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SAND LAKE #2 BLK 4 LT 34
MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. JUM,"-a,�OOw MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program _•. = _RO-Box-196650_. 47WElmore4load__. — Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http:l/www.muni.org/onsite par On -Site Wastewater Disposal System Permit Permit Number: OSP221113 Effective Date: 5/23/2022 Work Type: SepticTank Upgrade Expiration Date: 5/23/2023 Tax Code Number: 01113519000 Site Legal Address: SAND LAKE #2 BLK 4 LT 34 G:2224 Site Mailing Address: 8244 SEACLIFF ST, Anchorage Owner: SCHWENN MICHELLE A Lot Size in Sq Ft: 6750 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either. a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: Date: S Date: Municipality of Anchorage_ P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV221032 COSA#: Permit#:OSP221113 PID#: 011-135-19 Legal Description: SAND LAKE #2 BILK 4 LT 34 Engineer: Mike N. Anderson Your request for a waiver of the required 5 feet horizontal separation from the septic tank to the property line has been approved. The approved separation distance is 0.0 feet. In addition, the existing field is allowed to remain less than 10' to the waterline serving Lots 19 and 20. This waiver approval applies to the proposed septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ............................................... ■ ............................. ■ 1 Waiver is Granted: X Waiver is not Granted: Date:23 ZZ Approved by: Lra�� Name of Reviewer .............................. ■ ............................. ■ ............... **** VARIANCE/WAIVER REVIEW **** MUNICIPA-LITY OF ANCHORAGERU5)4 Development Services Department `'= ' ' Phone: 907-343-7904 On -Site Water & Wastewater Section _ Fax: 907-343-7997 ON-SITE SEPTICM/ELL PERMIT APPLICATION Parcel I.D. 011-135-19 Property owner(s) VELTKAMP Mailing address 8244 SEACLIFF ST, ANCH AK Site address SAME Day phone Legal description (Sub'd., Block & Lot) SAND LAKE #2 BLK 4 LT 34 Legal description (Township, Range & Section) Lot Size 670 Sq. Ft. Number of Bedrooms APPLICATION IS FOR: (® all that apply) Upgrade Absorption Field ❑ Septic Tank 0 Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: Initial ❑ Upgrade FD Renewal ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: TYPE OF DWELLING: Single Family (SF) 0 (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: 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: A.36c) Date of Payment: Receipt Number: Number: Permit No. nn ea z-1 113 Waiver Fees: =0 - 2 Z:�- fi / 3 5 Date of Payment: Receipt Number: Waiver No, O -S V 2 Z l Q 37_ GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc_ May 5, 2022 Municipalities of Anchorage On-Site Water and Waste Water Section 4700 Elmore Rd Anchorage, Alaska Phone 343-7904 Re: New septic tank permit & TWO WAIVER REQUESTS Legal: SAND LAKE #2 BLK 4 LT 34 To whom it may concern: This is a request for a septic tank permit and a zero foot lot line waiver on the above referenced lot, plus a waiver for the existing field encroaching less than 10 from the water line. The separation distance between the field and foundation are too close for the new tank to be replaced in the same location as the old tank therefore we are requesting a zero foot separation between the new tank and the west property line, see the site plan. The plan shows the 5-wide system, plus the required five foot separation. Given the soils are typical sands, the hole might slough but we are raising pipe and tank over two feet when it exits the house therefore the sloughing will be minimal and will not impact the existing trench. Currently the drain pipe exits under the footing which is too deep and will be revised over the top of the footing thus gaining us at least 2 feet of elevation. The existing field was installed 2.5 feet in the 5 foot waterline easement and has been functioning well for over 40 years this way with no issues. We don’t know where the water is located but it appears we are less than the required 10 feet separation. Water tests have been done for neighboring lots 19 & 20 (nitrate level were zero) which are shown on the site plan. This new tank and zero lot line waiver will improve this system. This tank replacement and water line encroachment waiver will not impact any of the neighbors or encroach on any wells, septic or open water issues. The tank will be decommissioned per the Uniform Plumbing Code (UPC). Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221113, Deb Wockenfuss, 05/23/22 1"=50' PROPERTY LINE EXISTING HOUSE-SAND LAKE ROAD-REPLACE EXISTING 1,000 GALLON PLASTIC SEPTIC TANK, 5' FROM FIELD, DOUBLE CO POST TANK. 0' WAIVER REQUESTED FOR TANK TO PROPERTY LINE. DRIVEWAY -SEACLIFF STREET-EXISTING WELL 100' RADIUS WELL SCALE: DJRDRAWN: DATE: SAND LAKE #2, BLOCK 4, LOT 34 Anchorage, Alaska BRENT VELTKAMP 5/6/2022 -W 82ND AVENUE- SAND LAKE #2 BLOCK 4, LOT 35 SAND LAKE #2 BLOCK 4, LOT 33 SAND LAKE #2 BLOCK 4, LOT 19 SAND LAKE #2 BLOCK 4, LOT 18 SAND LAKE #2 BLOCK 4, LOT 20 SAND LAKE #2 BLOCK 4, LOT 17 SAND LAKE #2 BLOCK 4, LOT 36 LOT HAS AWWU WATER SERVICE OLD TANK TO BE DECOMMISSIONED PER THE UPC. EXISTING FIELD LOCATED IN THE WATER LINE EASEMENT, WAIVER REQUESTED NITRATE LEVEL 0, NOV 2016 NITRATE LEVEL 0, JUNE 2014 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221113, Deb Wockenfuss, 05/23/22 WOOD FENCE N 89 �8'E 135.45 (PROP.) e �EGK ENTRY ASPHAC T ORNEWAY 13.4 2 OUSE FANNY SIN'LE WELL I • OEG� 5�0 • 48.1 596 in e.o • - — - — ——_---_--_---_---_--_ -------------- , ------ � 5'WATEREASEMENT w oo FENCE (BOOK 831 PAGE 166) OF q �q�;�p FSP. 49 TH* Y� s-/" N SHANE A. HOLT LS -6914 ol _ . -' �0 0 ���°fessiona� moo N 89 58'E 135.45 (PROP.) NOTE. AN ENCROACHMENT AGREEMENT REGARDING THE WELL ENCROACHING INTO THE ELECTRIC EASEMENT IS RECORDED AT BOOK 2168 PAGE 790 ELECTRIC EASEMENT (BOOK 768, PAGE 54) j j j AS -BUILT SURVEY NO CORNERS SET THIS DATE SCALE 1 ^ = 20 I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT -34 SLOCK4 SANDLAKENO 2SLIS ( ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN EXIST OTHER THAN NOTED. HEREON ( UNLESS INDICATED) DATED AT ANCHORAGE,ALASKA THIS 11 TH DAY OF NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE I APR/L , 2022 PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. 15411 FS 221-45 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 907-223-8615 72-013 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE ® DEPARTMENT OF HEALTH 81 ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska' 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME //�� PHONE NEW I% Jr l� 1 ❑ UPGRADE MAILING ADDRESS RQ. o y— kl� 9 9s"0 9 LEGAL DESCRIPTION Loi 3 L/ 9 L k, L SA I-K L LOCATION IF NO. OF BEDROOMS - r 711P-AEE- UY DISTANCE DISTANCE TO: oT I Absorpti� area .►.) Dwelling, PERMIT NO. �^ D .G 1, w-ZQ Manufacturer Mate ii E.L No. of com artmen -No.p SS-.. I bY�O N� gallons Inside length Liq. ca�y iIF HOMEMADE: 1510 1 Width Liquid depth a z DISTANCE TO: Well Dwelling PERMIT NO. _ Fa„ Manufacturer Material Liquid capacity in gallons DISTANCE TO: Well Foundati n Nearest lot line Q PERMIT NO. Lu U 2b 7_2Z F& Z w No. of lines Length of each Ii 1lip Total length of Ijn® Trench w dth Distance between lines inches ¢ H Top of tile to finish grade /� Material beneath tile Total effective absorpt'on area O / inches w Length Width Depth PERMIT NO. C7 a F wa Type of crib Crib diameter Crib depth Total effective absorption area w DISTANCE TO: Well Building foundation Nearest lot line .j s Depth Driller Distance to lot line — PERMIT NO. _j W FDISTANCF TO: Building foundation Sewer line Septic tank Absorption area(s) - OTHER PIPE MATERIALS ST 4 -Paa - SOIL TEST RATING INSTALLER N jD REMARKS d OF . 4• .Q: o. 2225-E : �m 'r -A'•, JUNE 25, 197.1` .: APPROVED DATLEGAL �S -,///d i 1-0 72-013 (Rev. 3/78) DEPHRTMENT ` ^ � ^o` �O� ��HLTH 0 FINED .^,= EMVIRONM�NTHL �OTECTION SEWAGE DISPOSHL , 264~4720 R.. L, SM!"SKIN 1:1 vqj'^�~���][^3^��� �����'yE�U�� IS UPON THE TYPE OF PUBLIC WELL HPPLICHNT DOUGLHS GHLL8�T BX 4~LL 09 LOCATION SAND Lk 272�2201 LEGHL LT]4 BLK 4 SHND LK S/D FEET LOT SIZE SQUHRE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DRHINFIELD MHXIMUM NUMBER OF DROOMS � ] SQIL RHTING (S8 BE RETURNED TO FT/BR)� 85 THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS� �M F=l W U-1= YET �Wlill-1:0������ DHYS OTHER REQUIREMENTS MY HPPLY. THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THEE TRENCH OR DRHINFIELD THE DEPTH OF F� TREMCH OR � PIT IS THE DI��THNCE BETWEEN THE SURF��CE GRO[/ND HND THE BOTTOM OF OF THE THE EXCHYHTION (IN FEET) ��� ��Q ����� THE GRHVEL DEPTH IS THE � ����� MINIMUM DEPTH OF GRHYEL B�TWEEN AND THE BOTTOM OF THE EXCHVHTIQN THE OUTFHLL`PIPE (IN FEET). � W U.::1 Fr::,- ��G.*.-'� C-')' 7 PERMIT HF9�LICHNT HHS THE RESPONSIBILI-rY TQ INFORM THIS DEPHRTMENT DUF;;:ING THE INSTRLLHTION INSPECTIONS OF HNY WELLS ADJACENT TO THIS PROPERTY HND THE P11,11-11'IBEIIN'..' C.'IF RESIDENCES THAT ME. WELL WILL �E. BHCKFILLING, OF HNY SYSTEM WITHOUT FINAL INSPECTION HND HPPROYHL DEPHRTMENT WILL BE SUBJECT TO PROSECUTION MINIMUM DISTHNC-E BETWEEN H WELL AND HNY 0W -SITE SEWAGE DISPOSHL 100 FEET FOR H PRIVHTE WELL OR 150 TO FEET SYSTEM FROM H PUBLICWELL IS UPON THE TYPE OF PUBLIC WELL OF HNCHORHGE. DEPENDING MINIMUM DISTANCE FROM H TO H PRIVHTE SEWER LINE IS 25 FEET TO H COMMUNITY SEWER LINE IS 75 FEET. MHY REQUIRE. ENLARGEMENT IF AND WELL LOGS ME REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ]0 OF THE WELL COMPLETION. DHYS OTHER REQUIREMENTS MY HPPLY. SPECIFICHTIONS AND CONSTRUCTION DIAGRAMS HRE HVHILHBLE TO INSURE PROPER INSTHLLHTION r �W Ell-,- ��� I CERTIFY THHT 1: I HM FHMILIHR WITH THE RE:QUIREMENTS FOR ON-SITE SEWEl S HND HELLS HS SET FORTH BY THE MUMICIPHLITY OF HNCHORHGE. 