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HomeMy WebLinkAboutSAND LAKE #2 BLK 4 LT 18Sand Lake #2 Block 4 Lot 18 #011-135-35 Sand L2.Ke. :510 #a 0 I I -135- 35-00� Eo. 47e Eo. On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: ADEC 7349 PID Number: 011-135-35 Dwelling: ❑ Single Family (SF) Q Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New 0 Upgrade Name: Sara R. Salter ABSORPTION FIELD 4ddress 00070 0 Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound and Lake Road Anchorage, AK 99502 El Other Lift Station Phone Sewer Line Number of Bedrooms 3 Soil Rating 1.2 GPD/SF Total depth from original grade 13-14 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 6-7 Ft.7 Gravel depth beneath pipe Ft. Subdivision Sand Lake No. 2 Block Lot 4 18 Fill added above original grade n_� _. Gravel length qn Township Range Section From Septic Tank Absorption Field Lift Station Holding Tank Sewer Line Well 95' >100' N/A >25' Surfacewater >100' >100, N/A N/A� Lot Line >5' 3'** N/A N/A Foundation >5' >10' N/A N/A I NA Curtain Drain None' Noted Remarks System installed by owner under ADEC Certificate to Opera e. ee waiveror we to septic tan an of L�rte AB€�Alaiversisstaed forlitf Con#irT fr 111 T1 Uf II 1 477 T l Lines I otal absorption area Number of trenches 420 Fel One TANK ❑I Septic ❑ S.T.E.P. ❑ Holdini Manufacturer Anchorage Tank ✓Iaterial Numbe Steel Two on level at and model Pump off level at between 1,000 if compartments water alarm at Inspections performed by Installer PIPE MATERIAL House to tank D3034 drain k to D3034 Owner Installed Drainfield F810 CO/MT .. Inspector Alan Harala BENCH MARK (Assumed elevation) 100 It Inspection tes: t _9/5/08 Zia 9/6IO8 Location and description aro 4'^ — NE Corner Back Sidewalk. COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Eur t%,€%im p Approval: Date 49 H- 4fL I- ANDI CE -4381 Approved �G{%UzyWL Date 05PM1921 41125 Ry&", 07493G 41Z,611y Sand Lake Road M 50.00 cn N 0 x v m rt o J W O 0 D a � O 0 ® v O N W N W M o cn N 0 Z cn in cn W iv N O J W O 0 D (O 0 0) 0 0) O 0 N u u A W NJM L4 00 W W -` O N W N W Cii W CI) ADEC Plan No. 7349 n SAND LAKE SUBDIVISION LOT 18, BLOCK 4 U U) U 4 INO Groundwater No Impermeable Layers 99.7 �N U U PID No.: 011-135-35 Page 3 of 3 NO. 2 � U 99.7 98.7 7' Drainfield Rock Length) NOTE: Monitor Tube is 2" Steel Pipe extended to bottom of trench. NOTE: Clean Outs and Monitor Tubes are F810 HDPE. They are protected by sideboards along the edge of both the septic tank and absorption trench and cannot be damaged by snow removal operations. PROFILE AS -BUILT No Scale 93.0 t Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://Www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program m e, 1)t �e r r Department **** VARIANCE/WAIVER REVIEW **** Waiver#: OSPI41421 COSA#: Permit#: ADEC PID#: 011-135-35 Legal Description: Sand Lake #2 Block 4 Lot 18 Engineer: Anderson Enstineering Applicant: Sara Salter Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the private well has been approved. The approved separation distance is 95.0 feet. In addition, the ADEC issued an Approval to Construct with the proposed field to be 2 feet from the property line and 5 feet from the existing field. This waiver approval applies to the existing septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. Add comments / explanations or DELETE ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties aremot affected by this waiver. ............................................................................... Waiver is Granted: X Waiver is not Granted: Date: O 2 / Approved by: �� Name of ReviewV **** VARIANCEIWAIVER REVIEW **** Sand Lake #2 Block 4 Lot 18 Parcel ID: 011-135-35 Waiver for 95 feet from well to tank 9/29/2014 General 1. Water samples show no coliform bacteria. 