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HomeMy WebLinkAboutSAND LAKE #2 BLK 6 LT 17and Lake #2 Block 6 Lot 17 #011-133-20 -IJN1l;lYHLl'1'Y VPANUnulu1k r Heal,",_ and Environmental Protect, �;n .� Fourth Floor nest 825 L Street Anchorage, Alaska 99501 264-4720 - /�-- INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME J_.Y � Y jj -om` + MAILING ADDRESS(_L41 L' PHONE C,' LOCATION �.J�—�i\Ct's�C �.J� LEGAL DESCRIPTION L-1 J(y SEPTIC TANK: DISTANCE I NUMBER OF Z FROM WELL_ I D ___- MANUFACTURER _ MATERIAL i COMPARTMENTS_ INSIDE LENGTH - INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY WOOGALLONS. TILE DRAIN FIELD: -0--p ) I I TOTAL LENGTH f DISTANCE FROM WELL D FOUNDATION 3S NEAREST LOT LINE_ OF LINE # Of Lines DISTANCE BETWEEN LINES � TRENCH WIDTH _1�IN. TOTAL EFFECTIVE ABSOR^TION AREA _ SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER C DEPT! 1: TOP OF TILE l -O FINISH GRADE' MATERIAL BENEATH TILE-_`�IN. ABOVE TILE IN. SEEPAGE PIT: DIAMETER OR WIDTH—, LENGTH_, DEPTH Log Crib _Rings_ Crib Size: DIAMETER___DEPTH DISTANCE FROM: WELL TOTAL EFFECTIVE BUILDING FOUNDATION_, NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT. i Well Class: L, J+ Depth:^^' Well Distance TO: Lot Line 101 Bldg: '-t(9 Sewer Line: Pipe Materials: # of Bedrooms: S Installer:�rz�e^rtilaFc� , Remarks: Sig t ` DATE �� 77 APPROVED..-._-` �-✓ iII{II I I ' � i I- LI� 1 t — I r-- DATE �� 77 APPROVED..-._-` �-✓ L4, 01,4,7 -�2 A D2PRRTMENT�EHLTH AND ENVIRON�ENTHi, ; �TECTlON ~ `� 2516 E� rjC',OR RD�/ HNCHORRGE/ HK. `276-2221 PERMIT NO. ( 76646 ) (3 T HPPLICHNT 6641 EHST 8TH HVE 279^8? LOCHTION WILCOX ST Lk~` LEGHL L17 B6 SHNDLHKE SUBD #2 LOT SIZE 6750 SQUHRE FEET—~ TYPE OF SOIL HBSORBTION SYSTEM I 1 MAXIMUM NUMBER OF BEDROOMS SOlL RATING (SQ FT/BR)� 85 THE REQUIRED SIZE OF THE SOIL HBSORPTIQN SYSTEM IS: �00 L ^ 011 C3 -Y F ---lb ���������� � :r THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DlSTHNCE BETWEEN THE SURFHCE OF THE GROUND HND THE BOTTOM OF THE EXCHVHTION (IN FEET) THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMOM DEPTH OF GRAVETHE OUTFHLL PlPE HND THE BOTTOM OF THE EXCRVHTION (lN FEET) 1- J11 :1 Fit M ED- n3 EIE: 1,:::- 1� �F:--"��7�������� BACKFILLlNG OF FI 1%1 SYSTEM WITHOUT FINHL INSFIE CTIONHND HPPROYHL 8Y THIS DEP8RTMENT WILL BE SUBJECT TO PROSECUTION. '' MINIMUM DlSTHNCE BETWEEN H NELL HND ANY' ON~SITE SENHGE DISPOSHL SYSTEM IS 100 FEET FOR H PRIVHTE WELL OR 200 FEET FORA PUBLIC WELL WELL LOGS HRE REQUIRED HND MUST 8E RETURNED TO THE DEPHRTMENT WITHIN ]0 DAYS OF THE WELL CUMPLETION SPECIFICHTIONS HND CONSTRUCTION DIHGRRMS HRE HVHILHBLE TO INSURE PROPER INSTHL-ATI ON. � �MM�1.� ��—�� F37 1:11160 ��PH�_- liE�---. rot r". -V �.--lf "C���� I CERTIFY THHT 1�I HM FHMlLIHR WITH THE REQUIREMENTS FOR ON-SITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPRLITY OF HNCHORRGE 2: I WILL I THE SYSTEM lNHCCORDHNCE WITH THE CODES ]� I UNDERSTHND THHT THE ENLHRGEMENT IF THE RESlDENCE IS REMODELED TO INCLUDE MORE THHN ] BEDROOMS SIGNED-,�d ...MAIIED C E S 2221 E. Northern Lights Blvd. #203 STRUCTURAL ENGINEERING ANCHORAGE, ALASKA CIVIL ENGINEERING CONSTRUCTION ENGINEERING SURVEYING — LAND AND CONSTRUCTION PHONE (907) 274.7711 July 15, 1976 caa Mr. Mark Forest ` 1 G%- _3 (010 6641 E. 8th Avenue Anchorage, Alaska Re: Soils Review for Individual Sanitary Systems Dear Mark: As per your request, I did inspect the general and specific area for deter- mination of soils capability on the following properties. Lots 14, 15,16, 17 Sand Lake Subdivision #2 I find that the soils over the entire four lot area are generally as follows: Surface to 1. 5 ft, depth - loam and organic (dry) to 1. 5 to 35 ft. and below coarse sands and gravel. The above determination of soils and depths was made by visual inspection of the proposed construction site wherein the surface material had been re- moved to a depth of approximately 2.5 to 3.0 ft. Additional depth and classification of soils was determined by inspection of a large commercial sand and gravel pit just south of and within 200 feet of this property, as well as roadway excavation embankments within 300 to 500 feet north. I hereby certify the soils as adequate for individual sanitary systems on said lot 14, 15, 16, 17 of Sand Lake Subdivision No. 2. Yours truly, CPT ER E�,I RING SERVICES . Cutler, P. E. /L. S. llale L. Cutter No. 1904-E Klunicipality of Anchorage Development Services Department • Building Safety Division ` On -Site Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL 011 2 FOR A SINGLE FAMILY DWELLING Parcel I.D. — t an COSA# HA 09 01 d' 1. GENERAL INFORMATION Expiration Date: q 3 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address SAND LAKE N2• BLOCK 6 LOT 17 8318 WILCOX STREET • ANCHORAGE AK * 99502 KIM HOWARD Day phone 720-8428 8318 WILCOX STREET • ANCHORAGE AK • 99502 BETH SIMPSON W/ KELLER WILLIAMS Day phone Day phone 727-8445 101 W BENSON BLVD #503 • ANCHORAGE AK • 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well (� Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site (! Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) sale, 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 riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SURE 101 ' ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 5 o ,17 Engineer's Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines d Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance ofthe system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTO. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any otherperson or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the Mowing `,t��Unuu ,fir QPM........