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HomeMy WebLinkAboutSAND LAKE #2 BLK 6 LT 20ao � MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & 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 UPGRADE MAI ING ADDRESS LEGAL DESCRIPTION L�-tti z LOCATION Lot C( n t) i? a r.1 D NO. OF BEDROOMS 1_3 Uy DISTANCE TO: Well �jpT ( Absorption area Dwelling �,5�(� PERMITO. a~. Q UJ I.- Manufacturer Materi No.'Jcompartments 0 Lie. capaci�y6 g6 ns VV-- IF HOMEMADE: Inside length .�_ Width Ligyiid-depth 6 DISTANC Well Dwelling PERMIT NO. ` C 2 F Man turer aterla _ apacity in gallons o w= ' DISTANCE TO: Well ND Z ( Foundation Z9.0 Nearest lot line r - z PERMIT NO. J LL z Z w No. of lin eS Long of each li e t Total length of lines (� Trench width - inches Distance bet on lines 1,,3 �-[[ cc F- O Top of the to finish grade , Material beneath tilep7-Total -imehes effective a sorption area w Length Width Depth PERMIT NO. U Q I- as W Type of crib 15rib de th Total e e absor tion area - -� W ISTANCE TO: Buildin found Nearest lot line - J J ss Depth Driller Distance to lot line PERMIT NO. 0 w � DISTANCE TO: Building foundation Sewer line - Septic tank Absorption area(s) OTHER I PIPE MATERIALS SOIL TEST RATING �S INSTALLERa REMARKS o -( ,Zm at I h b r/ D o f l L• APPROVED DATE LEGAL '(/7 Lao 6 C 72-013 13/78) DEPFIRTNEP•dT HEALTH AND EPd'v' I RCtP� MENTAL. OTECi' I CIPS li c eS- :T)*:EET, AP,It-HORAISE, A4::. -='-'`='F-iJ_ Al' LY?CE1aS pp yy ¢g p�,p Ir q g''' �v ® m- _ 264-4720 g-�• 14 @ @�-,_ q T_ _ g,,��, @ 'g' _ 0.J4 C...... G_.... 9 ': I -J C., 1.3 L� -A -....... _E" 1 ...T- g-- v.«:e° C:. � 1 "•i! IL..._ ll'•_a 2 v � 9 ....' 2 °� .N_ PERMIT P-40. r: 810800 BXIO-1682 345-2." APPLICANT E�:At-R-.•r 1- k -')O LOCATION I.JILCO'r:; :_._P•dG:' LEGAL L_ 0 B6 SAP DLAKE LOT IEE � afi=� t=tt-tAf::E FF' 'f TYPE OF SOIL ABSORPTION sYsTEC'1 I S : TRENCH C'1A;>;IP1i_thi NUMBER OF PEEFiCp'�- ._ -SOIL. RATING (SID FT/BR):= THE REQUIRED S I2 E OF THE SOIL ABSORPTION -TEM IS: t- IF-_ _T, F-4 L__ EE P-1 r_i'T ie - %. _. L.- I - THE. LENGTH DIMENSION I '['HE LENGTH (IP• -t FEET::' OF 'THE TREVICH OR E:tRAINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWE'E N 'THE SURFACE OF 'THE GROUND D AP•dD THE BOTTOM OF THE EXCAVATION ':!N FEET). THERE IS NO SET [-lT 'TH FOE". TRENCHES. THE GRAVEL DEPTH I THEE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTF't=TL.L. PIPE FIND 'THE BOTTOM OF THE. E. --`CA .'AT I ON (IN FEET). FE F"T- PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM M THIS DEPARTMENT NT DURII' G THE INSTALLATION I P•d'S,F'EC:T I ON OF' AP -JY WELI.._'S, ADJACENT •TCI THIS PROPERTY AND THE NUMBER OF RES. I DENCE: THAT 'THE WELL WILL 'SERVEE. I P- F F=" EF_ C:- -g-. I CH r -1- iii �a F �, �_ � � � �W CIA BACKFILLING OF' AP•d'r S•'r'STEI'1 WITHOUT FINAL INSPECTION AP';ID APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DI_;TANC:E BETWEEN A WELL AND ANY ON—SITE SEkIAGE DISPOSAL S4"STE7M IS :100 FEET FOP' A PRIVATE WELL OR 150 'TO Cio FEET FROM A PUBLIC WELL. F-)EPE.P• D I P• G UPON THE TYPE OF PUBLIC: WELL. MINIMUM DISTANCE FROM A PRI'v'ATE kIELL. To A F'RIVFiTE SE14ER LINE IS•".'= FEET AND fo A C:OP4P'1t_NITY _;EWER LINE I=; 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT W I TH I P•d 4_i DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLIT SPEC I F I CAT I CaNS AP•dD C:C'Pd'=;"fR}_IC:T i CII'd DIAGRAMS ARE AVAILABLE TCI I P•dSURE PROPER I P• STALLAT I Or 1. F=" U F-- rl 1 ___ E-" ' E.. ,, E: -e E a u 1E ✓ ^: -:_ _: T _ _:L I CERTIFY THA"f SET .1_ : I AM FAP'1 I L- I AR N I TE I THE REI !Lt I F:E'P'1E PdT S FOR ON—SITE -EEdC.F" : APANDL1EL.L ,ry: t IT; FORTH BY THE C'1UPd:E C i PAL I TY OF ANCHORAGE. : I WILL. INSTALL THE: SYSTEM IN ACCORDANCE WITH THE CODES. I UNDERSTAND THAT THE OPd--SITE SEWER SYSTEM MAY REQUIRE RESIDENCE IS REMODELED TO INCLUDE MORE: THAN ' BEDROOMS. APF'L_ I CAP 1- ' C'AP•dP•dY CAROL—AND <a t ISSUED BYq;tZ= ENLARGEMENT IF THE }� SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION O PERCOLATION • TEST Pouch 6650, Anchorage, Alaska 99502 276.2221 SOILS LOG — PERCOLATION TEST PERFORMED FOR: l+'s�� D L > h!t2 /%%fZJ_=/15 %"-�/V T6 DATE PERFORMED: aL !9. f g � LEGAL DESCRIPTION: /.r9% /C/ D �•�r /�/�Dal C��./�-1-(,�' �f�[�3�Aj _ SLOPE SITE PLAN l4)RJ)7'02'pw— DEPTH 1 %® AP 5`` tO / L 0,6,+.47 i%t�& 3 v. . i Gross 4- Depth to Net Reading Date Time Time Water Drop 5 5 of r, 0 p •: 6 ` • j ' A 7 0`� i 8 9 10 •q+� e tl •� �e 12-1 13 O' • �� 14OF r G15- 060004 16 fid. ,� � C%.