The URL can be used to link to this page

Home My WebLink AboutSAND LAKE #2 BLK 4 LT 19 MUNICIPALITY OF ANCHORAGE ~' DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE [~NEW 'DoOG LA,.q ~ALL~N'i- ~?~-zZol~ UPGRAD~ MAI LING ADDRESS LEGAL LOCATION ~ NO. OF BEDROOMS [ Well Absorption area Dwelling PERMtT ~ ~ Liq. capacity in gallons Inside length Width Liquid depth I ¢ ¢O IF HOMEMADE: ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O ~ ~ Manufacturer Material Liquid capacity in gallons ~0 DISTANCE TO: Well N¢~ I ~ F°undati~ ~ Nearest lot linelo PERMIT NO' ~ ~O~Z3 ~z-~ ~o. of,iT Length of ea~ 1~' Total length o~n& Trench w~ inches Distance between__ lines ~ ~ Top of tile to finish grade Material beneath tile Total effective a a Length Width Depth PERMIT NO, < ~ Type of crib ~ Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ¢ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO; Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST ~ATING INSTALLER APPROVED DATE LEGAL 72-013 (Rev. 3/78) D()L!F:jI..?::; GF LLFI!'q .... SFiND LI-~' LT. :!..Lq, BI.. I'~' 4. SRi'.!D Li.:::. "Z:;,.."t) L "341," '-CFi T i F.:RT Z NG ,:: S:;[;! F"i",..-'E',Fi:)= S5 .......... ='..~,.: ..... REiSE!F:F'T:[E,.'N S'T'S'F'EI'"i I.S: THE L. ENEq"H.' D I HEN:::.:; :!: ON :,'-'S THE LENGTH ,:;IN FEET.'.', OF THE TRENCH OFf: DRR):I',!FIEL..D. THE DEF'TH OF F:I TRENCh! OR P.T.T IS ',"'HE DZ'L:;TRi'.~CE BE']"I.,.!EEN THE SL!RF:'FICE OF THE GFi%!Lii'.4D R?-,ID THE DOTTOFt OF THE EXCFI',,,'FIT];E.~N (iN FEET), 'T ~-..~ r-..'~EE .... F' F'.: E:tE ~'-.~ E:::: ~...W ~---:~ % El:::,, 'T ~.--~ ;~r. :F.2';; ~;.i.' .. ~.-.--5~' -,:_.'.'t~ ~Zi~ F-" E; EE '"'iF' _ THE (3R!::i'....,'EL .F.:,EF'T!.-! I':2, THE ,,'"!;[NZ?ILiH DEF'TH OF G,r;.;:R',,,'EL BE'F~4EEi",I THE OUTF:T':'!L.L PIPE Fli",!,r.> THE BOT'T'OH ('.'~F' THE EXCFib'ATiOi'-,t (IN FEET). H:[N.'i:HLiH D:[STF:tNE:E E~E:T!.4EEh! R [,IEL. L FIN[.'.', I::~,i'4Y' ON-S]:TE SE!4FIGE DISPOSAL ?¢:STEH ZS C.~;~¢ FEE"F FOR R PRIVFITE HELl... OR ::!..5~ 'T'O 2~l(!il FEET FROifl R PL!DL.];C !4EL. L DEF'ENDZt'.,!G UF'ON THE TYPE OF F'LIBL.;!;C !,.IEL.~ .... H[(N;[HL.IH D~S'T'ANCE FROH R F'RZVFITE 14ELL TO F:! PRZVA"I"E SEP.!ER L]H'-,iE IS 2~i FEET FIND TO R C)Eff,!HUNZTY' SEIqER LiNE IS 75 FEET. HELL. LOGS RRE REQUZF:ED FIND I"tUST BE F:ETLiRNED TO THE DEF'RR"i"?tEIWT !.,.tZTHIN :~:Ei DF!YS OF THE HEL. L. E:OHF'L. ET ZON. O"i"HER RE(;!L!];REHENTS I'"IFI'¢ FIPPL?. '.~;F'EC;[FZCR'TZON% RND CONSTRLICT;[Ot'4 DIR(3F~FIHS FIRE F¢,/A :~I...RE~L.E "I"Et Z NSLIF:E PROF'EF~ Z NSTRL. LRT Z ON. ;!: CEF,::T i F'Y' TFiF:!T :~.; ~ Rf'i FR?"!~I..IAF,..~ !4;~"I"H THE PIEt;¢.JZ~EHEN'f'S FOR ON--~SI'TE SE~,.!ERS Bi'.4D i.,.!ELLS FIS SET F'O?.'i"H E:'¢ THE h'l!..IN ! E: I PAL Z ~!"'¢ OF' FiNCHOF~FiGE. 2: ;~ ~,.IZL. L ]:NSTRL. L THE SYSTEH ]:N ROC:O~:DFCN(::E !41TH THE CODES. ;~:: i UNDERSTFIND TFIF!T THE Of.,!--S:I;TE SEI.,.!ER SYSTEH ?!1::i'¢ F;~:E~;:IUZRE ENL.!:::I!:;~:GEh'iEI'.,!T :!:F THE R%tE:'[E,EH:3EZ TS f;~:E[,~ ~:,E!...ED TO ]'HZ.__::,E H-RE THRt'.,! PERFORMED FOR: LEGAL DESCRIPTION: 1 § 6 8 9 10 11 12 13 14 :15 16 17 18 19 20 G II-T MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION [] PERCOLATION TEST 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST A GON MoM~ ~ DATE PERFORMED: ~'/~'~ ~ SLOP~I SITE PLAN PERFORMED BY: CERTIFIED BY: DATE: 72-008 (6/79) PERCOLATION RATE (minutes/inch) \ Reading Date Gross Net Depth to Net Time Time Weter Drop 2225-E NE 2§, 197! WAS GF JND WATER ~k~ S ENC !~1 0 L 0 P E PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10~ 11 12 13 14 15 16 17, 18 19 20 MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE'T DEPARTMENT OF HEALTH AND ENVlRONMI~IVC~L PR'UTECTION 825 L, Street, Anchorage, Alaska 99501 264-4~ ?,,' 9 !982 SOILS LOG- PERCOLATION TEST RECEIVED HO ~ & ,~ DATE PERFORMED: SLOPE SITE PLAN SOl LS LOG PERCOLATION TEST WAS GROUND WATER ~,~ S ENCOUNTERED? I~ O L IF YES. AT WHAT E DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (minutes/inch) · .t I . ,n ~ TESTRUN BETWEEN . ~, FTAND ~ FT ,, PERFORMED BY: '~.