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HomeMy WebLinkAboutSAND LAKE #2 BLK 4 LT 12Sang �� µ a gap I`oU- 13 5- '-t1 MOA SAVE OF AUSK� FrankMurkowskl,Governor DEPT. OFF ENVIRONMENTAL CONSERVATION SANCHORAOGE, AK 99501 Phone: (907)269-7519 DIVISION OF WATER Fax: (907) 269-7600 http://www.state.ad—us/dec/ WASTEWATER DISCHARGE PROGRAM May 22, 2006 Michael N. Anderson, P.E. 4640 Shoshone Avenue Anchorage, Alaska 99516 Re: Lot 15, Block 4, Sand Lake Subdivision # 2, Anchorage, Alaska -Waiver of Separation Distance from two Class C Source Wells and an Onsite Wastewater Disposal System- ADEC Plan Tracking Number 5437 Dear Mr. Anderson: On April 21, 2006 we received an engineering report requesting that the required separation distance between two existing class C wells located on Lot 38, and Lot 12 and an existing onsite wastewater disposal system located on Lot 15, be reduced from 150 feet to 130 feet for each. The existing wastewater system consists of a 1,000 gallon two compartment septic tank and a soil absorption system which is 40 feet long and 5 to 6 feet wide with 18 inches of drain rock beneath the perforated pipe. The septic tank and drain field were approved by the Municipality of Anchorage in 1982 to serve the three bedroom single family home on Lot 15. The existing Class "C" well located on Lot 38 has been in operation since September of 1982, well's in the area are nearly 300 feet deep with confining layers identified in the well log. A recent nitrate sample results was 0.23 mg/l. The existing Class "C" well located on Lot 12 has been in operation since 1984, this well is reported to be 397 feet deep with confining layers identified in this area well logs. Therefore based upon the engineer's recommendations, existing site conditions and water sample results, the required separation distances are reduced as follows: The source well on Lot 38's separation distance is reduced from 150 feet to 143 feet to the existing septic tank and is reduced to 130 feet to the onsite soil absorption System. The source well on Lot 12's separation distance is reduced from 150 feet to 130 feet to the onsite soil absorption system. This approval does not imply the granting of additional authorizations nor obligate any state, federal or local regulatory body to grant required authorizations. Any person who disagrees with this decision may request an adjudicatory hearing in accordance with 18 AAC 15.195-18 AAC 15.340 or an informal review by the Division Director in accordance with 18 AAC 15.185. Informal review requests must be delivered to the Division Director, 555 Cordova Street, Anchorage, Alaska 99501, within 15 days of receiving the decision. Adjudicatory hearings requests must be delivered to the Commissioner of the Department of Environmental Conservation, 410 Willoughby Avenue, Suite 303, P.O. Box 111800, Juneau, Alaska 99801, within 30 days of the decision. If a hearing is not requested within 30 days, the right to appeal is waived. Thank you for your cooperation. If you have any questions please do not hesitate to contact me at 269-7519. Respectfully, WiG�%�✓ � Ir,jCPiGli� William R. Rieth, P.E. Environmental Engineer cc: MOA, Onsite cc: William Smyth, WW, w/o enc. 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 NdINEW UPGRADE MAI LING ADDRESS , L� T� LEGAL DESCRIPTION LOCATION`. N0. OF BEDROOMS \ TIZU RLAW VTT z Well �'f'" Absorption area Dwelling PERMIT NO. U Y DISTANCE TO: �/* V ' �, , _ I__ Z Manufacturer /) h Material No. of compartmen,s w F Fjt Liq. ca city in allonsIF HOENIADE: Inside length �^ Width -e.._ Liquid depth ❑ �-' DISTANCE TO: Well Dwelling PERMIT NO. J � Z =Z FQ- Manufacturer - Material Liquid capacity in gallons DISTA: NCE TO ell j Foundation f Nearest lot line �y t PERMIT NO. w= C� J LL z No. of lines, Length of each lin Total length of lines Trench widthel Distance betweenR Ii' P Z w - inches N FTop to finish Material beneath tile Total of tile grade �. effectjaabso area ❑ iaaH s Length Width Depth PERMIT NO. w 0 Q I- Type of crib Crib diameter Crib depth Total effective absorption area Wa LU Well Building foundation Nearest lot line DISTANCE TO: C ass D/ggt�h�,.