• •• 7a goo 17 ip. FRe Earl R. Barnard 18 �Q ��•. 754E 19 ���6�•pR0rESs�o�� WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? S Aldo I L O P E 20 I I PERCOLATION RATE (minutes/inch) u TEST RUN BETWE••ENN FT AND FT COMMENT42 S '9 �/1 %�p ` ��a ! % AA A !� ��/QM IeAJ� l�l`L.AF X2 PERFORMED BY: 72-008 (7/76) CERTIFIED BY:. Gross Net Depth to Net Reading Date Time Time Water Drop i 20 I I PERCOLATION RATE (minutes/inch) u TEST RUN BETWE••ENN FT AND FT COMMENT42 S '9 �/1 %�p ` ��a ! % AA A !� ��/QM IeAJ� l�l`L.AF X2 PERFORMED BY: 72-008 (7/76) CERTIFIED BY:. Gross Net Depth to Net Reading Date Time Time Water Drop 20 I I PERCOLATION RATE (minutes/inch) u TEST RUN BETWE••ENN FT AND FT COMMENT42 S '9 �/1 %�p ` ��a ! % AA A !� ��/QM IeAJ� l�l`L.AF X2 PERFORMED BY: 72-008 (7/76) CERTIFIED BY:. "Ju 41kKq i Ir W. W • ®• MU NICIP DEPTLITY OF ANCHORAGE �! ENVIRONMEOE ;;. Water Well Drilling TAI P'OT_CTION Nv Phone 349-3809 1 Anchorage, AK. 2 Well Owner'.), ''I . �r '(=1 ;. T l �,.,_,•,, Well Location (fx `A, "£ r f/ Size Casing Depth of Hole ` Static Water Levelo=•f. > feet Well Test ` Date,of Completion WELL LOG RECEIVED Date / Phone Cased to Gal per Minute for AUTHORIZATION TO DRILL I hereby authorize W.W.D. Drilling to proceed with the above work. Payment shall be made in the following manner: Rig up Minimum (50% of anticipated depth) feet. @ per foot Balance due upon completion. In the event it is necessary to institute legal proceedings to collect any amounts due on this contract, I agree to pay an additional sum of Ten percent (10%) of the original contract price as attorney's fees, plus costs, for legal proceedings. Name Date Address feet Hours WSW.D. i Water Well Drilling Phone 349-3809 Anchorage, AK. Well Owner Well Location MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PT. OF HEALTH g P,';OTECTION 2 2 �og2 s RECEIVED Date �� -•%L i— 'f Phone Size Casing „ Depth of Hole a2 65 , Cased to �0 J ' feet Static Water Level /aS feet Well Test Gal per Minute for % Hours Date of Completion �D /�9_� WELL LOG .CLt-t.c..Q�-� • � teJ�t.�...r.-of+h� .de,ll�i .;,,e...'; , .2D ��•S �- 5 .o i cam► 2 �: V : AUTHORIZATION TO DRILL I hereby authorize W.W.D. Drilling to proceed with the above work. Payment shall be made in the following manner: Rig up Minimum (50% of anticipated depth) feet. @ per foot Balance due upon completion. In the event it is necessary to institute legal proceedings to collect any amounts due on this contract, I agree to pay an additional sum of Ten percent (10°/a) of the original contract price as attorney's fees, plus costs, for legal proceedings, Name Date Address a i r AUTHORIZATION TO DRILL I hereby authorize W.W.D. Drilling to proceed with the above work. Payment shall be made in the following manner: Rig up Minimum (50% of anticipated depth) feet. @ per foot Balance due upon completion. In the event it is necessary to institute legal proceedings to collect any amounts due on this contract, I agree to pay an additional sum of Ten percent (10°/a) of the original contract price as attorney's fees, plus costs, for legal proceedings, Name Date Address Y co et tp SGS - 4JW J j w a zJ J � � � ` = a co W I 0 $ v w t ,r; I Y aMp � C i �, �,. ° Municipality of Anchorag On -Site Water & Wastewater Program x (907)343-7904 01 -f nl0y o 2 2015 CERTIFICATE OF ON-SITE SYSTEMS Parcel I.D. 011-133-17 Expiration Date: 1. GENERAL INFORMATION Complete legal description SAND LAKE #2; BLOCK 6, LOT 20 Location (site address) Current Property owner(s) Mailing address Real Estate Agent 8244 WILCOX STREET *ANCHORAGE, AK 99502 CURTIS WILLIAMS Day phone 245-1261 8244 WILCOX STREET *ANCHORAGE, AK 99502 ' Day'phone 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ WaiverlVanance request for: N/A Distance: — Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 521(0 - Waiver Fee $ Date of Payment 1 1/7l* Date of Payment Receipt Number CbJ5" GL Receipt Number COSA # o5 151 % of Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site Water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. i further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Address GARNESS ENGINEERING GROUP, Ltd. 