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SAND LAKE #2 BLK 4 LT 13
#011 em 135a=40 Municipality of Anchorage On -Site Water and Wastewater Program ° (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181440 PID Number: 011-135-40 Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade Name: JASON M. POPEK ABSORPTION FIELD - EXISTING ® Deep Trench E] Shallow Trench ❑ Bed El Mound Address ND 5431 W 82 Avenue, Anchorage, AK 99502 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 0. 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot SAND LAKE #2 4 13 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line Ft' -- -- Ft. Well 100'+ NA NA NA NA TANK ® Septic [:1S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCHORAGE TANK Capacity 1000 Gal. Surface water 100'+ NA NA NA Material STEEL Number of compartments 2 Lot Line 5'+ NA NA NA NA Foundation 10'+ NA NA NA LIFT STATION Manufacturer Capacity I i Curtain Drain NA NA NA NA -- -- Gal. Remarks Existing septic tank decommissioned Pump on level at -- in. Pump off level at -- in. High water alarm at -- in. per code and new one installed in same loc. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tank to 3034 Installer Mike N. Anderson drainfield _ Drainfield CO/MT 3034 Inspector Mike N. Anderson / FWCS BENCH MARK (Assumed elevation) 100 ft Inspection ectio15' 12/21/18 12/22/18 Location and description 2nd 31d 4'" GARAGE FLOOR COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp •� 5. iiasq d is Conditional Approval: Date W 049TH u e.eeesoo °ee000eeeao.c `.j Y -- •o s •eeoseo.......... ^v" ° MICHAEL N. ANDERSON J & AA Vf•° CE '469 •M1 '> �4��T�'`J ' � � '•"-4,. / Approved Date �LJ�� 1 0 X011 9 inspection Keport_V-i-iz.aoc L p_ OI 4' SOLID FROM HOUSE il\i \1-1 d d d d d SEPTIC SCALE: 1' = 20' FIN& GRADC NEW S.T, INSTALLED IN THE SAME LOCATION AS ORIGINAL S.T. & CONNECTED TO EXISTING FIELD Septic Design Prepared for JASON M. POPEK SAND LAKE #2 BLOCK 4, LOT 13 5431 W 82ND AVENUE, ANCHORAGE, AK Michael N. Anderson, P.E. 4601 Natrone Ave. Anchorage, Alaska 99516 (907)727 8864/FAX: (907)345 1391 AMN SCALE: SAND LAKE ROAD I N I _SECTION LINE _ CA o N00°05'01 "W 50.01' (NOO'00'00"W 50.00' R) 10' UTILITY ESMT 00 d r�1 nW OZ m SEPTIC • •• r D VENT • Mz (tyP) O C/) ;a Z cp Z O 00 (D O O Ci ON o cn _J M Z U1 Cri I� o O O - I I 30' 30' ( ANCH RAGE RECORDING DI TRICT, ALASKA AS -BUILT OF: SAND LAKE SUBDIVISION No.2 LOT 13 BLOCK 4 PLAT P-176 SURVEY CERTIFICATE: I, John L. Schuller. Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary- lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE: SCALE: E -MNL JAN 6, 2019 1 "=20' 19-001 DRA11N BY: CHECKID BY GRID NUMBER BOCK/PADE: JLS 2224 190101 DECK 24. O D 0 O !) n I x—x—x FSED 11.3' w EXISTINGPO w HOUSE o DECK LOT 13 BLK 4 N00`15'57"E 49.78' OO = FND 5/8" REBAR AW OF 49TH .. Aq ...... ....... ..............i •,JOHN L. SCHULLER: o fs�Z, LS -10408 Of ,mw 0 y L ND R��� U o ry 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax 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: OSP181440 Work Type: SepticTank Upgrade Tax Code Number: 01113540000 Site Legal Address: SAND LAKE #2 BLK 4 LT 13 G:2224 Site Mailing Address: 8149 SAND LAKE RD, Anchorage Owner: POPEK JASON M Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft Total Bedrooms: I 'J. Departniellt 12/17/2018 12/17/2019 - ❑ 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 Special Provisions: If tank cannot be located at least 5 feet from the drainfield, a waiver will be required. Received By: 4— Issued By: C"Ou Date: o 1{ 7 Date: 1 ay I d 3 Parcel I.D. 011-135-40 JASON M POPEK 907-351-7832 Property owner(s) Day phone Mailing address 5431 W 82ND AVENUE, ANCHORAGE, AK 99502 Site address 5431 W 82ND AVENUE, ANCHORAGE, AK 99502 Legal description (Sub'd., Block & Lot) SAND LAKE #2 BLOCK 4, LOT 13 Legal description (Township, Range & Section) Lot Size 6,600 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (Z all that apply) Absorption Field ❑ Initial 0 Single Family (SF) Septic Tank n Upgrade M (w/wo ADU) Holding Tank 0 Renewal 0 Duplex (D) 0 Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signatt,o operty owner or authorized agent) r Permit/Rush Fees: 167 Date of Payment: %9//"x-1/9 Receipt Number: A'3qlg Permit No. a's 101 F/ (4 40 Permit App_�9-1-12.doc Waiver Fees: Date of Payment: Receipt Number: Waiver No. Michael N. Anderson, P.E. Civil/Structural Engineering and Construction 4661 Natrona Ave. Anchorage, Alaska 99516 rn Phone 345-3377 Fax 