• yo,. ON-SITE ,__.WATERAND •: R': Attachments: COSA Checklist Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitra Adviso"/Ap Other / By: Original Certificate Date: 0 �_ taw. nAsi Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SAND LAKE #2• BLOCK 6, LOT 17 Parcel ID: 011-63.26 A. WELL DATA *ASSUMED BASED ON SURROUNDING WELL LOGS. SEE ATTACHED. Well type PRNATE If A, B, or C provide PWSID# N/A Well Log (YIN) YES Date completed 1/20/1978 Sanitary seal (YIN) YES Total depth 294 ft. Cased to •40+ ft. FROM WELL LOG Date of test 1/20/1976 Static water level 100 ft. Wires properly protected (YIN) YES Casing height (above ground) 12+ in. AT INSPECTION 5/11/2009 .137 ft. Well production 5 9•P•m• 2.9 g.p.m. WATER SAMPLE RESULTS: Coliform —_ 4- colonies/100 ml. Nitrate N-0 mg./L. Other bacteria 46 colonies/100 ml. Arsenic: 32 ��ug./L. Date of sample: 5/11/2009 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date Installed 9/20/1977 Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 5/11/2009 Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATABELOW EX STING GRADE Date installed 9/20/1977 Soil rating (g.p.d./Wo /bd 85 System type DEEP TRENCH Length 20 ft. Width 3 ft. Gravel below pipe 6 ft. Total depth •6.6 ft. EH. absorption area 320 ft' Monitoring tube "'YES Depression over field NO Date of adequacy test 5/11/2009 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 110 in. Water added 460 gal. New depth 26 in. Elapsed Time: 1075 min. Final fluid depth10 in. Absorption rate >= 450+ g,p.d. Any rejuvenation treatment (past 12 mo.) (YIN 8 type) NONE KNOWN If yes, give date — ••MONTIORING TUBE EXTENDS 6.5 FEET BELOW INVERT. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump ofr' level at High water alarm level Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot •95' On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Sewer /septic service line 25'+ Animal containment areas 50'+ Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 55+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 100+ Surface water 100'+ Driveway, parking/vehicle storage "'•0' Curtain drain NONE KNOWN Wells on adjacent lots "90' F. COMMENTS "PER EXISTING WAIVER. #WR050108. **PER EXISTING WAIVER (AMMENDED). #WR930065 '•*6" OF INSULATION UNDER DRIVEWAY 1990 HAA. G. ENGINEER'S CERTIFICATION I certify that I 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. Engineer's Printed Name JEFFREY A. GARNESS Date 51�t,/0 i 00 COSA Fee Qom_ Waiver Fee $ Date of Payment ✓ 2O7 Date of Payment Receipt Number12072-0 Receipt Number (Rev. 11/05) Municipality of Anchorage .• 46 • Development Services Department Building Safety Division -! On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # HA090146 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 6, Lot 17 of Sand Lake #2 Subdivision. This inspection revealed an arsenic concentration of 32.7 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.or /og nsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. ✓�.. ✓a 6w.I •J•1J 11\V✓LJ�1 If'IL. vlJll'1 1\LR• CJI Lot 7 Lot 9 x r J 4 .+»oma r.oe I Lot to I I N89a55'00"W 135.00 I SCALE: 1`= 30' I N89e55'00"Wrt3M. I Wt 16 I EASEMENTS OF RECORD. MIER THAN `•%jr_q ZHOSESHOWN ONYHERECORDED 11-30-oS PLAT ARE NOT SHOWN HEREON. 8EP to CD 0 0 0 0 CD Z 30 I 1 8293K A$rBUILT NO CORNERS SETTHIS DATE I fly oar* 1Mt I have va��Lot 1�7 E3bIrmpacbOn dc of ma kn&*iDg dosermed.DtOpatY' Sand Lake Subdivision NO.�y— krp aw,a tt shorted Vzf*W aro wivdn the propotty Ines and do not ovow or oneb0ach an me wwarty Vat; adjacent V*mto. mot no kror"narrks onto pmWV oeb„B agnnt ff a to Wvaed, txb me prenrses in quesam and that mere are ro toadweri- lmlmatlssi 6"05 or M' i vtsete easetaoM on said pmpady exmpt as Ybdceted Dated at Andarage. Alaska I this 29th doy of NEaooS FRED WALAM 6 ASSOCIATES Eminears and sufy"M tuIRL V.UZ T 91 )1� dt, d. \ Municipality of Anchorage • -- Development Services Department �•�""..:e j Building Safety Division ` i Onsite Water and Wastewater Program s 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/o6she (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 011-133-20 COSA # Nara) - Expiration Date: 3 - .2 7 - O 1. GENERAL INFORMATION Complete legal description SAND LAKE #2 BLK 6 LOT 17 Location (site address) 8318 WILCOX ST, ANCHORAGE, AK 99502 Current Property owner(s) TIMOTHY M. MARKOWITZ Day phone Mailing address 8318 WILCOX STREEET, ANCHORAGE, AK 99502 Lending agency Day phone Mailing address Real Estate Agent BECKY BREWER / PRUDENTIAL Day phone 301.4750 Mailing Address 3801 CENTERPOINT DR., ANCHORAGE, AK 99503 Unless otherwise requested, COSA will be held by DSD forpickup(2aul TALL Jkh 2. NUMBER OF BEDROOMS: 3� 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well✓❑ Individual On-site Q Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -She Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of Onsite Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample resufts. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Certificate of Ons to 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. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Watkins Engineering, Inc. Phone 907-349-1851 Address P.O. Box 110443• Anchorage. AK 99511.0443 Engineer's Printed Name Cindy W. Ellis, P.E. Date l Z - Z0 - O (O 49TH', 6. DSD SIGNATURE a WA CindVW. Oki V10 Approved for bedrooms. Zy CE.1osn Disapproved. '9Pq�E� .... Conditional approval for bedrooms, with the following sbpu Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: L.Z. - 2-7-06 (R« IM) Municipality of Anchorage Development Services Department Building Safety Division Onsite Water 6 Wastewater Program 4700 Bragaw Street P.O. Box 198850 Anchorage, AK 995188850 www.muni.orglonslte (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SAND LAKE i2 SLK 8 LOT 17 Parcel ID: 011-13320 A. WELL DATA Well type PRI It A. B. or C provide PWSID # _ Well Log (YIN) YES Date completed 1n011978 Sanitary sea[ (YIN) YES Wires properly proteded (YIN) YES Total depth 294 ft. Cased to 294 ft. FROM WELL LOG Date of test 1n0/1978 Static water level 100 ft. Wap production 5 g.p.m. WATER SAMPLE RESULTS: Coliform 0 cobnie0W ml Nitrate 421 mg/L Arsenic; 31.8' mg/I Date of sample: 11130/08' B. 8EPTICIHOLDING TANK DATA Casing height (above ground) 18+ in. AT INSPECTION 1211/2006 137 ft. 3.8 g.p.m. Other bacteria 0' colonies/100 mL Collected by: Cindy Ems Tank Typ"Werial STEEL SEPTIC TANK Data installed 9/2011977 Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (Y" YES Depression over tank (YIN) NO High water alarm (YIN) WA Date of pumping 11=2005 Pumper Northtand Pumping C. ABSORPTION FIELD DATA Date installed 9120/1977 Soil rating (g.p•dAe or ft=Ibdmt) 85 System type DEEP TRENCH Length 20 ft. Width 3 ft. Gravel below pipe 8 ft. Total depth 8.7" ft. ER. absorption area 320 fe Monitoring tube Yes" Depression over field No Oft of adequacy test 1211/2008 Results (PasWail) Pass For 3 bedrooms Fluid depth in absorption field before teat 0" tn. Water added618.3 gal. New depth 1.0" kr. Elapsed Time: 30 min. Final fluid depth 0 in. Absorption rete >• 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN 6 type) NO If yes. give date D. UFT STATION Date loataned N 'Pump on' level at _ in. Datum E. SEPARATION DISTANCES Site in gallons 'Pump our level at _ in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankilift station on lot 99 waiver Absorption field on lot 112 Public sewer main 100+ Sewer hteptic service Me 80 Manhole/Aoeess (VIN) High water alarm level at Meets starm & dreult rawremenb7 On adjacent late 100+ On adjacent kits 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Animal containment areas 100+ Manurelaninal excrete storage areas 100+ SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 22 Property line 10 Absorption field 10 Water main 100+ Water service line 64 Surface water 100+ Wells on adjacent kits 100+ in. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property Una 10 Building foundation 40 Water main 100+ Water Service line 65 Surface water 100+ Driveway, padriglvehide sbxW 0 insulated Curtain drain NA Wells on adjacent lots 95 waiver F. COMMENTS: 'Initial OB beat result 15 colonies. Repeat on 12h3105 result: 0 colonies. Arsenic results are before Vestment. Arsenic level an& basin, ent unit is <0.005. "Monitoring tube extends 3.64 ktto drainneld. Waivers for tank on subject lot tD well, well on Lot 7 Bilk 7 to drainfield on subject lot pending for Lot 8, Blk 7. O. ENGINEER'S CERTIFICATION I carry that I have delermined through field inspections and review of Municipal records that Me above systems are in conformance with MOA COSH guidelines in effect on dds date. Engineer's Printed Name Cindy W. Ellis, P.E. Date l2 - W ,D(o COSA Fee E C4 30 Waiver Fee $ _ Date of Payment 431 �� Date of Payment Receipt Number 339!' Receipt Number, (Rev. 71Am 49jd* W. Ellis Municipality of Anchorage ,.. .. • i` Development Services Department ° t •n4 Building Safety Division ' s• vrr On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # 060602 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 6, Lot 17 of Sand Lake 02 Subdivision. This inspection revealed an arsenic concentration of 31.6 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.or onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. SCS ReEN 1066961001 Client Name Watkins Engineering Project Name/a Sand Lake No 213 6 L 17 Client Sample ID Untreated Matrix Drinking Watcr PWSID 0 Sample Remarks All Dates/rimcs are Alaska Standard Time Printed Date?ime 12/08/2006 9:46 Collected Datcfrime 11/302006 14:00 Received Dsterrime 11/302006 14:20 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Mcdw Container ID Limits Date Date Init Metals by ICP/MS Arsenic 31.6 • 5.00 ug(L EP200.8 Waters Department Nitrate -N ND 0.100 mg/L EPA 353.2 Microbioloav Laborato C (<10) 12/04/06 12/07/06 Mll D (<10) Total Coliform 15OD. oColi coVI00mL SM209222B A (<I) /�'SClY� DYL lZ-/3 W/ D 14 k14 reat-, w& -(c>- 11/30/06 1DS 11/30/06 DPT 12-20-06;15:06 ; Please inform the client if OB ' count exceeds 10. r.. SGS/Cl i Drinking Water,Analysis Rppori READ IN=ucnoNB oN FhVP,RBE BEFbMtou ;907 561 5301 # 2/ 2 200 W. PO DRhIE,; r , ANCHORAGE• ..`t Te1:907S622Y19.'r.'c; < L Fax f • _ • • , • ` . �' tab Ref No. r• 7btal-Wif6rm-Bacterq' 1067254 1�119��1��� i n -MUST BE COMPLETED BY WATE 64PPUER ' ' ' '• e • Q PUBLIC WATER eYSMi IDI 'APRNATE WATER BYSTFJII Be,d Ream' rad I noloa a" ar- . N� 7 � Cl lis �' o rg9g3 -;t.......... jacterioloolcal Water Analvala Record! ' E) Ber d Reap i. tiise a hvoke. •..� ...,,.. SAMPLE COLLECTION: SAMPLETYPE: Data IZ (3 12.0 E3 Oho Utine 13 Trcatcd Water TO HE COMPLETED BY LABORATORY Samofe Recelvtnu: _ I DS -VI -Low Nbprrso& •• Fusulb mrybe unnlabb Q eq Nou[WANjr _ , •• ❑ . RUSH SAMPLE. t, Phona,th • Fax tk Received By. ME.(/ Comments .. ...............................................................:............. ....:.......:....................:.......... -;t.......... jacterioloolcal Water Analvala Record! ' IDADEC: MMb;aIUG IpZN RBSULTs. 'ANC'•FBK AN •.•�,• 'AA0,%ls Bailin: Jai Total C06M •DaWThI, MatylC ' rte. rr ... ' E Colt • • r.. . Senibt7e.n+[.,, •• Analytical Method: Y•• JAMBRANE FILTERRESULTS/ • Phoned t_t Fa dCr •• Olred Caerb Cobnb4t00at Dal • ' rt; Membrane.Filer•. VaMlntlon: • • .• .. s • wlil» . �` MMO•MUG- (P/A) wA.b►•. L*' ; , n D Sadsfactory, ' ,,.,... { o Uni4factory f r� • TRC •T..Ww�w MCr.1• IOn.om. Reported By. Datefl7me: i .- )-s .a C&V owft • •, Fomf#FWOCS3 1707103 SGS Ref.M 1066961002 CllentName Watkins Engineering Project Name/N Sand Lake No 2 B 6 L 17 Client Sample ID Treated - Arsenic hlatrit Drinking Water PIVSID 0 Samplc Remarks: All Dates/times are Alaska Standard Time Printed DateMme 12/08/2006 9:46 Collected Date/time 11/30/2006 14:00 Received Date/time 11/30/1006 14:20 Technical Director Stephen C. Ede Allowable Rep Analysis Parameter Results PQL Units WOW Container ID Limits Date Date Init Metals by ICP/M3 Arsenic ND 5.00 ug(L EP200.8 A (<I0) 12/04/0612/07/06 Mil �f ..P�Ct�feci �Uate r Municipality of Anchorage Development Services Department Building Safety Division Onsite Water 8 Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. fi���� HAA# b5Dlp3K 1. GENERAL INFORMATION Expiration Date: .:Uci -'1dQ Complete legal description SANDLAKE N2. LOT 17, BLOCK 6. Location (site address or directions) 8318 WILCOX • ANCHORAGE. AK 99502 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address LINDA ZAREMBA Day phone CALL AGENT 8318 WILCOX • ANCHORAGE. AK 99502 Day phone FAWN LAWRENCE w/ PRUDENTIAL J.W. Day phone 222-5322 3801 CENTERPOINT DRIVE #200 • ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As cerfilied 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 riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Finn GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SURE 101 * ANCHORAGE. AK 99507 Engineers Printed Name JEFFREY A. GARNESS, P.E. Engineers Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines 6 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the fest, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefil of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will R confer any legal right whatsoever. 5. DSD SIGNATURE Approved for *23 bedrooms. Disapproved. Conditional approval for bedrooms, with the flowing Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev. flgl) 337-6179 Date 1',i !S10S —�— Arsenic Advisory Manitenance Agreements Supplemental Engineer's Reort Other 1 Original Certificate Date: •, t ON-SITE •: la/a3lolm Municipality of Anchorage Development Services Department ` Building Safety Division Onsite Water & Wastewater Program , 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ek.