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Home My WebLink AboutSAND LAKE #2 BLK 6 LT 21Sand Lake #2 Block 6 Lot 21 #011-133-16 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211267 PID Number: 011-133-16 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name JANELL BRULOTTE ABSORPTION FIELD - QUANICS ® Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 8236 WILCOX STREET, ANCHORAGE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 3 GPD/SF 10 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 5 Ft. Gravel depth beneath pipe 5.35 Ft. Subdivision Block Lot SAND LAKE #2 6 21 Fill added above original grade VARIES 0.2-.36 Ft. Gravel length 23 Ft. Township Range Section Gravel width 5-6 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 246 Ft' 1 -- Ft. Well 50'+ 50'+ 25'+ TANK IZI Septic ❑ S.T.E.P. ❑ Holding ® Other QUANICS Manufacturer GREER Capacity 1500 Gal. Surface Water 50'+ 50'+ Material HDPE Number of compartments 2 Lot Line 5'+ *2'+ NA Foundation 10'+ 10'+ LIFT STATION Manufacturer QUANICS Capacity 1500 Gal. Remarks *WAIVER. EXISTING SYSTEM REMOVED & NEW SYSTEM INSTALLED IN SAME LOCATION. Alarm location' FRONT ENTRY Electrical installed by DRS PIPE MATERIAL House to tank 3034 Tank to 3034 Installer JRS drainfield Drainfield 3034 CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspdection 15' 9/16/21 2nd 9/17/21 Location and description 3`d 9/17/21 4" 9/20/21 BOTTOM OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVAL \ Conditional Approval:- Date A '•:t�,'� *: 49 TM ....�:* " " • " • ' Septic System A Approved - % '• Curtis Huffman f ��1631 pp _ Date q_30 % CE 128991 ..-��`� W [sTF�*o �izo/z }oNA��\P� Note: this approval does not include well permit requirements. N\, �w t�~4 kmt:v uoiuu 16) PID: 011-133-16 PERMIT: OSP211267 - WELL WELL WOODEN Lot 22 FENCE S 89 55'00"E 135' 28.2' 50' WELL RADIUS PL STAKED PRIOR TO CONST. ASPHALT to �o O Lu N R.A.P. O O a, 8.0' C QUANICS 0 POD/MH NEW REBUILT m� ELEC. %EF T FIELD Un CO A�FCO MH MH DCO GMT 89 b5'00"W 135' WOODEN FENCE Lot 20 A 50R WWELLDII A -C=12,8' B—C=37,6' PCO QUANICS A -D=16,7' 99'21 MH/ POD FIRCOS / B -D=39,3' 9.20 A -E=22.7' 5.0 B - E = 4 3, 5' 93.6 1.500—GALLON HOPE DPE TANK B -F=41,1' A -G=45,1' B -G=59,9' A -H=48,2' B -H=60,8' SAND LAKE #2 BLOCK 6, LOT 21 PREPARED FOR: JANELL BRULOTTE 8236 WILCOX STREET ANCHORAGE, AK 99502 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 DECOMMISSIONED EXISTING S.T. & INSTALLED NEW 1500 -GAL QUANICS SYSTEM GRADE DCO MTMT 98.65 CO 88.49 FINAL GRADE flQ FILTER FABRIC 2' 3.64 93.64 5.35' SEWER ROCK -- - ED SEPTIC SECTION SCALEI NTS 907-350-9566 firstwaterAK©gmoil.com 16' 30.0' E4 ORIGINAL 98.29 GRADE l— ORG SP/SW — vis. OBs. AT CONST. 