345-1391 December 14, 2018 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New Septic Tank Permit Legal: SAND LAKE #2 BLOCK 4, LOT 13 The owner has requested we proceed forward to obtain a septic permit to upgrade the aged septic tank on the subject lot. The proposed upgrade will serve the existing 2 - bedroom house. Due to restraining factors of the small lot, the existing septic tank will be removed and the new tank placed in the same location. The lot and area is served by private water and this system will not impact any of the neighboring properties due to the lot layout. There was conflicting data in the MOA file about the well's classification serving this property. Per the attached email from ADEC, the well is private. Please contact me if you have any questions. Sincerely, Michael N. Anderson, P.E. DESIGN CRITERIA: INSTALL 1000 -GAL SEPTIC TANK WITH PRE & POST TANK COs MAINTAINING 5' FROM PROPERTY LINE, EXISTING FIELD, DECK & OTHER REQUIRED SETBACKS, INSULATE TANK IF LESS THAN 4' OF COVER, Septic Design Prepared for JASON M. POPEK SAND LAKE #2 BLOCK 4, LOT 13 5431 W 82ND AVENUE, ANCHORAGE, AK Michael N. Anderson, RE DATE: 4601 Natrone Ave. Anchorage, Alaska 99516 DRAWN: (907)727 8864/FAX: (907)345 1391 SCALE: 0 to DECOMMISSION EXISTING LOT 12 S.T. PER CODE & INSTALL NEW 1000—GAL S.T. t MAINTAINING 5'+ FROM ADD PL, FIELD & DECK. PRE—TANK CO N90*00'00"E 135.00' X X _x4i X_x_X_X _X_X. X—X—X—X-Z.- _X_X Rif - LO co 0 Lo CO 00, to FCO '6' 0 0 ADD COs 38.0'O -01 C C�> 01 0 IG. CO 3- uj S.T.EXISTING Cq a 100' 2 -BR HOUSE E- 0 yo WELL 0 0 MT RADII 0 38.0' —C —'ED 0_ C:) N 0 DECK DECK 7.8' 01 6 PAVE x cnj — zi I > x N90'00 )0"E 1 00 X- x Septic Design Prepared for JASON M. POPEK SAND LAKE #2 BLOCK 4, LOT 13 5431 W 82ND AVENUE, ANCHORAGE, AK Michael N. Anderson, RE DATE: 4601 Natrone Ave. Anchorage, Alaska 99516 DRAWN: (907)727 8864/FAX: (907)345 1391 SCALE: 0 to 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 g} T PHONE B? .NEW ` (/1C a 7 ❑ UPGRADE MAILING,4DDRESS 257-0 n v 976/ LEGAL DESCRIPTION 7 J� LOCATION NO. OF BEDROOM T O _Y DISTANCE TO: ell �Q 'f Absorption area .�% Dwelling ��� PERMIT NO. q 0232 07 QManufacturer a Ar Material / No. of comps ments LU I.- rn Liq. capacit in allons IF MEMADE: Inside length Width Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. J Z 2 z F Manufacturer Material Liquid capacity in gallons w= DISTANCE TO: Well9 1 / Foundation Nearest lot line / PERMIT N08v6 z.2 J LL Z No. of lines Length of each line I�j,� Total length/ of Ii es Trench wi th j/ Distance between lines FZw ZE 1"Jr,� inches /�/ F Top of the to finish grade I Material beneath tile f Total effective a sorpti n area - w Length Width Depth - PERMIT NO. C7 a F wa Type of crib Crib diameter Crib depth Total effective absorption area Lu Cl) DISTANCE T0: Well Building foundation Nearest lot line lass G�•^ kUPG Depth Driller Distance to lot line PERMIT NO. w S�'� DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS �D SOIL TEST RATING T 1 12 yr fa'1 34 INSpTALLER rr �4,1 � — REMARK'SC �, ;I S 4PG O c� 1 1'T FOO LS fi a PROPZ66C0AA1UA1;71 WL LI. MDQ � -tea 14- I APPROVED DATE LEGAL w� S-A aKLOZ R la -k !� !� ~ rid .4 �fRfl 1 '7� �� �P�����- � U � �� �^� °_p '~~ DEPHRTMENT br HEHLTH HND ENVIRONMENTHL �ROTECTION - 825 L STREET, ANCHORAGE, HK 99501 " / 264�4720 �1�W EF F...-" ��1F;-Zfr-1 T 7" PERMIT NO: 8402]2 DATE ISSUED� 04/2]/84 � HPPLICHNTT&T CONST, HDDRESS: 2]20 DENNIS WRY � HNCHORHGE, HK 99517 CONTHCT PHONE: ]45-2670 LEGHL SHNDLHKE 4-2 LOT: i3. BLOCK: 4 SECTION� 10TOWNSHIP: 12N RANGE� 4W ` LOT SIZE� 6700 (SQFT. ORHCRES) MHX BEDROOMS.- 2 LISTED BELOW HRE THE OPTIONS HVHILHBLE TO YOU �N DESIGNING YOUR SEPTIC SYSTEM. CHOOSE THE OPTION THHT BEST FITS YOURSITE. � � �..... ... .... ����^������������������������������ ������ Ell �. ^ ��n I r� DEPTH TO PIPE BOTTOM (FT ) 4�0 4�5 4�0 GRHVEL DEPTH (FT. ) 11.0 0.5 5 TOTAL DEPTH (F^[ ) �L5.0 5.0 7.5 GRHVEL WIDTH (FT.) 25 15.0 5.0 GRHVEL LENGTH (FT� ) 14L0 ]0.0 Z3�0 GRHVEL VOLUME (CU.YDS� ) 14.9 16�6 24.4 TANK SIZE (GHLS)1/000.0 ** 1,000.0 ** 1/��0 0 ** SOIL RHTING /SQ.FT�/BR) 150 150 ^ 150 ** THNK MUST HHVE HT LEAST TWO COMPARTMENTS �..... ... .... .... ...����������� I CERTIFY T[FIT: 1. I HM FHMILIHR WITH THE REQUIREMENTS FOR Ohl -.-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE (MOH) HND THE STATE OF ALASKA. 