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Home My WebLink AboutSAND LAKE #2 BLK 5 LT 2\l' pil-\3LI-<15 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 0* ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPOnRTpw NAME r tj Z6 f/ 1l/j C l.._ o � UPGRADE MAI LI G ADDREolkn G �� U J� LEGAL DESCRIPTION ke. Block La Z LOCATION � I n NO. OF BEDROOMS � DISTANCE TO: Well Absorption area Dwelling ` b PE ITN . �N U ie14 F- Z Manufacturer Material No. of compartments WF �r G ti Liq. Mecjty'n gallons IF HOMEMADE: Inside length Width Liquid depth `-� DISTANCE TO: Well Dwelling PERMIT NO. JAZ SZ F Manufacturer Material Liquid capacity in gallons p DISTANCE TO: Welli� Foundation Nearest lot line PEFji11fIIT N w = r fY J W z No. of lines Length of each lirJ,1 { Total length of lire Trench width Distance between lines Z W inches ¢ F Top of tile to finish grade - 3 Material beneath tile inches Tota ffe tive abso 1tit�n area p r✓ Length Width Depth PERMIT NO. w QF• Type of crib Crib diameter Crib depth Total effective absorption area w 1 WWell w DISTANCE TO: Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. J W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER e PIPE MATERIALS PVC SOI L TEST RATING f� a'�8edroo P62, t� INST�LER so �- �— Dzz ,yam t k REMA C 7 , 1-00 r co ' to a log h r oz 4t. fo -FE .-t. ✓ :411 , , Ap+-W*444� 62 1/ S'r rf• APPROVED D TE LEGAL SHAW L-,ke. �,z Nock, L.ot- 2 has 72-013 (Rev. 3/78) t Department; Health and Environmental 'rotectionfVu F" 825 `v' Street, Anchorage, AK. -�;�)501 264-4720 HANDWRITTEN PERMIT # # # Permit # i�,- r_�•R ON-SITE SEWER PERMIT Toe/ Applicant: ��, f S /air f Mailing Address: �-aio8 Location: + Phone Number: 2` ;?A Legal Description: �T "L tAK& "L Lot Size: (0 750 Type of Soil Absorption System Is: Trench: _ Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: C19F' Soil Rating(sq.ft/br) /'9-0i��'lNG,c L^ OAX-Y The Required Size of the Soil Absorption System Is: DEPTH 1� LENGTH 3 GRAVEL DEPTH WIDTH . The length dimension is the length(in feet) of the trench or drainfield. 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 gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = 110010 GALLONS * * 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. * # * TWO(2) INSPECTIONS ARE REQUIRED # # # 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 a -private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3 * * * I certify that: (1) I am 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 codes. (3) I understand that the on-site sewer system may re uire enlar ment if the residence is remodeled to include more tha bedrooms. Signed: � t2.11� Issued by: Applicant Date: �Q (A�� SWP/024 (1/81) w f.dk� 7,S` SOILS LOG MUNICIPALITY OF ANCHORAGE a.r DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: NEDATE PERFORME LEGAL DESCRIPTION:_ 1 Y O 6 2 uad\►� c VV O p eu 6 6 5 14- 15- 6 d ° Gross Time 15 d 4 �NP 6 17 • 0 7 d a d 19- or 8 a • a COMMENTS 0 C ° O 9- 10 10- 11 11 00 O 12 0 0 � � e 13- 3 14 Date Gross Time 15 Depth to Water �NP 16- 17 18- 81920COMMENTS 19- 20- COMMENTS SLOPE WAS GROUND WATER S ENCOUNTERED? _ 1�L L O P IF YES, AT WHAT — E DEPTH? SITE PLAN Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) FT AND FT .t f0PAAV, Inn nc-,.it PERFORMED BY1rj Ei' 1// r a 1 CERTIFIED BY: 72-008 (6/79) f '�t ori / • E�II=1 ,19 MUNICIPALITY OF ANCHORAGE a® '� DEPARTMENT OF HEALTH & HUMAN SERVICES8 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.# 011-134-35 '' HAA# _ 1. GENERAL INFORMATION Complete legal description Lot 2, Block 5 Sand T,ake ,#2 Location (site address or directions) 8223 Seacliff Street Property owner Lisa Knox Day phone 248-7634 Mailing address 8223 Seacliff Street, Anchorage, AK 99502 City Martgage 263-0700 Lending agency Day phone Mailing address 121 41, Pirewee�' Lane, Anchorage, AK 99508 Agent _Century 21 Crawforrl RPaI RstatP Day phone 562-9X92 •�• 1--�_, arsaiiireikwxo- .. 1 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS. 3 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. 