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: SANDLAKE #2; LOT 17, BLOCK 6. Parcel ID: 011-133-20 A. WELL DATA Well type PRIVATE 1 cG If A, B, or C provide PWSID# N/A Date completed `Q/20/1978 Sanitary seal (Y/N) YES Total depth 294 R. Cased to 294 ft. FROM WELL LOG Date of test V20/1978 Static water level 100 R. Well production 5 — g -p.m -WATER SAMPLE RESULTS: Coofonn 0 ootonies/100 mi. Nitrate 0.1 mg./L. Well Log (Y/N) YES Wires property protected (YM) YES Casing height (above ground) 12+ In. AT INSPECTION 12/5/2005 140 R. 4 g.p.m. Other bacteria 8 colonies/100 ml. Arsenio: N/A mg./L. Date of sample: 12/5/2005 Collected by: GEG. LtO. B. SEPTICIHOLDING TANK DATA IT M Tank Type/Material GREER / STEEL Date installed 't/20/1977 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation deanout (Y/N) YES Depression over tank (YM)N9 High water alarm (Y/N) N/A Date of pumping 12/5/2005 Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATA Date Installed 872071977 Soil rating (g.p.d./ft'ort bd 85 System type DEEP TRENCH Length 20 ft. Width 3 R. Gravel below pipe 8 ft. Total depth *8.67 ft. Etf. absorption area 320 R' Monitoring tube "YES Depression over field NO Date of adequacy test 12/5/2005 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test DRY in. Water added 1590gal. New depth 8 in. Elapsed Time: 1290 min. Final fluid depth DRY In. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) NONE KNOWN If yes, give date **MONITORING TUBE EXTENDS 6.5 FEET BELOW INVERT D. LIFT STATION Date Installed "Pump on" level at _in. E. SEPARATION DISTANCES Sae in gallons High water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAlft station on lot *95' Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage "0' Curtain drain NONE KNOWN Wells on adjacent lots "90' F. COMMENTS *SEE ATTACHED WAIVER REQUEST ••6" OF INSULATION UNDER DRIVEWAY PER 1990 HAA G. ENGINEER'S CERTIFICATION I cerdy that I 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. Engineer's Printed Name JEFFREY A. GARNESS Date 171 1m 6 COSA Fee S Q Date of Payment c-5 Receipt Number LA (Rev. 12101) IBM Waiver Fee $ Date of Payment _L L`rC5 Receipt Number % 14 Municipality of Anchorage Development Services Department / Building Safety Division - On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # 050635 During a recent Certificate of On -Site Systems Approval inspection and test of the potable water supply well on Block 6, Lot 17 of SandL.ake #2 subdivision, an arsenic concentration of 29.2 micrograms per liter (ug/L) was reported for the property's water well sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private well 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/onsit ) or at 343- 7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. ,Pec .21.�2005 1 0:56AM&E ESGarness Ens ineer ins Group. Ltd..301 —SW SCSRCU 1057994001 Clint Name Gamess Engineering Grove, LUL ProjeetNameN Water Samples Clint Sample W Sand Lake SD Lot 17 Block 6 Matrix Drinking Water PWSW 0 T-30 0.13 6 E8 IP. 1 All DatnMmrs are Alasla Staotlard Time PrWcd Date/Time 12202005 9.29 Collected Datemme 12/052005 16:15 1leeeiyedDaternme 12106200514.00 Tec►akalDimtor Step6eaGTde Sample Remarks: Allowabk hep Analysis Para lew xaw b ?OL linin Medwd Conan lU L:aia Dun Oato mit Nitrato-N < 0.1000 0.100 mjIL PPA353.2 8 ("101 IZIM5 1C Metalvby ZCVIM9 Annie 293 5.00 Werablology Laboratory Total Coliform 1011. No Coli valL 6P200.8 12108/0512114105 TK coV)OumL SM209=1 A (41) 12106'05 TIF 1Dec.21•�2005 10:57AMzEEsGarness Eng ineer ins Group..Ltd '-301 . "S V 6GSI'CT&E ENVIRONMENTAL SERVICES Drinking Water Analysts Report for Total Coliform Baicteria RPM M5TRUCT9m ON REVTR-.E we w om CAtLwnwO Lmopu MUST BE COMPLETED BY WATER EuPKM p MMX WATER MTFM MW — — — — — — ❑ MWATE WATBR mTgI SAMPLE COLLECTION: rr.w� . MP•r.r�.-.ate'�... Date% ❑ 9" Rw+M SAMPLE TYPE T-36:No•13666 P• 2 TO. 907-SB2.2US,- I = 907.5615301 mnsea pswa(nrf, –91wlna ❑ Treated Wake TrarspaW . to tan 9Y_ ❑ Saone as c0I19C pr Ober. TO BE COMPLETED BY LABORATORY sample ReeelAntp Date: Tane:_(4to Temp: S4X- Delivery Method H ftQ Rm&ved Bmr.7,a� r- Q Repeat sample ❑ Untroated Water (rotor to lab rw 1 E) Special Purpose ❑ s.wpmtiew 7e nw.. eM; [] RUSH SAMPLE rift^ my ba wimomm ❑ a rwwwr.w Monet. .. .- Fax* .............................................................................................................................................. Ana"k tta0aa:. IZ "r 4sw An*ot: %r7 Ahab*&[ McOWW. -Mmrbmns rirw MMO•MUO (PIA) Reportod By. MM044UC WIN REALM TOW Cook m: E txg MEMBRANE FILYM RESULT& OYwGene mbde4n06nl VaMnaac No carer. • �L RGa $wdbAOM NIC FOX Adl a' Swe b 05wt Phoned O I'mad ❑ Dowtirw— spe*&.a Satlsfactory Unsatisfactory iNie+TrlYw.rtM q•re Datamb! 4.?%/ / L Forma FW DO,S3 12117)07 WwtlnasolVWK GmaipDaaWu Fwm 1217033M DEC -01-2005 13:15 PRUDENTIAL VISTA REAL EST 907 562 5465 P.02 � LDt1a Lot 7 I N89a55'00"W 135.00 Lot a Lot 9 N89°55'owTvv—t35-.m 0 0 0 0 0 CD Z 30 8293K AS-BUII-T NO CORNERS SET THIS DATE �...� I hereby certify Mat I Ileve perfartned a •e IrmDactbn otltb foiwA descr®ed_PoperH Lot 17 ck 6 SCALE. 1'= 30' � Sand Lake Subdlvfslon No 0� d �iEj ImpnovaneMs olWated Hereat are within the property lnrs *`' apd,ddoo not overlap or ena�nas.ch�On ftM"B PDWV � y � ,�4�arti�aM N ed}econt tt roto. Mat no Ww voornontys on MB V T $� tiod edjaront them wcroadt on Me prnnimes h q mk n std d4� aS � ,p rim Met Hero m.: ere no roadways. tralsb- leen tr dtw i d visele easenw os on said property " F9 as Ndcated at EASEMENTS OF RECORD. OTHER THAN V,�aoe 2 e.a�ey otN�2oo5 V. s� IMSESHOWN ON7HERECORDED 11 -3o -OS- FRED WAtATKA&ASSOCwTFS PLAT ARE NOT SHOWN HEREON. BEP ac - Englr~s and Surveyors GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS December 13, 2005 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Waiver Request for Sand Lake #2; Lot 17, Block 6, The existing 3 bedroom house is served by a private well and septic system. During our site visit to perform a well and septic system evaluation for the purpose of obtaining a Certificate of On- site System Approval (COSA) we noted that on the subject lot the separation distance from the well to the first septic tank pipe is 99 feet. We request you grant a 95 foot separation distance waiver from the well on the lot to the septic tank on the lot. The existing waiver for the separation distance from the well