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HomeMy WebLinkAboutSAND LAKE #2 BLK 4 LT 21and Lake #2 Block 4 Lot 21 #011-135-32 Municipality of Anchorage Page 1 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 9 Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: Swc)7n79n PID Number: 011 1 3522 Name: Larry Partusch ,�! Wastewater SystI�rlv em: ew ❑ Upgrade Address:9210 vanguard Drive Anchorage, AK 99507 ABSORPTION FIELD Phone: 344-5678 No. of Bedrooms: 3 01 Deep Trench 0 Shallow Trench 0 Bed 0 Mound 0 Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: I GPD/Sq. Ft. /O' Lot: Block: Subdivision: 21 Depth to pipe bottom from original grade: Gravel depth beneath pipe ' 4 Sand Lake No 2 S 19 Ft. 6 Ft. Township: Range: Section: Fill added above original grade: Gravel length: _ 0 . Ft. 3�' S Ft. • WELL: 0 New 0 Upgrade Gravel width: Number 7flines: Distance between lines: I Classification (Private, A,B,C): Total Depth: Cased To: Ft. Total absorption area: Ft. Pipe material:/1572v1 %y3�31–i Ft. Ft. S SQ. Ft. — ' Driller. Date Drilled: f Static Water Level: Installer. Sa�P/+' Date installed: - Ft. e%S 3 9 Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft SEPARATION DISTANCES Septic 0 Holding 0 S.T.E.P. To Septic Absorption Lift Holding rivate Manufacturer Capacity in gallons: From Tank Field Station Tank Sewer Lines IIfIvel-4 % // aoo Well' /V/moi 6S / Materi�IG l� Numb Compartments: Surface >;oo� }z�o� / " LIFT STATION N/ 'Lot Line /z. s /O_� / /�� Size in gallons: Manufacturer: Foundation 3/ d / !� / / "Pump on" level at: "Pum evel at: High water alarm at: Curtain Drain / / / Pump Make 8 M Electrical Inspections performed by: Remarks: BENCH MARK Location and Descrtption: eVGl1oor Assumed Elevation: / OO Ft ENf91 ® s�ie. ®.....F A �t� '4 /Z 9T �..e Inspections performed by:� Dates: 1s 9 /' 9 T! I• ..:. 2nd �z /3 1 .. MIGNAEL E, ANnEflS©N Department of Health and Human Services approvallow Reviewed and approved by: Date:.�`�`' Permit No. SW970290 Page of 3 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LT 21 , BLK 4 Sand Lake S/D, No. 2 PID No.: 01 11 3532 _ x X -X -X -X -X -X- - b o 06 06 FENCE (APX) 30.01 C2 C3 C4 - 1,000 gal. -,1 • 1 GRAVEL DRIVE o 160 B. septic S 1 +5 o 3 BR Else. C1 tank 81 I,� Lo TH-+ N e.o m H N o I N C4 " MT aa.38.0'A - I• WELL b b 5 00 ao 135.00' 1p0, radius -------- - -- =- -- PLAN AS -BLT -- - - - S1 - --- 41.0 - . — 34.6 - -- - --- - --5 2 - -- - 20' - — -- C47.8 i 36.8 ;� 3' 50.9 40.7 - - -- — - - --- - - -- - __- C4 ---5 3.6 4 zEcscm ---- - MT 42.0 47.2: SP1 Septic Pump, compartment 1 C5 43.2 50.5 •-------- — —- 2 2 . C Clean Out MT Monitor Tube OF A4a _ ! -- - - - - -- -- -- - - ----- - U AEL E. ANDERSON .: a$ � - - 439-E_- 3 Permit No. SW970290 Page I of 3 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 @ Anchorage, Alaska 99519-6650 e Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report LT 21, BLK 4 Sand Lake S/D, No. 2 ELEVATION OF A AS—BLT SP1 Septic Pump, compartment 1 SP2 2 C Clean Out MT Monitor Tube III WE. E. AN 4381-E 'o , / tMff':11:0�11 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW970290 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:PARTUSCH LARRY OWNER ADDRESS:9210 VANGUARD DRIVE ANCHORAGE, AK .99507 PARCEL ID:01113532 LEGAL DESCRIPTION: SAND LAKE #2 BLK 4 LT 21 LOT SIZE: 6600 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: (\ci - c�- 0z h PAGE 1 OF 1 7114V DATE ISSUED: 9/02/97 EXPIRATION DATE: 9/02/98 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: DATE: ws /9 ISSUED BY: DATE: $ eL August 17, 1997 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 21, Block 4, Sand Lake Subdivision No. 2 Septic System Design Impacts to Adjacent Properties Dear On Site Services Engineer: We hereby apply for a permit to install a new septic system on Lot 21, Block 4, Sand Lake Subdivision No. 2. The attached site plan and backup documentation identify the location, size and components of the new septic system proposed to serve the bedroom home to be constructed on the lot. The lots in this subdivision are very narrow and little area exists for the