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HomeMy WebLinkAboutSAND LAKE #2 BLK 3 LT 22nd Loke lock 3 Loi' 22 011-134 -03 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 Page of www.cLanchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: 0SPl11156 PID Number: 011-134-03 Name: Frank Box and Beverly Churchill Wastewater System: [] New [] Upgrade Address: 8030 Seaview Street Anchorage, AK 99502 ABSORPTION FIELD Phone: Number of Bedrooms: 3 [~ DeepTrench [] ShallowTranch [] Bed [] Mound [] Other: Soil Rating: Total Depth from odginal grade: LEGAL DESCRIPTION 1.2 GPD/Ft2 10.9-12 Ft. Block: 3 Lot: 22 Subdivision: Depth to pipe bottom from odginai grade: Gravel depth beneath pipe: Sand Lake No. 2 5.9-7 Ft. 5 Ft. Township: Range: Section: Fill added above odginal grade: Gravel Length: .5-1 Ft. 46 Ft. Well: [] New [] Upgrade e~ve~width: 3 Ft. Number1 of lines: I Dist .... _ between lines:Ft Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material: Class C Ft, Ft, 460 Ft2 ASTM D3034 PVC Ddller: Date Drilled: Static Water Level: Installer: Date Installed: Ft. , Whitters Excavating 8/3-5/2011 Yield: GPM Pump Set at: Ft. Casing Height Above Ground: Ft. TANK SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other: T~ To Septic Absorption Lift Holding >ublic/Pdvate Manufacturen Capacity: ~rom~ Tank Field Station Tank Sewer Line Existing Gal. Material: Number of Compartments: Well >100' >100' N/A N/A >25' Surface WaterLot Line >100'>5, >100'>10' N/AN/A N/AN/A ~ Size: Gal.Manufacturer:LIFT STATION "Pump on" level at: "Pump off" level at: in. High water alarm at: Foundation >5' >10' N/A N/A in. in. Pump Make & Model Electrical inspections performed by: Curtain Drain None Noted Remarks: Existing Septic Tank Exposed, Inspected and Verified Sound. BENCH MARK Location and Description: Flow Diverter Valve Placed. Existing Absorption Trench Finished Floor. Assumed Elevation: Connected for Future Use. Second Post Tank Cleanout 100.0 Ft. Was Found Inoperable and Removed. Inspections performedby: A. Harala Dates: 1at 8/4/2011 2nd 8/5/2011 Development Services Department Approval Conditional Approval Date: Reviewed and approved by: ' te: ,¢~ ',:~ - / 50.00 SOO'OO'OO"E Z --5 ® · Seoview Street Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT 4700 EImore Road Anchorage, AK. 99519-6655 - 343-7904 On-Site Wastewater Disposal System or Well Inspection Report Permit Number: OSP111156 Page 3 of 3 PID No. 011-134-03 ~ Existing Grade ~H~ ~'-~I Geotextile Fabric ~~.. 87.5 ---/ = = 87.5 92.5 -~ Drainfield Rock ~_~ ~92.5 } 75.4 46' (Center Line Trench Length) No Groundwater X~ NOTE: Trench Only Placed Under This Permit. Existing Septic Tank Verified Sound For Continued Use. PROFILE AS-BUILT No Scale Permit Number: Tax Code Number: Work Type: On-Site Wastewater Disposal System Permit OSPl11156 011134O3OOO 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: July 26, 2011 to July 25, 2012 Design Engineer: ANDERSON ENGINEERING Subdivision: SAND LAKE #2 Site Legal Address: SAND LAKE #2 BLK 3 LT 22 G:2224 Owner/Address: BOX THOMAS FRANKLIN & CHURCHILL BEVERLY ROBINSON 8030 SEAVIEW ST ANCHORAGE AK 995024165 Site Mailing Address: 8030 SEAVIEW ST, Anchorage Lot Size in Sq Ft: 6750 Total Bedrooms: 3 This permit is for the construction of: Y Disposal Field N SepticTank 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. Received By: ~'~W,~.~,,v~, ~2r~_.