2: I WILL INSTRILL THE SYSTEM IN HCCORDHNCE WITH THE CODES ]� I UNDERSTHND THHT THE ON^ -SITE SEWER SYSTEM MHY REQUIRE. ENLARGEMENT IF RESIDENCE IS REMODELED 111ORE THHN THE ] BEDROOMS. SIG�ED�� ISSUED B u�|�~�^�� - ~----� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST p _ � �- b �-�� • � �• PERFORMED FOR: PARA( U N Wc) E- S DATE PERFORMED: '/6'�- Z LEGAL DESCRIPTION: Lo 1 ' q LoT i, (' Kj 5 4N D L AK �. N O V. SLOPE-/ SITE PLAN T S L -T AN ML o9 �- ®® 5 ®® i - 6 6 7 _ g `i 1141 W aF1N 10." 1R® tAJ'a'` 9 O 10- WAS G ND WATER S 11 +/J � „ n ENCO N ERED7 O 12Ass"UU°'l"44 W( WLYU�I! P VIA, tf // A.0' S,A,ATHAT E 13 t% Reading Date Gross Time 14 Depth to Water `ov���gA OF Algsi+ 15 �P••• d, 16 � '�-' ..49TH E 17 ......... 2225 - .*,k,. P 19NE � ONAL F� 19 e �d 20 Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE e n TEST RUN COMMENTS t4® A�// / U-IAul':'�4.A_ pe� PERFORMED BY: 72-008 (6/79) CERTIFIED BY: (minutes/inch) DATE: 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. # 01 1-135-19 HAA #���� 1. GENERAL INFORMATION Complete legal description Sand Lake Subdivision 2 rot 34, Block u Location (site address or directions) 8244 Seacliff Drive Anchorage, Alaska Property owner Abel Veldcamp Day phone 440-7244 Mailing address 8244 Seacliff Drive Anchoraae, Alaska Lending agency Northland Moraaae Day phone 274-5150 Mailing address 2605 Denali S-tre�t Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 2 3. TYPE OF WATER SUPPLY: Individual well Community well X Public water 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 X 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. 72-025 (Rev. 1/91) Front MOA x21 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 Environmental Managem nt- Tnc- Phone ?'%-O,3E Address Engineer's signature--_ 6. DHHS SIGNATURE J Approved for bedrooms. Disapproved. Conditional approval for Additional Comments By: Date l'% bedrooms, with the following stipulations: Date V f" 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 (Rev. 1/91) Back MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERV,1r ;�^^ , EN1' — Environmental Services Division AL SERVICES DIVISIC, 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: Sandlake #2 E Lot 34 Blk. 4 Parcel I.D.: 011-135-19 A. WELL DATA Well type C Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production If A, B, or C, attach ADEC letter. ADEC water system number 8321 -FA -088 Date completed Cased to FROM WELL LOG WATER SAMPLE RESULTS: g.p.m. Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION g.p.m. Coliform 0 Coll f 1000t Nitrate 1Jon D Other bacteria Date of sample: 1L� S �? 2� Collected by: B. SEPTIC/HOLDING TANK DATA Date installed 7/1/82 Tank size 1000 Number of Compartments 2 Cleanouts (Y/N)_ Y Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) Date of Pumping 10/13/98 Pumper Isaac's C. ABSORPTION FIELD DATA Date installed ?./1 /P2 Soil rating (g.p.d./ff2 or 2/bdrm 85 System type Bed Length 40 ft. Width 5 ft, Gravel thickness below pipe 1 r� ft- Total depth 6 ft-. Effective absorption area 2c;ti f2� Monitoring Tube present (Y/N) Y Depression over field (Y/N) N Date of adequacy test 10/13/98 Results (Pass/Fail) Pas. For .2 bedrooms Fluid depth in absorption field before test (in.); n Immediately aftertinn gal. water added (in.): 16 Fluid depth 0 (ins) Minutes later: 30 Absorption rate = titin g.p.d. Peroxide treatment (past 12 months) (Y/N) N If yes, give date 72-026 (Rev. 3/96)" D. LIFT STATION N/A Date installed Manhole/Access (Y/N) High water alarm level at* _ Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot *107 ft. Absorption field on lot *115 ft. "Pump off" level at* On adjacent lots *103 ft. On adjacent lots * 123 ft. Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 6 ft. Property line **1 ft. Absorption field 5 ft. Water main/service line N A Surface water/drainage N/A Wells on adjacent lots 150 + ft. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line **2.5 ft.. Building foundation 13 ft. Water main/service line N/A Surface water N/A Driveway, parking/vehicle storage area 20 + ft, Curtain drain_ N/A Wells on adjacent lots 150 + ft. * Separation distances for well to septic waived from 150 ft. to 100 ft. per DEC F. ENGINEER'S CERTIFICATION certification to construct and operate. i certify that l have determined thru field inspections and review of Municipal records th tems are in conformance with MO HAA guidelines in effect on this date. �P� ................. .q , Signature Gel; .qT� '_•, Engineer's Name RRY A h GE5(IRl �, ij� Date �D—/S�%8 NOXE-969x: ** Waiver request attached to this document. HAA Fee $fid Date of Payment J� l6 Receipt Number Z�4,� `) 1 L6, Q 7 72-026 (Rev. 3/96)* Waiver Fee $ � \ % Cw Date of Payment i'�J 1 _; •-qS Receipt Number L u X12. f (0 2� ® Mm- icipality of Anchorage Department of Health and Human Services 825 "L" Street Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor http://www.ci.anchorage.ak. us October 21, 1998 Larry Helgeson, P.E. Environmental Management, Inc. 206 East Fireweed Lane, Suie 201 Anchorage, AK 99503-2703 Subject: Waiver Request for Sand Lake #2 Lot 34, Block 4 Waiver Request #WR980077 Parcel ID #011 135 19 Health Authirity Number #HA980365 Dear Mr. Helgeson: Your request for a waiver of the required 10 feet horizontal separation from the on-site wastewater disposal system to property line has been approved. The approved separation distance is 1.0 foot. This waiver approval applies to the existing on-site wastewater disposal system to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Donna C. Mears Civil Engineer On -Site Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR#JLa �P`iRt r� l-1 PID# C�1 \-\ �,�-1`\ HA# Permit # Date Received: October 15 1998 Legal Description: Lot 34 Block 4 Sand Lake #2 Engineer: Larry Helgeson P E Emvironmental Management Inc. 206 East Fireweed Lane Suite 201 Anchorage Alaska 99503 2703 Applicant: Abel VEldcamp Waiver Requested: Lot line waiver for: sout leachfield to lot line 2.5 feet north leachfield to lot line 6.5 feet and septic --tank to lot line 1 foot' Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Points: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: Date: Name of Reviewer Rec #: 04242/6228 Amount: $ 115.00 Date Paid: 10-15-98 FSM\ 1ROM.1EMTaAt MANAGBIEMT IKORPOMTED October 15, 1998 RECEIVED,- .� �99� OCT 1 b 1998 Miunicipainy of ianc0age Dan Roth Dept. Health & Human Services On-site Services Program 825 L Street, Room 502 Anchorage, AK 99501 RE: Waiver request for lot line separation distances for Lot 34, Block 4, Sand Lake Subdivision #2. Dear Mr. Roth, Environmental Management, Inc. (EMI) is submitting this letter as a request for a waiver for lot line separation distances. The subject property is located at street address 8244 Seacliff Dr. and legal address Sand Lake Subdivision #2, Block 4, Lot 34 in Anchorage. The Subject property's septic tank and absorption field do not meet the required minimum 10 feet separation. The south end of the absorption field is 2.5 feet from the lot line and the north end is 6.5 feet from the lot line. The septic tank at its closest point is 1 foot from the lot line. From field inspection and research of the neighboring wastewater systems the separation distance between the wastewater systems exceeded the requirements by the Municipality. These distances are shown in the following table. Summary Table Components Distance Status S. Leach Field to Lot Line 2.5 Feet Request Waiver N. Leach Field to Lot Line 6.5 Feet Request Waiver Septic Tank to Lot Line 1 Foot Request Waiver S. Leach Field to Lot #33 Field 14 Feet Meets Code N. Leach Field to Lot#35 Field 18 Feet Meets Code Septic Tank to Lot #33 Field 14 Feet Meets Code All Other Separation Distances Meets Code or Has Existing Waiver The separation distances between absorption fields and septic tanks on neighboring lots are greater than the required minimum by ADEC. This system should not have any impact on the performance or health concerns on any of the neighboring wastewater systems. It's proximity to the lot lines does not restrict the placement of future absorption field sites on the neighboring lots. If you have any questions concerning this request for a waiver please feel free to call at 272-9336. Sincerely, ENVIRONMENTAL MANAGEMENT, INC. Larry Helgeson, P.E. Senior Engineer 206 E. FIREWEED LANE, SUITE 201 • ANCHORAGE, AK 99503-2703 CONSULTING (907) 272-9336 • FAX (907) 272-4159 • TRAINING (907) 272-8852 • FAX (907) 272-0319 FtNVIRO\11F\fAL \N4M,AGEME\T INCORPORATED October 15, 1998 OCT 15 1990 On -Site Services Program Municipality of Anchorage 8251 Street, Room 502 ept. Health& Human Services Anchorage, AK 99501 RE: Health Authority Approval information on Lot 34, Block 4, Sand Lake Subdivision #2. To whom it may concern, Environmental Management, Inc. (EMI) conducted a septic inspection the property located at