7/97) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm DHI Consulting Engineers Phone 344-1 385 Address 800 E. Engineer's signature Blvd., Suite 3-545 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments By: 911k 1II.T.IC Anchorage, AK 99515 Date bedrooms, with the following stipulations: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1191) Back MOA #21 Municipality of Anchorage MAY 01 1998 DEPARTMENT OF HEALTH & HUMAN SSRVIeSSOF ANCHORAGE Environmental Services DiviS,1*1RONMENTALSERVICES DIVISION �ir15 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: Lot 2 Block 5 Sand Lake #2 Parcel I.D.: 01 1 -134-35-000 A. WELL DATA Well type C Log present (Y/N) Total depth Sanitary seal (Y/N) / If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to FROM WELL LOG Casing height (above ground) Wires properly protected (Y/N) N Date of test Static water level Well production Z 9 -P.M. WATER SAMPLE RESULTS: Coliform IVA Nitrate Date of sample: B. SEPTIC/HOLDING TANK DATA NA Collected by: AT INSPECTION N A Other bacteria N 4 Date installed 1 1/ 2 3/ 8 3 Tank size 10 0 0 Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) N/A Date of Pumping 4/22/98 Pumper Roto -Rooter C. ABSORPTION FIELD DATA Date installed 11/23/83 Soil rating (g.p.d./ftzorft2/bdrm) 125 System type trench Length 41 ' Width 2 .5' Gravel thickness below pipe 51 " * Total depth 99" Effective absorption area 348 ** Monitoring Tube present (Y/N) Y Depression over field (Y/N) N Date of adequacy test 4/26/98 Results (Pass/Fail) pass For 3 bedrooms Fluid depth in absorption field before test (in.); 37 Immediately after 450 gal. water added (in.): 37" Fluid depth 37" (ins) Minutes later: 0 Absorption rate = 450+ g.p.d. Peroxide treatment (past 12 months) (Y/N) N If yes, give date _ * measured depth to bottom of M.T. 72-026 (Rev. 3/96)' ** based on 51" depth of field D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at` Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot N�i� On adjacent lots Absorption field on lot A�/A On adjacent lots 1v 1A Public sewer main w /it Public sewer manhole/cleanout _l/ Sewer /septic service line / 1A Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation _ 29 1+ Property line 5 ± Absorption field_ 10 ± Water main/service line 10 ' + Surface water/drainage 10 0 ' + Wells on adjacent lots _ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line _ 2 * Building foundation 3 9 Water main/service line 10 + Surface water 100'+ Driveway, parking/vehicle storage area 8 0 ' + Curtain drain none Wells on adjacent lots 10 2 ' 103' F. ENGINEER'S CERTIFICATION * waiver requested & approved nspection report date 11/23/83 •ate4r 6"y OF f •v1 i, J certify th t f hav determined thru field inspections and review of Muni � pe6rds a #7,e ab o a systems are in conform ce w MOA HAA guid lines in effect on this date. o e V. Signature �e ooeo99�. ece uoa Engineer's Name CE -1580 s Date HAA Fee Date of Payment Receipt Number / 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number c.>•0= g835( nolomw ROOTER SEVIIER-DRAIN Ir JUICE 0.00 lot De4,a4 w o r�ooeL>:5 ° F4164 u�X N2 91.233 P. o. Bou 112688 ANCHORAGE, AK 99611 (987) 346-2513 Phone 345-5284 Fax Jeb Address T, - -w. AA gn-0?74- [M75 SALESMAN S- DAYS CuSTOhIEP pnDERI ROTO -ROOTER SERVICE CALL HRS. STEAM THAW INP HRS. TRIP CHARGE HRS. OVERTIME CHARGE ADDITIONAL LA80R CHARGE HRS. HRS. A PLUMBING PUMPING SERVICE HRS. (GAL. HRS. HYDROJEfSERVICE HRS. TV CAMERA INSPECTION HRS. MATERIALS Y PLEASE PAY FROM THIS INVOICE r TOTAL FOOTAGE CLEANED OR TH PROBABLE �,' OF STOPPAGE *I� BLADES USED r 6T- A we LINE GLEANED ❑ JOB NOT GOARANTEED FOR FOLLOWING REASON - WORK ACCEPTED BY ❑ see additional job ieforrnalfon form apachad. In myon.:;anNCBSQIJyT{AT'prlrling♦fmrle"1111LE tXmm e]II Aul- ^.rhvlwr<w^"r, at"+� Mi Ho uJ52J07:T1 04-29-1998 02:42PP1 907 345 82134 P.01 MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # ell -13,41-35- HAA # "&(0,&l 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 2; B.2ock 5; Sand Lake 02 Location (address or directions) 8223 SeaaP. AA S.tnee (b) Propertyowner H.U.D. #023211-203 Telephone : (home) Business Mailing Address 605 (Veit 4th Avenue, anchon.age, Alaska. 99501 (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Manston Ptopenti.e�s,Ine. ATTN: Jahn Hubeh. Address 4103 Tunnaga.i.n Anchorage, Ata-6ka 99503 Telephone (e) Mail the HAA to the following address: (or check here ["f hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 E1910 River Loop Road No. 204 Eaala River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family I1X Number of bedrooms 3 3. WATER SUPPLY Individual Well ❑ Community INx 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 R. 