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Home My WebLink AboutSAND LAKE #2 BLK 4 LT 9 10 43 & 44and Lake 2 Block 4 Lot 10 #011 � 135�54 Municipality of Anchorage Page Of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 v Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report V1 3 9& 0 // — / Z_/jr Permit Number: _53 P I D N u m ID e r: Name: 6 �/ i-0 NJ li/lA h /4 Wastewater System: 0 New VUpgrade Address: twal soa4 ABSORPTION FIELD Phone: I No. of Be s: 4/eepTrench El Shallow Trench FJBed IlMound 00ther LEGAL DESCRIPTION Soil Rating /,9 Total Depth from winyl grade: GPD/Sq. FL Lot: Blo . ck: Subdi n: Depth to pipe bottom fro rn onEgi )I grad Gravel depth beneath pi�,e 5 to q &A N))k441,e�7 Ft. Ft. Township: Aange: Section Fill added above orif.)inal grade: ___0_ Gravel length: FL 6e _�5 Ft. WELL: El New El Upgrade Gravel width: Number of lines: Distance between lines: t�?_ Ft. Ft. Classification (Private, A,B,C): Total Depth: i Cased To: Total absorption a Pipe ;I�ial, Ft. Ft. SQ Ft �; 3 _ Driller: Date Drilled: Static Water Level: Installer: Date installed: Ft. Yield: I Pump at at Casing Height Above Ground: TANK E-= )� i ST i N 62 GPM 1 Ft. FT Ft. SEPARATION DISTANCES JI/Septic 0 Holding 0 S.T.E.P. To Septic Absorption Lift Holding Public/Privale ManUfacturec Capa ity in gallons: From Tank Field Station Tank Sewer Lines Well 5; -5) 130 Material: Number - of Compartments: Surface Water 0 LIFT STATION Lot Size in gallons: I Manufacturer: Line Foundation q Ll "Purrip on" level at: Pump off' level aL High water alarm at: C urtain P"mp Make & Model _F octrical Inspections performed by: Drain Remarks: BENCH MARK t Location and Description: tv" 5 Atr k , Frov, o1a, o tr Lj e Assumed Ele4ation: OJP /067 - Ft. N,91NEtR'S SEAL _2 Inspections performed by: id Dates: 1 st 2nd?�� ad Department of He7al h an app" V tdrvices 41 Reviewed and approved by Date: 72-013 (Rev. 9191) VIOA 25 V No. CE -2225 TOBBEN SPURKLAND P.E. LOT 10, BLOCK 4 SAND LAKE 12 SEPTIC SYSTEM AS BUILT 203 W 15TH. AVENUE DATE: DEC, 6, 1995 ANCH. AK. 99501 8121 SAND LAKE ROAD (Qn7) 970—AOIA I I WILLMU BOUGHTON I I SHEET: 21J GRID OF .................. . AV C--) ,V J,�t / !�- . 49th BBEN SPURKLAND No. CE-L22tj . . . . . . . . �40 LSS 21 Vide 1,5f' Long 9' Deep 5' Sewer rock 3.5' Co ver 25 E M onitor Cleon 17 INV.EL. Mira Fi 140 85.71 5 Ft oF Septic Rock Cleanouts Monitor, 6' Co ver 97:t BOTTOM TESTHOLE 81 NO WA TER OR BEDROCK NV SCALE FXIS TIN6 9 TEEL SEPTIC TANAI EXIS TING L V& CRIB N17 SCALE m a 85.7 1 ll� I EXIST LOG CRIB EXIST SEPTIC TANK -O,V,"d 17-/ TOBBFN SPURKLAND P.F. L17T 10, BLaCK 4 SAND LAKE #2 SEPTIC SYSTEM AS BUILT 203 W15th Ave Anchorage Ak 99501 Rlz?l SAND LN(E RLIAD DATE: _0EC 6, 1995 P7q-�ql� WILLIAM BOUGHTIN I I SHEET; 313 GRID: 2224 w PAGE 1 OF MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREETf ROOM 502 ANCHORAGEf ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950396 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:BOUGHTON WM R & SHIRLEY N OWNER ADDRESS:8121 SAND LAKE RD ANCHORAGE, ALASKA 99502 PARCEL ID:01113543 LEGAL DESCRIPTION: SAND LAKE #2 BLK 4 LT 10 LOT SIZE: 6750 (SQ. FT.) NUMBER OF BEDROOMS: 2 THIS PERMIT: 2 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED:11/29/95 EXPIRATION DATE:11/29/96 S'A > o"DF 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THE EXISTING LOG CRIB MUST EITHER BE PROPERLY ABANDONED OR COMPLETELY DOCUMENTED IF CONTINUED USE OF THE CRIB IS PLANNED. cz_�_ t__'�' - I I ?