2. I WILI IN ACCORDANCE WITH ALL i'10H CODES AND REGULATIONS/ HND IN COMPLIHNCE WITH THE DESIGN CRITERIA OF THIS PERMIT. I I WILL RIA. -ERE TO HLL MOH HNDSTATE OF ALASKA REQUIREMENTS FOR THE SET BACK DISTANCES F�OM ANY EXISTING WELL, WHSTEWHTER DISPOSAL SYSTEM OR PUBLIC SEWERHGE SYSTEM ON THIS OR HNY HDJHCENT OR NEHRBY LOT. 4 I UNDERSTHND THHT THIS^PERMIT IS HLID FOR H MAXIMUM OF 2 BEDROOMS AND HNY'ENLHRGEMENT WILL REQUIRE AN HDDITIONHL PERMIT. IF H LIFT STH -I -ION IS INSTALLED IN AN AREA COVERED BY MOH BUILDING CODES/ THEN (1) HNELECTRICHL PERMIT AND INSPECTION MUST BE OBTHINED/ (2) AS -BU ILTS WILL NOT BE HPPROVED WITHOUT HN El ECTRICHL INSPECTION REPORT/ AND (]) THE ELECTRICHL WORK MUST BE DONE BY H LICENSED ELECTRICIAN. SIGNED � DATE: .... �........ ____.... .... t�_�-~��~~~~~_~~~�~~~����~ HPPLICANT: T&T C T SE". UE BY DATE: ' �� �~ SOILS LOG MUNICIPALITY OF ANCHORAGE • ae DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: J Q n (�7 Con ru C ) D Y> DATE PERFORMED: LEGAL DESCRIPTION: 2 FT xo 3 4 � � . �1p 'S anci I dry ' G�L�CnYl� `)i n 5 i 6- 7 QCGct�) 011Cc yaueI, 8 y ' cAr ,I 1'-0l,J Yl 5P G rcaued, sand 10 1%CA r� , I 16h+ � bro uj n PLAN JERCE ■■I■■ MMI■■ M■!M■ ■E■■ ■■■■ MM■M MEMO MEMO ■■MM ■■■■ 11 WAS GROUND WATER ' ENCOUNTERED? 12 3 IF YES, AT WHAT DEPTH? 13- 14- 15- 16- 17 314 15 1617 i i 18- 19-- 20-1 8 19 20 T�fl PERCOLATION RATE I t) Q� ' k3bft (minutes/inch) TEST RUN BETWEEN FT AND FT it S 'NO L O .4- P— E Reading Date Gross Time Net Time Depth to Water Net Drop COMMENTS K d PERFORMED BY: clod &`�,5- bUte Jar co/Do—a,04kRTIFIED BY: 72-008 (6/79) DATE:.7h'/) {.1 v E'U I it, ,e yT ti; STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATIQWNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & CONSTRUCTION AND OPERATION CERTIMOWMAL PROTECTION A. APPROVAL TO CONSTRUCT for SEP �, 1984 PUBLIC WATER SYSTEMS RECEIVED 5>q.�Al l —I= 4 — Vie' Plans for the construction or modification of J• I -EP WELL 4 S5 fwl_ Ly _ ) � 1��Ct�crc s�N� cr4KC �� 0Lol--SS4 �} —7 �__1i 4 pu tc water system located In iJ C f�Gi� 7� , Alaska, submitted In accordance with 18 AAC 80.100 by NL/rK FAIU-' 90*7 V rli{ d6N Dir-F�have been reviewed and are 9 approved. ❑ conditionally approved (see attached conditions). eY 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. 8. APPROVED CHANGE ORDERS Change (contract order no. or deaapttve reference) Approved by Date ,'YsTf'(`,? H0i?rZgizc)J7')1c SEPA94T-1601 C. APPROVAL TO OPERATE 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 public water system was completed on (date). The system Is hereby granted Interim approval to operate for 90 days following the completion date. 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 operate. I&"? (Rev. 1144 DATE DISTRIBUTION: 1. WHITE - ENGINEER (complete Sectlom C) 2 YELLOW - WATER SYSTEM FILE (Complete Section Q 9. PINK - ENGINEERRdUNI-BOROUGH (Complete Section C) 1. GOLDENROD - A&UNI-00ROUGH (Complete Section A) MUNICIPALITYI° 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. 011-135-40 1. GENERAL INFORMATION Complete legal description SAND LAKE #2 BLOCK 4, LOT 13 Expiration Date: �N N Location (site address) 5431 W 82ND AVENUE, ANCHORAGE, AK 99502 Current property owner(s) NATHAN CHOTT Day phone Mailing address 5431 W 82ND AVENUE, ANCHORAGE, AK 99502 Real estate agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment /- 6o Z d Z, Date of Payment Receipt Number ©SJz Receipt Number COSA# -5 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE AK 99516 Engineer's Printed Name _CURTIS HUFFMAN, PE Date 5/5/2022 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FWr.5 6. DSD SIGNATURE System #1 Approved for System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms of= -49 7H ��i�� 'g • .9 ��� • . Curtis Huffman I� 9 CE 128991 �,rJF�, • 5/5/2 . •'c��GAMW pROFESS100 bedrooms, with the following stipulations: 1 By:� V�' Original Certificate Date: 5 a 7 0 a a The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: SAND LAKE #2 BLOCK 4, LOT l.3 Parcel ID: 011-135-40 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system A. WELL DATA — PRIVATE "C" WATER OFF PROPERTY ❑ Well log is filed with Onsite (or attached) Well production at time of test _gpm Date drilled Water storage tank volume_ gallons 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 Static water level at beginning of test _ft. Comments B. TANK DATA Age of tank(s) 3_5 years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank 50" ® Standpipes/foundation cleanout per record drawing Date of pumping 5/4/2022 D. ABSORPTION FIELD DATA Which system tested (date installed) 5/31/1984 ® ALL standpipes present per record drawing Total measured