on Lot 7, Block 7, of Sand Lake #2 to the drainfield on Lot 17, Block 6, of Sand Lake #2 is approved for 97 feet. We have measured it to be 95.5 feet and are requesting that it be amended to a separation distance of 94 feet. The following items are justification for the waiver: The lots are generally flat in the area. The house is in between the well and the septic system on the subject lot. If the septic system was to overflow, it appears that the effluent would not travel toward the well head. The location of the septic system is in a very visible area so that if any effluent was to surface, it would be noticed and the problem corrected. The other path of contamination is subsurface migration of wastewater if the tank should begin to leak. As can be seen on the attached well logs, the aquifer is relatively deep. The well depths range from 265421, with water being encountered at the bottom of the well. The static water levels range from 85-130 feet, which are surrounded by clay, sand, and gravel that have served to inhibit the migration of untreated wastewater into the aquifer. Recent water sample results indicated nitrate levels to be 0.1 mg/L and coliform bacteria results to be 8 OB with no coliform. Based upon the aforementioned facts, it appears that there is minimal risk associated with granting the requested waivers. The well that serves Lot 8, Block 7; Sand Lake #2 was drilled on October 2, 1978, and the septic system that serves Lot 17, Block 6, Sand Lake #2 was installed on 9/20/1977. It is our understanding that the property owner of Lot 8, Block 7; Sand Lake #2 is responsible for the waiver fees. 3701 E. Tudor Road, Suite 101 *Anchorage, AK 99507 Ph: (907) 337-6179' Fax: (907) 338-3246 * Website: garnessengineering.com If you have ;c y questions, please contact us at 337-6179. Thank you for your assistance. P.E., M.S. 3701 E. Tudor Road, Suite 101 ' Anchorage, AK 99507 Ph: (907) 337-6179' Fax: (907) 338-3246' Website: gamessengineering.com SAND LAKE /2; LOT 20, BLOCK 6, SAND LAKE /2; LOT 16, BLOCK S. SAND LAKE /2; LOT 15, / BLOCK 6, / SAND LAKE /2; LOT 14, BLOCK 6, SAND LAKE /2; LOT S. BLOCK 7, SAND LAKE A LOT 6, BLOCK 7, SAND LAKE /2; LOT 7. BLACK 7, SAND LAKE /2; LOT 6, BLOCK 7, \ SAROAKE:K ; LOT 9. \ SAND LAKE /2; LOT 10, \ BLOCK 7, GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS MI L NdOMZ MI N • MOW ClOn3T1 IN • PX (rOfj�" � ANG wwp.wpl—M�^ PREPARED FOR: PHONE NUMBER: PACE NUMBER: LINDA ZAREMBA 602-882-4195 1 OF 1 LEGAL DESCRIPTION: DRAWN BY: SAND LAKE #2: LOT 17, BLOCK 6, B.F.M. MC OF WORK- DATE: R WAIVER PACKAGE (R". mros) 12/1 SAND LAKE /2; LOT 11, filimm M ON LOT 17, EXISTING 3 SAND LAKE /2; LOT 19,AS INSTALLED BEDROOM BLOCK 6, WELL ON LOT =RESPONSABIUTY HOME 7, R IS THE SPONSABIUIY TOHE WAVER e �.\ -7 — EXISTING 1000 / GALLON TANK SAND LAKE LOT 16, BLOCK 6, � I � � I � SAND LAKE /2; LOT 16, BLOCK S. SAND LAKE /2; LOT 15, / BLOCK 6, / SAND LAKE /2; LOT 14, BLOCK 6, SAND LAKE /2; LOT S. BLOCK 7, SAND LAKE A LOT 6, BLOCK 7, SAND LAKE /2; LOT 7. BLACK 7, SAND LAKE /2; LOT 6, BLOCK 7, \ SAROAKE:K ; LOT 9. \ SAND LAKE /2; LOT 10, \ BLOCK 7, GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS MI L NdOMZ MI N • MOW ClOn3T1 IN • PX (rOfj�" � ANG wwp.wpl—M�^ PREPARED FOR: PHONE NUMBER: PACE NUMBER: LINDA ZAREMBA 602-882-4195 1 OF 1 LEGAL DESCRIPTION: DRAWN BY: SAND LAKE #2: LOT 17, BLOCK 6, B.F.M. MC OF WORK- DATE: R WAIVER PACKAGE (R". mros) 12/1 SAND LAKE /2; LOT 11, filimm EXISTING 3 BEDROOM 1 HOME SAND LAKE /2; LOT 16, BLOCK S. SAND LAKE /2; LOT 15, / BLOCK 6, / SAND LAKE /2; LOT 14, BLOCK 6, SAND LAKE /2; LOT S. BLOCK 7, SAND LAKE A LOT 6, BLOCK 7, SAND LAKE /2; LOT 7. BLACK 7, SAND LAKE /2; LOT 6, BLOCK 7, \ SAROAKE:K ; LOT 9. \ SAND LAKE /2; LOT 10, \ BLOCK 7, GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS MI L NdOMZ MI N • MOW ClOn3T1 IN • PX (rOfj�" � ANG wwp.wpl—M�^ PREPARED FOR: PHONE NUMBER: PACE NUMBER: LINDA ZAREMBA 602-882-4195 1 OF 1 LEGAL DESCRIPTION: DRAWN BY: SAND LAKE #2: LOT 17, BLOCK 6, B.F.M. MC OF WORK- DATE: R WAIVER PACKAGE (R". mros) 12/1 SAND LAKE /2; LOT 11, filimm 0 AkAt!k 2 Mayor Mark Begich Municipality of Anchorage P.O. Nn 19Ck)50 • A1Mhom9c, Alaska 9D.i19.6CZ0 • Tcicphmc (907) 31:t&'101 • ra%(907)31.3-82(X) 470011mWaw Stud • Anchnmge, Ahi.ka 99.07 %m .munl.org Ilull(iing Safety Division 12/23/2005 Gamess Engineering Group 3701 East Tudor Road, Suite 101 Anchorage, Alaska 99507 Subject: Waiver Request for Sand Lake #2 Subdivision, Block 6, Lot 17 Waiver Request #WR050108 Parcel ID #011-133-20 COSA# HA050635 Dear Mr. Gamess, Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the private well has been approved. The approved separation distance is 95.0 feet. This waiver approval applies to the existing septic tank to private well 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 343-7904. Sincerely, �tA.YW�o- Julie Makela, P.E. Civil Engineer On -Site Water & Wastewater Program Community, Security, Prosperity Municipality of Anchorage t,.F= Development Services Department , f+ r Building Safety Division On-Sitc Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchoragc.ak.us (907)343-7904 Waiver Review Worksheet WR#: 050108 PID#:011-133-20 HAM 050835 Permit#: Date Received: 12/1512005 Legal Description: Sand Lake #2 Subdivision Block 8 Lot 17 Engineer. Garness Enpineerlon Group Applicant: Linda Zaremba Waiver Requested: 95 feet from well to septic tank on subiect lot Criteria: Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Points: %.0 4.5 a. a r2 3 02.0;� Total: r9_4 ...................................................................6866........ Waiver is Granted: _Leff�: List Conditions or Reasons for above: Waiver is not Granted: Date: 1,21,291ala-6 By: i Of A l — ame of Reviewer ............................................................................. 15 Rec#: 74580 Amount: $920.00 Date Paid:12/902005 Sand Lake #2 Subdivision, Block 6, Lot 17 Parcel ID: 011-133-20 Waiver for 95 feet from septic tank to well Issued December 22, 2005 General 1. Total coliform and nitrates were not detected for the water sample collected from the well on the subject lot. An other bacteria concentration of 8 colonies per 100 milliliters was reported for the water sample. 