., s :L, 1�1k-? 1.4-71 72-013 (Rev. 3/78) e :\ \\ [ \ / \ \ 2 2 2 2 / ) q ) 9 2 §ZF \ \ j ) ) ) \ /\ � \ / / / / § \ ) \ ) \ \ \ \ 2 ' . `2 )2 \ % p @ \ t En \ }to / / \ \ $ :\ \ / Qu :[ \ : :\ / \ \\ [ \ / \ \ 2 2 2 2 / ) q ) 9 2 §ZF /\ � \ / / / / \ \ \ ) `2 )2 \ :7 :f \ t En \ }to / / \ Qu :[ \ : :\ \\ [ \ / \ \ ) q ) 9 2 §ZF /\ \ \ co \ (Q \ t En \ }to TYPE OF SOIL H�SORPTION SYSTEM IS� DR AIN- TED THE BEQUIRED SIZE OF THE SOIL HBSORPTION S�STEM IS� �EEIPA C_i �� THE LENGTHODIM�NSION ~��9 / `HEHLTH Pn_ k� OF THE TRENCH o�p��TMENT 'L �"�Uv�r/�D ".`� HND ENYIRONMENTH' +�� L9b0DTECTION , � 825 STREET, HNCHORHGE/ HK SEWER LINE IS 25 FEET ��ND THE ��XC�VHTION (IN 264~4720 � PERM--- W� �-4�� PTH �LE�� ( ��—��J�� .''� " /yn u THE � OF GRHVEL [HVHTION HPPLICHNT STEYE CHR�SON/J SCH�f�L� 7801 HRL�NE LOCHTION WILCOX/W�8OTH 26]~245] LEQHL L21 812 SAND Lf --WE #2 6750 SQUHRE FEET TYPE OF SOIL H�SORPTION SYSTEM IS� DR AIN- TED THE BEQUIRED SIZE OF THE SOIL HBSORPTION S�STEM IS� �EEIPA C_i �� THE LENGTHODIM�NSION IS �HA !�ENCH THE LENGTH (IN FE�T) OF THE TRENCH OR DRHINFIELD �"�Uv�r/�D ".`� .xv �n OR / � �UTTOM OF PIT IS THE DISTHNCE BETWEEN THE SURFHCE OF THE � BY SEWER LINE IS 25 FEET ��ND THE ��XC�VHTION (IN FE�T) TO PROSECUTION THE�L u��v�OTUEPTHFISHTHEXt�I�IMUM �-4�� PTH �LE�� HND .''� " /yn u THE � OF GRHVEL [HVHTION B^TWEEN THE OUTFH�L`PIPE (IN FEET). �.... �� o�F:u IL[L0;U�� PE��ITLHPPLICH�7pHHSITHE RESPONSIBILITY A7��5j =� �� STEM TO INFORM THIS DEPHRTMENT DURING `U.1.R ".^"nS�p�N��/ V@, OF ANY WELLS 90J CEP"TO THIS PROPERTY HND THE BY SEWER LINE IS 25 FEET ��ND SEWER LINE IS 75 FEET TO PROSECUTION ~~~—�LL�� E,^. �ME��oWu�L�NY <��a A7��5j =� �� STEM ��EE��K�� DISPOSHL ,�'nn/ m| UE SUBJECT WITHOUT FINHL INSPECTION HND HPP��8VHL BY SEWER LINE IS 25 FEET ��ND SEWER LINE IS 75 FEET TO PROSECUTION OTHERHPLY� SPECIICHTIONS MINIMUMTDISTHNCERB�TWEEN H WELL. HND HNY ON_SITE �,=N'�cE ru��r/O/' 1Y�TE WELL OR 150 TO 200 SEWHSE DISPOSHL SYSTEM IS �.v F::�U8LIC WELL FEET FROM H PUBLIC WELL DEPEN�ING MI��IMUMMDISTHNCE FRO� H PRIV TE WE�L TO H � 'u �o nuN1|� PRIVHTE SEWER LINE IS 25 FEET ��ND SEWER LINE IS 75 FEET OTHERHPLY� SPECIICHTIONS HND CONSTRUCTION DIHGRHMS HRr 1�Gi]RE PROPER INSTAI LLFlTION. Rr.E --- ------- �F::.,�� I CERTIFY THHT 1FORT � IHHMyFHMILIHR WITH THE R�QUIREM�NTS FOR ON_SITE SEWER5 HND WELLS AS SET WILL I - �~`~''`'`''=�� ]� I '. N HCCORDHNCE WITH THE CODE�. RESID�.=~.`�/' ;�z HE TE SEWER SYSTEM MHY REQUIRE ENLHRGf�ME��T IF TH."^-`c'e/vucu / CLUDE� MORE THAN ] BEDRUOMS SIGNED HPPLICHNT ~�~-^`z=- ISCHNELL ISSL�D BY t..—•�,� TadLEY BRUST AM ASSOCIATE' Phone 344-6 '+ SOILS LOG MINEERS' SURVEYORS PLMNERS ❑ PERCOLATION 1610 Dimond Drive, Anchorage, Alaska 99507 TEST SOILS LOG — PERCOLATION TEST PERFORMED FOR:—•,J��1/-�1-- ` " j��Ar%.. LEGAL DESCRIPTION:_ DEPTH lFFFTl t-- 1 2 3 4 5 6 7 8 9- 10- 11 — 12- 13 14 15 16 17 18 19 20 COMME `>r j 4 /0 ,0" s7lr; L ;rte sem/ /cf0 -f c x,11 "e' �w rf� r„ . • x''99 Ry I9TH O. 986-E J1! DATE PERFORMED: ` SLOPE WAS GROUND WATER S ENCOUNTERED? !� L C P IF YES, AT WHAT E DEPTH? ReadingI Date I Gross Time �I■■"■E■MEEM MEN ®®��1� ■". M11MEM�11� ��■ MKIMMMMEMOS ala iON �I■■"■E■MEEM MEN ®®��1� ■". M11MEM�11� ��■ MKIMMMMEMOS iON Net Depth to Net Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT PERFORMED BY: S%�/�G'�`5A�157 CERTIFIED BY:u3'/ DATE: 2-008 (6/79) APPROVAL TO CONSTRUCT. Plans for the construction of ,•rl �� b'�� .: - °?! l�-�.E �rl K L rf f 5 f/%a / ct ;i .'t ! '( t, blic water system located in f -a ht.