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HomeMy WebLinkAboutSAND LAKE #2 BLK 4 LT 245 end ee SIO +fa 01I-13s-2q-Ooo low,t ply apt Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211066 PID Number: 011-135-29 Dwelling: ❑ Single Family (SF) ❑ with ADU ® Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name CRIS ROGERS ABSORPTION FIELD ® Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 8333 SAND LAKE ROAD, ANCHORAGE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 2 GPD/SF 10 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 4 Ft. Gravel depth beneath pipe 6 Ft. Subdivision Block Lot SAND LAKE #2 4 24 Fill added above original grade VARIES -0.47 TO 0 Ft. Gravel length 20 Ft. Township Range Section Gravel width 2 Ft. Beds: Number of Lines -- Distance between lines -- Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 240 Ft' 1 -- Ft. Well 50'+ 50'+ 50'+ 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ® other ADVANTEX Manufacturer ORENCO / ANCH. TANK Capacity 1500 Gal. Surface Water 50'+ 50'+ 50'+ Material COMPOSITE PLASTIC Number of compartments 2 Lot Line 5'+ 5'+ 5'+ NA Foundation 10'+ 10'+ 10'+ LIFT STATION Manufacturer Capacity Gal. Remarks Alarm location SOUTH UNIT BACK SE ROOM Electrical installed by RISING SON Installer MNA PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Drainfieid 3034 Co/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspdecctiiosn 1s' 8/16/21 2nd 8/16/21 Location and description 3`d 8/17/21 4" 9/1/21 TOP OF TANK AX20 POD ON-SITE WATER AND WASTEWATER SECTION APPROVAL OF Al� Conditional Approval: Date eTM .....�:* Septic System • • • • • • • •� . r Curtis Huffman : Approvq d S��Z ��j�``�i••. CE 128991 .-,. ,W� Date(? [��'rlF�• 9/11/2021. •��C�AW FOpROF aESSIONP�' �1- Note: this approval does not include well permit requirements. O\ROF 1SS r % u V �, PID: 011-135-29 PERMIT: OSP211066 LOT 23 ASPHALT DRIVE WELL 10'X10' ELEC. ESMT. REC AT BOOK 962 PG. 287 WOOD FENCE 5' WATER EASMENT REC AT MNA BOOK 1227, PG. 528 LOCATED WATERLINE LOT 30 PRIOR TO CONST. WOOD FENCE VI I NEW ADVANTEX LOT 29 A I FAP 2.0 1500—GAL LOT 24 1 SYSTEM r SHED AT �---� GRADE FCO CO MHn DCO NO FOUND. WELL SERVES LOTS 23, 24, 29 & 30. , 50 WELL RADIUS F' TH21-1 WATERLINE LOCATED ALONG NORTH PL 100' WELL, RADIUS A—C=25.8' B -C=19.5' FCO r DCO A—D=31.4' co 99.99 M MH B—D=24.0' A—E=36.0' AX20 POD B—E=31.8' 97.03 A — F = 4 9.4' 96.16 1500 -GAL ADVANTEX B—F=37.4' FAP 2.0 TANK A—G=61.0' B—G=52.1' A—H=62.4' B—H=54.7' SAND LAKE #2 BLOCK 4, LOT 24 PREPARED FOR: CRIS ROGERS 8333 SAND LAKE ROAD ANCHORAGE, AK 99502 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 (: G -MT VACANT (PARK) CO MT CO 100.60 FlNAL GRADE 100.13 oRu 1, ORG/0! FlLTER FABRIC 6.60 96.60 SEWER ROCK SP SEPTIC SECTION SCALES NTS 907-350-9566 firstwaterAKOgmail. com DRY -6/12/21 TH21-1 18' 80H SUPPORT SERVICES: ' MP, OF AL,w-LI-11QZ..� 9 TH DATE: 9/11/2021 A rtis HuffmanSURVEY: HOLT 'r CE 128991 `� Af SCALE: 1" = 20. 9/11/21 1A+� PAGE: 1 OF 1i�ssto��' NO Water CONSULTING 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 firstwaterAK(L�gmail.coin SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: SAND LAKE #2 B4 L24 20 TH P .... ....t...... r . Curtis Huffman ' �'F�, •. CE 128991 .• �`44� o • �11✓2� • .��C. PROFESSION""-�W PERFORMED FOR: CRIS ROGERS TESTHOLE # 21-1 DATE PERFORMED: 8/5/2021 GROUND WATER ENCOUNTERED: NO IF YES, AT WHAT DEPTH: NA DEPTH TO WATER AT MONITORING: DRY DATE: 8/12/2021 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: RAPID PERCOLATING SOILS — INSITU SAND SATISFACTORY AS FILTER VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION Reading Date Gross Net Time Time Depth to Water Net Drop 8/5/21 5 min 6" 6" 5 min 6" 6" 5 min 6" 6" PERCOLATION RATE <1 (MIN / INCH) TEST RUN BEWTWEEN 5 & 6 FT PERC HOLE DIAMETER 6" PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH PERFORMED BY: FWCS / MNA - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 9/1/2021 MUNICIPALITY OF ANCHORAGE On -bite Watsr &Wastcwawr Program PO Box .96$50 4;'C L•:mpre Road Anchorage, Alaska 95619LO660 P111004' (907) 343.7904 Fax: (W) 3.43-7997 hRp;rh Aw.enwi, 0ndile 0n -Site Wastewater Disposal System Permit Perrnit Number: 0SF211066 VVork Type. Septic Upgrade Tax fr4S�g hltrnli�r• t1111'��?