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG provided an engmeenng evaluation of the well an&brseptic system in accordance with the guidelines end regulations established by the Municipally a Anchorage and industrypractims. The reporfedres ifs describe the condition of the systom/s on the canals of the evaluation. Separalkn distances were measured to roadpyidentifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operationallife of all wefts and septic systems depend on a variety of vadablesincluding, but not limited to, sal conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the famiy utilizing the syslews. These conditions can vary, and are outside the control of GEG. Satisfadwy lest results do riot guarantee futureperformance of the sysfemis, therefore, GEG makes no womanly (express w implied) regarding the future performance onhe well aseptic system. GEG makes no representation whether an alternative well or septic system can be insfalled on the propedyin the event odbarofthe commit systems fad. The confenf stills report is for the sae benefit of the personviudy who retained GEG. Reliance now the information provided in this report by any ofher person orparty, including but not limited to subsequent propedypurchasers is net authorized. In shat, GEG disavows any legal duty to anyone other than the persoalpady, who paid for this report. 6. DSD SIGNATURE -) System #1 Approved for bedrooms. M System #2 Approved for Disapproved. Conditional approval for i bedrooms. Phone 337-6179 Date 11 7_ J_ bedrooms, with the following stipulations: n h.....11 �. ?ROFESSI� IA Ab 114 1110, 11 fA Aria kh.4m rf fA cf S fico I � 04 Art Original Certficate Date: The municipality or Anchorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The MunicipalrYy of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist I -- Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other (Rev. 10112/12) /AW If more than 1 septic system Is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: SAND LAKE #2; LOT 20, BLOCK 6 Date of test Parcel ID: 011-133-17 Static water level its xqIs -_ A. WELL DATA Well production 200 y,p,m, *ORIGINALLY DRILLED TO 205' ON 10/21/1981, DEEPENED ON 1/11/1982 Well type PRIVATE If A, B, or C provide PWSID# N ZA Date completed *1/11/1982 Sanitary seal (Y/N) YES Total depth 401 ft. Cased to 205+ ft, WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 10/8/2015 6.2 g.p.m. Collected by: GEG. Ltd. Arsenic[,"_Lqlug./L. Date of sample: l0/7/2015 B. SEPTIC/HOLDING TANK DATA ISTEEL SEPTIC TANK IS APPROACHING THE END OF ITS USEFUL LIFE TankType/Material SEPTIC/STEEL Date installed 10/7/1981 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (YM) YES Depression over tank (Y/N) NO High water alarm (YM) N/A Date of pumping 9/22/2015 pumperMCDONALD'S PUMPING SERVICE C. ABSORPTION FIELD DATA*BELOW EXISTING GRADE TO BOTTOM OF SU P Date installed 10/7/1981 Soil rating (g.p.d./ieo /bd 85 System type TRENCH Length 30 . ft. Width 4-8 ft. Gravel below pipe 5 ft. Total depth *7.6+ ft. Eff. absorption area 300 fe Monitoring tube**YES Depression over field NO Datsofadequacytest 10/14/2015 Results(Pass/Fall) PASS For 3 bedrooms Fluid depth in absorption field before test **0 in. Water addedl,193 gal. New depth **0 in. Elapsed Time: 0' min. Final fluid depth **0 in. Absorption rate >= 450+ g,p,d, Any rejuvenation treatment (past 12 mo.) (YM & type) NONE If yes, give date **SUMP ONLY EXTENDS 42 INCHES BELOW INVERT OF LATERAL. FROM WELL -LOG Date of test 1/11/1982 Static water level its xqIs -_ 8. Wgj�o Well production 200 y,p,m, WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 10/8/2015 6.2 g.p.m. Collected by: GEG. Ltd. Arsenic[,"_Lqlug./L. Date of sample: l0/7/2015 B. SEPTIC/HOLDING TANK DATA ISTEEL SEPTIC TANK IS APPROACHING THE END OF ITS USEFUL LIFE TankType/Material SEPTIC/STEEL Date installed 10/7/1981 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (YM) YES Depression over tank (Y/N) NO High water alarm (YM) N/A Date of pumping 9/22/2015 pumperMCDONALD'S PUMPING SERVICE C. ABSORPTION FIELD DATA*BELOW EXISTING GRADE TO BOTTOM OF SU P Date installed 10/7/1981 Soil rating (g.p.d./ieo /bd 85 System type TRENCH Length 30 . ft. Width 4-8 ft. Gravel below pipe 5 ft. Total depth *7.6+ ft. Eff. absorption area 300 fe Monitoring tube**YES Depression over field NO Datsofadequacytest 10/14/2015 Results(Pass/Fall) PASS For 3 bedrooms Fluid depth in absorption field before test **0 in. Water addedl,193 gal. New depth **0 in. Elapsed Time: 0' min. Final fluid depth **0 in. Absorption rate >= 450+ g,p,d, Any rejuvenation treatment (past 12 mo.) (YM & type) NONE If yes, give date **SUMP ONLY EXTENDS 42 INCHES BELOW INVERT OF LATERAL. D. LIFT STATION Date installed Size in gallons Manhole/Access (W/N "Pump:on" level at in. "Pump off" High water alarm level at Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots *90'+ .