HomeMy WebLinkAboutSAND LAKE #2 BLK 3 LT 6and Lake
lock
Lot 6
011-134
-43
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program, 4700 Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of 3
www.cLanchorage.ak, us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: OSPl11237 PIP Number: 011-134-43
Name:
Micheal & Blanca Buford Wastewater System: [] New [] Upgrade
Address:
8055 Seacliff Street ABSORPTION FIELD
Phone: Number of Bedrooms:
[] Deep Trench [] Shallow Trench [] Bed [] Mound [] Other:
LEGAL DESCRIPTION soil Rating: Total Depth from original grade:
1.2 GPD,Ft= g Ft.
Block: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe:
3 6 Sand Lake #2 3 Ft. 6 Ft.
Township: Range: Section: Fill added above original grade: Gravel Length:
.5 Ft. 32 Ft.
Well: [] New [] Upgrade Gravelwidth: 3,0 Ft. Number of lines:l I Distance between lines:Ft.
Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material:
Existing Class 'C' Ft. Ft. 384 Ft2
Driller: Date Drilled: ! Static Water Level: Installer: Date Installed:
Ft. Chuck's Backhoe 9/28/2011
Yield: GPM Pump Set at: Casing Height Above Ground:
Ft. Ft. TANK
SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other:
'~ To Septic Absorption Lift Holding ~ublic/Private;Manufacturer: Capacity:
From ~ Tank Field Station Tank Sewer Line Anchorage Tank 1000 Gal.
Material: Number of Compartments:
We,, 157.7 150.2 25+ Steel 2
Surface Water 100'1' 100+ X / LIFT STATION
Lot Line 10.1 5.7I Size: Manufacturer:
Gal.
Foundation 17.2 28,4 "Pump on" level at: "Pump off' level at: I High water alarm at:
in. in.I in.
Curtain Drain N/A Pump Make & Model Electrical Inspections performed by:
Remarks:
BENCH MARK
Location and Description:
Basement FF
Assumed Elevation:
100.0 Ft.
Engineer's Stamp
Inspections performed by: PANNONE ENG. SVC, LLC Dates: 1st 9/2812011
2nd 9129/2011 ~ ¢\r.- ........... < ·
Development Services Department Approval .-~_~..." ',, "."
Conditional Approval Date: ~ '¢.~ 49T~ '~
~ oSteven R. Ponnone:,~7~
;~.~n% No. CF 8.149
Reviewed and approved by:-/~~}o~x/r~ X--~x,'"~/~jo_~ Date: / LO- ~,'3" / /
1
*KP~ "..r. ....... .~ ..... .
'~ ~ T1 36.2 19.1
~44 WELL (E) /
- T2 39.0 25.1
~4~ k~ /~ ,.~/ DC 39.8 27.6
~ ~ Cl 31.4 39.7
3 02 57.9 45.8
¢/ ~ / M2 54.9 43.3
I ", '., / C2~
IN FAILURE ~ ":. ; D TH-1 ~ ¢ ./~ 'L "/ 2n
~~~% ABANDONED PER CODE ~ ~ "', I DC ~x X~V :':
'",,,,. t X.ST,.O
~ /~~'~ ~.~ ~,, %__', TI~} ~%~~AREA
~ M~ I~ HOUSE ~ ~j
: "' ,~',,, (E) / ~a ~ 1~ NEW DRAIN FIELD
/ ' ~~ ~ ~ :'
i / ~ '.:,~ ~ '-~
~ ,~- ',. ~ 201 7
/ ~OOOg SEPTIC TANK (E) ~7"~ ~: -- "... I ~., ~: ~E~'~Z'NO SEPT,C
/ ABANDONED PER CODE ~ / ~'~'., ~'.,
~ AND REP~CED WITH 157.7 / "
,~w ~ooo~ S~TC TAXX / F ~ "" :':II%~X'ST'~O S~T~
~__~:. INSTALLED DCO ,/ ~ '"',
~ ~:S(':'~LL ~] ~ * DE% GRANTED WAIVER OF 100'
, ~ FROM CLASS 'C' WELL ON LOT 8
TO SURROUNDING SEPTICS IN
~ CONSTRUCTION AND OPERATION
~ ~ CERTIFICATE FOR PUBLIC WATER
NOTES: P~O~ ~G ~C, L~
~. op. ~'~~ o/~/~ q
~AW~,O ~.0. ,OX ~00~ ~,C,O,~. ~X ~,S~O ~-'
SAND LANE ~2, BLOCN 5, LOT 6~~~ ....... P.LD. NO
~CHAEL e BLANCA BURFORP __~~~-~-4~
~0~ S~ACUFF STREET .**~~~.{~ ,~,~ ,o.
,~ ~. .~ osp~2~7
~ :c~ '- ...... · %v~ Sh~e~
PLA~ AN~ORAOE, A~ 99502
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION WAS INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE
STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE
WASTEWATER DISPOSAL SYSTEMS.
2. ALL WORK WAS IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS.
5. SCOPE OF WORK: INSTALLED NEW SEPTIC TANK AND SOIL ABSORPTION SYSTEM.
4. NO GROUNDWATER WAS OBSERVED AS EVIDENCED BY THE SOIL TEST HOLE. AN APPARENT WATER TABLE WAS NOT
OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 14 FEET BELOW EXISTING GRADE.