~~ ' 'CERTIFIED BY: '~'~'¢ ~ DATE: 72-008 (6/79) CONSTRUCTION AND C PERATION CERTIFICATE ALASKA E~EPARTMENT OF ENVIRONMENTAL CONSERVATION . PUBLIC WATER SYSTEM APPROVA~L TO CONSTR U~CT_ constru ionof r/('/Z)Jt~l~ ~..,z~-I~' ~bD ' /~0T.~ ~~~'~ ~ ~I-F~ ~ ~ ~.L,,~ ~ ' public water system located ~n ~ ~I C ~'1 o ~ ~ ~ ., Alaska, submitted in accordance with 18 AAC 80.]00 by ~C) C( C~ ~ ~ L~b~ have been reviewed and are [] approved, 1~ conditionally approved (see attached.conditions). ICe ¥ opo)* ~ ,~' ~_ ? . 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. APPROVEDCHANGEORDERS Change [contract order no. Approved by or descriptive reference] Date The "APPROVAL TO OPERATE" section must be completed before any water is made available to the public, APPROVAL TO OPERATE The construction of the '~,?.~l) f ~ " ¢ "~ /'~[', public water system was completed on / ' / 5 ,~ ~-- (date). The system is hereby granted interim approval to operate for 90 days following the cpmpletion date. BY TITLE DATE As-built plans submitted during the interim appr~)val period, or an inspection by the Department has confirmed the system was constructed according to the approved plans. The system is hereby granted finaJ~approval to opera~_ ~2 --' ') Municipality of Anchorage Development Services Department Building Safe{y Di,~isi(~n On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Parcel I.D. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING : .... HAA # ,/~/,,~o~o~w Expiration Date: 1. GENERAL INFORMATION · Complete legal description Location (site address or directions) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless othenyise requested, HAA wi#be held by DSD for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class. ~ Public Water System Well [] [] [] TYPE OF WASTEWATER DISPOSAL: Individual On-site FZ-I Individual Holding tank [] Community On-site Public Sewer [] I The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 vedfy that my investigation, based on procedures outlined in the Health Authority 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 tTpe of slructure 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. NameofFirm /*=*lc~/*-*/o/. 'T,,c/,n;¢c~/' .~¢~-u;,¢~,.,.. Phone Address I~/~'..,~(::/ ~'c~o --~'/.~ /~r~c~,o~'~,~ Engineer's Printed Name '7",4~'o~'o,~' [=. ,,'~oo ,--~_ * Date' t1'/ Additional Comments" Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other (Rev. 01/02) Odginal Cedificate Date: ,t/=t/¢7 Municipality of Anchorage Development Services Department ,', Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak, us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription:J..o~ ~ ~/~ q.~ Sonar' ]-,0/~.¢ ~'/~ ~'~ A. WELL DATA Well type ~'laX. l' '~'" Date completed Total depth fL IfA. B. or C provide PWSID # Sanitary seal (Y/N) Cased to fL FROM WELL LOG . . -B. Date of test fL g.p.m. Static water level Well production WATER SAMPLE RESULTS: Coliform ~:) colonies/100 mi. Arsenic: --.- . rog.fl. SEPTIC/HOLDING TANK DATA Well Log (Y/N) Wires properly protected (Y/N) Casing height (abo~ve ground) in. AT INSPECTION ~ g.p.m. Nitrate < O. I mg./1. Other bacteria ~ Z:~ colonies/100 mi. Date o, fsample: Io/Z,"lt'o,.3 Collec, ted by: , ~f~/,-/o,~ TankType/Matedal !. ~,el~qa /'~'f'~el" . ..... - .Da. re in,stall.ed,'7/'. t./'~. Tanksize IOa~ gal. Number of Ccmpartment '~' ' Cleanot,its (Yin · Foundation cleanout (Y/N) '¢' '. Depression over tank (Y/N) /,J High water alarm (Y/N) Dateofpumping lO i/1~/03 Pumper' ABSORPTION FIELD DATA .... :.. Date installed 7 ! I ¢'gZ Soil rating (g.p.d.ll~ or ft=/bdrm) E~.~'. ~'e,~, System,type $'? ,~.~,~'¢ ,~'~,,,e ~ e~,,( Length ~ ,ff. Width 5" ff. Gravel be[ow pipe /, 5' ft. Total depth .~ ft. '~ff. absorption area?-~'~" ft: Monitoring tube ~ Depression over field /y' . Date efadequac7 test {o('Z.'7/~ Results(Pass/Fail) po,.~r Fcr_,~__.bedrooms Fluid depth in abscrption field before test ..O__ in. Water added~'l 2. gal. New depthlO, t,' in. E!apsed Time:~ m~n. Final fluid decth~.3~,'in. Absorption rate >= ~,,~"'~:~ a.p.d. Any rejuvenation :reatment (pas; 12 mo.) (YIN & type) /Vo~/, /~'no ~.