71M ECKLUND MOA DRY — 7/30/1981 1981 7ESTHOLE 5urr�K i StKvic;t5: 9TH TH DATE: 9/21/2021 tis 'Huffman .44 A4 SURVEY. KGL CE 128991 DRAWN: FWCS 9/21/2021 SCALE: 1" = 30 PAGE: PAGE: 1 OF 1 28.2' 0 Y w o N p Ld 8. U 0') O W Lot 1 n U5 w 28.2' 50' WELL RADIUS PL STAKED PRIOR TO CONST. ASPHALT to �o O Lu N R.A.P. O O a, 8.0' C QUANICS 0 POD/MH NEW REBUILT m� ELEC. %EF T FIELD Un CO A�FCO MH MH DCO GMT 89 b5'00"W 135' WOODEN FENCE Lot 20 A 50R WWELLDII A -C=12,8' B—C=37,6' PCO QUANICS A -D=16,7' 99'21 MH/ POD FIRCOS / B -D=39,3' 9.20 A -E=22.7' 5.0 B - E = 4 3, 5' 93.6 1.500—GALLON HOPE DPE TANK B -F=41,1' A -G=45,1' B -G=59,9' A -H=48,2' B -H=60,8' SAND LAKE #2 BLOCK 6, LOT 21 PREPARED FOR: JANELL BRULOTTE 8236 WILCOX STREET ANCHORAGE, AK 99502 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 DECOMMISSIONED EXISTING S.T. & INSTALLED NEW 1500 -GAL QUANICS SYSTEM GRADE DCO MTMT 98.65 CO 88.49 FINAL GRADE flQ FILTER FABRIC 2' 3.64 93.64 5.35' SEWER ROCK -- - ED SEPTIC SECTION SCALEI NTS 907-350-9566 firstwaterAK©gmoil.com 16' 30.0' E4 ORIGINAL 98.29 GRADE l— ORG SP/SW — vis. OBs. AT CONST. 71M ECKLUND MOA DRY — 7/30/1981 1981 7ESTHOLE 5urr�K i StKvic;t5: 9TH TH DATE: 9/21/2021 tis 'Huffman .44 A4 SURVEY. KGL CE 128991 DRAWN: FWCS 9/21/2021 SCALE: 1" = 30 PAGE: PAGE: 1 OF 1 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211267 Work Type: Septic Upgrade Tax Code Number: 01113316000 Site Legal Address: SAND LAKE #2 BILK 6 LT 21 G:2224 Site Mailing Address: 8236 WILCOX ST, Anchorage Owner: BRULOTTE JANELL Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Q Disposal Field I1 Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date: Qt"cnt ,S Q v Delmi-tme]It Lot Size in Sq Ft Total Bedrooms: 7/22/2021 7/22/2022 6750 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: Onsite shall be present for bottom of trench inspection to confirm the insitu soil does not i appear to be clean gravels (GW or GP). A sieve analysis may be required if soils are questionable. 3 Sw►AccL';„It �-o ©• h1CS clue -�-b a�a�lab��;�-,�. _ t'�L.- &/Z3 jZI Co # 2: R,v 15 2 VLu New i r u� I i Zi is a,�p I i Ca'- o v\ r- ck:k e-` 3 V d /-s7--E -%r COT -r s d rn. 15-Z0' LoV10 I d'031n. - 11IlI2i "C- Received By: Date: Issued By: caltsw Date: 7 Z ,20,E l MUNICIPALITY F ANCHORAGE Development Services Department �`_` {% Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 011-133-16 Property owner(s) JANELL BRULOTTE Day phone Mailina address 8236 WILCOX STREET, ANCHORAGE, AK 99502 Site'address 8236 WILCOX STREET, ANCHORAGE, AK 99502 Legal description (Sub'd., Block & Lot) SAND LAKE #2 136, L21 Legal description (Township, Range & Section) Lot Size 6750 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Fx� Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank El Upgrade El (D) Holding Tank F-1Renewal 1-1Duplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: V-C\'kn�ie-1A %n e_ (e -c,-,+ f L Distance: 2 �f I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: I I old 1 Receipt Number: 105 D Permit No. 05PZ 112 r07 Waiver Fees: Date of Payment: Receipt Number: Waiver No. () S ii all 0+1 GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc a - tot 1 w P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 a (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Section p�cnt S Ucpartmcnt xxxXX TA_RIAN(__"E/WA1xV_7ER REVIEW ?C'KxX Waiver#: OSV211044 COSA#: Permit#:OSP211267 PID#: 011-133-16 Legal Description: Sand Lake #2 