�tic?�1 SIto Legal Address: SAND LAKE #2 13LK d LT 24 0,2224 Sita Mailing Address: 8333 -SAND LAKE fi`D, APT A, Awhorage Owner. RODE RS C RI S W b hgn Enginear: FIRST WATER CONSULTING I:his permit r$ for this &8i5f' F1 Di smsel Flold Q Soptic Tank 0 Holding Tank ❑ Privy Effective Date: Expiration Date: Lot siza In Sq Ft Total Seldrooms: 3(34!202 1 3022 6600 F-1 Private Well ❑ Water Storage All eanstructiorl Shall be In accoreanco wlt.h: 1_ The attached approved desion- 2- All mquiramenw ape-cified in Anchorage N1kinigipaI Ggd ia GY,�iptors 1 �.�5 and 1 rz,&6 and IhQ St= Of AI2e12 Wastewater disposal Regulations (1 B AC72) and Drinking Water Rego Iation s (18AAG80) 3. The wasteweler wde requl res I n spectlan s d urin g the insWilation- The engineer sha II notify the Development Services Department per AMG 15. - Provide notiftation �y cal lirig 1907) 343-T904 (2427). 4- From Oaa he r 15 to Apri 1 15. a su bsu rface sail abso"on system under construction during freezi ng weather shian be either: a. Opened and Clow -d on the Seale day, or h. Covered, sealed. and heated to prevent freeaing Special Provisions; 3 An additional test hale is Tequired to be done prior to the construction of the septic field- Constructian may proceed at ye ur cmm risk before the 7 day water monitarin0 is complets. Please submit stamped and signed resu Its with the Ass -bulk# I nspeclion RepW. N the resuNs rL%qulre a desig n aha ng e. construGi ion of the system will stop peri.ding On -Site review and approval. 2. The watsr liner, serAng Lots 23, 29 and 30 are to be Io,catsd prior to construction - 3. The RD is to snow the water lines. 4/512021 Received ey. Date: Issued By: data: -f 5 r MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section Parcel I.D. 011-135-29 ON-SITE SEPTIC/WELL PERMIT APPLICATION Property owner(s) CRIS ROGERS Day phone. Mailina address 8333 SAND LAKE ROAD, ANCHORAGE, AK 99502 Site address 8333 SAND LAKE ROAD, ANCHORAGE, AK 99502 Legal description (Sub'd., Block & Lot) SAND LAKE #2 134, L24 Legal description (Township, Range & Section) Lot Size 6,600 Sq. Ft. Number of Bedrooms _ Phone: 907-343-7904 Fax: 907-343-7997 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field 0 Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank ElUpgrade Fx_1 Duplex (D) El Holding Tank ❑ Renewal El Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: .561.5 Date of Payment: 2 —, 7 - 2, Receipt Number: '`] 1 7 I Permit No. Cr:W2.1 10 6 6 Waiver Fees: Date. of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com March 12, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: SAND LAKE #2 BLOCK 4, LOT 24 The property owner has requested we obtain a permit to upgrade the failed septic system of the above referenced lot. We propose to install one deep trench and 1500-gallon Advantex system to serve the existing 3-bedroom property. The design is based on area soils and to verify soils a test hole will be conducted prior to construction. No groundwater was observed in area testhole groundwater monitoring. The slopes are flat at the proposed upgrade location. The lot and adjacent lots are served by a Class C private water well located on the property and waterline serving the residence and adjacent lots will be located prior to construction. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211066, Deb Wockenfuss, 03/30/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211066, Deb Wockenfuss, 03/30/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211066, Deb Wockenfuss, 03/30/21 MUNICIPAL—= OF ANCHORAGE, ADVANCEIPWASTEEWAM TREFATMENTSYSTEM M'AINTENANCE.4ND RMEPAIRAGREEAIENT MS MAINTENANCE AND REPAIRAIrl EENtENT, reran. the "AGREEMENT' ma4e and rllr c atured imo as or this i o f rv�!�, Of n 2-1- buy andh x meen Ab 'NE 'c M ip herein the mOW - K- an4l the univ ality, -of A, nc-b . . . arm a, hemi -Axwh -ge Mim i icapAl Code, -dics � is (AMC) 15.65.365. In consim -derkinn of atu"al"ll c ClvlcnaWr,.,cunt&inpd h i ffimpm totit AgTeement agme. as follows: Svoems. The Mumizlij3alitv grants. pen� tilun to the Owner to utilize and operatemn Advariced Wastewater Tr to System WVWTS.� desxnbed as AN AQVANTEX SYSTEM iocmd at flog aldescrip4jon) SAND LAKE #2 BLOCK 4, LOT 24 Maintenance, kepaim Rnd :alterations.-- - -------- ------------------ -- (Owing :i rectuired, to read, understand, and. irdti �- iiwzh :section -1) rr sIt t Tlrou�i xhoL a fl-ic, tem of Chis A m-ment.thw e O-nbaea-cr inm a smMcm mc rt gr with an. AWWTS, s-ervice and mainLenanu. provider Eippmved by the Murdeipalityur, the manufimmmr"s. repmemative. The AWW-.0S,,,4m9t be maintained in: asallsfactory, candition capabW of perfomning as demigned, an. d pvAucing t mtedsep& effluent in 8cr,A)rdaRc-c--Aith- the Cquipment'sapproval for operation In the Municipality. It f b�:,Lheresponsib ]k a pa i i y of th', Owner dtainp th-- tcnn of this Ag.mmcm T, -y f fia T -1 m11 mpailr(s) M, airiten, atice, &ULtstment(s), replacement co.smi, and inTmtj'qr -m - 'this includes an ammuml maiftte= ue fee, (�.ypicgly S4,00 to aAo,- 0mier agmes thmal only mainlenaftee and. repair pm-wrmr elupprmied by the.,Murd"cipuRty or the manufactumr's repm-scm4w %vill ins.pcot and, tuake anytiocessmy maLnxetrdftm, rirs or permitted aher-afluns to the !qstem- Cd- --owncr ackno,01edgres flmt regular maihtongnm of: AWWTIS. reduces thl, c putent-iiit fid-Wre of the syuem, Wh[ChQClktld inclu4c smage backup and costly re -pairs: ardminfield Mc�.p I mcmr nt. (rc v. 0 5 11 MAI Is) Plago I of 3 Ownu acknowledge,,i that t Al he: M-qn!-:;ipEd[ -y may mquest. records of mainten tujoe and repeirsman ffie:manLLfEir;turffr's,rep re--entative ormainten mce provider. A?0-wrw,r acknow1mign, that the frac for failing to maLotain and. repair an, AWWT'S. may be assessed in. accordiance with, AMC' 14.60,030. wneTawes eta g mmit fl)e M' = 3 ty. c ona l ass to test mid inspea thIg AWNFE S,, The Mun,14LPaffity wifl.1 gjve at lemqt 24-houT rLotize 4 C-NN'ner agrees that any Salt Or ITansfer of fific, of the, pro will nn- t coq cu ithcuta nr.w Cerd'-ficate- of07)-sits Syswnus ApprovaL ek—owner agrees that the AW l' i-witallatian and mmalacnanc c; requirarnantsa-S provided. b, - Ibe n0installer appTovc and d bythc Mun, icipatft,-v = the govenling y AWWTS v-cndL -fm r th-- conMruefibn, maintenaftee rqak of d -Lo Ownces AWI?T& 0-wner agrees to maintain re=,teme-niloning of ffie AIX,%,,ITS asrequired by 11he AWW- T -S .approval.. 3. Torm The teem of thi's Agreement sball begin on the date of approrvail by the Muni i afity to operate the installed system, or -upon tram-fer of title aid shallconttnuc MIT whilie dw- AWWTS is ol-nTational., or until title i-5 tT musfurc4l, 4, NouWaiver. Tho failuc oftheMunicW1I y 1tI at any time io enf'=c aprovisionaf,this Agreement sMI in no wky co-r-,stitute a -waiver of the lynavisions, nor in an,,., way affect the vaildity of The Agree�eixt or -any, poitbc=f, or thR right of tbe. MuAcipalvy thereafter to enfbirce every! provi:don, here -of, 5, Amon -ft This Agreement Mall ordy be amended byauil)uflzed repressefflatives of the Ov-rww "- 14unicipality. Any aft= � pt to aumnd this, agrm-went byoithcr an =authorized--epresenwive orutauthhorized, atearts shall be, ,mid. 