~2 Date: 7/Z~7/' i, ~ Issued Municipality of Anchorage P.O. Box 196650 · 4700 Elmore Road Anchorage, Alaska 99519-6650 · (907) 343-7904 · Fax (907) 343-7997 http:llwww.muni.or.qlOnsite Development Services .Department On-Site Water and Wastewater Pro.qram **** VARIANCE/WAIVER REVIEW **** Waive~: OSPl11157 COSA#: Permit~: OSPl11156 PID#: 011-134-03 Legal Description: Sand Lake #2 Block 3 Lot 22 Engineer: Anderson Engineering Applicant: Franklin Box and Beverly Churchill 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 1.0 foot. An additional field to field waiver is granted. The proposed field may be 7' from the existing field on the lot and 9' from the fields on lots 2 and 3. This waiver approval applies to the proposed absorption field only. Any furore 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: ~7/.~.~//' Approved by: Name of Reviewe[/ Rec#: 071708 Amount: $200.00 Date Paid: 7/11/11 **** VARIANCE/WAIVER REVIEW **** UNICIPALITY OF Community Development Department Development Services Division On-Site Water & Wastewater Program Mayor Dan Sullivan ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 011- [3~ - 05 Property owner(s) Mailing address ~:~ I Site address Legal description (Sub'd., Block & Lot) <~A--,~,t i~.J~,.~' /'Jo. ~; Legal description (Township, Range & Section) Lot Size ~-', '7 r50 Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR: ([~ all that apply) Absorption Field Septic Tank Holding Tank Privy Private Well Water Storage THIS APPLICATION IS AN: Initial [] Upgrade '~ Renewal [] THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: 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. (Signature of property owner or authorized agent) e~____~j/rm Rush Fees: Date of Payment: Receipt Number: Permit No.~'"'?~,, i© i ~.i',3 kc Waiver Fees: Date of Payment: Receipt Number: Waiver No. G:\Building\On Site\Forms\Client Forms\Permit App_010411 .doc (Rev. 1/11 ) ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) July 10, 2011 Municipality of Anchorage Development Services Department On-Site Water and Wastewater Program 4700 Elmore Road Anchorage, AK 99519-6650 Subject: Lot 22, Block 3, Sand Lake Subdivision No. 2 Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The existing absorption system on the subject lot has failed and must be upgraded prior to issuance of a COSA. We are therefore requesting a permit be issued for the upgrade of the septic system to accommodate the three-bedroom home on the lot. The attached Site Plan and backup documentation identify the location and configuration of the existing and proposed septic system. The existing 1,000 Gallon Septic Tank will be uncovered, inspected and tested and verified sound for continued use. If it is found defective it will be replaced with a new 1,000 Gallon Septic Tank. The existing absorption trench will be left intact and tied to the new system with a flow diversion valve. Also identified on the plans are the locations of the existing well on this and adjacent lots and adjacent septic systems. All Class C Wells in the area have blanket waivers to 100'. We are currently working with ADEC to acquire new waivers, if necessary. Protective radii are shown to the adjacent wells. Drainage arrows are shown indicating the current drainage patterns. The drainage patterns will be maintained after construction. The test hole recently placed on the lot indicated Poorly Graded Sand (SP) at a depth of 7.5' and extending to the bottom of the hole at 23'.. The percolation rate was determined to be 3 minutes per inch. We