� , DATE: V_ RECEIVED BY: 'Z �70 ISSUED BY: DATE: 1 TSPURKLAND P.E. 203 WEST 15TH. AVENUE SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Jim Cross Municipality of Anchorage Department of Health and Human Services On -Site Service Section 820 L Street Anchorage, Alaska 99501 Subject: Septic System Upgrade Permit Lot 9,10, 43,44 Sand Lake #2 Gentlemen: November 30, 1995 Due to an oversight the location of the existing septic tank was shown incorrectly on sheet 2/3 of the permit application. A corrected sheet 2/3 is enclosed showing the distance between the existing well and septic tank stand pipe to be 53 feet. This measurement was obtained in the field. The closest part of the septic tank is more than 50 feet from the well. The well and septic system was constructed in 1965. At that time the separation distance between wells and septic tanks was 50 feet. On November 1, 1995 the tank was exposed and examined. No leaks or pitting of the steel was evident. In letter to the owner on Nov. 3, 1995, 1 recommended that the tank be replaced, however, both the owner and the purchaser of the property elected not to replace the well. A copy of the CAMA record for this property is enclosed for your information. Vn11rq 6 —147 — — — — — — I I I R= 15OFT 7 46 I CLA55 " C PWSID 2179 4 —8 45 PROP TRENCH LOG CRIB SFA LLL Jtt'lk, I I ANA s R V\ . . .......... ..... ..... ....... .... CLASS "A'-�- ell PYISIO 213649 n- OF A .......... .. 12 41 — LA 13 40 s 4 t h .. .................... ... .... 0 7 0,:: ?.5 0 1 ?5 50 7,5 180 1?5 1 00.. ....... ..... ... B FN SPURKLAND 50 F T, RE 41 AV S, Lf No CE -2225 oA, o .. cT Lloi OF SEPTIC TANK TOBBEN SPURKLAND P.E. LOT 203 w 15TH. AVENUE 10, BLOCK 4 SAND LAKE12 SEPTIC SYSTEM DESIGj ANCH. AK. 99501 812f SAND LAKE ROAD DATE: NOV. 1, 1995 (907) 279-3916 11 WILLIAM BOUGHTON SHEET: 213 GRID: 2224 T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 Subject: Septic Up Grade Permit Lot 9,10,43, and 44 Sand Lake #2 William Boughton Gentlemen; November 9, 1995 We are applying for a up -grade permit for Mr. William Boughton. The existing system does not pass an adequacy test and must be replaced. The present system is undocumented, but have been in operation since the late 60's. Site inspections shows that the system consist of a Stack Steel up- right steel tank and a log crib. Excavation of the tank did not show any signs of leakage or deep corrosion. We propose to leave the existing tank in place, and install a deep trench outside of the 100 foot radius of the well serving the residence. The trench will be installed deep enough to allow for tank replacement in the future. Well waivers to PWSID #213849, and 217974 have been applied for. Yours Tobbe.4 SDurkland P.E. I T.SPURKLAIND P.E. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN No Ground Water or Impervious Layer to 16 ft. Use Standard Trench Soil Rating. I > min/in = See Sieve Analysis Use 1.2 gal per sq.ft/day No. of Bedrooms 2 Required Area per Bedroom: 150/ 1.2 — 125 sq.ft.. Total area required: 2 x 125 — 250 sq. ft. Finish Floor Elevation 100.00 Ground Elevation at Absorption Field 99 Outlet Existing Tank 94 Top of Crib 93.5 Top of rock 93 6 feet of cover Testhole Total Depth 16 Elev. of bottom 83 No bedrock or impervious layer. See gravel pits No water Bottom trench elevation 88 Rock depth 5 ft. Length of trench 250 / 10 = 25 ft. SYSTEM CONFIGURATION STANDARD TRENCH TOTAL LENGTH 25 FT TOTAL WIDTH 2 FT TOTAL DEPTH 11 FT ROCK DEPTH 5 FT COVER 6FT SEPTIC TANK EXISTING The installation of this septic system will not prevent wells from be installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Pending and/or concentration of surface runoff will not result from this installation. WAIVERS ARE REQUIRED FOR ENCROACHMENT TO CLASS A WELL PWSID # 213849 AND CLASS C PWSID 9 216075 Municim-31ity of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMEDFOR: W1,11101. LEGAL DESCRIPTION: )-6� I !�-' a't"t I - 0 la 2 3 4- 5 6- 7 8- 9 10- 11 12- 13- 14- 15- 16- H 14 o i—a 17- 18- 19- 20 - COMMENTS RA �e Y� I— atL'c K � DATE PERFORMED: Township, Range, Section: bl-Urt: SITE PLAN WAS GROUND WATER ENCOUNTERED? t� -0 IF YES, AT WHAT L DEPTH? 