- Y (r c t Alaska, submitted in accordance with 18 AAC 80.100 by__� tr�Q 'tft l �jcr �- d (n, have been reviewed and are J71 approved. ❑ conditionally approved (see attached conditions). Pi /, ).✓,G U'O l �/r✓P "`e---°-' �,�tf UJt'J Yr I(-l�'?ii ��r �Ri'1 P')f.t �°.�i �. l {� �. : BY 'rI7LE. r= - 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. APPROVED CHANGE ORDERS Change (contract order no. Approved by Date or descriptive reference) :. P, ✓"-��J/ f, -)t' �! rt> �2�'�r.rf"f`C � ,(%:-t r, iv�i� /'1 r:,-�.^!.-t�°.9. !•'Gt.r,r - - t,� �irti 4e) 10 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 cpmpletion 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 - V M N 0 1 V v 3 I I s d r N � ` — a i N � I G L L O F Z � y c c O 7 11 So. OU r o '^ ' � r r i A 14 n z } n O 1 0 F r rs of A V M N 0 1 V v 3 MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services T DIVISION OF ENVIRONMENTAL SERVICES alt 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING - Parcel _ Parcell.D.# _Ll1 --1a7-rii-� HAA# 1- 910I)3Q 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Block, '2, 1"g ke se"D # 2 Location (address or directions) 80 4lO Lv( l Ko x -"reel (b) Property owner Mailing Address Telephone: (home) (c) Lending Institution Telephone -- Mailing Address (d) Real Estate Company and Agent Re- f`tax P%erfi� - 1«ds'y/i/6) Address 26Q0 (27r6ec,vac 14k 995'03 J Telephone 2 76� Z 76/ (e) Mail the HAA to the following address: (or check here 1+9, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single -Family 50 Number of bedrooms 3 Business Z7�-276/ ?4-r) 2 3. WATER SUPPLY Individual Well ❑ Community Sd Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ® Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 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 r-10HO, p %ctin-i cat Servo -ov Telephone 3 t -13 s S Address MS -30 EGtio -V. 6"OoragP Ak !2'9Y10' Date Jun 2 9 d�-T a•>peYF+CA H�ee:oesteccaeso ceea eca to.z ev �� h� Engineer's Seal =E 1 6. DHHS APPROVAL Approved for edrooms by 7n 't'`"� '�O Date Approved Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible forerrors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) • Health Authority Approval (HAA) EDCHECKLIST - FEBRUARY 1984 1 343-4744 JAN 2 9 1911 Inof 2f Vock 2 Legal Description: � � Miun'.clpali;y o`i Anchorage SQ,r)rk %.a.ke- S �0 •� Dept. Hein th u Human Services A. WELL DATA Well Classification C If A, B, C, D.E.C. Approved (Y/N) 5" Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results Comments DEC IZ14er Of Ct,00r'47110( P_1c10SeC B. SEPTIC/HOLDING TANK DATA Date Installed & 8 2 Size 10GC,Qttl No. of Compartments Standpipes (Y/N) Y Air -tight Caps (Y/N) ± Foundation Cleanout (Y/N) `I' Depression over Tank (Y/N) Al Date Last Pumped 27 19 0 hx _T'(crac r Pumping/Maintenance Contact on File (Y/N) A A. for N. R Holding Tank High -Water Alarm (Y/N) 61, A. Temporary Holding Tank Permit (Y/N) Al, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well lo H 4rrm co. To Building Foundation 371 4!; -Om C.a• To Property Line 19 r �rom C• o, To Disposal Field �J To Water Main/Service