�w &VgAe-� Absorption field on lot 100'+On adjacent lots 100'+ V3W Public sewer main Sewer /septic service line Public sewer manhole/cleanout Holding tank N/A 100'+ 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 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line **4'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 2'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *WR0300061 **PER 10/7/1981 MOA INSPECTION REPORT 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 COSH guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date I I I j (Rev. 11105) ... . ........... y Ga ness,: CE 3 ,•'. 4�napro f es sioro�c Municipality of Anchorage 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 # OSC151609 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 20 of Sand Lake #2 Subdivision. This. inspection revealed an arsenic concentration of 28.9 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.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. 14 13 24 23 2 21 20 17 16 15 14 13 r �1-aL. � C o ; 5• 11 �. �1k " 14 WEST 82nd AVENU V n II�' 1 2� ( / 2 �3 �v. 3/" 3/83 77 w ✓ 9 �0\ o � 131 ( I 1k 21A ALASKA WATER AND WASTEWATER CONSULTANTS, INC. 6901 DEBARR ROAD. SUITE. 28. ANCHORAGE, AK, 99004 PHONE (907) 337-6179/FAX: (907) 336-3246 3AL DESCRIPTION: SAND LAKE SUBDIVISION (F2; LOTS 18 & 19, BLOCK 6 DE OF WORK: SITE PLAN FOR WAIVER REQUESTS EPAREO FOR: PHONE NUMBER: GERALDINE AUSTERMUHL (907) 344-0506 D': DRAWN BY: PACE 12/20/99 K.T.W./J.L.M. 1 1 = 100' 1 OF 2 A. Mtmicipality of Anchorage Department of Health and Human Services WAR 825 "L" Street Rick Mystrom. P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor htip://www.ci.anchorage.ak. us 343-4744 January 6, 2000 Jeffrey A. Garness, PE Alaska Water & Wastewater Consultants, Inc. 6901 DeBarr Road, Suite 2B Anchorage, Alaska 99594 Re: Waiver Request For Lots 18/19 Block 6 Sand Lake #2 Subdivision, Waiver Request Number WR990101, P.I.D. 011-133-49 Dear Mr. Garness: Your request for waiver of the required 100 feet horizontal separation from a private well to an on-site wastewater disposal system has been approved. The approved separations are as follows: 1. The on -lot well to septic tanks on Lots 6, 7, 18 & 20 Block 6 Sand Lake #2 Subd. of 92, 78, 65 & 90 feet respectively; 2. The on -lot well to wastewater absorption fields on Lots 18/19 Block 6 and Lots 6 & 7 Block 7 Sand Lake #2 Subd. of 90, 95 & 93 feet respectively. This waiver approval applies to the existing on -lot water well to septic systems separations only. Any upgrades to any of these items will require all separations be met or another waiver approval from this office. Sincerely, C/ / ; Daniel J. Rob Civil Engineer On -Site Services Program a MUNICIPALI`.CY OF ANCHORAGE Department of Health and Human Services on-site services Section Waiver Review Worksheet WR# Rg99ntn1 PIU# A11�133_�i9 _ HA# 11A990j_a _.. Permit #_! , Date Received: December 27,_19999 Legal Description: Sand -- Engineer: Alaska Water &,Wastewater Conenlranrs —__ 6901 Debarr Road, Suite 2A An_aharage, AK gg504 --- � Applicant: Geraldine Ay`ermub�^ — -- Waiver Requested: A blanket 65. feet frnm rhe ura11 tQ all ennrnnnhj ig-4ap4;;L„- b: a 0!1 feta. *&u to all eReE eaeh+ng'draitfields. Criteria: 1. Geology: Points: A: Water Table — B. Soil Sorption _— C. Permeability -- D. Water Table Gradient -- E. Horizontal Separation — TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: -..>< Waiver is NOT Granted: List Conditions. or Reasons for. above: �JE4 I¢TA i/ -f, V — Date : I - By: Rec #: 05490 — Amount: $_gg0.nn ^ Date Paid: ,a.��T-- yX f L t � +jr 4 f �U• x'I &Y11 Lf1`/3 slb'f u ){ OSS Nv7'i Welk - nccir. Linky+ _SPCC y C 5 "a isaeaea � ' r '_ 4a 7 20uood� A ti s 41l ss sa ..