0 P E Depth to Water Af r 44- 4 1 Monitoring? Date: 1-7/ Not Reading Date T—Drop I Tin I, Time Water PERCOLATION RATE < (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT —FT 1 1,1 & f 14 PERFORMED BY: CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIOELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) VACANT 6 47 7 460 1 ASS "C" �� (�- 00 fLj 2 179 r::� I - ff5) #5 )qj 42 41 we id PWSID 15849 13 ZO OF "It 44,q 41* 7 4W 4 h A �9thl 1 ..... . ......... 1 7 ......... . .... TUB EN SPURKLAND No. CE -2225 /< 40 (D 61 19 9+16 15 11+14 I 12 1 13 R -poo 50 0 50 loo 150 200 e5o 300 SCALE, I' - 100 FT TOBBEN SPURKLAND P -E- LOT 10, BLOCK 4 SANT LAKE If2 SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE ANCH. AK. 99501 8121 SAND LAK[ ROAD DATE: NOV. 1, 1995 (907) 279-3916 WILLMY BOUGHTON 11 SHEET: 1/3 GRID: 2224 50 F T, TIlpFN SPURKLAND No E- 225 AV # ................ TOPPE� SPURKLAND P.E. 203 W 15TH. AVENUE LOT 10, BLOCK 4 SAND LAKE f2 SEPTIC SYSTEM DESIGj ANCH. AK. 99501 8121 SAND tAKE ROAD DATE: NOV. 1, 1995 (qn7) 970-�Qlk 11 WILLMY 9OUGHTON 11 SHEET: 213 GRID: 2224 W CI-) A 49th I OB EN SPURKLAND �B E No. CE -2225 S. -S... Monitor Miro �'i 140 ?I Vicle 50' L. ong 9' Deep 5' Sewer rock 3,5' Co ver *11 C'ea nou ts Monitor 4' Topsoil 6' Cover EXIS TING S TELL SEP TIC 7A NK INSTALL Double Clecn Outs EXIS TIN& L 176 CRIB Na SCALE INSTALL DOURLE CLEANOUTS 5 Ft oF Septic Rock NV SCAL E EXIST. LOU CRIB EXIST, SE[IDIV TANK I 1 TOBBEN SPURKLAND P.E. 203 W15th Ave LLIT 10, BLIYCK 4 SAND LAKE SEPTIC SYSTEM DESIGN Anchorage Ak 99501 8121 SAND LAKE RI)A-V DATE: NVV, 4 1995 11 WILLIAM BDUGHT(IN SHEET: 313 GRID: :�?224 TONY KNOWLES, GovERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGEANESTERN PUBLIC SERVICE OFFICE 555 CORDOVA STREET ANCHORAGE, ALASKA 99501 (907) 269-7505 November 27, 1995 Tobben Spurkland, P.E. 203 West 15th, Avenue Site 203 Anchorage, Alaska 99501 Subject: Lots 9, 10, 43, and 44, Block 4, Sand Lake Subdivision #2 Separation Distance Waiver; Anchorage, Alaska ADEC Project 9621-VVV-317-025, Review Dear Mr. Spurkland: This letter is in response to your November 13, 1995, submittal in which you addressed the items covered in our November 6, 1995 meeting. During the meeting, we discussed the Final Operation Approvals that this office issued for the two Public Water System Source Wells. Both approvals granted a lesser separation distance between the source wells and the wastewater disposal systems serving homes that were to be connected to the Public WaterSystems. Our review of this office's files on both public water systems showed that Departmental staff had knowledge of the existing wastewater disposal system, but failed to include it on both previously granted waivers. After reviewing your November 13, 1995 submittal, the notes that I took during our November 6, 1995, meeting, and discussing this issue with other Departmental staff, I find that the requested waivers are reasonable. Therefore, in accordance with the provisions of 18 AAC 80.030, the following separation distances have been granted: , Between the existing Class A Public Water System Source Well (PWSID # 213849, Lot 12, Block 4, Sand Lake S/D #2) and wastewater disposal system serving the home located on Lots 9, 10, 43, and 44, Sand Lake S/D #2 from 200 feet to 100 feet. Between the existing Class C Public Water Systersi Source Well (PWSID #217974, Lot 7, Block 4, Sand Lake S/D #2) and the wastewater disposal system serving the home located on Lots 9, 10, 43, and 44, Sand Lake S/D #2 from 200 feet to 100 feet. The existing septic tank located on Lot 9, Block 4 will need to be relocated if it is within the 100 foot protective radius of