HomeMy WebLinkAboutSAND LAKE #2 BLK 3 LT 2
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP231281
Work Type: SepticTank Upgrade
Tax Code Number: 01113447000
Site Legal Address: SAND LAKE #2 BLK 3 LT 2 G:2224
Site Mailing Address: 8023 SEACLIFF ST, Anchorage
Owner: SMART TOBY D & JILL H
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Effective Date:
Expiration Date:
»ent
�o' ;:, ';,,f S('
V ,
•r
D( partment
Lot Size in Sq Ft:
Total Bedrooms:
9/12/2023
9/11/2024
6750
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions:
• Submit the Well Decommissioning Log with the IR.
r
Issued By: —�—_
Date:
Date:
�'lX Z Z
3
MUHMPdL UTY O AHCHORALE
t1 a
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWERIWELL PERMIT APPLICATION
Parcel I. D. _ 011-134-47
Property owner(s) Toby Smart
Mailing address 8023 Seacliff St, Anchorage, AK 99502
Site address 8023 Seacliff St, Anchorage, AK 99502
Day phone (907) 529-7059
Legal description (Sub'd., Block & Lot) Sand Lake #2 Block 3 Lot 2
Legal description (Township, Range & Section)
Lot Size 6,750 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑ Single Family (SF) ❑X
(w/wo AD U)
Septic Tank
❑X
Upgrade ❑X
(D) ❑
Holding Tank
❑
RenewalDuplex
❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION
INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 022 S Waiver Fees:
Date of Payment: 3/Z`{ Z-3 Date of Payment:
Receipt Number: 003 3 /D Receipt Number:
Permit No. Waiver No.
Permit App_-'- :
May 30, 2023
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Sand Lake #2 Block 3 Lot 2 - 8023 Seacliff Street
Septic Tank Replacement
Dear On-Site Services Engineer:
The owner of the above lot has a septic tank that has reached its end of useful life, so we are
submitting this permit application for its replacement. The attached site plan identifies the
location of the home as well as the wells and septic location. No conflicts exist between this
proposed system and any other wells or septic system, whether on this lot or adjacent lots. We
are replacing the septic tank with the same size designed for 3 bedrooms.
The new septic tank will be a minimum of 100 from all wells and surface water. Please refer to
the attached plan for the septic design. If this design is followed, there will be no adverse impacts
to adjacent properties.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231281, Deb Wockenfuss, 09/12/23
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CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FD - FLOW DIVERTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
1"=20'
SAND LAKE #2, BLOCK 3 LOT 2
FEET
0 20 40Benjamin Schiller
CE 12592REGISTEREDPROFESSIONA L E N GINEER
8/23/23
SEPTIC PLAN
CHAIN LINK FENCE
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3-BDRM HOME
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6
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4
7
6
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DECOMMISSION
EXISTING TANK PER UPC
NEW 1,000 GAL
SEPTIC TANK
EXISTING TRENCH
TO REMAIN IN
SERVICE
SHED ON BLOCKS
WATER KEY BOX W/ ASSUMED
WATER LINE ROUTING
EXISTING WELL
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231281, Deb Wockenfuss, 09/12/23
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W. 80TH AVE
LOT 1
LOT 2
LOT 3
LOT 1
LOT 23A
SAND
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Taylor L. Dosch
No. 189892
R
E
GISTEREDPROFESSIO N A L L A N D S U R
VEYOR
/' MUNICIPALITY OF ANCHORAGE
'i~i 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
[] UPGRADE
MAI LIN'G~D;$S v
DISTANCE TO: ' [Well [~/ Absorptionar. Dwelling
Manufacturer ~~ MateriaS~L No. of com~ments
Liq.7~n gallons IF HOME.DE: Inside length Width Liquid depth
DISTANCE TO: Well Dwelling PERMIT NO.