Sand lake Subdivision #2, Block 4, Lot 34. We are requesting the Health Authority Approval process to be expedited on this property. The interested parties are only waiting on this document to close on the property. In this letter is information that may help any questions and concerns about this property's well and septic system. The separation distances are in question. A waiver is being submitted with this health authority approval for the lot line separation requirements. A waiver is on file at DEC for the distance from the well on the lot to the septic and absorption fields within 150 feet of the well. All other separation distances were adequate. Before any water was added to the leach field the monitoring tube was pumped out to remove some debris that had been collected over the years. When this occurred the pumpers sucked approximately 3 feet of ground below the monitoring tube. The inspector, Chad Helgeson, filled this hole back to the bottom of the monitoring tube with soil and clay. It was determined that the monitoring tube was adequate to determine the level of water in the absorption field. The absorption field absorbed all the water that was put into the system 30 after stopping the water into the field. If you have any questions about the system or testing methods please feel free to call at 272-9336. We appreciate any help you can give us to expedite the closing of the property. Sincerely, ENVIRONMENTAL MANAGEMENT, INC. Chad Helgeson, E.I.T. Chemical Engineer 206 E. FIREWEED LANE, SUITE 201 • ANCHORAGE, AK 99503-2703 CONSULTING (907) 272-9336 • FAX (907) 272-4159 • TRAINING (907) 272-8852 • FAX (907) 272-0319 MUNICIPALITY OF ANCHORAGE M� • Department of Health & Human Services M — DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D.# C>il— li��)-lCl HAA# " Mot C)L Iia 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 34: Btock 4; Sand Lake #2 Location (address or directions) 8244 Sea (b) Property owner ANF C. Telephone: (home) Business Mailing Address 590 FaAt 34,th Ayewuof Apwhatnago, APaAka 9950.3 (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent 2001 REALTY Attn: Nancy Bengh-Pottock Address 1345 blest 9t17 quite #201 Anahonage, A2aoka 99501 Telephone 976-9001 (e) Mail the HAA to the following address: (or check here)U, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Eagle River Loop Rodd No_ ;94 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family)Q Number of bedrooms` 2 3. WATER SUPPLY Individual Well ❑ Community OX Public ❑ Note: if community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site EXx Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 �GI.'i N.Yh 1S IilS ..:..1.Y'_ .Y..3✓�r •n ..r rAv. t. .r ten'. lid.-: .r r.n_�.n..�.-.v. 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 inspection. Name of Firm Address 5 & 5 ENGINEERING - - 1- �:••.---� c Date Eagle River, Alaska 99577 Telephone /2_2 9 ar0.1�s °r� VIC 2t 0PE3S100 �► 6. DHHS APPROVAL �l� II// pP u/o a y , �a� rra�tz l a o t— ..Approved roved for bedrooms b Date ApprovedDisapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in 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 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) \ �' • Health Authority Approval (HAA) CHECKLIST -FEBRUARY 1984 343-4744 i a , ; Legal Description: A. WELL DATA Well Classification Well Log Present (Y/N) _ Total Depth Cased to Static Water Level Casing Height Above Ground G Date Completed Electrical Wiring in Conduit (Y/N) Depth of Grouting SEPARATION DISTANCES FROM WELL: If A, B, C, D.E.C. Approvedr(YTJ) % Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot \ ' ; On Adjoining Lots \ o To Nearest Edge of Absorption Field on Lot � ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ; Dategl�} Water Sample Test Results _�_�tSP�mx�-�+ �iJpc fes' Comments Z ��� D1 � [ r`�b-�\k!;" mac-, F=llL B. SEPTIC/HOLDING TANK DATA Date Installed -I -62-Size t � No. of Compartments Stand pipesd.3/N) -Air-tight Capsd5�N)_Foundattiio(nn Cleanout(YVN) _ Depression over Tank (Y&O � Date Last Pumped ' _ 7 - 88 Pumping/Maintenance Contact on File ( ; for >� t�1 Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well _ `Af :�'5 ( To Building Foundation To Property Line To Disposal Field To Water Main/Service Line \ b �r S To Stream, Pond, Lake or Major Drainage Course Comments -l"N \JrQ359- vkp,;e�' �. � V +�� �L�� -?JH cJ6t, 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �� �2— Type of System Design j�%� t-�-r'lr7�� Date Installed — (— �Z Length of Field 4c f r Width of Field Depth of Field Gravel Bed Thickness 1 4 ` Square Feet of Absortion Area '� �S-Y1 Statndpipes Present4VN) Depression over Field (YLW C4 Date of Last Adequacy Test Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well �'Z3� ) To Property Line To Building Foundation Lot t To Water Main/Service Line i 2— To Existing or Abandoned System on On Adjoining Lots To Cutback (if present) Q L'Ar, To Stream, Pond, Lake, or Major Drainage Course 1 L To Driveway, Parking Area, or Vehicle Storage Area d Comments �* D. LIFT STATION Date h 6talled Size in Ga "Pump On" Level I, /X High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in inspection. S & S ENGINEERING Signed 17034 Eagle K1VertU0FRTaVWo. 