depth from grade 15.8 ft (max) Measured depth to pipe invert from grade 6_6 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective MOA IR I VED -- SHOTS 9.5' ED+/ - Well disinfected for coliform test? ❑ Yes 0 No Q Coliform bacteria is Negative Nitrate mg/L ® Nitrate less than MRL (ND) Arsenic 46.1 ug/L ❑ Arsenic less than MRL (ND) Collected by_ Date of Sample 5/5/2022 F: C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 5/5/2022 Results 2 Pass For 3 bedrooms Fluid depth prior to test 1 in Water added 450 gal New depth 43 in Elapsed time 1440 min ® Code -required soil cover over field Final fluid depth 1 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: MT/DCO AT GRADE. SHOTS SHOW ABOUT 9.5' ED. HEAVY SLUDGE 8.5-9.5' ED. FIELD IS 2BR BUT MOA HAS GIVEN 3BR COSAS IN THE PAST. FWE C : E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No Neighboring Absorption- Fields > 100' Water Service Line > 10' ® Yes Animal Containment > 50' ❑ Yes if No ❑ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑ Yes if No ft 0 Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No _ Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No _ Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No _ Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No —ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 44 TM ....:*:� .... ....... Curtis Huffman / CE 128991 g,* d�l�dF�pROFESSIO P�'�-,Adw ®� ft ft ft ft ft ft ft ft MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904 On‐Site Water and Wastewater Section Fax: 343‐7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Arsenic Advisory Certificate of On‐Site Systems Approval # OSC221195 Subdivision: Sand Lake #2, Block: 4, Lot: 13 A water sample revealed an arsenic concentration of 46.1 micrograms per liter (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On‐Site Water and Wastewater Program website (www.muni.org/onsite) or at 343‐7904. This advisory must be attached to all copies of the subject Certificate of On‐Site Systems Approval. • ,(y Municipality of Anchorage L On-Site Water and Wastewater Program a` ski n (907) 343-7904 SA EY . CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 011-135-40 Expiration Date: CL0,-LA et. J �� 019 1. GENERAL INFORMATION Complete legal description SAND LAKE#2 BLOCK 4,LOT 13 Location (site address) 5431 W 82ND AVENUE,ANCHORAGE,AK 99502 Current Property owner(s) JASON M POPEK Day phone Mailing address 5431 W 82ND AVENUE,ANCHORAGE,AK 99502 Real Estate Agent • Day phone 2. TYPE OF DWELLING: ' Z Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class 0.Well ® Community ❑ Public Water System ❑ Public Sewer ❑ • WaiverNariance request for: Distance: Received by: ___adDate: i/QI/f COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 524, Waiver Fee $ Date of Payment l941716 Date of Payment ' Receipt Number A3a( /g— Receipt Number COSA# O3 C 17 16LU Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377 Address 4640 SHOSHONI DRIVE,ANCHORAGE,AK 99516 Engineer's Printed Name MICHAEL N.ANDERSON,PE Date 12/12/2018 dam ' •n 1 6. DSD SIGNATURE A^ m :-i System #1 Approved for bedrooms. j •,�, System #2 Approved for bedrooms. r1i` ��.. •.: •.•' 1I Disapproved. ti; t,`7 . • � Conditional approval for bedrooms, with the following stipulations:' I^ CU..;'�,�.�5� U.) O f l�j ���� kt � rJ Q_ t'cO 1�Az b `J CJ t1 beet-, co 3- b e drop o r C�-�5 i1 <P?i /c z u —i+1€ c t- f ON-SITE \ z WATER ANu By: i<SA ../Q..9. L L l o \ ASTEWATERi al Certificate Date: 3,C.1,;1 09 '7\7.0n pROGRPm The Municipality of Anchorage Development Services DM'ay (DSD) issues C icates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independ civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory .';.' Septic System Advisory Arsenic Advisor,• Well Flow Advisory Other COSA blue sheet 10-10-12.doc • j • .1. . If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system _ Certificate of On-Site Systems Approval Checklist Legal Description: SAND LAKE#2 BLOCK 4,LOT 13 Parcel ID: 011-135-40 A. WELL DATA -SEE ATTACHED ADEC CLARIFICATION Well type PRIVATE ("C") If A, B, or C provide PWSID#213849 Well Log (Y/N) Date completed Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform JJE6,colonies/100 mL Nitrate rip mg/L Arsenic: 446,I ug/L Date of sample: 12/14/18 Collected by:_F.W.C.S. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed t f I _ Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping NA-NEW TANK Pumper C. ABSORPTION FIELD DATA Date installed 5/31/1984 Soil rating (g.p.d./ft2 or ft2/bdrm) 150 System type DEEP TRENCH Length 15.5 ft. Width 3 ft. Gravel below pipe 11 ft. Total depth 14.2 ft. (Measured 12/12/18) Eff. absorption area 341 ft2 Monitoring tube Y Depression over field N Date of adequacy test 12112/2018 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 58 in, Water added 630 gal. New depth 64 in. Elapsed Time: 1110 min. • Final fluid depth 55 in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed Size in gallons_ Manhole/Access (Y/N) Y "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: - NA— NO WELL ON LOT Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line Holding tank___ Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10' Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots_100'+ ABSORPTION FIELD ON LOT TO: Property line 10' Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain '50'+(None Known) Wells on adjacent lots 100'+ F. COMMENTS Vacant system presoaked per code prior to testing. G. ENGINEER'S CERTIFICATION � OF 4144 alt I certify that I have determined through field inspections and od /+` ".•.� i review of Municipal records that the above systems are in .f�.•49TH • conformance with MOA COSA guidelines in effect on this date. ia;, r+;,; ,� • t' Engineer's Printed Name MICHAEL N.ANDERSON,PE .�' : MICHAEL N. ANDERSON . � CE-9469 • Date 1211212018 ✓� • l /_,/'/ • �` 1V pRafEss��;,i�r COSA canary sheet_2-6-15.doc MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT • 14 c,'u% 907-343-7904 On-Site Water and Wastewater Section 1 Fax: 343-7997 www.muni.org/onsite Arsenic Advisory Certificate of On-Site Systems Approval # OSC181643 Subdivision: Sand Lake #2, Block: 4, Lot: 13 A water sample revealed an arsenic concentration of 40.1 micrograms per liter (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On-Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. Mailing Address:P.O.Box 196650*Anchorage,Alaska 99519-6650*www.muni.org 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 Municipality of Anchorage ,o ��� Development Services Department ' Building Safety Division i= �/' On -Site Water and Wastewater Program s , r 4700 Elmore 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 09 02 IG 0, Parcel l.p; r(y l i =13-G7-1/0 COSA #_� Expiration Date: 1. GENERAL INFORMATION Complete legal description 5:nA Lnkh4 *.Z RIK 4 Lj %I Location (site address) •'?i49 S;..d 1417.. Qozj, gg5c.-7- Current Property owners) maiq .)un it Day phone 249- aC-o4 Mailing address Sarnc. -- Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class A Well Public Water System ❑ Day phone Day phone 146 - 7Z TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Address 2o3 W, 15th Engineer's Printed Name 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Phone 219-3516 Date ' l C2.* • 49?H ,C AFiS E.SPURY,LAND, bedrooms, with the following stipulations: Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other (R.,. 11105) -Original Certificate Date: R '-/- 1=0ct— Municipality of Anchorage \ • '�1 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 CHECKLIST Legal Description: $., Lqk, 2 BIK 4 Loi 13 ParcelID: A. WELL DATA Well type A If A, B, or C provide PWSID # 213641 Well Log (Y/N) Date completed = Total depth — ft Date of test Static water level Well production Sanitary seal (Y/N) — Cased to — ft FROM WELL LOG WATER SAMPLE RESULTS: `— ft Coliform — colonies/100 mL Arsenic: mgA B. SEPTICIHOLDING TANK DATA Wires properly protected (YN) Casing height (above ground) — in. AT INSPECTION ft _ 9.p -m. — g.p.m. Nitrate — mg/L Other bacteria ^— colonies/100 mL Date of sample: = Collected by: —' Tank Type/Material A %ma, T^ .5fel Date installed 5 3r 19t3 Tanks¢e hxo gal. Number of Compartments Z Cleanouts(YIN) Y Foundation cleanout (Y/N) - Y Del Date of pumping7pm _ C. ABSORPTION FIELD DATA Date installed 5 31 t y Soil ratir Length 16.5 ft ession over tank (YM) N High water alarm (Y/N) N Pumper At iio �e Strvi uo (g.p.d./ft= /bdr 150 System type DEEP Trt�cl. rdth 3 ft. Gravel below pipe ft. Total depth I bj ft. Eff. absorption area 14 fe Monitoring tube 3 Depression over field A/ Date of adequacy test A 2 Results (Pass/Fail) ►PUSS For 3 bedrooms Fluid depth in absorption field before test6q_in. Water added 5W gat New depth (o 3 in. Elapsed Time: Io min. Final fluid depth 5G,5 in. Absorption rate >= 1i50 g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) Alone k^o w n If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) 'Pump on' level at in. `Pump off" level at in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requi encs? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: No WdJ o n Lot Septic tank/lift station on lot On adjacent lots Absorption field on lot — On adjacent lots — Public sewer main — Public sewer manhole/cleanout Sewer /septic service line Holding tank Animal containment areas Manure/animal excrete storage areas — SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 151* Property tine S,+- Absorption field 5 t* Water main 3 Water service line .tea. Surface water -103 A%O• Wells on adjacent lots 1031 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line IO 1* Building foundation I Orr Water main 30 r+ Water Service line 30 Surface water M0. Driveway, parking/vehicle storage S + ' Curtain drain N• O • Wells on adjacent lots 4-160t+ F. COMMENTS: Amc WnIVG2 'To M% A Wcll R I001, G. ENGINEER'S CERTIFICATION ��-•' t� •Sf (� I certify that I have determined through field inspections and 491H. review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. • (- • .7� �Yl v Engineer'sr Printed Name _-LA(z5 SO�r�I and /�;�"S lg.'�SUpRq�CAN� wi Date811_ 2�ico� n COSA Fee $ 490 Waiver Fee $ Date of Payment I ZI oy Date of Payment Receipt Number O-+9 637 Receipt Number (Rev. 11105) ------ - Im ANNE* -- N Mr \1Y� N 12 135.00' 14 I] SURVEY CERTIFICATION �� Prepared by �[Robert E. Johns, Jr. & Assoc. r.....,.�R..�..�. �PPoo� -1)< Professional Lond Surveyors 7700 Now D"Fle r Lr.rA.Prrrrr �. .�..� � •i�r i �.��i.�%. j{ 7} WOOUG[..Y/61w ihoa �.Aw.r .•"r 1 SedA 1„ m 30' RV Lot Ss. Roe. Flat Flo No, FOUIOATION AMJLR7 L Nrr C AUm o. rr/ r•Y mal Od. furwrv! G-21-09 Drww 1X OIIYIOM DX RFJ TIC RT NS. Oct* IROW.• Or"" •.O 21-5 f,-22-09 2224 9154 mmAL SRUCOAIE AS-MttT , ,A�er.rrwad l•f Lot 13 BIrxk 4 "�....���� Sand Lake 02 LOT amw*v SURWY TYPE SYMBOLS FDu0A11MN N-SuCT • SET RtBAR DRAINAGE i AfMULT ft. NRRA.R"R. T ROT RAR ... A&~ ... EMENET ... 17'OiMM7 D MOUND ROAR �--�--� MOOD PENCE '7'" OOFFOI[E �00�i A�RtED ELEV. �,...y-.,f STK FEMCi �n� �re�r IT IS THE RESPONSBRJIY Or THE WILDER OF CONSTRUCTONL TO %Im" PROPOGED lU1LDR� TV P"3 0 GRADE AND UM TY CONNECTIONS 7HE 0031ENCE OF ANY EAl1ENTS. COVENANT V040I4 DO NOT APPEAR ON THE_RECOROM UNDER NO CIRCUMSTANCES 94OULD AN THE SLJRVF" TADS RES•01»JTr FOR THE I LIS7[D DsrAMm PIRv PRIOR TO ONLY rHOW IMPROVEMENTS ABOVE GROUND AND NILE V L K I RELATIVE 9"/ENCVS. VE"& Z►TMC CA(ANLYNTL JVWRALNS. 01MVERAYM• IETERWNE ITC.. ARE SMOW IN T•IR APPROf MATE LOCATION. ONLY. IINOW TMCTDNS MAY "EVENT SOME IM"OVDdWM rRON DOIO >mN AND LOCATED. ON PLAT. I ALL DISTANCES ARE RECORD UNLESS OTNERVMOE NOTIM. K USED FOR CORSTR IwN OR rm ESTAW9R4 MOt.EE1MY DR FW@M 1115 ISACTKN ONLY NMO ASKAWS FINANCIAL UAMR/TY ONLY rOR Rc CONT Or 71-C "WY. CALRLO RLPRODUCTON MAY CRUX OgpRs IN SGLE. 38.0' E70snNG o \ N NOUSE 14: .. ! •- . O.s 38.0' N 90'00'00" W 135.00' 14 I] SURVEY CERTIFICATION �� Prepared by �[Robert E. Johns, Jr. & Assoc. r.....,.�R..�..�. �PPoo� -1)< Professional Lond Surveyors 7700 Now D"Fle r Lr.rA.Prrrrr �. .�..� � •i�r i �.��i.�%. j{ 7} WOOUG[..Y/61w ihoa �.Aw.r .•"r 1 SedA 1„ m 30' RV Lot Ss. Roe. Flat Flo No, FOUIOATION AMJLR7 L Nrr C AUm o. rr/ r•Y mal Od. furwrv! G-21-09 Drww 1X OIIYIOM DX RFJ TIC RT NS. Oct* IROW.• Or"" •.O 21-5 f,-22-09 2224 9154 mmAL SRUCOAIE AS-MttT , ,A�er.rrwad l•f Lot 13 BIrxk 4 "�....���� Sand Lake 02 LOT amw*v SURWY TYPE SYMBOLS FDu0A11MN N-SuCT • SET RtBAR DRAINAGE i AfMULT ft. NRRA.R"R. T ROT RAR ... A&~ ... EMENET ... 17'OiMM7 D MOUND ROAR �--�--� MOOD PENCE '7'" OOFFOI[E �00�i A�RtED ELEV. �,...y-.,f STK FEMCi �n� �re�r IT IS THE RESPONSBRJIY Or THE WILDER OF CONSTRUCTONL TO %Im" PROPOGED lU1LDR� TV P"3 0 GRADE AND UM TY CONNECTIONS 7HE 0031ENCE OF ANY EAl1ENTS. COVENANT V040I4 DO NOT APPEAR ON THE_RECOROM UNDER NO CIRCUMSTANCES 94OULD AN THE SLJRVF" TADS RES•01»JTr FOR THE I LIS7[D DsrAMm PIRv PRIOR TO ONLY rHOW IMPROVEMENTS ABOVE GROUND AND NILE V L K I RELATIVE 9"/ENCVS. VE"& Z►TMC CA(ANLYNTL JVWRALNS. 01MVERAYM• IETERWNE ITC.. ARE SMOW IN T•IR APPROf MATE LOCATION. ONLY. IINOW TMCTDNS MAY "EVENT SOME IM"OVDdWM rRON DOIO >mN AND LOCATED. ON PLAT. I ALL DISTANCES ARE RECORD UNLESS OTNERVMOE NOTIM. K USED FOR CORSTR IwN OR rm ESTAW9R4 MOt.EE1MY DR FW@M 1115 ISACTKN ONLY NMO ASKAWS FINANCIAL UAMR/TY ONLY rOR Rc CONT Or 71-C "WY. CALRLO RLPRODUCTON MAY CRUX OgpRs IN SGLE. 