Manufacturer Material Liquid capacity in gallons
lines / ' ~ r Materia~eath tile/~ i nchesinChes Total
"°'°' Distance~2~ lines
Length Width Depth PERMIT NO,
Type of crib Crib diameter I Crib depth Total effective absorption area
Well , Building foundation Nearest lot line
DISTANCE TO:
Class Depth Driller Distance to lot line PERMIT NO,
DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
M~T~?ALS
so,
T RATING ~
INSTAELER ~ ~
KS / ~
AP~ DATE LEGAL
72-013 ~v. 3/78)
DEPARTMENT ._.~' HEAL]"H RN[." ENYIRONMENTFIL ,-'ROTECTION
825 'L" STREET., RNCHORRGE, BK. D~50t
264-4728
BOX 4-t2-:24 RNCH.
PERMIT NO. ( 8iOii~: )
LOT SIZE
RPPLICRNT PRUL ROSELRND
LOCRTION H. 80TH & SEACLIFF
LEGRL LOT 2 B "~" SRND LAKE ~2
'TYPE OF SOIL. ABSORPTION SYSTEM IS: TRENCH
6750 SQURRE FEET
MRXIMUM NUMBER OF BEDROOMS
:SOIL. RATING (SQ F'T,"'BR)= ±25
]"HE REQUIRED SIZE OF TNE SOIL. ABSORPTION SYSTEM IS:
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF' 'THE TRENCH OR DRRINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETHEEN THE SURFFtCE OF 'THE
GROUND F:IND THE BOTTOM OF THE Ek. iCR',/RTION (IN FEET).
THERE IS NO SET 14IDTH FOR TRENCHES.
THE GRR',/EL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETHEEN THE OUTFIaLL PIPE
RND THE BOTTOM OF THE E',,.',CR',/ATION (IN FEET).
PERMIT F~PPLICANT HAS THE RESPONSIB!LIT"/ TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF 8NY HELLS RDJACENT TO THIS PROPERT'¢ RND THE
NUMBER OF RESIDENCES THAT THE HELL HILL SERVE.
BACKFILLING OF RN"r' S"¢STEM HITHOUT FINRL INSPECTION RND RPPROYRL BY THIS
DEPARTMENT HILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETHEEN A HELL AND RNY ON-SITE SEHRGE DISPOSAL S'¢STEM IS
±00 FEET FOR A F'RIVATE NELL OF.': ±50 TO 2E'~0 FEET FF.:OM A PLIBL. IC HELL DEF'EN[:,ING
UPON THE TYPE OF PUBLIC HELL
MINIMUM DISTANCE FROM A PRI'v'RTE HELL 'TO R PRIVRTE SEHER LINE IS 25 FEET AND
TO R COMMUNITY SEHER LINE IS 75 FEET.
HELL LOGS RF.:E REQUIRED RND MUST BE RETURNED TO THE DEPARTMENT HITHIN 2:l::'~
OF THE HELL COMPLETION.
OTHER RE~qUIREMENT':; MR"r' APPLY. SPECIFICATION'""] RND CONSTRUCTION DIAGRRMS RRE
R',,,'AILABLE TO INSURE PROPER INSTALLRTION.
! CERT!FY THRT
±: t AM FRMILIRR HI'TH THE REQUIREMENTS FOR ON-SITE SEHE~_-] AND HELLS RS SET
FORTH BY THE MUNICIPRLIT¥ OF RNCHORAGE.
2: I HILL INSTALL 'rHE SYSTEM IN ACCORDANCE HITH THE CODES.
.~:: ! UNDERSTAND THAT THE ON-SITE SEHER SYSTEM MR"r' REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLIJDE MORE THRN -~: BEDROOMS.
~ ' // 'v'4. 0
! SSI_lED E:Y [:,AT
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ~ PERCOLATION
Pouch 6-650, Anchorage, Alaska 99502 276-2221' TEST
SOILS LOG - PERCOLATION TEST
SITE PLAN
10
11
12
13
14
15
16
17
18
19
20
WAS GROUND WATER
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
PERFORMED BY: [~ ~lt [ ; ~~
72-008 (7/76)
(minutes/inch)
WATER WELLS
665 W. 87th Avenue
Anchorage, Alaska 99502
WELL CONSTRUCTION LOG
USGS no.
__Type of rig
Well location.' (address & legal description)
I~,~ It Casing: d~p~h ~ ,~ ~t. diam. ~ in.