6. Any civil, action afi:3Jn-R fiorn. Nis Agreement S ml, I�e broL01 jai the Supenor Cotte for t1he Third Judicial Distriet of the State of Alaska at Anoborage, err la of the State Gf- Masks. Rh all the rights, and obligations. of tile parties un&T diuip. .r' 7. Smrabfflty not thm remaining provisions of the Agreement. (rte. 05 f, I W- 2 014.) Page 2 of'3 OWNER: By: (signature) Date: Cr -1:5 L,3 jZ owe. fs (print name) 14 STATE OF ALASKA THIRD JUDICIAL DISTRICT The foregoing instrument was 20 J, byl NOTARY PUBLIC FOR My Commission expires: MUNICIPALITY: ) ss. rdi edged before me thi day of & AR Z.. , By: (signature) (print name) Date: Title: (rev. 0/18/2018) Page 3 of 3 I— C) X; �1' MUMCWAUTY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 011-135-29 1. GENERAL INFORMATION Complete legal description SAND LAKE #2 BLOCK 4, LOT 24 Expiration Date: 7 (fl — Z— I Location (site address) 8333 SAND LAKE ROAD, ANCHORAGE, AK 99502 Current property owner(s) CRIS W. ROGERS Day phone Mailing address Real estate agent 8333 SAND LAKE ROAD. ANCHORAGE. AK 99502 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic Water Storage ❑ Holding Tank ❑ Community Well - "C Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $_ ,5%� Waiver Fee $ Date of Payment 22 ZI Date of Payment Receipt Number 7 j ZZ i '1 Receipt Number COSA # 05G Z J I� Z g Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from, my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 3/15/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FIJ[.5 6. DSD SIGNATURE System #1 Approved for System #2 Approved for 3 bedrooms q— /S_-2 ( bedrooms OF�°��� .. 49 TH .... ......... . CCE 128991 Huffman ,•�� PROF S!S �A���'��" Disapproved Conditional approval for bedrooms, with the following stipulations: VL c du�nf�((A(.(((r, ON-SITE ..err—n AAI r'1 m� 1NAST=vATER oz PROGRAM S 2 1 Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory )O Well Flow Advisory Other MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 :,tet ��� On -Site Water and Wastewater Section Fax. 343-7997 www.muni.org/onsite Arsenic Advisory Certificate of On -Site Systems Approval # OSC211128 Subdivision: Sand Lake #2, Block 4, Lot 24 A water sample revealed an arsenic concentration of 13.6 micrograms per liter (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. �� s s sMail�ng AddressP =0 sBox196650 *anchoNage Alaska 99519=6650 munio g Legal Description: SAND LAKE #2 BLOCK 4 LOT 24 If more than 1 septic system on lot: COSA Checklist # _of A. WELL DATA — CLASS C SHARED PRIVATE WELL ❑ Well log is filed with Onsite (or attached) Date drilled 6/28/1983 Total depth 410 ft Cased to 410 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 2/24/2021 Static water level at beginning of test 138 ft. Comments WELL DATA PER MOA RECORD DOCS. B. TANK DATA Age of tank(s) NEW years Tank type/material ADVANTEX / PLASTIC Measured operating fluid level in septic tank NA ® Standpipes/foundation cleanout per record drawing Date of pumping NA D. ABSORPTION FIELD DATA Which system tested (date installed) NEW FIELD ® ALL standpipes present per record drawing Total measured depth from grade 10 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 011-135-29 Structure served by this system Well production at time of test 3.4 gpm Water storage tank volume_ gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate mg/L ® Nitrate less than MRL (ND) Arsenic 13.6 ug/L ❑ Arsenic less than MRL (ND) Collected by W Date of Sample 3/2/2021 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date NEW FIELD Results ❑ Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min ® Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: F� -' E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ❑ Yes if No* ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ® Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No _ Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: ® Yes Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No _ Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No —ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *MEETS CAT III WITH REMOTE MONITORING SEPARATION REQUIREMENTS PER CODE. G. ENGINEER'S CERTIFICATION l certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. ,:pe • �� TH .... ......