//--FILTER FABRIC
~ ~7.7
TH-1 97.2 I
FILL `3.5 ~ ._~ /~ '~'::~"'F"O.;~.,~
-2_.~ --DR t ~': :~ ~,,,,,__ 94.2
SW 6i0 ~ , ~x-4" ¢ DRAIN PIPE
-9 ~ ::~¢~, ~--GRAVEL
6.0
-14 83.2
-~s''-~ 82.2
SECTION
No groundwater
monitored
.~ .~ ._~ 0I-
: 97.7/ 97.7
-- '99.0- _ . (Fg)~.~.i_ __'_(FG)
_ .......... /
94.9/ 1000 g SEPTIC 4.3
TANK (P) 94.2 / :' : '.:' i i':: .: ;:' ' , :i.i." : :: ~ -- 94.2
CONNECTED AT 88.2-- :" "" "'' ': ': 1--88.2
MIDPOINT OF FIELD DEEP TRENCH SEE DESIGN
PROFILE
DESIGN PARAMETERS LEGEND
PRIMARY SEPTIC SYSTEM
NO. BEDROOM: 4 (450 gpd) --W--- WATER LINE/ ABBREVIATIONS
TANK SIZE: 10009 WELL RADIUS CU COPPER
PERC RATE = 1-5 MPI DiP DUCTILE IRON PIPE
SOIL RATING: 1.2 GPD/SF ~ SS ~ NEW SEPTIC TH TEST HOLE
AREA RQD: `375 SF FC FOUNDATION CLEAN OUT
SYS. TYPE: DEEP TRENCH 6.0' E.D. T# TANK CLEAN OUT NO.
MIN LENGTH: `31.25 LF C# CLEAN OUT NO.
USED: M# MONITOR TUBE NO.
,32 LF X 3' WIDE, 6' E.D., R.I. RIGID INSULATION
9' TD DCO DOUBLE CLEAN OUT
TOTAL AREA: `384 SF DV DIVERTER VALVE
FS FLOW SPLITTER
~'~'~"~'--~'~.~,· ,. D a t e
NOTES: PANNONE SVC, LL,C '"~ 10/4/11
RECORD DRAW, NG P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211 ~.~'~r.~...'~~'~'~"/I, --.'l-~f~
Scale
NTS
P.I.D. NO
SAND LAKE #2, BLOCK 3, LOT 6
MICHAEL & BLANCA BURFORD --.¢,~,,.....,~ ..,~~ '_'~',~-'~ann°~e ~ ;PERMIT NO.
8055 SEACLIFF STREET 'I~.'. .~.~",~- 0SPl11237
DETAILS ANCHORAGE, AK 99502 ,~,~-~;~;.;¢.s(~-~.? Sheet
Permit Number:
Tax Code Number:
Work Type:
On-Site Wastewater Disposal System Permit
OSPl11237
01113443000
Septic
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 EImore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Upgrade
Permit Effective Dates: September 13, 2011 to September 15, 2012
Design Engineer: PANNONE ENGINEERING SERVICE
Subdivision: SAND LAKE #2
Site Legal Address: SAND LAKE #2 BLK 3 LT 6 G:2224
Owner/Address: BURFORD MICHAEL J
8055 SEACLIFF STREET ANCHORAGE AK 995024164
Site Mailing Address:
8055 SEACLIFF ST, Anchorage
Lot Size in Sq Ft: 6750
Total Bedrooms: 3
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage
All construction must be in accordance with: 1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Date:
Date:
Municipality of Anchorage
P.O. Box 196650 · 4700 Elmore Road
Anchora,qe, Alaska 99519-6650 · (907) 343-7904 · Fax (907) 343-7997
httl3:llwww.muni.or,qlOnsite
Development Services Department
On-Site Water and Wastewater Pro.qram
,epartment
**** VARIANCE/WAIVER REVIEW ****
WaiVerS: OSPl11238 COSA#:
Permit: OSP111237
PID#: 011-134-43
Legal Description: Sand Lake #2 Block 3 Lot 6
Engineer: PEa
Applicant: Michael and Blanca Burford
Your request for a waiver of the required 10 feet horizontal separation from the absorption field
to the property line has been approved. The approved separation distance is 4.0 feet. In addition,
the proposed absorption field is approved to be 14 from the existing absorption field.
This waiver approval applies to the proposed absorption field only. Any future upgrade to the
on-site wastewater disposal system will require all separation distances be met or another
approval from this department.
Waiver is Granted: X Waiver is not Granted:
Date: C~/~_~,/,~/ Approved by:
Name of Reviewer~
Rec#: 067352 Amount: $200:00 Date Paid: 9/2/11
**** VARIANCE/WAIVER REVIEW ****
Community Development Department
Development Services Division
On-Site Water & Wastewater Program
[ UNICIPALITY OF ANCHORAGE
Phone: 907-343-7904
Fax: 907-343-7997
Mayor Dan Sulfivan
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. (~:~l.~-
Property owner(s)
Mailing address ~'0~_-"~'- 5¢.,~(..~.~'F'~I~.j
Site address
Legal description (Sub'd., Block & Lot)
Legal description (Township, Range & Section)
Lot Size ~) 7&,'q~ Sq. Ft. Number of Bedrooms
Day phone
THIS APPLICATION IS FOR:
(1~ all that apply)
Absorption Field
Septic Tank
Holding Tank
Privy
Private Well
Water Storage
THIS APPLICATION IS AN:
Initial []
Upgrade J~
Renewal []
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
?IEL,O 'lo /--07 o F q'
I certify that the above information is correct. I further certify that this application is being made
for a Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Sign'at~rAj3f ~¥0p~r~y owner or authorized agent)
Rush Fees: ~'~ ,'~ -
Date of Payment: ~ - ~ - ~, ~_
Receipt Number: Oto-'~ "~. ~:~'- ~¢.