systems. The lot will be served by a Class C Water System with the well located as shown on the Area Map. ADEC has issued a waiver of the normal protective radius from 150' to 100' to the well. A copy of the waiver and the certificate to construct the Class C Well are attached f or your review. The testhole placed in the area of the proposed absorption trench revealed well graded sands with a percolation rate of less than 1 minute per inch. No groundwater was noted during excavation nor during the ensuing monitoring period. We are therefore proposing placement of a 20' long by 10' effective depth deep absorption trench for disposal of septic effluent. The material encountered in the test hole is a well graded sand with a much larger than 51% component passing the No. 4 Sieve. A sand liner is therefore unnecessary in this case. A study of wells in the area indicates a low level of nitrate content in the water. The ground surface of the lot slopes from west to east at a grade ranging from 1% to 4%. The surface of the ground in the area of the new trench is fairly flat. No conflicts were noted between the new trench and any wells in the area with the protective radii as modified by ADEC. Lot 21, Block 4, Sand Lake No. 2 August 17, 1997 Page Two If the system is constructed as designed the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the area. 3. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern w i I I be maintained. 4 3 fi a a i, Sincerely°~'' / 111-A, a.. '../ell/`�•nw`1.01(/av- �'i `e'" � y % .� w j � _/ r Michael E. Anderson, P.E. F4RV— ifs Attachmentss�sa A.,,z, 10' ELECTRIC ESMT. i EXISTING BUILDII Z'a � t / 113 x . j �,3 / /✓ ROM ;' 1 IOWEFj' POLE �' - .! LL T --ANCHOR /. / / I n / \ ^ 1 Oct 1 m W Ix I I w 1•° r .:3 107 106 ------- 104 1j4 RET WALL J I ,03 / SIDEWALK EXISTING I / ' I 1 I IF3001 LOT 33 LOT 32 LOT 31 PRolee t%ve ALTERNATE SITE . - . 150 ap01� - 0 TH NO. 1 loo, PJ?Or RADIUSCTIVE o\ x LOT 20 THREE BEDROOM LOT 22 HOME J� I U PROPOSED CLASS C WELL +f> T3E SITE PLAN F [ it Jj SCALE 1" 20' S p � 3 SAND LAKE ROAD RIGHT OF WAY MONITOR TUBE O 20' LONG X 10' EFFECTIVE DEPTH. ABSORPTION TRENCH O 1,000 GALLON SEPTIC TANK O �a 7 FOUNDATION CLEANOUT THREE BEDROOM HOME SYSTEM PLAN NO SCALE F .e9CA���sa"+reh:z `-. �YnTy •it Ge FUVn`liY:'J h ;I LOT 21, BLOCK 4, SAND LAKE SUBDIVISION N0. 2 DESIGN FACTORS: Three Bedroom Home Perc. Rate: LT 1 Min./Inch Application Rate: 1.2 GPD/SF SYSTEM REQUIREMENTS: Deep Trench System 1,000 Gallon Septic Tank 10' Drainfield Rock 3 Bedrooms X 150 GPD / 1.2 GPD/SF = 375 SF of Absorption Area 375 SF/20 SF/LF (Absorption Area) = 18.75 LF Trench Length Therefore: Construct a Deep Absorption Trench With One Lateral 20' in Length with 10' of Drainfield Rock Beneath the Lateral. Distribution Pipe in Trench Placed at 3.5' Below the Original Ground Surface. 8Au�1r t. 6&Vra cr, Le FAarbr. TYPICAL DEEP TRENCH SECTION (NO SCALE) NOTE: Grade Area Over Trench to Drain Away. Minimum 3 of Cover over Septic System. aoe. co.v rr' E ERS SEAL E e i 1' .f` OYgf/`� Municipality of Anchorage Ems'` sjt DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: /SDinell Homes DATE PERF LEGAL DESCRIPTION: L Z / { 7 Township, Range, Section: DSLOPf EPTH OGy 1 2- 3- 4- 5- 6- 7 3 45 6 8- 9- 12- 13- 14- is- 16- 17- is - 19 9 12 13141516 171819 WAS GROUND WATER M-nMENEENEEME IF YES, AT WHAT DEPTH? cam to wal e' urcr �o A1onilminpl to%�2 ReadingDate Gross Time Net rime Depth to Water Net Drop BMW ;05" -'/to 0-� /�7•9>6 ■■"■ MEIN Emilio OMEN MEMO NIIIIIIII�iIIIIMI �MMMMMMM.