� 1f.s..�...a.. a .. �• �:v ..� .. «...� �14�..J�.ia: aJ�f�i ��+ AF .i 8 u er al+�U de'sr is i'ldBA�a iYl Conc. Blk T'I,nds';10n �I -ice `.� Municipality of Anchorage Development Services Department Building Safety Division On -Site Water 8 Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904476, C CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 011-133-17 HAA# D2 J 15� 1. GENERAL INFORMATION Expiration Date: Complete legal description SAND LAKE SUBDIVISION #2: LOT 20, BLOCK 6 ❑ Individual Holding tank Location (site address or directions) 8244 WILCOX DRIVE * ANCHORAGE. AK 99502 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address WENDY WHITE Day phone 248-5546 8244 WILCOX DRIVE * ANCHORAGE, AK 99502 Day phone Day phone Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 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 watei 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. 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 watei 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. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, or prior to closing for the engineering services provided. 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 Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone Address 3701. E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the 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 of the system, nor do they guarantee that there are no hidden defects or encroachments. AKW WC, inc. 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 other person or party is not authorized, nor will It confer any legal right whatsoever. S. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. 337-6179 Date Z 6 d Conditional approval for bedrooms, with the fllowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineers Reort Other By: Original Certificate Date: O 03 (Rev. 12111) Municipality of Anchorage *." • Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 South Sragaw St. P.O. Box 196650 Anchorage, AK 995196650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: SAND LAKE SUBDIVISION #2: LOT 20, BLOCK 6 Parcel ID: 011-133-17 A. WELL DATA Well type PRUATE If A, B, or C provide PWSID# N A Date completed 1/11/1982 Sanitary seal (Y/N) YES Total depth 401 ft. Cased to 401 ft. FROM WELL LOG Date of test 1/1111982 Static water level 125 ft. Well production 200 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Arsenic: N/A mgR.. B. SEPTIC/HOLDING TANK DATA Nitrate 0.1 mg./L. Well Log (YM) YES Wires properly protected (YM) YES Casing height (above ground) 18+ in. AT INSPECTION 5/28/2003 151 ft. 8.1 g.p.m. Other bacteria 0 colonies/100 mi. Date of sample: 5Z28/2003 Collected by: AKWWC Tank Type/Material STEEL Date installed 10/181 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation deanout (Y/N) —YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 7/21/03 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA Fes: 'OR—AD-El Date installed 10/7/61 Soil rating (g.p.dJftibrtj@rm85 System type TRENCH Length 30 ft. Width 4'-8 ft. Gravel below pipe 5 ft. Total depth 7.5 ft. Eff. absorption area 300 ft' Monitoring tube **YES Depression over field NO Date of adequacy test 7/29/03 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 110 in. Water added gal. New dep945.5 in Elapsed Time: 60 min. Final fluid depth 42.5 in. Absorption rate >= 450 g,p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) SEPTICLEAR If yes, give date 6/18/03 **M.T. ONLY EXTENDS 47' BELOW INVERT ***135 GALLONS WAS INTRODUCED IN 17 MINUTEST D. LIFT STATION i Date installed "Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 1008+ Public sewer main N/A Sewer /septic service line 25'+ *WAIVER REQUESTED On adjacent lots *90'+ On adjacent lots 1001+ Public sewer manhole/deanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5' Property line 5'+ Absorption field 5' Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 4' Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehide storage 1'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS DRAINFIELD IS ONLY OPERATING IN THE TOP 14% OF THE SYSTEM. G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. of a Go as: Engineers nn1e.NamA_ JEFFREY A GARNESS79 4- s,a•.......••.Dateoprofeeaw�a HAA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number (Rev. 12101) 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.d.