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. # ri HAA # �V k�`'1 fi �•14-1 1. GENERAL INFORMATION Complete legal description Lot 13; Stock 4; Sand Lake Subdiv.ia.ion #2 Location (site address or directions) 8149 Sand Lake Road Anchotage, AK Property owner Chn,%s & Roberta. Gaineh Day phone (707) 426-3694 Mailing address 615 Fitieda Dkive Sui.6un City, CA 94585 Lending agency Mailing address Agent Ray Dah.2/ Dynarn.ic Pxopentieh Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 2 3. TYPE OF WATER SUPPLY: Individual well Community well XXX Public water Day phone Day phone 244-7611 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 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& S ENGINEERING Phone G c y_ g 7 17034 Eagle KjVer Loop Road No. 204 Address Eagle River, Alaska 99577 Engineer's signature 6. DHHS SIGNATURE X Approved for 2 Disapproved. Conditional approval for Additional Comments By.. Date 7 11r / j d"� 0 p f kv . •!� -ROP ERT C. COWAV. f CE - 8801 bedrooms. 111Th bedrooms, with the following stipulations: Date S-2 —& 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 engineer's work. 72-025 (Rev. 1191) Back MOA X21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 0 Anchorage, Alaska 99501 • (907)343-4744 4 - �744Y OF 1aNCMG?RA01 ENVI9QNM:N1A1 4rweIcP.-s DIVISION Health Authority Approval Checklist RECEIVED t` `'`I 1 1f X1996 Legal Description: )-0 i ! 3 13 L0 c rc iA'40 "'rg -* Z Parcel I.D.: R F C E 1 V P D A. WELL DATA Well type L' " s S fl If A, B. or C, attach ADEC letter. ADEC water system number a 1 3 &- 41 Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production WATER SAMPLE ULTS: Coliform Date completed Cased to FROM WELL LOG Nitrate g.p.m. Casing heighe ground) protected (Y/N) AT INSPECTION Other bacteria ,p4e of sample: Collected by: B. S C OLDING TANK DATA Date installed r / 3 / � S Y� S y Tank size ) 0 0 0 Number of Compartments g.p.m. Cleanouts ((!P/N) yh-J Foundation cleanout (Om Depression (Y/Q N C) High water alarm (YO Ny Date of Pumping 5�>lI a� Pumper 14 om f S46r v, c9 C. ABSORPTION FIELD DATA Date installed a/ / �! Soil rating (g.p.d./ft2 or - dr )J-0 System type '7- Length Length I S 2- Width 3 Gravel thickness below pipe 1 I Total depth Effective absorption area 3 4 ) Monitoring Tube present&/N) YeJ Depression over field (YA z p Date of adequacy test y // 2 1 Results (Pass/Fail) P l -s -S For ;Z bedrooms z, Fluid depth in absorption field before test (in.); I r10 Immediately after')O6 gal. water added (in.): 3 Fluid depth a- / (ins.) Minutes later: 1 j0) Absorption rate = 3 0 0 g p d Peroxide treatment (past 12 months) (Y/N) nre A�f- k N0 w ti If yes, give date D. LIFT STATION Date installed Manhole/Access (YIN) High water alarm level at* Cycles t� E. SEPARATION DISTANCES Size in gallons "Pump on" *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ; On adjacent lots Absorption field on lot ; On adjacent lots Public sewer service line "Pump off" level at* Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FRO EPTIC OLDING TANK ON LOT TO: Building foundation / S f Property line S Absorption field_ Water main/service line 30 Surface water/drainage �� Wells on adjacent lots . AOCC wA.V Q2 'f0 CL/ilf A- t✓f LL +7 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 'I U -,A-- Water main/service line II 0 4 Surface water l 00 �'- Curtain drainrvoN4, Kr,ow,v F. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area S� f -4, 0 3 Wells on adjacent lots I a J ` Property line 1 0 I certify that I have determined thru field inspections and review of Municipal record lf�e�/{Z7u-�v are in con ormance w th OA HHAA gui elines in effect on this date. �v - 4 00, �� rte,• f Signature ` 9 f Engineer's Name I 6612. i C. Co wrq„/ 1 t ertng t. ere...•,,,/ / "BERT C. COWAN F Q 1 Date °/ 7 / S` / C1 `X t� Z:E-8201 ......;.••;' HAA Fee $ r%0- e&ID Waiver Fee $ _ Date of Payment T fcs� Date of Payment Receipt Number �7 Receipt Number Rev. 8/95 OSS: liaa.wk.doc MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date 5�! p z (a) Legal Description (include lot, block, subdivision, section, township, range) 10-L13 13L r, 4 .sAMD 4i4►TE 'r -F?_ [f / ) 5'Cc or!o Location (address or directions) (b) Applicants Name/_f re6Aj 3e._ /,1,„ ,y Telephone - Home Business Applicants Address (c) Applicant is (check one) Lending Institution ; Owner/builder Buyer E::1 ; Other (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. Type of Residence Single -Family 5i� Multi -Family Number of Bedrooms 2- 3. 