�.... • Curtis Huffman �'��, •. CE 128991 .• �� e�* 9111/21. •\F��� FO PROFESStONP -4ft—W ft ft ft ft ft ft ft ft 0 0 0 0 0 Z 49 1H - V 0 SHANE A. HOLT G J4� LS -6914 O O4aA '•-�..... � ca o �QX°fessional �o THE INFORh4.4 RON HEREON 15 FOR THE USE OFLENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLIC15 BE7tVEEN EXISTING STRUCTURESAND PL; U7ED LOT UNESAND/OR EASEME-.NTS,-AND IS NOT TO BE USED FOR POSITIONINGADDITIONAL STRUCTURES, IMPROVEMENTS, OR FFNCELINES. EASEMENTS OFRECORDORANYOTHER LEGAL ENTITY, OTHER THAN TH05EAPPEARING OA' THERECORD PLAT; ARE NOTSHOWN HEREON, ( UNLESS INDICATED) NOTE,- FE,NCELINES THAT MAYAPPEAR ON THIS DRAbVING ARE NOT 70 SE USED TO DETERMINE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. AN!' R4VING SHOWN HEREON MAY BEAPPROXIMATE DUE" TO EXCESSIVESNOW ANDIOR ICE. THIS DOCUMENTIS PREPARED FOR THE OWNER OF RECORD,- ONLY. NO OTHER USE BY OTHERS /S AL LOWED, INCLUDINGANYSURVFY DATA OR MEASUR6Y76V7S HEREON WITHOUT 1,11RITTEN PERM1551ON. AS BU/L T SURVEY I"=20' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLO!•19NG DESCRIBED PROPERTY LOT24, BLOCK 4, SAND LAKE NO 2 SUB ANCHORAGE RECORDING DISTRICT, ALASKA, AND TI -IAT THE VISIBLE 1AiPROVE—AIENTS SITUATED 7HEREOAI ARE WITI-IIN THE PROPERTY L1,VESAN0 AIO VISIBLE ENCROACHMENTS EXIST OTHER THAN IVO TED. DATEDATAIV0-10RAGE,ALASKAT,L115 757-f DAYOF AUGUST _, 2021 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGEYAK 99507 F8211-53.215-72 907-345-5513 Covtd t�i cn� Development Services Department On -Site Water & Wastewater Section Parcel I.D. 011-135-29 e "'N Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description SAND LAKE #2 BLOCK 4, LOT 24 Expiration Date: 7 (o ` Z- ! Location (site address) 8333 SAND LAKE ROAD, ANCHORAGE, AK 99502 Current property owner(s) CRIS W. ROGERS Mailing address Real estate agent Day phone 8333 SAND LAKE ROAD, ANCHORAGE, AK 99502 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic Water Storage ❑ Holding Tank ❑ Community Well - "C" ® Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 570 Date of Payment 22 ZI Receipt Number 7 COSA# OSGZI �I2`r� Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 3/15/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to°tslil these various and dynamic characteristics and are outside the control of the evaluator of the l well and septic system. Therefore, any estimate of how long a system will function satisfactory g�Q: • • • . for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FWCS ' *' •� TH •'* 6. DSD SIGNATURE �, • '. Curtis Huffman j System #1 Approved for bedrooms r��'F���;•• CE 128991 TFC' • .1/15/x1 •'F� r System #2 Approved for bedrooms liIFoDROFESSIONP� Disapproved Conditional approval for bedrooms, with the following stipulations: o WAST-VATER o PROGR Aft 13*' Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory y O� Well Flow Advisory Other Legal Description: SAND LAKE #2 BLOCK 4 LOT 24 If more than 1 septic system on lot: COSA Checklist # _of A. WELL DATA — CLASS C SHARED PRIVATE WELL ❑ Well log is filed with Onsite (or attached) Date drilled 6/28/1983 Total depth 410 ft Parcel ID: 011-135-29 Structure served by this system Well production at time of test 3.4 gpm Water storage tank volume_ gallons Well disinfected for coliform test? ❑ Yes ® No Cased to 410 ft ® Coliform bacteria is Negative ® Sanitary seal is functioning correctly