Block 6 Lot 21 Engineer: First Water Consulting Applicant: Janell Brulotte Your request for a waiver of the required 5 feet horizontal separation from the AWWTS absorption field to the east property line has been approved. The approved separation distance is 2.0 feet. See engineer's waiver request for justifications. Original 1981 field was installed 2 ft from east property line and should have been addressed with previous COSAs. Therefore, waiver fee has been waived. This waiver applies to the east property line only. This waiver approval applies to the existing/proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ■aaaaaaaasaaaaaa0aaaaaaaaaaaeaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaeaaaaaaaaaaaaaaaaaI Waiver is Granted: X Waiver is not Granted: Date: 7 3 2 i Approved by:`��'�Nx�� Name of Reviewer aaaaaaaaaeeavaaaaaaaeaaaaaaaaaaaaaaaaaaaecaaevaavacaaaaanaaaaaaaaaaaaaa2Maa0aaI q 111, `� IN?III 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com July 7, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: SAND LAKE #2 BLOCK 6, LOT 21 The property owner has requested we obtain a permit to upgrade the failed septic system of the above referenced lot. We propose to remove / replace the existing field with augmentation by installing one deep trench and a 1500-gallon Advantex Tank System to serve the existing 3- bedroom property. The design is based on the application rate and groundwater monitoring of area soils. Area soils show are predominately SW 1-1.2 GPD rated soils and no groundwater was observed in area testhole groundwater monitoring data. The slopes are flat at the proposed upgrade location. The lot and adjacent lots are served by private water wells as shown on the design. The recent Ken Lang as-built shows the existing field pipes at approximately 2.8 from property line. MOA records docs show the field to be 6 to property line and we respectively request a waiver of 2 to property line. Granting of this is justifiable because there have been no known issues the past 40 years and an Advantex system is proposed. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211267, Rebecca Carroll, 07/22/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211267, Rebecca Carroll, 07/22/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211267, Rebecca Carroll, 07/22/21 71 10' C.E.A. EASEMENT7 (Doc. No. 1982-036680-0) Lot 5 WELL N 89'55'00"W 135'1 FENCE LOa I 7 Lot 20 NgpGs I 30.0' I I I D 0 O X � N I Lot 3 M Lot 22 M I J WOODEN Ji FENCE S 89'55'00"E 135' '0 SNED 50.6, .. Z 12.2' o y U 28.2' ASPHALT Q O W N 0 y -O e.° RAP.: Lot 4 O Lot 21 O w 8.0. m — m 0 6,750 S.F. "' N w I K O -WELL SEPTIC //, PIPES J/ Y 28.2' I 71 10' C.E.A. EASEMENT7 (Doc. No. 1982-036680-0) Lot 5 WELL N 89'55'00"W 135'1 FENCE LOa I 7 Lot 20 NgpGs I 30.0' I I I D NOTE: THERE ARE NO BEARINGS ON THE RECORD PLAT. BEARINGS SHOWN HEREON ARE FROM THE BLM PLAT OF SECTION 10, T12N, R4W, SEWARD MERIDIAN, ALASKA, ACCEPTED MAY 12, 1952. DISTANCES ARE HELD FROM THE RECORD PLAT No. P-176. PLOT PLAN _-_ AS BUILT _X- SCALE _1 30_- GRID _ SW 2224__ Project