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SAND LAKE #2 BLK 4 LT 8
Sand Lake Block 4 Lot 8 #011-135-45 Municipality of Anchorage Community Development Department Page 1 of 3 On-Site Water&Wastewater Program 4700 Elmore St. •P.O. Box 196650 Anchorage, AK 99519-6650•http://www.muni.org/onsite •(907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181295 PID Number. 011-13545 0 New U Upgrade , Name: PETER PRITCHARD ABSORPTION FIELD Address: 0 Deep Trench 0 Shallow Trench 0 Bed 0 Mound 8101 SAND LAKE*ANCHORAGE,AK 99502 0 Other Phone: No.of Bedrooms: Son Rating: Total Depth from original grade: (907) 748-1119 3 Gam,FL Ft. Depth to pipe invert from original grade: Gravel depth beneath pipe: LEGAL DESCRIPTION Ft. Ft. Subdivision: Block: Lot: Fill added above original grade: Grave • gth: SAND LAKE#2 4 8 G \�\ Ft. I ownshlp: - Range: - section: - Gravel- width: �.l\c:)'B 'Beds Number of lines: Distance between lines: !� FL Ft. SEPARATION DISTANCES Total absorption- -: Number of trenches. Dist between trenches: To Septic Absorption Lift Holding Public/Private From Tank Field Station Tank Sewer Lines SQ.Ft I Ft. Well - - - - 25'+ TANK • Septic 0 S.T.E.P. ❑Holding 0 Other Manufacturer: Capacity: Surface Water 100'+ � GREER TANK 1000 Gal. �� - N/A Material' Number of compartments:Line 5'+ �} STEEL 2 Foundation 10'+ _ LIFT STATION Curtain DrainNONE KNOWN Manufacturer: Gal. Remarks: OLD SEPTIC TANK REMOVED PER CONTRACTOR "Pump on'level at: 'Pump off'level at: High water alarm al: Pump Make&Model' Electrical Inspections performed by: PIPE MATERIAL House to tank EXISTING/D3034 Tank toeld EXISTING/D3034 d Installer WILCO EXCAVATION Drainfield EXISTING CO/MT EXISTING/D3034 Inspector GEG, Ltd. BENCH MARK (Assumed elevation) 100.00 Ft. Inspection Dates: 1st 9/4/2018 2nd Location and Description: 3rd - 4th TOP OF GARAGE SLAB ENGINEER'S S A.L Community Development Department Approval 4o�ooN.Q 4 Conditional approval: Date: v f 1ts i_. ' •.+00 411111 o -.J,f GI A. ess., I Oa. r E 7 3 ...: .Q�O fJJJMA 04 `0 °�'�•'!`. oAry Approved: Tm �c�Clund Date: 9/1 Z/18 LICENSE400apr0fesslOr%40 #AECC884 0,X .O0 .� Inspection Report_1-1-12.doc PERMIT NUMBER: PARCEL ID NUMBER: ' OSP181295 RECORD DRAWING 011-135-45 /• I / LOT5 // LOT 48 I / —— A B /—' 1 TAKEN FROM SURVEY I i� I I N ST1 24.0 30.0 I // I SAND LAKE#2:BLOCK 4, N.\ ST2 31.5 35.5 // I LOT 5,6,47,48 I DBL1 34.5 37.0 I / LOT6 / I DBL2 35.0 38.0 / I LOT 47 I / V / 1 I :rd .. \III jO �j _ \ SAND LAKE#2; • �''��'7mitiIIIfi//a -/ \ BLOCK 4,LOT 46 Q j SAND LAKE#2; :. . ''''....•1 I BLOCK 4,LOT, 0 I IS M • M ,- <. i \ `�� / N. SAND LAKE-1'4,,DRIVEWAY , i KEY BOX N/027:........BLOCK 4,LOT 45 �'---L.' • EXISTING 3 WELL IS BELIEVED 1-0-33 FEET \ BEDROOM / TO SERVE ONLY �(. W1 HOUSE/ LOTS 7,8,45 AND 46 1 �� i Apr \ / IDECI 1 61 Q , EXISTING FCO \ SHE. r NEW 1000 GALLON DEEP ill BURIAL SEPTIC TANK WELL RADAII FLAGGED BY A PROFESSIONAL LAND SURVEYOR, DBL1&2 / \ RETAINED BY THE CONTRACTOR,PRIOR TO CONSTRUCTION Z I EXISTING ORAINFIE LD \ _ _ r < I \\\` --- —iii I I Cf) I I SAND LAKE#2;BLOCK 4,LOT 9, LOT 10,LOT 43,LOT 44 09 �J9 \ o�S� \ 1 \ \ \ \ \ SCALE: V I \ 1"=40' . OF 41.' -E .det i TA . • GARNESS ENGINEERING GROUP, Ltd , :, ENGINEERING.SALES°CONSULTING • 3701 E TUDOR ROAD,SUITE 101'ANCHORAGE.AK 99507'PHONE(9071 3374179'FA%(9071 338-3248'7.EBSITE v.ww 9emessen9n...F9.com N i' ' .; PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0/� _ ey •. • ,-. s . &u a PETER PRITCHARD 907-748-1119 2 OF 3 ♦jai C 7953 •(� / LEGAL DESCRIPTION: DRAWN BY: �;...• D, i � .1 SAND LAKE#2; BLOCK 4, LOT 8 D.J.G. ♦. e•• •/ 1i- PE OF WORK: ,DATE: LICENS 44 PROFESS .:' SEPTIC TANK RECORD DRAWING SITE PLAN 9/12/2018 #AECC884 ,�II�u%lis'' PERMIT NUMBER: PARCEL ID NUMBER: ` OSP181295 RECORD DRAWING 011-135-45 FINAL GRADE=99.45-99.51 ST1 sr TOP OF TANK AT INLET=93.47 0 o TOP OF TANK AT OUTLET=93.53 — --Ml .#1– ...--n.--------Z— NEW 1000 GALLON INVERT OF BUNG AT INLET=93.09 SEPTIC TANK-10'MAX BURIAL DEPTH INVERT OF BUNG AT OUTLET=92.97 .*looms Ili 44 44 , I 1�•�••�e ,♦♦♦, . toAil Na. z .* GARNESS ENGINEERING GROUP, Ltd : 4`��e• 4.1h -1'= •' '� ♦ • �.d «•: ENGINEERING SALES'CCNSUI TING ‘• .� 0 3701 E TUDOR ROAD.SUITE 101•ANCHORAGE,AK 99507'PHONE(907)337'6179•FAX(907)3393246•15EBSITE www yemessenOneenng COM . SW •PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ♦ J- •.Game- �i PETER PRITCHARD 907-748-1119 3 OF 3 ♦♦cam'•• �g LEGAL DESCRIPTION: DRAWN BY: . \1!•• •• • SAND LAKE#2; BLOCK 4, LOT 8 D.J.G. �* 4 9 � TYPE OF WORK: DATE: LICENSE♦♦�••••••e •• P� •• SEPTIC TANK PROFILE 9/7/2018 #ECC884,1il �5S11 ��• 1 .N," ,,r,0 MUNICIPALITY OF ANCHORAGE 4.,. F vocnr On-Site Water&Wastewater Program S;. ..-....e•, PO Box 196650 4700 Elmore Road i ''`' " '- Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 http://www.muni.org/onsite j III 1)cI,artntcnt On-Site Wastewater Disposal System Permit Permit Number: OSP181295 Effective Date: 8/24/2018 Work Type: SepticTank Upgrade Expiration Date: 8/24/2019 Tax Code Number: 01113545000 Site Legal Address: SAND LAKE #2 BLK 4 LT 8 G:2224 Site Mailing Address: 8101 SAND LAKE RD, Anchorage Owner: PRITCHARD PETER Lot Size in Sq Ft: 6600 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field El 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 LSpecial Provisions: There is a 10 ft electrical easement along the west property line. This shall be shown on final record drawings. (1,rt Received By: L. 4--- Date: ♦ 7 / 8 Issued By: PILSJW.0._ CcouttrU Date: ?M r8 MUNICIPALITY OF ANCHORAG 71-1 5 6 7 4 �9 Q� • Community Development Department Phone: •07-343-7904 0/8 Development Services Fax: 987- 3-7997 •A On-Site Water & Wastewater Program °`6 Mayor Dan Sullivan 9 G 9 9 1 �` On-Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 011-135-45 Property owner(s) PETER PRITCHARD Day phone 907-748-1119 Mailing address 8101 SAND LAKE 1" g8- ( oAD, ANc- o(ZAG£ , AK 9'1 501- Site OLSite address 8101 SAND LAKE R 0 FPI . Legal description (Sub'd, Block& Lot) SAND LAKE#2; BLOCK 4. LOT 8 Legal description (Township, Section& Range) Lot Size Sq.Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (Zall that apply) Initial ❑ Single Family (SF) Absorption Field ❑ Upgrade (w/wo ADU) Septic Tank ® Duplex (D) ❑ Renewal ❑ Holding Tank ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: N/A Distance: - I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: /fir` 1.5' Waiver Fees: Date of Payment: •D 4�`�To 6Date of Payment: Receipt Number: 0622 Receipt Number: Permit No. 05Do / Waiver No. (Rev.01/11) ._ uanics GARNESS ENGINEERING GROUP, Ltd ArJva,xcd hca ,cv t9,sm,» � ENGINEERING SALES CONSULTING Dealer August 22, 2018 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic Tank Upgrade for Sand Lake #2; Block 4, Lot 8 To whom it may concern: The existing 3-bedroom home is served by a private well (serves 4 lots — see design drawing) and septic system. The existing 1983 steel septic tank was dry upon inspection by GEG employee Erik Widger on 8/13/2018. Per the owner (Peter Pritchard) the tank had not been pumped. In short, it appears the tank is in a state of failure and does not hold water. We are proposing to decommission the existing septic tank per UPC and install a new 1000-gallon steel septic tank. See attached design drawings regarding separation distances, surface water and other MOA code requirements. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. Sincerely, Ad e"r- 1/1 a ,-ss, ' E., M.S. Pre f• 3701 East Tudor Road, Suite 101 *Anchorage,Alaska 99507-1259 Phone: (907)337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com i. I // 'GEG.Ltd.HAS A 8 PAGE SPECIFICATION / LETTER THAT PERTAINS TO THIS DESIGN.TO / OBTAIN A COPY OF THE LETTER CONTACT GEG.BY PROCEEDING FORWARD WITH THIS LOT 5 / LOT 48 INSTALLATION,THE ENGINEER,WELL DRILLER. / CONTRACTOR AND PROPERTY OWNER AGREE / THAT THEY HAVE READ THESE ——•� SPECIFICATIONS AND AGREE TO ACCEPT THE - -/ TERMS AND CONDITIONS OUTLINED. / / \\ I // 1 N. / I SAND LAKE#2;BLOCK 4, N NOTE:THE CONTRACTOR SHALL // I LOT 5,6,47,48 HAVE THE SOUTH LOT LINE AND / I ALL WELL RADII SHOWN FLAGGED / LOT 6 BY A REGISTERED LAND SURVEYOR // LOT 47 PRIOR TO CONSTRUCTION. / ` ,a_ " et ••O •/ . j \ SAND LAKE#2; • ... .T`y is k;.MI 1111 IIA _=j \\ BLOCK 4 ,LOT 46 • SAND LAKE#2; !a 7 BLOCK 4,LOT 7 • I \ —— • • I•'*: f DRIVEWAY•.'';• ( \\\ 1 EXISTING / \\ HOUSE / WELL IS BELIEVED oo 33 FEET \ / TO SERVE ONLY jZ \\ W �< w -a\ / LOTS 7,8,45 AND 46 L J / 1, SAND LAKE#2; • \ // OGS BLOCK 4,LOT 45 \ / JI EXISTING FCO INTEGRITY TO BE CONFIRMED;REPAIR AS NEEDED PROPOSED 1000 GALLON STEEL SEPTIC TANK; Q INSTALL DOUBLE CLEANOUTS AFTER TANK / EXISTING SEPTIC TANK TO BE • \ / ZI DECOMMISSIONED PER UPC / I N\\\\--- ``_ _//// Q I --- v / I SAND LAKE#2;BLOCK 4,LOT 9, LOT 10,LOT 43,LOT 44 0'9°$ V \ o'3��� \ 1 \ \ N \ \\ S ALE: I \ \ 1"=40' \ ` ..4%\1►\1%11111 „...:4,I:a;6 1.::\ GARNESS ENGINEERING GROUP, Ltd , : 1iN .\* : ► . , ' • . i.. f 0 3701 E.TUDOR ROAD.SUITE 101'ANCHORAGE.AK 99507•PHONE(907)337-6179'FAX(907)338-3246'WEBSITE ww.gamessengineenng.corn PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0 4 A •ey A. arness PETER PRITCHARD 907-748-1119 2 OF 2 •�� ' C -79 3 °4= PROJECT/LEGAL DESCRIPTION: DRAWN 8Y: . °°••.,.1j ZZ 1 . •'•(• SAND LAKE#2; BLOCK 4, LOT 8 D.J.G. I. ♦ p�,,,_ ••_,* 1,\, 44, TYPE OF WDRK: DATE: 41LICENSE I ;;;"**** SEPTIC SYSTEM DESIGN UPGRADE 8/22/2018 #AECC884 I1 9.7\4 e/ 9D LEGEND: SET • FND �oo' .0" pO 5/6'R8 w/CAP O 5/6' R8 0 0 ,g 0 pts• A1.,1ON. �AloKvuENT NOTE: LANTECH HAS NOT EXAMINED THE �O'``! ' ....,CqsA FENCE-E-TACK O x- x — DOCUMENTS THAT CONTAIN THE 3' R.O.W. pA\Q'•' .! OvERHAi C- TAKE. O, TH y O MOMMEN p e . 4 g— e po c.c.s_ I � CONCRETE- I • J C�,- G'� ASPHALT- I 1 VA t GRAVEL- I 1 Q0' nrleth L. Greyer, 0t'0 SEPTIC s�tAwovtaEQ O +, LS-8202 a p r v 1% ,essonO �DOOOoo '�\�c�� LOT 46 S ROW TAKE ry LOT 7 in 30' x X y � S 8�'55'0Q' EY r135.00' Y—Y Y-�—Y �Yy T -:�1X 0l o111. • ' 24.2 x Q 0 x o i a2% 1 LiJ = EXISTING • k Y N HOUSEeN LOT 8 I LOT 45 m o 0 . i0 o r x 4 o Q o 0 z 0 45.3 24.2 v' 1 ..s ; i•rn \ SHED i • C 30' r TuY Y Y I Y_ '1...- —.--Y - N89'S5'00"W 135.00 LOT 9 LOT 44 • • AS-GUILT OF: LEGAL DESCRIPTION: 0"0e"e0 "n KATH1 JOHNSON .3,'•, .--s ,?_. - with JACK WHITE COMPANY Ss':'; "... LiaritemErl LOT 8, BLOCK 4, SURVEY'CERTWFICAfON: LAN TECH hos conducted a physical survey of this properly as shown on this droving and thot the knprove.nents stunted thereon LAND & CONSTRUCTION SURVEYORS-PLANNERS-ENGINEERS ore within the proprtr lines and no encroochments exist other thon noted. 440 WEST BENSON BLVD. I 103 SAND LAKE SUBD. NO. 2 EXCLUSION NOTE: It is the o.neri responsbiity to determine the existence ANC1tORACE. ALASKA 99503 562-5291 (fox)561-6626 of ony soirenents. coxenonts, or restrictions .rich do not oppeor on the w III wrw ..x.. x.[ xw .....a recorded subdivision plot. NOTE: Under no chcurnstonces should any dote WOW 98-L-743A1 1'-20' I OCT 15, 1998 89 2224 KEN 424/76 ( PLAT P-176 hereon be Ased for construction or for establishing property lines. (,~ 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 r PHONE ._~ ~NEW MAILING ADDRESS LEGAL DESCR~PT~O~ ~' LOCATION ~ ' ~ DISTANCE TO: IWell ~ b~' 'Absorption area~. / [ V~ ~1~*ellin~'~' ~ ~ Manufacturer Material No, of compartments Liq. c~pacit~ in gallons ~ Inside length Width Liquid depth ~O ~ IFHOME~DE: ~ --- ~ Well Dwelling PERMIT NO. DISTANCE TO: ~ ~ ~ Manufacturer Material Liquid capacity in gallons ~ Fgund~Jon :~2 DISTANCE TO: Well ~00~¢, , Nearest lot line No. of lines J Length o; e2 12~, Total ,oegth of IiZx / Trench width¢.einches Distance between lines ~ G Top of tile to finis6 grade Material beneath tile ' Total effective a~o[p~ion area ~ Length Width Depth PERMIT NO. ~ ~ Type of crib Cr~b 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: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL =EST~ATI"" 2 " , INS~LLER REMAR~I I ' -- APPROVE~ DATE LEGAL 72-013 (Rev. 3/78) Permit # Applicant: ,MUNICIPALITY OF ANCHORAGE.