� Driller Distance to lot line PERMIT NO. J Lip//Vyl�l. W � Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALS p/ SOI L TEST RAT NG1 ' 1-�' 1:50 N INSTALLER Roio x REMARK i r: i g r 8r L 6006% tile: K- Vo G GAP T'e A W i I)'i Ii elr 6'06.SF r3 C OAi Ai v& Lk L>'L _ r ti , MOM A 14 — APPROVED DATE LEGAL 1 6 1.��� lob-� 72-013 (Rev. 3/78 i ' �U P�I �I ����� �� �r�� ������ ` DEPHRTMENT 6r (7 it HND ENVIRONMENTHL �ROTECTION , '^ 825 L STREET/ HNCHORHGE/ HK 99501 ^~ _ 264�4720 PERMIT NO� DHTE, ISSUED HPPLICHNT �DDRESS� LEGHL DESCRIP LOT SIZE� MHX BEDROOMS 8402]1 04/2]/84 T&T CVONST 2]20 DENNIS WHY HNCHORHGE/ HK 9g517 ]45~2670 SUBDIVISION� SECTION� 10 6700 (SQLFT 2 SHNDLHKE #2 LOT: 12 TO�NSHIP: 12N RANGE: 41,1 OR HF. -RES) BLOCK: 4 LISTED BELOW HRE THE OPTIONS HVHILHBLE TO YOU IN DESIGNING YOUR SEPTIC SYSTEM. CHOOSE THE OPTION THHT BEST FITS YOUR SITE. � - -~~-- �~�~~~��~­ _�~~�~­ __�~­__. ��� �-���������� �����» ��. �»����][PA ' DEPTH TO PIPE BOTTOM (FT� ) 4.0 40 4%0 GRHVEL DEPTH (FT� ) 11.0 0.5 I5 TOTHL DEPTH (FT. ) 15.0 4.5 7.5 GRAVEL WIDTH (FT. � 15.0 5.0 GRHVEL LENGTH (FT� 0.0 0 GRHVEL VOLUME (CUYDS) 149 166 24.4 TANK SIZE (GALS) 1)000. 0 000.0 ** SOIL RHTING (SQ�FT�/BR) �150 150 � 150 **THNK MUSTHHVE HT LEH�T TWO COMPHRTMENTS I CERTIFY THRT� 1. I HM FHMILIHR WITH THE REQUIREMENTS FOR ON --SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE (MOH) HND THE STATE OF HLHSKH. �I WILL INSTHLL THE SYSTEM INHCCORDHNCE .WITH ALL MOH CODES AND REGULATIONS, HND IN COMPLIHNCE WITH THE DESIGN CRITERIA OF THIS PERMIT. ] I WILL HDHERE TO HLL MOH HND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK DISTANCES FROM HNY EXISTING WELL/ WHSTEWHTER DISPOSHL SYSTEM OR PUBLIC SEWERHGE SYSTEM ON THIS OR HNY HDJHCENT OR NEARBY LOT. 4 I UNDERSTHND THHT THIS PERMIT ISVHLID FOR H MHXJMUM OF 2 BEDROOMS AND HNY ENLHRGEMENT WILL REQUIRE AN HDDITIONHL PERMIT. IF � LIFT STHTION ISINSTHLLED IN HN AREA COVERED BY MOH BUILDING CODES/ THEN (1) HN ELECTR�CHL PERMIT AND INSPECTION MUST BE OBTAINED/ (2) HS_BUILTS WILL Ni. -T BE HPPROVED WITHOUT HN ELECTRICHL INSPECTION REPORT/ AND (]) THE ELECTRICHL WORK MUST BE DONE BY H LICENSED ELECTRICIAN. ` SIGNED DATE: 8PPLICHNT� T ISSUED BY DHTE� ^ ~� � �) X SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 0 PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: nc)) (�I©nc- ruc d)OYl DATE PERFORMED: OC b CN i LEGAL DESCRIPTION: L 1U n('1 h',A NC SLOPE F IT '3and-5 . II}- 1 ' tMuej ) Clr�j 2 brown '/' - ) and, , e l e,(An 3 ` i 4 t / b ro L,) Yl 1 SIP 0-1e�yl 5 o i Occ- epi o oal !Q3Yuc i 7 / ; Gjrc�) darK brro"n 8 9 1 / 10 j k / SITE P WAS GROUND WATER S 11 i i ENCOUNTERED? L O 12 / / E IF YES, AT WHAT DEPTH? 