~,,, If'/es. give date N. ~, D. LIFT STATION Date installed 'Pump on" level at , Size in gallons in. ·Pump off' level at in. Manhole/Access (Y/N) High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: /~/. ~'. ' ' '" '"' ' " *' ' ':' ' ' ' ' On'adi~ ~'" Septic tank/lift station on lot c~nt 16ts ~' '"' - Absorption field on lot Public sewer main ~ On adjacent lots Public sewer manhole/cteanout Sewer/septic service line Holding tank SEPARATION DISTANCES FROM sEpTIC/HOLDING TANK ON LOT TO: Building foundation ~Y 5"* Property line I ,~' ° Water main '~, ~'~ ~ Water service line I '3~ Wells on adjacent lots ! OC,, ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Absorption field Surface water ~ Property line Water Service line Curtmn drain j~Jon¢ Building foundation ~(::>° Surface water, :;>'! ¢~o ', W~IIS bn a~lja'cent lots, ;:> 4'00' Water main ~ Io ~ Driveway, parking/vehicle storage I certify that I have 'determined t~reugh tTe/d inspections and review of Municipal recoNs that the above systems are in conformance with MOA PAA guide/ine's in'effect on this date. Engineer's Printed Name COMMENTS .waiver Fee S I,,,A"O ~"~ gate°'f'PaYm'en!' ~ t' Receipt Number ,-1~461~ ~ Municipality '.of Anchorage P.O. Box 196650 ~' 4?00. Bragaw St~cct ' Anchorage, Alaska 995'19.6650 · (907) 848.8801o F,-uX (907) 8q8-8200 ' h ttp://~v.muni.org. 1/8/2004 Ted Moore Flattop Technical Services 14530 Echo St. '.AnChorage, Alaska 99516 SubjeCt: Waiver Request for Sand Lake #2 Block 4 Lot 19 Waiver Request #WR040002 Parcel ID #011-135-34 HAA# 030591 Dear Ted Moore: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to property line has 'been approved. The approved s. eparation distance is 7.0 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the omsite wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questi0ns regarding this waiver, please call our office at 343-7904.. Sincerely, Civil Engineer . . On-Site Water & Wastewater Program Municipality of Anchorage Development. Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage, ak.us (907) 343-7904 WR#: 040002 PID#: 011.135-34 Date Received: 118103 Waiver Review Worksheet HA#: 030591 Permit#: Legal Description: Sand Lake #2 Block 4 Lot 19 Engineer: Ted Moore .Flattop Technical Services 14530 Echo St Anchoraqe, Alaska 99516 Applicant: ,Wayne Eski Waiver Requested: 7' Lot Line Waiver Criteria: Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Points: Total: Waiver is Granted: Waiver is not Granted: List Conditions or Reasons for above: Name of Reviewer mmmmmmmmmmmm mmmmmlmmmmmlmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmlml Rec#: ,44819 Amount: $150 Date Paid: 11812004 CIVIL & ENVIRONMENTAL ENGLNEERLNG ~' ENERGY CONSERVA~ON & ~YS~ TIIEO~RE F. MOORE, P.E. 14530 ECHO ST. Pti: (907)345-1355 ~CHORAGE, ~KA 99516 November 20, 2003 M.O.A. DSD P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: By means of this letter I am requesting issuance of a waiver allowing the soil absorption drainfield on Lot 19, Block 4, Sand Lake S/D/t2 to be reapproved in its present location approximately 3 feet from the north property line common with Lot 18 instead of the normally required 10 feet. The waiver should also reflect that the drainfield is approximately 7 feet from the south property line. An as- built survey is enclosed on ~vhich I have delineated the locations of relevant features. I am also enclosing a copy of a recently issued waiver from the State DEC allowing the drainfield to be 3 feet from the community water line.bringing water to this residence. All of the lots in this subdivision are only 50- wide and most are served by approved Class "C" community wells for which the separation distance to on-site septic systems has been waived down from 150' to 100'. There is also a private well on the west side of Lot 18, which necessitated that the septic system on Lot 19 be constructed at the east end of the lot. Because the lot is so narrow, it is physically