204 Company Eagle River Alaska 99577 Date ��"�' AS % I MOA No. �"9� ♦' Receipt No. C:215 -S-4 8 Date of Payment Amount: $ Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 74@,date of this %.4 A.bW A ShWw W+w 1457 I S E OF L&S STEVE COWPER, GOVERNOR d DEPT. OF ENVIRONMENTAL CONSERVATION/ ANCHORAGE/WESTERN DISTRICT OFFICE 563-6775 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 DATE: November 30, 1989 PWSID: CLASS C To Whom It May Concern: According to the records on file in this office, the SAND LAKE #2 S/D BLK 4, LOT 34 water system is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, aL '0_1 - '/� //7 VERA E. CRAIG Environmental Fie Officer NOTE: This approval is contingent upon all residences being single family, 2 bedrooms or less; serviced by this well.ZIEC r MUNICIPALITY OF ANCHORAGE r • Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # 611 -- HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 34, Block 4, Sand Lake #2 Location (address or directions) (b) Property owner n u r Telephone: (home) Business r n Mailing Address '%�� E14th Anchgex Alaska (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent 90m RealtyNancy Bergh—PolIork NEWArITZ .. •IN KM!!!!!!!!._ •• Telephone (e) Mail the HAA to the following address: (or check hereO_if hold for pick up.) List contact person and day phone number below: 17034 Eagle River Loop Road No. 204 Sagle RI 2. TYPE OF RESIDENCE Single -Family ff Number of bedrooms 2 3. WATER SUPPLY Individual Well ❑ Community? Public ❑ Class C Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ff Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, 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 S & S ENGINEhKING Telephone Address 17034 Eagle River Loop Road No. 204 Eagle River, as a 99511 Date Co 6. DHHS APPROVAL r/ Approved for bedrooms by 6 Date Approved Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 o2P Jam' MUNICIPALITY OF ANCHORAGE (MOA) ,cz o, He tg jhAftdEpproval (HAA) MUNICIP ENVIRONME gN��Eff a EEIRRUARY 1984 a 343-4744 �. 4 � 2 11988 Legal Description: I� -22q A. WEL'1. DATA REC Well classification ( If A, B, C, D.E.C. Approved SAV) — Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground - Date Completed Depth of Grouting Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) 7 To Septic/Holding Tank on Lot 1 ; On Adjoining Lots c)2 To Nearest Edge of Absorption Field on Lot �?/'� r ; On Adjoining Lots k t o, To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by 1Fa �( ; Date Water Sample Test Results Comments 12K-� v`�f��/� ►J C B. SEPTIC/HOLDING TANK DATA Date Installed -'Z Size� �d No. of Compartments 2 Standpipes &N) y Air -tight Caps ON) _Y Foundation Cleanout (V1) Depression over Tank (Y89 P=S I Date Last Pumped Pumping/Maintenance Contact on File (Y/N) for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEP ) TIC/HOLDING TANK: To Water -Supply Well PS To Building Foundation `J To Property Line o To Disposal Field S I To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page 1 Of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ✓ /tan-- Type of System Designh Date Installed I _ j — 8-2, Length of Field �o Width of Field S ( Depth of Field (a / / Gravel Bed Thickness S Square Feet of Absortion Area Statndpipes PresentdVJ) `1 Depression over Field (Y/� Date of Last Adequacy Test Results of Last Adequacy Test�� SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well I Z� To Property Line To Building FoundatioJ� \2 To Existing or Abandoned System on Lot t � ; On Adjoining Lotss � To Water Main/Service Line 1,0 /4- To Cutbal@c (if present) To Stream, Pond, Lake, or Major Drainage Course - To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION r S � Date Installed "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments b Dimensions Manhole/Access (Y/N) _ "Pump Off" Level at ::� _Vent(Y/N) Pumps les during Adequacy Test. "Check Permitted Bedroom Rating Against HAA Request" I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in inspectionS & S ENGINEERING Signed 17034 Eagle River Loop Road No. 204 Eagle River, Ala5ka Company 99577 Date MOA No 'U9 