either Public Water System Source Well 7-4 4�e-Xc- 4 &-v// 44cl t /0.? *',e� vesl, el V.Iry C A#-O"l Tobben Spurkland, P.E. 2 November 27, 1995 This waiver will remain valid until one of the following items occur: 1) the wastewater disposal system serving the home on Lots 9, 10, 43, and 44, Block 4, Sand Lake Subdivision #2 again requires upgrading so that it again impacts any public water systems in the area; 2) the demand changes; 3) the existing private water system becomes a public water system; or 4) groundwater contamination occurs. This approval does not imply granting of any additional authorizations, nor obligate any state, federal or local regulatory body to grant required authorizations. Due to the time period in which the first set of waivers were issued ( 1983-1984) and the fact there was sufficient information presented to the Department at that time to include the wastewater disposal system serving the home on Lots 9, 10, 43, and 44, Block 4 Sand Lake Subdivision #2, it has been determined that charging of fees can be waived for this project. Thank you for your cooperation with this Department. If you have any questions, please do not hesitate to contact me. KKK/pt Sincerely, @2)te �. � M MM Keven K Kieweno, P.E. Environmental Engineer cc: Robbie Robinson, MOA, DHHS, On -Site Services Municipality of Anchorage Development Services Department Building 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 FOR A SINGLE FAMILY DWELLING Parcell.D. 011_65__S�L/ COSA4 0yQQ S'�2 1. GENERAL INFORMATION Expiration Date: / I - / -) - 0 -1 - Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address SAND LAKE #2 BLOCK 4,LOT 10 8121 SAND LAKE RD. * ANCHORAGE, AK 99502 THOMAS RAUBA Day phone 248-8495 8121 SAND LAKE RD. *ANCHORAGE, AK 99502 Day phone FSBO Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 2 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage El Community Class—Well 171 Public Water System El TYPE OF WASTEWATER DISPOSAL: Individual On-site N Individual Holding tank El Community On-site 1:1 Public Sewer E] 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 litle (except between spouses) for properties served by a single-family on-site wastewater disposal ancilor 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineers work. 4. STATEMENT OF INSPECTION BY ENGWEER As certified by my seat 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 andlor wastewater disposal system is (are) sale, 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 andlor 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. Address 3701 E. TUDOR ROAD. SUITE 101 * ANCHORAGE. AK 99507 Engineer's Printed Name JEFFREY A. CARNESS, P.E. Engineers Comments: in conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational life otalf wells and septic systems depend on the local soils condition. groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized. nor will it confor any legal tight whatsoever. 5. DSD SIGNATURE 1,-fo Approved for �?, bedrooms. Disapproved. Conditional approval for _ bedrooms, with the flowing Phone 337-6179 Date — P, /.5-/oq kkk;��j OF 4".6r. ON-SITE 1Z. WATER AND WASTEWATER PROGRAM VSt '4'_ Attachments: COSA Checklist Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate 4 Advisory Other C, Original Certificate Date: (R� IIM5) Municipality of Anchorage Development Services Department Building 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 0 CERTIFICATE OF ON-SITE SYSTEms APPROVAL CHECKLIST Legal Description: SAND LAKE J2, BLOCK 4, LOT 10 Parcel ID: 10.1.1 .1'3 _52'5_�A A. WELL DATA *PER 1995 HAA Well type PRrVATE If A, B, or C provide PWSID# N/A Date completed *1968 Sanitary seal (Y/N) YES Total depth *300+ ft. Cased to *,300+ ft. FROM WELL LOG Date of test Static water level Well Log (Y/N) NO Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 08/08/2007 164 6.36 Well production 9 -p -m- —9 -p -m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 0-252 mg./L. Other bacteria 0 colonies/1 00 ml. Arsenic: 34.7 ug./L. Dateofsample: 7/2/2009 Collectedby: GEG Ltd. R 1995 HAA Jkqr B. SEPTICIHOLDING TANK DATA *PE Tank Typ e/Material SEPTIC/STEEL Date installed *PRE 1968 Tanksize *1000 gal. umber of Compartments *1 Cleanouts (Y/N) YES Foundation cleanout (Y/N) I Depression over tank (YIN) NO High water alarm (Y/N) NO Date of pumpim 5/13/2009 Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATA �BELOW EXISTING GUNEI PRE 1968/ LOG CRIB/ Date installed $02/4-5/1995 Soil rating (g.p.d./ft'oMf/bdr_r�) 1.2 System type DEEP TRENCH Length ***8/25 ft. Width **08/2 -ft. Gravel below pipe *'*NONE/5 ft. *0*6/ ***ONOI Totaldepth $10.62 ft. Eff. absorption area 384/250ft' Monitoringlube YES Depression over fieldhLO- Date of adequacy test 08/08/2007 Results (Pass/Fail) PASS For 2 bedrooms Fluid depth in absorption field before test DRY/DRY in. Water added 401 gal. New depth DRY/DRY in. Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 300+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN _ If yes, give date **TESTED THE 1995 SEPTIC SYSTEM ***PER TOBEN SPURKLAND 1995 INSPECTION REPORT ****NO �CLEANOUT FOR LOG CRIB IS PRESENT. D. LIFT STATION Dateinstalled— Sizeingallons— Manhole/Access(Y/N) ------ —1 "Pump on" level at—in. ' *Pumpofrievel . . High water alarm level at—,in. Datum -------- Cycles tested— Meets alarm & circuit requirements?. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: *PRE 1973 (ASSUMED) Septic tankAift station on lot *53' On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5t+ Absorption field 5'+ Water main N/A 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 N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots **100'+ ** CLASS 7A* WELL ON BLOCK 4, LOT 12 PWSID# 213849) F. COMMENTS WAIVED TO 100' AND CLASS V WELL ON �LOCK 4. LOT 7 SEPARATION biSTANCE'wArVED TO 100' (SEE ATTACHED D.E.0 G. ENGINEER'S CERTIFICATION i certify that I have determined through field inspections and review of Municipal records that the above systems are In conformance with MCA COSA guidelines in effect on this date. Engineers Printed Name JEFFREY A. GARNESS Date 13 us—o q COSA Fee S Date of Payment Receipt Number 0 0 (Rev. 11105) Waiver Fee $ ........ . .. . % J r C I 00"P'01 Date of Payment Receipt Number N DISTANCE 7974) ... ....... Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsitc (907) 343-7904 Arsenic A(lvisory Certificate of On -Site Systems Approval # 090252 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 4, Lot 10 of Sand Lake #2 Subdivision. This inspection revealed an arsenic concentration of 34.7 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/onsit ) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. N I* OC) ZO I ZM 0 - U)- > 0 6m Z ::) � U) -Acd- CL Lij z V) V) 0 —i �jb ui 06 z 13381S iinous .00*09 3.,00.00*00 N r_x—x—x L4 mt V) LOO to G oo� 09 * —3.,060.00.00 N al —X—X—X AN I III p D il" ow. b ro C*4 .00*09 1.00.0040 N 00 9 t� 313110801_1_� Ire*# O'OC AV iff –0 LL 1-3 006 0 0) : : .0 Ar # �% # # LL: N Z Z vi D w ob z ;.t All AVIN3 O*tt M"03 z z fn 6 .0,or 00 9 t� L: 313110801_1_� Ire*# # 4c. AV iff –0 LL 1-3 006 0 0) : : .0 Ar # �% # # 'ek 4�O v N Z L: 313110801_1_� .S'ttl .00,09 i� 1.00.00.00 N Z Z D ;.t All AVIN3 O*tt M"03 z L: o L4 z ---------------- .00*09 3..00,00*00 N .0 GV08 3>ffl ONVS 1.00.00.00 N z IL o wo z g-0 UR N K w LLJ L)L�Oza zo 0 LLJ 0 oz t; L2 Oz 8 ww It U got =n) 0 Loo zo LLJ I z Li 9 -9 0 0 C3 x 0 z z En x W 2 ffi 0 :3 L) t6 CL 0 W.Q z cli z .j CIA Lo Vi 0 Ix co, N m L'i > C14 w Zo C'*4 'i U) n Li 0 x U) = CL 0 < 8 L) tl: C-4 I MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services U On -Site Services Section AECEWE" P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 P, �r_ o 6 19 Muni-il.