have designed the new trench with an application rate of 1.2 gallons per date per square foot. We are proposing to place a 49' long (outside measurement) trench by 3' wide with a 5' effective depth. The total depth of the system will be 13' with the distribution line at 8' below the existing surface. The test hole was placed to a depth of 23' with water monitoring ongoing. No groundwater was detected during the excavation of the test hole and none has developed to date. Lot 22, Block 3, Sand Lake No. 2 July 10, 2011 Page Two The ground surface on the lot is virtually flat in the area of the absorption trench. The trench will be placed parallel to the contours of the ground as much as possible and in conformance with design criteria. A minimum of 100' will be maintained between all components of the septic system and all wells and from any surface water in the area. If the system is constructed in accordance with our design the following statements apply: o The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments SAND LAKE SUBDIVISION LOT 22, BLOCK 3 NO. 2 I - 0 I .... SS I I ~'--~ West 80th Avenue "~- ---SS Ex~xting 12" DIP Sewer Main 135.00 k \ ~ 155.00 ' ' I ~ AWWU Sewer Service / o (1} / // © I · / / / x / / / '~< / us / / / / / AREA MAP SCALE 1' = 50' 0 Z 0 Ld(.P 3.00,00.00S E O0'Og 7 LOT 22, BLOCK 3, SANDLAKE SUBDIVISION NO. 2 DESIGN FACTORS: SYSTEM REQUIREMENTS: Three Bedroom House Deep Trench System Perc. Rate: 1-5 Min./Inch (Est.) Existing 1,000 Gallon Septic Tank Application Rate: 1.2 GPD/SF 5' Drainfield Rock 3 Bedrooms X 150 GPD/1.2 GPD/SF (Application Rate) = 375 SF Absorption Area 375 SF/10 SF/LF -- 37.5 LF Trench Length THEREFORE: Construct an Abosrption Trench 49' Long (Outside Dimension) x 3' Wide x 5' Effective Depth. Flow Line Elevation in Trench to be 8' Below Original Ground Surface. Total Depth to be 13' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption Trench. ,6I, 1011 Natural Backfill Geotextile Fabric 4" Perforated PVC (Holes Down) -- Drainfield Rock TYPICAL 5' WIDE TRENCH SECTION NOTE: Grade Area Over Trench to Drain Away. , ~ E Minimum 6' Separation From Bedrock. ~ ............... ~....,.. Minimum 4' Separation From Groundwater. Minimum 100' Separation From Wells in the Area. -~-~ ','~'~ No c~e~ Minimum 100' Separation From Su~ace Water ,e?~.~...~ Legal Description: -~' OF Municipality Of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater ProgYam 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.ci.anchoraqe.ak.us (907) 343-7904 Soils Log - Percolation Test 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS 5- 6- -t ' '~'~'~ WAS GROUND WATER J '~/~,~.J ~ll~. ENCOUNTERED' S IF YES, AT WHAT DEPTH" ~' ~/~ ~ Depth to Water After p Monitoring? ~ E Township, Range, Section: Site Plan TEST RU,N BETWEEN -'~ V-,'¢~ FT Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE. ,.~ (minutes/inch) PERC HOLE DIAMETER AND -;~ FT PERFORMED BY: /~,,.r~ o i CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) July 10,2011 Municipality of Anchorage Development Services Department On-Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Lot 22, Block 3, Sand Lake Subdivision No. 2 Separation Distance Waiver Absorption Trench to Lot Line Dear On Site Services Engineer: Lot 22, Block 2, Sand Lake Subdivision No. 2 is only 50' wide with very little area for a septic system upgrade. Sufficient area has been located at the northwest corner of the lot which will support a new absorption system. This area, however, encroaches into the 10' setback from the property line. Soils at this location are well to poorly graded sandl with silt which is normally effective in the absorption and treatment of septic effluent. Placement of the absorption trenche within 1' of the lot line will not adversely affect neighboring lots. We hereby recommend a lot line waiver be issued allowing placement of the absorption system within 1' of the northern and western lot lines. Sincerely, Michael E. Anderson, P.E. ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) July 25,2011 Municipality of Anchorage Development Services Department On-Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 22, Block 3, Sand Lake Subdivision No. 2 New Absorption Trench to Existing Trench Dear Onsite Services Engineer: Very little area is available on Lot 22, Block 3, Sand Lake Subdivision No. 2 to construct a new absorption system. Sufficient area is available for the new absorption trench but it will encroach to within 7' of the existing trench. Most if not all of the absorption will be through the bottom of the new trench and will not migrate toward the old trench. The extreme east end of the northerly absorption trench on Lot 3 is 9' from the proposed trench. In addition the south end of the absorption trench on Lot 2 is 9' from the proposed absorption trench. The effective depth of this trench is 6' so the required separation is 12'. A waiver is also requested from the extreme end of this trench. We recommend the new trench be placed at 7' from the existing trench on the lot and at the distances noted above from the adjacent trenches. Sincerely, Michael E. Anderson, P.E. °°73 ..- ~ 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 blofio.; ) LEGAL DESCRIPTION ,~ DISTANCE TO: JWell ~0~' Abso~ptionarea 9, Dwelling/F` PERMiTN~2~/~ ~ Manufacturer ~ Material ~ ~ ( No. of compartments Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O Z ~ Manufacturer ~ --~ ~ Material Liquid capacity in gallons ~ ~ ~ DISTANCE TO: ~ ~ ~ No. of lines ' Distance between lines~ --~ / Length of each lin~/ Total length of Hn%.¢/ Tron~5'~h' ~incho' Total offectivo,~sorption area *~ Top of tile t. finish grade Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ¢ DISTANCE TO: Well Building foundation Nearest lot line ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: BuJldfng foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS E Z SOIL TEST RATING - REMARKS I APPROVED DATE LEGAL F! P F' i.~ I C F,' N T i '" F'FFF T - ~.~ L..22 B2-": S.RN,L') LAk'E ,~;~2 LOT' SiZE T'T'Pg' ....... AF c'r",..,_.T .......... F~8c, - t-~'P'T I FiN S'¢5;'TEH ,T ....'<: TRENCH ..................... I- ....... FEET TIqE' RE(:.:!UIRED S]:-2'E Ii[ T-Ic' .... , ,t ...: 51L:! t L RBSORPT I ON S'T"5'TEH I S ' ]"FIE LENGTH DZMEN.5;!Ohl IS THE LENGTH (ZN FEET) OF' THE TREN(.':H 0[;.': C, RF:I:(NFZELD. THE DEF'TH OF R TRENCH OR PIT iS THE DISTF!NCE E~ET!4EEN THE 5URFRCE' 0[:' ]'HE GROLi.NE:, P, ND T'HE DO"f"TCIH OF ]-HE E;:-:;C:F!VRTi'ON <IN FEET). THEF.:'E !S N0 SET F!i[::,]'H [:OR TRENCHES. THE GRR'v'EL DEF.'T.hl :I:S THE MiNIMUI',! DEPTH 0[:' GRR'v'EL BET[tEEN THE OLITF'FiLL. P'[F'E FIND THE DOTTOi"! OF' ]"HE E?-,'CR',/RTION ,:.':[N FEE]'). PEF. fi'ITT F:IF'F:'L)~C.:FIh!T lqFlc ]',LIE ~?c':'<,'",,,-.-c~- T",- . ~ . ...... . ..... ' ........ ~ .. !.~.::, i..,:,. L ;. ]:rqETFILLF:ITION .........!'i%I':PFC'TT-t'.i"-:.~ . O[: ,c.~*i'-,,,, t.'.IEiL. LS I:~F.:'-..i'F!'_'Eh T Tr].._ THIS F'F.':OF'EF~:T"r' F:!N[:, THE · .:...