13- 3 Date Gross Time Net Time Depth to Water Net Drop 14 14- 15- 15 16- 1617 17 1 / a 18- 8 19 19 -_ 20 -1-1") +01 COMMENTS rn0A Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE /i� ® f r jab (minutes/inch) TEST RUN BETWEEN FT AND FT PERFORMED BY: /lL I San / 6OL-6 I//j1,MnWjf-ERTIFIED BY: 72-008 (6/79) DAT From: Brannan,Thomas W(DEC) thomas.brannan@alaska.gov B Subject: RE:PWSID 213849-CLASS A or Private"C" Date: December 14,2018 at 10:08 AM To: bmwfish brentwestern@gmail.com Our records indicate that the system is private. -T.W. Public Water System Summary AK2213$49 SAND LAKE HOMEOWNERS ASSN. Public Water System Information Primly Facility Service Local Name Clay Served Region Served Active Source Count PWS Type Connections SAND LAKE 412 L10-13.40-42 8s ANCHORAGE ANCHORAGE A GW 3 KR 6 Comments: Senile.y Survey Data, Surveyor. AK2213848 SAND LAKE HOMEOWNERS ASSN. Estimated Use by Population Type Average Daily Population Annual Operating Annual Operating Effective aegis Effective End Count Type Period Starts Period Ends Date Dete 17 R t I 1 12/31 1/1/1997 AK2213849 SAND LAKE HOMEOWNERS ASSN. Public Water System Facilities facility Name Facility Code Active Water Type Available OS SAND LAKE HOMEOWNERS ASSN OS001 A OW P SS SAND LAKE HOMEOWNERS ASSN. SSODI A G1V P WL SANO UKE NOM/OWNERS ASSN. W1DO1 A OW P AK2213849 SAND LAKE HOMEOWNERS ASSN. Sampling Points Facility Code Sampling Pi Code Description Type Type Active 05001 SPOSOOIPC SAND LAKE NNONEOWNER5 OS A OS001 SPDSOO1TCR SAM)LAKE*IOIIEOWNERS OS A 55001 SPSS001 5.4*)LAKE HOSIEO HERS A WL001 SPWLOG1 SAND LAKE HOUEOW1IERS NW A AK2213849 SAND LAKE HOMEOWNERS ASSN. Administrative/Owner information Owner Type Owner Name Addreaa Phone fax OW SAND LAKE n0A 8140 SEACLEF STREETANCf4ORAOE.AK 99502 907-243-0503 OP SHEIEL8PIE,NANCY 8140 SEACUFF ANCHORAGE,AK 99502 907.243-0503 OP CUNNfiGHAll,NK 8140 SEACLFF STREET ANCHORAGE,`K 90502 907445.2479 AC SMFFF1 R*SF NAkf.Y Klan fir Af l iF ANCi4nRA[if AK ARS07 07.T9.VMM Original Message From: bmwfish [mailto:brentwestern@gmail.com] Sent: Friday, December 14, 2018 9:47 AM Tn FPn71. luctin C (f)FC) <iuctin.fen7l analacka.env> Cc: Robertson, Roy A (DEC) <roy.robertson@alaska.gov>; Brannan, Thomas W (DEC) <thomas.brannan@alaska.gov> Subject: PWSID 213849 - CLASS A or Private "C" There is conflicting information in the MOA files, I cannot find anything online with ADEC and the manager of the well said ADEC sent a letter (she can't find) that no water quality monitoring was needed - so I need to know if this is an A or private well. In one MOA file there's reference to ADEC reclassifying the well from A to C in an ADEC letter dated 5-23-97. Sounds like its a private well, but its been noted as an A within the past 10 years too. Please let me know. Thanks, Brent Western 907-440-4601 OF rar f ry - rA U� A L A5''' STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION CONSTRUCTION AND OPERATION CERTIFICATE for PUBLIC WATER SYSTEMS A. APPROVAL TO CONSTRUCT I —r= A - 33t'p Plans for the construction or modification of WAFEV. WELL J SC .<Ti5j j L 6 T ' 0LA-ssA4 may,, !'3 1+G9 ,DrT4bf 1r�1 >Et y 2 $LOc tc j} sA ?J P L ri K E � �c water system located In /�' C 6-t Alaska, submitted In accordance with 18 AAC 80.100 by ALAS K14 ENU-TAOn NFAITAC 1210NT RL)C S have been reviewed and are 9 approved. Z❑ conditionally approved (see attached conditions). ,. � A �e 67 6 7jj //-17-x/ BY TITLE DATE If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. B. APPROVED CHANGE ORDERS Change (contract order no. or dncdpttm retewn * Approved by d se s s � Horzill Lis /0& fit. 'ECg x(Jc 61CU. -E-0 3 )VTU � • C. APPROVAL TO OPERATE pw S -Q Date WL s E PA(R r477a►t7 -1r1-el C2w owc 1 cAkkM C �s P11 The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water Is made available to the public. The construction of the A)A:Me SyCrS1!