Static water '.vel /~.~ ft. (above,~)~_ ~,and surface. Date~'~
Finish of well: (~d, screen, perforated, open-hole, ether)
Describe intervals and size:
Well yield tested by (pumping, bailing, air) at~" .gal/min.
for~ ~* _hours with ~'~ .ft. of drawdowa from static level.
'344-0498
Nearest community
Location sketch or remarks
DRILLER'S MATERIAL LOG
Give description of strata penetrated
(size of material, color, hardness of drilling, and water content)
Depth below land
surface in feet
Z? _tog ~.~
--tO
~te.
--.fo
/ IU' / / ~// / ~: -'
CONSTRUCTION AND OPERATION
' ENVI.~ .
ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION.
PUBLIC WATER SYSTEM
L oT.
RECEIVED
APPROVAL TO CONSTRUCT
Plans for the construction of
~ approved.
~.2 '-~ J - F ~ ~ J(~/. ) public water system located
Alaska, submitted in accordance with 18 AAC 80.100
have been reviewed and are
Z_/,,Z/_.E] conditionally approved (see attached conditions).
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,
or descriptive reference)
Id~: ue I~a
Approved by Date
J
The "APPROVAL TO OPERATE" section must be completed before any water is made available to
the public.
APPROVAL TO OPEBAcTE~ . ' ~-~-~-.%% '
'""" ' ' ''' ~ c' -/:/'~'
heconstruct,on ( he;¢' ¥- ·, '- '
water system waskompJeted on -%- '/~/ ~' ('- ./ (date). The system is hereby
granted interim ap¢~.~perate for 90 days following~t on date.
8Y TITLE DATE
As-built plans submitted during the interim appr~)val 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 op_e. rate~,
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. .011-1~4-47
1. GENERAL INFORMATION
Expira~ionD~[e: ,~"-- L.~..., 0 ~
Complete legal description
LoCation (site address o~' directions)
Current Property owner(s) VICKY
Mailing address 8025
SAND 'LAKE SUBDIVISION #2 LOT 2, BLOCK 3
8023 sEACUFF STREET * ANCHORAGE, AK. 99502
I~. HIL'P#EIN-HAGBERG Day phone '243-5057
sEACI,IFF STRI~ET * ANCHORAGE, AK. 99502
Lehding ag(~ncy
Mailing address
Real Estate Ageht
Mailing address
Day phone
, cAROL BUTLER w/ 'REMAX Day phone
2600 CORDOVA s~i~EET * ANCHORAGE, AK. 99505
276-2761
Unless otherwise requested, HAA will be held Dy DS~) for pickup.
· 2. NUMBER OF BisDRoOMS: 5
TYpE OF WA'~I~ ~uI~PLy: TYi~E OF WASTEWATER DISPOSAL:
Individual Well F-] Individual On-site I
Individual Water Storage [~ Individual Holding tank r-]
Community Class. "¢" Well I Community On-site F'I
Public Water System [] Public Sewer [-]
I
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 (excepLbetw.. een spouses) ._[or_properUes_seryed_by_a_single.family_on=site_wastewate~p~a~n~r
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 samples. (Certificates may be'reissued for a period of up to one year with valid
water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
4. STATEMENT OF INSPECTION' BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verffy 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 GARNESS ENGINEERING GROUP, Ltd.
Phone 537-6179
Address 3701 E. TUDOR ROAD,-SUITE-101-*-ANCHORAGE,.*AK-99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date
Engineer's Comments:
In conducting this evaluation, GEG, Ltd. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separaEon
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
DSD SIGNATURE
~ Approved for --~ bedrooms.
Disapproved.
Conditional approval for ,~
bedrooms, with the fllowing stipulations:
' ~.'
Attachments:
HAA Checklist
Septic system Advisory.
Well Flow Advisory
~ t. PROGRAM ,: .
~.<o~ ~,,,'
Manitenance Agreements
Supplemental Engineer's Reort
Other
Original Certificate Date:
(Rev. 17./01)
Legal Description:
A. WELL~!DATA
Well tyjse "c"
D~te Ico~pl0ted
Total depth
Dat test
~;taiic rater level
.... MuniciPalitY of Anchorage
Development Se ices Department
: - Buildin9 Sa[oty Division
· ~' On-Site Water & Wastewater Program
- . 4700 South Bragaw St.