-ality of Andhorage CERTIFICATE OF HEALTH AUTHORITY Dept. Health & Human Sen'Aces APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 7 1. GENERAL INFORMATION Complete legal description .. Left� I o E'v,� Lj HAA # Location (site address or directions) . 2' 12- 1 O� A IN 1--') L- L --A 14- ff-- V__ b Property owner 3X/ I U 14 0 Lj 67 1+ —i o t_� Day phone Mailing address v, I. - Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State A DEC at,#e,^+- Ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: L// 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 (ROV. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my sea[ 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 furtherverify 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 LIC S i2v Y Vt 0, 'd Phone -7 3 q e Address �20 '-Z' Ly_/ 14 �Zj' Engineer's signature Date 6. DHHS SIGNATURE —4 Approved for bedrooms. Disapproved. Conditional approval for Additional Comments bedrooms, with the following stipulations: CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto 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 engineers work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 0 Anchorage, Alaska 995010 (907) 343-4744 Health Authority Approval Checklist rri 4 Legal Description: Lol 10 , B '->A �,l ID )-AYE �Z- Parcel I.D.: Oil 135:0— Y .1 A. WELL DATA Well type If A, B, or C, attach ADEC lette r. ADEC water system nuim ber Log present (Y/N) Date completed Total depth ?2 0-0 Cased to Casing height (above ground) Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: AT INSPECTION lolig-If 3�- — g -p -m- 9 -p -m - Coliform — 0 — Nitrate N D Other bacteria Date of sample: "A 0 / 013— - Collected by: B. SEPTICIHOLDING TANK DATA Date installed / n L09 Tank size 106V Number of Compartments / Cleanouts (YIN) Foundation cleanout (Y/N) Depression (Y/N) N1 High water alarm (YN Date of Pumping Pumper Pe P-1 a /I C. ABSORPTION FEELD DATA Date installed Soil rating (g.p.d. /ft2 10;2- syste or Wfbdrin) in type 14'4�"ell Length a� 57 Width Gravel thickness below pipe Total depth Effective absorption area p'250 Monitoring Tube present(Y/N) -Y-- Depression over field (Y/N) Date of adequacy test Results (Pass/Fail) For 6�2- bedrooms Fluid depth in absorption field before test (in.); /,-//A Immediately after �_`gal. water added (in,): Fluid depth tll/ (ins.) Minutes later: Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) tl//-- If yes, give date cm (n 00 :Z 5� G) rIt D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum "Pump off' level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 35 _; On adjacent lots V0 Absorption field on lot 4i>O ; On adjacent lots / Public sewer main %, Public sewer manhole/cleanout Sewer /septic service title _790 -Lift station — N114 - SEPARATION DISTANCES FROM SEPTIC/14OLDING TANK ON LOT TO: Building foundation /(��> I — I Property line 9 Absorption field 75 Water maiii/service line Surface water/drainage N Wells on adjacent lots / / C) , SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation qql Water main/service line Surface water 0 0 Driveway, parking/vehicle storage area. Curtain drain u W Wells on adjacent lots /1.2>0 Property line F. ENGINEER'S CERTIFICATION j�� C� - A,11. f Municipal record.�'4;�'fhe ah o�j I certify that I have determined thru field inspections and review o gre in conformance with MOA HAA guidelines in effect on this date. ea V� 10 Signature Engineer's Namelobbe(., !9RU)(V_1a,,J PIZ- Ty CE -2225 Date HAA Fee $--a co C d -D Date of Payment 2, 3 Receipt Number Rev. 8/95 OSS: haa.wk.doe Waiver Fee $ Date of Payment Receipt Number