Nitrate mg/L ® Nitrate less than MRL (ND) ® Wires are properly protected Arsenic 13.6 ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) 12+ in. Collected by FW'ES Date of flow test for COSA 2/24/2021 Static water level at beginning of test 138 ft. Date of Sample 3/2/2021 Comments WELL DATA PER MOA RECORD DOCS. B. TANK DATA Age of tanks) NEW TANK PENDING years Tank type/material ADVANTEX / STEEL Measured operating fluid level in septic tank NA ® Standpipes/foundation cleanout per record drawing Date of pumping 3/16/21 D. ABSORPTION FIELD DATA — NEW FIELD PENDING Which system tested (date installed) NA ❑ ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A —pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date NEW FIELD PENDING Results ❑ Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min ❑ Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date , Comments/Deficiencies: F E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ® Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: ® Yes Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No _ Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No _ Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION4. -����~�`���� 1 certify that l have determined through field inspections and review �AW �� `•��� of Municipal records that the above systems are in conformance •:� �¢ with MOA COSA guidelines in effect on this date.: • , Tf•I .. • .'; .. .... ....�:. 1d ' Curtis Huffman ��29 CE 128991 ,• c4`� � 3122/21. •�c��0 RROFESSt* 1" ft ft ft ft ft ft ft ft Arsenic Advisory Certificate of On -Site Systems Approval # OSC211128 Subdivision: Sand Lake #2, Block 4, Lot 24 A water sample revealed an arsenic concentration of 13.6 micrograms per liter (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. k � � Nla�lmg pKddress �P O Box 196650 * AFnchorage, Alaska 99519 6650 *www muni org ` o 0t'M o & GVO&---3,YV\ QNVS'- �— % m / \ I? \ 0 First Water CONSULTING 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com gmail.com March 22, 2021 Municipalities of Anchorage On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: CONDITIONAL COSA LEGAL: SAND LAKE #2 BLOCK 4, LOT 24 PHYSICAL: 8333 SAND LAKE ROAD, ANCHORAGE, AK 99502 The permitted 3 -bedroom septic upgrade has been impeded due to winter conditions and other factors. We are therefore requesting a Conditional COSA at this time and will proceed with the upgrade once conditions allow. The system has been working for the occupants and granting of this Conditional COSA will not impact any of the neighboring properties or pose a public health risk. Attached are 2 bids and escrow letter from title for the pending installation. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. F WE i t.reiriG i< -v I� vrev. s/}al OF ANCHORAGE 10MUNICIPALITY DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 'i ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE EW OU 6Aj.,.�,/kNT r l�Gj(--ll%a � El MAILING ADDRESS � B0 ' /[ '� C14 (}, k '1 R Sri LEGAL DESCRIPTION UT V� 0, S&ND k&KtH LOCATION INO. OF BEDROOMS 0 t-� SAN L't K (;= 1z 1 -5 Vy DISTANCE TO: Well ��� Absorption area Dwelling •2,7 PERMIT NO. 93033 a C LU Manufacturer Material No. of compartments Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth O �-' � DISTANCE TO: Well Dwelling PERMIT NO. J Z 2 z F Manufacturer Material Liquid capacity in gallons 0 w= DISTANCE TO: Well t Foundation Nearest lot line /p PERMI T N0aO. C3 3 J LL z Z w No. of lines f Length of each line Total length of ins Trench width Distance between lines H �- ,a inches --' cc F Top of tile to finish grade Material beneath tile Total effective absorpPtion area 0 -7,'Z-inches p�(s� Length Width Depth PERMIT NO. LU 4~a W Type of crib Crib diameter Crib depth Total effective absorption area w w DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. J Lu DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER 0 wl H Vrs ( REMARKS,, `� `- Q -T.