2. The house is between the tank and well. 3. Tank is down gradient from the well. ADEC Criteria Points Water Table Depth to water bearing layer 200 feet Depth of tank 10 feet 190 feet 7.5 Soil Sorption Soil descriptions Permeability Soil descriptions DEC PTS Depth From Depth To Thickness Calc. Pts Sand and gravel 1 10 50 40 0.21 Gravel and clay 3 50 75 25 0.39 Grvl w/ clay & sand 2 75 100 25 0.26 Silty sand 2 100 200 100 1.05 100 200 100 1.05 190 1.921053 1.9 Permeability Soil descriptions As perADEC waiver guidelines, with a minimum point value of 13.6, no bacteriological pollution possible but chemical pollution possible but unlikely from household chemicals. Waiver is approved. DEC PTS Depth From Depth To Thickness Calc. Pts Sand and gravel 1 10 50 40 0.21 Gravel and clay 0 50 75 25 0.00 Grvl w/ clay & sand 0.7 75 100 25 0.09 Silty sand 2 100 200 100 1.05 0 0.00 0 0.00 0 0.00 0 0.00 190 1.36 1.4 Water Table Gradient - Not calculated Horizontal Separation 95 feet between tank and well 2.8 Total Points 13.6 As perADEC waiver guidelines, with a minimum point value of 13.6, no bacteriological pollution possible but chemical pollution possible but unlikely from household chemicals. Waiver is approved. D Q 0 Iz LU Y g 0 z U) 1 301 UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FlNANOAL UABIUTY ONLY FOR THE COST OF THE SURVEY, LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE LOT SURVEY SURVEY TYPE SYMBOLS FOUNDATION AS- UXT SE7 REBAR DRAINAGE ASPHALT Q FINN. STRUCNIIE AS -SS -MALT o FOUND REBAR gig WOOD FENCE CONCRETE ❑ 0.07 PLN! ... AS-BMLT... LOT SURVEY ... TOPOGRAPHY .... e:::.. fl ­.. .,,. � �1521 . ® ASSUMED ELEV. „--,-,c METAL FENCE ® WOOD DECK IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. SURVEY CERTIFICATION I_���T►�1�r._ PLAN FOUNDATION AS -BUILT L R• L ,r.r Y. h.67 te'" tW I ne. o.renr ., rlue YRwy a eb bnMtln an NY let aM eql + M i,wtl • N bY°Mla, s 4•e• MM. n 4x• N ro �aeaCmnb �1 ,N� FINAL STRUCTURE AS -BUILT L R L A i- lw•eY —m enl I 49th 4121 prOfession4 ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. ALL DISTANCES ARE RECORD UNLESS OTHIERWTSE NOTED. Prepared by Robert E. Johns, Jr. & Assoc. Professional Land Surveyors 1700 Brink Drive. ANCHORAGE, ALASKA 99504 Scale. 11l _ 30' Rec. Lot S.F. RAG. Plat File No. °°`° S"'"`YGd 09/17/14 Drawn bY• REJ Cheeked bJMK Date Drawn: 09/17/14 GrI& 2224 WO' 14-445 Lot 18 Block 4 SAND LAKE #2 STATE OF ALASKA Department of Environmental Conservation CONSTRUCTION AND OPERATION CERTIFICATE for DOMESTIC WASTEWATER DISPOSAL SYSTEMS LEGAL DESCRIPTION: may, �,. c zf �,, > # -0 ADEC Plan Tracking Number: A APPROVAL TO CONSTRUCT Plans for the construction or modification of: a domestic wastewater disposal system located near or in: Submitted in accordance with 18 AAC 72.225 by: / These plans have been reviewed and are: 0 Approved �J Conditionally approved (see attached conditions) BY: %fo_2�F�2ct✓,r_ 1 d6J /01 -,TITLE: William R. Rieth 4 f 1 a'jdC� /�f�ic gy Alaska. A .A i Envrionmental Engineer DATE: 1"j'ez If construction has not started within two (2) years of the approval date, this certificate is void and new plans and specifications must be submitted for review and a new approval before construction. B APPROVED CHANGE ORDERS Change (contract no. or descriptive reference) Approved By Date C APPROVAL TO OPERATE The "APPROVAL TO OPERATE" section must be completed and signed by the DEC WW before this system is made available for L.1se. The construction of the domestic wastewater disposal system that was completed on: (date). The system is hereby granted interim approval to operate for 90 (ninety) days following the completion date. BY: TITLE: Envrionmental Engineer DATE: William R. Rieth D FINAL APPROVAL As -built plans submitted during the inerim approval period, or an inspection b the DEC WW, has confirmed the system was constructed according to the aooroved Clans. The system is hereby granted final approval to operate. F -W TITLE: Envrionmental Engineer DATE: William R. Rieth ORIGINAL: FIRM/INSTALLER COPIES: 1. DEC ENGINEER 2. DEC SITE FILE State of Alaska AUG B 1 2008 Dept. of Environmental Conservation DEC 555 Cordova Street Division of Water QU8ity Anchorage, AK 99515 'Wastewater Discharge Pr®aram Attention: Mr. Bill Rieth, P.E. Subject: Lot 18, Block 4, Sand Lake Subdivision No. 2 Three Bedroom Duplex Certificate to Construct Septic System Dear Mr. Rieth: The septic system serving the three bedroom duplex on Lot 18, Block 4, Sand Lake Subdivision No. 2 has failed and must be upgraded immediately to prevent damage to the house and a possible health hazard. The property is currently served by a private well located at the front of the house and more than 100' from both the proposed septic tank and trench at the back of the lot. The location of the well and the proposed and existing septic system are shown on the attached drawings. A waiver will be require to reduce the separation distances required from the absorption trench to the Class C Well on Lot 24 to the southeast and the Class C Well on Lot 17 to the