-}' .:,.'_',~.. (]F F?.'~:':'Tp~-,.,'"F,:' ....... ,.- - ................ El .......... 'THR'I" THE: !.,If-:' .L!xLL E:FH-I.:'F'T Tt'.J3 OF: g!h,!'.? ':' ,"-r-F.'-.4 !.,.lfTi..iO.I]" F'rNfiL Z!'-,ISF'EF-r'"L-~hi FiND FIPF'r~:'E',,'A_. ECT' '"~ ~'- ................... ,1 .::, r.:. ............... I ~-} ± DEPP. RTME'r.,Fr' N?.LL BE SLtB,)'EC:T T'O F'RO'SE': HINIMUH DIS'TRNCE BE'r'HEEN R k!El._L RBi[:, RN'.,,-' ON-SITE SE!.qRGE D!SPOS;F~,L. S?57'FEM Z00 FEET FOF.: F! PR!VRTE NELL [)Fi: iDE~ TO 2g~,':3 [':'['!ET' FROM Ft PUBLIC .klEL.L E.',E!:::'EFiDZI'.,IG UF'ON 'THE T'¢F'E OF PUBLIC 1.4ELL. HINIHUH D!S'TFir,iCE FROH R F'Ri',/RTE !.,-!EL.L. 'FO R F'RI'v'FITE SEF.iER LIr.,IE IS 25 F:EET FiND 'TO F[ COHHUr,!'[T? 5El.,.i[-i:R LZh!E i5; 75 FEET. OTHEr-;;: REr/.!UIREHENT'S HRh.' Ffi::'PL.?. F;PECIF_T. CRT:[(}NS Fl!'.~D CONS'T'r;.:UCTZON i.'.:,IFIGRRM5 FiRE ~',,,'FIiLRBLE TO ZNE;t..IRE PROPER ir4E.:,TRL. LFiTI['ir,[ ! CERTIF"r' T'HFiT i: .,r. Fir"! F'F!MI'L.!F!R NITH TIqE REQU!REHENTE FOR O!'4-:;S!TE 5--;ENERS Ff. ND FIELL.:'5 FIS SET FOF.'Tiq B"r' THE HUN:[C:£F'FILIT"¢ OF FiNE:HORFtGE. 2: ~ kiILL !NSTFiL. L. THE S'¢ETEr,'t IN FICCORDF!NCE. !.4iTH THE CO[::,E:'F;. }'.:':: I U.i',iE:,ER.STf~N[:, THF!T T.I-.iE ON--i~.SITE SEi.,.!ER S?5;TEH HF!'T' F:EQULrR['Z ENLi:::i.'RGE."MENT IF THE FREE!£:,EhiCE iS F:iEPIOE)ELED TO !NC:[.U[:,E HORE THFIN 3 L::EDROONS. F!F'F'LZE~:i?-iT HU~..,~IST CON?T' !HE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage. Alaska 99501 ' 264-4720 SOILS LOG -- PERCOLATION TEST 3 SLOPE 7 9 10 --11 12 13- I WAS GROUND WATER /~ /.~ tV(.~ ENCOUNTERED? 14 15 16 17 18 19 2O COMMENTS " 0 ~ Z te ~ Gh PERFORMED 72-oo8 (6/79) SOILS LOG PERCOLATION TEST IF YES, AT WHAT DEPTH? 81TE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop H~O - ~ ;30 ~ o.~ ~ PERCOLATION RATE L~ 8 (minutes/Mc ,CERTIFIED BY: ~y C, I~eid, Jr. '"CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT Plans for the construction of by public water system located -~' ~ -= '~:~ Alaska, submitted in accordance with 18 AAC 80.!00 have been reviewed and are approved, ~¢~/./ E; conditional y approved?ee attached conditions). 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 ~o.~.:~ or,er no. Approved by Date Or ~eic~iptive reference) Thc "APPROVAL. TO OPERATE" section ~nus p etee before any water is made available to the public. APPROVAL TO OPERATE The construction of the water system was completed on. /~b-,-'-~(~ ~, .- ~'~_ .(date). The system is hereby g~.~ed interim approval to operate for 90 days following the completion date, TII'LE'~ ~; DATE '~ As-built plans submitted during the interim approval period, or an inspection by the Department has '"' ' confirmed the system was constructed according to the apl)roved plans. The system is hereby granted .. operate. .-. fin~¢ approval to ~ - %" ~ DATE Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program f. 4700 Elmore Road 05¢ ~ ~ Anchorage, AK 99507 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF. ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 011-134-03 Expiration Date: / !- ~ "' / / GENERAL INFORMATION Complete legal description Sand Lake Subdivision No. 2, Block 3, Lot 22 Location (site address) 8030 Seaview Street Anchorage, AK 99502 Current Property owner(s) Franklin Box and Beverly Churchill Mailing address 8030 Seaview Street Anchorage, AK 99502 Day phone Lending agency Day phone Mailing address ' Real Estate~A§'ent :Mailing Add~eSS Unless otherWiSe requested, COSA will be held by DSD for pickup. 