No. ___21=3651A1---- 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, in C. , (907) 522-6476 Phone 0000�p�0 (907) 522-4625 Fax oo pF q Professional Land Surveyors kenOlongsurvey.com c y jonathonOlangsurvey.com I hereby certify that I have surveyed the following described property: �' LOT 21, BLOCK 6, SAND LAKE SUBDIVISION No. 2 (PLAT No. P-176) 0* 49 LH Anchorage Recording District, Alaska, and that the improvements situated thereon are . . • . . . . . . . . . . . . . . . ' •' •' . . . . • • • . within the property lines and do not encroach onto the property adjacent thereto, that Q no improvements on the property lying adjacent thereto encroach on the surveyed O'0 KENN li L,4N •�•� premises and that there are no roadways, transmission lines or other visible O 0 o G easements on said property except as indicated hereon. OO . -Lu. '1,� Dated this the y of d -� 04 �Fp •LS ....* ____ Da ��_______, _____, at Anchorage, Alaska Q a �"� � • � �" a0 0 4'X�, OpeSSIONAt, 10 It is the responsibility of the owner to determine the existence of any easements, 40000�a covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 0 O X � N M M NOTE: THERE ARE NO BEARINGS ON THE RECORD PLAT. BEARINGS SHOWN HEREON ARE FROM THE BLM PLAT OF SECTION 10, T12N, R4W, SEWARD MERIDIAN, ALASKA, ACCEPTED MAY 12, 1952. DISTANCES ARE HELD FROM THE RECORD PLAT No. P-176. PLOT PLAN _-_ AS BUILT _X- SCALE _1 30_- GRID _ SW 2224__ Project No. ___21=3651A1---- 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, in C. , (907) 522-6476 Phone 0000�p�0 (907) 522-4625 Fax oo pF q Professional Land Surveyors kenOlongsurvey.com c y jonathonOlangsurvey.com I hereby certify that I have surveyed the following described property: �' LOT 21, BLOCK 6, SAND LAKE SUBDIVISION No. 2 (PLAT No. P-176) 0* 49 LH Anchorage Recording District, Alaska, and that the improvements situated thereon are . . • . . . . . . . . . . . . . . . ' •' •' . . . . • • • . within the property lines and do not encroach onto the property adjacent thereto, that Q no improvements on the property lying adjacent thereto encroach on the surveyed O'0 KENN li L,4N •�•� premises and that there are no roadways, transmission lines or other visible O 0 o G easements on said property except as indicated hereon. OO . -Lu. '1,� Dated this the y of d -� 04 �Fp •LS ....* ____ Da ��_______, _____, at Anchorage, Alaska Q a �"� � • � �" a0 0 4'X�, OpeSSIONAt, 10 It is the responsibility of the owner to determine the existence of any easements, 40000�a covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 k C*) ENVIRONMENTAL ENGINEERING DIVISION / ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT It�/LA� NAMEAA OT1k®l- PHONE D JJ � NEW ❑ UPG'tADE MAILING ADDRESS LEGAL DESCRIPTION t �A t i Ls� LOT � � �I� LOCATION I Wil COX e �^ NO. OF BEDROOMS U Y DISTANCE TO: Well I O ® Absorption area �ss' Dwelling 1 y PE�� MI gip' 0 _ K! wQ ~ Manufacturer Material I No. of compartments Vl Liq. capacity in gal ons IF ADE: Inside length Width Liquid depth O Y J02 DISTANCE TO: Well Dwelling PERMIT NO. O Z Q x � Manufacturer Material Liquid