Permit No. ,._.xo '~,1 ~ ~"-/
Waiver Fees: ~.~
Date of Payment:
Receipt Number:
Waiver No. ("~.~_>
G:\Building\On Site\Forms\Client Forms\Permit App__010411 .doc (Rev. 1/11 )
Pannone Engineering Services LLC
Steven R. Pannone, Principal
Re§istered Professional En§ineer
E-maih steve~panengak.com
September 19, 2011
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
4700 S. Bragaw Street
P. O. Box 196650
Anchorage, Alaska 99519
Subject:
Sand Lake #2, Block 3, Lot 6
Septic System Permit Upgrade Request
Ladies and Gentlemen:
I am writing to request a permit to construct an upgraded septic system be issued for this property. The
proposed system will serve an existing three-bedroom house. Currently the lot is developed. The lot is
served by a community class 'C' well. The existing drain field is in failure and shall be re-used as a reserve.
A new drain field will be installed east of the existing field and will be sized to handle a three-bedroom
waste stream. The surrounding developed lots are served by the same community well. The community well
is located over 150 feet from the proposed soil absorption system.
1. Soils. One test hole was excavated by Pannone Engineering Service in August of2011. See the soil
log attached. Ground water was monitored for seven days. No ground water was monitored to a depth of
fourteen feet (14') below ground level after the monitoring period. Bedrock was not encountered in the test
hole. It is my opinion, based on the results of the percolation tests and overall soils appearance; an
application rate of 1.2 gallons/day/square feet should be used, using a conventional wastewater treatment
system.
Soil Absorption System Design.
a. See Sheet 2 of the design package
3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and the
existing drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water
and drainage ditches.
4. Topography: The average topography in the area of the proposed septic system is approximately 10
percent based on the survey information in the area of the septic system. There are no steep slopes within the
vicinity of the proposed drain field.
Mailing: P~O. Box 100217, Anchorage, AK 99510-O2!7
Physical: 615 East 82r~'~ Ave, Cuite B6~ Anchorage, AK 99503
Telephone: (907) 272-8218 FAX; (907) 272~-g211
Page 2 of 2
Waiver Request:
1.) I request a drain field to lot line waiver of 4 feet. Granting this waiver will not impact current or
future development on any of the surrounding lots.
2.) I request a new drain field to existing drain field waiver of 14 feet. The existing drain field has an
effective depth of 10 feet. The soil is well drained and this separation distance will not affect the
operation or life span of either field.
3.) Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification
that the review is complete and that there are no further comments is received from MoA On-Site
Department, the note will be removed and "Issued for Construction" drawings will be issued.
The proposed installation will not affect the future development of the surrounding or existing lots. There
are no wells within 150 feet of the proposed septic location.
If you have any questions or concerns, please contact me at 272-8218.
Sincerely,
Steven R. Pannone, P.E.
Owner/Civil Engineer
Attachments:
Mai~ing: P,Oo Box 100217~ Anchorage~ AK 99510~,0217
Physical: 6t5 East 82® Ave, Suite B6, Anchorage, Al< 99503
Telephone: (907) 272-8218 FAX: (907} 272-8211
----/~ o rY
~oo~4¢. %~ WELL (E) /~/ ) 23
~ ~ 3 22
~ o ~
/
% ~ ~ . ~ ~ X CAUTION
DRAIN FIELD (E) : / ~ %% / AREA 174~
~ IN FAILURE --. '"',. ,5 ",, '/~ % ./~ ' 2n
~RE-USE AS RESERVE* ~ ~" ',,,./~y',: % ~
.*/ t ~ ~~ ' (~7 ~~~~ DRAIN FIE~D (P)
/ I/. " ~~:T%%~.' ', 52 .~F x 6 ED
- VERI~ INTEGRI~ OF ] --~~~~~x 3 W x 9' TD
lO00g SEPTIC TANK (E) ¢::~ ~%~ '~': Px 195~,
' ",~.':.'.f / ", I] % ¢ EXISTING SEPTIC
IF FOUND TO BE LEAKING :/ ~ .... ; '" ~/' ~ ~-~AREA
ABANDON PER CODE AND REP~CE ~ / 7/~ '"'. ~'
W/ 10009 SEPTIC TANK (P) 1~0.5 ~., ,:~,l~E~ST,.O ~T~
INSTALL DCO AND DVt.' / ",, , '~
k ~ c~ss 'c' / ,
% WELL (E) ~ * DEC ORANTED WAIVER OF 100'
'~ ~ FROM C~SS 'C' WELL ON LOT 8
TO SURROUNDINO SEPTICS IN
~ CONSTRUCTION AND OPERATION
~ ~ CERTIFICATE FOR PUBLIC WATER -
SYSTEM (8521 -FA-157)
FOR CONSTRUCTION p,O, BOX 100217 ANCHORA6E, AK g95~0
~~ .....L ~9/~s/~
,,o,~ (9o~) ~-~a~ r,x (9o~) ~z-~a~ ~.. ~ ~,¢~¢~ ~c,~
~ ~..'~ ~ ~ '..~ ~ ~"=so'
SAND LAKE ~2, BLOCK 3, LOT 6 -- W~-134-43
~t~~~ 0SPl11237
8055 SEACLIFF STREET f~l Sheet
PLAN ANCHORAGE, AK 99502
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF
ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF
ON-SITE WASTEWATER DISPOSAL SYSTEMS.
2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS.
,3. SCOPE OF WORK: INSTALL NEW SEPTIC TANK AND SOIL ABSORPTION SYSTEM.
4-. NO GROUNDWATER WAS OBSERVED AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS
OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 14- FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER
IMMEDIATELY.