- P.O. Box 196650 Anchorage, AK 99519-6650 I .....
. . www.ci.anchorage.ak.us -
.~ (907) 343-7904 ·
HEALTH AUTHORITY A PROVAL CHEc;t IST -
,SAND LAKE S/D i#2; LOT 2~ BLOCK.'3~ Parcel ID:
COMMUNITY WELL"
..... IfA, B, Or C provide PWSID# 8221-FA-164 Well Log (Y/N)
:Sanitary seal (Y/N) . Wires propel y protected
Cased to __ft,
FROM WELL LOG
· WATER SAMPLE RESULTS:
Col form O colonies/100 mi.'
A~seni(~:' ! N/A mg./L.
Date of sample: 3/02/2004
Casin ground)
i ·
AT INSPECTION
g.p.m.
Other.bal teria~ 0
Collected by:
Date insi!llid ' -
Cleanouts (Y/N)
- High water alarm (Y/N)
MCDONALDS' PUMPING
-B. SEPTIC/HOLDING TANK DATA
Tank ~Type/Material - STEEL
Tank'siz~ 1000 gal. Numberof~Compartments 2
Foundation cleanout (Y/N).YES De~)res~io'n over tank (Y/N} NO
Da, te~fpgmping 3/11/2004 '~ PUmper
:C. ABSORPTION FIELD DATA ~ : }~[*BELOW EXISTING ORADEI :
D~t~o in~;t~lled . 6/04/'1981 Soil re[lng ~r,~bdrm) 125 - sys
Lengt,h ,I1[ 40 ff.' -: ~ Width' - 36 ff. Gr~
Totaldepth 12,6 ft. Eft. absorption area-375 ft* Monitoring tube YES~
D~t~ Cf ;~equaCY test 3/02/2004'i' .; .';Results (Pass/Fail),~ PASS
FlUid dep!h in absorption field before test ',18 '. in t* '. Water*added 1200 gal
Elapsed .,lime: ! 197 min. Final fluid di~pth 51,75 in. Absorptio~
Any reluyenabon treatment (past 12 n~o'. & typei YES
.
!.
011-134-47
.in.
N/A
~m type ." TRENCH
~el below pipe 6 ft.
Depression over field NO
For 3 bedrooms
New depth 67 in.
45O g.p.d.
rate >=
If yes, give'date 1/29/2004
6/04/1981
YES
__colonies/100 mi.
GEG~ Ltd..
D. LIFT STATION
Date installed '. ..Size in gallons '
,,Pump on" level at.~in' '~
~ ~ · Cycles.tested - ,,
SEPARATION DISTANCES ~
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station ~0n' i°t · 1 oo'+
Abs(~rption field or{ lot '100'+
Public sewer main N,/A
Sewer/septic Service line' - ~ 10'+
Holding tank
%
Manhole/A~
,, High water alarm level at in.
· Meets alarm & circuit requirements?.
On adjacent lots .100'+
On adjacent lots' '100'+
Public sewer manhole/cleanout - N/A
N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Absorption field
Surface water.
Building foundation 5'+ ~
Water main · 10'+.
Wells on adjacent lots 100'-!-
Property line. 5'+
Water service line · 10'+
Building foundation' . 10% Water main
Surface water 100'+
Wells on adjacent lots 100'+ . ,
100' BI_~NKEI WAIVER
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT.TO:. ~
Property line ' *'2'+
Water service line 10'+
Curtain drain ' NONE KNOWN
COMMENTS ~,
*ADEC
5'+
100'+
10'+
Driveway.. parking/vehicle storage
G. ENGINEER's CERTIFICATION ......
I certify that i have determined through fieldinspections and
· review of Municipal records that the above systems are in ~
conformance with MOA HA~ guidelines in effect on this date.
Engineer's Printed, Name JEFFREY A. (~ARNESS
Date ~'/,~,"/0 '~
10'+
HAA Fee $
Date of Payment
Receipt Number
(Rev, 12/01)
Waiver Fee $
Date of Payment
Receipt Number.