-~ Department'~ '[ Health and Environmenta[ .~rotection 825 ~ Street, Anchorage, AK. ~9501 * * * HANDWRITTEN PERMIT * * * WELd_ AND/OR ON-SITE SEWER PERMIT Location: Phone Number: Legal Description: L ~ ~ -~/~7~ ~' Lot Size: Type of Soil Absorption System Is: Trench: ~ Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) /O0 The Required Size of the Soil Absorption System Is:' DEPTH /,~-- LENGTH ~2~ . GRAVEL DEPTH '~ WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDI-NG) TANK SIZE = /O~O GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31~ 1 9 8 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that~ bedrooms. SigneS ~ ',/DT~. Issued by: ~ Applicant Date: ~CL ~ ~ SWP/024 (1/81) SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264~,720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST COMMENTS .5' PERFORMED BY: {% ~ SLOPE SITE PLAN of' 72-008 (6/79) WAS GROUND WATER /'~ ENCOUNTERED? I - 0 [ O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST UN BETWEEN ~ FT CERTIFIED BY: CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION . PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT Plans for the construction of ]_,o-J~ ~/' S'~ ~ (¢~ ~ ~ approved. BY .public water system located , Alaska, submitted in accord.~nce with 18 AAC 80.]00 have been reviewed and are tC-/ [] conditionally approved (see attached conditions). DATE If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. APPROVED CHANGE ORDERS Change (contract order no. Approved by Date or descriptive 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 public water system was completed on (date). The system is hereby granted interim approval to operate for 90 days followin9 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 operate. BY TITLE DATE TO"W~Om It May Concern 3~p,: ; : jE%o F MEsSy%GE The attached permits with the installation as-builts are Valid Permits. A permit only expires, if ~ne On-site sewer system and well:have NOT been installed during the year of issuance.~ REPLY ~ SIGNED DATE ~=~,r-~,,,u~-~:~. 4S 412 SEND PARTS 1 AND 3 WITH CARBON INTACT - PART 3 WILL BE RETURNED WITH REPLY. DETACH AND FILE FOR FOLLOW-UP NOTE: Public water 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 XXX NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1191) Fronl MOA #21 • • Municipality of Anchorage i_ On-Site Water&Wastewater Program 5 I ° (907)343-7904 � s sF. ` SEP 0 7 2018 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL ti c , 6 L9 q Parcel I.D. 011-135-45 Expiration Date: _ -• t G - o I 1. GENERAL INFORMATION Complete legal description SAND LAKE#2:BLOCK 4,LOT 8 Location (site address) 8101 SAND LAKE*ANCHORAGE,AK 99502 Current Property owner(s) PETER PRITCHARD Day phone 907-748-1119 Mailing address 8101 SAND LAKE*ANCHORAGE,AK 99502 Real Estate Agent RHONDA PRICE Day phone 907-830-9791 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 On-site U Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well U Community On-site ❑ Public Water System ❑ Public Sewer ❑ WaiverNanance request for N/A Distance: - • Received by:, Date: / ! 1 -//8 COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee$ 5220 Waiver Fee$ Date of PaymentI i��I Date of Payment Receipt Number C3p3'306 Receipt Number COSA# 05C1? 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 GARNESS ENGINEERING GROUP,Ltd. Phone 337-6179 Address 3701 E.TUDOR ROAD,SUITE 101 "ANCHORAGE,AK,99507 Engineer's Printed Name JEFFREY A.GARNESS,P.E. Date 9)7)/ € Engineers Comments: In conducting this evaluation,GEG provided an engineering evaluation of the well and/or septic system in accordance with the .��sSU\ ,, guidelines and regulations established by the Muniapality of Anchorage and industry practices.The reported results describe the .�-( rO condition of the system/s on the dafe/s of the evaluation.Separation distances were measured to readily identifiable features. .� \� ,' 4 f♦♦ Hidden defects or encroachments may exist that were not identified during the evaluation.The operational life of all wells and septic ��'��•'•' •. ♦♦ systems depend on a variety of variables including,but not limited to,soil conditions,groundwater levels(that may fluctuate during 1 •• the year),quality of construction(materials and workmanship),and the water usage of the family utilizing the system/s.These4 I. .. * ♦♦ conditions can vary,and are outside the control of GEG.Satisfactory test results do not guarantee Mum performance of the (1°4 % system's therefore,GEG makes no warranty(express or implied)regarding the future performance of the well or septic system. M • GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the /„ ,,,, current systems fail.The content of this report is for the sole benefit of the person/party who retained GEG.Reliance upon the ♦�`' t ♦ J ley A. am s :t information provided in this report by any other person or party,including but not limited to subsequent property purchasers,is not ♦♦ C E 795 •'- '.:" • authorized.In short,GEG disavows any legal duty to anyone other than the perso'party who paid for!his report ♦♦ 4' 0 r 6. DSD SIGNATURE ..<(4),,4)..,...-so.'''••... . �.Pte • : tri PROFESS\C� �4 LICENSE II,•. ��_4 #AECC884 System#1 Approved for -3 bedrooms. System#2 Approved for bedrooms. 1 vi 't:. Disapproved. Conditional approval for bedrooms,with the following stipulations: ON-SITE WATER AND .