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HomeMy WebLinkAboutSAND LAKE #2 BLK 4 LT 11Sand Lake #2 Block 4 Lot I I #011- 135-42 7 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP241205 PID Number: 011-135-42 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New X Upgrade Name GARTIN ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 8133 SAND LAKE RD ❑ Other Phone ber of Bedrooms Soil Rating Total depth from original grade =2u'r GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot SAND LAKE #2 BLK 4 LT 11 Ft. Ft. Fill added above original grade Gravel length Township Range Section Ft Ft Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Fts Ft. Well 100'+ 50'+ TANK 9 Septic 0 S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water 100'+ GREER/ANCH TANK 1000 Gal. Material Number of compartments Lot Line 10'+ NA PLASTIC, DEEP BURIAL 2 Foundation 10'+ ILIFT STATION Manufacturer Capacity Remarks TANK DEMO PER UPC, Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank Tank to 3034 drainfield 3034 MIKE N ANDERSON, P.E. Drainfield CO/MT 3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 100 ft Inspect ectioes: 1s' 9/21/24 2 Location and description aro 4t TOP OF MANHOLE 100 ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date —� �,qE • • • • '`'= i ; •> All 49TH :� �• ., W. 1 MICHAEL N. ANDERSG d :c,. Septic System / f ' Approved �/ Date �� `%s'• CE -9 69��,, a •trom No e. this approval does not include well permit requlrem nts. '°' i�f\4 '•��7C"P'E�5Sluh�•� rRp� n�rr»i�a� 7 Permit No. OSP241205 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: SAND LAKE # 2 BILK 4 LT 11 PID No.: 011-135-42 I WELL A I I i \ TCO -81ENCH, TOP OF MH I EXISTING FCO 1 I I \Wil COMM. WELL ELE�ATED DECK I 1 I I \ / I � i i AS81JiLT__----- SCALE.1=50' — — SEPTIC SECTION N.T.S. OWN ♦ DF /� • �..........•,..� • i 49TH ;MICHAEL N. ANDERSON; �Z= No. CE 9469 S ��'•.•10-6-24 i MARK A B — -- �� T 01 12 15 / T 02 16 12 CD2 CO3 19 20 16 R NEW 1080 ALLON PLASTIC TANK i \ TCO -81ENCH, TOP OF MH I EXISTING FCO 1 I I \Wil COMM. WELL ELE�ATED DECK I 1 I I \ / I � i i AS81JiLT__----- SCALE.1=50' — — SEPTIC SECTION N.T.S. OWN ♦ DF /� • �..........•,..� • i 49TH ;MICHAEL N. ANDERSON; �Z= No. CE 9469 S ��'•.•10-6-24 i MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241205 Work Type: SepticTank Upgrade Tax Code Number: 01113542000 Site Legal Address: SAND LAKE #2 BLK 4 LT 11 G:2224 Site Mailing Address: 8133 SAND LAKE RD, Anchorage Owner: GARTIN ELAINE M & Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: 9/5/2024 9/5/2025 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received -By: _ E-5sLweA -to M11 Date: Issued By: Date: ��-Z q 2 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 011-135-42 Property owner(s) LATIN Mailing address 8133 SAND LAKE RD Site address 8133 SAND LAKE ROAD Day phone Legal description (Sub'd., Block & Lot) SAND LAKE #2 BLK 4 LT 11 Legal description (Township, Range & Section) Lot Size 6600 Sq. Ft. Number of Bedroom 2 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank F Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Waiver Fees: _ Date of Payment: 1. Z Y Date of Payment: Receipt Number: Receipt Number: Permit No. L,_ eZC4/?_0,_ Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc JULY 16, 2024 Municipalities of Anchorage On-Site Water and Waste Water Section 4700 Elmore Rd Anchorage, Alaska Phone 343-7904 Re: New septic tank permit Legal: SAND LAKE #2 BLK 4 LT 11 To whom it may concern: This is a request for a septic tank permit on the above referenced lot. This tank replacement will not impact any of the neighbors or encroach on any wells, septic or open water issues. The tank will be decommissioned per the Uniform Plumbing Code (UPC). Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241205, Deb Wockenfuss, 09/05/24 1"=50' PROPERTY LINE DOUBLE CO AFTER THE TANK AND CO AT THE BEGINNING OF THE TRENCH SCALE: DJRDRAWN: DATE: SAND LAKE #2 BLK 4 LT 11 Anchorage, Alaska ELAINE GARTIN 7/16/2024 DRIVEWAY ALL MT/CO TO BE LOCATED AND EXTENDED ABOVE GRADE MT/CO FCO EAST 82ND AVE TCO NEW 1000 GALLON PLASTIC TANK, OLD TANK TO BE REMOVED PER THE UPC. MAINTAIN 5' FROM DECK PILES, 10 OF FOUNDATION, 5' FROM FIELD TYP. SURVEYOR TO STAKE 100' WELL RADIUS PRIOR TO EXCAVATION 10 ' U T I L I T Y E A S E M E N T SA N D L A K E R D 100' CLASS A WELL RADIUS WHICH SUPPLIES LOTS 11, 12, 13, 40, 41, 42 FOR 2-BEDROOM HOMES ONLY PER ADEC WAIVER LOT 12 LOT 13 LOT 42 LOT 41 LOT 40 EXISTING CO LOCATED & TCO ELEVATED DECK WATER KEY BOX MAINTAIN 10' FROM THE PROPERTY LINE TYP. WELL LOCATION OVER LAYED W/ SURVEY Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241205, Deb Wockenfuss, 09/05/24 30/ 0 2 QI EDGEOFASPHALT I �o U WOOD FENCE M N 89 59'36" E 135.56 ( PROP. 457 9,5pH -ASPHALT-- ' Z4.1SHED o ASPHAL T I ASPHALT DRIVEWAY k/ 111P4 411 � alai I1I M r �P � � � I w I G0� I w • • 0,0000 0 o MI 97 1 13' � o U Y / N 89 59' 36" E 1 5.56 ( PROP. A WOOD FENCk, ' t CHA/NLINKFENCE WOOD FENCE---- 30' OF A�q�;�p 49 TH* u N SHANE A. HOLT LS -6914 'v'°fessional �Qo THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES• EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT ARE NOT SHOWN HEREON ( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS• ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE• ONLY VISIBLE IMPROVEMENTS ARE SHOWN HEREON •WELL REFER TO PLATS P176,2003-95,2015-55 AS—BUILT SURVEY SCALE 1 = 20 NO CORNERS SET THIS DATE FENCE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 11 BLOCK 4 SAND LAKE NO. 2 ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS 18TH DAY OF JULY , 2024 5203238-14 HOL T LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 907-223-8615 ry i o �nev. o/ is MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE t NEW C_piVsj,ucfi Aj 134&—Z6701 ❑UPGRADE MAILING ADDRESS `232G DECHORAGE- AK g961" LEGAL DESCRIPTION L i Lev S L E -VQ # P T -Y i LOCATION NO. OF BEng ODMS � L L) Y DISTANCE TO: Well 10 ,�, Absorption area / Dwelling 15-61, PE MIT NO. 8 L 6 F z ti� Manufacturer G R G Material -Si EEL No. of compments Liqcapacity in gallons I IF HOMEMADE: Inside length Width Liquid depth ��z DISTANCE TO: Well Dwelling PERMIT NO. = z Manufacturer Material Liquid capacity in gallons ❑ DISTANCE TO: Well Foundation t Nearest lot line PERJI�IJ©O�a �0�� ( J W!2 J LL z F Z w No. of lines Length of each line I Total length pf lines I Trench idthY inches Distance bet a 'nes F Top of tile to finish grade Material beneath tile 19 Total effectiv ara U� ❑ i S_ tiw� Length Width Depth PERMIT NO. w t7 a F w° Type of crib Crib diameter Crib depth Total effective absorption area LU DISTANCE TO: Well Building foundation Nearest lot line I ss Depth Driller Distance to lot line PERMIT NO. w DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS C: N AND 0,3034 f Jl SOIL TEST RATING, a�©148,0e -1 INSTALLER RItPP1 1-5X8N-Odl REMARKS NSC (-tA.) .,uS LL -P dU6 s 8U;1 01A.)C,P cue'' 0 t ENCA N0 C 13; -f !'O A I T- vi _Z APPROVED V DATE LEGAL ry i o �nev. o/ is ' +` /~^`�- , >'—� �" � � ������� ��1 T � �'�� �i���� �����, ` DEPHRTMENT b�� HEH�TH HND ENVIRONMENTHL r�OTECTION � /` STREET, HNCHORHGE/ HK 99501 . 264~4720 E_ F: 0-,g E'--- F;? Vo E=-'. F­�! Ull 11~� PERMIT 0 DATE ISSUED: 04/2]/84 HPPLICHNT� T&T CONST HDDRE DENNIS WHY HNCHORHG�, HK 99517 CONTACT PHONE ]45�2670 � LEGHL DESCRIP� SUBDI`ISION� SHNDLHKE #2 LOT: 11 BLOCK: 4 SECTION� 10 TOWNSHIP� 12N RANGE: 4W LOT SIZE: FT. OR ACRES) MHXBEDROOMS 2 LISTED BELOW HRE THE OPTIONS HV!ILHBLE TO YOU IN DESIGNING YOUR SEPTIC SYSTEMCHOOSE THE OPTION THF-ITBEST FITS YOUR SIFE. EE". V-4 C-�'.8-U ' F E -E. E» 0-4. E»a F:�][�-0 DEPTH TO PIPE BOTTOM (FT� ) 5.0 6,0 5.0 GRAVEL DEPTH (FT. ) 95 0.5 ]0 TOTHL DEPTH (FT� ) 14�5 6�5 8.0 GRAVEL WIDTH (FT. ) 2�5 15.0 5.0 3 16.0 ]0.0 ]5.0 GRHVEL VOLUME (CU. YDS. ) 14.8 166 22.6 THNK SIZE (GHLS) 1/000. 