✓ LO -n 11 12 17114 g jq2 �L0« 4 s4p-�u6lie water system was completed on +� (date). The system is hereby granted interim approval to operate for 90 days following the completion date. BY TITLE DATE As -built plans submitted during the interim approval period, or an inspection by the Department, has confirmed the system was constructed according to the approved plans. The system Is hereby granted final approval to cps e. —S— BY L TITLE DATE DISTRIBUTION: 1. WHITE - ENGINEER (Complete Section C) 2 YELLOW - WATER SYSTEM FILE (Complete Section C) 9. PINK - ENGINEERfMUNI-BOROUGH (Complete Section C) " n \ ALASKA OUIROWnTAL ConTROL SHUNS, IX Cngineerinq & 6nuironmenlal Studies MUNICIPALITY OF ANCHORAGE June 20, 1984 DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION Department of Health and Ehvironmental Protection I JUL Z 41984 825 L Steet 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 absorption area. 2) Septic tank distance between septic tank and from lot line. 1200 Wes[ 33rd Auenue. wile B ® Anchorage, Alaska 995039(907) 561-5040 The above mentioned compromising distances occurred during the excavation of the septic systems. It was felt that if a compromise 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,, 4K - Larry Montgomery Environmental Engineer MUNICIPALITY OF ANCHORAGE • `� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services C4 On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # i l - 3s-- 4-1 '-GUU HAA # �A 1. GENERAL INFORMATION Complete legal description Com, i 1 Z. Is k - Location (site address or directions)': Property owner Day phone Mailing address^�%�'-�%�✓1 Lending agency Day phone Mailing address r Agent 77A-L,a) phone -%»>G Address S ; Ctf : ccs rl.�C% 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 ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date ofthis inspection. Name of Firm Address Engineer's signature Naska % atar & 847 6. DHHS SIGNATURE 4 Approved for �� bedrooms. By: Disapproved. Conditional approval for Additional Comments Phone 33-7-6179 Date —e-, /( 3 �S 'r-OFESS'k� ' bedrooms, with the following stipulations: 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 courtesyto purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-M (Rev. 1/91) Back MOA #21 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION Municipality of Anchorage All 14 1991 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division RECEIVE dh 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description:Lo 1 Z-, g V- 41 Parcel I.D.: O 4'1-000 A. WELL DATA �^'o �t� sit) �$2 Well type 0.01" tr f A B, or C, attach ADEC letter. ADEC water system number �� 3 present (Y/N) Date completed Total depp Cased to Casing heightve (ground) Sanitary seal (Y/9PS-1 Date of test Static water level Well production WATER SAMPLE RES Coliform WELL LOG Nitrate Wires erly protected (Y/N) AT INSPECTION Collected by: bacteria B. SEPTIC/HOLDING TANK DATA Date installed 5 31 Jf� 4— Tank size %000 Number of Compartments Cleanouts (Y Foundation cleanout (Y/N) Depression((YY/,N,)) Af High water alarm (Y/N) Date of Pumping o q' Pumper /UCe' r I r►t�F�va' C. ABSORPTION FIELD DATA Date installed S3/ Soil rating ( . t2 or ft2/bdrm) System type Length I+ Width 3 ( Gravel thickness below pipe i� I Total depth Effective absorption area 309 Monitoring Tube present (Y/N)--Y— Depression over field (Y/N) N0 Date of adequacy test f/ Results (Pass/Fail) For bedrooms O Fluid depth in absorption field before test (in.); Immediately after (� gal. water added (in.): Fluid depth (ins) Minutes later: Absorption rate = DO f�' —g-p.d. Peroxide treatment (past 12 months) (Y/N) � If yes, give date (�cxaJ.n/ 72-026 (Rev. 3/96)' D. LI ION Date installed Manhole/Access (Y/N) High water alarm level Cycle tested E. SEPARATION DISTANCES *Datum Size in gallons SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ) oc) + On adjacent lots "Pump off" level at* i /bO Absorption field on lot 100 t 4' On adjacent lots loo + Public sewer main /J 1A- Public sewer manhole/cleanout /V ��- t J_ Sayer/septic service line � `t' Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ((3 Property lineG- Absorption field ° Water main/service line 10'4- Surface water/drainage (0O td" Wells on adjacent lots 10014 - SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: I Pew— 1484- I4Sp. aEl` -4T-' t Property line; Building foundation 8 • Water main/service line _ t ;F Surface water (oO "�' Driveway, parking/vehicle storage area Curtain drain NOTE-- (&JOlt.