north. A copy of the waiver request is included with this package. The new system will be composed of a 1,000 gallon septic tank and a 30' long x 3' wide x 6.5' effective depth absorption trench constructed as shown on the attached Site Plan. All components of the system will be constructed outside the 100' protective radius for the well on the lot. The absorption trench will be constructed 2' from the west lot line as the existing absorption trench is now 10' from the property line. Only 5' separation will be achieved between the edge of the existing trench and that of the new trench. The existing trench will be abandoned in its current location. The topography of the lot is fairly flat with only a slight grade to the east. Nor surface water has been seen in the area. No groundwater has ever been reported in the area as the soils are very loose and granular. The system is sited at the only location available on the lot which is outside the protective radii of adjacent wells. This location is more than 50' from any slope greater than 25%. The bottom of the absorption trench is more than 6' above bedrock and any impermeable Lot 18, Block 4, Sand Lake No. 2 August 9, 2008 Page 2 of 2 layer and more than 4' above any observed groundwater. There is little or no potential for health hazards or noxious odors at this location. Construction of the system will be completed by a certified installer with experience in the Anchorage area. The septic tank and materials will be procured from local approved sources. It is anticipated the system will be constructed in August of 2008 and put into service immediately. A certified as built will be submitted to ADEC upon completion of construction along with a request for a Certificate to Operate the new system. Sludge from the tank will be removed by a commercial septic tank pumper on a regular basis and deposited into the AWWU sewer system at an approved location. Residuals are expected to be only normal domestic wastewater sludge that typically collects. No seasonal or daily variations in flow are anticipated. A check in the amount of $270.00 is enclosed as the plan review fee. We have also enclosed the Owner's Statement and General Checklist. We hereby request a Certificate to Construct be issued for the proposed septic system. Sincerely, Michael E. Anderson, P.E. Attachments VIC'-AE'.. E AND _:SC\ Sand Lake Road �. 50.00 a m X d m V D z 0 r F— D r O 0 mm J E4 n CO x a p � C D oM rrr1 C130 O W rn F- C) I AJ T O 0 m v �3 C 5-p O Cf) C� O �o z 4�1 z O0 ,so. �a o N `591,. 3ID --_-- g XM o m ♦r'.i A Z: Dx �++ AV •/.t.~ of y:�� OJo �04 AM f5Radtua b! ta. e .* m LOT 18, BLOCK 4, SAND LAKE SUBDIVISION NO. 2 DESIGN FACTORS: Three Bedroom Duplex Pere. Rate: 85 SF/BDRM - Use 125 SF/BDRM Application Rate: 1.2 GPD/SF SYSTEM REQUIREMENTS: Deep Trench System 1,000 Gallon Septic Tank 7' Drainfield Rock 3 Bedrooms X 150 GPD/1.2 GPD/SF (Application Rate) = 375 SF Absorption Area 375 SF/14 SF/LF = 26.8 LF Trench Length THEREFORE: Construct a 30' Long x 3' Wide x T Effective Depth Absorption Trench at the Location Shown. Flow Line Elevation in Trench to be 4' Below Original Ground Surface. Total Depth to be 11' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption Trench. Maintain 100' Separation from Wells in the Area. 7'0" 3' Drainfield Rock TYPICAL DEEP TRENCH SECTION (NO SCALE) 04 NOTE: Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. .1 Minimum 4' Separation From Groundwater. >>% "p Minimum 100' Separation From Wells in the Area. Minimum 100' Separation From Surface Water or Streams.Bios MICHAEL E. ANDERSON No. ce- wi Natural Backfill 3'6" Geotextile Fabric 6" 4" Perforated PVC (Holes Down) 7'0" 3' Drainfield Rock TYPICAL DEEP TRENCH SECTION (NO SCALE) 04 NOTE: Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. .1 Minimum 4' Separation From Groundwater. >>% "p Minimum 100' Separation From Wells in the Area. Minimum 100' Separation From Surface Water or Streams.Bios MICHAEL E. ANDERSON No. ce- wi DEPARTMENT OF ENVIRONMENTAL CONSERVATION DIVISION OF WATER WASTEWATER DISCHARGE AUTHORIZATION PROGRAMS August 21, 2008 Michael E. Anderson, P.E. Anderson Engineering P.O. Box 240773 Anchorage, Alaska 99524-0773 555 CORDOVA ANCHORAGE, AK 99501 Phone: (907)269-7519 Fax: (907)269-3487 http:�,'www.state.ak.us/dec/ Re: Sand Lake Subdivision #2, Block 4, Lot 18 -South Anchorage -Waivers & Conditional Approval to Construct a Wastewater Treatment