[LE 1IMEENNNEN eo�- 3;io: o Z,3 in=======�7�i WAS GROUND WATER M-nMENEENEEME IF YES, AT WHAT DEPTH? cam to wal e' urcr �o A1onilminpl to%�2 ReadingDate Gross Time Net rime Depth to Water Net Drop BMW ;05" -'/to 0-� /�7•9>6 3:v7 0-� "7,t eo�- 3;io: o Z,3 13,3$ b, 3; /l — g / Z,ev 20 PERCOLATION RATE < (minutesimch) PERC HOLE DIAMETER TEST RUN BETWEEN JAL FT AND 31L FT COMMENTS Testhole presoaked prior to ttzct _ MatPri a l PnetmntPr.PA in i-Pathnl P well ^graded sand. More than 51% of mgterial Nn_ 4 SIPVP_ PERFORMED BY: 1 "��RTIFY THAT r THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: /� / %®r 17 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 21, BLOCK 4, SAND LAKE SUBDIVISION NO. 2 GENERAL: 1. The scope of this project includes the procurement and installation of a new 1,000 gallon septic tank. It also includes the construction of a new 20' long by 10' effective depth deep absorption trench. The distribution pipe in the trench to be placed 3.5' below the existing ground surface. Due to the small size of the lot it is imperative that a I I separation distances from existing and proposed wells be carefully measured prior to construction. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION 1. A new 1,000 gallon septic tank must be procured from an approved source and installed at the location shown on the Site Plan. Lot 21, Block 4, Sand Lake No. 2 August 17, 1997 Page Two 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. Lot 21, Block 4, Sand Lake No. 2 August 17, 1997 Page Three 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trenches to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). Lot 21, Block 4, Sand Lake No. 2 August 17, 1997 Page Four 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: A minimum of two inspections are required by Municipal Ordinance. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. Ou �r PkI fTuI n - DEPT. OF ENVIRONMENTAL CONSERVATION / ANCHORAGE/WESTERN PUBLIC SERVICE OFFICE 555 CORDOVA STREET ANCHORAGE, ALASKA 99501 July 23, 1997 Mr. Michael E. Anderson, P.E. Anderson Engineering P.O. Box 240773 Anchorage, AK 99524 TONY KNOWLES, GOVERNOR (907) 269-7505 RE: Lots 21, 22, 31, 32 Block 4 Sand Lake Subdivision No.2; Request For Waiver of Horizontal Separation Distance, Class "C" Well, and Stormwater Plan Review. AWPSA Project Nos. 9721 -WV -174 -050,9721 -DW -174-139, and 9721 -WW -133-331. Dear Mr. Anderson: This letter is in reference to the materials received in this office June 20, and 23, 1997, regarding a stormwater plan review, and a waiver request for a lesser horizontal separation distance between a proposed class "C source well and supporting on-site wastewater disposal systems to serve the above referenced lots. The Department has completed its review of the submitted materials which included a cover letter, site plan, surrounding soils logs, surrounding well logs and a history of water quality sampling in this area. Based upon a review of the submitted information the Department has the following comments concerning approval or nonobjection of this project: , Stormwater Plan Review: From the information submitted a limited amount of fill material was to be removed for development of the above_ referenced lots. A verbal nonobjection was given to Mr. Randy Ross with the Municipality of Anchorage, Department of Public Works Project Management and Engineering to issue the fill permit. This nonobjection was based upon a review of the completed ADEC stormwater pollution prevention and plan review checklist, and profiles of the developed lots which indicated appropriate best management practices for the treatment and management of stormwater runoff. Horizontal Separation Waivers: After reviewing the submitted information it appears that the minimum separation distances proposed between the new class "C' well and supporting wastewater disposal systems should present minimal threat of contamination. However, the density of surrounding on-site Approval to Construct section verifying this Department's approval. This approval does not imply the granting of additional authorizations nor does it obligate any other state, federal, or local regulatory agency to grant required authorizations. Thank you for your cooperation with this Department. If there are any further questions regarding the above, please do not hesitate to call Sincerely, Michael Lu, E.I.T. Environmental Engineer MLU/ph alewaoVnNWaotattr attachment cc: Randy Ross, MOA/DPW/Project Management & Engineering STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION CONSTRUCTION AND OPERATION CERTIFICATE A. APPROVAL TO CONSTRUCT for PUBLIC WATER SYSTEMS Plans for the construction or modification of Lot: 10220IS _37 SACSaad La lee sub44WA4 dI2 9721 -DW /7Y -at public water system located in ARCJkr3i!?Aq0 Alaska, submitted in accordance with 18 AAC 80.100 by A% d n�.