Line 2b' f To Stream, Pond, Lake or Major Drainage Course > 100 Comments DCC cerhtzrteer1-2 waiver Oe ngF"jre SWarexhoq o6,rlefnce O OWA A0 100' 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata HO C77/Gd,-m Type of System Design 5'GU7o(e G2r�i(n�7elr,{ Date Installed 7 4/8 2 Length of Field S3 Width of Field Is' Depth of Field 7/ Gravel Bed Thickness Square Feet of Absortion Area ISS qtr rte. Statndpipes Present (Y/N) Depression over Field (Y/N) N Date of Last Adequacy Test y /Z 7 / 90 Results of Last Adequacy Test Ar.(eFIA" {b r 3 bedrL�ornr SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well 127- 1 f7ro/n /'7, T To Property Line S To Building Foundation 36' To Existing or Abandoned System on Lot - ; On Adjoining Lots To Water Main/Service Line > 2s'' To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course - To Driveway, Parking Area, or Vehicle Storage Area Comments DFC cer .4 /7 rip G(cyc.un iv loo' The S' S2/fczra%Gn du}ecnre hefcueeii -)%e demso- veld ano( -khe tmo,aprk h'pe 7,evv sh&cvA cart -hme oimf)6//et&7 D. LIFT STATION N, A Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments 1� Dimensions - t7 ap, /& T��/ev Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. "Check Permitted Bedroom Rating Against HAA Request" I certify that I have checked, verified, or conformed to all MOA and HAA 9 ti I' s r ° tkt on the date of this inspection. �3 Signed ° to o. Company Fic f ivy F ecAn icaf S relcc'e1 onoa°e0000aoe 000aw>a oaece Date Engineer's Seal eaeae eea°.aaaa..ae ee �,; THEODO:; F '%OORE MOA No. 9D —o(� CE- FJ t41 u00 lrll�"v- Receipt No.c� y� L�� f Receipt N Date of Payment —C/ Waiver Fee: $ Amount: $ C Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 WALTER J. H/CKEL, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION �A ANCHORAGE WESTERN DISTRICT OFFICE 563-6775 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 January 25, 1991 FOR: Ted Moore PWSID #215299 Sand Lake #2 Blk 2 Lots 17-21 My review of the records on file in this office reveals that the Sand Lake #2 Blk 2 Lots 17-21 Class C Public Water System is in compliance with the provisions of 18 AAC 80.060, State of Alaska Drinking Water Regulations. Sincerely, Timoth A. Karnowski Environmental Engineer TK/skpf 1X9 grin lel on rooycIcc; pap_ei b y (,, !l. Fr MUNICIPALITY OF ANCHORAGE�� • Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES �1 i 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # C1 \ — 1'S'; -,C LA HAA # VA f' 9( 1 n', 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) G.o F 2 �f f3 /Gc tr 2 Said G,ulTe #2 SSD Location (address or directions) Fi0 r!D Gv; l co x Sf (b) Property owner AEi Fr cl Re nax Telephone: (home) Business 276-Z?'57 Mailing Address - 2600 99603 (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent 8e /-tax Pe-aa-erfier - /`9r//re /-clee,,el) Address 2600 Cordovat- SA, Aelchvnajm AA 99503 Telephone (e) Mail the HAA to the following address: (or check here ®, if hold for pick up.) List contact person and day phone number below: l oQ I-fyore, oma- CAr<r 411ae-a( 396 - r3Si 2. TYPE OF RESIDENCE Single -Family ® Number of bedrooms 3 3. WATER SUPPLY Individual Well ❑ Community I9 Public ❑ Note: If community well.system,,must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ® Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 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 Fla f% %ch/ir ca/ .Sere rc <r Telephone 3 yS" (35' S Address /`/ "�0 Echo Sf Ancharrr�fP Abr WSIK Date Nio, y 3 M10 �G : • ' •'•. 