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SAND LAKE #2 BLK 3 LT 5
and Lake #2 Block 3 Lot 5 #011-134-44 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: t95 P l V fQR Co PID Number: 011-134-44 Dwelling: ❑■ Single Family (SF) ❑ Duplex(D) ❑ Multiple(SF and/or D) Project: ❑ New [' Upgrade Name: VIOLET YEATON ABSORPTION FIELD Address ❑ Deep Trench ❑ Shallow Trench 1:1 Bed III Mound 8047 SEACLIFF ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Ft. Ft. SAND LAKE #2, BLK 3, LOT 5 Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Tank Line Ft2 Ft. Well * TANK ❑i Septic ❑S.T.E.P. ❑Holding ❑Other it, l L . Manufacturer Capacity Surface Water 100'+ ANCH TANK 1000 Gal. Material Number of compartments Lot Line 101+ NA STEEL 2.0 Foundation 101+ LIFT STATION Manufacturer Capacity Curtain Drain UN 1 Gal. Pump on level at Pump off level at High water alarm at Remarks in. in. in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034Tank to 3034 Installer drainfield MIKE ANDERSON,P.E. Drainfield CO/MT Inspector MIKE ANDERSON, P.E. BENCH MARK (Assumed elevation) 101.9 ft Inspection 1Y' 5-21-18 ' Location and description dates: 2"` 3rd 4th BACK DECK COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL `ngs Smp .r�• O F q ikkl• 4 Conditional Approval: Date %y'`P:•• '•S•}�-t(�a • •v 'dId �: 49TH • r d� /••• • f A. MICHAEL N. ANDERSON :oc/ 1°.4 -A7:.. CE-94 9 .��� Appr � Date V �1S tll,001-ES[st�zA`�..� a,.o� Inspection Report_9-1-12.doc Permit No. OSP/ 4/(O Ci(0, Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: SAND LAKE S/D #2 BLK 3, LOT 5 PID No.: 011-134-44 MARK A B TC01 47 29 CO2 42 29 CO3 56 43 LOT 4 x (ii5 x I x —x x X X x TCO2 x CO3 B CO2 ° o --004 / " k TC01 / DRIVEWAY (� CO, 7 I s K MT1L� I A NEW 1000 STEEL TANK X X X X Y---1 BENCH, ELEV 101.9 LOT 6 100' WELL RADIUS ASBUILT SCALE: 1"=20' rco co, rico, rcoz COS .4\\\\\\111 �.• c OF ♦♦ liii �02 i i , NEE f49 T" * ...., , ♦• 9 S,E[t ieNN cto A : ' pi4A\% • • • 00 :..M CHAEL N. ANDERSON/ / .7 •1♦ r>„. .�)•• No. CE 969/ ...: SEPTIC SECTION ♦� •, �\, N.T.S. 44I �1\c-;"s" 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 .a "! J http://www.muni.org/onsite I)('pal'tinct1I CNURo On-Site Wastewater Disposal System Permit Permit Number: OSP181096 Effective Date: 5/21/2018 Work Type: SepticTank Upgrade Expiration Date: 5/21/2019 Tax Code Number: 01113444000 Site Legal Address: SAND LAKE #2 BLK 3 LT 5 G:2224 Site Mailing Address: 8047 SEACLIFF ST, Anchorage Owner: YEATON VIOLET F &THOMAS A SR Lot Size in Sq Ft: 6750 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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 Received By: Date: tr(7/r/417 Issued By: �� ( i / Date: J-7 �� `,1 NIIClP/4\ UP( MJF ANC F'AGE • 678 ~Community Development Department Phon r) Development Services Division h' •107. On-Site Water & Wastewater Program !WAY 1 8 2018 a � ON-SITE SEWER/WELL PERMIT APPLICATION `�� 68L9c Parcel I.D. 0 11-1.3q"4�4'006 Property owner(s) Day phone Mailing address Site address Legal description (Sub'd., Block & Lot) SuU , La Lt �1=1- 2 IS 3 I-14c Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field aF Initial ❑ Single Family (SF) 2._ (w/wo ADU) Septic Tank Upgrade ,QC Duplex (D) ❑ Holding Tank ❑ Renewal ❑ 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: Z) / Waiver Fees: Date of Payment: 61I$1!7 Date of Payment: Receipt Number: 2.2 .503 I Receipt Number: Permit No. 3,S.,O/ /OC6 Waiver No. Permit App_9-1-12.doc May 18, 2018 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage,Alaska 99519-6650 Fax 249-7847 Re: Septic tank replacement Legal: SAND LAKE#2 BLK 3 LT 5 To Whom it may concern: This is a request for a tank excavation permit to replace the existing septic tank ASAP. The tank was installed in 1982 and needs to be replaced. This replacement tank will not impact any of the neighboring properties due to the lot layout or pose any health or safety risks by waiting a couple of weeks. Please call me if you have any questions. Sincerely A4_ Mike Anderson, 4661 Natrona Ave. Anch, Ak 99516 727-8864 ( v wti( 5 o SLI I vOvn atn5 ti S r C LOT 4 `" t <- �r 30 x N r- .( x S 90'00'00" W 135.00' x r1 � f1 r x x x A x Z 44.4' 0 ih, g/ O /EXISTING HOUSE i l 0 .................. InsK3 :..........:.:.::::� 20.0' 1•0 LOT 5 W K o = O i ''(:) N 4K0 Cri N O 24.4' © K O CI H to lv—x X X X Y 1! S 90'00'00" E .4 135.00' (x 30' LOT 6 ,, NOTE: SNOW AND ICE MAY CONCEAL MINOR SURFACE FEATURES. 