} WASTFWATER 't. PROGRAM t By: I�A-�u t'fi QLU -1 I i rY .c,,L_6.41 d Original Certificate Date: 31, 1,2/ 2018 The Municipality or Anchorage Develop,emt Services Division(DSD)issues Certificates of On-Site 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 X Nitrate Advisory V Septic System Advisory Arsenic Advisory ( Well Flow Advisory Other (Rev.10112/121 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: BLOCK 4, LOT 8 Parcel ID: 011-135-45 A. WELL DATA COMMUNITY WELL Well type If A, B, or C provide PWSID# Well Log (Y/N) Date completed Sanitary seal (Y/N) Wires properly protected Total depth ft. Cased to ft. Casing h-': above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well . e.•ction g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 ml. Nitrate ND mg./L. Collected by: - GEG, Ltd. Arsenic: 34.4 ug./L. Date of sample: 8/29/2018 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 9/4/2018 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping NEW Pumper - C. ABSORPTION FIELD DATA `BELOW EXISITNG GRADE Date installed 12/5/1983 Soil rating (g.p.d./ft2orfbdr� 100 System type DEEP TRENCH Length 26 ft. Width 4 ft. Gravel below pipe 6 ft. Total depth "11.5 ft. Eff. absorption area 312 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 8/13/2018 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 644 gal. New depth 14 in. Elapsed Time: 120 min. Final fluid depth 8 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) NONE KNOWN If yes, give date - • SUMP EXTENDS APPROXIMATELY 54 INCHES BELOW THE LATERAL LINE • PER OWNER, THE HOME WAS PARTIALLY VACATED ON 7/1/2018 AND COMPLETELY VACATED ON 7/15/2018 D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off'level at .• wa er alarm level at in. 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 On adjacent lots Public sewer main Pu• ' - —ver manhole/cleanout Sewer/septic service line Holding tank Animal co -.- - areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ 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 `0' Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS PER THE INSPECTION REPORT THE TRENCH LENGTH IS 26 FEET.AS CAN BE SEEN ON THE ATTACHED RECORD DRAWINGS,A SMALL PORTION OF THE TRENCH MAY BE LOCATED UNDERNEATH THE DRIVEWAY .''1vas•itliIn .4 OF 4 4• G. ENGINEER'S CERTIFICATION ,`P,,.•••"""" ...4 .t.'♦ I certify that I have determined through field inspections and Ala9 �'� , •0 review of Municipal records that the above systems are in • conformance with MOA COSA guidelines in effect on this • date. %�; ,f.e . Garn-ss;•'•i• Engineers PrintedName JEFFREY A.GARNESS �•%%j;: CE— •'Z= a / ..♦'Fo 4 171/* ,,\ • . Date / i t S� 4• / LICENSE I I ES ''4 #AECC884 ��"� (Rev.10/12/12) MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT • f 907-343-7904 On-Site Water and Wastewater Section ` ' Fax: 343-7997 www.muni.org/onsite Arsenic Advisory Certificate of On-Site Systems Approval # OSC181470 Subdivision: Sand Lake #2,Block 4, Lot 8 A water sample revealed an arsenic concentration of 34.4 micrograms per liter (ug/L). 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. Mailing Address:P.O.Box 196650*Anchorage,Alaska 99519-6650*www.muni.org PLAT NO. P- 176 SAND LAKE SUBDIVISION NO. 2 LOT 8, BLOCK 4 6,750 S.F. WELL EI I x N 90°00'00"E 135.00' • , x x x 44.4? A x A s n A A—,,—A—n--A---x---A—A—A X X X N CO x CONCRETE—b' I 24.0' f co x O b A.C. DRIVE KE BOX I b g - i � Y W o EXISTING b i b QJ 30' 0 BUILDING 00 p O • • = O ZO SEPTIC SYSTEM 0 I °O Q O a I O U) Z I DECK �' % Z • 24.0' 12.2' 10.1' I .—j'--3' RIGHT-OF-WAY TAKE • (8K 257, PG 349) -. + SHED 0 1 • N x x x ,. A N 90°00'00"E 135.00' 1 "=20' AS - B U I L T I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO 006\■1 GASTALDI LAND ENCROACHMENTS EXIST EXCEPT AS INDICATED. 44 OF A '♦ SURVEYING, LLC IT IS THE RESPONSIBILITY OF THE OWNER TO • ' '•••"••• 4 4 �1 JEFF A. GASTALDI, R.L.S. DETERMINE THE EXISTENCE OF ANY EASEMENTS, • ,`P•.•' •.••S,- •' 2000 E. DOWLING RD., SUITE 8 COVENANTS OR RESTRICTIONS WHICH DO NOT - * 4TH• •.•* ANCHORAGE, ALASKA 99507 APPEAR ON THE RECORDED SUBDIVISION PLAT. ■ j PHONE 248-5454 UNDER NO CIRCUMSTANCES SHOULD ANY DATA • v • ■ HEREON BE USED FOR CONSTRUCTION OR FOR 0 • .1e ery A. Gosloldi •: t GRID DATE 445-6091 f, 2224 9/7/2018 ESTABLISHING BOUNDARY OR FENCE LINES. w�TSP'••;/7/ -($••••�,c' •Alb ANCHORAGE RECORDING DISTRICT, ALASKA �.. A'ofess;onol -°�.0° F.B. JOB NO. �`,■,,�� 10-08 SLS284 NOTE : NO CORNERS SET THIS DATE. 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. 011-135-45 1. GENERAL INFORMATION Complete legal description Expiration Date: SAND LAKE #2 BLOCK 4, LOT 8 Location (site address) 8101 SAND LAKE ROAD, ANCHORAGE, AK 99502 Current Property owner(s) VANA REINO Day phone Mailing address 250 AUSTRALIAN AVE S. #1504, WEST PALM BEACH, FL 33401 Lending agency Day phone Mailing address Real Estate Agent ART CLARK Day phone 223-5545 Mailing Address Un/ess otherwise requested, COSA will be held by DSD for pickup. 2. NUMBEROF BEDROOMS: 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 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 vedfy 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. DSD SIGNATURE Approved for Disapproved. Conditional approval for Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 11/06/2010 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of:the well and septic applies only to the conditions as of the day tested. The flow and. abSorptiOn rates may change dueto subsurface conditions that may not be observed from the'surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future ' ~ ~"":OF':: ':~ :' ;'"~" occupants or can ArcTerra guarantee that no unseen .:.~~., ........~.~.. '... - :.'. encroachments, deficiencies or discrepancies exist. ..:~.:~. ,..... ...... ~! .... bedrooms. bedrooms, with the following .... d(~' , st~pulafion~,.