impossible for a 40-foot long absorption system not to encroach on the specified 10' separation from the property lines. This same situation is true on many of the nearby lots. As shown on the site plan, the monitor tube at the north end of the trench is only 4 feet from the property line, indicating that the dralnfield is possibly as close as 3 feet from the property line. Since the systems encroaching on the specified 1 O-foot separations are perpendicular to the lot lines, there is little potential impact on the functionality of any existing or proposed septic systems on adjoining lots. Accordingly, it is my opinion that the requested waiver can and should be granted. Please give me a call if you have any questions on this analysis. Sincerely, Ted Moore, P.E. ~ ~ / I tu~4 LOT ~ Anchorage Recording Oistrictt Alaska Z*,eme.l, Of r~ord 0~ t~ Hat et ~aord ore riel *ho~n ~reon LOT SURV~ CERTIFICATION LEGEND ~l/2U/U3_14:19 FAX.~O?2§97~SO DEC D~&~W P001 '". '": :' , i'm '"" '" .., ,I th\ ,: :P Il u DEPT. OF ENVIRONMENTAL CONSERVATION DMSION OF ENVIRONMENTAL HEALTH / DRINKING WATER AND WASTEWATEK PROGRAM / FRANK H. MURK~WSKI, GOVERNOR 555 CORDOVA ANCHORAGE, AK 99501 Phone: (90'/)269-7519 Fax: ~0'/) 269-"/630 hup'.//www.$tate.ak.u.'dd ~c/ November 20, 2003 Ted Moore. P.E. Flattop Technical Services 14~30 Echo Street Anchoxage, Alaska 99516 Re: Sand Lake # 2, Block 4. Lot 19-Request for a Waiver Between a Water Line and a Wastewater Soll Absorption Field, Class C Public Water System, PWSID # 2160'/5, ADEC # 36"/4 Dear Mr. Moore: The Department has reviewed your request dated November 4, 2003 to waive the required .~epat~tion distance between an existing onsite soil absorption system and an existing class C water line that serves lots 19, 20, 33, 34 and 35 of Block 4 Sand Lake Subdivision Number 2. The soil absorption system is located on lot 19. The plans show the homes ar~ supplied water by a common I~A inch distribmion line. The individual lots were allowed to develop in the mid 1980's with on-site wastewater soil absorption disposal fields. Th~se disposal fields were installed in the past and did not provide [he requLt~d ~eparation distance or' 10 feet betweea the disuibution line and the absorption system. The water distribution line that enters lot 19 is located in an easement and crosses at right angles to the soil absorption system that serves ~his lot. The horizontal separation distance was field determined to be 3 feet between drinking water line and the edge of the onsite soil absorption field. Thc depth of thc water line is from 3 to 4 feet and the soil absorption field is beneath 4½ feet. Samples taken on October 27, 2003 indicate that the source water had no total coliform detected and ,,was beneath thc detectable limit for nitrate. The well log i~dicated the soils from 0 to 52 feet to be a sand and gravel. Thc Municipal/t/es soil xating indicates subsurface soils to be well graded gravel. No evidence indicates public health is being threatened from this site condition. Based on the information submitted, it appears the requested reduced separation distance is protective of public health. Therefore, in accordance with the State Drinking Water Regu!atious (18 AAC 80.020), the following waiver is granted for the existing site condition: The separation distance 3 feet between the water distribution line from Cia.ss C public water well located on Lot 34, Block 4, Sand Lak~ # 2 Subdivision and the on-lot wastewatcr soil absorption system serving the home on lot 19 of this same : subdivision and block is granted. If the wastewater disposal system fails or contamination can be traced back to the system, the waiver will be invalid ~nd the system reconstructed to meet minimum required separatiou distances. This approval does not imply the granting of additional authorizations nor obligate a~y state, federal or loc~ re~lato~ b~y to ~t ~cquir~d ~u~o~za~ons. ~y person who disa~==s wi~ ~s decision may ~quest an adjudic=to~ ~=~g ~ accordant= wi~ ]~ ~C 15.195- lg ~C 15.340 or ~ info~ ~view by ~c Division ~or ~ ~cco~dan~ wi~ 18 ~C 15.