ILTER FABRIC
TH-1
FILL 3t. 0 ~ _~_/~!!i.~
~ ~'""-G RAVE L B ED D I N G
SW I J 2 51---''-GRAVEL
6.0
8FCIION
No groundwoter
monitored
o u,O ~
O-J ..,J O~
F-4" Di~ P~rf Pipe
1000 g SEPTIG --
PrOfl LE D~Ep TRENCH SEE DESIGN
DESIGN PARAMETERS LEGEND
PRIMARY SEPTIC SYSTEM
NO. BEDROOM: 4- (450 gpd) --W-- WATER LINE/ ABBREVIATIONS
TANK SIZE: lO00g WELL RADIUS CU COPPER
PERC RATE = 1-5 MPI DiP DUCTILE IRON PIPE
SOIL RATING: 1.2 GPD/SF ~ SS ~ NEW SEPTIC TH TEST HOLE
AREA RQD: 575 SF FC FOUNDATION CLEAN OUT
SYS. TYPE: DEEP TRENCH 6.0' E.D. T# TANK CLEAN OUT NO.
MIN LENGTH: 51.25 LF C# CLEAN OUT NO.
USE: M# MONITOR TUBE NO.
R.I. RIGID INSULATION
`32 LF X 5' WIDE, 6' E.D., DCO DOUBLE CLEAN OUT
9' TD DV DIVERTER VALVE
TOTAL AREA: 584 SF FS FLOW SPLITFER
NOTES: PANNONE ENG BYe, LLC ~ __,?~. Oate
~ ~ Oh A/.~ ~ 9/~ 5/~
FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 ~'~..~- .....
PHONE (907) 272-8218 FAX (907) 272-8211 ~'t.~." .~,l~:L-'~J~a Scale
~*.- 49 TH ~1 ...,& NTS
P.I.D. NO
SAND [_AK£ #2, BLOCK 3, lOT G ,01~-134-43
MICHAEL & BLANCA BURFORD '&~81v'?n°?e~-,~ 4-~ -'/~-~ ~ERMIT NO.
8055 SEACLIFF STREET *~'~'~" "~'~ ISheet
2
SOILS LOG - PERCOLATION TEST
SLOPE
,
1 -- FILL GRAVEL/SAND ~ "'"~i i,,5
FILL
3 OR ORGANICS
FINE SAND ~ HOUSE
6 -- SW (BROVVN)
10 --
SW SAND (GRAY)
42--
13 --
WAS GROUND WATER SLOPE
44 T ENCOUNTERED? N
BOH[ PROBED TO 15 --
15 -- __ NOBEDROCK IFYES, ATWHAT
DEPTH? -0-' ! TH
16 -- X
DEPTH TO WATER AFTER
17 -- MONITORING? -DRY-
18 -- DATE: 9/1/11
WATER
19 READING DATE CLOCK NET TIME LEVEL NET DROP
TIME
READING
DATE PERFORMED: 8/24/41 1 8/24/11 3:53 --- 3.39 --
2 4:03 10 MIN 6.70 3.31
3 4:03 -- 3.39 --
4 4:13 10 MIN 6.69 3.30
5 4:13 --- 3.39 --
6 4:23 10 MIN 6.69 3.30
PEROLATION RATE 3.0 (min/inch) PERC HOLE DIAMETER 6 inches
TEST RUN BETWEEN 4.5 FT AND 5.5 FT
COMMEN?S: ?est :hole excavated b.y CI-IUCt~'S BAC:KI-IO]~. ?rec ;hole ~vas presoaked.
Test run £or oz~e ho~zr. I,ast 3 rcadinc;s reported
?:ER:FORMt~D :BY: Steven R. ?a_n~zo~e~ P.E. ! CERTI~'¥ TI-IAT TI-IIS T~ST WAS ?:ERiFORM]~D IN ACCORDANCE
WI?I-I AI~I, STAT]~ AND MUNICI?AI~ OUIDI,IN]~S IN ~E:Fi~ECT ON TI-IE DATE O1~ TI-IIS T~EST.
A~-~.~·. D a t e
PANNONE ENG SVC, LLC
FO~ CONSrSUCTION P.0. [t0X 100217 ~NCHORAG[, ~K ~0510
PHON£ (007)272-82~8 F~X (007)272-8211 '
.....
SAND LAKE #2, BLOCK .5, LOT 6 ~.~¢~..~"r.~,~_____. ~ 011-134-43
MICHAEl & BLANCA BUR?ORD~h'onnor~e~.,~ ~, ...... · ~ PERMIT NO.
¢,~,~,~¢~/~, CE 8149~,~
8055 SEACLIFF STREET 0SPl11257
SOILS LOG ANCHORAGE, AK 99502 ~ ". -" Sheet
WATER
CLOCK
READING DATE NET TIME LEVEL NET DROP
TIME
READING
1 8/24/11 3:53 --- 3.39 ---
2 4:03 10 MIN 6.70 3.31
3 4:03 --- 3.39 ---
4 4:13 10 MIN 6.69 3.30
5 4:13 --- 3.39 --
6 4:23 1 0 MIN 6.69 3.30
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
PHONE
~ NEW
[] UPGRADE
NAME
MAI LING ADDRESS
LEGAL DESCRIPTION
LOCATION
DISTANCE TO:
Manufacturer
Liq.
DISTANCE TO:
IF HOMEMADE:
Well
Absorption_araa
__ Dwelling ~ ,
Material .~.~,-- ~ ~
Dwelling
NO. OF BEDROOMS
PERMIT NO.~/'x ~,~ (~.(?