2. The well on the subject property was installed on January 20, 1978 at a total depth of 294 feet. The well is cased to a depth of 294 feet. The well log for this property and other surrounding properties identifies numerous layers of clay with gravel and clay. 3. The existing septic tank on the subject property was installed on September 20, 1977. The septic tank is constructed of steel with a total depth of approximately 10 feet below the ground surface. 4. Due to lot size and location of septic systems and water wells on surrounding properties, there does not apear to be an area on the subject property to meet the current minimum separation requirements for a wastewater disposal system or water well. ADEC Criteria Points Water Table 8.0 Depth of water bearing zone in well 291 feet Assumed bottom of septic tank -10 feet 281 feet x=181/190+7.0 x=8.0 Soil Sorption 4.5 Soil descriptions from well log for subject property Gravel 0 - 60 feet Clay 60 -120 feet Clay with gravel 120 -190 feet Clay 190 - 280 feet Clay with gravel 280 - 291 feet (50/281 x 0) + (60/281 x 6.0) + (70/281 x 4.5) + (90/281 x 6.0) + (11/281 x 4.5) Permeability 2.2 Soil descriptions from well log for subject property Gravel 0 - 60 feet Clay 60 -120 feet Clay with gravel 120 -190 feet Clay 190 - 280 feet Clay with gravel 280 - 291 feet (50/281 x 0) + (60/281 x 3.0) + (70/281 x 2.0) + (90/281 x 3.0) + (11/281 x 2.0) Water Table Gradient 2.9 Subject area is relatively flat Assume 0% slope Horizontal Separation 2.8 95 feet between septic tank and well x=20/25+2.0 x=2.8 Total Points 20.4 As per ADEC waiver guidelines a point value of 20.4 is almost sure to be free of any form of contamination from household sewage. MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES w� 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. # C"11 \ - � 11'_;TAC) HAA # ` QQ LL-\ �z 1. GENERAL INFORMATION Complete legal description hof l7� (3foc� 6� Sante GakC ##2 Location (site address or directions) 031/8 Wet co Property owner Ml c h ae l f Cone; e k'l rch"r Day phone S61- YS YO Mailing address 88 YO 13421)�v Crc.(6 14k 9-93- o P - Lending agency 61w rtorfquge - Uletrr[n 6;:p.r-ref Day phone 363 -07elo Mailing address h'oS w 36 f`' �uP J f}nchv�avc i4k 9953 Agent t3ar6ctre, an /'16(r >'on Reed 1=s%fC Day phone 2 Y6 - Zeay Address 2 &oy W. hfor f!i [r') AIllbr `9 [ Ak 993-(7 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 -"' U� 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 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 #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 F'IaFfoP T,echaica / Serve' ,er Phone 3 YS_- 35.5— Address 1 HS3 D .cclw St.. Al) cAoferc , Ak 99S-16, Engineer's signature ��""` _ Date_maZ y ? 199a 0 A4 114 Jr y • . • n • S.k76Y •jo s+ .......................... : THEODORE F. MOORE ,•� 1/'i CE - 3589 j n' 6. D� SIGNATURE #� 14'Awms�^a"�°'a Approved for bedrooms. Disapproved. 0 Ccnditional approval for bedrooms, with the following stipulations: Additional Comments NdTE : The ews /-t Well on AoFj 7 and a R/a�t2 7, Sal& hake 112 SID-, Ins Palled draln)�('efd on mg/ef rP iPs1 than f -he ,Sefback GCu{rence of /ao' Date L— 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. 1/91) Back MOA x21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:Lo � B1,k 61 SAku LAKE # Z Parcel LD A. WELL DATA Well type •PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number N,k DATGT OF Log present (Y/N) y Date completed ro/z°(78 �oGDwe"r`NDriller ill i d l e Total depth 2,1q Cased to 29y Casing height I`I Sanitary seal (Y/N) y /J,p4 vt - -5 /0 FROM WELT Date of test 6[20/78 78 [ ��- �7 64 Static water level I ° o G }, � 01/ J Well flow 5 I)�� 1 J I �/ AM l/ e Pump level .- SEPARATION DISTANCES FROM WEL i Se tic/holdin tank on lot J02 �>Ue 1 / c/" �/% A/711 P 9 Nov Absorption field on lot W1, r, C 96 G Public sewer main > /00, (_/_1 g 6 Sewer service line 7S' -- - _ WATER SAMPLE RESULTS: Coliform O cal /1GCJ nt.Q Ni Date of sample: 7 /7/q 2 -7116-1, /00' S EPV E b :ria O co/,/ raom.( a T6C{4. S✓Cs, B. SEPTIC/HOLDING TANK DATA Date installed -71201-77 Tank size 1000 GAS Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) y Depression (Y/N) N High water alarm (Y/N) N.A - Alarm tested (Y/N) NA . Date of pumping 7Ol z Pumper Is A,4 CC SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 10.2' On adjacent lots �> /00 Foundation 2.,q- To .sTo property line 12 Absorption field 10 Water main/service line >50 Surface water/drainage > /O° 72-026 (Rev. list) Front CONTINUED ON BACK PAGE m �3 PO Oz i rn c - r Fri z� rn N �� _ -.. w cn O C `z y 2 N 20 " m Z /00' S EPV E b :ria O co/,/ raom.( a T6C{4. S✓Cs, B. SEPTIC/HOLDING TANK DATA Date installed -71201-77 Tank size 1000 GAS Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) y Depression (Y/N) N High water alarm (Y/N) N.A - Alarm tested (Y/N) NA . Date of pumping 7Ol z Pumper Is A,4 CC SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 10.2' On adjacent lots �> /00 Foundation 2.,q- To .sTo property line 12 Absorption field 10 Water main/service line >50 Surface water/drainage > /O° 72-026 (Rev. list) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed _ Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off' level at Cycles tested — Surface water _ Date installed 9(20/7-7 Soil rating SS a'13PRM _System type-rRt,^rcft Length 20 --Width Gravel thickness Total absorption area 3-70 13 Cleanouts present (Y/N) Depression over field (Y/N) Results (pass/fail) Total depth Y Date of adequacy test 7 /Ib /9Z for Peroxide treatment (past 12 months) (Y/N) N0�4C 1<40VN If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: q-7' a q9' To we"LLs Well on lot 119 On adjacent lots Eor i �s> RJ_k '7 -Property line IS To building foundation W2 t To existing or abandoned systern on lot N.A' On adjacent lots 5 0 Cutbank N .A Water main/service line_ _ i70 Surface water >/''o Driveway, parki g/vehicle storage area 7R6NCH VltDER p,� r✓SWAY �194o rl,A•A. REPOQ'rED 6" rNs✓�Arw•.(� Curtaindrain ryaµe; 03see✓c-P E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Nor5: fps report ct co 1990 an t 1969 H -AA cer'hficafel✓ the rlrk%,nFiea c.o, rS 97' from -fh(1 we Il on 1.7,rr 87 aAoC 93' ;Cron the well oil 1_0,, Gofh cue11� QrE eCr1tleri a1 Fcr fh<J trench inS�e+llafrbn, r +4,�•OF At" Signature gne'e c �,�y1v°; •° "`.' a,° Engineer's Name 714 eoololy F Moore Date —7(A 11Y 2 2 /9'9 e HAA Fee $ / 70 00 Date of Payment ;7_—_-2_ ,5 - `l Z - Receipt Number n-/ /.? 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number m �y d �, d' °• `yam � *: 49 ,(y} • _L •se••°°e aeeese•/as%eeee •.