0A v{ 8 °. THEODORE E ".400RE ff Engineer's Seal �' ,•. CE -3539 •,•'�Rw� 6. DHHS APPROVAL Approved for "� edrooms by Date ApprovedDisapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. -72-025 (Rev. 7/88) Back Page 2 of 2 • Gti o Ey G\Q \P�\ P�S�� f�G • � MEN A. WELL A A Well Classification Well Log Present (Y/N) MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 'r' j 343-4744. Date Completed Legal Description: Ot&ck- 2, SGY/!oC 6.a f.2 # 2 S/Q Total Depth Cased to Depth of Grouting Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results If A, B, C, D.E.C. Approved (Y/N) t Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date Comments DCG /eH-ems of ewrovQ/ pnciatec'( B. SEPTIC/HOLDING TANK DATA Date Installed 7/cf/82 Size (6'25!r I No. of Compartments 2 Standpipes (Y/N) i Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Depression over Tank (Y/N) 2 Date Last Pumped Y/2-7 /Fo yv Xkct r Pumping/Maintenance Contact on File (Y/N) Af• 4. for Al. A Holding Tank High -Water Alarm (Y/N) NIA•. Temporary Holding Tank Permit (Y/N) Nr '• SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well !D H ` C,&_ To Building Foundation - 37 f 4-&m c. o. To Property Line 19 To Disposal Field !!' To Water Main/Service Line ?S-' To Stream, Pond, Lake or Major Drainage Course 5 (Go' Comments _ D E G Ce /' fi.4r ecciC cx-,c<j"j ✓reFu'r re a( Sell dz/-er /4o,7 duEancP dc' u--�n �e IUUI 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 110 p ' ZOdrin Type of System Design S w rde d�2`+0 F4W Date Installed 7 / 8/ B 2 - Length of Field 63 Width of Field Depth of Field Gravel Bed Thickness S Square Feet of Absortion AreayS7 �cr /nsp. mart Statndpipes Present (Y/N) Depression over Field (Y/N) Date of Last Adequacy Test H/27 /20 Results of Last Adequacy Test hde uaEe -Cor 3 Gi drooml SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well 1-22' ! rr m M, T. To Property Line b To Building Foundation 36 To Existing or Abandoned System on Lot ; On Adjoining Lots To Water Main/Service Line ':-, 2S' To Cutback (if present) N, To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, .or Vehicle Storage Area > 5.0 Comments DCC Cer%f-rrcr�P u�crrvel requited S2�crrcrJ�*an p(rt�tCnCP can �6 too prcvr fo c D. LIFT STATION �),A Date Installed Size in Gallons "Pump On" Level at 2 ccrcrfc04 066 144ACe beA+eeo dru rn srreV /cc net er IL/l' j f e S tin o C,wexnC CW -a t.-e� ccf' / Dimensions High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Manhole/Access (Y/N) *`Check Permitted Bedroom Rating Against HAA Request** "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ne_e+ � %% ev Signed �jt',�r, c.� ,� � K�,,..... �3 Company Ft4f449 %�� ' �"� S2rvtc o1- r t�d , Engineer's Seal /KeAX3 IPO Date MOA No. 96, THEODOREF.:A00:«..