3 Receipt No. Date of Payment Amount: $ 20 100 Receipt No Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Rack Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 1334 ANCHORAGE, ALASKA 99503 DATE: ! (--)/ 2 0,/'Ll PWSID: To Whom It May Concern: STEVE COWPER, GOVERNOR 563-6775 According to the records on file in this office, the U /9 ,j 4T SL. uLk,- c/ S�JC �iV/-I'AW'aiter System is in compliance with the State of Alaska Drinking Water Regulations. sincerely, Michael ...Lewis, PE Environmental Engineer- MPL:pkk �/Ss �f�viG.ld�Y % fflc� irlf L� r MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMEkT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date —JUL—'l C94 (a) Legal Description (include lot, block, subdivision, section, township, range) T3LOCK ��s%�[� L.41:r d4b7 Location (address or directions) (b) Applicants Name DL • � L% �1,-CA-c` Telephone - Home Business`�����/fes Applicants Address (c) Applicant is (check one) Lending Institution ; Owner./builder ; Buyer ; Other F� (explain); A rr�iJ, (d) Lending Institution CCU)2LT (j IVA-j JQA/A-L- Sl:a= cu.'tjelephone Address 4t,< qei =i (e) Real Estate Co. & Agent �J)A-yj- rEC.b4Ut,j<- Address 4Z4 8Sr' Zvi .2-0;2 Telephone 4 (i - ( J C='U (f) Mail the HAA to the following address: 2. Type of Residence Single -Family Multi-Family Other (describe) Number of Bedrooms S 3. Water Supply Individual Well Community Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite [zt Public Community Holding Tank Note: If community well system, must have wz"itten confirmation from the State Department of Environmental Conservation-.attesting to the legality and status. [Page 1 of 2] 5. Engineering Firm Providing Inspections, Tests File Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, 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 regula- tions in effect on the date of this inspection. Name of Firm�A C Telephone Address 712_'�;_ 6 D Date % (ENGINEER SEAL) 6. DHEP Ap rp oval Approved for bedrooms By Approved __X_ Disapproved Terms of Conditional Approval gH �oeo°000 oo010 ©00 O� tltl�LCi 00 00 OOOOO..°00tj A e THOMAS R. SPAITH o (9 CAUTION Conditional THE 14UNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRON11ENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 21 7--19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 A. WELL DATA Legal Description: LoT ;3 J�LOCk 4 1AAJb [,AItfc _ Well Classification If A, B, or Cr D.E.C. Approved(Y/N) YES Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At _ Casing Height Above Ground 215, Sanitary Seal on Casing (Y/N) LS Electrical Wiring in Conduit (Y/N) Depression Around V\bllhead (YM) N v Separation Distances from Well: To Septic/Holding Tank on Lot .1051 On Adjoining Lots I Q 2-1 To Nearest Edge of Absorption Field on Lot , 23� ; On Adjoining Lots 1 �� To Nearest Public Sewer Line �>- /00 ' To Nearest Public Sewer Cleanout/Manhole .:�!- 100 / To Nearest Sewer Service Line on Lot Water Sample Collected By /v( /�r-� ; Date 'l Z!d 84_' �T Water S le Test Results A77 S C,4G7-0V Ccaanent a AVrACI C -b D c C_t-2'_T1 r1CA-! C OG O/OL' AnA/4i \ JA w1z-8- DE 15"O' SEPA2rd- 12 W 927 S ib 100 ' B. SEPTIC/HOLDING TANK DATA Date Installed Size /000 eA-4- No. of Compartments 2— Standpipes Standpipes (Y/N) Y(,5 Air -tight Caps (Y/N) �i cS Fcundation Cleanout (Y/N)VL-Is Depression over Tank (Y/N) NO Date Last Pumped sJIA Pumping/Maintenance Contract on File (Y/N) AJI,01-; for A Holding Tank High -Water Alarm (Y/N) AI/A Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply vbll ► 0 4s- / To Building Foundation To Property Line 10" To Disposal Field 5 To Water Main/Service Line /J .A To Stream, Pond, Lake, or Major Drainage Course /J Comments <ArljLrrtcl� OC-?/Llit8Z 2-2-1 ,¢ti'f� �S�i�TIC_ �4-l'li/Lj �[rg� [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed "711 /82 Length of Field 40 � Width of Field e� 0 Depth of Field C Gravel Bed Thickness Square Feet of Absorption Area 6® Standpipes Present (Y/N) Y,S Depression over Field (Y/N) NO Date of Last Adequacy Test 61-A Results of Last Adequacy Test n114 Separation Distance from Absorption Field: To Water -Supply Well J 23 / To Property Line 1 D To Building Foundation 12- To Existing or Abandoned System on Lot V4 )A ; on Adjoining Lots I Z� ` To Water Main/Service Line To Cutbank(if present) ti1IsC To Stream/Pond/Lake/or Major Dra' nage To Driveway, Parking Area, or Vehicle Storage Area > 3 d Comment A)6)7- Ik U R(,�i),e ZL -- - D. LIFT STATION Date Installed Size in Gallons Alm_ A10PL1Ck (3L.e7 "Pump on" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Comments Dimensions Manhole/Access MIN) "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 conformed to all MOA HAA Guidelines in effect on the date of this inspection.