No. of compart!~ents
Liquid depth
PERMIT NO.
Manufacturer Liquid capacity in gallons
DISTANCE Th:
No. of lines · Length of each line__ --~
Top of tile to finish grade
Foundation z
T~tal length of lines~
Materiel beneath tile
Depth
Material
Nearest Iot~
Trench widths/
~ ?~ nches
] '~__O inch es
Length
Width
Distance between I nes
Total e f f e c t i v~ a ~) s o r~t i o./z~j;e~
PERMIT NO.
Type of crib Crib diameter 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 Absorpt on area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER _
REMARKS
APPROVED
DATE
72-013 (Rev. 3/78)
LEGAL
PERMIT NO.
f-lLlt'-,t I ~-: I RLT T"-~" ,]F CI[-.IL---:H
DEPARTMENT OF HERLTH RND EN,IRLNMENTHL PROTECTION
825 "L" STREET, ANCHORAGE., AK. 99501
( 820952 )
flit-,! S ! TF SE~4EF-: PEF:F"I I T
RPF'L I E:RNT
LOCRT I ON
LEGAL
MRRK TOUSEN SRR BLX 40...,-~H _..
SEE f":ONDITTLN=, OF PERMIT BELOW
L6BT~ SRNr:), LAKE #2 LOT SIZE
99'9999 SQUARE FEET
TYF'E OF '=]OIL ABSORPTION SYSTEM IS: TF.:ENF:H
MAXIMUM NUMBER OF BEDROOMS
SOIL RATING '..'",Q FT,'BR.~-
THE REQUIRED SIZE OF THE;,U'--IL HB.=,ORFTI_N- '- ' n '-"-'r-TEM"- IS:
[:, FF" T~' ~ .... :1';, ' L Ff-,~i_.~T H: 2":~-_ 6RR"-,,"EL ~-,EF"TH=
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFBCE OF THE
GROUND RND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRRVEL DEPTH IS THE MINIMUM~DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE
AND THE BOTTOM OF THE EXCRVRTION (IN FEET).
F-:EQL~ T RE[:, SEPT I i::: TRI'-,t~:: ¢-~ T ZE= :.1..~-400 ~..3RLL~]i'4S
PERMIT APPLICANT HAS THE RESPDNSIBILITY TO INFDRM THIS DEPRRTMENT DUF..IN= THE
INSTALLATION INSPECTIONS OF RN'-r' WELLS Rr:,JRCENT TO THIS PROPERT"r' AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE,
Ti..~O ( 2 ::,, ! [4SPECT I ~2,1'4S RF~E RE6-!Li f RE[)
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND AF'PRO'v'RL BY THIS
[:,EPRR. TMENT WILL BE SUBJECT TO PF.:OSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
±00 FEET FOR R PRIVATE WELL OR t50 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM R PRIVATE NELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO R COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED RND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DRYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY RPPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRRMS ARE
RVRILABLE TO INSURE PROPER INSTRLLRTION.
F'EF."~'-I I T E)-C.F· I RES [:,E~2Ef-IBEF-: "'~: :_1_ .,
I CERTIFY THAT
i: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND HELLS RS SET
FORTH 8Y THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS.
RPF'L I CANT MARK SEN
MUNICIPALITY OF ANCHORAGE
DEPARTN1ENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOl LS LOG ~
[] PERCO LATIO~N
TEST
SOILS LOG- PERCOLATION TEST
SLOPE
1
2,
3
4
5
6
7
8
9
10
11
12
13
14
15-
16---
17
18
19.
20
COMMENTS
PERFORMED BY:
72-008 (6/79)
DATE PERFORMED:
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE
r' ~ '(minutes/inch
.... .....
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. o~.z-~34-43
GENERAL INFORMATION
Complete legal description Sand Lake #2, Block 3, Lot 6
Location (site address) 8055 Seacliff Street
COSA #
Expiration Date:
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Micheal 8, Blanca Buford
8055 Seacliff Street, Anchorage, AK 995o:z
Day phone
Day phone
Real Estate Agent
Mailing Address
Unless otherwise, requested, COSA will be held by DSD for pickup.
NUMBER OF BED:ROOMS: 3
TYPE OF .WATER: SUPPLY:
Individual Well []
Individual Water Storage []
Community Class _C Well [~
[]
Public Water System
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding Tank
Community On-site
Public Sewer
D
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Pannone Engineering Services, LLC Phone 272-82~.8
Address P.O. Box ~.oo2~7, Anchorage, AK 995zo
Engineer's Printed Name Steven R. Pannone, P.E. Date
Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with MOA DSD Guidelines & Regulations. The reported results describe 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 hfe of all wells and septic systems depend on the local soil condition, ground water
levels that may fluctuate during the year, and the water usage of the family being served by the system. ~r~/x,-.~-..X...r;; ..........
These conditions are outside the control of the evaluator of this system. All systems eventually fail and m
satisfactory test results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. PES can therefore not provide any warranty for future
performance nor give any estimate of how long the system will continue to meet the operational ~~'""'
requirements of the M0A DSD. The content of this report is for the sole benefit ofthe owner listed
above. Any reliance upon or use of this report by any other person or party is not authorized nor will it ~~ 81
confer any legal right whatsoever. -,~ ......
5. DSD SIGNATURE
Approved for --~ bedrooms.
Disapproved.
Conditional approgal for - __ bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
(Rev. 11/05)
Original Certificate Date:
"Pump on" lever at in.
Detum
~P~~ D~~' F~~L~ ~ LOT TO:
Size in,gai.~s
=Pumpeff" level: at,
in.