0 ** 1/00�I 0 ** 1,000. 0 ** SOIL RHTING (SQ�FT�/BR) 150 150 150 ** THNK MUST HAVE' HT LEIST TWO COMPHRTMENTS I CERTIFY THH -1. I HM FHMILIHR WITH THE REQUIREMENTS FOR ON-SITE SEWERS HND WELL��-HS SET FORTH BY THE MUNICIPHLITY OF �NCHORHGE (MOH) HN| THE STATE OF ALASKA. 2 I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH ALL. MOH CODES AND REGULATIONS, AND IN COMPLIHNCE WITH THE DESIGN CRITE:IH OF THIS PERMIT. ] I WILL HDHERE TO ALL MOH HND STATE OF HLHSKH REQUIREMENTS FOR THE SET BACK DISTHNCES FROM HNY EXISTING WELL/ WHSTEWHTER DISPOSAL SYSTEM OR PUBLIC SEWERHGE SYSTEM ON THIS OR HNY HDJHCENT OR NEFRBY LOT` 4. I ONDERSTHND THHT THIS PERMIT IS VHLID FOR H MHXIMUM OF 2 BEDROOMS AND ClNY ENLHRGEMENT WILL REQUIRE HN ADDITIONAL PERMIT. IF H LIFT STHTION IS INSTHLLED IN HN HREH COVERED BY MOH BUILDIN6 CODES, THEN (1) HN ELECTRICHL PERMIT HND INSPEC.ION MUST BE OBTAINED/ (2) HS~BUILTS WILL NOT BE HPPRDVED WITH �T HN ELETRICHL INSPECTION REPORT/ HND (]) THE 'ELECTRICHL WORK MUST BE DONE BY H LICENSEELECTRICIH�. ` ^$^^ SIGNED DHTE ���, HPPLICHNTT&T C ISSUED BY DATE ____. 1 -.,KY �1 SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION M PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: --rand �—I on 1 Yet is f)Qe) DATE PERFORMED: � of LEGAL DESCRIPTION: QjLArjQ h C.,1 � C F ` 5 g -a vel 'Sand) celr� 1 bro Q3 vi 2 �m ScLr,ct 3 �rc�Oc 1, �rr, 4 ML GraveN %*11+, 5 O\rt:� , 1 is h+ 01-0wYl s 3P ,net I ci e-cXri awry gine, brow)' 7 8 t6, Sp Gfmoe lVJ ' 9 dn6 , 0 can f* � b rov3n 10 SLOPE 4 WAS GROUND WATER - A , S 11 ENCOUNTERED?_ L C' Y-CLQell� �ah'I, ° 0 12 l' IF YES, AT WHAT E J DEPTH? 13 � � c�larK brown i 1 14 1 15 1 � vr�v�.li� ucinc� 16 1 % CA 1r� , C i eZLh 17 I bresLon 1 18 1 <1 19 TO 41 2a COMMENTS Reading Date Gross Time Net Time Depth to Water Net Drop 01 ((�� AA ppM PERCOLATION RATE ��� {:-]hR r l (minutes/inch) TEST RUN BETWEEN FT AND FT PERFORMED BY: +&,�Yj lMarO MCI Yl CERTIFIED BY: 72-008 (6/79) DATE:. x 96A V ALASKA h OIROnO NAL COnTnOL S6WIUS, IX Engineerinq & Cnuironmental Studies MUNICIPALITY OF ANCHORAGE June 20, 1984 DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION Department of Health and Environmental Protection 825 L Steet 1J U L 2 41984 Anchorage, Alaska RECEIVED. Attn: K. Bandt Subject: Lots 11, 12, 13, 40, 41 and 42; Block 4 Sand Lake #2 Dear Keith: The above mentioned lots are to be served by a class 'A' well, and separation distances were waivered (attached sheet). The residences and foundation were under construction at the time of installation of the on-site septic. The permits were issued by your department, for single family dwellings. The permits were designed, for the most part, at depths of 10 to 15 feet (total depth). In the soils rated for this area, this presented problems -in that with the depth, the excavations tended to enlarge greatly. In an attempt to circumvent this, the excavator had our office on location during the actual excavation. The lots are extremely small, generally about 6,700 square feet in size. With the class 'A' well restrictions, and the prior establishment of the foundations, the available space for on-site septic was limited. The proximity of neighboring private wells also influenced the establishment of the septic systems. In all cases, the absorption areas and septic tanks adhered to the 100 feet separation from adjacent private wells. Also separation distance (waivered) to the class 'A' well were enforced. Absorptions were confined to 10 feet within the property lines. As the absorption areas were excavated, the trench would widen -due to caving in of