and Onsite Soil Absorption System-ADEC Plan Tracking Number 7349 Dear Mr. Anderson: On August 11, 2008, the Department received an engineering plan submittal for a three bedroom duplex to be served by an onlot wastewater treatment system with, a new two compartment 1,000 gallon septic tank and a new soil absorption system (deep trench type effective depth 6.5 feet) at the above location. The soils testing included well logs and file records which indicate a well graded sand (SW)exists. Using an application rate for SW soils of 1.2 gallons per day per ft2 (the 3 bedrooms 0150 gallons per day requires 375ft2)of leaching area. With the effective depth of 6.5 feet a length of deep trench approximately 30 feet is required to be installed. Waivers were requested to the Class C source wells in the area as follows: 1) The separation distance from the new 1,000 gallon septic tank to the Class C source well serving Lot 17 is request to be reduced from 150 feet to 112 feet. 2) The separation distance from the deep trench type soil absorption system to the source well serving Lot 17 is requested to be reduced from 150 feet to 132 feet. 3) The separation distance from the deep trench type soil absorption system to the Class C source well serving Lot 34 is requested to be reduced from 150 feet to 126 feet. Based upon the engineer's recommendation, past waivers of similar size in the area, soils information provided, the well logs from the area and the drinking water samples which indicate that nitrate as nitrogen was not detected. These waivers are approved. Should the disposal system or septic tank be found to be failing or can be shown to be endangering public health, corrective engineering actions will be required. The Department has reviewed the engineering plans submitted waivers were granted for the onsite wastewater disposal and treatment system and per the Wastewater Regulations 18 AAC 72.225 conditional approval to construct the proposed system is hereby issued. A 'Certificate to Construct" for the community wastewater system is enclosed. Please use the referenced plan number in correspondence regarding this system. This approval is contingent upon compliance with the following conditions: 1) If the applicant fails to construct, alter, install, or modify the system within two (2) years after the date that the department issues an approval to construct, the approval is void, and plans must be resubmitted, (along with associated fees], for department review and approval. 2) Deviations from approved plans which affect capacity, flow, operation, major design of units, point of discharge, materials of major system components (such as pipe, lagoon liners, etc.), or separation distances, must be approved by DEC in writing prior to their implementation. 3) This approval is contingent upon compliance with the conditions of Wastewater Disposal Regulations, 18 AAC 72.235, Certification of Construction. The noted section of the regulations requires that a "Certification of Construction" be completed and submitted to the Department within ninety (90) days of completion of construction. As -built plans or record drawings should indicate any changes or deviations from the approved plans to facilitate final review. A "Certification of Construction" form is enclosed for your use. 4) This approval is contingent upon your receipt of any other state, federal or local authorizations which are required for your project. You are required to obtain all other necessary authorizations before proceeding with your project. 5) You are advised that if this development will require placing fill in wetlands or working in a stream, river, or lake, permits from the U.S. Army Corps of Engineers and the Alaska Department of Natural Resources may be required. A Coastal Projects Questionnaire will help you identify other permits and approvals that may be required for your project. 