%tJ Wells on adjacent lots /0e7 F. ENGINEER'S CERTIFICATION� "10F A4 %% � ® may+_ ®� �c �%�2® I certify that I have in conformance inspections and review of Municipal Ps in effect on this date. Signature w /f Engineer's Name ��.1«`7 �* - ��l✓� Date 43 / 3 !-ei- HAA Fee $' Date of Payment �f 1 /J �-`7 Receipt Number 12 0 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number are JQ,ELAA.., �u1 v -tea -q/ ..VISTA REAL ESTATE I\C f7j002 111LJ.'/H/JI1J 11 Y'� iIU /JUJJJ'fU,N.L/ L , , l�f►r�"it' FAx Nota 767 lie '�" a 11 .` TO pa9eg �fir' fiv pp„ L FPCEP PFI0116 a PhM11 41 ax# th gel VAQ1 R JU r ®T+ I/ VIA? (�M{AryTE pew lrll tM @rfe°0!R A°bMdfiewe06o.1��i1` �p jq1 wO i �✓iArfnq� �pAatl� ���, i LOW Y 0 LOT M141011 rGUNDArm f. IT INA66 01 ,A/1rtwo FAT+OM 1 461 Mi11f1 ALL TV or SM611Vle(Ig91 ofVggA4T& iIN OA MI !, 2816 fmI1/Feh/lll`4T� 1 TMA NUILD41 To YIAIiT ALL ALrY�TIQre OITs °EMT TI ALL Of 1T11p1 a. "Is FLAT Mons MTI � FA /I FAIF r r Au e s TAYrr 0104% tot 111000 aeos* Tme ip f of TIME "11"91911464 lAYR 4�°°kor°r�pNF '� tirrei i°°i e 1r1r4T1 rILRqe4 T A�O+I11Ta "I- °L�L4 erir®il0A_{��e eT A�1109eiaiili eA .es ijIenAL MITAMi.a.nhla Yq/ AA r M G MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES. Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I. D. # n i )i — — L1 I 1. GENERAL INFORMATION HAA # 'ARA 1-1 D �)D1 Complete legal description Lot 12; Btock 4; Sand Lake Subdivision #2 Location (site address or directions) 8141 Sand Lake Road Anchonaae. AK Property owner Tkacy BeiA Day phone 659-5059 (w) 243-7840 Mailing address 8141 Sand Lake Road Anchorage, AK 99502 Lending agency Day phone Mailing address Agent Tim R.itt.01 2001 Ron.P.tU Day phone 276-2001 Address 2600 Denati S.ti.eet, Suite 400 Anchorage, AK Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 2 y 3. TYPE OF WATER SUPPLY: Individual well Community well XXX Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX 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 MOAN21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I 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 Address 17034 Engineer's signature 6. DHHS SIGNATURE Approved for 2 bedrooms. Disapproved. Conditional approval for Additional Comments By: Phone oj�y- 01Z714" Date Z Z/_ bedrooms, with the following stipulations: Date 7 —4,;e — 9¢ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev.1/91) Back MOA #21 ® Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LoT /Z 9LK(I- Parcel I.D. A. Well Data Well type CLASS A Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow A, B, or C, attach ADEC letter. ADEC water system number Z/3 M1 Date completed Driller Cased to Casing I Wires properly protect FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: INSPECTION Z UJ O o UX U. O h g.p.mr : a 1 U Z) Z Septic/holding tank on lot f U3 t ; On adjacent lots Z<ZU 1 U, Absorption field on lot On adjacent lots / 00 r� Public sewer main /S /� Public sewer manhole/cleanout /CSO Sewer service line ZS Petroleum tank /V oN L KNOc,3e—) WATER SAMPLE RESULTS: C'L4 S A W €CL Coliform N/14 Nitrate Other bacteria N�19 Date of sample: NIA Collected by: /U/,J B. SEPTIC/HOLDING TANK DATA Date installed 5131/yq-- Tank size (pyy (-q L Compartments z Cleanouts&) yds Foundation cleanout() Y(ff Depression (XL