<. TFIcODQk`e F. }.90CRE CE -3.5139 //✓ ,7V J Receipt No. CJ Receipt No. Date of Payment1:26— C � 3 -16 / Amount: $ 2 6 — O U Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 May 2, 1990 FOR: FLATTOP TECHNICAL SERVICES ATTN: TED MOORE 563-6775 PWSID: Class C According to the records on file in this office, the Sand Lake #k2, Lots 21, 19 & 18 Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, Vera Craig Environmental Fiel Officer VC: bas MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONiIMENTAL HEALTH DEPARTMENT OF HEAL11i AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. Gat-ye-ral Information Application Date 5/3/84 (a) regal Description (include lot, block, subdivision, section, township, range) Lot 21, Blk 2, Sand Lake subdivision #2 Location (address or directions) 8040 Wilcox (b) Applicants Name David BQrl Applicants Address 8040 Wilcox Teleohot:e 243 - (c) Applicant is (check one) Lending Institution Owrer/builder;-=-�' ; Buyer ; Other f:::l (explain); (d) Lending Institution First rational Bank Telephone 265-3440 Address 646 W. 4th Ave. (e) Peal Estate Co. & Agent ERA Bowden, Inc. Ed Roehm Address 570 W. 53rd Ave Te _le phone 2. Tyne of Pasiderce Single -Family : <' I Number of Bedrooms 3. Water Supply 562-4316 Multi -Family 3 Individual Noll 1 � Ccnirrunity F—=-( Other (describe Public Note: if commnity well system, must have written confirmation frcm the State Departffert of Envirorsre ntal Conservation attesting to the legality and status. Is the wall adecTiate for the number of bedrooms specified in t7: s iiAA (Y/^I) Y ` 4. Sewage Disposal Onsite ublic Community Holding Tark Is the wastewater disposal system adequate fcr the number of h-edroems (Y/N) Y [Page 1 of 21 2 -Ir 5. Engineering Firm Providing Inspections, Tests, Data and Information I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed Date Name of Firm ,,w= Telephone Address . eo4 .S lgned by % � /' �.' ��'�p/ lb: �.�% epee°°pxaxatd��r>)✓ Date _ -y s ;°5. e sy (ENGINEER SEAL) 6.DHEP An roval Approved for C3 bedrooms Approved, Disapproved Terms of Conditional Approval By 2��z�L. �; Date Conditional The Municipality of Anchorage Department of Health and Environmantal Protection do not guarantee the continued satisfactory performance of the water supply anal/or tr wastewater disposal system. This approval indicates that, as of the validation do shown. above, based on the data and information furnished �V ar. engineer, register•ec the State of Alaska, the water supply and wastewater disposal system is safe ar_d f tional for the number of bedroom and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following address: KB2/d5/s (Page 2 of 21 A MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) b,)'I MAY 8 1984 CHECKLIST - FEBRUARY 1984E C E I V E D A. WELL DATA LEGAL: Lott 1, Blk 2, Sand Lake Subd.#2 Well Classification Community If A, B. or C. D.E.C. Approved(Y/N) y Well Log Present (Y/N) Y Date Completed 8/23/82 Yield 60 Mm - Total Depth 400' Cased to unknown Depth of Grouting -- Static Water Level 125' Pump Set At 380' Casing Height Above Ground 12'.-+ Sanitary Seal on Casing (Y/N) Y Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) N. Separation Distances from Well: To Septic/Holding Tank on Lot 105' On Adjoining Lots 100' + To Nearest Edge of Absorption Field on Lot 125' ; On Adjoining Lots 100' + To Nearest Public Sewer Line N/A To Nearest Public Sewer Cleanout/Manhole N'/A To Nearest Sewer Service Line on Lot N/A Water Sample Collected By D. Maney ; Date 5/3/84 Water Sample Test Results Satisfactory for Total Coliform Comments B. SEPTIC/HOLDING TANK DATA Date Installed 7/82 