capacity in gallons D wx DISTANCE TO: Well �. Foundation �F3� Nearest lot line PERMIT NO. sl o of Uj E Z H Z w No. of lines Length of egg I)ne Total length f Ines Trench width �- inches Distance between lines ZF O Top of tile to finish grade / f1 3� Material beneath the inches Total effective absorption area w t7 Length Width Depth PERMIT NO. Q F wa Type of crib Crib diameter Crib depth Total effective absorption area W TANCE T0: Well Building foundation Nearest lot line .j Class Pr, Vx,,vr Depth Driller Distance to lot line PERMIT NO. �� 0*61 w i:DISTANCE TO: Building foundation Sewer line Septic tank/®� Absorption area(s) OTHER LEGAL PIPE MATERIALS .4 LL SOI TESLuc T RATIN %/ -ypq�� q A INSTALLER ` REMARKS U - Ale LL SA!51n �t*r�� 04 _tJ_H_ _t� I Yi 14A APPR D DATE W_�Loep /L✓�f�� zeq7.2 77013 (Rfev. 3/78) DAILY DRILLING LOG OF SYREN, BROS. DRILLING, INC IINI�ALITY ANCHORAGE ENVIR, 2701 Eagle Street Anchorage, Alaska 99503 274-6437 OWNER OF LAND..aaDXy..LC4=AZ& ... C..Puilder.) ........................ DEPTH OF WELL..........` ......................................................... ....................... R ADDRESS ...... ;L...O. Box 10-1682 Anch. Ak. 99511 1* ............................ STATIC LEVEL OF WATER F I ....... ...... I. - WELL - SITE ... LQ.t.2.1 D)J� .6.... DATE - STARTED ........ .... DRAW DOWN FT....... .................... GALS. PER HR/MN.........2?..gallons der minute ..................................... DATE -ENDED .......................................................................................... KIND OF CASINGA..AUA�Q .....B ;�q!Y .. Rjase!j KIND OF FORMATION: FROM ........... 9. .......... FT. TO ........ l0 .......... FT ...... wet sand &gravel FROM ......... 19. .......... FT. TO ........ .......... FT ....... s.and .................... FROM........ 2a .......... FT. TO ........ 2.9 .......... FT....Roa; seam.......... FROM ......... 29 .......... FT. TO........ .......... FT .......sand ........................ FROM ......... 35 .......... FT. TO ......... .......... ....................... FT FROM.........` .2 . .......... FT. TO ....... 1!aQ .......... FTAg4n.. sand............ FROM ....... 192 .......... FT. TO ...... 1.5.9 .......... FTAP)n4 ........................ FROM ........ 15.0 .......... FT. TO ...... 29.9 .......... FT.Ae�! ... s.and ............... FROM ....... 29.Q .......... FT. TO ....... 3.1.Q .......... gravel FROM ..... ............ FT. TO...... ......... FT....Slm .................... FROM ..... ............ FT. TO ....... ......... 4,24 FROM..... ............FT. TO ....... ......... FT..AXra!(�!..L.water ........... FROM........................FT. TO ....................... FT ................................... FROM........................FT. TO ....................... FT ................................... FROM........................FT. TO ....................... FT ................................... FROM........................FT. TO ....................... FT ................................... FROM........................FT. TO ....................... FT ................................... FROM........................FT. TO ....................... FT .................................. FROM ....... 