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, 555 Cordova Street, Anchorage, Alaska 99501, 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, William R. Rieth, P.E. Environmental Engineer Enclosure: As stated cc: William Smyth, WW, w/o enc. DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE WESTERN PUBLIC SERVICE OFFICE 555 CORDOVA STREET ANCHORAGE, ALASKA 99501 October 23, 1996 W TONY KNOWLES, GOVERNOR (907)269-7519 RECEIVED ocr 29 1990 - Donald F. Duhr Municipality of Anchorage Dept. health & Human Sere;- 3433 McKenzie DriveUOS Anchorage, Alaska 99517 Subject: Lot 18, Block 4, Sand Lake 92 Subdivision, Separation Distance Waiver AWPSA Project Number 9721 -WV -257-017, Review Dear Mr. Duhr: This letter is in response to the submittal received on September 13, 1996 regarding a separation distance waiver from the existing Class "C" public water system source well to the existing septic system on the lot. This Department has completed its review on the submitted materials and the existing file we have in this office. The review indicates a minimum of three waiver requests that have been made to this office since 1986, of which two of the three requests were denied. However, your August 30, 1993 request was not denied, but instead additional information was requested by this department. The current submittal does not include the additional information as requested in the Department's September 9, 1993 letter, therefore, we cannot approve the request until the following information is submitted for review. Until the requested information has been submitted, we can not complete our review of your request. The items of concern are as follows: A recent (within one month) water test analysis needs to be completed for Nitrate/Nitrite and total coliform bacteria. 2. As -built drawing of the drinking water system, under the stamp of Professional Engineer (P.E.), needs to be submitted for review and approval to this office. 3. A recent adequacy test (within the last six months) for the on-site septic system. 4. The separation distances for all the septic systems or other possible source of contaminations that are contained within the 150 feet protective radius of the Class "C" source well needs to be submitted to this office. Mr. Duhr 2 October 23, 1996 5. The waiver request will need to be submitted under the stamp of a Professional Engineer (P.E.) registered in the State of Alaska in accordance with 18AAC 72.0151. 6. The State Wastewater Disposal Regulation (18 AAC 72) have been modified to require fees for separation distance waivers. The fee for this waiver project is $230. The fee invoice # 203042 is enclosed for your use. Please submit the required fee to this office. The above information needs to be submitted in order for this Departmenttocomplete the waiver request. Thank you for your cooperation with this Department. If you have any questions, please do not hesitate to contact me. Sinc rely, Keven K Kleweno, P.E. Environmental Engineer Encl: As stated cc: Jim Cross P.E. MOA/DHHS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99509 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME IPHONE [NEW ❑ UPGRADE _ v© MAILING ADDRESS LEGAL DESCRIPTION ' OCA LOCATION NO. OF BEDROOMS e 12A 4z Well / Absorption area Dwelling ' PERMIT NO. U Y DISTANCE TO: �Q r 1919;;7011 i Manufacturer /'1 Material No. of compartments z wr 6 z, �� � w Liq. capacity in gallons Inside length Width Liquid depth IF HOMEMADE: Y DISTANCE T0: Well Dwelling PERMIT NO. JVZ z Material Liquid in = F Manufacturer capacity gallons o Well / Foundation / Nearest lot line, PERMIT NO. w = DISTANCE TO: %® J w z No. of lines Length of each lime Total ength of lines Trench width Distance between lines PZ w —� I/S_ inches '9a F Top of tile to finish grade -. Material eneath the / / Total effective absorption area .._ p inches Length Width Depth PERMIT NO. w C7 F Type of crib Crib diameter Crib depth Total effective absorption area a wa Lu Well Building foundation Nearest lot line DISTANCE TO: J J Class ai Depth ,a� - cJ Dir Distance tolot line PERMIT NO. LU Building fou;-7nr�an Sews) erline / Septic tank Absorption area(s) DISTANCE TO: xg� OTHER PIPE MATERIALS n A- 72Zl SiTI L TEST RATI NG r b - INSTALLER REMARKS Y � CR��w0 aa3de p•��tf? - • { J h A .eo•eiaz • ,y L i� ry � e .�i Earl R. Barnard z F ' 3 ,ei�A°e 754-E i OpaO-n saoo�• �� s. L lop,, 0e, � Xd" APPROVED DATE LEGAL 72-013 (Rev. 3/78) v P. M 1 1_ 1 F=' n_ I -r ke 97-1 F_" f7i FE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET: ANCHORAGE, AK. 99501 264-4720 PERMIT NO. ( 800068 ) APPLICANT PAUL ROSELAND BOX 4-1324 243-0058 LOCATION SAND LAKE&82ND LEGAL LOT 18 BLK 4 SANDLAKE SUB #2 LOT SIZE 6750 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). 