® Date ,l MOA �5 �'U ^e Company ��? r�,7vLz.s i�� No. 0 eoeo 000aoos. ° o 00 00000000®0 000th KBl/d5/s o e THOMAS R. SMITH o r; 2248-E ° (Page 2 of 21�'°� c.. 2-1584 July 24, 1984 PO._,_ 4H 6-650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Security National Bank Pouch 7777 Anchorage, Alaska 99502 Subject: Lot 34 Block 4 Sand Lake Subdivision #k2 It has been this Department's policy that a health authority approval is good for two(2) years from the date of sign off, except that a water sample analysis is assumed to be good for only sixty(60) days. This term is primiarly based on the need for an adequacy test of the on-site sewer system. However, this approval term could be altered based on one of the following: (1) At the descretion of the lending agency requesting an update of the approval. (2) If the community water system does not meet the State of Alaska compliance on current water sampling, or; if the community water system does not meet with State of Alaska approval. (3) If the on-site sewer system shows signs of failure by overflowing sewage. If there are any further questions, please call this office at 264-4720. Sincerely, Keith E. Bandt Environmental Engineering Manager KEB/ljw Time APPLIC VT FILLS OUT UPPER HAL. ;ONLY rProperty Owner r4,(4 J Time - Phone Mailing Address )k "L Zip Code Buyer Date Date Date Date Address "v Zip Code Lending Institution /„J •7 Phone Address Zip Code Field Notes: /79 /yam 10, Realty Co. & Agent DFPT C' Phone Address Zip Code Legal Description l J br r Street Location ( ) CONDITIONAL APPROVAL' e of Residence G` Single Family BY: ' ulF ❑ Multiple Family No. of Bedrooms- edrooms❑ Date Sewer Installed 0Other Well Log Received Water Supply Well to Tank Septic Tank Size ❑ Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Nwe Disposal Individual �� ��,aa �. - LLsI � -I -�a !4- Year Individual Installed: ✓' _ ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank - NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time - Time 01CM— Date Date Date Date Inspector Inspector Inspector Inspector R'YQ`t"1 Field Notes: /79 /yam 10, MUNICIPALITY OF AN DFPT C' ENVIRi31i1;.-f,:'..- ;.,p.-LTION cu"If 14 1982 RECEIVED ( '2 APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' - G` DATE BY: ' ulF Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received I—Q V Well to Tank Septic Tank Size 72023 (3182( C l CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION. PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT 'Plans for the construction of t2L r �� •�z .!A l� l o T S �� ?� `(� el -<: r I C lei public water system located in Y1 ! i•1 C, r' a r» _ , Alaska, submitted in accordance with 18 AAC 80.100 by have been reviewed and are ❑ approved. ❑ conditionally approved (see attached,conditions). le e y $o:n es rr P" p" �`f s h u +of f �.0UCC( C ,.0.e Y'U:<-C t♦JMri C't C ocj qo Sal rf ci�Uhk S�aVia:� OUI<ie cr 6c_cly, e•:v ire ciyu_rgew 1707X:r 0V rfje =r�, '7 TITLE(�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. APPROVED CHANGE ORDERS Change (contract order no. Approved by Date or descriptive reference) The "APPROVAL TO OPERATE" section must be completed before any water is made available to the public. APPROVAL TO OPERATE The construction of the Sip ,f 0 Ts 1 A.0r � 3 � � �'� public water system was completed on ~ -- (date). The system is hereby granted interim approval to operate for 90 days following the cpmpletion date. By TITLE DATE As -built plans submitted during the interim 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 DATE MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Date: November 30, 1994 To: File From:; �mes Cross, P.E., Program Manager, On-Site/Water Quality Subject. Separation Distance Waiver. The well located on Lot 34, Block 4, Sand Lake Subdivision #2 is a Class "C" well, which typically require 150 feet horizontal separation from septic systems. However, this well, known as the Sand Lake S/D Lots 19,20,33, and 34 Class C Public Water System, was granted a waiver on its construction and operation certificate. This waiver states: "Waive 150 ft. well to septic separation to 100 ft. 9-9-82." this was signed by Bruce E. Erickson. During the process of reviewing a Health Authority Approval worksheet on Lot 36, Block 4, Sand Lake #2, it was discovered that the septic tank on Lot 36 was located within the 150 ft radius of the Class C well. This tank had not been specifically mentioned in the waiver or the file on Lot 34. A phone discussion with Bill Lameroux of ADEC on 11/28/94 confirmed that this waiver could be applied to the septic tank on Lot 36.