2.. NUMBER' OF BEDROOMS: Three (3) Day phone 3' TypE' OF ,WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class c Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding Tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of 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 daysfrom 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 o 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 bedi'"6br~s and type of structure indicated herein. I further v~rify that based on the information obtained from the Mu.nicipality of Anchorage files and from my investigation ahd inspection, the on-site water supply and/or Was!e~ater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and r~gulations in effect at the time of installation. ~: Name of Firm Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. DSD SIGNATURE [,,"/ Approved for Disapproved. bedrooms. Date 8/6/2011 Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev, ~ 1/05) X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: .- / / Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (9O7) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Lot 22, Block 3, Sand Lake Subdivision No. 2 Parcel ID:. 011-134-52 Legal Description: A. WELL DATA Well type Class C Date completed 4/2/82 Total depth 416 ft. If A, B, or C provide PWSID # 8221-FA-105 ' Well Log (Y/N) Sanitary seal (Y/N) Y Wires properly protected (Y/N) Cased to 416 ft. Casing height (above ground) FRoM WELL LOG AT INSPECTION g.p.m. Date of test Stati~ water level Well production WAT~ER SAMPLE RESULTS: cotifom~ - 0 colonies/100 mL Arsenic:. "50 ~.,. ug/I SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size. ·.1,000 gal. g.p.m. Nitrate N/D mglL Other bacteria 0 Date of sample: 6/8/2011 Collected by: A. Harala Date installed Number of Compartments 2 _ Cleanouts (y/N) Foundation cleanout (y/N) Y ' Date of pumping 612312011 C, C°lonies/100 mL ABSORPTION FIELD DATA Date installed 8/5/2011 Length 46'** Tdtal depth 11-12.5 Depression over tank (Y/N) N High water alarm (Y/N) Pumper Around the Clock Pumping Soil rating (g.p.d./ft2 or ~/bdrm) 1.2 SF/BDRM ft. Width 3 ft. ft. Eft. absorption area 460 ft2 Monitoring tube Date of adequacy test .New Const. Results (Pass/Fail) ~ Fluid depth in absorption field before test in. Water added Elapsed Time: ~ min. Final fluid depth Any rejuvenation treatment (past 12 mo.) (YiN & type) System type Deep Trench Gravel below pipe 5 ft. Y Depression over field N For ...... bedrooms gal. New depth in. in. Absorption rate >= g.p.d. N If yes, give date Y >18 in. 6/18/82 Y N Do LIFT STATION Date installed "Pump on" level at. , Datum in. E. SEPARATION DISTANCES Size in: gallons "Pump off" level at Cycles tested in. Manhole/Access (Y/N) .... High water alarm level at Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/In station on lot >100' Absorption field on lot >100' Public sewer main N/A Sewer/septic service line >25' Animal containment areas >50' On adjacent lots >100' On adjacent lots >100' Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas N/A > 100' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: >5' Property line >5' Building foundation VVater main N/A Wells on adjacent lots Water service line >10' >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Absorption field >5' Surface water >1oo' Property line 1'~"' Building foundation >1o' Water main N/A Water Service line >10' Surface water >100' Driveway, parking/vehicle