P~lic 'se~,er,'~n
Sewer/septic
Manhole/Access (WN)..,
High 'water alarm .level. at
Meets alarm& circuit requirements?
in.
On adjacenttots.,
On adjacent tots
sewer man'he~/cleanou,t ,,
Holding tank __
Manure/animal' exer~e sterage
Buiid~g:.~f~n ,z;~; Prope~y line :~o~.
Water.,, me_jn, ~ ~ s~i~ l~e ~+
S~A~I~'~TA~ F~:'~PT~N' FIELD ON EOT TO:
,~!-fou~ation 28.,.
Abse~ptien'~etd ~.-,.q., ·
Sub!Water.
Weits:o~ adjacent tots , ~;o+
~main
D~ivew~,.~hicle eterage
lo+
G~
Rece!p' t~er
(Rev.
Waiver Fee $
Date of Payment
Receipt Number
No. cE 8149
Municipality of Anchorage
Community Development Department
Development Services Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On-Site Systems Approval # 111374
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 6 of
Sand Lake #2 subdivision. This inspection revealed a nitrate concentration
of 49.8 milligrams per liter (mg/L) was reported for the property's well
water sample. The Environmental Protection Agency (EPA) has established
a maximum contaminant level (MCL) of 10.0 mg/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. Please see the
attached "Nitrate Fact Sheet" for important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
30.00'
Lot §
~. CONCRETE
Z~ GRAVEL
10.4.' x 16.1' PATIO '--~ I
%.1 I
51.7'
CHAIN-UNK
59.1'
Lot 20
1 STORY
10.3'
HOUSE PATIO
WiTH FULL
BASEMENT
24.3' 6,750 s.f.
IN 90'O0'O0"W 135.00'
WOODEN RETNNING WALL ~
CLEANOUTS
Lot 19
FENCE
3.9' x 7.2'
GREENHOUSE I
7.0' x 7.0' SHED
I Lot 18
Lot
7
I
I
I
NOTE: LOT IS SERVED BY a COMMUNITY WELL.
PLOT PLAN AS BUILT X SCALE 1" = 30' GRID SW 2224 Project No. 11-165
Long (907) 522-6476
Regisfered Land Surveyors (907) 522-4625
kenOlangsurvey, com/ JonafhanOlangsurvey.com
& Associafes, inc. 11500 DaryI Avenue, Anchorage, Alaska 99515-,3049
Phone
Fax
I hereby certify fhaf I have surveyed fhe following described properly:
Lof 6, Block 5, Sand I-eke No. 2, (Plaf P-176)
Anohoroge Recording Dlsfricf, Alaska, and fhaf fhe Improvemenfs slfuafed fhereon are
wlfhln fhe properly Ilnes and do nor encroach onfo fhe properly adJaeenf fherefo, fhaf
no Improvemenfa on fhe properly lying adJaeenf fherefo encroach on fhe surveyed
premises and fhaf fhere are no roadways, fronsmisslon lines ~or ofher visible
easemenf, on sold properly exeepf as Indleafed hereon.
Dared fhls fhe ~'~ Day .of ~::~P~. , "CO ~\, af Anohoroge, Alaska
If is fhe responsibility of fhe owner fo defermlne fhe eXlsfence of any easemenfs,
oovenanfs, or resfricflons whleh do nor appear on fhe recorded subdivision plaf.
~ ...- ....... ;~.-. ~,.~
{:....: ............... .....
~ ~ ". KENNETH 'OYI.AI~O~." .o:~
~;~"-. LS=~o~ .."~
~'~ IO~ ~
SGS Ref.# 1113704001
Client Name Pannone Eng. Srv. Printed Date/Time 08/12/2011 16:05
Project Name/# Sand Lake #2 Collected Date/Time 08/09/2011 11:05
Client Sample ID BK 3 LT 6 Received Date/Time 08/09/2011 13:00
Matrix Drinking Water Technical Director Stephen C. Ede
PWSID 0
Sample Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic
49.8 * 5.00 ug/L EP200.8 C (<10) 08/10/11 08/11/11 NRB
Waters Department
Total Nitrate/Nitrite-N ND 0.100 mg/L SM20 4500NO3-F B (<10) 08/09/11 AYC
Microbiology Laboratory
E. Coli
Total Coliform
Negative 1 100mL SM20 9223B A 08/09/11 DLC
Negative 1 100mL SM20 9223B A 08/09/11 DLC
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
p.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 011-134-43~
1. GENERAL INFORMATION
Complete legal description
Lot 6; Block 3;
Sand Lake #2
Location (site address or directions)
Property owner
Mailing address
8055 Seacliff
AnChorager AK
Donald (Lee) walter~''' "DaYp'hone (425) 235-7275
15035 134th AvenUe S.E, Renton, WA ·98058
Lending agency
Mailing address
Day phOne
Agent
Add re~s
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
xx
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:
xx
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 [Rev. 1/91) Front MOA #21
./
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 Municipalityof Anchorage files and from my investigation and inspection, the on-site water
is in cor0pliance with all Municipal and State codes,
supply
and/or
wastewater
disposal
system
ordinances, and regulations in effect on the date/of~this inspection.
//
Name of Firm ALASKA WATER ;~/WAST~E~TE~R CONSULTA~ne 337-61 79
~.///~ /Anch
Address 6901 Debar~ B orage, AK 99504
Engineer's signature ~/~~ ~~ Date
..,~.~' Iil_.f~~.
bedrooms.
DHHS SIGNATURE
~. Approved for '-?
Disapproved.
Conditional approval for
%,.
bedrooms, with the following stipulations:
Additional COmments
Date2 //.. ¢C/ .