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcell.a.# f'-)~l- L.~4--[.-L-I'~ HAA#
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
Location (address or directions)
~o~3 _C~ C h'~o
(b) Property owner .,4 H FC ~
Mailing Address ~' ~-~ Q
(c) Lending Institution A/,,,~.
Telephone: (home)
Telephone
Business
Mailing Address
(d) Real Estate Company and Agent
Address ~ ~ 3'~' '~"' -624.
Telephone .;5--d' P- - / 8 Z ~
(e) Mail the HAA to the following address: (or check here I~, if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Number of bedrooms
Single-Family []
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 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 legality 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 th is
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional .end 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 ~'/~ ~",/-~ "[-~c/~ ~'c~ ! ~c, ¢..r Telephone
Address //.-/ 5.~ 42 ~"c4~, ._~/~ /ZY/~CAO/"~'~'.~/ ,~A:
Date Oc-¢-c,b-e/- l~ /gqC~
6. DHHS APPROVAL
Approved for
Approved .~'
bedrooms by '~ _~_~/~// ~~a~a t e
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 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
WELL DATA
Well Classification ~'~ If A, B, C, D.E.C. Approved (Y/N) ~'
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)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
; Date
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
Comments
SEPTIC/HOLDING TANK DATA
Date Installed'ff'/¥/~/ Size 106'0'~
StandPipes (Y/N) ~' Air-tight Caps (Y/N)
Depression over Tank (Y/N) b/
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
No. of Compartments
~' Foundation Cleanout (Y/N)
Date Last Pumped /d'/~/~O
~, ~- ; for
~, ,4, Temporary Holding Tank Permit (Y/N) ^h/~..
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well log I ~C~,~ ¢. o,. To Building Foundation
To Property Line ~ '~ ~ -¢¢-'~ ¢-¢/, To Disposal Field
To Water Main/Service Line fi.5- '
To Stream, Pond, Lake Or Major Drainage Course
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~'/~ /~'/
Width of Field ~' '
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
~75- O'
/G,~-,~ Type of System Design
Length of Field
Depth of Field II
Bed Thickness
,-,/,. Statndpipes Present (Y/N)
Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation
Lot N,A-.
5"1'
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
'7'-r'¢,n t ~
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ~
To Cutback (if present) /~,~.
Comments
D. LIFT STATION
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
Date Installed
Size in Gallons
"Pump Qn' Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
**Check Permitted Bedroom Rating Against HAA Request**
I certiiy that I have checked, verified, or conformed to all MOA and HA~t~r~e~jn effect on the date of this
inspection. ,~ OF ~/~
Signed .~7~~ ~~ ~ '~" ~ ~
ComPany ~/~ ~ ~¢~ ~- ~:'' ~ ..... %~ L~ ~'~ ~:~ ¢ ~¢¢~
Date (~ / !0 / ~ ~ __ _ _ ~¢~(~~ ~ ~~
· HEODO~E F. MOORE ~
Receipt No. ~~ -- (~ Receipt No. ~ '-
Date of Payment /O--//- ~ ~ Waiver Fee: $ ~ ~
Amount: $ / ~ ~
Date of Payment /~-//--
z2-0~ (~. z/~) B~k Page 2 of 2
Tom Fink,
Mayor
unicipality of nchor ¢
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
October 17, 1990
Ted Moore, P.E.
Flattop Technical Services
14530 Echo Street
Anchorage, Alaska 99516
Subject: Waiver Request for Lot 2' Block 3 Sand LaKe ~2
Waiver Request ~WR900046, PID #011-134-47, HA900439
Dear Mr. Moore:
Your request for waiver of the required 10 foot separation
between a septic system and a lot line has been approved. The
waived distance is 2 foot from the absorption field to the lot
line.
This approval applies to the existing septic system lot line
separation only. Any future upgrade to the septic system will
require all separations be met or another approval from this
department.