~ .. ;'--', ,~ WATER AND : m: : wastEWatEr:' Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory By: (Rev. 11/05) X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: //- //0 "/O Municipality of Anchorage Development. Services Department Buildfng Safety DivisiOn On-Site Water & 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 CHECKLIST Legal DescriPtiOn: SAND LAKE #2 BLOCK 4, LOT 8 Parcel ID: 011-135-45 A. WELL DATA Date'completed- Sanitary seal (Y/N) _Y Total depth - ft. Casedto - ft. FROM WELL LOG Date of test -- Static water level - ft. Well production - g.p.m. WATER SAMPLE RESULTS: Coliform N~.G colonies/100mL Nitrate ND mg/L Arsenic: 62.1 mg/I Date of sample:10/28/20/0 B. SEPTIC/HOLDING TANK',DATA wres tV/N) _X Casing height (above ground) -- in. AT INSPECTION Collected by:. AzcTezza Tank Type/Material Septic/Steel Date installed 12/5/1983 Tank size 1000 gal. Number. of Compartrn~ntS _2 Cleanouts (Y/N) _Y FoUndation cleanout tV/N) _~ Depression over tank (Y/N) __N High water alarm (Y/N) N Date of pumping 10/27/10 Pumper McDona]ds C. ABSORPTION FIELD DATA Date installed 12/S!1983 S0il, rating (g.p.d./ft2 or ft2/bdrm) 100 System type Tl~tch Length 26 ff. ~'Wm-~d~ _~,ff. Gravel below pipe 6ff. Total depth 12 ft. (Measured 10/28/10) Eft; absorption area 36~. ft2 Monitoring tube Y Depression over field N_ Date of adequacy test ,10/28/2010 Results (Pass/Fail) ]'ass For 3 bedrooms Fluid depth in absorp'don field before test 6 in. Water added ?90 gal. New dePth 30 in. Elapsed Time: :1380 min. Final fluid depth 6 in. Absorption rate >= 4,50+ g.p.d. Any rejuverra, o. treatme~. ~ t2 mo:) (Y/N & type~ ~, ghee date-- LIFT STATION Date installed "Pump on" level at __ Datum in. E. SEPARATION DISTANCES Size in gallons "Pump off" level at Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot -- Absorption field on lot - Public sewer main. - SeWer/Septic:~ewi~e line. - Animal containment areas - in. ManhOle/Access (Y/N) ... High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots - On adjacent lots.. -- Public sewer ma~hole/clean0ut- - HOlding, flirik i~='? .:: ?. Manure/animal excrete storage areas Building foundation Water main 25'+ Wells on adjacent lots 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Property line $'+ Water service line 25,+ SEPARATIONDISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 6' Building foundation 10'+ Water Service line 25'+ Surface water 100'+ Curtain drain 50'+ (1NTo~te~rtow~t) Absorption field 5'+ SUrface water 100'+ F. COMMENTS *Served by Class "C" well on adjacent lot. Va~t system sur~h=~ed prior to I ~,i~ that l have datelined through field inspe~ions and ''.~~~'~':* review of Munidpal m~rds that the a~ve systems are in co~o~an~ w~ MOA COSA ~i~lines in effe~ on ~is date. Engineets Printed Name KE~E~ M. D~S ~'~~? Date 11/06/2~0 '~':~~' COSA Fee $490.00 Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Water main Driveway, parking/vehicle storage Wellson adjacent lots lo0'+ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and 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 APPRO /AL FOR A SINGLE FAMILY DWELLING ParcelI.D. 011- I$~'- '/5' HAA# .,~'~: ' "':',. ~,~ Expiration Date: - 1. GENERAL INFORMATION'-,, Completelegaldescriptio.n ' ';,~.,,,.~ ...~_~,~,_ ¢f--~, /~-~ <¢' .~_~,'~ Locaiiofi. (site address or directions) .: . Curr~r~t Property owner(s') ' -'r,)',~/'~ ~".~.ft..,~.~ .f~4~/k,_Day phone E",,2'~- o~/~,~ Day phone Lending ageficy" .~ "~' Mailing address Real Estate Agent .. Mailing Ad'dress ';'~ - 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. t~,, Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ~- .~ community On-site .D [] 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 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 er 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 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 Eagle River Engineering Services 1042t VFW Rd., Suite 201 Address ~'~ R!ver, !..v. 99577 Engineer's Printed Name DSD SIGNATURE [.,,"'" Approved for .~ Disapproved. Conditional approval for Phone /,,,~/z/- 5"/~7~'' Date bedrooms. bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date:.~.~.~ 0 ,-~ (Rev 01~2) 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 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Date completed rt//~ Total depth ~/~1. ft. ~,~,~.,,~ ~.~.: .~./_ ~, ~d(-~ ~' Parcel ID: Ifa, B, or C provide PWSID # ~Z__I-/',~ - ~".~ Well Log iY/~ Sanitary seal {~N) ~ Cased to ~/~,.- ft. FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS;: g.p.m. ~tl-/$5% Wires properly prote~:ted (~N) ~ Casing height (above ground) ~/~.. in. AT INSPECTION g.p.m. Coliform .[? colonies/'~00 mi. Arser~c: ~/A~ mg/I. B. SEPTIC/HOLDING TANK DATA Nitrate ~, 100 mg./I. Date of sample: C= Other bacteria ,,q/~.. colonies/100 mi. Collected by: ~ Tank Type/Material Tanksize ( t7OO gal~ Poundation ch~anout (2~N) ~ Depression over tank (¥~ . Date installed Cleanouts ~tN) C~ ~...-. d High water alarm (Y/~ Date of pumping ABSORPTION FIELD DATA ' '" Date installed ~ Soil rating (g.p.d./ft2 or~ /~ Length ,2.~, * ft. Width ~ I ft. Pumper ~-~d..~,yl -,/~, ./~,~ ,~E_ System type ~ Gravel below pipe (~ ' ft. Total depth I1' ft. Date of adequacy test ~"/(,%//O -<' Results ~-'~Fail) Fluid depth in absorption field before test ~' in. Water added_~,,~ gal. Elapsed Time: G~, min. Final fluid depth ~ in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y(~& type) Eft. absorption area ',~il~,'ft2 Monitoring tube '_rjif~-'~ Depression over field For ~ bedrooms New depth II in. ~"~ g.p.d. If yes, give date D. LIFT STATION Date installed Size in gallons 'Pump on" level at __ in. 'Pump oft" level at . Datum Cycles tested Manhole/Access (Y/N). Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main On adjacent lots ~ (~n t~dj~cent lots l, ..wer man.o,e,c,eanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation .,..q.O ~ Property line ,=.~-0 ' Water main -f ,3 S" I Water service line -¢ ~5' ~ Wells on adjacent lots I~,~ I SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ' ~, ' Building foundation ','/~" Water main + ~$° '~ Water Service line ~-,,Z<~ ~ Surface water ¥/'~c~" Driveway, parking/vehicle storage Curtain drain.