.. ,~ Mur{icipality of/~r~horage 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 eng 9.eer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
ana 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. ·
72~5 (Rev. 1/91) Back MOA#21
Municipality of Anchorage r~ ~ c E I V~
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division FI~E~ 0 9 10
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
MUNICIPALITY OF ANCHOP, AGE
ENVIRONMENTAL SERVICES DIVISION
Health Authority Approval Ohecklist
Legal Description: Z.O¥ ~ ~ /dd~/d ,.~ ,.~dlF~C~/ ~. "~.~ -
Parcel i.D.: (--)// ,/-~ ~'~' ~//,-,~
A. WELL DATA
We, type
Log present (Y/N)
Total dop~h'~'~.~
Sanitary seal (Y/N)~"~'~
Date of test
Static water level
If A, B, o~attach ADEC letter. ADEC water system number
Date completed
Cased to
Casing height (above ground)
Wires properly protected (Y/N)
FRO~PECTION
Well production
WATER SAMPLE R~E/~JJLTS:.
Coliform T; Nitrate
Date of sample- J /'-z"'7-- /c:)~'
B. SEPTIC/HOLDING TANK DATA
Date installed q_/~_~o~_, Tanksize
Foundation cleanout~q)
Date of Pumping /0/'~/~
C. ABSORPTION FIELD DATA
/
Length c~ ~ ~: Width
EffectiVe absorption area /"/'~ /
Date of adeq~c~"~est' [D-//~,/~(~
g.p.m.
Collected by:
~ g.p.m.
Other bacte Ha~~_
/4- oUJCl_, /,gE,
Number of Compartments ,?-- Cleanouts{~N) .
/ Depression (Y N~,) /~ High water alarm (Y~ /~/
Pumper
Soil rating (glp,d./ft[ O~__~ j ~
/
Gravel thickness below pipe
System type Ef-ee~ ~X~'/'J ~
/ /
Total depth //-/' /7/
Monitoring Tube present ~'N) y Depression over field (Y~)] .
Result (~=ail) ~a ,-.q 5 For ~
Fluid depth in absorption field before test (in.); ,~ ! ' Immediately after ~o~ gal. water added (in.):
Fluid depth ,-~" (ins) Minutes later:. / ~ ~ ~) Absorption rate = /-~(~) -/- g.p.d.
Peroxide treatment (past 12 months~) ~ -~ ~{~, give date /~ ~ 7- ~
o
bedrooms
//
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
~/~ Size in gallons
mp off" level at*
~ *DatUm
High water alarm level at*
Cycles test~e~~ ,, ,, ~
E. SEPARATION DISTANCES ' I 5 (~'*-
Public sewer main . ~ ~
S~ Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
/
Foundation ,~ -/- Property line
Water main/service line
Absorption field.
Surface water/drainage/~ -/-
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO'
Property line -/ -- Building foundation ,/~ ¥'- Water main/service line
Surface water /~ ~ -/'- D~veway, parkin~vehicle storage area
Cu~ain drain ~D M ~ /~ ~ ~ Wells on adjacent lots
~.G~N~.'SC~.T~F~CAT~ON /~ ~¢ ~m ~ ~O' ~ ~ '~ '~//
I ce~ that/ha~et~ l~i~ld inspections and review of Municipal records ~ ~b~ ~sa~
.
in confo~anc~wit~ ~fl~ ~ui~ines in effect on ~,s date.
Signature ~~ ~~ -
// ~ //~ ~ r .~ ~
HAA Fee $.
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Rick Mystrom,
Mayor
Municipality of Anchorage
Department of Health and Human Services
625 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
http://www.ci.anchorage.ak.us
February 11, 1999
Jeff Garness, PE :-.
Alaska Water & Wastewater Consultants, Inc
6901 De Barr Road, Suite 2B
Anchorage, Alaska 99504
Subject:
Waiver Request for Lot 6 Block 3 Sand Lake Subdivision #2
Waiver Request #WR990007
Parcel ID #011-134-43
HA990051
Dear Mr. Garness:
Your request for a waiver of the required 10 feet horizontal separation from the
absorption field to property line has been approved. The approved separation distance is
9.0 feet.
This waiver approval applies to the existing absorption field to property line separation
only. Any future upgrade to the on-site wastewater disposal system will require all
separation distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-4744.
Sincerely,
Daniel J. Roth
Civil Engineer
On-Site Water Quality Program
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR# i~O~(~(~--~ PID#
Date Received:~
Legal Description:
Engineer: ~
Criteria: 1. Geology: Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
Special Conditions:
3. Other:
Waiver is Granted: ~ Waiver is NOT Granted:
List Conditions or Reasons for above: ~FE f~6/~£~Rl$ ~d~f~
OF I~$ Ti F,c~ TI~N.
Date: 2-11-
Name of Reviewer
Rec ~: ~.~,u3.(~q'~((~C'%~:~.'~ Amount: $ %[~ Date Paid:
Alaska Water & WaStewater Consultants, Inc.
6901 Debarr Road, Suite 2-B - Anchorage - Alaska 99504
Phone (907) 337-6179 ~ Fax (907) 338-3246
Consulting Engineers
February 8, 1999
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
FEB 09 1999
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICE8 DIVISION
Subject: Lot Line Waiver for Lot 6, Bk 3, Sand Lake #2.
To whom it may concern:
When the septic system for this lot was installed on 9/16/82, it was noted that the trench was 9
feet from the lot line. In addition, it was noted that a lot line waiver would be required. At this
time we are requesting the waiver. The existing encroachment has existed for over 17 years with
no known adverse imp~
244-9612.