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 OS�0 G A. WELL DAT�� Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 a 343-4744 Date Completed Electrical Wiring in Conduit (Y/N) Legal Description: L`a�V1G-s Depth of Grouting SEPARATION DISTANCES FROM WELL If A, B, C, D.E.C. Approved (Y/N) Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot `� I 1 ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot �1) ; 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 Water Sample Test Results Comments V.��G \SS7 ; Date B. SEPTIC/HOLDING TANK DATA Date Installed1�_�'e$Size k �� No. of Compartments P'2�— StandpipestVN) y—Air-tight Capso/N) Foundation Cleanouf:?WN) _ Depression over Tank (Ydd? F- ( a ate Last Pumped (0 Pumping/Maintenance Contact on File (Y/NA p ; for Holding Tank High -Water Alarm (Y/N) P Temporary Holding Tank Permit (Y/N) P SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well To Building Foundation To Property Line To Disposal Field 1� To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course dol ark CommentsA PL JS p'I��6es 72-026 (Rev. 7/88) Front Page 1 of 2 61 !.-V 7!l DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 DATE: June 29, 1990 PWSID: CLASS C To Whom It May Concern: STEVE COWPER, GOVERNOR 563-6775 According to the records on file in this office, the SAND LAKE #2 S/D, LOT 2, BLOCK 5, water system is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, G VERA E. CRAIG Environmental Field Officer s Time APPLIC IT FILLS OUT UPPER NAL. JNLY Property Owner LX_.: , (` , C_Gzt/ % TA- C-_ Date Phone .\ Inspector Inspector Mailing Address Zip Code Ctc7 --n cL /2 A Buyer MUNICIPALITY OF ANCHORAGE Address - Zip Code Lending InstitutionYG j0l/T�� yL.�iG. Phone RECEIVED ( ) APPROVED BEDROOMS `CONDITIONS OF APPROVAL Address - Zip Code - Realty Co. & Agent % j!!i Phone DATE Address i Zip Code Legal Description _ ; �� 7"'" Street Location Z.. Date Sewer Install(e�d Type of Residence Well Log Received Septic Tank Size 2. p�&-ngle Family Well to Tank ❑ Multiple Family _ No. of Bedrooms ❑ Other Water Supply ❑ Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. El' Community For wells drilled prior to that date, give well depth (attach log if available). /❑"Public Utility Sewer Disposal widual Year Individual Installed: Public Utility When Connected to Public Utility: Cl Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. s Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspect A Field Notes: MUNICIPALITY OF ANCHORAGE DEPT. OF I:',.!... : ENVIROPJ1V1-NTAL FROT--C'ION RECEIVED ( ) APPROVED BEDROOMS `CONDITIONS OF APPROVAL ( ) D PROVES---- Ate'- (((�___ ( ) CONDITIONAL APPROVA J�Q� DATE B�� i Soils Rating Date Sewer Install(e�d Well 7o Absorption Area Well Log Received Septic Tank Size 2. //— Z .tel p 5 Well to Tank 72023 DIU) j �} � Blit SHEFFIELD, GOVERNOR -S Ent DEPT. OF ENVIRONMENTAL CONSER"TION Telephone: f907)274-2533 Address: 437 E Street Suite 200 Anchorage AK. 99501 October 19, 1983 Alaska Environmental Control Services Inc. 1200 W. 33rd Avenue, Suite B Anchorage, Alaska 99503 Dear Sir: Subject: Lot 2, Block 5, Sand Lake #2, Class "C" Well, (8421 -FA -193) We have reviewed the plans and specifications for the subject project. Enclosed with tris letter is a "Certificate to Construct" for the drinking water system. The "Approval to Operate" section of the certificate must be completed by a representative of this Department prior to placing the system in operation. �I v BEE/msm Enclosure Sincerely, Bruce E. Erickson Environmental Engineer G S- (� / _ ,-S—C) � CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION PUBLIC WATER SYSTEM aPPROVAL TO CONSTRUCT 4grri for the construction of 4- 07 1 t ) _f /— If rj -1 r r 1 public water system located Alaska, submitted in accordance with 18 AAC 80.100 have been reviewed and are Ell approved. A3 conditionally approved (see tached 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. Approved by Date or descriptive reference) {{ // C '7 r _ j J l C iL,E Cl. i � .J� .il ,{ ��S r/_T ,�:�!( t J f•� ,�iT The "APPROVAL TO OPERATE" section must be completed before any water is made available to the public. APPROVAL TO OPERATE The construction of the public water system was completed on (date). The system is hereby granted interim approval to operate for 90 days following the completion date. TLE 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 pians. The system is hereby granted final approval to operate. DATE E310wis—