%o�:r .•� have been reviewed and are Q approved. ❑ conditionally approved (see attached conditions). 27 Y j TITLE '� DA E If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. B. APPROVED CHANGE ORDERS Change (contract order no. or descriptive reference) Approved by Date C. APPROVAL TO OPERATE The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water is made available to the public. The construction of the public water system was completed on (date). The system is hereby granted interim approval to operate for 90 days following the completion date. DATE As -built plans submitted during the interim approval period, or an inspection by the Department, has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to operate. BY TITLE 180407 (Rev. 11183) DATE DISTRIBUTION: 1. WHITE - ENGINEER (Complete Section C) 2 YELLOW - WATER SYSTEM FILE (Complete Section C) 3. PINK - ENGINEERIMUNI-BOROUGH (Complete section C) 4. GOLDENROD - MUNI -BOROUGH (complete section A) Municipality of Anchorage a On -Site Water & Wastewater Program (907) 343-7904 a APR 2 9 2014 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL s Z y Parcel I. D. 011-135—z Expiration Date: 1. GENERAL INFORMATION Complete legal description SAND LAKE #2' BLOCK 4 LOT 21 Location (site address) Current Property owner(s) Mailing address Real Estate Agent 2. TYPE OF DWELLING: 8309 SAND LAKE ROAD *ANCHORAGE, AK DANIEL HERTRICH Day phone 8309 SAND LAKE ROAD *ANCHORAGE AK N Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROQ]MS: 3 4. TYPE OF WATER SUPPLY: Day phone 223-0678 TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class C Well Community On-site ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request i 'a Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ "J a6v � Date of Payment Receipt Number COSA # Waiver Fee $ _ Date of Payment 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, Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date `[I Gt� I if - 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 000tS���O� system under the conditions encountered at the time of the test, and separation o OF A4 OQ4 distances measured to readily identifiable features. The operational life of all wells and o �� . . . . . !.qS�4 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. .t These conditions are outside the control of the evaluator of the system. Satisfactory test /////Q• * :: 4 T' -% '.OG results do not guarantee future performance of the system, nor do they guarantee that \D .l� ........... '• . there are no hidden defects or encroachments. GEG, LTD. can therefore not provide \ 6 any warranty or future estimate of how long the system will continue to meet the,rr' . . .� operational requirements of the ADEC or MOA DSD. The content of this report is for OO '.'effF A. Go ness, the sole benefit of the owner listed above. Any reliance upon or use of this report by any�n y. CEjj— 7 mm O V si •'' other person orparty is not authorized, nor will it confer any legal right whatsoever. 4nuP.. q . . '1•io� 6. DSD SIGNATURE __Ief� System #1 Approved for 3 System #2 Approved for Disapproved. Conditional approval for bedrooms. bedrooms, bedrooms, with the following Original Certificate Date: 545-11 Th9 M icipality or Anchorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon rhe given in paragraph 5 by an independent professional civil engineer registered in the State ofAlaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist 1/ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other raav 1110,91 ON-SITE `y�� y� WATER AND � o WASTEWATER o ti tal tionspPnGRAM .