~g5. I,fo~ renew ~qu~U must b, dd~wr~ to d~e DM~ioo D~e~or, 555 Co~do~ St., ~ehomge, Al~ka 99501. wi~ 15 days of ~e pe~t decision. Adju~o~ heafln~ requ~ must bc delivered ~o ~he Consulter of ~e Depan~nt of ~v~ron~n~ Co~e~fion, ~10 Wilou~by Avenue, Suite 303, Jun~u, ~ka 99801, with~ 30 days of the ~t deeP,on. ~ a he~g ~ not ~ques~d w~ 30 days, ~e fighl to ap~al is w~ved. ~ you ~or ~o~ eoope~a~on. ~ you ~ave ~y ques~on plebe do not hesitate to contact me a~ 269-~519. ' Restfully, WDliam R. ~e~, P.E. ~vko~ent~ En~neer ¢c: David .l'o~mso~, DW/WW Jamie Stazel, DW/¥v'W 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description LOT Location (site address or directions) prOperty owner Mailing address Lending agency Mailing address Agent Address Day phone 338-q384 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~' 2- TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer 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 o 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 F'LATToP T~cH. Address _ 1~$3o ~ch'o Engineer's signature ~~ ~ ~ Date DHHS SIGNATURE ~' ApProved for ~' Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineeYs work. 72~)25 (Rev. 1/91) Back MOA*~21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LoT Iq. I~LK ~ 5~t, i5 LAKE ~z Parcel I.D. A, WELL DATA Well type ~-. Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height Wires properly protected (Y/N) FROM WELL LOG ; On. adjacent lots Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line g.p.m. AT INSPECTION ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform O~!/~oo,~ Date of sample: G//5/~'a Nitrate ~, o, / ~,/.~. Other bacteria Collected by: ~'L,~TTOP ~vc5 , B. SEPTIC/HOLDING TANK DATA Date installed 7/t/~2 Cleanouts (Y/N) ~' Tank size ! woo ~//Z Compartments Foundation cleanout (Y/N) ¥ Depression (Y/N) High water alarm (Y/N) N. ~. Alarm tested (Y/N) Date of pumping 7/' ! I ~ '~ Pumper .~'J',~,~¢.,- SEPARATION DISTANCES FROM SEPTIC/HOLD NG TANK TO: Well(s) on Io~: ~ .A. ~ On adjacent lots ~ 1~8; Foundation /-/'~ To propertyline "~10' Absorption field $' Water main/service line Surface water/drainage ~> !oo ' 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE. FROM LIFT STATION TO: Well on lot On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed -7[i Length ~O Width Total absorption area Depression over field (Y/N) Results (pass'fail) Peroxide treatment (past 12 months) (Y/N) No~f Soil rating ~,5 ~' Gravel thickness Cleanouts Present (Y/N) Date of adequacy test for System type Total depth bedrooms oF If yes, give date N,A, SEPARATION DISTANCE FROM ABsoRPTIoN FIELD TO: Well on lot tq .A. To building foundation On adjacent lots Surface water onadjacentlots ¢/~o' Propertyline I~' ~¢¢- To existing or abandoned system on lot ti.A, Cutbank i~.~. Water main/serviceline ~ (oo Driveway, ~arking/vehicle storage area ~ ,5-o Curtain drain N,A, E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature ,~-~ ~' ~ Engineer's Name '7'"~_~c~Or'~ /:=. ~oc,~' Date ~'-~ly ~ I~Z HAA Fee $ / 7(7 Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99503 WALTER J. HICKEL, GOVERNOR (907) 349~7755 June 29,1992 FOR: Ted Moo~-e Flattop Technical Services PWSID # 216075 My review of the records on file in this office reveals that the Lot 19 Block 4 Sand Lake #2 Subdivision Class "C" Public Water System, is in compliance with the routine coliform bacteria sampling requirements of 18 AAC 80.200. Sincerely, Rachel Clark College Intern RC/cf MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # ~-//--/~Z Z-/ HAA # ,/~/~ /~-/~ 0 ~ ~ 7 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or directions) (b) Propertyowner ~r~ I'c}e~z V Mailing Address Z~ ~-- ¥5- _C'~nM /.~/'-~ (c) Lending Institution Telephone: (home)3*%'--?o..c~' Business Telephone Mailing Address (d) Real Estate Company and Agent f~ Address "'~d'O0 ~'or ~:~c~ Telephone (e) Mail the HAA to the following address: (or check here I~, if hold for pick up.) List contact person and day phone number below: V-etA or- Cfi,-'cr ~v..~- )~,~.5" 2. TYPE OF RESIDENCE Number of bedrooms Single-Family [] 3. WATER SUPPLY individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and statbs. 4. SEWAGE DISPOSAL On-site [] Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 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, functiona 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. NameofFirm ~'/~:/'~? 7%c~n~'¢~/ _~,r-~,(~. Telephone - ~- tT~ Address ~~ ~ ~/' ~ c~°r~~~ ¢~¢~ Date :~ /~ ........ · -"' ~ ,'s -, CE-3~9 .' ,~',, 6. DHHS APPROVAL ~-~~ ~.Date Approved for__ ~ -bedro°ms by Approved ~-~ Disapproved. Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (Rev, 7/88) Back A. WELL DATA Well Classification C (od.r '~ ~ :' Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments MUNICIPALITY OF ANCHORAGE (MOA) NiClPALITHeeI~I~(A~ty Approval (HAA) ONME NTA~J~I~'~.~I~E B R U A R Y 1984 343-4744 F P 1990 Legal Description: Ao~ 6 Date Completed Depth of Grouting If A, B, C, D.E.C. Approved (Y/N) Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed 7/I/88 Size Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on FiFe (Y/N) Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line _~ To Water Main/Service Line No. of Compartments ~" Foundation Cleanout (Y/N) Date Last Pumped "~/{8'/Pc~ b ; for /'~, ,~. Temporary Holding Tank Permit (Y/N) /v',/~. Air-tight Caps (Y/N) N To Building Foundation To Disposal Field To Stream, Pond, Lake or Major Drainage Course Comments ~_~C 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 7/I /~'2 Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test ~'.5' C7' /,'~¢(,'-,~ Type of System Design _ ~ Length of Field ~'~ Depth of Field ~'.5' ' Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well / To Building Foundation Al;,4. ; On Adjoining Lots Lot To Water Main/Service Line ~n ~' To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course ~ too' To Driveway, Parking Area, or Vehicle Storage Area Comments -~ e.x,,a,o,~c To Property Line ~ ~ ' To Existing or Abandoned System on D. LIFT STATION /~l;/). Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at_ Vent (Y/N) Pumping Cycles during Adequacy Test. Comments **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company ~ w; ~.~ -- P :~ :~ ~ngmeer s Seal " " ~/ ~/ Receipt No._ ~ ~.~ Date .5"'~_./~ / ~ MOA No. _ ¢~ -~(¢ Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Waiver Fee: $ Date of Payment Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION STEVE COWPER, GOVERNOR ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 August 31, 1990 563-6775 FOR: Flattop Technical Service Attn: Ted Moore PWSID: ~216075 According to the records on file in this office, the Sand Lake ~2 Lot 19, Block 4 Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, V.~RA E. CRAIG ~ Environmental Specialist VEC:pf MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or directions) (b) Property owner ~r~c¢ Mailing Address (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address ~'OO Telephone Telephone: (home)3 Y3-- 7'05- Z Business Telephone ~'~4- - ~ (e) Mail the HAA to the following address: (or check here I-'Zl, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family [] Number of bedrooms 3. WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation fr?m the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 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, functiona 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 Date Approved for ~ bedrooms by ~ ate Approved ~//~'~ Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval ceriflcated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 O¢~\q'- MUNICIPALITY OF ANCHORAGE (MOA) ~,:~ ~.v~'~.~'~¢-~_~,~ Health Authority Approval (HAA) .~S¢;'~'i~.kg~t~"~Y.~A~,./~x CHECKLIST - FEBRUARY 1984 ~.O~' ~" 343-4744 ~ ~' ,~ Legal Descnphon: A. WELL DATA ~gq~x~ Date Completed Depth of Grouting Well Classification ~' (a ¢ Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results h Comments ~O~ ~::~,~..¢ ,,-o ~,,c~/' If A, B, C, D.E.C. Approved (Y/N) ~ Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole B. SEPTIC/HOLDING TANK DATA Date Installed 7/l/~ .Size Standpipes (Y/N) ~ Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) IOoa ~,,~! No. of Compartments Air-tight Caps (Y/N) N, ,~. Foundation Cleanout (Y/N) Date Last Pumped '~/16't'2~2 ; for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ~ I y~' To Property Line ~ t,o ' To Water Main/Service Line (4'~ /< To Stream, Pond, Lake or Major Drainage Course Comments DI=C ~,'~ ~ ~x ~ To Building Foundation To Disposal Field 5' 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 7/' f / <~ ~' Width of Field 5- ~ Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field /¢,¢ r Depth of Field ~', b- ' Gravel Bed Thickness h 3- ~ Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well I 'i'd ' To Building Foundation Lot N, A, To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments r d) To Property Line ~ ~ O' To Existing or Abandoned System on ; On Adjoining Lots ';~ ~O' To Cutback (if present) ~o~ ]~ (0~~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA gui~d~i~jj%~ect on the date of this inspection. ~.~'~. ?,,, ....... h ~ ~ ~ Signed ~~~ ,~'~ ~/%~"' ~,/~'":¢~¢, Company ~[~ ~'~ ~¢~ '-~z ...... ~ "- ' ¢ ...................... ~,';,~ngineer s Seal Date ~/~ ~/,0 ~.~~,~~ MOA NO. ~0 - O (~ '~ o THEODORE F. :AOORE' ~ ~.,.~ % Cu-3o39 · ~3 Date of Payment ~ ~ ~ ~ () Waiver Fee: $ Amount: $ / ~ ~) ~ Dateof Payment 72-026 (Rev. 7/88)Back Page 2 of 2 ANCF[ORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 February 22, 1990 563-6775 FOR: Attn: Flat Top Technical services Anchorage, AK. Mr. Ted Moore PWSID, According to the records on file in this office, the Sand Lak9 ~2. Lot 19. B1QC.k..~ water System is tn compliance with the State of Alaska Drinking Water Regulations. Sincerely, VERA E. CRAIG Environmental Field Officer MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION · DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-472O Application Date '~-~, GENERAL INFORMATION (ai (b) (c) Leg21 Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name ~, J~l ~E,~ [,Jl~ Telephone: Home ~° Applicant Address _,~ ~,¢'~ /~eT'Of~e~. ~ Applicant is (check one): Lending Institution []; Owner/~; Buyer []; Other [] (explain); Business (d) Lending Institution F~tl~.~,_l- ~L.~tdP_a~AJTE~ ~ ~O~T Telephone Address ~.~~ · ~ ~ ~'~ ~ ~m.~ (e) Real Estate Company and Agent ~ Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number 'of Bedrooms Other WATER SUPPLY Individual Well [] Community~Ji~ 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~, 'Publicl"l Community [] Holding Tank [] Not~: If co~mmunity'~ell system, must have wi'itten confirmation from the State Department of Environmental Conservation attesting tO the legality and ~tatus.. ,-:_.,;:., '" ;ii;,:i~ : .,..; ENGINEERING FIRM PROVIDI~'~ ~ INSPECTIONS, TESTS, FILE SEARCH, D~-....;, 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 complian, c,e with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~o,-~,~~ Telephone Address - / ~ ..t bl~ ¢/ Date ~f~ ¢[v/~:~ Engineer's Seal DHEP APPROVAL Approved for' bedrooms by Approved /~ Disapproved Terms of Conditional Approval Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given Jn 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 requirements. Employees of DHEP do not conduct inspections'or · analyze data before'acertificate is issued! The Municipality of Anchorage is not responsible for errors or omissions in the . ' ,../., .;'.' professiorfal engineer, s..work..; .:;_ ;;,:: %!:;<~ -,/.~.:'.{. ':,.. ' ,,.~:,.~!,,-.~,, ,.. .... i.-,i ~ '.: :,., ,~ /'i,~?':.~:,i:~-,!. :/'.. WELL DATA Well Classification Well Log Present (Y/N) Total Depth MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 O~.~_~a, Des_cription: L '~ Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot If'A, B, C, D.E.C. Approved (Y/N) Date Complete~l Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments To Nearest Public Sewer To Nearest Sewer Service Line on Lot ~" ~, ;Date ~//'.~/~:~'-~ B. SEPTIC/HOLDING TANK DATA Date Installed 7/~2.' Standpipes (Y/N) '/? ~- Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line /7 / To Water Main/Service Line .~' /f'~ / Course Size /~O No. of Compartments -~-~ Air-tight Caps (Y/N) · ~(' Foundation Cleanout (Y/N) y Date Last PumPed ~ ~- [. ~ ~ . . ; for Temporary'Holding Tank Permit (Y/N) /~ To Building Foundation ~ ~ / To Disposal Field ~' ~ ~ Comments To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed "~/N -~- Width of Field ~'~ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test ,Type of System Design Length of Field Depth of Field /---/'~'~ / Gravel Bed Thickness _ .//~/' Standpipes Present (Y/N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation (~/! TO ~ter Main/Serve/ne~ To Stream/Pond/Lake/o¢ Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area / To Property Line To Existing or Abandoned System on On Adjoining Lots . 30! To Cutbank (if present) Comments LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N} Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Agains~ HAA Request ** I certify th~ I have Checked, verified,.,,or conformed to all J¢O,~ and HAA guidelines in effect on the date of this inspection. Signed '~-~ Date-y~/~'~' Company MOA No. Date of Payment '~ ~ ~ ~ -%. % -, Engineer's Seal Amount: $ Page 2 of 2 203 W. 15th AVE 'C' SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-391 C, LEGAL: LOCATION: OWNER: RESIDENCE: SEPTIC SYSTEM: S E P T I C S ¥:S T E M A D E Q U A CY LOT 19, BLOCK 4, SAND LAKE #2 8245 SAND LAKE ROAD TEST B. KIESSLING SINGLE FAMILY, TWO BEDROOMS FROM MUNICIPAL RECORDS: TANK: GREER STEEL, TWO COMP ABSORPTION SYSTEM: ABSORPTION AREA: SOIL RATING: : INSTALLATION DATE: DATE OF PUMPING: JULY 7, 1986 DATE OF TEST: JULY 3, 1986 1000 GAL. DRAINFIELD 256 SQ. FT. 85 JULY 1982 WATER WAS ADDED TO THE SUMP AT A CONSTANT RATE OF 6 GALLONS PERMINUTE. THE WATER LEVELS IN THE TANK AND SUMP WERE MONITORED. THE ADDITION OF 250 GALLONS ~CAUSED THE WATER LEVEL TO RISE .5 INCHES IN THE TANK AND 2.75 INCHES IN THE SUMP. AFTER 15 MINUTES THE WATER LEVELS WERE DOWN TO THOSE PRIOR TO THE TEST. TEST RESULT: THIS SYSTEM MEETS THE CODE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The operational life of all septic systems depends on the local soil conditions, 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 this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requi- rements of the Municipality and State. TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND WITH 2.5 FEET OF COVER, LIQUID DEPTH 46.5 INCHES. SUMP WAS 81 INCHES DEEP AND A LIQUID DEPTH OF 19.5 INCHES. DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g950t BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-~533 DATE: Jnly 10, 1986 PWS I.D.# Class "C" To Whom it May Concern: According to records on file in this office the Sandlake Subdivision T.n~ lq; ~ln~ 4 Water System is in compliance with the State Drinking Water Regulations Sincerely, APPLIC IT FILLS OUT UPPER HAL 'ONLY Property OwnerAddress ~"~ ~"~/~0i',-"5"~ -- l ~ Phone Buyer Address 5 ~ Zip Code Lendinglnstitution ~/~ 5~Ab~,/~ Phone Address Zip Code Realty Co. & A~nt Phone Address / Zip Code reet Locati~ ~ ~-/~ ~ ~ ~ ~ ~ of Resi~nce Single Family ~ Multiple Family No. of eedroo~ ~ Other ater Supply Individual A~ACH WELL LOG, A w~l log is required for all wells drilled since June 1975. Community For wells drilled prior to that date, give well depth (attach log if available), ~ Public Utility or Disposal Individual o~ ~ ~. Yoar Indiv~ual InstalloO: ~ ~ Public ~ility When Connected to Public Utility: ~ Holding Tank '- NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector inspector Inspector Inspecto., Field Notes: C"~,~J~~' ~ ~, (~' ~'' MUNICJPALI~ RECEIVED ( ~PPROVED BEDROOMS *GONDITION8 OF APPROVAL ( ) DISAPPROVED ( ) OONDITIONAL APPROVAL' BY: . - Soils Rating Date ~wer InstaUed Well To ~sorpiion Area WeU Log Received %~ Well to Tank Septic T~k Size 72-023 {3/82}