~,.1,e-~.z. ~/1Wells on adjacent lots ~ (..G~'~' 't-leo' F, COMMENTS Absorption field II ' Surface waler -/-/04~ ~' Date of Payment .'~V/.,'~t'-'-,~("~_ Date of Payment Receipt Number I_b~_~-'~ _ ~ R~eipt Numar (Rev. 1~01) G. ENGINEER'S CERTIFICATION review of Municipal records that the above systems are in ~...,.,,~o¢.}~t/~ /, \~ J H~ F~ $ ~. ~ Waiver F~ $ SAND LAKE ROAD , N 00'00'00# W 50.00' 58.2 $O0'O0'O0"W 50.00 r- 0 ~ ~ 0~ ~o~ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.a nchorage.ak.us (907) 343-7904 ON-SITE SEWER/VVELL SUBMITTAL COMMENT SHEET To: Chris Wood Legal description: Sand Lake #2 Block 4 Lot 8 The attached paperwork has been reviewed and Is being returned for the following reasons: Original signature or stamp missing on Calculation error in design. Additional soils information needed. Water monitoring results inadequate. Discrepancy in information submitted. Topographic information missing or inadequate. Incomplete; missing Effective absorption area Incomplete; missing Monitorinq tube Additional adequacy test information needed. Water sample unacceptable. Measured/proposed distances/dimensions missing. Locations of all soils, percolation and water monitoring tests not shown. Proposed system too deep for soils Information submitted. Well log required. D~ Omission in narrative. Insufficient fill over tank or field. [] Other. Separation distance absorption field to wells on adjacent lots must be t00 feet. Name of reviewer: Jeff Date: 5/31/2005 Please supply the necessary information and re-submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK 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 Parcel I.D. Cf CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete'legal description Location (site address or directions) Property owner Mailing address _~.ioi ,Sr,;~ ~,,.~J~¢_ Lending agency Mailin_g address Agent K ¢-~r¼; Day phone. Day phone.. Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~'~ TYPE OF WATER SUPPLY: Individual well Community well '~ Public water NOTE: Al< q~i 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 o 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. NameofFirm /~q,~ :,C~.,~,r~'t{-~.~ Y~.,~,.~3~r~,~4-~ ~c, Phone Address ~z~ ~ F,-~_~ec~ Engineeffs signature ~ ~~~~ Date DHHS SIGNATURE Approved for -7'/-/REg bedroorns. Disapproved. Conditional approval for bedrooms, with thee following stipulations: Additional Comments 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 pumhasers of homes anQ their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not ' conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA ~1 Legal Description: ~/~c~ '~' ~>! ~l<~c.k c~ .5~,,m(~ ~,~_ <~/oc~.~ ~arcel I.D.: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502. Anchorage, Alaska 99501. (907) 34~_4174~4 ~ Health Authority Approval Checklist '"~r.)NMEN~AL A. WELL DATA Well type ~/~;~' (~ Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADE© water system number Date completed Cased to FROM WELL LOG Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION Date of test Static water level Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform Date of sample: B, SEPTIC/HOLDING TANK DATA Date installed i'~/5-/~ ~ Foundation cleanout (Y/N) Date of Pumping IO/~/c-!. ~ C. ABSORPTION FIELD DATA Nitrate Other bacteria l-//~-~l ~ Tank size tc~oo Depression (Y/N) Pumper ~c[,o~-~%~ Number of Compartments *~- Cleanouts (Y/N) . High water alarm (Y/N) ~ Date installed T~'/5-/~:~' Soilrating (g.p.d./fForffYbdrm)[Oo ~'~ ~ Systemtype ~'-('~c.~. Length ~ ~, Wi~h ~ Gravelthickne~belowpipe~, Totaldepth Effective ~somfion area ~ ~ ~.~ Monitoring Tube present ~) ~ Depression over field ~) Date of adequacy test ~o/~/~ Results (Pa,/Fail) ~S For Fluid depth in absorption field before test (in.); Fluid depth 0 (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) Immediately after'~Z 5-gal. water added (in.): Absorption rate = ~ S-~ 5- g.p.d. If yes, give date bedrooms 72-026 (Rev. 3/96)* LIFT STATION Date installed Manhole/Access (Y/N) Size in gallons "Pump on" level at* High water alarm level at* Cycles tested E. SEPARATION DISTANCES *Datum "Pump off" level at* Absorption field ~ ~ ~ ~-, Wells on adjacent lots ~ 03 .[' ~,, SEPARATiON DiSTANOES FROM WELL ON LOT TO: ~//~ ~--C~J~ ~/ ~5~ C on o.~,~,¢~-?r lot, Septic~olding tank on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic sewice line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation Z O ~, Prope~ line ~O ~, Water mai~se~ice line ~ Su~ace water/drainage ~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Pmpe~ line Sudace water )[ ~{, Building foundation tS- + ~,, Water main/service line ~Jo~e.- J~l~_ o~_.c~ Driveway, parking/vehicle storage area ~'~'O ~-, ~' I aa + .~.¥, Curtain drain J~e_. O~o5~'~.~. Wells on adjacent lots F. ENG~EER'S~ERTIFICATION C~'-~r;-¢~..~t~..~ C(~.~-r~_~- c~c~ ~{~-,~¥~, . I certify that I have determined thru field inspections and review of Mdnicipal records that the above systems are in conformance with MJ~.~ HAA guidelines ij3-effect on this date. · Sig natu r~~c-~,.~-.,,~----~ ~ Engineer's Name ~ .~ ~'/~//' ~. Date ,//~,x//~/~' ' HAA Fee $ Date of P,¥ment//~//~/~ ~0., . Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 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 ~~204 Address Engineer's signature DHHS SIGNATURE /',~. Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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 ot 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. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: &cT A. Well Data Well type Log present (Y/N) Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Total depth Cased to Casing height seal (Y/N) Wires properly protected (Y/N~..~ Sanitary FROM WELL LOG AT~13ECTION Date of test ~ Static water level .~ Well flow ~ g.p.m. .g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/hetd~;..