�. Io S�o I pt� AF q``At ��• �N . 2225-E •••�� JUNE 25 97 k` ,'• ,•N ,w ��1 0 5`•••••.•e••• ,S fill �3 APPROVED DATE LEGAL ),i i< -v I� vrev. s/}al t'_lUP-J 10 1 F—f9l I _ra-0 ODF:7- . DEPHRTMENT L HEALTH AND ENVIRONMENTAL . OTECTION � ` ^ 825 'L' STREET, ANCHORAGE/ HK. 99501 - 264-4720 //u 1-4 IFE P L_ ��� Cl r-4 1 _r IF=" _0H.- 1= L4 F= R! F=l F= P-4 11 1� PERMIT NO. ( 8]0]38 ) APPLICANT DOUG GALLANT BOX 4—LL 99509 561-1165 LOCATION LEGAL L24 84 SAND LAKE #2 . LOT SIZE 999999 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 SYSTEM IS: � CNE:F"T'H� -S-a I ���F��j=j E> j= F:�- -r 4E. THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF 13RAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). �E'C-! L-1 I F -:.E-= C-- _E_- WE F=� -T 1 0::- ����Ez, 1 7" F= -1 cl 0 0 1:3 F=l CK�� 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. — — — _f_ Z-1 CO w-- 12 > I fr-4 2E.- F:o EE: A::- -Y- 1 Cu r-4 -"EF ��F= ��CZ! U I PZE: r.o __— BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET HND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 33.0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. ^ I CERTIFY THAT i: I HM 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 CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. SIGNED:~-)--- SOILS LOG MUNICIPALITY OF ANCHORAGE • +� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Dou Cl V GL { (:L:1 DATE PERFORMED: 43 LEGAL DESCRIPTION: Lo -r 2IL 13� K q SAND LAKE" A SE -C-10 Tt 2O,,,A'! W SLOPE SITE PLAN SILT 1 2 ML 4 O V 5 a o SAND A mN (AP�AX/F.>_ 6 d p 7 o Cq 9 O 10 0 v v 11 O d A) & / 12 d e • 13 Date Gross Time Net Time Depth to Water 19oTTO" 0 F 14 01..E 15 16 ,. �� �4L✓J,S1 41 17 © •� f,• 49TH 18 19 F ): F 2225-E : �o J NE 25, 1971 cy�'� 20 V'<" ••. •�• s 9V-Jf'niy p \� S ERNE WAS GROUND WATER NO L ENCOUNTERED? O P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop ERNE i■■■■■■■E■ MU ■ri■i MINE OMME MN O ■■■■■■Qi ■ ■ ■■■■■■E■ ■ ■■MMM■■■MIN E�EME■■■MM MEMO ■MM■■■■M■■ WAS GROUND WATER NO L ENCOUNTERED? O P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) ` TEST RUN BETWEEN FT AND FT COMMENTS ��� l�� V h V0rj hl PERFORMED BY: 72-008 (6/79) CERTIFIED BY: T7j DA 3 W. 15th "C" SUITE `:20ANCHORAGE,EALASKA 99503 CONSULTING ENGINEER 11V TELEPHONE: (907) 279-3916 S E P T I C S Y S T E M LEGAL: LOCATION: OWNER: RESIDENCE: WELL: LOT 24, BLOCK 4, MUN/c/pALrTM OF ANCyO _Nv;:.i>iV tNT yFALTH RAGA A D E Q U A C A� VT4TN SAND LAKE #2 JAN 2 0 1987 8333 SAND LAKE ROAD DOUG GALLANT DUPLEX THREE BEDROOMS CLASS C WELL C. j�VED SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: TANK: ANCH. TANK TWO COMP. 1000 GAL. ABSORPTION SYSTEM: TRENCH ABSORPTION AREA: 264 SQ. FT. SOIL RATING: 85 INSTALLATION DATE: JULY 1983 DATE OF PUMPING: JANUARY 19, 1987. ISAACS PUMPING SERVICE DATE OF TEST: JANUARY 19, 1987 TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND WITH FIVE FOUR OF COVER AND 48 INCHES OF LIQUID. TRENCH WAS 12 FEET DEEP AND DRY. 450 GALLONS OF WATER WAS ADDED TO THE TRENCH. THIS CAUSED AN IMMEDIATE WATER DEPTH OF 12 INCHES IN THE SUMP. WITHIN 10 MINUTES THE TRENCH WAS DRY. 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. • (l41� h.J ,� a ••• v o x e s• • e�" •�/Y/`/tai'• ••. •••4�J/� gam, o. 2225-E JUNE 25. 1971 3 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: Lo I 024. I�L ocy_ y SAND kAZi'"'.. 