storage 5' Curtain drain None Noted Wells On adjacent lots >100' F. COMMENTS: *** Centerline Length. **** See Lot Line Waiver. in. Receipt Number Q ~ ~;~--~'~ ~ Receipt Number (Rev. 11/05) 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 Arsenic Advisory Certificate of On-Site Systems Approval # 111292 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 22 of Sand Lake #2 Subdivision. This inspection revealed an arsenic concentration of 50 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA)'has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On-Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. SGS Ref.# 1112363001 Client Name Anderson Engineering Printed Date/Time 06/13/2011 14:04 Project Name/# Sand Lake S/D #2, L22, B3 Collected Date/Time 06/08/2011 16:10 Client Sample ID House Hose Bib Received Date/Time 06/08/2011 16:50 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic 50.0 * 5.00 ug/L EP200.8 C (<10) 06/09/11 06/10/11 NRB Waters Department Total Nitrate/Nitrite-N ND 0.100 mg/L SM20 4500NO3-F B (<10) 06/09/11 AYC Microbiology Laboratory E. Coli Negative I 100mL SM20 9223B A 06/08/11 DLC Total Coliform Negative 1 100mL SM20 9223B A 06/08/I1 DLC ~z :>~o z --I x 0 Z 0 0 NOO'OO'OO"E 50.00' 4.8~ Z cO Parcel I.D. # 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 1. GENERAL INFORMATION Complete legal description Lot 22; Block 3; Sand Lake Subdivision ,~2 Location (site address or directions) 8030 Seaview Street Anchorage, AK Property owner Mailing address Lending agency Mailing address Agent Address Frank Box 8030 Seaview St. Anchorage, Alaska USA Fedsral Credit Union P.O. Box 196613 Anchorage, AK Day phone AK 99502 243-7763 Day phone 99519 786-2823 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 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 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 MOA #21 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 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. $ & s ENGINEERING Name of Firm ~=n~ .~.,~ .;~.. L_~c~. ,,^-~ ..,- ~^~ Eagle River, Alaska 99577 Address Engineer's signature Phone 6. DHHS SIGNATURE ~ Approved for ~-~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: Date 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. 72~25 (Rev. 1/91) Back MOA#21 Municipality of Anchorage .... 44UN/C/PAttrr cvqVI E UF ANcH DEPARTMENT OF HEALTH & HUMAN SERVIa§ Environmental Services Division ~ , DIVI$10 825" L" Street, Room · 3~t3~74~4 502 Anchorage, Alaska 99501· (907) Health AuthorJtyApproval ChecklJst R£CEIVED Legal Description: Lo T- 2a. A. WELL DATA 8/.~< $ ~'~q~0~Ot~g m :~ ParcclI.D.: Oil - /3 "/ -o 3 Well type ~' L ~ s 5 C. If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed depth Cased to C~ve ground) Total Sanitary seal (Y/N) / Wires properly protected (Y/N) FROM~ AT INSPECTION Date of test ~ Static water le~W~ .W~oduction g.p.m. WATER SAMPLE RESULTS: Coliform O Nitrate Date of sample: / /~ to / '3 (o Date installed ~ / ~ 2. Tank size Foundation cleanout (~Iq) ¥ ~ £ C), / Other bacteria O Collected by: )o o o Number of Compartments ~2_ Cleanouts ~N). 