310.......... FT. TO ...... .......... ....... FROM ........................FT. TO ....................... FT ..... FROM ....... M6 .......... FT. TO ...... 4,24 ......... FT..clay., ... sm_&raV.el & water FROM ........................ FT. TO................... FT..... FROM...... 4�24 .......... FT. TO ...... 43n ......... FT..2!-K..n2A MISCL. INFORMATION: FROM........................FT. TO ....................... FT ................................... DRILLER'S NAME ..... TYPE CrF= ,rill ABSORPTION ! Ep" 1 _; : ..fF:Eh?t=-! i piA:x;Ip'1UN p'•1LIMBER OF BEDROOM — _OIL EATING 50 FT,.,'FR) = THE REQUIRED SIZE OF THE S C r I L_ ABSORPT i Or.Aj"��CTEM I S : r �( THE LENGTH DIMENSION I S THE Li':.p+!GTH < I h-? FEET) OF THE:: TRENCH OR THE DEPTH OF FI TRENCH OR IT I. THE DISTANCE F;L: ! i•.!E'EN THESURFACE :E OF THE E GROUND !-!C',D THE. BOTTOM OF THE EXCA'a+HTION -'IN FEET;. THERE IS r -4O SET 1�41DTH F'Cr.R TRENCHES. THE GRAVEL DEPTH IS THE. MINIMUM DEPTH OF GRAVEL BETWEEN "I FIE i_t1.1CF'FIL_I_. PIPE Apar, THE BOT...F.r,N OF' THE EXCF!VF!TI! t-4 <IN FEET). F'ERII I T ADPL_ I CANT HA`5 THE. RESPONSIBILITY TO INFORM M THI_= DEPARTMENT D1 ... IF:I p•416 THE INSTALLATION INSPE:C:TIr."iP S OF ANY WELL'S A AC-EpdT' TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL i••I.T.LL 'SERVE. P. CD ;.;5 ANCHORAGE, AK. e-- , ' E ° �=x STREET, : 2G Ln L1 WITF3OUT.. FINAL IN'SPE'CTION FIp'•D FiPF'1?:O';.yi-. BY THIS DEF'C{F;-IMENT WILL BE'_SUBJECT 1810801 T*O PROSEC:i_ITION. i PERMIT NO. FIF'F'L-.I CANT c>Hp'?p' Y C:AROLANI.) FSC r E:;::;:i.� � -:1 ,; � y - �' �; ;, LOCATION WILCO".., LEGI=(F_ UOT;_:i BLr• 'E,HP•dDLFi!;Hi-TKE. LOT SIZE 6,750 Sr_!(-IARE. FEET TYPE CrF= ,rill ABSORPTION ! Ep" 1 _; : ..fF:Eh?t=-! i piA:x;Ip'1UN p'•1LIMBER OF BEDROOM — _OIL EATING 50 FT,.,'FR) = THE REQUIRED SIZE OF THE S C r I L_ ABSORPT i Or.Aj"��CTEM I S : r �( THE LENGTH DIMENSION I S THE Li':.p+!GTH < I h-? FEET) OF THE:: TRENCH OR THE DEPTH OF FI TRENCH OR IT I. THE DISTANCE F;L: ! i•.!E'EN THESURFACE :E OF THE E GROUND !-!C',D THE. BOTTOM OF THE EXCA'a+HTION -'IN FEET;. THERE IS r -4O SET 1�41DTH F'Cr.R TRENCHES. THE GRAVEL DEPTH IS THE. MINIMUM DEPTH OF GRAVEL BETWEEN "I FIE i_t1.1CF'FIL_I_. PIPE Apar, THE BOT...F.r,N OF' THE EXCF!VF!TI! t-4 <IN FEET). F'ERII I T ADPL_ I CANT HA`5 THE. RESPONSIBILITY TO INFORM M THI_= DEPARTMENT D1 ... IF:I p•416 THE INSTALLATION INSPE:C:TIr."iP S OF ANY WELL'S A AC-EpdT' TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL i••I.T.LL 'SERVE. P. CD x : w : x TC 5 : = F, E r- 3 1 �_A r ,., F.' . e n �_.-1 ' E ° �=x E.HCK:FILLIhIG OF Flhh' 'SYSTEM WITF3OUT.. FINAL IN'SPE'CTION FIp'•D FiPF'1?:O';.yi-. BY THIS DEF'C{F;-IMENT WILL BE'_SUBJECT T*O PROSEC:i_ITION. i T I?A I NUM D I'E•'TT=iNCE E �ETb.1EEh-d A kIE:LL AND HC'd'r ON—SITE 'SEkIA GE DISPOSAL '.;';'STEM 1 :100 FEET' FOR F! 11F.-I'VATE I.•TEL.L OR :150 TO 200 FEET FROM H PUBLIC WELL DEPENDING PON THE TYPE` OF' PUBLIC: l.