•�e. �. a •ee eeeeeee eex 7eeeseee el• '. THEODORE F. RAopRE ' e a `�5,•° Ct -3589 10" 0 a"�r •. 4 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. # 9,4 / - / 33 — 20 HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) /7 66 Sa,,J /zAe 4 z 7-/�2N 2y'� sio Location (address or directions) (b) Property,i-)W'. r Mailing`°Addtess"° ♦. 1l {.E�`y i..V.3.. (c) Lending Institution - Mailing Address (d) Real Estate Company and Agent (';�e Telephone: (home) Business276 -.Sj?p5p Telephone Address 2-466 Co roloya ��o�ayc f%t 7?J-0.7 Telephone 6276— o2 %6� (e) Mail the HAA to the following address: (or check hereX,, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family,j Number of bedrooms_ 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 th legality and status. 4. SEWAGE DISPOSAL On-site;'9 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 m �Q�GSc Telephone '2 Telephone /r� Firm �1 Address 0 D Date GJ�lG�j /j2S 6e-ert +'*.VA%,4f% OF A j e0 ��• QTIN Engial �•••ou•••••♦ •••••••••••••Y IEWY imo, �'#�prolC$$Io���s�♦ 6. DHHS APPROVAL � � bedrooms b ` 4,;v -ate /2 Approved for Y Approved \ Disapprove Conditional Terms of Conditional Approval Nvi`e:Tie exlff�K/ cre/� off lots ,-g e� BIA7 jz c/ 2zje aa? �e�e lns7z//e!/ Su�s�j�0- �ID 4e 01ra/A4e o„ 7V/ J- /o7'a,,d ae-e less 74 e- 7yie !'e7vlpeLl S��arafrc 0,{. /oo' 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 MUNICIPALITY OF ANCHORAGE • T 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. # O/ Z33 — Zd HAA # v\ q- q- '�) 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) 41764 Sa,d Lade Z Location (addressor directions)..' 8 ��S` `✓ C -.)C ;?y (b) Property owner FFG Telephone: (home) Business 2?ZC/0 . Mailing Address (c) Lending Institution n Mailing Address Telephone (d) Real Estate Company and Agent rD-a42 x Address 2-c'00 404-4u,2 f}n.� Telephone (e) Mail the HAA to the following address: (or check herd if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single -Family Number of bedrooms 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 th legality and status. 4. SEWAGE DISPOSAL On-site 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 4eZs7-t"c Telephone a 7g5r S 'rS Address SIJ s2So0 6 4�r a� Date PAI .Agq 0� . rN *. "a, 6. DHHS-APPROVAL �� Approved for bedrooms by Dates' Approved --- Disapproved Conditional Terms of Conditional Approval lVorc Te ex/srin? W& 11r oh /Q 7--r 7a...�18 o>' -el, 7 '!� were %llsTa�l«� Su6Sc�uc�Y Ta Tic 7-ILZ v�uis-�� S jd� Ya Tian oL' ldD `• 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 forerrors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 A. WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) • Health Authority Approval (HAA) R MUNICIPAQIW"M{T)RF BRUARY 1984 ENVIRONMENTAL SERVIC0044 Legal Description: /117 " �'`a A.;4 0 � _6 APR 1 0 1994 V ± A-, u: Ae If A, B, C, D.E.C. Approved (Y/N)�/� Well Log PresentV/N) Date Completed 1' w-o?r Yield SG (5; 0? - Total Depth 4`7 Cased to P�W Depth of Grouting ._ Static Water Level /-S-) Casing Height Above Ground Electrical Wiring in Conduit &N) SEPARATION DISTANCES FROM WELL Pump Set At Sanitary Seal on Casing&N) Depression Around Wellhead (Ye) To Septic/Holding Tank on Lot /no / ; On Adjoining Lots f6071/ To Nearest Edge of Absorption Field on Lot �66 i ; On Adjoining Lots /DOr� To Nearest Public Sewer Line A�4 To Nearest Public Sewer Cleanout/ManholeA�,'1- To Nearest Sewer Service Line on Lot 2J`? Water Sample Collected by L %tee d ; Date/x/98 Water Sample Test Results ,Qs — A -/Y-2 4-r ND Comments B. SEPTIC/HOLDING TANK DATA Date Installed -Z4' 7 Size 1000 No. of Compartments 7 Standpipes6%N) Air -tight CapsVjl/N) Foundation Cleanout&qN) Depression over Tank (Y9 Date Last Pumped s'�}°"'�q-Zsascs. Pumping/Maintenance Contact on File (Y/N) � ; for AV-49- Holding JCAHolding Tank High-Water,AJarm (Y/N) Temporary Holding Tank Permit (Y/N) SEPARATION DISTANbES%FROM SEPTIC/HOLDING TANK: To Water'-Supply'To Building Foundation To Property Line rf/ To Disposal Field /b To Water Maiih/Seryice:bne l"ar / .. / To Stream,:Pond, L�, e.or Major Drainage Course /oo s Comments /�{eL;CAE A CCS -06 z✓e 72-026 (Rev. 7/88) From Page 1 of 2 C. ABSORPTION FIELD DATA , Soils Rating in Absorption Strata r Type of System Design Date Installed Z6 �7 ? Length of Field Width of Field Depth of Field d i Gravel Bed Thickness Square Feet of Absortion Area Statndpipes Present ON) Depression over Field (Y/1 / Date of Last Adequacy Test��P $ i Results of Last Adequacy Test �W r4 SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well /DOr'/ To Property Line /b To Building Foundation �� To Existing or Abandoned System on Lot n3/4 ; On Adjoining Lots > Zo / To Water Main/Service Line Z__� iTo Cutback (if present) A4_ To Stream, Pond, Lake, or Major Drainage Course Z D / To Driveway, Parking Area, or Vehicle Storage Area 7--1 i u- Comments Itt /9 tr f . &tc-k rI7'{iVmX28% Jw,� �S � 7�e L �C�a.. Pte/ Tz� 4,14 • Au Ae err//ccs ap'1i4e- 74;;(( s 7re,� �o//r7�7u, Tem Oe D. LIFT STATION Date Ins'taUed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y Comments Dimensions Manhole/Access (Y/N) "Pump Off' L� "Check Permitted Bedroom Rating Against HAA Request" nt (Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked ified, or confo med to all MOA and HAA guidelines�pn the date of this inspection. Signed Company Date /v ° �• �,✓.ee.. 4er's Seal MOA No. two -o© Receipt No.� Date of Payment Amount: $ / 20 e6n 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 anee oeae�eoo+�eee se°uig ' s 8Y C. REID, J . fl > ° GE+2251 ` ~ V Delta vl�� 4%.-- 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. # I - i.'13 -_')G HAA # 11 Sq LQ) ^2 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Z,67-17 $�oCK sold E. A`i T;z.✓ niliJ Location (address or directioca g."..= F-3/8 GJ/LGax "_rC r4+A64�l�GiH98'yMy=4i ��^RY% (b) Property owner Ae 41914Jb �!s�A�eE Telephone: (home) Business 276.5399 Mailing Address (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone yl ao Co'eha✓,+ 7�76— 7-76 / Z"AX 5-av "P7" (e) Mail the HAA to the following address: (or check here K if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single -Family Number of bedrooms 3 3. WATER SUPPLY Individual Well$ Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site, 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 xEcj Address i��v IJ jj Date S -3o -X7 Telephone Alew Z"7f—S>i�� Ae • C. RM A g)peer s Seal#*J�*%so CE .2251 ,*,* Ar 6. DHHS APPROVAL _ r Approved for 3 bedrooms by A!