1-1 r F;;.o E: GA U I F;,I Ez- E -s I -E F=' -Ir I 1::� _r n " P� Cl PD 01 C-3 F-1 I I PERMIT APPLICANT HAS THE RESPONSIBILITY 'TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- -rW#=i <;2 > I " _. � F=A=-?" I C, " _• F - 6F -'F= Fic, Ez CA U I F"[-= C-8 BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THAT -1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED: ---- Q_ ,ftPPLIC&K PAUL ROSELAND ISSUED,' 11/4. 0 6 y SOILS LOG MUNICIPALITY OF ANCHORAGE • +.c DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST Pouch 6.650, Anchorage, Alaska 99502 276-2221 SOILS LOG - PERCOLATION TEST PERFORMED FOR:1 `1d`J�'�..JaNSJ DATE PERFORMED: �� 7E- LEGAL DESCRIPTION: Ler K 4 tz' A&wp 1—✓!1ecr- :5 u zr-:7 YA o ci r)PF SITE PLAN DEPTH 2 DS` 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS PERFORMED BY: 72-008 (7/76) 137,0"Iq 5ftt o (41') 69P) r I � ---- ----- -T i G vw�N `�Jawu9 WAS GROUND ENCOUNTERED?ATER �\ v � d O P IF YES, AT WHAT E DEPTH? tom$' �E��tSo2Nf IS 4f U Reading Date Gross Time Net Time Depth to Water Net Drop �— e Q ---0-�- — - ; - j- U Reading Date Gross Time Net Time Depth to Water Net Drop e PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT I- HOWARD TEAL � � � �ziLLirs9 saa-oasa WATER WELLS A"ICIPALITY OF ANCHORAGE DEPT. OF H_ALTH 8, ENVIRONMENTAL PFOTECTION 665 W. 87th Avenue Anchorage, Alaska 99502 OCT 3 1 198 WELL CONSTRUCTION LOG RECEIVE® Drilling Co. r�� USGS no. Driller- �r�Typeoof rig ��>°i/"w�%a'�Date well completed Well owner `1i� [ J Nearest community f fir\ � C r Well location: (address & legal description) `1 \ 1 l� i)� L Location sketch or remarks Depth of well, 2- ft. Casing: depth: Z a L—II. diam. 6 in. Static water level[_It. (above, below) land surface. Date.7�kowl Gi Finish of well: (open-end, screen, perforated, open -hole, other) Describe intervals and size: Well yield tested by (pumping, bailing, air) at 1/4 gal/min. for /-,gL> hours witheft. of drawdown from static level. DRILLER'S MATERIAL LOG Depth below land surface in feet Give (size of material, description of strata penetrated color, hardness of drilling, and water content) b —to r 14- to 7-5 %` t o O d ° ® - /0 0 to fes( 1 o t? B to -�•J 0 - Qi '770 t03-32, 1114 r to � to to f to to to to to to to to -+ DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME NUMBER OF,BEDROOMS SINGLE FAMILY \ DATE DATE 1 ❑ MULTIPLE FAMILY DATE 7. WATER SUPPLY - NU INDIVIDUAL* 1b - INSPECTOR INSPECT• INSPECTOR depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM MUNICIPALITY O A ORAGE ENVIRONMENTAL PFOTECTION MUNICIPALITY OF ANCHORAGE YEAR ON-SITE SYSTEM WAS INSTALLED. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION n qry 1980ry 825 L Street - Anchorage, Alaska 99501 OCT 2 4 • ENVIRONMENTAL SANITATION DIVISION RECEIVED Telephone 264.4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PRORTYOWNER PHONE ` Q MAILING DDRESS x-15 PROPERTY RESIDENT (If different from ab ve) PHONE - 2. BUYER. \J PHONE � MAI LING ADDRES: llGG77%% L4 9 ^, J , 3. LENDING INSTITUTION ^ PHONE j1�jJJ, MAI LING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESC IPTION �l STREETLOCATI N 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY - NU INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM �J INDIVIDUAL/ON-SITE` YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) /J 6u / /Z u �- C.6� 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS O ONE ❑ THREE ❑ FIVE ❑ TWO ❑ FOUR ❑ SIX ❑ OTHER 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank. Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS r C-6 S 73 b—APPROVEDFOR3 BEDROOMS IZ�CONDITIONAL APPROVAL (letter must acco pan- ertificate) ❑ DISAPPROVED DATE (, ��-- BY 72-010 (Rev. 6/79) 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M. SULLIVAN, MAYOR DEPARTMENT OF HFALTH AND ENVIRONMENTAL PROTECTION October 29, 1980 Paul Roseland Post Office Box 4-1324 Anchorage, Alaska 99509 Subject: Lot 18 Block 4 Sand Lake Subdivision #2 Approval for your individual sewer and water facilities cannot be granted until the following items have been completed: L_(1) The water analysis report be delivered to this department from Chem Lab, 5633 B Street, for tv our review. �2) The cleanout to the septic tank should be above ground level and capped off. (3) The cleanout at the end of the trench has a depression �ull�yi around it and needs to be filled in with impervious dirt. Please notify this department for a reinspection when the noted descrepancies have been corrected. If there are any further questions, please call this department at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: First National Bank of Anchorage