If you have any questions, please contact me at 337-6179, or
RECEIVED
FEB 9 1999
Municipality of Anchorage
Dept. Nealth & Human Services
9072767670 02/03 '99 15:02 N0.751 01
CT&E Ref.#
Client Name
Project Name/#
Client Sample ID
Matrix
Ordered By
PWSID
990338001
AK Water & Wastewater Consultants Inc.
8055 Seacliff
8055 Seacliff
Drinking Water
Sample Remarks:
Client PO//
Printed Date/Time 01/29/99 15:06
Collected Date/Time 01/22/99 14:20
Received Date/Time 01/22/99 14:40
Technical Director: Stephen C. Ede
Released By / ~ A
Results PQL Units Method
Allowable Prep Analysis
Limits Date Date Init
Total Coliform
Nitrate-N
0
0.100 O
col/lOOmL SM18 92228
0.100 mg/L EPA 300.0
01/22/99 gAP
10 max 01/22/99 01/22/99 SCL
CT&E Environmental Services Inc.
Laboratory Division ~,~j~,~,j~-~'~,J~,~,~e'~'~,~'~'~,~
200 W. Potter Drive
Drinking Water Analysis Report for Total Coliform Bacteria Anchorage, AK 99518-1605
Tel: (907) 562-2343
READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE Fax: (907) 561-5301
MUST BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY
[] PUBLIC WATER SYSTEM I.D. #
[] PRIVATE WATER SYSTEM
Send Results
[] Send Invoice
Send Re~ul~ [3 Send Invoice
Mailing
City
Zip cod~
SAMPLE DATE:
Month
SAMPLE TYPE:
~ Routine
[3 Repeat Sample (for routine sample
with lab ref. no. )
[] Special Purpose
SAMPLE LOCATION
Day Year
13 Treated Water
~iL Untreated Water
Time Collected
Collected By
Plez~ Print
Analysis shows this Water SAMPLE to be:
Satisfactory
Unsatisfactory
[] Sample over 30 hours old, results may
be unreliable
Sample too long in transit; sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
new sample via special delil/ery mail.
Time Received ' ;z4 ¥ 0
Analysis Began ] (~ ~
Analytical Method: 'l~Membrane Filter
,tn MMO-MUG
* Number ofco~onias/100 mi.
suit* Analyst
Fbks Jun
Date: Time:
Client notified of unsatisfactory results:
Phoned Spoke with
Date: Time: .
BACTERIOLOGICAL WATER ANALYSIS RECORD
MMO-MUG Result: Total Coliform E. Coli
Membrane Filter: Direct Count C') Colonies/100 mi
Verification: LTB __ __ BGB. COLIFIRM
Comments:
Fecal Coliform Confirmation
Final Membrane Filter Results
Reported By '~--~-~-~ Date
Coliform/~ O0 mi
[]
Faxed
[]
Faxed
TNTC ' TOO Numerous To Count
OB = Other Bacteria
~l~~ Member of the SGS Group (Soci(~t6 Gbn6rale de Surveillance)
J
ENVIRONMENTAL FACILITIES iN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI. NEW JERSEY, OHIO, WEST VIRGINIA
APPLIC'-'" IT FILLS OUT UPPER HA1 '" ONLY
Preperty Owner "7"-~; 7~ ~J~""~ Phone
Mailing-Address ¢/'~ .4 ~'0~/ ~/0~ d Zip Code
Buyer
Address Zip Code
Lending InstitutiOn Phone
Address AI~ ~t~ )' Zip Code
Realty Co. & A~nt Phone
Address Zip Code
Legal Description /0~ ~ ~/ ~ ~4'~ ~J~ ~ ~
Street kocati~ ~
Type of Resi~nce
~Single Family
~ Multiple Family No. of Bedroo~~
~ Other
Water Supply
~ Individual A~ACH WEgL LOG. A wall log is required for all wells drilled s~nce June 1975.
~Community For wells drilled prior to that date, give well depth (altach og if available).
~ Public Utility
Sewer Disposal
~lndividual Year Individual Installed:/~,~ '~
~ Public UtBity When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date '~,
Inspector Inspector Inspector Inspector
Field Notes:
(!:"~' 2 ,-'. 198~
RECEIVED
( ~ ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
BY:DATE
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
72-023 (3182)
CONSTRUCTION AND OPERATION CERTIFICATE
ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION.
PUBLIC WATER SYSTEM
APPROVAL TO CONSTRUCT
Plans for the construction of / O"~' ' ...~ ~ >¢' "· ,~ ¢~,- i~'.. ' ' ,..-. '"/J'!.;i"; .... ',~t
r/ ]~' '' t. ~, '11~/' ' ':'"'-, ¢~.. ~.-~ ?'~q -- J .:,'" ¢~ -"', -' 4' ?'¢ '. - ("J' ' public water system located
, Alaska, submitted in accordance with 18 AAC 80.100
have been reviewed and are
[] approved.
[] conditionally approved (see attached conditions).
.,, ,..;, ,. ; --~ ..
BY TITLE ' -
DATE
If construction has not started within two years of the approval date, this certificate is void and new
plans and specifications must be submitted for review and approval before construction.
APPROVED CHANGE ORDERS
Change (contract order no. Approved by Date
or descri ~)tive reference)
The "APPROVAL TO OPERATE" section must be completed before any water is made available to
the public.
APPROVAL TO OPERATE
The construction of the '~ :.; i_ ,-~ ' ~ :~.' ~'- '¢: ,,' ~ - ~ ~. ~)ublic
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 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.'approval to ope[a_,te.
BY TITLE DATE