149, A. WELL DATA Well Classification If A, B, C, D.E.C. Approved (Y/N) — Y Well Lo Present Y/N ! % T Log ( ) —,_— Date Completed �'� �,f��'=� Yield �� ' Total Depth qIG Cased to y�� ' Depth of Grouting N 0 N1 Static Water Level / V/ Pump Set At E077-0 /-I Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Sanitary Seal on Casing (Y/N) V Depression Around Wellhead (Y/N) N On Adjoining Lots To Nearest Edge of Absorption Field on Lot j) q ; On Adjoining Lots To Nearest Public Sewer Line N ul1 To Nearest Public Sewer Cleanout/Manhole N r) t4 To Nearest Sewer Service Line on Lot y �` Water Sample Collected by j • S ; Date r /l (� 1 Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed %� S Size s 5f5C� No. of Compartments LL L Standpipes (Y/N) / 1>✓ 0 Air -tight Caps (Y/N) Foundation Cleanout Y/N) y/ Depression over Tank (Y/N) Date Last Pumped Pumping/Maintenance Contract on File (Y/N) for Holding Tank High -Water Alarm (Y/N) fu/'�'C Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well ! D I To Property Line _> To Water Main/Service Line Course Comments Page 1 of 2 72-026(11/84) t'/t To Building Foundation 3 To Disposal Field /b To Stream, Pond, Lake, or Major Drainage C. HBSORPTION FIELD DATA Soils Rating in Absorption Strata 6� Type of System Design f �2 NG61 Date Installed 71 � Length of Field cv_ 2 - Width of Field 3U Depth of Field _ Gravel Bed Thickness Square Feet of Absorption Area 02— Standpipes Present (Y/N) U IUB Depression over Field (Y/N) Date of Last Adequacy Test / 9�fi 7 Results of Last Adequacy Test �aSS Separation Distance from Absorption Field: To Water -Supply Well To Property Line 1 U To Building Foundation L% To Existing or Abandoned System on Lot On Adjoining Lots To Water Main/Service Line To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area f Comments D. LIFT STATION N G. /N/L Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments — Dimensions Manhole/Access (Y/N) — "Pump Off' Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** 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 5IT-0 � 7 Company MOA No. Receipt No. Date of Payment Amount: $ Page 2 of 2 72"026 (11/84) Engineer's Seal AP"PLIf NT FILLS OUT UPPER HAI 'ONLY PropErty Owner �-- ����� G�� gid_ r �- Time Phone Mailing Address J="lrYri -^�� G r' - ?Li . Zip Code ��) (7 `/ -✓"s Buyer / Inspector Inspector Address Zip Code Inspector Lending Institution �i � ���-�i v�' i 1� Phone Address .- 6Y 2 Y o " , Zip Code <c�N•.t Realty Co. & Agent Phone Address Zip Code 'CONDITIONS OF APPROVAL Legal Description ,� /s _31 Street Location ,� ,�=�0!' ,[ - ,� ,✓" DATE ! ( " e ^ g 3� Type of Residence ❑ Single Family Date Sewer Installed Multiple Family No. of Bedrooms Well Log Received Septic Tank Size Other Well to Tank Water Supply ❑ Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. 'R Community For wells drilled prior to that,date, give well depth (attach log if available). "❑ Public Utility Sewer Disposal /`T Individual .. Year Individual Installed: 7 (Ss - ❑ Public Utility Wheh,Connected to Public Utility: ❑ Holding Tank - NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: MUNICIPALITY OF ANCHORA GIZ DEPT' OF H9i':LTti i': ENVIRONfJEN1AL PROTECTIOR <c�N•.t EcEIVE® (2 ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL` DATE ! ( " e ^ g 3� BY: L� l_ a z, Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size Well to Tank 72"023 (31821 ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT y� p Plans for the construction of - public y b L i (� f �•� I S �� �) �� public water system located in Alaska, submitted in accordance with 18 AAC 80.100 by C)o (A G C�A/T_ have been reviewed and are Aapproved. D conditionally approved (see attached conditions). - TITLE - DATE If construction has not: started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. APPROVED CHANGE ORDERS_ Change (contract order no. or descriptive reference) Mr? d -e "j T Approved by Date M The "APPROVAL TO OPERATE" section must be completed before any water is made available to the public. APPROVAL TO OPERATE C_ t:7 ky The construction of the 6'4AIP L a k to is �cl •-30 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 fin approval to operate. S TITLE y DATE