High water alarm (YIN GAlarm tested (Y/N)J'M Date of pumping 1' 0� 3 Pumper DENALI SEwEs24- DPZJAlN SE2U16E SEPARATION DISTANCES FROM SEPTIC/HG6&Nfr-TANK TO: /03'4- Well(s) on lot %D3 + On adjacent lots _ _ ,roundation To property line Absorption field z S / Water main/service line �U / Surface water/drainage /0-0 �f /N S/'E'c T;,01_f 72-026 (3W)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANC1= FROM LIFT STATION TO: On adjacent lots D. ABSORPTION FIELD DATA Manufacturer Manhole/Access (Y Cycles tested off" Level at Surface water Date installed S/3//�'4- Soil rating (GPD/Ft2) O System type li , c -H Length Width 3 Gravel thickness 1 I Total depth /r c� Total absorption area 36? OY� ? Cleanout present N) `�CS Depression over field (Y/� N� Date of adequacy test � / 2 I ��! 4— Result as ail) for -Two CZ Bedrooms Water level in absorption field before testes After test U Peroxide treatment (past 12 months) (Y/N) lJ 3N6 Gimme lo/. Q If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ./QS r-1 �On adjacent lots / oS rf )� Property line / Z r To building foundation Z S ` To existing or abandoned system on lot c e1•ESt'1u7 On adjacent lots ZD rf Cutbank N'ilt--)tr il�tg6kr Watermain/service line 1c)'"F Surface water /OCA r -f Driveway, parking/vehicle storage area O �z�� vvve� GwcwE� Curtain drain N61 -JE KN ct-.rJ A W'AIV&L G2�+ru� 9/SId� ��D/zlvEwwY WIDENED Z AF✓L f99! NIA. ENGINEER'S CERTIFICATION l certify that l have checked, verified, or S&S Signature 17-02 Engineer's Nam agle Date HAA Fee $ 5�C9d- e C/ Date of Payment /�6 — �\� Receipt Number /0 C5 / C g !Y l 72-026 (3/93)' Back MOA and HAA guidelines in Waiver Fee $ Date of Payment Receipt Number, 'of, ,isinspe6tlon. r DS t MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF.HEALTH & HUMAN SERVICES M� _• Division of Zhvironmental Services On -Si -fie _Services Section, P O Box 196650 Anchorage, Alaska 99519-6650 X343=4744 CERTIFICA I EOF HEALTH AUTHORITY APPROVAL FOR A,SINGLE FAMILY DWELLINGFil- ,;. Parcel I.D. # HAA # 1. GENERAL INFORMATION::. Complete legal description.Lot 12 Kock 4; Sand Lake. Subdivision #2c Location (site address or directions) 1 8141 Sand Lake Road Property owner H U.D. 0141-025574 Day phone Mailing address G05 Wut 4th Avenue:, Anchorage, Ak. 99501 Lending agency Day phone Mailing address Agent Lou Campbell ASSOCIATED BROKERS Day phone 563-3333 Address 640 Wu t 36th Avenue Suite One, Anchohage, AK. 99503 • Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 2 N 3. TYPE OF WATER SUPPLY: Individual well . Community well - -- - xx Public water NOTE: If community well system, provide written confirmation from State ADEC attest - Ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site". xx Holding tank Community on-site . Public sewer - NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91)- Front MOA #21. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm s R c ENGIN155-RING Phone e`f y 17034 Eagle River Loop Road No. 204 Address E -91a River, Engineer's signature Date J/ sOF Ati %k ®�• V 6. DHHS SIGNATURE Approved for Disapproved. -Conditional approval for bedrooms. = f Lr bed rooms,:; with the following stipulations: X- ir 1. e Additional Comments The Municipality of Anchorage Department of Health and:Human Si Approval Certificates based only upon the representations given in professional engineer registered in the State of Alaska. The DHHS does and their lending institutions in orderto satisfy certain federal and state r conduct inspections or analyze .data before a certificate is issued. responsible for errors or omissions in the professional engineer's work 72.025 (flee. 1/91) Back MOA #21 vices (DHHS) issues Health Authority aragraph 5 