~tank on lot /~.~ Absorption field on lot /~)O~--¢-~- ; On adjacent lots ; On adjacent lots lC'- Public sewer main Sewer service line WATER SAMPLE RESULTS~ Coliform z~ Nitrate Date of sample: / o - / ?-~5 2' Collected by: B. SEPTIC/I.I~i~ta~-TANK DATA Date installed /E- ~--~ ~ Tank size / Cleanout.~)N) ~ Foundation cleanout(~) High water alarm (Y(~ ~ Date of pumping /~- / ~ ~- Pumper SEPARATION DISTANCES FROM SEPTIC/HC~_Dii,~G ~ANK T0: Well(s) on lot ~L~o./.~'" On adjacent lots To property line ?~3 ~ . _ ~ Absorption field Surface water/drainage /~ ~ 72-026 (3/93)* Front Other bacteria Ea~lo River, Aia~[~a 9~577 Compartments (' Depression (Y/~I~ Alarm tested (Y/N) /~/~. Foundation /C~ "-/- Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) ",.~mp off" Level at ~ted Meets MOA electrical codes (Y/N) ~ SEPARATION DISTA~,EI~M LIFT STATION TO: On adjacent lots D, ABSORPTION FIELD DATA Date installed Length ~" Width Total absorption area ---~/~, Date of adequacy test //~/ Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Cleanout present ~N) Result~fail) Soil rating (GPD/FF) .,/~r_b ~//_S/~ Gravel thickness Surface water System type T Total depth Depression over field (Y/I~ for "~-h//,,~ Bedrooms After test ,,/~0/tJ~'~ /~/~.~/~3 If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /'V'0/,Jcc' To building foundation On adjacent lots ~.~ Surface water /~c~ /-..~ Curtain drain ~)0/'-~ E. ENGINEER'S CERTIFICATION On adjacent lots / 00' ~"~- Property line To existing or abandoned system on lot Cutbank ,A./o,.~ /~,'~E'~'E:/.J~-Water main/service line Driveway, parking/vehicle storage area ~- -~ I certify that lhave ch~ or con formed t o all MOA and HAA guidelines in effect on the date of this inspection. :?:i· ':' .,. ' Signature Engine · HAA Fee $ ?/"~) ~'~') ;~ Date of Payment f'Z~ '~t" ~- ~ ~ aeceiptUumber -~-2 ~-;~7 ('- ~//- Waiver Fee Date of Payment Receipt Number 72-026 (3/93)* Back OST-- 12 : 2.~ T I MES It is the,responsibil~t~ of the ~ner to the existence'of any ea$~ent$, covenants,'or.re~ strtctton$1which do not appear on the recorded $ division plat, Under no c(r¢~stances .shduld any data hereon be used for construction or lot"estab- lishing boundary or fence lines. The surveyor ta~e~ rg~ponsibt)t~X..¢Or=~h~.tniti~)~tr~nsmction only. LOT _ _.g.._ II)LOOK ~, "(,- --ANCHORAOE Ft:EGORDING DISTRICT ANCHORAGE; AL,ASKA 99501 ~ '"~sfo. ..... ~'"'":"1 ~f~ .1',~ NOTE ' '"~"'N ¥$ OF' ~ECORD ~ OTHER:THAN, THORO& SHOWN ~ THE RECORDE~ P~Ym ARE N ~H~N H~EON, " ": MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # ~/~//~/,~',~-'-/-/,~- HAA # .,~,~,~ --(~-,~',~ ~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 8; Block 4; Sand Lake Subdivision #2 (b) (c) (d) Location (address or directions) 8101 Sand Property owner Mailing Address Lake Road, Anchoraqe, Alaska HUD Telephone:(home) #I TI=~251799-203 Business Lending Institution Mailing Address Telephone Real Estate Company and Agent MARSTON PROP~RTIES/Ed TolZeq Address 4105 Turna.q~n Bo~r_vvara, Anchorag e, Alas ka Telephone 248-1717 99517 (e) Mail the HAA to the following address: (or check here~ if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING/694-2979 17034 Eagle River Loop Road~ Suite. 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Number of bedrooms ? Single-Family,l~ 3. WATER SUPPLY Individual Well [] Community [] Public [] Note:I If community well system, must have written confirmation from the State Department of Environmental' Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL -' On-site~ Public [] Community [] Holding Tank [] Note; If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page I of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functiona end adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Telephone L~¢¢'''~ -~''~ ~' Name of Firm Address Date 17034 Eagle River Loop Road No. 204 Eag|e River~ Ataik,~ 7~.,, ~ 6. DHHS APPROVAL Approved for ~, bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orde~ to satisfy certain federal and state requirements. Employees of DHHS dO not con'du'bt inspections or analyze data before a certificate is issued, The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88)Back Page 2 of 2 ~.~:'V"',i,M~41CIPALITY OF ANCHORAGE (MOA) ~ Health Authority Approval (HAA) ~[~, CHECKLIST - FEBRUARY 1984 ~.~_~ I Description: / "~L~. ,Z~ Date Completed Depth of Grouting A. WELL DATA .~ ', ..... Well Classification Well Log Present (Y/N) Total Depth__~ Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Cbhduit (Y/N) SEPARATION DISTANCES FROM WELL: If A, B, C, D.E.C. Approved~)__/~__ Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Septic~HOlding'Ta;nk on Lot ../Vt i t.2.¢.? · On Adjoining Lots To Nearest'E~ge of Absorption Field on Lot ~ / ¢2¢;~'-J¢ ; On Adjoining Lots To Nearest Public Sewer Li'ne To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ''~ .'~, 1~, ~/, ~/~ ~"~ ~/~;Q-~- To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ~.-~""IE~Size Standpipes (~N) / Air-tight Caps~N) Depression over Tank (Y/~ Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well \ To Property Line ~ To Water Main/Service Line To Stream, Pond, Lake'~)r Major Drainage Course Comments A'~¢ ~¢~Pt ~/ No. of Compartments */ .Foundation Cleanoutd~'4) ~,/' Date LaSt Pumped ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of.2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~?~-'- Width of Field --'¢5¢1 Square Feet of Absortion Area Depression over Field (Y/~ Results of Last Adequacy Test Length of Field ~ Depth of Field \ o Gravel Bed Thickness L~ Statndpipes Present ~N) Date of Last Adequacy Test Type of System Desigrf~.¢~'~¢--~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~ ~ To Property Line To Building Foundation ~.~ ~ ~ To Existing or Abandoned System on Lot t~//~, ; On Adjoining Lots To Water Main/Service Line I~%;)~'~(' To Cutback (if present) t To Stream, Pond, Lake, or Major Drainage Course I ~)~c) To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION ~.