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: SAND LAKE SUBDIVISION #2; LOT 20 BLOCK 6 Parcel ID: 011-133-17 A. WELL DATA Well type PRIVAn if A, B, or C provide PWSID# NIA Well Log (Y/N) YES Date completed 10/21 /81 Sanitary seat (YM) YES Wires properly protected (YM) YES Total depth 205 ft. Cased to 205 ft. Casing height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 10/21/81 5128/2003 Static water level 125 ft, 151 ft. Well production 1.8 g.p.m. 8.1 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Nitrate 0.1 mgA. Other bacteria 0 colonies/100 ml. Arsenic: N/A mgJL. Date of sample: 5/28/2003 Collected by: AKWWC B. SEPTICIHOLDING TANK DATA Tank TypelMaterlat STEEL Date installed 10/7/81 Tank size 1000 gal. Number of Compartments _ 2 Cleanouts (YM) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) _ O High water alarm (Y/N) N/A Date of pumping 7/21 /03 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA Date installed Ioh181 Soil rating (g.p.dJftbr bdrm 85 System type TRENCH Length , ** 30 ft. Width 4-8 ft. Gravel below pipe 5 ft. Total depth 7.5 it Eif. absorption area 300 ft Monitoring tube **YES Depression over field NO Date of adequacy test 7/21 /03 Results (Pass/Fall) PAS For 3 bedrooms Fluid depth in absorption field before test _ 35 in. Water added*135 � gal. New dept►*43'5 in. Elapsed Time: 153 min. Final fluid depth 40.5 in. Absorption rate >= 450 g,p.d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) SEPTICLEAR If yes, give date 6/18/03 **M.T. ONLY EXTENDS 43.5" BELOW INVERT ***135 GALLONS WAS INTRODUCED IN 17 MINUTESI D. LIFT STATION Date installed Size in gallons "Pump on" level at in. E. SEPARATION DISTANCES High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ j Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ 'WAIVER REQUESTED On adjacent lots +901+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5' Property line 5'+ Absorption field 5' Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 4' Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 1'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS DRAINFIELD IS ONLY OPERATING IN THE TOP 14% OF THE SYSTEM. G. ENGINEER'S CERTIFICATIONco I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in ' .' • .. ' .. ' """ • "' ... conformance with MOA HAA guidelines in effect on this date. QQ fr A. Go ness.: Engineers Printed ame JEFFREY A GARNESS 'V a —7953 �Fe� Date 7�L0 4's^sd Professlc�a �c4 HAA Fee $ 375 + 150 `RLxSh Date of Payment :2=.2-9-0.3 Receipt Number 3 Cl z z (Rev. 12101) Waiver Fee $ 1 OCID Date of Payment 7-2 9 — 0 3 Receipt Number 3 9 ;- 5%z WRO3006 JUL-28-2003 MON 1200 Ph FAX NO. P. 02 N SCALE: 1'•-30' BLK 6 1 4 i 21 i 30' I , S89.5.5•E 135.00' • Lq � —" % Wood Gravel Driveway LLJ o ir—� Porch PCC Wolk g L ,Chain Link 39.0 3'1,� to g Fence c b C.0:s Old 00 i Ir o I ' Well LOT 20 • N N DWoodeck I m p I 10 2 ; 39.0 33.3'—•� h 3 N89.55'W 135.00' to I I I I 30' ti I 19 1 -Level I Wood Frome House on Cone. Blk Foundation Recertified JULY 23, 2003 ,, I� o om raawe wyW of ft labwn PREPARED FOR: '�•'•"• Kerwin & Wendelon White ��';,••• •., �+�� LOT 20. BLOCK 6, _ rGj�• �/ SAND LAKE SUBDIVISION NO.2 .. ••••• •�• AS -BUILT YIpIpMMYp tLttW Y,tIt011 N WMIIYI h GIOpM/ •.w...•••.• awt MN do nal aYVYp a100*0cN an so ww" �• •••••• t / Mnv 0*0@0Cwtlo.Balm tnalawnoft an to vtN. arz aro / s►.�.. toraertorr J pavey ytn woeowvwm woofth m rr p«++w CR /25/03 2224 ��?,�•, Ne. 3N3•S ••' .i h 4�bn Uld to vwt M m Medns9't. twwNpbn 1071.1 No. F. 111, j= No. 11 «.••.••''• ��� a tdNah�ir�.«ewnw an wa P�aw'N doePt 2309 Notes 2339 KARABELNlKOFF Annw.oaMttta,vat25thdava-!Yj)�.20 23 SURVEYING w)3r•3at 8/4/2003 Municipality of Anchorage o ,�E•. a Mark Bcyich, Mayor Sir [Tr Building Safety Division P.O. Box 196650 • 4700 Braga«• Street Anchorage, Alaska 99519-6650 • (907) 343.8301 • Fax (907) 343-8'300 littp://i%i%-w.nittiii.org Jeffrey A. Garness, PE Alaska Water & Wastewater Consultants, Inc. 3701 East Tudor Road, Suite 101 Anchorage, Alaska 99507 Subject: Waiver Request for Sand Lake #2 Subdivision Block 6 Lot 20 Waiver Request #WR0300061 Parcel ID #011-133-17 Health Authority Approval Certificate Number HA030368 Dear Mr. Gayness: Your request for a waiver of the required 100 feet horizontal separation from the septic tank to private well has been approved. The approved separation distance is 90.0 feet. This approved separation distance is the well on the subject lot to the septic tank on the adjoining Lot 21 Block 6 Sand Lake #2 Subdivision. 