3~ 3' Depression (Y/~ /~ O High water alarm (Y/~ ~ 0 Date ofPumping C//c~/q 5- Pumper C. ABSORPTION FIELD DATA Date installed (o Length 3 / Width Effective absorption area Date of adequacy test Soil rating (g.p.d./fl2 or~-~ 3 ) ~' 0 System type T.n <~ c~ Gravel thickness below pipe ~ Total depth / (~ Monitoring Tube present(~/N) ,Vi )' Depression over field CY~ ~' © Results (Pass/Fail) ~o/~ ,r j For -~ bedrooms Fluid depth in absorption field before test (in.); ~1, / ~ '~," Immediately afterg~-~gal. water added (in.): Fluid depth Z ! ~/ 4 ~"~ / (ins.) Minutes later: (o 0 Absorption rate = : q~ g.p.d. Peroxide treatment (past 12 months) (Y~) NO~ ~0w~ ~yes, give date S & S ENGINEERING i~0.i4 ~.agie River Loop Road No. 204 Eagle River, Alaska 99577 D. Lll~r STATION Eo Date installed Size in gallons Manhole/Access (Y/N) ~ High water alarm level at* / *Datum Cycles tes~ SEPARATION DISTANCES c.; ~.,q ~'..~ C SEPARATION DISTANCES FROM~'WELL ON LOT TO: ! oo t~ 4~'o 4- ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Lift station ~holding tank lot on Absorption field on lot Public sewer main Sewer/septic service line "Pump off' level at* loo SEPARATION DISTANCES FROIVt/SE~--~-~OLDING TANK ON LOT TO: / / Building foundation ~ ~ Property line ~Z ~ -P Absorption field Water main/service line ~0 'q- Surface water/drainage J00 J'7~ Wells on adjacent lots ],.CO SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ~ o 7c Water main/service line Surface ,~ater / ,.o o r, ~ Driveway~-parking/vehicle storage area (, 0 Curtain drain t~°r~L kt~o~n/ Wells on adjacent lots ) ~0 'q~ Property line F. ENGINEER'S CERTIFICATION I certify that I have determined thrufield inspections and review of Municipal records in conformance with MOA euidelirIes in effect on this date. Signature En~neer s N~e HAA Fee $ Date of Payment ~/~ Date of Pa~ent / ~ ~/ ~~ Receipt Number Receipt Number Rev. 8/95 OSS: haa.wk.doc CLIENT: HEALTH AUIHORITY APFROVALS SEWER & WATER MAIN E~TENSIONS SEWER &WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSIIE W/~STEWATE R DISPOSAL SYSTEM DESIGN 96-02-08 10:57 RCVD ADEQUACY TEST FORM ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. ~- ~,'~/'~/~( ~ 024' DATE: LEGAL DESCRIPTION: LO # OF BEDROOMS: .~ SEPTIC TANK/FIELD SEPERATION TO WELL: TYPE OF ABSORPTION SYSTEM: ABSORPTION FIELD DATA: Depression over field (Y~,~): SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Driveway, parking/vehicle storage area: Curtain drain: Foundation: SEPTIC DATA: Date of pumping: ~/~)'/¢~-- Pumper: ,~C~ O Foundation cleanout {~/N): ') ~: 5 Depression LIFT STATION: "PUMP ON" level at: ~ -- "PUI~P uFF'q~'~l-~J[i' METER GALLONS ~.~,;~) LIQUID LEVEL TIME READING ADDED ~ 7~r~ /~' ~'~," COMMENTS (TOTAL) S.T. M.T. M.T. 3.~~ ~.~ ~7~1 ~I ~ )e c, ~,~ OFF o '[ ~,~,, CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 THIS SYSTEM IS NOT GUARANTEED AGAINST SUBSEQUENT FAILURE RESULTS: 17034 NORTH EAGLE RIVER LOOP · SUITE 204 ° EAGLE RIVER, ALASKA 99577 Time Date Date Da~e Inspector Inspector Inspector Conditional Approval Date Sewer Installed Permit No. Septic Tank Size Holding Tank Size Soils Rating Well To Absorption Area Well Log Received  Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property owner ~ ~"~ ~))~. Phone Mailing Address ~7~( /~ fir Buyer Address Phone Lending Institution Address RealtyCo.&Agent ~ ~q~r [f~IrL~it~ ~t~{,~+, Phone Legal Desoription ~Z/~ ~,~ /~1~ ~ Street Location j~ul ~u Type~f Residence ~ Single Family ~ Multiple Family No. of Bedrooms ~ Other Water Supply A~ACH WELL LOG. A well log is required for all wells drill6d since June ~ Individual Community 1975. For wells drilled prior to that date, give well depth (attach log if ~ Public Utility available.) Sewp~e Disposal ~ Individual Year Individual Installed: ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.