~ )/:k-- Date Installed Size ii~r~mJrtep~ "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at P m~Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company Date MOA No. Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back 17034 Eagle River Loop Road N~_ 9_n4. Eagle River, AlasJ(a 995~/ /~ Waiver Fee: $ /~ 0 Date of Payment Page 2 of 2 360:1 C STREET. SUITE :1334 ANCHORAGE, ALASKA 99503 STEVE COWPER, GOVERNOR 563-6775 TO: S & S ENGINEERING DATE: December 27, 1988 PWSID: CLASS C, 216075 To Whom It May Concern: According to the records on file in this o?fice, the SAND LAKE #2, LOT 7, BLOCK 4 Water System is in compliance with the State o? Alaska Drinking Water Regulations, VEC:pkk Si ncerel y, Vera E. Craig ~1 Environmental Fie~d/O¢¢icer MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRON~ENTAL HEALTH DEPARTMENT OF ~ALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Descripti. on (include, lot, block_ subdivision, section, township, range) Location (a~dres. s or directions) ~d~' ~ Telephone - Home Business ~'~?¢3 (c) Applicant is (ch~ck one~) Lending Institution ~--~ ; Owner/builder ~-~; Buyer ~-~ ; Other ~ (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. ~ype of Residence Single-Family~ Number of Bedrooms 3. Water Supply Individual Welli Multi-Family Other (describe) Community~ Public~-~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Sewage Disposal 'Onstte ~ Public ~-~ Community ~--~ Holding Tank ~--~ Note: If community well system, must have written confirmation from the State Department of Envirorm~ental Conservation attesting to the legality and status. [Page 1 of 2] e Engineering Firm Providin~ Inspections~ Tests, File Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the M~nicipality 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 regula- tions in effect on the date of this inspection. Name of Firm~ Telephone Addres Date /D-- / ~- ~ -' , ,4 ~ ~'~,;o . ~.~'~. ~. Approved for ~ bedrooms By ate~ Approved ~ Disapproved __ Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE .REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALAS-K~. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ~NALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/DI8 [Page 2 of 2] 7-19-84 Well ClassificationC~ ~'~ Well Log P~esent (Y/N) ~I~ tt MUNICIPALITY OF ANCHORAGE (MOA) o=TY PROVAL Le~gal Description: ~, ~/~ ~"-- Depth of Grouting Total Depth ~%~__ Cased to Static Water Level ~_~___P~ ~t At ~ Casing Height Above Ground__~ Sanitary Seal on Casing ~N) Electrical Wiring in Conduit ~) Depression A~ound Wellhead (Y~ Separation Distances from Well: To Septic/Holding Tank on Lot /~ ~ To Nearest Edge of Absorption Field on Lot /~ z~ To Nearest Public Sewe~ Line P~ ; On Adjoining Lots /~<p ; On adjoinin~ Lots To Nearest Public Sewer Cleancut/Manhole /tJ~ To Nearest Sewer Service Line on, Lot Water Sample Collected By ,L~-~ ; ~teID-W- Water Sample Test R~sults ~;,~-~_./,,_~ B. SEPTIC/HOLDING TANK DATA Date Installed t~$'- ~::~ Size /~700 Standpipes ~/N) Air-tight Caps ~/N) Depression ove~ Tank (Y~J Date Last Pumped No. of Ccmpa~tments ~ ' Foundation Cleanout~) Pumping/Maintenance Contract on File (Y/N) /_~>~ for ~I~ Holding Tank High-Wate~ Alarm (Y/N) z~/.~,~ Temporary Holding Tank Permit (Y/N) ~/~ Separation Distances from Septic/Holding Tank: To Water-SupplyWell /~ ~-~ f TO Property Line To Water Main/Service Line Course /IA To Building Foundation ~ TO Disposal Field ~ TO Stream, Pond~ Lake, c~ Major Drainage Receipt Date Paid: Amount: [Page 1 of 2] 2-15-84 Ce ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed {~-~ ~ Width of Field ~ '~ Square Feet of Absorption A~ea Depression over (Y~ Results of Last Adequacy Test To ~t~ter-Supply Well To Building Foundation Lot To Water Main/Service Line Length of Field ~ Depth of Field ./~ Gravel Bed Thickness ~7/ Standpipes Present ~/N) Date of Last Adequacy Test Separation Distance from Absorption Field: /~P -/ To P~operty Line ~P -~ To Existing or Abandoned System on ; On Adjoining Lots ~cP 7/~ To Cutbank(if present) '/~/~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storag~ Area Corar~nts .~L'-'-~I~r/.c~-]~tto~.. ~/)w"¢/- ,P'~.'P~_ ~or,' {/- '% 0'~ ~.P.o..4.2~,,o D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Levgl at ~ A Tested for ~J~' Electrical Codes(Y/N) Dimmnsions Manhole/Access (Y/N) "Pump Off" Level at__ Vent (Y/N) Pumping Cycles du~ingAdequacy Test. % Meets MOA Co~nts ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, or conforn~d to all MOA HAA~( on the date of this iD~pection. Signed ~,~ ~ ~.. Date KBi/d5/s [Page 2 of 2]. CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPAFITMENT OF-ENVIRONMENTAL CONSERVATION PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT Plans for the construction public water system located in ~;~.~J. (Ft~.~.~ ',, Alaska, submitted in accordance with 18 AAC 80.100 by T~ -T ~r~d~~'~. have been reviewed and are ~ approved. :~ ' BY conditionally approved (see attached conditions). 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 - Approved by Date Chan ge (contract order no. - or ¢e$crll~tlva reference) J r , / - The "APPROVAL TO OPERATE" section must .be completed before any water is made available to t~he public. APPROVAL TO .OPERATE ~. f ~ .-, ~- ~-- t (date). The system~shereby water system was completed on granted interim approval to operate for 90 days following the cpmpletion date. 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 fina[~pproval to Operate, ~, -,..?o - .? TITLE DATE DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, GOVERNOR Telephone: (907) ' Address: 274-2533 PWS I.D.# According to records on file in this office the / ~[~ ~, ~.__ ~ Water System is in compliance-with the State Drinking Water Regulations Sincerely,