Sincerely,
Daniel J. Roth
Civil Engineer
On-site Services
Concur:
On-site Services
ljw#7
/'v' 8 ? °~',3" W
/ 35', OD
BASEMENTS OF RECORD, OTHER THAN
tHOSE SHOWN ON THE RECORDED
=LAT ARE NOT SHOWN HEREON, A~'
FY/__
T~ts As-built shall not ~e used for
any purpose other t~an flnenol,g ,
requi?ements. Under ho circumstances
shou]fl any data h'ereon fie used for
construction or. for
~oi]n'dary or fence lines.
AS.BUILT NO CORNER8 SET THIS DATE
I hereby certify that ! have l~erformecl a Mort~gee's in.
Anchorage Recording ;Precinct, Alaska, and that the improve-
ments sliuatecl thereon a~e within the property Unes and do
not overlap or encroach on the property lying adjacent there.
to, ~at no improvements on prope~y lyi~ a~iacent thereto
encroach on the premises in ~uestion and t~at the~e are no
roadways, transmission lines er other vis,bio easements on
~aid ~roperty except aa indica~d hereon,
Date~ at ~chorsge,
Engineers and Su~eyov~
MUNICIPALITY OF ANCHORAGE
DIVISION OF ~NVIRONMENTAL HSiALTH
DEPARTMENT OF HEAL%H AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information
Application Date
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lo~tion (ad~ss o~ ~ireqtions)
(b) Applicants N~ ~d~'J ~, (t~..~ ~- ~.~ ~ ' '
. ~.~,..~'-~ .....
Appli nt .is
~al Estate ~. & ~nt
(e)
Address
Telephone
2. T_~pe of Nesidence
Single-Family ~
Number of Bedrooms
3. Water Supply
Individual Well
Multi-Family
Other (describe)
Note: If c~,~unity well system, ~ust have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
Is the well adequate for the number of bedroons specified in this HAA (Y/N)
4. Sewage Disposal
Onsite ~7 Public ~ Con~nunity ~-~ Holding TapR ~ '
Is t~ wastewater disposal system adequate for the number of b~drccms (Y/N)
[Page 1 of 2]
2-15-84
5.~ En__gineering Firm Provi?"~g Inspections, ~%sts~ Eata an¢ nformatlon
I certify that I have checked, v~rified, or conformed to all MOA HAA ~uidelines in
effect on the date
~ of A this lnsne~dtion.
S igne do~z~17c .Date
Nar~ ~ Telephone ~
6. D_HEP Approval
Approved fo~
Approved .~
Disapproved ~-~ Conditional ~-~ .
Terms of Conditional Approval
/he Municipality0f Anchorage Department of Health and EnviropmmntalProtection dces
not guarantee the continued satisfactory performance of the water supply and/or the
wastev~ter disposal system° This approval indicates that, as of ~he validation date
sheen above, based on the data and information furnished by an engineer registered in
the State of Alaska, the w~ter supply and wastewater disposal system is safe and fun~
· tional for the n~mber of bedrocks and type of structure indicated.
( lX4EP SEAL)
7. Mail the FJWI tc the follcwing address:
KB2/d5/s
[Page 2 of 2]
2-15-84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AIYI~ORITY APPROVAL (HA_A)
CHECKLIST - FEBRUARY 1984
Well Classification ~_~
Well Log P~esent (Y/N) ~/
Total Depth ~.~ ' Cased to
Static Water Level ~Q ~ ~
Casing Height Above Ground ~ /
Electrical Wiring in Conduit (Y/N)
NOII'DRIO~4 'iVINE!AIHO'~IAN'3
~ H..LTCBH JO 'ldEq
::JOV~OHDNV 40
If A, B, O~ C, D.E.C. Approved(Y/N) y
Date Completed ~'2~- ~ I Yield
Depth of Grouting kl,//~ J I _
Sanitary Seal on Casing (Y~_~J_~
Depression A~ound Wellhead (Y/N) y
Separation Distances _~om Well:
TO Septic/Holding Tank on Lot ~ 00 + ~~ On Adjoining' Lots J 00
TO Nearest Edge of Absorption Field on Lot ~(~' ; On Adjoining Lots
To Nearest Public Sewer Line . ~.//k To Nearest Public Sewer
Cleanout/ManhOle
~..//~ To Nearest Sewe~ Service Line on