Post Office Box 4-2090 99509 PGE QG Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 011-135-35 Expiration Date: &-30 1. GENERAL INFORMATION Complete legal description Sand Lake #2131ock 4 Lot 18 _ ._ Location (site address) 8237 Sand Lake Rd. Current Property owner(s) Shasta Hood Day phone Mailing address 8237 Sand Lake Rd. Anchorage, AK 99502___ Real Estate Agent _ _ Day phone 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) ❑X Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ WaiverNariance request for: 3 TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. Distance: COSA Fee $_550 Waiver Fee $ Date of Payment 3 15 Date of Payment Receipt Number Q 3 55 36i _ Receipt Number COSA # 0S C-d'D 1 I 1 1 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 ARCTERRA CONSULTING, INC. _ Phone 696-6111 Address .20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 __- Engineer's Printed Name KENNETH M. DUFFUS _ _ _ Date _ z - Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future +_--- occupants or can ArcTerra guarantee that no unseen l encroachments, deficiencies or discrepancies exist. Awl 1 0 TN 6. DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. KENNETH M. Ul% 711, Conditional approval for bedrooms, with the following stipulations: C ©SA ®SL 114 / T(o & WaiEV" S rtM Lo ips C o f I-eckedt /(L! -Y_ S ►mol IV, t/ S/ e- P", VK01y_ Original Certificate Date: 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__ Septic System Advisory Well Flow Advisory COSA blue sheet 10-10-12.doc Nitrate Advisory Arsenic Advisory Other —_?C tP 04Igv���vr.� 12�stsP Legal Description: COSA Checklist Sand Lake #2 Block 4 Lot 18 If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 7/30/80 Total depth 332 ft Cased to 332 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 22 in. Date of flow test for COSA 3/2/22 Static water level at beginning of test 163 ft. Comments B. TANK DATA Age of tank(s) 14 years Tank type/material Septic/Steel Measured operating fluid level in septic tank 49" ll Standpipes/foundation cleanout per record drawing Date of pumping Z-2-1 ` 2 © ZZ D. ABSORPTION FIELD DATA Which system tested (date installed) 9/2008 It ALL standpipes present per record drawing Total measured depth from grade 12.75 ft (max) Measured depth to pipe invert from grade 5.75 ft (min) ❑ N/A — pressurized field © Monitor tubes go to bottom of effective. If not, state depth into effective Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 011-135-35 of Structure served by this system Well production at time of test 3.0 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes E Nc ® Coliform bacteria is Negative Nitrate mg/L ® Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by Arcterra Consulting Date of Sample 2/28/22 STATION ❑ Requir aintenance completed Age of lift station years Lift station material Comments: Adequacy test date 3/2/22 Results p✓ Pass For 3 bedrooms Fluid depth prior to test 50 in Water added 450 gal New depth 51 in Elapsed time 20 min Final fluid depth 50 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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 95* ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25'2] Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ft ® Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No ft 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 ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Yes Absorption Field > 5' Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' Yes if No ft Community Wells > 200' ® Yes if No ft 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' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No 3** 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 ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *Waiver # OSP141421 **See Anderson Engineering 2008 letter. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet 49� M M. CE 711 Ati RLAvs H--- ]7 Project: Enter project name All Tasks All Reports ❑ Logout Tasks Files Status Info Reports Discuss I Reviews I OSC221111: SAND LAKE #2 BLK4 LT 18 Dept: Onsite Well and Septic Status: Show All Response: Show All v Search: Enter keyword Type: Show All Cycle: Show All Time: Show All v Refresh [Select One] " Apply I (0 selected) Add Comment Add Library Comments PlBQSH enter y0U1 responses Onsite Type your response here. r Ref.