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, 5 ;V) (-/ — Daniel J. Roth Civil Engineer On -Site Water & Wastewater Program 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.ci.anchorage.ak.us (907)343-7904 Waiver Review Worksheet WR#: WR030061 PID#: 011-133-17 HAM HA030368 Permitil: Date Received: 9/ 03 Legal Description: SAND LAKE #2 SUBDIVISION BLOCK 6 LOT 20 Engineer: ALASKA WATER & WASTEWATER CONSULTANTS. INC. Lr-1,271:px[�lri'P,IIt Criteria: Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Points: ............................................................................... Waiver Is Granted: X Waiver Is not Granted. List Conditions or Reasons for above: Y EE A MN 0014 E 4 Date: By: Name of Reviewer ............................................................................... Rec#: 39252 Amount: $800.00 Date Paid: 7/29/2003 WAIVER REQulElr wigtvp-x RE4ufsr F oR S IV UM8 R Wye 034O66l OLOCk g L J4/VER 14E47uEST AOlt TAt 4/47El2 WELL OAS ri-/E juBJEcT L TO TKE S'EPT/G Tfj%�VK UA/ T�.(E RDJD/Asmo& C aT 2 / BLOCk G SAND L, Aee `2 SK PO/✓/S�oA/. 5 E PT/c TPovK l9�i Tl{E S F Pr' C TANk OoV L- oT 2/ L"Qs TvasTR KcTEo /ti /4S/. i�r- S ou.Tl� F T�ivK IS Ca�v srRH c rxp /�v �9 ie f G w s a Tc.s. Tit SO/L / S IiFSC�i��rl 14 5 �'► C LE'�iv S/4N10 61?A vF J- /a .SaA,a L.J9kF' Trp/c,qLc�/ r4.e./7 loA-j �- r/-(i4r TieCAr F_ FfL a P,---7- /HFGfiT R 5'Hvie T i✓F ;- 'wF�� %fl� wRiF� wF_LL IN quFST/O,V wrtsO�,G,�ALLY a.v 2Av JAac STRacjE / 9' 82 ri-ef D� FPEa�p To 441 PM,, TI,IF of rG/.SAL !�-ELc PRique 1. -'Tc-( & 577** -1 c of 1 2S TitF OFf'REA t0 &-P-u Is Es7'i.a,g r,p TO PR apccc r/2- 000 6 1' Y, 7 (-("r /¢ Fu /4C E�? /S S ��vp L I9k E /J WELL / "&v/ AJ 4ND /S WCLL COaFiA�S0 WIC -/-r CLAY' L/4 }'Figf BETI..EF,V iT /9N+d GIQOK,v4 f kKFi4-GE /�u ExL,�St pf /U4 frE�T: f�►�Ig-rjsiQ t-AtiPLEr /Nd/C I�TF_ N o ®i4 -c TiE�er,9 1 NO /wi nCN-TEJ pF. T'F_ c 774 )3 LEI ,c!/(„K P,Q JA, Ec s- vp rKItA• TKE' r 45 frrc rA*k' /ti Q u s r/c*.� tkE ru B i 'z FL fYT/✓/� L i L � vE(, OV F ✓� �¢L,L D. F. C. 5. R W. X86 � 7io dill 0 W1ZvA1r6L SC)P.4l?4ricN V O yC L- kx/ D Ao? Gn M&T G+ -A /vE'IP .. C. RI OKiyNO TcTyI, pa I IVT.f 8.r 3.6 2.0 2.9 z/ N N N "�� l90 H N h N H C &6 /.o � X86 3.0 = l • 9'8 6 W1ZvA1r6L SC)P.4l?4ricN V O yC L- kx/ D Ao? Gn M&T G+ -A /vE'IP .. C. RI OKiyNO TcTyI, pa I IVT.f 8.r 3.6 2.0 2.9 z/ ALASKA. WATER F- WASTEWATER nu,.:,.vNxwx»nnr.a...n. CONSULTANTS, INC. *►.�xx.....^>w,�.,.:..a •n.x::.r ,. a,�n.M�w.,.�,..,x•., July 29, 2003 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Waiver Request and Health Authority Approval for Sand lake Subdivision 92; Lot 20, Block 6 The existing 3 -bedroom house is served by a private well and septic system. During evaluation, we noted that the well on the subject property is only 95.9 feet from the first compartment clean- out for the septic tank, which serves Sand Lake Subdivision #2, Lot 21, Block 6. To be conservative, we are requesting that you grant a 90 feet separation distance waiver between the subject %yell and septic tank. Justification for this waiver is summarized as follows: • The lots are generally flat. The wells for both properties are located on the west one-half of the lot. The septic systems are located on the east one-half of the properties, near Wilcox Drive. Structures lie between the well and the septic system. If the septic system on Lot 21 were to overflow it would have to run over the ground and cross the driveways for both properties in order to migrate towards the wellhead. This could not occur without getting the attention of both parties. Furthermore, based upon our evaluation of the topography, it appears that overflowing effluent Nvould not run towards the wellhead. • 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 only feasible path of contamination is subsurface migration of wastewater when the steel septic tank corrodes to such an extent that it begins to leak. Attached are well logs for a number of nearby properties. The wells are a minimum of 200 feet deep, with some being over 500 feet deep. The