'Street Ordered By Pamela Finnesand Legend -...... ...: rage,Alaska 99501 Legal Description: Septic Standpipe® ! t i Department Lot 5, Block 3, SURVEY CERTIFICATION: LANTECH has conducted a physicd survey of the ..''Concrete:.' • . property as shown on this drawing and certifies that the knprovements Water Well ® ick}y :562-5291 Sand Lake Subdivision situated thereon ore within the property lines and no encroachments exist Fence—X—X— Overhang HRH e other than noted. .. 243-8985 N o. 2 EXCLUSIONARY NOTE: It is the owners' responsibility to determine the '" existence of any easements, covenants, restrictions or right–of–way » takings which do not appear on the recorded subdivision plat. Under 1 Plot: P-176 Sc e 1 =20 no circumstances should any data hereon be used for construction, Grid: 2224 Ref 97L579A :) for establishing property lines, or for plot–plan purposes. 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 ZJ NEW ONALD 7�ZbSE L -7723 ❑UPGRADE MAILING ADDRESS O 3a^ C+ .5D LEGAL DESCRIPTION 1_d I E; LoC,1.GS S V,E 1\40 Z LOCATION 30�ScACL N0. OF BEDROOMS 3 E t- DISTANCE TO: WellAbsorption area Dwelling PERMIT NO. $20/06 UY lot 37 F_ G Manufacturer Mater No. of compartments LU F ^' IFr= N Liq. capacity in gallons I F HOMEMADE: Inside length Width Liquid depth o-c� 0 Y DISTANCE TO: Well Dwelling PERMIT NO. J 0 2 02 F Manufacturer - Material Liquid capacity in gallons O DISTANCE TO: Well Foundation "� Nearest lot line PERMIT NO. w= 1 20`/0$' J LL z No. of lines Length of each line Total length f lines Trench width Distance between lines f, ? O inches Q F. p Top of tile to finish grade ' � Material beneath tile 7 6 Total effective allsgrf�,ti.Q�n area !f r—inches jf Length Width Depth PERMIT NO. LU 0 Q F- Type of crib Crib diameter Crib depth Total effective absorption area Lu W Well Building foundation Nearest lot line DISTANCE TO: J Class Depth Driller Distance to lot line PERMIT NO. J Lu DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS c s- E T> E tz - SO I L TEST RATING v !�- INSTALLER s C 1_ F REMARKS 61 t FA 1 111 AZ •. d VI -,*; 49TH. n • ................. '� ..`6 o. 2225-E -'z, _ t%% • ' JUNL Zb, °0;��- ai; APPROVED DATE LEGAL -T, &`2y,z 1�0� �v2 � .►�� 72-013 (Rev. 3/78) � .-M.1 FV 11) Ty 1=1 PVA W 04 K:s F? 5:1 C21 E T� DEPHRTMENT �� HE�LTH �ND EHVIRONMENT�L T�CTION �~ 825 / STREET` HNCHORHGE/ HK9� )1 ^ 264~4720 M phi Koo 0310 14 EE i;v V EE foy M 1 -1 PERMIT NI ( 820408 ) HPPLICHNT RONHLD ROSELHND BOX 4~�]24 24�~772] LOCHTION 80 F LEG HL L5 B] SH ND LAKE #2 LOT SIZE 7770 SQUHRE FEET TYPE OF SOIL HBSORPTION SYSTEM IS� TRENCH MAXIMUM NUMBER OF BEDROOMS :m ] SOIL RHTING 150 THE REQUIRED SIZE OF THE SOIL ABSORPTION S.;YSTEM IS� lot 131 ��r NO W L. ED; K 0=1 M 1-1 SETZ::: THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR CRA INFIELD THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFHM OF THE GROUND HND THE BOTTOM OF THE EXCHYHTION (IN FEET). 100 FEET FOR H PRIVHTE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING THERE IS NO SET WIDTH FOR TRENCHES_ 19N0 TO H COMMUNITY SEWER LINE IS 75 FEET. THE GRAVE! DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFHLL PIPE HND THE B8TTOM OF THE EXCHVHTIGN (IN FEET), ��!%I UNK", 1 E."'R Ez K M FEW E"E: E. Is a IF- Y :,F K:: 0- 1=1 AV! Fa: �I .' 7r -f 11. goo got PEP �����Ir, � PERMIT HPPLICHNT HHS THE RESPON5IBILITY TO INFORM THIS DEPA'RT'MENT DURING THE INSTHLLHTIQN INSPECTIONS OF HNY WELLS HDJHCENT TO THIS PROPERTY HND THE NUMBER OF RESMENCES THAT THE WELL WILL SERVE ��������T 14,11.0 M F&I m �t 1EE 90 F-il I F ! IEE.E:�� BHCKFILLING OF HNY SYSTEM WITHOUT FINAL INSPECTION fAND HPPROVHL BY THIS DEPHRTMENT WILL GE SUBJECT TO PROSECUTION. MINIMUM DISTHNCE BETWEEN H WELL AND ANY CIA -SITE SEWAGE SYST�M IS 100 FEET FOR H PRIVHTE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTHNCE FROM H PRIVATE WELL TO R PRIVHTE SEWER LINE IS 25 FEET 19N0 TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED HND MUST BE RETURNED TO THE DEPHRTMENT WITHIN ]0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS APPLYSPECIFICHTIONS HND CONSTRUCTION DIHGRHMS HRE HVHILHBLE TO INSURE PROPER INSTALLATION. ��!