Size 1000 No. of Ccmpartments 2 Standpipes (Y/N) Y Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) N Date Last Pumped 5-7-84 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/dolding Tank: To Water -Supply W� ll 105' To Building Foundation 38' A To Property Line 5' + To Disposal Field 11'� To Water Main/Service Line 10' + To Stream, Pond, Lake, cr Major Drainage Course None Noted Comments (Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 140 Type of System Design drainfield Date Installed 7/82 Length of Field 53' Width of Field 60" Depth of Field 6:'5' Gravel Bed Thickness 31 Square Feet of Absorption Area 457 Standpipes Present (YIN) Y Depression over Field (Y/N) N Date of Last Adequacy Test -- Results of Last Adequacy 'lest system installed 7/82 Separation Distance from Absorption Field: To Water -Supply Wb11 125' To Property Line 5' ' To Building Foundation 561 To Existing or Abandoned SySyste Wn. Lot -- On Adjoining �ots 18' To Water Main/Service Line 101+ - To Cutbank(if present To Stream/Pond/Lake/or Major Drainage Course None Noted To Driveway, Parking Area, or Vehicle Storage Area . Conrtnents�e�-�i.z� u.s' Y� * k/ Y D. LIFT STATIN/A Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(YM) Com¢ents Dimensions Manhole/Access (YIN) "Pump Off" Level at Vent (YM) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, or, conformed to all MOA HAA Guidelines in effect on the date o this inspection. Signed r Date 4 CompanyMOA No. 5 % 8 KB1/d5/s (Page 2 of 21 t u �� HILL SHEFFIELD, GovERNOR fi Y DEPT. OF ENVIRONMENTAL CONSERVATION Telephone: !9m 274-2533 ' .address: 437 E. Street Suite 200 Anchorage, AK 99501 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & March 20, 1984 ENVIRONMENTAL PROTECTION MAR 2 1 1PA4 To Whom It May Concern: RECEIVED CEi1/ED According to records on file in this office Sand Lake Subdivision No. 2, Block 4, Lots 7, 8, 45, 46 are in compliance with State Drinking Water Regulations. Sincerely, Bruce E. Erickson Environmental Engineer BEE/msm Attachment cc: Alaska Environmental Services C Time APPLIC'`NT FILLS OUT UPPER HAL 'ONLY Time Property OwnerPhone Mailing Address p'7_ !t✓O L, f� �tf Zip Code�� cz« Buyer A,o i7-jE-'i�. Date Address Date Zip Code Lending Institution I(��--- di� EIr�D.P>i'CG'=� Phone Address seuTi-,�- Zip Code Realty Co. & Agent 0G_hJ77-r f Z- / - a7?yCac �� TE'v �j c_ Sp Phone Address e- C l 7e-1 d , if/—' Zip Code ��,j �- % Legal Description Field Notes: DEPT. Cr ENVIROidhLl•„A- ..0,'QCTION Street Locationc�- C CT 2 2 1982 RECEIVED Type of Residence 'CONDITIONS OF APPROVAL ( ) DISAPPROVED IX Single Family !(�7 �L a-- egy9 \- ❑ Multiple Family No. of Bedrooms BY: ❑ Other Date Sewer Installed Well To Absorption Area Well Log Received Water Supply Well to Tank ❑ Individual - ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. R Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal Dr Individual 9c7Cd 2S - L"4 C C Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time y cz« Date Date Date Date Ic- - t Inspector Inspector - Inspector Inspector Field Notes: DEPT. Cr ENVIROidhLl•„A- ..0,'QCTION C CT 2 2 1982 RECEIVED 1--+ APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL` !(�7 �L a-- egy9 \- DATE BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size Well to Tank CVLJ �JI6Lf /,i