aquifer is very deep and protected by geological stratums of clay and sand that has served to protect restrict the flow of contaminants into the aquifer. This encroachment has for approximately 22 years, and recent water samples (from the well on Lot 20, Bk 6) indicated non- detectable nitrate levels and no bacteria. Based upon the aforementioned facts, it appears that there is minimal risk associated with granting the requested waiver. The septic system on Lot 21 was installed on 10/01/81, and the well that serves Lot 20 was drilled on 10/21/81. In short, the septic tank was in place prior to the well, so the owners of Lot 20 are liable for the waiver fees. 3701 E. Tudor Road, Suite 101 *Anchorage, AK 99507 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akw%vc.com 1NVe are requesting that this waiver and the HAA be expedited so that an established closing date can be met.T OA rush fee was submitted with this package. If you have any questions, please contact a 337-6179. Thank you for your assistance. .E., M.S. 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507 Ph: (907) 337-6179 * Fax: (907) 338-3246 ' Website: ak%mc.com SAND LAKE S/D /2 1 LOT 2, BLACK 6 SAND LAKE S/D j2 1 ' LOT 23, BLOCK 6 I I \I SAND LAKE S/D 12 I \ SAND LAKE S/D t2 /LOT 3, BLOCK 6 I \ LOT 22, BLACK 6 ' / \ 4SAND LAKE S/O #2SAND LAKE S/D 2 T 21, BLOCK 6 LOT 4, BLOCK 6 \ ^ / �� / 100 — — / ' 86 WPNER pn51S w I /� EV y W SAND NE S/D 2 1� VLDL V / LOT 5, BLOCK \ \ T 20, BLOCK LAKE CK 6 1-01/ SAND LAKE S/D /2 SANLOT 199. BLOCK LAKE S/D 62 I LOT S. BLOCK 6 v I X \ SAND LAKE 5/D J2, — /'kgD LAKE O / \ / \ LOT 7, BLOCK LOT 16, BLOCK 6 6 7/29/2003 pF qq DRAWN BY: p C!......... 4 ALASKA WATER & WASTE`VATL'R A.J.G./J.W.M. -� CONSULTANTS, INC. 1 — 40, „poo 3701 E. TUDOR ROOD. SUITE 101 • ANCHORAGE. AK 99507 • PHONE (907)337.6179 ' FAX (907U38 -32L6 PREPARED FOR: PHONE NUMBER: PACE NUMBER: WENDY WHITE 248-7586 1 OF 1 QO y LEGAL DESCRIPTION: Q op, C 79 •'��e`QQ SAND LAKE #2 LOT 20, BLOCK 6 TYPE OF WORK: uvgedP�ofesslo°°���� SITE PLAN FOR WAIVER REQUEST 4�DOfessW o ` 07/30/2003 00:01 907-348-8931 v� /offale ALASKA. WATER WASTEWA CONSULTANTS, INC. SEPTIC ADEQUACY TEST DATA LEGAL DESCRIPTION: 4Z 2V � � � �L STUET ADDRESS: CLIENT: O "4 �GL7 NUMBER OF BEDROOM: a GALLONS PER DA NEEDED: PAGE 01 SEPTIC: *SEE H.A.A. SITE VISIT CHECKLIST* DATE OF TEST: FIELD MEASURE NTS: TOP OF MT/SUMP TO BOTTOM-----------� (MT,) / TOP OF MT/SUMP TO DISTRIBUTION LINE-- (MTI) / (MT2) % STICK-UP OF MT/SUMP--.---'------------'-----'------ (MTl) / (MT2) TOP OF MT/SUMP TO LIQUID LEVEL--------- � (MTI _ (MU) ' Sr z 4j,0 RESULTS: PASSED ABSORBED GALLO SIN X00 _ MINUTES (� _GPD) FAILED - SEE ATTACHED LETTER �,//off-- 3'r x 2-7 �Ig,� rnmments- Pte. _ � :YA1 4&44.' .4�te�— : T z• , Signature: l �Date ' Ala -'9 6901 Debw Rud, Suite 2-8 - Anchomp. Aluks 99504 - Ph: (907) 337-6179 • Fuc: (907) 338-3246 • aww@(RaWOA.net J/ kff�l @a tro 01.47 taIt y ow WAN NIEUM Em Mm . l 1�I�� �mjfflr�-�����taiT' Sr z 4j,0 RESULTS: PASSED ABSORBED GALLO SIN X00 _ MINUTES (� _GPD) FAILED - SEE ATTACHED LETTER �,//off-- 3'r x 2-7 �Ig,� rnmments- Pte. _ � :YA1 4&44.' .4�te�— : T z• , Signature: l �Date ' Ala -'9 6901 Debw Rud, Suite 2-8 - Anchomp. Aluks 99504 - Ph: (907) 337-6179 • Fuc: (907) 338-3246 • aww@(RaWOA.net J/ `TlrW Time ne N y c7C,c�� StR°tA Date Date Date -a t- \'2--)-- '�6'a U'D Inspectur Inspector Inspector Comments Conditional Approval MUNICIPALITY OF ANCHORAGE U^ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION - „AN 8 IaO� RECEIVED Date Sewer Installed Permit No. Septic Tank Size ° 3 p_ Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank PLO APPLICANT FILLS OUT LOWER HALF ONLY Property Owner D,4NN V C A VO Phone Mailing Address 15'0 Avy� �� �� ANCAv� /' Buyer Address Lending Institution-J(/���pw'l Phone Address ._'&) e- 14N4 o / f 4- VZ,` 4300 Realty Co. & Agent Phone Address Legal Description o HCl dZ&6 -5^VcZ Street Location $�� l/��Yrr� TypeoResidence N�Single Family ❑ Multiple Family No. of Bedrooms ❑ Other Water Sypply Lf Individual ATTACH WELL LOG. A well log is required for all wells drilled since June ❑ Community 1975. For wells drilled prior to that date, give well depth (attach log if ❑ Public Utility available. Sewe!gpeDisposal I / ri Individual 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.