�Date _ /Z -gO/ Approved X Disapproved Conditional Terms of Conditional Approval NOTE: The existing wells on Lots 7 and 8 Block 7 Sand Lake #2 S/D installedsubsequentto the drainfield on this lot are less than the required setback distance of 100 feet. 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 ,Ly Qx ox P�\cp A � MUNICIPALITY OF ANCHORAGE (MOA) a JHealth Authority Approval (HAA) �\��� �� S CHECKLIST -FEBRUARY 1984 , ` 343-4744 Legal Description: �T /7 BOK �O S� GAKEZ Ta.✓ ,edt,) 7,6e— /o A. WELL DATA Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Present `7/N) Date Completed—� —7� Yield r Total Depth Zi Cased to Z9� Depth of Grouting X A Static Water Level /3S Pump Set At Ab i Casing Height Above Ground / Sanitary Seal on Casing&N) Electrical Wiring in Conduit &N) Depression Around Wellhead (YO SEPARATION DISTANCES FROM WELL: r � To Septic/Holding Tank on Lot �� ; On Adjoining Lots /� To Nearest Edge of Absorption Field on Lot /&V t" ; On Adjoining Lots To Nearest Public Sewer Line N To Nearest Public Sewer Cleanout/Manhole r To Nearest Sewer Service Line on Lot Water Sample Collected by iEECS /• A46V Date Water Sample Test Results B/te-T Comments A)lezr , hi'J Ts 7- 3 —7-7- , B. SEPTIC/HOLDING TANK DATA Date Installed'Size /070 No. of Compartments Z_ Standpipes&N) Air -tight CapsoYN) Foundation Cleanout&N) Depression over Tank (YON Date Last Pumped S �89 lAf# e S Pumping/Maintenance Contact on File (Y/N) ��� ; for HoIding�T rtl ftigi Wa Alarm (Y/N) — --Temporary Holding Tank Permit (Y/N) SEP _ is �, To7tSuPP:ella'.: •vr�8mrxs»ar+at, •v To ,roperty Lin '�v 0l�riif9�fl4.ki TRS®✓•0 bay To WateT,!oMainY,Serv(ce tin6as , To Stre,'d�I,,Ropd,�I-MG&A Comments SEPTIC/HOLDING TANK: Drainage Course To Building Foundation To Disposal Field 010 /t 72-026 (Rev. 7/88) Front Page 1 _ of 2 40 / U C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �S Type of System Design c� Date Installed / -u - Length of Field 7-0 Width of Field J Depth of Field /0 Gravel Bed Thickness U Square Feet of Absortion Area Statndpipes Present(!9N) 17,487- &F Depression over Field (Y/6) Date of Last Adequacy Test Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well To Property Line To Building Foundation 3S _IA-_ To Existing -or -Abandoned System on._ ` Lot A On Adloming Lots To Water Main/Service Line YS To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course 7� To Driveway, Parking Area, or Vehicle Storage Area TXE✓cd 1?A6e d,Zn45-t✓01 - to IAOSWL/4711a✓ o✓ER 7XIV7 ehl, Comments %M/w 97 661H rJE&L- &;tf 1-7 B 7 Ax/Ib 95' fRe,A7 tJEcG 6,A -,- rj� 217 SA uh LAtfv' -4z . 3e7# or- 7hi-5F tJEiLs �Xlusb Acrr?Q 77//s T,WV iJs7a1LAr10*1 D. LIFT STATION Date n 44ed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at �` �: "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for _ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N), Comments "Check Permitted Bedroom Rating Against HAA Request" I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in Nffgq in the date of this inspection. ®F %% SignedE . (�L/i�-- �►�+°���•eeeet�.9t� Company S j� �Fl% 8.446:•: Y En's Seal Date •.••• ••e . . Q d A No. . GOP O OY C. REID, J p ®` CE - 2251 °°e°°°•e••°ee0 Receipt No. �` `�/ Receipt No.®��role3llu�'��rn Date of Payment — Waiver Fee: $ Amount: $ Z - o Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 rpt_. i i t -;F /A IY L fi t:4 r%rX DEPARTME[, OF HEALTH AND ENVIRONMENT, , IECTION ' 825 'L Street, Anchoraor?. Alasa 99501 I �l 2.64-4720 Date Received: April 4, 1978 #1: Time 2:30 p.m. #2: Time #3: Time Date 4-5-78 Wed Date Date Insp Pratt Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Coast Mortgage Company Mailing Address: 4797 Business Park Boulevard Phone: 279-0665 2. Property Owner: Alan W. Hannon _ Phone: 344-7491 Mailing Address: 2611 Guam__ 3. Legal Description: Lot 17 Block 6 Sand Lake Subdivision #2 2nd house on Wilcox on the right, green in colour 4: Single Family Residence: (x) Number of Bedrooms: Three Multiple Family Residence: ( ) Number of Bedrooms: 5. Well System: Individual Well (x) Community/Public System ( ) Permit -# Depth of Well 294' Well Log on File (x) Construction Bacterial Analysis 6. Sewage Disposal System: On --site System (x) Public Utility ( ) Permit # Installed 1977 Installer Septic_ Tank Size /op p Manufactures Absorption Area 3;X a Soils Rate Material f � 7. Distances: Well to Septic Tank to Sewer Line Nearest Lot line to Nearest Lot Line to Absorption Area Absorption Area 0 Page 7=,ao Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 17 Block 6 Sand Lake Subdivision #2" Comments: Affadavit Attached: Letter Attached: ( ) Approved: y�" Date: 44 Disapproved: Date: Department Worksheet: s` M -09P 0 Z66l ; 0d`J 11Vw IMM IM31N1 80d ION __-- I L61 'jdV (apes J8y40 ea5)—0301A08d 30tlUM 33NVdnSN1 UN ""' W+Od Sd 31V0 NO MMISOd .................................... (Palnbe+ ae} 04XG) AHM-130 1tl103dS _ aQg .—.—""..... """"' AINO 33SS3NOOV 01 83A1134 098 ""'.""" AIUO aessaippe 01 AIaAIIaP 44% S3 IMS O56 " PBJBA!Igp BJ84M PUB 0499 'w04M 01 SM04S 'Z 1d1303N Ogg ----- AjUO aassaippe 01 AiaAllap 4AM Nunn.5I _.......... Pajemjap alep_pue w_oyM of sM04S 'l S33A WN011100tl X03 S301AN35 3VN011d0 3000 dIZ ONV 3J TS '"0"d 'ON (INV 133815 01 AM (aze;sod snld) +)OC—JJVW 03131JUJU dU.1 1d11d.1U 0 -1h F1 00 -' MUNICIPALITY OF ANCHORAGL e Department of Health and Environmental Protection d.; I 825 L Street, Anchorage, Alaska 99501 264-4720 quest for Approval of Individual Sewer and Water Facilities 1. Property owner: rJt Anf 11v AIII)II11 67111 Mailing Address: Phone: 3Ci II -7 `1 % 2. Name of Buyer: A`ff/v 7'i I-1 /19 L % Phone: V oN� Mailing Address: �ILG0i< 5T/1'L � 3. 4. Lending Institution: X13 �6A G L Mailing Address: Realtor/Agent : 7/_N/VL 2 /'1146 G,7 c-✓ A f-,/ Mailing Address: Phone: Phone: 5. Legal Description: X07 % % - /3Loc k 6 2L, SCJ ��� ok (N /r C_ C 0 i� ST I3 GL % _ �~� _ L c Street Location: � 6. Single Family Residence: (U')/' Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: 7. Water Supply:_. *Individual Well (✓) Public/Community System ( ) If Individual Well, well depth a 9 If Community System, name of system 8. Sewage Disposal System: *1On-site System ( Public System ( ) If On-site System, date of installation: —Z 7 *NOTE: A well log is required on ALL wells drilled since 6/75. **If on-site sewer system is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77