� Original Certificate Date: 545-11 Th9 M icipality or Anchorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon rhe given in paragraph 5 by an independent professional civil engineer registered in the State ofAlaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist 1/ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other raav 1110,91 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 21 Parcel ID: 011-135-32 A. WELL DATA Well type C If A, B, or C provide PWSID# 218539 Well Log (YIN) Date completed Sanitary seal (YIN)_ Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height (abo round) Date of test Static water level Well production WATER SAMPLE Coliform FROM WELL LOG colonies/100 ml. Nitrate LVmg./L. /L. Date of sample: 4/16/14 B. SEPTICIHOLDING TANK DATA Iii uu Collected by: GEG. Ltd. Tank Type/Material SEPTIC/STEEL Date installed 9/12/97 Tank size 1000 gal. Number of Compartments E Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping 14ALo1Ll Pumper + HOM19 Sel^Vi CeI C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 9/12/97 Soil rating .p.d./ orft2/bdrm) 1_2 System type TRENCH Length 31.5 _ft. Width 4 ft. Gravel below pipe 6 ft. Total depth *11.08 ft. Eff. absorption area 378 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 4/16/14 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test o in. Water added 960 gal. New depth E in. Elapsed Time: E min. Final fluid depth o in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN "Pump on" level at in. "Pump off level High water alarm level at in. Cycles tested Meats alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot *100,+ CLASS C COMMUNITY WELL LOCATED ON LOT On adjacent Absorption field on lot *100,+ On adjacent lots Public sewer main Sewer /septic service line manhole/cleanout Holding tank Manureianimal excrete storage areas SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5'+ Properly line 5'+ Absorption field **5' Water main ***UNK Water service line ***UNK Surface water 100'+ Wells on adjacent lots 100'+PRIVATE/150'+PUBLIC (OR WAIVED TO 100 FEET) SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line 10'+ Building foundation 10'+ Water main ***UNK Water service line ***UNK Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 1 00'+PRIVATE/1 50'+PUBLIC (OR WAIVED TO 100 FEET) F. COMMENTS *WAIVER APPROVED BY ADEC (1997). **PER MIKE ANDERSON, P.E. ***THERE IS NO MOA RECORD DOCUMENTING THE LOCATION OF THE WATER MAIN OR SERVICE LINES FOR PWSID #218539. G. ENGINEER'S CERTIFICATION 1 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 al&� (Rev. 11/05) _OTI z CE -7953 PrIo fe/sSionooc HENT BILLIW6 YTBMf BEAR B.pI3 YflMN I I 20 N89° 55' 00"W 135.00' O ey LL o o 30.0' o6 LL! o D a i 18.0' `N o I z EXISTING O z Q .....'.... 8.0 HOUSE g U i J o. 26.5' o NcNi 00 38.0' V) Z WELL 0 o QEll In N89° 55'00"W 135.00' I 22 30' iI I UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE UNES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL UABILTY ONLY FOR THE COST OF THE SURVEY. USTED DISTANCES PREVAIL OVER SCAUNG REPRODUCTION MAY CAUSE ERRORS IN SCALE. LOT smR ey SURVEY TYPE - SYMBOLS FOUNDATION AS -BUILT ❑ FINAL SRNCNRE AS-BUA.T SET REBAR 7= ;w SET ::::'::' :, ASPHALT ❑ Mot Pur+ ... AS-eucT ... Inr wRN.Y ... mpocxAVNY D FOUND REBAR 8 @ g WOOD FENCE `.i:A'"' CONCRETE T CaRNEM T flCATNb A NO OORNERS 97 004 ASSUMED ELEV. n--Yr"X METAL FENCE ® WOOD DECK PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBIUTY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WALL BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES, WELLS. SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY, SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CERTIFICATION � �far•A•�t' Pre ared b PreparedY PUN ,. Robert E. Johns, Jr. &Assoc .PLOT „•n 0;0t� •p'' . �� Professional Land Surveyorsil N w•.eNK•roNo" ewLamI rr .rnwwr. wl,uwaI verm% =Wes M,uN m •;••�••'�p^ �• 1700 SHnDrive.•=era ..g.ea "x•Wrae L -r Y • ANCHORAGE, ALASKA 99504 0 ReLot S.F. R. Plot Flle No.130FOUNDATION AS -BUILT •o•T•► •/ ••• ••` wa, ns eaw iNwIM.• ew.m.wMnYI, as yN w a MrmmwNmY•n�. -eeeerwb,.lte/n. vew.'°la ^warr• n.wa - .. S .••••••T •• Date Surveyed: 04/19/14 Drown b Checked b Checked K wuaw'oalem °"N'n >NwM„�ww rwrMw.en -'' ' R ,.r si. t. ROBERT OHNS, ,M Date Drawn: 04/20/14 GNd: 2224 _ W.O. 14-130 nWM M, •. o : p FINAL STRUCTURE AS -BUILT y.a1%• w.ft yr ea' •� m's 4121—S A'�ej� ��'O •••••..,•• Legal Description: .�.w..KK...m: ��a,A ........ ....••r••y�a•1 Lot 21 Block a�b.• ����u::::•��`• SAND LAKE#2 Municipality of Anchorage GG BV Community Development Department G rvd 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 # OSC141161 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 21 of Sand Lake #2 Subdivision. This inspection revealed an arsenic concentration of 12.1 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.or /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 DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I. D. # 01113532 HAA # 1. GENERAL INFORMATION Complete legal description _Lot 21 Rl ock a RLqnc2 La ire s11h.]; vi sinn No _ 2 Location (site address or directions) Property owner Spinelli Homan Day phone 344-5678 Mailing address 9210 Vanguard Drive Anchorage, AK 99507 Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Three (3) XXX Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: if community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 01) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's signature r ' 44c t Date 3 L2_3 /9 6. DHHS SIGNATURE �' Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: e c_ Date -9 auTlc The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (BBV. 1/91) Back MOA W21 ., _ 9 —:y.I , Conditional approval for bedrooms, with the following stipulations: Additional Comments By: e c_ Date -9 auTlc The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (BBV. 1/91) Back MOA W21 .4 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES RECEIVE Environmental Services Division 16 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343&42 3 1998 Health Authority Approval Checklist Municipality of Anchorage Dept. Health & Human Services Legal Description: rot 21 , Block 4, Sand Lake #2 Parcel I.D.: 01113532 A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test If A, B, or C, attach ADEC letter. ADEC water system number 218539 Date completed Cased to FROM WELL LOG Static water level Well production WATER SAMPLE RESULTS: Coliform Nitrate _ Casing height (above ground) Wires properly protected (Y/N) _ AT INSPECTION Non Detect Other bacteria Date of sample: 3/12/98 Collected by: Alan Harala B. SEPTIC/HOLDING TANK DATA Date installed 9/12/97 Tank size 1, 0 0 0 Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) N Date of Pumping New Pumper Construction C. ABSORPTION FIELD DATA Date installed 9/13/97 Soil rating (g.p.d.ff or ftz/bdrm) 1.2 System type Deep Trench Length 31 .5 ' Width 41 Gravel thickness below pipe 61 Total depth 1 0 ' Effective absorption area 378 SF Monitoring Tube present (Y/N) Y Depression over field (Y/N) N Date of adequacy test New Const. Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test (in.); Immediately after_ gal. water added (in.): Fluid depth (ins) Minutes later: Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date 1 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) None on Lot High water alarm level at* Cycles tested Size in gallons "Pump on" level at* *Datum E. SEPARATION DISTANCES - Public Water System SEPARATION DISTANCES FROM WELL ON LOT TO: y— "Pump off" level at* Septic/holding tank on lot >100' On adjacent lots > 10 0 Absorption field on lot >100' On adjacent lots� l n n 'n n ' Public sewer main Public sewer manhole/cleanout Sewer /septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation >51 Property line >51 Absorption field > 5' Water main/service line > 10 ' Surface water/drainage � 10 n ' Wells on adjacent lots; 10 n ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line > 10 1 Building foundation > 10 ' Water main/service line >10' Surface water > 100 ' Driveway, parking/vehicle storage area >10' Curtain drain None on Lot Wells on adjacent lots >1 nn' F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records that�i(e systems are %in conformance with MOA HAA guidelines in effect on this date.. :f e. ®F A �l$ .... <� Signature°_ Engineer's Name Michael F.- Anderson, P_ F. Date HAA Fee $ s ILC,) Date of Payment 3 "1 SS Receipt Number os( �-,S�:2771 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number • . � S MICHAEL E..ANDE°SON ;