3. Water Supply Individual Well E:::] Community Other (describe) 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 E7 Community E:j 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] V 4-13 A 4 _/1 ivD 4/1 Pi c 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 s °Vc- Telephone JL .1 y� Address Date_ 9,/�r,. 6. DHEP Approval ^1 (ENGINEER SEAL) Approved for bedrooms Approved )( Disapproved Terms of Conditional Approval 3 .°v; fiC BY /�u u_. �_. (l.,�uZt" ['_! Date CAUTION Conditional o •oeaaoo oe/ygya �/)�aoata ao•. �.. Leroy Reid, Jr..,'+�i�', JJ °oo N 1 2251 •E THE 14UNICIPALITY 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 ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: 40+13 Aebc_h4 A. WELL DATA J�4 RJ D 1,A Well Class ificationeomet,v,vs rt -1 If A, B, or C. D.E.C. Approve N) Well Log Present (Y/N) PIA - —Date Completed Yie�jd Total Depth 01#4 Cased to A)IA Depth of Grouting AA� Static Water Level 01Q Pump Set At V/4 Casing Height Above Ground WJAP Sanitary Seal on Casing Electrical Wiring in Conduit (YIN) NIA, Depression Around Wellhead (Y/N) Separation Distances from Well: 01 To septic/Holding Tank on Lot / 0 3 On AdJoining Lots /oti To Nearest Edge of Absorption Field on Lot Lg 7 ; On Adjoining Lots /VV�m To Nearest Public Sewer Line Mole To Nearest Public Sewer Cleanout/Manhole "A To Nearest Sewer Service Line on Lot #U1,4 Water Sample Collected By YV� Date N�I� Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed $ 3i 4 Size /1666 No. of Compartments `L Standpipes O/N) Air -tight Caps N) Foundation Cleanout N) Depression over Tank (Y l Date Last Pumped ,(>114 pumping/Maintenance Contract on File (Y/N) for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit ( ALA*_ Separation Distances from septic/Holding Tank: To Water -Supply Wz11 !O3 '+^0 To Building Foundation ,lf To Property Line 4` To Disposal Field 4f To Water Main/Service Lire To Stream, Pond, Lake, or Major Drainage Course Comments u� c Receipt # �0 O d Date Paid: �- Amount: (Page 1 of 21 2-15-84 t/1— L 13 #/-K4 SAeUO2_.4MC C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata J SCS g/ Type of System Design �RENcI+ Date Installed _ 5/)¢N Length of Field Width of Field 3 ` Depth of Field ! S Gravel Bed Thickness it, Square Feet of Absorption Area .34}1B► Standpipes Present tvm) Depression over Field (Y[° Date of. Last Adequacy Test T/� Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply 4\b 11 ) E> -7 +- V To Property Line f g To Building Foundation Z$,� To Existing or Abandoned Syster, on Lot /U JK ; on Adjoining Lots > 30 / To Water Mair./Service Line To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course ti/4 To Driveway, Parking Area, or Vehicle Storage Area > JO� Comcrentsp" (DA& &-c D. LIFT STATION Date Installed A) /1' Dilrensions /Uld Size in Gallons AJ Manhole/Access (Y/N) "Pump On" Level at AJIA- "Pump Off" Level at High Water Alarm Level at N/J4. Vent (Y/N) AJ/n Tested for A)Ji4- Pumping Cycles during Adequacy Test. Lets MOA Electrical Codes(Y/N) NJa, Comments Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or, conformed to all MOA HAA in effect on the date of this inspection. Signed Date i ,� .• °° Co>ipa s t S ►nom e MOA No. -O2y /� !NO oo°o •ne �e3 KB1/d5/s ®'�^ eroy C. Reid, Jr.'4 4 iP ea No.2251,E Q'T�� •, ou se conn ,��. (Page 2 of 21 2-15-84 STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION CONSTRUCTION AND OPERATION CERTIFICATE for PUBLIC WATER SYSTEMS A. APPROVAL TO CONSTRUCT !;>yz J -t= A - 33(o Plans for the construction or modification of % kFlFP. WELL # L OTS e t-A-ss.4 1 , 41-e) j ) 4# Z! Z &0c is �} sA N D LAKE �pu�itc water system located In C 14G i �D_ TTC� , Alaska, submitted in accordance with 18 AAC 80.100 by NL1S KR ENU-T I(OU 7ENTr4t deNTC6L S have been reviewed and are Wapproved. ZCl conditionally approved (see attached conditions). ".0 A r E 6 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 dewriptive mferenee) Approved by Date o SE PT 1 s Irg TFjwr Hon14aZOA) TOL SE CO l o r7 C. APPROVAL TO OPERATE p to boi+,Oov- +000 W o w tot C&IQ rL 4�c; The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water Is made available to the public. t [eke K� The construction of the �ei�� W�►N/tLOTS 1 12t llj - 91 � �z � ocr� 4 sa, public water system was completed on'' 3 4— � j / (date). The system is hereby granted interim approval to operate for 90 days following the completion date. 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 ope e. �e �72� E7f ^S - BY —�— TITLE = DA DISTRIBUTION: 1. WHITE - ENGINEER (Complete Section C) 2 YELLOW - WATER SYSTEM FILE (Complete Seetlon C) 3. PINK - ENGINEERF?AUNI-BOROUGH (Complete Section O)