# 3 Changemark note #01 Well Tim 3/30/22 10:56 AM Cycle 2 and Ecklund Septic Unresolved COSA Y (S).pdf O - Who took the water sample? Exactly where was the �i D Markup _ _ - 'cam sample taken? Responded by: DEA DUFFUS - 3/30/22 12:08 PM We (Arcterra) took the water sample as stated on the COSA, and it was taken from the / outside soioot. we have confirmed that the outside soioots are raw water. G I 1 V t. °e✓t� ,=< Municipality of Anchorage , On -Site Water &Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL �. Parcel I.D. 011-135-35 Expiration Date: 1. GENERAL INFORMATION Complete legal description SAND LAKE #2; BLOCK 4, LOT 18 Location (site address) 8237 SAND LAKE ROAD *ANCHORAGE 99502 Current Property owner(s) SARAH SALTER Day phone 244-9974 Mailing address 8237 SAND LAKE ROAD *ANCHORAGE 99502 Real Estate Agent JUSTIN BELL Day phone 343-9838 LU HTTKIL 2. TYPE OF DWELLING: ft; ■ Single Family (w/woADU) MIT 2 'ti' ✓ s F-1Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) ' d! J e 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site individual Water Storage Storage n u individual Holdingt 'g` tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ WaiverNadance request for. n/U Distance: — Received by: Date: /� r COSA to be released to the engineer, unless othemise requested b'y, the engineer. COSA Fee $ 524- ✓IS �oG o, �D Date of Payment_ 60'(a�'�i,1/�q (� Y Waiver Fee $ Date of Payment Receipt Number y�ot o l" Receipt Number COSA# 05,cj '1 ✓� 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. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd, Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE �. System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. Phone 337-6179 Date +L' Z L' N -f Conditional approval for bedrooms, with the following stipulations: �F �� ON-SITE V`VATER AND c� WASTI WATER o^ PROGRAM j J � 1 Original Certificate Date: Z'0 "-a I/-/,/ The Municipality or AricKorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. _ 7. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (R— 11/M) Nitrate Advisory Arsenic Advisory Other 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 18 ParcellD: 011-135-35 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 7/30/1980 Sanitary seal (Y/N) YES Total depth 332 ft. Cased to 332 ft. Well Log (YIN) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 7/30/1980 10/22/2014 Static water level 117 ft, 163 g, Well production 10 g.p.m. 4.54 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate ND mg./L. Collected by: GEG. Ltd. Arsenic:91 .5_ug./L. Date of sample: 9/17/2014 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 9/5-6/2008 Tank size 1000 gal. Number of Compartments 2 Cleal outs (YIN) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 9/17/2014 Pumper MCDONALDS PUMPING SERVICE C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 9/2006 Soil rating (g.p.d./ft2or �/bdrm 1.2 System type DEEP TRENCH Length 30 ft. Width 3 ft. Gravel below pipe 7 ft. Total depth *12.65 ft. Eff. absorption area 420 ft' Monitoring tube YES Depression over field NO Date of adequacy test 10/22/2014 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 46 in. Water added 495 gal. New depth ***83 in. Elapsed Time: 440 min. Final fluid depth 51 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) YES If yes, give date9 17 2014 *`*3" INTO C/O AT END OF TRENCH D. LIFT STATION Date installed Size in gallons Manhole/Access "Pump on" level at in. "Pump 0 level High water alar level Cycles tested Meets alar & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot *95' On adjacent lots 100'+ Absorption field on lot 100'+ Public sewer main — N/A Sewer /septic service line 25'+ On adjacent lots Public sewer manhole/cleanout N/A Holding tank Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 101+ Surface water 100'+ Wells on adjacent lots PVT 100'+, **CLASS C 112' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *31 Building foundation 101+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots PVT 100'+: **CLASS C 126' F. COMMENTS *SEE MIKE ANDERSON P.E. WAIVER **SEE 2008 ADFC WAIVFR G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date Ip Z �Jl`i (Rev. 11105) Municipality of Anchorage Community Development Department Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # 141566 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 4, Lot 18 of Sand Lake 42 Subdivision. This inspection revealed an arsenic concentration of 19.5 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval.