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HomeMy WebLinkAboutSAND LAKE #2 BLK 4 LT 20and Lake #2 Block 4 Lot 20 #011-135-33 MUNICIPALITY OF ANCHORAGE 1 i • DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 4 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 AAM`, F�/"F.IV � 12 � N N a ,3a1 — — `;9j$ j t ❑ UPGRADE MAILING ADDRESS ?-00 sox 106 cH 5 i l LEGAL DESCRIPTION - �,,.®r 3 K_ 14 S&ND K E '=P - LOCATION - NO. OF BEDROOMS O v, SAND D i�v E R 1), 3 U Y DISTANCE TO: Well i L43 '2' Absorption area j Dwelling 3 PERMIT NO. p 2' a Q w l- Manufacturer N mac? C N K `Inside Material 5 TiEFE . No. of compartment tioo y Liq. capacity in gallons length 6 00 IF HOMEMADE: Width Liquid depth D�z DISTANCE TO: Well Dwelling PERMIT NO. = z Manufacturer Material Liquid capacity in gallons w= Well DISTANCE TO: Foundation Nearest lot I Q PERMI�,N3, 7 ! j J LL z Z w No. of line Length of each line Total length of lines Trench width Distance between lines ~ ¢ F0- Q Top of rile to finish grade �/ _ ?� Material beneath inches , 6� �I 4 Total effectige ab�rption area inches d` W Length Width Depth PERMIT NO. C7 - a F W° Type of crib Crib diameter Crib depth Total effective absorption area In DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. J LU ig DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS C 2 SOIL TEST RATING 8 INSTALLER 1 _ Y,(— REMARKS` d6 .,W fo 0 �?..::........ Q ;• N . 2225==_q U FSS••......•' G..;� APPROVED DATE LEGAL 771 6/7- 7-/A- 14C ao 1; _V Co F=-F:� 9:3 E= ' DEPARTMENT OF HEALTH HPROTECTION ENVIRONMENTAL /' ' OTECTION ' ^ 825 'L' STREET, ANCHORAGE, HK. 99501 264-4720 /')� � ` - J-cv� ! Cd PA _-WE E=�Ua0F= R- V- F= . PERMIT NO. ( 8]02]7 > ' APPLICANT ERNIELHNNET � LOCATION P.O. BOX 110821 HNCH 345_3811 LEGAL LOT 20 BLK 4 SAND LAKE SUB LOT SIZE 9999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = SOIL RATING (So FT/BR)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SSTEM IS: SYSTEM WITHOUT FINAL INSPECTION AND -=-- ������::g:;2 ���Ova 0= 9 8�EE: F=, -IF " = -:�- THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH�n� DR8INFIEL[> THE DEPTH OF H 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). Q LJ I F-4 a r.a �a p, -r I gl- -r��� ���a�"� 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. -IF W CH < _2 _-_8 I PA r-4 E7 87_� -r I CH PA _<=- Fl F;?_ F= ���U I F_< F= Ezu BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL. SYSTEM IS 100 FEET FOR H PRIYATE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F`:: 4 1�I —= SEE 7. ���FEE ���� :E�: -1 � ��=--- I CERTIFY THAT 1: I 8M FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CQDES 3: I UNDERSTAND �THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE,,!-� REMODELED TO INCLUDE MORE THAN ] BEDROOMS. SIGNED: -7K6 - ' 'iJUC;H G-6i�C 907! 264--111 1 -lAn lfJIENI-C,' 2 � V I R O N ivi L h.'TA LP I, O T C CT ION ,Permit #: 820731 January 31, 1983 TO: Permit Applicant Subject: Lot 20 Block 4 Sand Lake Subdivision #2 A permit issued by this department for an individual well and/or on-site sewer system has expired as of December 31, 1982. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log needs to be sent to this department for documentation of the installation date and to close the permit. If a private engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files and documentation. If there are any further questions, please call this office at 264-4720. Sincerely Q � Robert C. Pratt, R.S. Acting Program Manager Sewer and Water Program RCP/ljw enc: Copy of Permit SWP/057 ` , ` PERMIT NO ' � ���M—..: 1 u 0=1 Al C! R -A Ch W FA G6 E= DEP�RTMEHT���HEHLTH AND E�VINTHL/~NOTECTION 825 ' STREET/ HNCHORHGE/ HK9� J. 264~4720 EE: FE: 9�%, EE�� ( 8207]1 ) | / HppLICHNT ERNIE LHNNET PO BOX 608 ]45~]811 LOCATION LEGAL L20 6'4 SAND LH�E #2 LOT SIZE 999999 SQUHRE FEET TYPE OF SOIL HBSORPTION SYSTEM IS, : TRENCH MAXIMUM OF BEDROOMS � ] SOIL RHTING (SQ FT/BR)� 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM I5� Q W 104 W 10 == yEs K~FEE: P -A ff'_`3 W 1-1 — :710.2 F�,': 9-71 V EH 11,, El- K F=* W wl ==a � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH UPON OR D�HINF�ELD THE DEPTH OF H TRENCH OR PIT IS THE BETWEEN H PRIVHTE THE SURFHCE QF THE 1 MD HND THE B8TTOM OF THE EXCHVHTION (IN FEET). APPLY. SPECIFICHTION� HND CONSTRUCTION DIHGRHMS HRE HVHILHBLE TO INSURE PROPER THERE IS NO SET WIDTH FOR TRENCHES. THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFHLL PIPE RND THE BOTTOM OF THE EXCHVHTION (IN FEET), "IFET&K-0 1 KIM> I C: P-3 ��: LEE" ED ��� 9�,� PERMIT HPPLICHNT HHS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTHLLHTION I�SPECTIONS DF ANY WELLS HDJHCENT TO THIS PROPERTY HND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE 1:1 C,' 1 t-ri sw URE7 C� 1p- 3, �-Iff F41 A F --y 0F. -r'! ��Fw. E-A . ...... B�CKFILLING OF ANY SYSTEM NITHOUT FINAL INSPECTION HND HPPRO\�� BY THIS DEPARTMENT NILL BE SUBJECT TO PROSECUTION MINIMUM DISTHNCE BETWEEN HNELL HND HNY ON—SITE DISPOSHL SYSTEM �00 FEE FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC NLLEDEPENDING UPON THE TYPE OF PUBLIC NELL MINIMUM DISTHNCE FROM H PRIVHTE WELL TA H PRIYHTE SEWER LINE IS 25 FEET HND TO H COMMUNITY SEWER LINE IS 75 FEET- OTHER REQUIREMEr-TS 1lHY APPLY. SPECIFICHTION� HND CONSTRUCTION DIHGRHMS HRE HVHILHBLE TO INSURE PROPER INSTHLLHTION. 10 " 1 E E���_F . .... Yl:-:::- EE ME: 1EE M RE, m ly: 11:1.0 A �,E. 2. I CERTIFY THAT l: I HM THE REQUIREMENTS FOR ON~SITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE 2� I WILL INSTALL THE SYSTEM IN HCCORDHNCE WITH THE COC�S . ]� I UN�ER5THND THHT THE ON—SITE SEWUT SYSTEM THE RESIDENC E THHN ] BEDR�OMS � �~___~�_~~~~�� HP, P�lCHNT ExmIE LHNNET ISSUED BY__�.��/_ ���~ ^�'��� ~~_DHTE—__~/y SOILS LOG F MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION El PERCOLATION 825 L. Street, Anchorage, Alaska 99501 264-4720 TEST' \_ I SOILS LOG - PERCOLATION TEST PERFORMED FOR:_Errme. Lanny ' cc f 11 ii, ,1 DATE PERFORMED: � 1 LEGAL DESCRIPTION: 5r -I A I aVo �7 c L n I i , . ! , 1 (r-T)-arg nIcz 2 ip 3 4 5 \� 6 7 1 h �� 0 11 ' - W AM 12 13 14 15 16 17 18 19 20 l� J PERCOLATION RATE (minutes/inch) COMMENTS `EST RUN BE EEN c—%I I , , _ 1-- r—IFTAND FT. PERFORMED BY: 72-008 (6/79) AIR�I! G CERTIFIED /he DATE: -27L --L— ,O dow, \J- r;ov c s zols it OO s _. Municipality of Anchorage << On -Site Water & Wastewater Program 0(_p (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 011-135-33 1. GENERAL INFORMATION Expiration Date: "2 -a 6 '-( 7 Complete legal description SAND LAKE #2: LOT 20, BLOCK 4 Location (site address) 8253 Sand Lake Rd. *Anchorage 99502 Current Property owners) Mailing address Real Estate Agent Viany Cabrera Day phone 242-9467 Lome Seward Day phone 632-3661 2. TYPE OF DWELLING: O Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class "C" Well Public Water System wai,envadan® request roc Received by: 7 y Date: COSA to be released to the engineer, unless otherwise requested by Ne engineer. COSA Fee $ rL[p- 00 Date of Payment I Receipt Number I COSA# 6SC 011 I I Waiver Fee $_ Date of Paymenl Receipt Number Waiver # Distance - TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site S ❑ Individual Holding tank ❑ 0 Community On-site ❑ ❑ Public Sewer ❑ Received by: 7 y Date: COSA to be released to the engineer, unless otherwise requested by Ne engineer. COSA Fee $ rL[p- 00 Date of Payment I Receipt Number I COSA# 6SC 011 I I Waiver Fee $_ Date of Paymenl Receipt Number Waiver # Distance - 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK, 99507 Engineer's Printed Name Engineers Comments JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG provided an engineering evaluation of the well androrseplicsyslem in accordance wdh the guidelines and regulators established by the Municipality ofMchorme and indusut loactices. The momedresufts describe the Phone 337-6179 Date t1'2'51t (r, condition otem simeMs on the dailies of the evaluation. Sepamtlon distances were measure f to madilyidenofiabl. lams. 4 Hidden names or encroachments may exist Malwere not identified during the evaluation. The operational life ofel wellsmiiseplic systems depend on a variety of variables including, but not limited to, soil emotions, groundwalerlelels (that may fluctuate during the year), quality of constmclion (materials and workmanship), and the water usage of the family utilising the synews. These conditions cal vary, and am outside the con lel of GEG. Salishice,q festresults do notgumbee hnumpombomance oflhe sysfeMs: Membra. GEG makes no warranty(eVmss or implied) regarding the blumpedolnance of the well or septic system. GEG makes no representation whether an alternative well orseptic system con be installed on the property in the event either ofthe Y. anent systems fail, The content of this report is for the sole benefit ofthe persoNparty who retained GEG. Reliance upon the 0 ' infonnaGon prondedin this repot by any other,emen vpadg including but not limited to subsequent pmpertypmrbasee, is not avlhoncedlnshort. GEG disavows any legal duty to anyone other than the persrfearly who pad ler this report 6. DSD SIGNATURE 4144WFESSt�• LICENSE System #1 Approved for bedrooms. pFECCBBa System #2 Approved for Disapproved. Conditional approval for i bedrooms. bedrooms, with the following stipulatiJON_ SATE 1- Original Certificate Date:—� The Municipality or Anchorage 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 4!5� Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other (Rev. 10112112) 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 LOT 20, BLOCK 4 Parcel ID: 011-135-33 A. WELL DATA WELL IS LOCATED ON SAND LAKE #2, BLOCK 4, LOT 34 Well type CLASS 'c" If A, B, or C provide PWSID# 216075 Well Log (Y/N) Date completed Sanitary seal (Y/N)_ Wires properly protected (Y Total depth ft. Cased to ft. Casing hei ove ground)in. FROM WELL LOG /AT INSPECTION Date of test Static water level Well productio R SAMPLE RESULTS: 23 Coliform 0 colonies/100 ml. Nitrate NO mg./L. Collected by: 6;; 6 .]D09 -- Arsenic: 26.8 ug./L. Date of sample: 11/17/16 B. SEPTIC/HOLDING TANK DATA 33 YEAR OLD SEPTIC TANK IS APPROACHING THE END OF ITS USEFUL LIFE. Tank Type/Material SEPTIC/STEEL Date installed 6/22/83 Tank size 1000 gal. Number of Compartments 3 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 11/16/16 Pumper MCDONALD'S PUMPING SERVICE C. ABSORPTION FIELD DATA eELow ExIsrlNc GRADE Date installed 6/22/83 Soil rating (g.p.d./ft2or ft /bdr 85 System type DEEP TRENCH Length 35 ft. Width 3 ft. Gravel below pipe 4 ft. Total depth '8.4+ ft. Eff. absorption area 280 ft' Monitoring tube YES Depression over field NO Date of adequacy test- 11/15/16 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth inabsorption field before test 0 in. Water added 552 gal. New depth 16 in. Elapsed Time: 120 min. Final fluid depth 5 in. Absorption rate >_ 450+ g,p,d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date — 2056 GALLON PRE—SOAK WAS PERFORMED ON 11/14/16 D. LIFT STATION Date installed Size in gallons_ "Pump on" level at in. "Pump off' level Cycles Manhole/Access (Y/N) wa er alarm level at in. Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot On adjacent lot. Absorption field on lot On adjacent lots Public sewer main manhole/cleanout Sewer /septic service line Holding tank containment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 51+ Absorption field 5'+ Water main 10'+ Water service line UNKNOWN Surface water 100'+ Wells on adjacent lots 100'+TO PVT & CLASS "C" SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line J3' Building foundation 10'+ Water main "UNKNOWN Water service line ""UNKNOWN Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent Iots100'+TO PVT & CLASS "C" F. COMMENTS 'WR950003 "MOA RECORDS ON SAND LAKE #2 LOT 19, BLOCK 4 INDICATE THAT THE WATER LINE IS 3' OFF OF THE SHARED LOT LINE. G. ENGINEER'S CERTIFICATION r*: f I certify that I have determined through field inspections and :... review o(Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this 0 A ^• :•� date. I r^ : J• ey ness 4 Engineer's Printed Name JEFFREY A. GARNESS ��# %, CE -7953 Date I I Z 5/16 ��� PROFESS\ONP� LICENSE "114%iskiwL #HECC884 (Rev. 10/12/12) 4 Qicwate dmnv Frorri Surveys, LLC Project No. 16-131 Date: November 21st, 2016 50.00' N00. 04' 25'8 EHED N 16.3' w tat so i 0 N on m / I J / SAND LAKE 2 I 12.2 �� U Bl4o. Lot 20 of Block 4 z°/6,831 s.f. an � o em s«esa. aea — / ISIsrVxlr,rallw., .l al, ultf liv Lvpe 3 5.2 8.0' 0 / 0.0/' Lar 18 LOT 19 sem. wt '!` DE(K LOT t1 1 10122 24 s' 'i"' +li• - r I i ,• 2nd dory Oer6 S I a I n in, v 7"' si Li ' I 10' E1e[•. ur al Easment N007 04' 25'8 I I I I I ? I o L - I I I I '1 r vl \ Edge of Pavement^ N2f /7 --7S ROW, Legend: —9 — FLII Electric Meter/Outside Power Gas Meter t{j1 W'ell .D 0 Mail To, � Fence W SAND LAKE ROA -OHP- Over Hanging Power L Central Notes-. L f,,eptmg for gross Oegllgerce, the habdlty for this survey Shall not exceed the fact of preparing this survey. 0 to 3 25 50 2. Dimensions to property lines are pus/minus 0.1ft. Fact i. This document is created for the periese of a single property transaNloo and is melee to Federal Copyright Lay. 4. !his survey was performed based on field abeservatlons proportioned from cerre6h,eiright-of-way. No properly corners, bloa6 corners or street mersecion monuments were recoverable vtch The project Scope. TMS Survey IS not based on record plat P-176. This survey represents visible improvements and conditions at the :ime of the survey. This document does not constitute a - boundary Survey and IS Subject to any Inaccuracies that a suis Qllent boundary Survey may reveal. _ u i5 the responsibility of the Owner t0 determine the pvv,wpn of any eaSpment S, ro`/e n ant S, Or ez 2t ns hrth do nor appear o the recorded plat Underno circumstances should this document be used for construction or for establishing a bound',, or fence Ime. r N r� ri I Jai Ade—Built Survey i orm,rea 91 twrie Seward Lot 20, Block 4 of Sand Lake Addition No. 2 I Pierre M Stragier hereby certify that I he,, performed a Mortgage Inspection Survey en Rte suldiii property as described above on November 21s1 2016 q.22 frontier Surveys, LLC cot N/A crm:n'/< • - 050 W. 58th Ave. Suite E Anahorage, Alaska 99518 nfo®lrontiersurveys.corn — ':907,460.1686 F6 75-003 (18A) Municipality of Anchorage Development Services Department Building Safety Division s 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 # OSC161571 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 20 of Sand Lake #2 Subdivision. This inspection revealed an arsenic concentration of 26.8 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. Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater 4700 South Bragaw St 5 A `r. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. o I i - i 3.f - 3 3 Expiration Date:q�� �[,t 1. GENERAL INFORMATION Complete legal description 14, 13 te-c k Y, San ( /a He Location (site address or directions) 8 2 s3 -CRa f L.li k Ro( Current Property owner(s) Jeff Or cu 41 - Day phone 2.29 —a qua Mailing address fs 24'J Sano( 4a k, Rq(. - �g c_ yob ,P 995_0 Lending agency Day phone Mailing address Real Estate Agent Man o - F S G'D' Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD forpickup. 2. NUMBER OF BEDROOMS: 3 229 —S7oo 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class 6 Well 9 Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of 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 private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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 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 installati Name of Firm F !a h%P Tech n o ca / Se �� �� Phone .,, 3 /S—/ 3 sr Address _ lWS3D 6ciwSf. �+c_/�o% 9S'0Z Engineer's Printed Name 2--A J'• r `Gv'�' _ Date ads01 " v s4 a�EER arraarasaaeaaasasa•rca•a 5. DSD SIGNATURE ' mTHEODORE F. MORE =t-. •a CE -3589 Approved for —3—bedrooms. 5� a•°•rsosaa••rr Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: _ f�, �Qp t _ Original Certificate Date: C/ 0 (Rev. 01M2) 1Vlumclpallty of Anchorage Development Services Department Building Safety Division _,.. s. Er'. On,=Site Water�1�7asteV✓ate`"r"Program Mm"', 'x �ouffi Bragaw ��' OX nEch ro ageC9fi965��""w`."_a k ci ancoraga ak us r«.'r.5k� u,5"w Sv,+mrt""kr 3 vel ft ft 9p At co ornes _ m ra e < 4 mg er acera _� colonies Date of sample: 8 3/1, Collected by talc hbo itc� s!oa ��yo� �c �S'frpr Date metalled 6 / 2 2 / 8 � irs trassiraiq 1�Ot�/ 1Nafer a�ded� gal" �„ m Absorptron rate) -11 1ue1/ o n /-.od 3 JAN y195 02.24PM TRANFoIASKA TITLE ANCHORAGE _ • 2/Zimmmmmim= Z 0 Z TME J3 U c! Lam' fQz 7WIS GAT 48 S p .s'A.A<E 9LEr�:. Nd Z at G®. , Block. 4�7rx' Lake Sum• 11/0.2 iric}lorage Reeord" Proeinet, Alaska twoa! i RVE`� IF(CER, C'L„,A;C'tON tMregrvTigrThertlfPra�Y+�fRdTus➢r<Whabrna�aMf�7ib�+0 ®sE ereeyandflWtheMnpOVN}r►Rsl�ha�edtlfereenase�IthMTMP'sP' o :6 �ttr tinea tlrd aormrawa�p arenereaoh M OQleiOei! MAY analfq!!ai � � � 1pro�aneres an e�eceht RODS!' overly v enaaaeA on 1te premeea e+erOon and lherTtiere are nD reed�.eya, ufAty hre v char vbible •mem®ees an acid PMWIY MCBM " WAMM ed hereat 3eala `//_ 3D 1 Date pTepored 5Y: 1f G iaw oty swo / ^4 - / j� ,Tdv am. a [mid Wmye,. (./ . ,j iA9718T9�64C7C �9 W SVAO Ars. /�d�s oy+, ak rm $9501 F a. Na. pmperry °t'..or��� g agency address Gxady Thomas/ VISTA REAL ESTATE Y I�LI�L LJIfYIL YLYI U J C mytyI(— 0 MN 99503 Day phone Day. phos. Idress 4241 "8" Skeet Anchanaae, AK= 99503 less otherwise requested, HAA will be held for pickup: IMBER`OF,BEDROOMS 3 WU ., . n PE OF WATER SUPPLY ' - r Individual well ' _ ., �; Community well XXX -� , � T � `Public `' -- water )TE If community.well system, provide written confirmation from Stato ing to theegality and status of system PE OF WASTEWATER DISPOSAL 72-M (Rev. 1/91) m � Z, y r rA �, attest- I,�Iri, _ f 1i_- y 10. 1 z E i �t • 'DEC ;�rz; I , ROBERT C. COWAN CE -88 1 `t? nN41S SIGNIATuRE <Additional Comments ® Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:/,07 0(0 I LSC k 4; �4Nk fJ+r��lParcel I.D. 011 `L 33 A. Well Data Well type &MQA117,V If A, B, o� attach ADEC letter. ADEC w ter system number Log present (Y/N) / I Date completed Driller Total depth 1 Cased to— 'Casing height /u Sanitary seal (Y/N) Wires properly protected (Y/N) /r m FROM WE L LOG AT INSIDE TION o Z Date of test h%% M �_ z� Static water level t°°r`t Well flow 9.p -m. 9-10- � n lid v a Pump levell ID w, 2: SEPARATION DISTANCES FROM WELL TO: n / Z Septic/holding tank on lot Nle ; On adjacent lots 0" Absorption field on lot N /,4 ; On adjacent lots A/ Public sewer main N/A Public sewer manhole/cleanout Sewer service line N/4 Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: I /� 9 S Collected by: (L)FE-NAM- B. SEPTIC/GTANK DATA Date installed 4,-i4 -/T_Tank size W()() -Compartments oC Cleanouts ON) T Foundation cleanouoY N) Depression (Y4 High water alarm (Y/6 AIA Alarm tested (/Y/N) / Ph / Date of pumping 1 3 95 Pumper �I`t� � SEPARATION DISTANCES FROM SEPTIC/H9H*NG TANK TO: / Well(s) on lot / �' o On adjacent lots / r� Foundation 5 To property line 3 Absorption field S / Water main/service line (y Surface water/drainage 72-026 (area)• Front -* 3� PEn>b �� klm vr�,, /? u�7�v CONTINUED ON BACK PAGE IFT STATION Date installe Size in gallons Vent (Y/N) "Pump High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: On adjacent lots D. ABSORPTION FIELD DATA rer "Pump off" Level at tested Surface water Date installed q5 2 b�3 Soil rating (r 8 S S �� System type , Length -C'>S� Width r Gravel thickness Total depth t-� 6,,cy 61 Total absorption area o2 SF Cleanout present &9N) Y. 5S Depression over field (Y/9 kJ Date of adequacy test ! 3 1']S— Results (pass/fail) PRSS for -3 Bedrooms � r Water level in absorption field before test 061 Aftertest 0' 1� Peroxide treatment (past 12 months) (Y6 CUT /6",Wr j If yes, give date N�,4 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: r Well on lot 4�—IA_On adjacent lots / E6 Property line 3 4� 5a,4,7�+ fIL To building foundation /D To existing or abandoned system on lot On adjacent lots /U '4- Cutbank N1.9- Water main/service line lU Surface water NO �� Driveway, parking/vehicle storage area Curtain drain 3J�}) -* YtlfNv,�2 ►2o'Q u e 57" E. ENGINEER'S CERTIFICATION 1 cerlify that 1 ha ve checked, verified, or conformed to all MOA and HAA guidelines in effect 9LL4this inspection. Signature Engineer's Name ����R r C- C�,'.4 Date / / / 9 S— HAA Fee $ 7 g Date of Payment �� / 5 Receipt Number 6 '�14 Li 72-026 (3/93)' Back t;°.t C -8301 Waiver Fee $ e;lo Date of Payment 412 � Receipt Number r/ a Mmicipality of Anchorage Department of Health and Human Services +}i Rick Mystrom, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 January 25, 1995 Mr. Robert C. Cowan, P.E. S & S Engineering 17034 Eagle River Loop Road, Suite 204 Eagle River, AK 99577 Subject: Waiver Request for: Lot 20, Block 4, Sand Lake Subdivision #2 Waiver Approval: # WR950003 Dear Mr. Cowan: - Your request for waiver(s) of the required 10 foot horizontal separation of an absorption field to a lot line has been approved. The approved separation distance(s) are: Absorption Field to Property Line 3 feet This waiver approval applies to the existing absorption field to lot line separation only. Any future upgrades to either will require all separation distances be met or another approval be obtained from this department. Sincerely, Daniel J. Roth Civil Engineer On -Site Services kb MUNICIPALITY OF ANCHORAU1:; Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR950003 PID# 011-135-33 HA# HA950025 Permit # Date Received: 1-19-95 Legal Description: Lot 20 Block 4 Sandlake Subdivision #2 Engineer: S & S Engineering 17034 N. Eagle River Loop Road, Suite 204 Eagle River, AK 99577 Applicant: Warren Flies Waiver Requested: Absorption Field to Property LIne - 3 feet Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: X Waiver is NOT Granted: List Conditions or Reasons for above: 7-4(5 If .figAV 1_19'Kk Su 9 i f wgs �IFF9�ut T �v DIFJc�Ll7✓1(E LoT7 /N T/-C/I 1'u13 wirffour 1Nt9lv6iPJ To VgR�aus /Tc�,KS. F,V61VCrl? JAr n/1 CASE 0 3' &0- fFBL m-diGG)A)/G/v j/- 1T 4FrGG77-"F, AD7-O/a/.V6 L aT3 1 TY %6 ttF6AlOE Date: J -257 - By: P&/ RoTL/ Name of Reviewer Rec #: 00642 (0004) Amount: $115.00 Date Paid: 1-19-95 S& January 16, 1995 ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street SEWER WATER MAIN EXTENSIONSTENSIONS P.O. BOX 196650 Anchorage, Alaska 99519-6650 SEWER& WATER INSPECTION REFERENCE: Lot 20 Block 4 Sand Lake Subdivision #2 ENGINEERING STUDIES Request you issue a Health Authority Approval on the AND REPORTS referenced property and grant a waiver for the horizontal separation distance between the leachfield and the property line at 3 ft. WELLINSPECTION &FLOWTEST We do not an anticipate adverse affects on the adjacent P Y properties. If we may be of further service please contact us. SITE PLANS Sincerely, ROAD DESIGN '-=��✓'/ �C�i?"�_ Robert C. Cowan, P.E. SOIL TEST PERCOLATION TEST RECEIVED JAN 1 91995 STRUCTURAL& MECHANICAL INSPECTIONS M11nic,palr iy of Ancl�ora�e DOW. p Health & Human SerWces ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 /040/95 - MUNICIPALITY OF ANCHOR,6,GE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALIH & DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION [' :; I ONi:4Ei\i L Pi:OIECiiGN DIVISION OF ENVIRONMENTAL HEALTH o �T� ia85 j CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY RECEIVED 264-4720 Application DateyA ��a z es 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) S -P-53 so%Kw "k -e. (b) Applicant Name Cita; a "414-9-4 Telephone: Home Business W? d Wofr% Applicant Address `,® /10 19�L, A . " (c) Applicant is (check one): Lending Institution ❑ ; Owner/b44kwX; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution At 0.5 Telephone_ 70� ; �k& 5 7 UP - AZ Y3 Address I& gv-ift (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms .3 3. WATER SUPPLY Individual Well ❑ Community K Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this 'nspection. Name of Firm ��4444 Telephone 0117 R 3®.� Address �Lo I U !s Date P °.e.�.• % Engineer's Seal PQ "r•� , iJJ 2225_E 25,191�N`...• i ;9 6. DHEP APPROVAL Approved for bedrooms byDate Approved Disapproved Conditional Terms of Conditi nal Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 �) A,IUNICIPAL i' Or ANICHOet,C- DEPT. OF HEALTH &< MUNICIPALITY OF ANCHORAGE (MOA) E VI OM0E:`dI'L P;;CTECTION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 6o) r:" IwJr 264-4720 Legal Description: L © / Ao., RiC 51 `.1 E SA N D G 6 K. E 14;L S t= c 10 T lR.IV li tX� A. WELL DATA Well Classification Class. ff If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Total Depth Cased to Static Water Level Casing Height Above Ground — Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Depth of Grouting Pump Set At Yield Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot /C93 ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot % 15® ; On Adjoining Lots To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA — To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date ! n/Z -_5 k Date Installed (- as Size /moo No. of Compartments % L0, D Standpipes (Y/N) % I.Y9 Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) Depression over Tank (Y/N) Date Last Pumped 23 /8 5 Pumping/Maintenance Contract on File (Y/N) �% ; for NA. Holding Tank High -Water Alarm (Y/N) KLA Temporary Holding Tank Permit (Y/N) N/A Separation Distances from Septic/Holding Tank: To Water -Supply Well 4&25 To Building Foundation To Property Line '> f C2 To Disposal Field To Water Main/Service Line Course Comments Page 1 of 2 72-026(1 1/84) To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata P Type of System Design 2L 116 { Date Installed 617 Z 3% Length of Field �� Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area gs(7 Standpipes Present (Y/N) 0 Ne Depression over Field (Y/N) Date of Last Adequacy Test 01-4 -_-1 A's Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well I % / To Property Line "S0 To Building Foundation a I To Existing or Abandoned System on Lot AL 4 e- ; On Adjoining Lots % 3 b To Water Main/Service Line >/O To Cutbank (if present) NONE To Stream/Pond/Lake/or Major Drainage Course IV © tv 1 To Driveway, Parking Area, or Vehicle Storage Area > � o Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at C) High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments — Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) ** Check Permitted Bedroom Rating Against HAA Request ** Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or onformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date Company MOA No. Receipt No. Date of Payment < Engineer's Seal Amount: $ *SFT,.-✓ q ••aoe a •* • i Page 2of2-•e •o. 2225-E. UN'i 20, 1971 R? _ 72-028 (11/84) 4 -~ - T.•. •' _ _ CO'0 e Ca �p'G3�3LaaD� poGa CONSULTING ENGINEER 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 S E P T I C S Y S T E M A D E Q U A C Y T E S T — — — — — — — — — — — — — — — — — — — — — — — — LEGAL: LOT 20, BLOCK 4, SAND LAKE NOM2NDEPTC'O OP ANC/-�p LOCATION:, 8253 SAND LAKE ROAD �NVIRpn, E���kf ECTION� OWNER: ERNIE LANNET /Q�Jri RESIDENCE: SINGLE FAMILY, THREE BEDROOMS RECEIVED WATER SYSTEM: CLASS C WELL, COMMUNITY SEPTIC SYSTEM: DATE OF PUMPING: DATE OF TEST: TEST PROCEDURE: FROM MUNICIPAL RECORDS: TANK: ANCHORAGE TANK STEEL, TWO COMP. 1000 GAL. ABSORPTION SYSTEM: TRENCH ABSORPTION AREA: 280 SQ. FT. SOIL RATING: 85 INSTALLATION DATE: JUNE 1983 OCTOBER 25, 1985 OCTOBER 23, 1985 SYSTEM WAS INSPECTED. TANK WAS FOUND BURRIED 6 FEET WITH 47.5 INCHES OF LIQUID. TRENCH SUMP WAS FOUND 14 FEET DEEP WITH 4 FEET OF PIPE STICK OUT OF THE GROUND. THERE WAS NO WATER IN THE SUMP. 100 GALLONS OF WATER WAS ADDED TO THE TANK. WATER LEVEL ROSE .5 INCHES. NO WATER REACHED THE SUMP. 350 GALLONS OF WATER WAS THEN ADDED TO THE SUMP. WHEN THE WATER WAS TURNED OFF THE WATER COULD BE SEEN DRAINING INTO THE GRAVEL. THE SUMP WAS DRY WITHIN 1 MINUTE OF THE END OF THE TEST. HE ;LIQUID DEPTH OF THE TANK WAS AGAIN 47 INCHES. 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. BILL SHEFFIELD GOVERNOR r DEPT. OF ENVIRONMENTAL CONSERVATION Telephone: (907) Address: ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 274-2533 ANCHORAGE, ALASKA 99501 DATE: 10-25-85 PWS I.D.# Class "C" ��U�(CIPtiU , �CPp � OF � � "0j p H��(��N�R�G 4 F,CF1 P T c 10jV ` (y�0r l To Whom it May Concern: According to records on file in this office the Sand Lake #2 (8235 Sand Lake) Water System is in compliance with the State Drinking Water Regulations Sincerely, Jim Allen Regional Sanitation Supervisor APPLK INT FILLS OUT UPPER HAL '.ONLY Properly Owner C r �.�.-,•� CihP /'C-tZ.. c� /4.-/f-� ��-'%"� Phone Maim^.g Address mss` i✓T_.'�' S7 2 / Zip Code Buyer Address= G-"" Zip Code Lending Institution i.- i_ Tf /�f%� � J /( ✓.CJ Phone Address -- ` ,, '_ , Zip Code Realty Co. & Agent _ Phone Address Zip Code Inspector Legal Description J Street Location Type of Residence Ingle Family ❑ Multiple Family No. of Bedrooms ❑ Other Field Notes: ,��$ 1 Water Supply MUNICIPALITY OF ANCHORAGE J i�(�� 5� �/✓�r/g�1._a ❑ Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. �ommunity For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility . ,. 0 „ f a0 81, d Sewer Di�iposal Z2�---- RECEIVED M-rri'dividual Year Individual Installed: � -C, ,, ii -- ❑ Public Utility When Connected to Public Utility: El (5) APPROVED BEDROOMS ❑ Holding Tank ( ) DISAPPROVED NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REOUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Ok-kDl,CV\I-Q Date Date Date Date �c> - t Inspector Inspector Inspector Inspector Field Notes: ,��$ 1 MUNICIPALITY OF ANCHORAGE J i�(�� 5� �/✓�r/g�1._a DEPT. OF HEALTI t: ENVIRONMENTAL PROTECTION . ,. 0 „ f a0 81, d RECEIVED ` /7) (5) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDI IONA APPROVAL' DATE BY: e Soils Rating Date Sewer Installed Well To Absorption Area / Well Log Received b S b - -1- ti -P- 3 Well to Tank / e j Septic Tank Size 22-023 (3182) I����� G October 18, 1983 eju Ernest G. and J anacee Lannet P.U. Box 110021 Anchorage, AK 99511 :subject: Lot 20 Block 4 -band Lake #2 Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: The depression over the server system will need to be filled so that surface water drains away from the sewer system. Please notify this department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264"4720• sincerely, Jim Roberts Associate Environmental Specialist JR87/p/Ell