the sidewalls. Gravel had to be placed in the trench immediately upon verification of the proper depth. During the excavation, the area separating the septic tank and absorption area also collapsed in. The permits were issued in probably the only configuration that would fit the lots. The only compromising distances are: 1) Separation distance between septic tank and absorption area. 2) Septic tank distance from lot line. 1200 West 33rd Auenue. Suite B • Anchoraqe. Alaska 99503 • (907) 561-5040 The above mentioned compromising distances occurred during the excavation of the septic systems. It was felt that if a cmpromise had to occur, then the tank would be the exception. If you have any questions please do not hesitate to contact our office at 561-5040. Sincerely, q Larry Montgomery Environmental Engineer 4i • � r OF TN 4FALAS J STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION CONSTRUCTION AND OPERATION CERTIFICATE A. APPROVAL TO CONSTRUCT for PUBLIC WATER SYSTEMS SAO Plans for the construction or modification of wkTE►Z WELL 1 SUSTrj!1 t- OTS ?? CLAlS-4 it f ct u 9 FZI n,- re q SA N pt A K E ubMc water system located il N 11� 0 Alaska, submitted in accordance with 18 AAC 80.10 In 4 been reviewed and are approved. conditionally approved (see ❑ attached conditions).. 67 DATE TITLE BY If construction has not started within two years of the approval date, this certificate is void and new plans an specifications must be submitted for review and approval before construction. S. APPROVED CHANGE ORDERS A Change (contract order no. or descriptive reference)Approved by Date ancel SEP o S E S S O t2 i Z�I+J ri �, C2 bel bu,� o►•�1r) L8 /Oct fit, Ea It F/-1?- Y wows* u ►'.ia7T_ r is 'i`I.t @ b i l & 3 jUT U e� CrS C. APPROVAL TO OPERATE p w S 0 A 13 i4 The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water is made available to the public. Qk� Iy i7 /ire cif 442 i7LO((c 4 Sipu6lic The construction of the - e water system was completed on (date). The system Is hereby granted interim approval to operate for 90 days following the completion date. DATE BY TITLE As built plans submitted during the interim approval period, or an inspection by the Department, has confirmed plans. The system is hereby granted final approval to the system was constructed according to the approved TITLEDA E BY DISTRIBUTION: 1. WHITE • ENGINEER (Complete Section C) 2 YELLOW - WATER SYSTEM FILE (Complete Section C) 3. PINK . ENGINEERIMUNI.BOROUGH (COmpleI9 Section C) MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 011-135-42-000 Expiration Date: 9/6/2025 Legal description SAND LAKE #2 BLK 4 LT 11 Site address 8133 SAND LAKE RD Anchorage AK 99502 Current property owner(s) GARTIN ELAINE M & X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: M Original Certificate Date: 10/11/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water &Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application t 1. GENERAL INFORMATION Parcel I.D. 011-135-42 Complete legal description SAND LAKE #2 BLK 4, LT 11 Location (site address) 8133 SAND LAKE RD, ANCH AK Current property owner(s) GARTIN Day phone 2. ON-SITE SYSTEMS SIZED FOR 2 BEDROOMS 3. TYPE OF WATER SUPPLY: ■❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: X Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑■ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑■ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Distance: Expedited review requested: ❑■ By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 0 u Waiver Fee $ Date of Payment /O/ �� `� Date of Payment COSA #' S C �j �l Waiver # COSA Applicalion_June 2022 COSA Checklist Legal Description: SAND LAKE #2 BLK 4 LT 11 Parcel ID: 011-135-42 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Well production at time of test 