above by an independent is as a courtesy, to purchasers of homes luirements. Employees of DHHS do not 'he Mui7icipalit} }of Anchorage is not � . oil, Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST 44 Legal Description: a1Z i d3J6cr4{6A,.jd1.Ar,-_, Parcel I.D. A. WELL DATA Well type A If A, B, or C, attach ADEC letter. ADEC water system number Z 13 Log present (Y/N)Date completed � 11A Driller N10 Total depth lJIJc4 Cased to Casing height ry�6 Sanitary seal (Y/N) t'I Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION MUNICIPALITY OF ANCHORAGE NVIRONMENTAL SERVICES DIVISION Date of test � �} OCT 8 1991 Static water level Well flow g.p.m. WH I V E Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Y I O3 r"i" ; On adjacent lots (yO + I Absorption field on lot 4- (O S t + ; On adjacent lots OO t Public sewer main Nj A r Public sewer manhole/cleanout r)/b4 Public sewer service line fJ I IA Petroleum tank _;) oNe. <NOLJAJ -)F l.Jaiuer�rrs4a%c� �- S- d� WATER SAMPLE RESULTS: Coliform �13isfiAG�Dtr�f Nitrate�Atlsfi4Gt �4 1�.�•1 Other bacteria Z�d� Date of sample: Z -} - `1 Collected by: B. SEPTIC/HOLDING TANK DATA Date installed _ -3 Tank size f Ofd 9 A Compartments Z Cleanouts (Y/N)� Foundation cleanout (Y/N) Depression (Y/N) f High water alarm (Y/N) �N � I L Alarm tested ((Y//NN) �f � Date of pumping 1� D - 2 - I A4-6 c �/`%f�v `i!7 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: r , r Well on lot ( L) 3 f On adjacent lots Foundation— To oundation To property line I t7 4- Absorption field Z . *N Water main/service line _Z t Surface water/drainage 100 � 72-026(Rev.391) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION } IQ Date installed 'v V ' Manufacturer Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manhole/Access (Y/N) "Pump off" level at SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots Cycles tested Surface water Date installed :S- -_--� I - 8/4 Soil rating 1!0-(2 �Zae System type G4 Length Width b Gravel thickness Total depth115 Total absorption area -�,O Cleanouts present (Y/N) u Depression over field (Y/N) >J Date of adequacy test Results (pass/fail) ts� for L) bedrooms Peroxide treatment (past 12 months) (Y/N) al[A If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot j 0_5 ,t On adjacent lots * 105"t Property line To building foundation 2 To existing or abandoned system on lot On adjacent lots D �I- Cutbank Water main/service line r Surface water / lJ0 Driveway, parking/vehicle storage area Curtain drain t.JAi�eir I rAQ cd F- S— 8-{ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on tge dateofthis inspection. s�fy,PA a'3,e�*i y'.3 k t ®•�h ' a W� S & S ENGINEERING ®mon cs I •de Signature 17034 Eagle RiNer Loop Road No. 2N r . u Eagle River, Alaska 99577 49`Tf1 Engineer's Name Date \ o -7 — 'I HAA Fee $ Date of Payment /,o - / Z—` Receipt Number �,3 l 31'3 ( �&vs, 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number �• R03ER MAR �•• p6215 •°\ DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 "C" STREET, SUITE 322 ANCHORAGE, ALASKA 99503 FOR: S & S Engineering WALTER J. NICKEL, GOVERNOR f r 563-6775 October 3, 1991 PWSID 213849 My review of the records on file in this office reveals that the Sand Lake #2 Class "A" Public Water System, is in compliance with the routine coliform bacteria samples requirements listed in Table C, and with the inorganic sampling listed in Table B of 18 AAC 80.200. Sincerely, Byron Roys Environmental Engineer printed on recycled paper b y.C. n. MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPAR'T'MENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date 9/j�614 i� (a) Legal Description (include lot, block, subdivision, section, township, range) Leti? 