%I UNK", 1 E."'R Ez K M FEW E"E: E. I CERTIFY THA -IF 1� I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE, Ah I WILL INSTALL THE SYSTEM IN HCCORDHNCE WITH THE CODES ]: I UNDERSTHND THAT THE ON .... SITE SEHER SYSTEM MHY RE(.xUIFRE ENLHRGEMEFIT IF THE RESIDENCE IS f-:EMOE)ELED TO INCLUDE MORE THHN Z BEDROOMS. SIGNED ~ ~... _..... ~_��~~~~� GPPLICHNT RONHLD ROSELHND ISSUED BY.- __ Y40 �( SOILS LOG " MUNICIPALITY OF ANCHORAGE • a.e DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - /PERCOLATION TEST PERFORMED FOR: Pao I LDLL 7 / �I7lJ DATE PERFORMED: r III (� LEGAL DESCRIPTION: ).t?nd Lnf1 (3 � AIIv k 72-008 (6/79) v • • �-� Municipality of -Anchorage On-Site Water and Wastewater Program (907) 343-7904 SAFFTY CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 011-134-44 Expiration Date: �� ( Z-17 1. GENERAL INFORMATION Complete legal description _SAND LAKE #2 BLK 3 LT 5 Location (site address) _8047 SEACLIFF ST ANCH. AK Current Property owner(s) _VIOLET F & THOMAS YEATON •_ Day phone Mailing address _SAME Real Estate Agent - Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ® Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance reque-.t for: Distance: Received by: / , Date: , — �—/ COSA to be released to the en. neer,unless otherwise re. • ed by the engineer. COSA Fee $ 5210 Waiver Fee $ Date of Payment 5/6118 Date of Payment Receipt Number IP 65-O3 Receipt Number COSA# Q 4)(10`0�.(�7' Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm MIKE N ANDERSON,P.E. Phone 727-8864 Address 4661 NATRONA AVE. Engineer's Printed Name MIKE N ANDERSON,PE Date 5/14/18 44.,,c1 t .* * MICHAEL N. ANDERSCN ;t't I4 • 6. DSD SIGNATURE c'•• CE-9469 • ` `p System #1 Approved for 3 bedrooms. i)JQ<��•• Kl,� •'���� 1 PROF SS1O,• �,�"ti System #2 Approved for bedrooms. � �����.� Disapproved. Conditional approval for bedrooms, with the following stipulations: \..\'� ofp'vcy� MATER Mit) •• wAS oG PRRAMR o <‘' \ces By: VI"\-. Original Certificate Date: V ^4] lU The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10.12.doc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system _ Certificate of On-Site Systems Approval Checklist Legal Description: SAND LAKE #2 BLK 3 LT 5 Parcel ID:_011-134-44 A. WELL DATA_NO WELL ID NUMBER. LOCATED ON LOT 8 AND SERVES 4- 8. Well type If A, B, or C provide PWSID# Well Log (Y/N) Date completed Sanitary seal (Y/N) Wires properly protected (Y/N) Y Total depth ft. Cased to ft. Casing height(above ground) FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic: ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA c' Tank Type/Material STEEL Date installed 2 s-2.1-12 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout(Y/N) Y Depression over tank (Y/N)� N High water alarm (Y/N) N Date of pumping ) Pumper a_vlS` " 0 C. ABSORPTION FIELD DATA—1985 SYSTEM TESTED Date installed 6/241 1982 Soil rating (SF/BED) 150 System type DEEP TRENCH Length 30 ft. Width 2.5 ft. Gravel below pipe 8.0 ft. Total depth 12.75 ft. Eff. absorption area 480 ft2 Monitoring tube Y Depression over field N Date of adequacy test 5-12-2018 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 500+gal. new depth 0 in. Elapsed Time: 1 min. Final fluid depth 0 in. Absorption rate >= 450_g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) N If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm &circuit requirements? E. SEPARATION DISTANCES COMM.WATER WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5' Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+PRIVATE,150'+CLASS C ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10 Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+(None Known) Wells on adjacent lots 100'+PRIVATE,150'+CLASS C COMMENTS DUE TO THE AGE OF THE TANK THE MOA WILL ISSUE AN ADVISORY ,,,;•-q U ,A 'Axl e G. ENGINEER'S CERTIFICATION : 49t •• * I certify that / have determined through field inspections and e,. . review of Municipal records that the above systems are in •MICHAEL N. ANDERSON ;or 'r conformance with MOA COSA guidelines in effect on this date. r • CE 9469 r Engineer's Printed Name MIKE N. ANDERSON,PE f P• ld • •0 EScI Date 5114/2018 �`��>>�t� COSA canary sheet_2-6-15.doc • 30' LOT 4 1 X I I S 90'00'00" W 135.00' x —x- x x x A x C -:- w z . 