4+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑Q No X Coliform bacteria is Negative Nitrate 0.257 mg/L ❑ Nitrate less than MRL (ND) Arsenic 59.9 ug/L ❑ Arsenic less than MRL (ND) Collected by MNA Static water level at beginning of test ft. Date 9/6/24 Comments COMM. WELL LOCATED ON NEIGHBORING LOT B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NEW ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) ELL ❑ ALL standpipes present per record drawing Total measured depth from grade 15 ft (max) Measured depth to pipe invert from grade 5.5 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced 2000 gallons 5/10/24 date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 5/11/24 Results Q Pass Fluid depth prior to test 0 in Water added 300 gal New fluid depth 5 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate 300 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 114 in Effective depth used 0 in Effective depth remaining 114 in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) ❑■ Septic Tank/Lift Station on Lot > 100' if No _ ft Community Sewer Manhole/Cleanout > 100' ❑ Yes if No _ ft ❑ Yes if No _ ft Neighboring Tank > 100' ❑ Yes if No _ ft Private Sewer/Septic Line > 25' ❑ Yes if No _ ft Absorption Field on Lot > 100' ❑ Yes if No_ ft Holding Tank > 100' ❑ Yes if No _ ft Neighboring Absorption Fields > 100' ■ ❑ Yes Animal Containment > 50' ❑ Yes if No ft ❑ Yes if No ft ❑■ _ if No _ ft _ Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑Yes if No _ ft ❑ Yes if No _ ft 9 N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑■ Yes if No _ ft Surface Water > 100' ■❑ Yes if No _ ft Tank to Property Line > 5' ❑■ Yes if No _ ft Wells on Adjacent Lots: Field to Property Line > 10' ❑ Yes if No*?5 ft Private Wells > 100' Yes if No _ ft Water Main > 10' _ ■ ❑ Yes if No ft Community Wells > 200' ty _ "»DD' Yes if No _ ft Water Service Line > 10' ❑■ Yes if No _ ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS * ALLOWED UNDER THE OLD CODE, ** SEE ADEC WAIVER EXISTING FCO NOT ON SURVEY ASBUILT, BUT ITS ON THE RECORD DWGS. G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm AAt/? AA ay ,r < t7✓r t � Engineer's Printed Name Su rnC� COSA Checklist June 2022 Phone 727-8864 Date OF A[NR* gs`�pd p/e*„' MllCHAEL N. ANDERSON CE -9869 v t�lgfo s(0 (llfll� � E�`��i s 0 N49THyvC � s—/" MUNICIPALITY DEVELOPMENT SERVICES DEPARTMENT N "d 907-343-7904 r v, On -Site water and Wastewater Section Win~ Fax: 343-7997 www.muni.org/onsite Arsenic Advisory Certificate of On -Site Systems Approval # OSC241411 Subdivision: Sand Lake #2 , Block: 4, Lot: 11 A water sample revealed an arsenic concentration of 59.9 micrograms per liter (ug/Q. 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. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date �Z�— Y7 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property Owner Telephone: Home Business Mailing Address (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent o// c Address Telephone Z7�—Z00% (e) Mail the HAA to the following address: or: Check here �, if hold for pick up. List contact person and day phone number below. �zz /3S-3 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms 3. WATER SUPPLY Individual Well ❑ CommunityA Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite X Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (Rev 8/861 Front 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site 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 Telephone �`YZ� /� SS5 Address Date 'L.'01 ngine 's Sbeif' �4 oo *:•49TH �•. �4d �0..... :....... ..0 �.- . . 0.0.06...... / •� HUGHR.SEVAN ;•'v,� CE 7225 J'> rAW 1 `9��'►tiEoe'�`1��... 