Water Sample Collected By ~r. ]~,Ak,,/tq_.y ; Date
Wate~ Sample Test Results ~,
B. SEPTIC/HOLDING TANK DATA
Date Installed 6 ~ ~' ~1 Size t O0(~ ~,~ No. of C~,~oartments. ~
Standpipes (Y/N) y Air-tight Caps ~ Foundation cleanout (Y/N) y
Depression over Tank (Y/N) ~ Date Last Pumped ~- J.~-~ q
Pumping/Maintenance Contract o~ File (Y/N)N//k ; for
Holding Tank High-Water Alarm (y/N) N.//% Temporary Holdir~3 Tank Permit (Y/N)
Separation Distances f~on Septic/Holding Tan~:
To Water-Supply Well ~ 00 ~
To P~operty Line ~ 0 i+
To ~ter Mai~vi~ Lir~ ()~~
Counts
TO Building Foundation ~ ~ ~
To Disposal Field % O ~
To Stream, Pond, Lake, c~ Major D~ainage
[Page 1 of 2]
2~15-84
C. ABSORPTION FIELD DATA
Soils Pating in Absorption Strata !q~ ~/~) Type of System Design
Date Installed [~ _ ~ ~ ~ [ Length of Field ~ 0 ~
Width of Field .~ ~
Square Feet of. Abso~pti0n A~ea
Depth of Field ~ /
Gravel Bed Thickness '~ ~
~7~ ~ Standpipes P~esent (Y/N) ~
Depression over Field (~Y/N)(JN.~'^)fD~3~0 Date of Last Adequacy Test
Results of Last Adequacy Test
Separation Distance from Absorption Field:
/
To Wate=-Supply Well I O0 z'+ To P~operty Line i 0 '~
To Building Foundation ~ ~/+ To Existing or Abandoned System
Lot ~.//~ ; On Adjoining LOts ~0/+
To Water Main/Se~ice Line ~0~c To Cutbank(if present)
To Stream/Pond/Lake/o~ Majo~ D~aina~e Course N~
To Driveway, Parking A~ea, o~ Vehicle StoIrage A~ea ~ /4-
Co~m~nts
S/A
Date Installed
Size in Gallons
"P~m~ On" Level at
High Water Alarm Level at
Tested for
Electa~ical Codas(Y/N)
Din~nsions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
· Pumping Cycles du~ing Adequacy Test.
Msets MOA
Co~,~ents
** Check permitted Bed~cx~n Rating A~ainst HAA Request
I certify that I have checked, verified, o~ confo~md to all MOA
on the date of th~sz,~nspe~on.
Company
KB1/d5/s
[Page 2 of 2]
HAA Guidelines in effect
INSPECTION APPOINTMENTS
TIME ,, ~.' TIME TIME
DATE DATE \['~-~-~--~ {~ \AJ._tV~
INSPECTOR~
~UNICIPALITY OF ANCHORAGE T ~ICIPALITY ANCHO~G~
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC ~ DEPT OFOF
, HEALIH &
825 L Street - Anchorage, Alaska 99~01 ENVIRONMENTAL P2OTECTION
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720
)IRECTIONS: Complete all parts on page 1. Incomplete requests will not be proce~ed. Please allow ten (10) days for processing.
PROPERTY RESIDENT {If different from ab ) PHONE
PHONE
2. BUYER
~AI EING ADDRESS
PHONE
3, ~ENDING INSTITUTION
MAI LING ADDRESS ~ '~
STREET LOCATION
6. TYPE OF RESIDENCE
~ SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF BEDROOMS
-~,~ One [] Four
Two [] Five
[] Three 'El Six
[] Other~
7. 'tN~T E R SUPPLY
~ INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LO(~. A well Icg is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach Icg if available.)
8. SEWAGE DISPOSAL SYSTEM
~ iNDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
.YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
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
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTI LITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
~1 INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tank qr F-IHolding Tank
Size: /~)~-") If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK M AN U FACTU R E R ~,~
TOTAL ABSORPTION AR EA MATERIAL
4. DISTANCES Septic/Holding Tank IAbsorption Area Sewer Line I Nearest Lot Line
I
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
[~'~'PPROVED FOR .,~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED //"-~