19..6 CC,,a 911IIIIIIIIIIi1111111►11111111111c o x fX 44.4' ©� O/ (1) O \ • ON LC(?) W I o L� o e L_ o N EXISTING HOUSE -__- 4A U vii Q 20.0' LOT 5 0 i o "' W r o (I) I fs . ocsi ,7.4 o S O 24.4' O 100 O I to Q0000p� x x X_ X oQ �.. A��6, S 90'00'00" E in 135.00' v�,`� •..........qs4� I p�.. 49TH /. •-•y*00 �....: .. .......... p LOT 6 ::t. / 30' Qm STEVEN CALLAG'AN: •o O QQ�"� c,L�-112J034 �Q' ..°ip, 40Q na 2 ZZVel J 04p afes ssiiJonot X60 • C ^ 250 H Street Ordered ay Adrian Jaime ADDRESS: 8047 SEACLIFF DRIVE PARCEL NUMBER: 011-134-44-000 Legend: \/v'T' + Afpholt Anchorage,Alaska 99501 Legd Description: Lot 5 Block 35 tic Ston Survey Department s s SURVEY CERTIFICATION: LANTECH hos conducted o physical survey of me �1QB Concrete�..` property as shown on this drawing and certifies that the improvements Water Well Phone:562-5291 situated thereon«e within the property lines and no encroachments exist i„ .1 Overhang......4:7-.41 Sand Lake Subdivision p� y Fenae—x—x— �If' tOrFl Inc Mainline other than noted. yayd:eea aacli(vcte.1P•inyLiEF lLry•Ju 1.�Pyirry Phone:243-8985 NO. 2 EXCLUSIONARY NOTE: It is the owners' responsibility to determine the - Y existence of ony eosements, covenants, restrictions or right—of—way takings which ce not oppeor on the hereon b subdivision plot. Under AS BUILT Dote: 5/22/2018 Drown By. MH/SC Plot: P-176 Scale. 1"=20' no circumstances should any data hereon be used for construction, AS- W«k Order: 18048 Checked Sy SC Grid: 2224 Ret 97L579A/2014—L-28 for establishing property lines.or for plot—plan purposes. Municipality of Anchorage • On -Site Water &Wastewater Program g (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel LD. 011-134-44 Expiration Date: �i' r G Ij 1. GENERAL INFORMATION Complete legal description SAND LAKE S/D #2 BLOCK 3 LOT 5 Location (site address) Current Property owner(s) Mailing address Real Estate Agent 2. TYPE OF DWELLING: 8047 SEACLIFF DRIVE, ANCHORAGE, AK, 99502 PAMELA FINNESAND Day phone 250-9960 8047 SEACLIFF DRIVE ANCHORAGE AK, 99502 AMY MACKEY—HORNAK W/ KELLER WILLIAMS Day phone 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: lix r; UBMIT"DA MAR 18 2014 830-1294 TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class C Well Community On-site ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: a � Received by: _"' Date: COSA to be released to the engineer, unless olhermise requested by the engineer. COSA Fee $___ 5a� �O• $ Date of Payment 3/f,14lid. �1 Receipt Number ON34- COSA # Q15CIL / a 0 "aver Fee Date of Paymen Receipt Number Waiver # Distance: — 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. t further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system islare) 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. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater evels 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 therefor; 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 isted 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. 6. DSD SIGNATURE ��System #1 Approved for -3 bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. IaI*MW 337-6179 Date 00600 OF A °004 THIt °( 0..... ............ 0_ f A. G mess; i CE -7953 4�nd1'rofessio— bedrooms, with the following stipulations: OF iCrf ON-SITE WATER AND �o WASTEWATER i , `0" IIJFWT SERC By ri�r/�„_,,.-'� �1 ,-_-�.-Original Certificate Date: ��/' The Mugierpaf ;orArrchotage Develop, emt Services Division (DSD) issues Certificates of On Systems Approval (COSA) based only upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist I Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other 1Rav 1111R1 Ap If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: SAND LAKE S/D #2; BLOCK 3, LOT 5 Parcel ID: 011-134-44 A. WELL DATA Well typecOMMUNirr Date completed Total depth ft. Date of test *NO ID NUMBER. LOCATED ON LOT 8 AND SERVES LOTS 4-8. If A, B, or©provide PWSID# Sanitary seal (Y/N)— Cased to ft. FROM WELL LOG Static water level/ ft. Well Log (Y/N) Wires properly AT INSPECTION Weiroduction g.p.m. - WATER SAMPLE RESULTS: Coliform lte�r colonies/100 mi. Nitrate ND mg./L. Arsenic: '4_7-'57ug./L. Date of sample: 2/28/2014 B. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTIC/STEEL ground) in. g.p.m. Collected by: GEG, Ltd. Date installed 6/24/1982 Tank size 1000 gal. Nu bar of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) i Pi Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 3/)7- Pumper J `�'�} k'�7 1 � C. ABSORPTION FIELD DATA Date installed 6/24/82 Soil rating (g.p.ddit or /bdrm) 150 Length 30 ft. Width 2.5 ft. System type TRENCH Gravel below pipe 8 ft. Total depth * 12.8 ft. Eff. absorption area 480 ft' Monitoring tube **YES Depression over field NO Date of adequacy test 2/28/2014 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 62 in. Water added 500 gal. New depth 62 in. Elapsed Time: 110 min. Final fluid depth 58 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date **NOTE: SUMP ONLY EXTENDS 6" BELOW INVERT. 2" MT INSTALLED TO 39" BELOW INVERT ON 8/13/2003. WATER WAS INTRODUCED INTO SYSTEM (135 GALLONS) BEFORE A LIQUID LEVEL COULD BE MEASURED IN THE MT, THEN 500 GALLONS WERE INTRODUCED FOR ADEQUACY TEST. TOTAL DEPTH AND LIQUID DEPTHS CALCULATED BASED UPON ELEVATION OF LATERAL LINE INVERT. 4 D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off" level at -,5[e alarm level at n. Cycles E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on Public sewer main Sewer /septic service Meets alarm & circuit requirements? On adjacent On adjacent lots Holding tank COMMUNITY WELL manhole/cleanout containment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 150'+ CLASS C/ 100'+ PRIVATE SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 15D'+ CLASS C/ 100'+ PRIVATE F. COMMENTS G. ENGINEER'S CERTIFICATION a� P` i certify that t have determined through field inspections and P/* 9 review of Municipal records that the above systems are in """"' .. conformance with MOA COSA guidelines in effect on this date. p ' Je Engineer's Printed N me JEFFREY A. GARNESS �O s 4 fP Date eh`i �b4��° (Rev. 11105) s -... .',r ........... y A.NCarA CE -7953 3.k.1..14 Municipality of Anchorage o a w az Community Development Department Development Services Division s On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # 141089 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 3, Lot 5 of Sand Lake #2 Subdivision. This inspection revealed an arsenic concentration of 42.5 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.or /og nsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. X' o 0 VVV o'�ppc N r 0 0 C/I 1 °- a X rye ® m � � c9 �i pOppc r o � � oo5m� mma $ iac0 p* 0 a � a D .o. 5 n m _ y3 m emc CL z ao r�w 2 D ro —1 �mo'•«a o�n a � W 0 <m� m m w 0 �• n u r n f) N r 0 0 C/I am0,2 2, '0 °- a X rye ® m m "a n W. 9 M oo5m� mma $ iac0 p* 0 a w m aQ a D .o. 5 n m _ y3 m emc CL z o <. CA �mo'•«a o�n a � W 0 <m� m a� F- 0 m �mav a semq.... m p O oxr� ^ma� a Z Np mn 3 n o r C s Z 1 om 0 0 C/I am0,2 2, '0 X (0 O a�ado o oo5m� mma $ n m w m aQ a D .o. 5 n m _ y3 m emc z o �mo'•«a o�n O 0 <m� m a� m m �mav a semq.... Kmmn A N � o u r rt m m o � Cl m N x = a x m L SHED S 00°00'00" W W p O O W O r 0 C/I mm X (0 O Qo 12.0' n o a o 2 0 m m L SHED S 00°00'00" W W p O O W O r 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. 011-134-44 HAA# Qq 1. GENERAL INFORMATION Expiration Date: ' I a P, — O 3 Complete legal description SAND LAKE #2: LOT 5, BLOCK 3 Location (site address or directions) 8047 SEACLIFF Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address JOHN do DONNA PORT Day phone 248-0992 8047 SEACLIFF STREET • ANCHORAGE, AK 99502 CAROL BURNETT Day phone Day phone 2525 C STREET SUITE 100 • ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class C Well Public Water System 3 265-9169 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties Served by a private or Class C well and may be reissued with new water 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. TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site ❑ Individual Holding tank ❑ N Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties Served by a private or Class C well and may be reissued with new water 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 verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage riles 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 ALASKA WATER & WASTEWATER CONSULTANTS. INC. Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKWWC, Inc. 