6. DHHS APPROVAL Approved for 4wo CQ bedrooms by / "� '� ^" -� Date Approved & Disapproved Terms of Conditional Approval Conditional CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (Rev 8/86) Back MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) ENVIROWEN7AL SERVICES DIVISION CHECKLIST - FEBRUARY 1984 264-4744 APR 2 7187 Legal Description: A. WELLDATPkECEO\1ED Well Classification �/�i/u�i If& B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by Date � Z�9,'I X57 Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed '17,AI- 841 Size �'©fl No. of Compartments 7 - Standpipes Standpipes (Y/N) y Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) A/ Date Last Pumped �/_Z_Z9Z Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well C"e e) To Building Foundation To Property Line �/��� To Disposal Field To Water Main/Service Line N/fr To Stream, Pond, Lake, or Major Drainage Course�P Comments l� C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed j? Length of Field Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present (Y/N) Depression over Field (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: ` � J To Water -Supply Well ,4Z To Property Line � To Building Foundation Lot N 2y Al To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course On Adjoining Lots To Existing or Abandoned System on 5_0 To Cutbank (if present) N�A To Driveway, Parking Area, or Vehicle Storage Area X vl� Comments ��C% a�Gr�oe, �fe D. LIFT STATION %✓� Date Installed Size in Gallons "Pump On" Level at — High Water Alarm Level at Tested for Electrical Codes (Y/N) — Comments Dimensions Manhole/Access (Y/N) "Pump Off' Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I h heck ,verified, or conformed to alll MOA and HAA guidelines in effect on the date of this inspection. Signed DateL��� Company MOA No. GE f7—oo (y Receipt No. ! U U / OF r'6".••••••.;Q Date of Payment q f s k� e •s�,+� T A A Pu/ Aw En Sia t♦ Amount: $ Page 2 of 2 72-026 fRev. 8/86) Back s *: 49TH •.* �� �� ••• HUGH R. BEVAN ya ,7J CE 7225 •. rt �qf ••.......•• ��`°AW eP� Off SS���'�`~.p ' \ P.O. Box 112952 BEVAN ENGINEERING Anchorage, AK 99511 (907) 522-1393 April 27, 1987 Municipality of Anchorage Department of Health & Environmental Protection 825 »L» Street ` Anchorage, Alaska 99501 Re � AHF -C, Health Authority Application Lot 11 Block 4 Sand Lake Subdivision #2 Gentlemen � During the period from April 6 to April 22, 1987 I performed test on the septic system research, site investigations, and absorption field testing persuant to Health Authority Approval on the a�ove referenced lot. a 2 bedroom home^ The septic tank was pumped and the volume I took a water sample for coliform analysis and the lab results were satisfactory. I performed an absorption test on the septic system and determined that absorbed at a rate of 450 gallons per day <gpd). This exceeds the 300 gpd required for a 2 bedroom home^ The septic tank was pumped and the volume removed was 1000 galons. To my knowledge I have assembled all of the information requested on the HAA Application and Checklist" I a� submitting this data to you for your review" Please contact me if I can provide any additional information" (ph 522~1383) ' Sincerely, �ugh R" Bevan P"E. Attachments � HAA Application HAA Check1ist Sewer Record Drawing Soils Log CoIiform Analvsis Septic Pumping Receip� 87221~s 1 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date-/-� _%/� T _ (a) Legal Description (include lot, block, subdivision, section, township, range) Z0 -t-/1 /3tt; df -VA ,L)o ZAjrL 'A'2 ' ZA) R4 -W 12a c- /t1 Location (ad/dress or directions) �3/4'u n L.lr it : Rn (b) Applicants Name fe 7-c,/)0et-gu-t;u4l Telephone - Home Business Applicants Address (c) Applicant is (check one) Lending Institution Owner/builder ; Buyer [:::I ; Other F:�j (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: i 2. Type of Residence Single -Family Number of Bedrooms 3. Water Supply Multi -Family Other (describe) Individual WellEl Community 77-1 Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite Public 1= Community 1= Holding Tank = Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] �r A � 3AA'� e./,VvE .MZ 5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information 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 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 regula- tions in effect on the date of this inspection. Name of Firm �f �,�` Telephone gni 4oct� Address_L,g(�3n Date_. (ENGINEER SEAL) 6. DHEP Approval Approved for 2 bedrooms Approved Disapproved Terms of Conditional Approval By �`f' Date CAUTION Conditional 1W�d p9B06000p-. �.iR e se:asaaa.�� o.asur � ==09 s e �4 a le py C. "sid, J .' J 1No. 2?51 E 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 ALASKA. 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 ANALYZE 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/D18 [Page 2 of 2] 7-19-84 ` MUNICIPALITY OF ANCHORAC:: DEPT. OFF HEALTH ENVIRONNIENTA.L PROTCC_, I MUNICIPALITY OF ANCHORAGE (MOA) ISEP 14 9934 HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 RE CEI VE D Legal Description: 4ol-11 A. WELL DATA SAND L,p KE 'Z- Well Classification C2 Y ar�un,tfiY If A, B, or C, D.E.C. Approved N) Well Log Present (YM) Date Completed Yield Total Depth .[)6114 Cased to ti/k4 Depth of Grouting �— Static Water Level ,yb= Pump Set At eU%sd Sanitary Seal on Casing (YM) Casing Height Above Ground (Y/N) Electrical Wiring in Conduit 4 Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot /p � +- On Adjoining Lots o To Nearest Edge of Absorption Field on Lot 16 on Adjoining Lots2E /D ,, To Nearest Public Sewer Line V4 To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot -ada__ Water Sample Collected By A�t� Date_ iu► Water Sample Test Results Ccmmntsp c 41 _ e lA Az; zt B. SEPTIC/HOLDING TANK DATA Date Installed Size I. BDa No. of Compartments Standpipes &N) Air -tight Caps (gVN) Foundation Cleanout Y ) Depression over Tank (Y&—Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (YM) Temporary Holding Tank Permit (Y/N-- Separation Distances from Septic/Holding Tank: To Water -Supply We 11® 102* To Building Foundation ls�� To Property Lire 7 or To Disposal Field 4.S To Water Main/Service Line —d4&. To Stream, Pond, Lake, or Major Drainage Course Comments Receipt # s' C k,22 13 Date Paid: y -/c1-,-4 Amount: 445-, Cy C2 [Page 1 of 21 2-15-84 C. L1 13 4 SAV D LA Ke 9*2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata )Sp UI Type of System Design tj?,&tic 14 Date Installed b�3a/8� Length of Field / 6 Width of Field Depth of Field )"5-1, Gravel Bed Thickness Square Feet of Absorption Area 304-0� Standpipes Present Depression over Field (Y/O Date of Last Adequacy Test Results of Last Adequacy Test Nw.� Separation Distance from Absorption Field: To Water -Supply tnt? 11 40 ) p z To Property Lire / 3, A: - To To Building Foundation IZC ` To Existing or Abandoned System cn Lot AJ /At ; On Adjoining Lots 230 To Water Main/Service Lire �/ To Cutbank(if present) 601: To Stream/Pond/Lake/or Major Drainage Course 41+ To Driveway, Parking Area, or Vehicle Storage Area I� Comments PE,e Mr,ua Il Si3�i; cT ®b ec_ L,._J A ', v P p D. LIFT STATION,:. Date Installed �/ Diirensions Size in Gallons Manhole/Access (Y/N) ,tet/y} "Pump On" Level at 'I "Pump Off" Level at A Y1 High Water Alarm Level at 4t/P-4- Vent (Y/N) �Q/M Tested for ai /a Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(Y/N) A.IjA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or confcrred to all MOA HAA Guide�� s� n -effect on the date of this inspection.Or A4 Signed �,If -,AA--Date '� (7�'•e eD�` e®o�e°��o-�ti /e Compan C 5 ,vim MOA No. -t o � KB1/d5/s e L oy C. Reid, r.e tie .2251-E 9.• �c o�ooe o4�0 f<, Q�9 �pROFf-_S51Q`�F �9' [Page 2 of 21 3 e 2-15-84