131-Ket �'� 2/dfT� t/2 -U X-4cj SE,- iC, Location (address or directions) (b) Applicants Name PP ��- 'r` Cc>fv�t.4'�e {,'u.,. Telephone - Home Business Applicants Address (c) Applicant is (check one) Lending Institution Owner/builder ; Buyer r:::i ; Other (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: J �c m � 2. Type of Residence Single -Family Number of Bedrooms 3. Water Supply Multi -Family 21 Other (describe Individual Well =1 Community IZIPublic M 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 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] 1. 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 regula- tions in effect on the date of this inspection. Name of Firm ATelephone p SGi-;vac Address Date "S���J¢ 6. DHEP Approval i (ENGINEER SEAL) Approved for bedrooms By S of A'°!'k e°p°on°aoo°pooq��„q_F�x ° o p (ems Ai o vv,* oO ,* Leroy Reid, Jr. ' d�'�'To 2257.E rCG �$i.�lfr hate,', :'f /sA✓ 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 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 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 i LIWIPAILIf T S"OF f; �cHCRiX�"9 DEPT. OF HEALTII (. ENVIRONMENTAL PRCT!. TIOi'I SEP 14 1984 RECEIVED Legal Description: LC, -j /2 ,( zdclt y SA.,JQ /-AK& 'Z - Well Classificationc-o~t,u,,u,' ty' If A, B. or C, D.E.C. Approve4YJN) Well Log Present (Y/N) ,{J/,Aq- Date Completed ,t�& Yield�i Total Depth Cased to _��� Depth of Grouting `y /y.} Static Water Level T�� Pump Set Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (YIN) Separation Distances from Well: To Septic/Holding Tank on Loto 1OS'*- ; On Adjoining Lots® /Qp' To Nearest Edge of Absorption Field on Loth /, 5 ; On Adjoining Lotso )oo ( To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole%!4 To Nearest Sewer Service Line on Lot Water Sample Collected By dj 444- Date aJ1a Water Sample Test Results A,)I . Commnts Pe&7 M a14 AsKal c"F- ;D L) COL W14', uE2 B. SEPTIC/HOLDING TANK DATA Date Installed _ 7 3> Size / 60 C�, No. of Ccmpartments Standpipes (jf) N) Air -tight Caps Y ) Foundation Cleanoutx�— Depression over Tank (y6b Date Last Pumped 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 Gell o To Building Foundation To Property Line dF, To Disposal Field 2,5 To Water Main/Service Lire To Stream, Pond, Lake, or Major Drainage Course j Comwnts�EX Receipt # , q b 24J 3 Date Paid: Amount: CEJ (Page 1 of 21 2-15-84 -94,v t,q /rte Z C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata A-001 Type of System Design-�9&A&_1+ Date Installed , 3,342e Length of Field )ct � Width of Field 3 Depth of Field ); Gravel Bed Thickness 111 Square Feet of Absorption Area 30,90 ( 0,90( Standpipes Present AkN) Depression over Field (YA) Date of Last Adequacy Test �4y+ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well Q )6511 4- To Property Line To Building Foundation 2 $,5-- To Existing or Abandoned System on Lot tiZlA On Adjoining Lots > 30 1 To Water Main/Service Line _ J -To Cutbank (if present) ti/M To Stream ord /P /Lake/or Major Drainage Course y /�. �T To Driveway, Parking Area, or Vehicle Storage Area 41. Comrents 4eg moa 0 dpEc_ CuA;ue_l( D. LIFT STATION Date Installed A) A Dimensions A J A Sizes in Gallons ,t/ y► Manhole/Access (YM) "Pump On" Level at ,�/d+ "Pump Off" Level at High Water Alarm Level at / �]/ Vent (YM) ,4_j/a Tested for _2/A Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or, confcr-md to all MOA HAA Guidelines in effect on the date of this inspection. _� ®� Signed Date �4 ��Q(� OF•eoaf Q(-1��i P ••• °°° Compan �JL e_ -� „b C_ MOA No. S re zj- -o 2 4 ®0* d• ° 0� v s/ • S ••• gyp• •••°•2... KBl/d5/s ®®c ° Leroy C. Reid, J . No. 2251-E ". v (Page 2 of 21 ,.. 2-15-84