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 otherperson or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE ✓ Approved for _- bedrooms. Disapproved. Phone 337-6179 Date S 1803 011,611 1 0", Conditional approval for bedrooms, with the fllowing stipulations: pro f SSiOn�p� J ON-SITE •'; �i ZZ -V: WAT€D Ak1r ; tn= ZZ WASTEWATER : c • c7n P1Dr1r�DA�A —r-rcvcTrV- Attachments: %O%'•.,, ,.•••��� HAA Checklist Manitenance Agreements J�JJJ`�JJJJ�1,`` Septic System Advisory Supplemental Engineer's Reort Well Flow Advisory Other gy: Original Certificate Date: (Rev. 12101) >> Municipality of Anchorage • '�' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Sregaw St. P.O. Box 196650 Anchorage. AK 9951M650 www.d.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: SAND LAKE S/D 2: LOT 5. BLOCK 3 Parcel ID: 011-134-44 A. WELL DATA •SERVES LOTS 4 — 8, LOCATED ON LOT 8 Well type CLM C If A, B, or C provide PWSID# Date completed Sanitary seaLp Cased to fL FROM WELL LOG Date of test Static water level WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 0.1 mgJL. Wires properly protected (YIN) Casing height (above ground) in. AT ft. g.p.m. Other bacteria 0 oolonies/100 ml. Arsenio N/A mg /L. Date of sample: 7/31/03 Collected by: AKWWC, INC. B. SEPTICIHOLDING TANK DATA Tank Type/Material STEEL Date installed 6/24/1982 Tank size 1000 gal, Number of Compartments 2 Cleanouts (YM) YES Foundation cleanout (YIN)MES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 7/31/03 Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATA •TO BOTTOM OF MT INSTALLED ON 8/14/20031 Date installed 6/24/1982 Soil rating p.d r ft%drm) 150 System type DEEP TRENCH Length 30 ft. Width 2.5 IL Gravel below pipe 8 ft. Total depth •9.6 ft. Eff. absorption area 480 ft' Monitoring tube "YES Depression over field NO Date of adequacy test 7/3 t /03 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test0*0 in. Water added 900 gal. New depth 9.00 in. Elapsed Time: 19 min. Final fluid depth 2_5 in. Absorption rate >_ "450+ g,p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — •+ORIGINAL SUMP THAT WAS USED FOR ADEQUACY TEST ONLY EXTENDED 6" 8 W INVERT. NEW MT INSTALLED 8/14/03 TO 39" BELOW INVERT. MT DRY ON 8/13. I D. LIFT STATION Date installed Size in gallons Manhole/A "Pump on" level at in. "Pump off" n. High water alarm level at in. Datu Cycles tested Meets alarm &circuit requirements? E SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot _ .. WELL nt lots Public sewer main - Public sewer manhole/cleanout Seg c! service line Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 1001+ Welts on adjacent lots 150'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 100+ Building foundation 101+ Water main 10'+ Water service line 100+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 150'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and\ - review of Municipal records that the above systems are in ....• • . •' . ' . • • . "' • "" conformance with MOA HAA guidelines in effect on this date. ,J ff A ess:' Engineer's Printed lee JEFFREY A. GARNESS 7953Date 432'2•� , ........ a o HAA Fee $ Date of Payment Receipt Number, (Rev. 12101) Waiver Fee $ _ Date of Payment Receipt Number, MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICESIPALITY OF ANCHORAGE Division of Environmental Services 44MENTAL SERVICES DIVISION On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 AUG 2 7 1997 343-4744 CERTIFICATE OF HEALTH AUTHORITY RECEIVED APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # t)l l - ) �1-L�-i HAA # '�1QS1C�Sc14 1. GENERAL INFORMATION Complete legal description __ SAND L AYQE 2- LoT 5 Q k__31 Location (site address or directions) 804-7 Property owner Q&via,Ld Z�se_&LLj Day phone Mailing address Lending agency Day phone Mailing address II r� Agent f' a a )'Kd-&V"14cl J i CK "1'1. C_ Day phone 626 - 76 3 7 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water E04 ' q_ fes/ 13 K 3 S L HL NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) Front MOA021 5. By: 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 of this Health Authority Approval application 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 10 ��{�+ r,vy ktak4.cV 7-iff Phone V-71-39/ Address Engineer's signature 1�`- '`� Date DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments MITIC bedrooms, with the following stipulations: Date 9 d The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates 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. 72025 (Rev.1/91) Back MOAN21 Municipality of Anchorage LITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SVIk�NTAL SERVICES DIVISIC Environmental Services Division a 825 L Street, Room 502 • Anchorage, Alaska 99.501 • (90"14707 Health Authority Approval Checklist RECEIVED Legal Description: Gol,"d 4ct lu. A' I- tw j t5-0 6Y, 3 Parcel I.D.: A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number >! -o4s I/— �a NK 3 S. Log present(Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production Date completed Cased to FROM WELL LOG Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION WATER SAMPLE RESULTS: I - M -1 41 1d,2 -7 r rc Coliform / Nitrate 1� Q Other bacteria N l� Date of sample: Olt 3,/f -7 Collected by: Y,5> g.p.m. B. SEPTIC/HOLDINGTAN//K DATA Date installed �� C�'� Tank size /VV<t Number of Compartments L Cleanouts (YIN) Foundation cleanout (Y/N) */ Depression (Y/N) 1` High water alarm (Y/N) l'-) Date of Pumping �Pumper l /J a.a, c C. ABSORPTION FIELD DATA Date installed �`1 l s ?— Soil rating (g.p.d./ft2 or ft2/bdrm) System type 44,14 Cir/ I r r r Length � Width '3oIf Gravel thickness below pipe _� Total depth f/e� Nil / , Effective absorption area � Monitoring Tube present (Y/N)� Depression over field (Y/N) _� Date of adequacy test a r Results (Pass/Fail) For bedrooms r/ Fluid depth in absorption field before test (in.); Immediately after 420 gal. water added (in.): _ r/ _ Fluid depth J (ins) Minutes later: 410 Absorption rate g.p.d. Peroxide treatment (past 12 months) (Y/N) �, If yes, give date 72-026 (Rev. 3/96)" D. LIFT STATION PQ JJ Date installed Manhole/Access (Y/N) High water alarm level at` _ Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at ,Pump off" level at* "Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer /septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: , � �® Foundation � i Property line 35 Absorption field " Water main/service line 7�s Surface water/drainage f.& Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: t Property line 40 Building foundation 50 fWater main/service line i Surface water y 1A Driveway, parking/vehicle storage area Curtain drain ty/A Wells on adjacent lots c i F. ENGINEER'S CERTIFICATION 1 certify that 1 have determined thru field inspections and review of Municipal records thai the above sy�§terrts are in conformance with MOA HAA guidelines in effect on this date. 0 Signature tee, Engineer's Name L Date F HAA Fee Date of Payment a Receipt NumberQ 72-026 (Rev. 3/96)" Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE f LA) q DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES . IInn ii CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date 34;( sle 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lo r i. 8e ,�r'0-"SA.m n L-Ae E'A Z S EL ► o_ T i Location (address or directions) 8 D Q % (b) Property Owner goCW4MX Telephone: Home 2y8 -A%77 Business Mailing Address 8 0 q % �� tA (c) Lending Institution Telephone Mailing Address 3'1n t C (d) Real Estate Company and Agent NON j Address Telephone (e) Mail the HAA to the following address: or: Check here L? if hold for pick up. List contact person and day phone number below. 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms 3. WATER SUPPLY Individual Well ❑ Community K Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWA,,G����///E DISPOSAL Onsite tp� Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (Rev 8/86) Front 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 watersupply 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. 27Q 3 9%6 y Name of Firm Telephone J Address Date Engineer's Seal 5.. 6. DHHS APPROVAL 2 bedrooms by ��- Date Approved for Approved x Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates 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. Page 2 of 2 `�i 72-025 (Rev 81861 Back MUNICIPALITY OF ANCfflICIHPpALITY OF ANCHORAGE (MOA) ENVIRONMENTAL SERVICEYI64 SIOPf UTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 !%At,Q 2 5 1988 264-4720 ( 3 -30 -Ss' Legal Description: 5 St ZY SAN 1* RECEIVED -LAS 2- SEGto. 'ilaN !2N A. WELL DATA Well Classification it If A, B, C, D.E.C. Approved (Y/N) oil Well Log Present (Y/N) Date Completed Total Depth Cased to 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 Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Depth of Grouting 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 To Nearest Sewer Service Line on Lot r3 ;Date 3 -ZZ- 8Q) Date Installed e: W2 Size 10'0-153' No. of Compartments T O Standpipes (Y/N) T I&O Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Depression over Tank (Y/N) �� Date Last Pumped �&A.J 1 !86 J%&4%C.9 Pumping/Maintenance Contract on File (Y/N) �l/�r ; for WA Holding Tank High -Water Alarm (Y/N) N%4 Temporary Holding Tank Permit (Y/N) NiL0► Separation Distances from Septic/Holding Tank: To Water -Supply Well X X To Building Foundation 3 To Property Line % O To Disposal Field To Water Main/Service Line 1 * 0 To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) n, C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata I 0 Type of System Design 74 N(4 Date Installed �( (� j� If a Z Length of Field3 O if / ?4 Width of Field 3 � Depth of Field Gravel Bed Thickness 8 Square Feet of Absorption Area Vito 0 Standpipes Present (Y/N) 1IME Depression over Field (Y/N) 11.4Date of Last Adequacy Test 36 Z,/& A Results of Last Adequacy Test (AAs S FW',- 7!r r.sC �•� raorsiS Separation Distance from Absorption Field: ! O To Water -Supply Well 15-G -11— To Property Line To Building Foundation ✓� To Existing or Abandoned System on Lot NO him ; On Adjoining Lots 7 O To Water Main/Service Line 7 ! t� To Cutbank (if present) ��NC To Stream/Pond/Lake/or Major Drainage Course NO N AI To Driveway, Parking Area, or Vehicle Storage Area J O Comments D. LIFT STATION Date Installed — Size in Gallons — "Pump On" Level at (� o N! JE7 High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off' Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify thattIII have checked, verified, or Wnformed to all OA an HAA guidelines in effect on the date of this inspection. Signed • Date 3 Company MOA No. t ea•�• i=. e Receipt No. Date of Payment _ --`'ti '� Engineer's Seal F-' ; t -t Q Amount 1 0-0 Q e �( ;..'. N .2225-�. 4.f J NE (971 Page 2 of 2 'S y d: 72-026 (11/84) SV& 0SN& STEVE COWPER, GOVERNOR d o DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 563-6775 3601 C STREET, SUITE 1334 ANCHORAGE, ALASKA 99503 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MAR 3 01988 DATE: March 30, 1988 RECEIVED PWSID: CLASS C WELL To Whom It May Concern: According to the records on file in this office, the Class C Well serving Lots 4 — 8 Block 3, Sand Lake Subdivision Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely Michael P. Lewis Environmental Engineer MPL:Pkk STEVE COWPER, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 563-6775 3601 C STREET, SUITE 1334 ANCHORAGE, ALASKA 99503 DATE: March 25, 1988 PWSID: Class C well To Whom It May Concern: According to the records on file in this office, the Lot 5, Block 2. Sand Lake Subdivision, Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, Ronald S. Klein Environmental Field Officer RSK:pkk AVE "C" SUITE 203 -,,20A CHORtAGE, ALASKA 99501 CONSULTING ENGINEER I v TELEPHONE: (907) 279-3916 SEPTIC SYSTEM ADEQUACY TEST r LEGAL: Lot 5, Bloc 3, Sand Lake #2 l t LOCATION: 8047 Seacliff OWNER: Ron Roseland RESIDENCE: Single Family, Three Bedrooms WELL: Community Class C SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: TANK: Greer Steel Two Comp. 1000 gal ABSORPTION SYSTEM: Trench ABSORPTION AREA: 480 sq. ft. SOIL RATING: 150 INSTALLATION DATE: June 1982 DATE OF LAST PUMPING: May 1987. Isaacs DATE OF TEST: March 18, 1988 TEST PROCEDURE: System was inspected and measured. Tank was found with five feet of cover and a liquid depth of 49 inches. Sump was dry. 550 gallons of clean water was added to the sump while the water level in the tank was monitored. The water level did not change. Ten minutes after the end of the test, the sump was dry. TEST RESULT: This system meets the code requirements of the Health and Social Services Department of the Municipality of Anchorage. NOTE The operational life of all septic systems depends on the local soil conditions, 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 this septic system. We can therefore not give any estimate of how long this system will function satisfactory for current or future occupants. r 1c61 •SZ 3Nn( s'�z'ON zz d ..: .r f� 4