•.lE'LL. MINIMUM D I=•TANC:E: FROM A PRIVATE k!E:LL TOA PRIVATE _:;EWER L I' p•dE I ;w: FEET FihdL, 1-0 F! COMMUNITY SEWER LINE IS 75 WELL LOGS ARE`.' REQUIRED AND MUST BE f:ETUW-4ED TO THE DEPARTMENT 1A I TH I N :i t DAY OF THE. HEI -..L. C:OMPLETIOr-4. OTHER REr.>!i_I I F:ENENT'E• MA'r' APPLY. SPECIFICATIONS AND CONSTRUCTION D I FIG TRAM' � FIRE AVAILABLE TO 1PI'm;UF:E:. F'7<?:IF'-ER INSTALLATION. I CERTIFY THAT : 1 AM FAM I I....1 AR H I TH THE REQUIREMENTS FOR t: t -J ITE SEWERS Fir -AD WELLS AS WET FORTH BY THE MUNir'I'PALIT'r' OF Ar-JCHOlTAGE. 1 F•11.1...L INSTALL THE sY. TEN IN ACC:OR"'.-IANC:E: WITH THE CODES. 1 UNDERSTAND THAT THE ON—SITE SEWER SYSTEM NAr' REQUIRE Ep•dLAF,GEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3. BEDROOMS. !C+MS. ,r SIGNED: FIF'F'LIC:HP• G:'F•'Ip'dNY C:AROLrih•D , r AL SUILS LUL3 y � MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION El PERCOLATIONTEST Pouch 6650, Anchorage, Alaska 99502 276-2221 SOILS LOG — PERCOLATION TEST PERFORMED FOR: CA �1 %Sjo_12�*7—A415&K� DATE PERFORMED: VOeO LEGAL DESCRIPTION: Lpr i/�/� J< ' ;E7, �— SLOPE SITLr PLAN 19Je' Z-7 2 / /v 3 ;b 4 4 4' 5 0o 6- 7- 8 7 8 9 �' 10 11 G• 12 U 13 `D O 14 , : 8 15 SV1 0'. , IV 16 J0 a 17 18 19 C ®%tw�fF- SSt"4m; L WAS GROUND WATERS S ENCOUNTERED? _[�L(L—_ L O P E IF YES, DEPTH7AT WHAT I YS✓�.i. GF�.C' � T��i Gross Net Depth to Net Reading Date Time Time Water Drop II I _ EJ {{ t � I � I YS✓�.i. GF�.C' � T��i 20 I I PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS % rE� ' / Is 'iCJ�.'�'T"�' -%i/1lM2 0 Ar'& �% .C+. L'7/�� PERFORMED BY: 72-008 (7/76) CERTIFIED B DATE:��,� Gross Net Depth to Net Reading Date Time Time Water Drop w 20 I I PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS % rE� ' / Is 'iCJ�.'�'T"�' -%i/1lM2 0 Ar'& �% .C+. L'7/�� PERFORMED BY: 72-008 (7/76) CERTIFIED B DATE:��,� I MITA 0 vjcl� O CA rn rn 'co M C'7 O O CD CY) Q O a N O Q Q Q cn CD C O 4- O N m _U 4- S.. a) LO N O N rn N co ai D C O co .Q x W N O Li) C) N Q J O1 CD L- Y 0 J L ym Q W _I Y X QJ O 0 J Z U) C9 o N ao Q U) U N N o M 0 J CO z T- o z 0 I— Q W 0 w 2 U) N (D C 0 a) Q O Q a) U X M X M. L) o`` 0 0 CL a a� a -0 _L .V 3 }i L) U) N L CL O O F- a) X E U L C d CD O O 0 U C •� y cn N O 0 �, o +O+ • V ^ Q Q) < Q N > > = Cl) O Q rn E p N .0 o U Q.., � �0 a) N (3)� ?>> ca z m Q O U 3 E Q. z in v Q% C L Q. ,r = 'D •C O j p wO .Q i CL i- 0. N N v 0 = O L x 0 +; +� -v n cn fn N E Q. 'a 0 O D_ Q o O 4- Q cn L n UIL ° cn > _cl)U 0 O C o Q 0) v N Qo co ` ^ cC w U Q O (j E o N O = U) t ,U) >, v Q V Q a) X ui c m 0 U - z LL OPM F- r1mm o. Wom U) lasm z a) C) Q) co 0 4 - co CL 0- 0 0 - CL cn E W CD U) 0 0 N 4— co V - Al 64 LL i� O LL U) 0 8 U) 0 0 (D CL 0 U) 0 > a) U) U -E CL CL c 0 Li E E E (D .0 (D 0 U) U) C d 0 c i> E u)❑C (D L cn cnU 0 U) cc 0 (D �o UL F - co > + M CL Nca c ❑ 0- (D 4) C/) a) ❑ 2 0 0 a) 0 0 u CD m 0 CN -0 0 1- 0 — 0 L) cu ca L - a LU caa 0 Co C13 N m CO U O 0 M CL 0 U) 0 E El T co 0 UO. El N a. LU M 0 U) U) U) U)> 0 2 W w El -0 ca Lu — cr U) cC U) a) o LL Z L 0 a) m z U) 0 w ujU. F- IL cn a) > t6 0 0 V cn WO P: (D CL iL ui a) U) a) a) (D O U) .> 0- CC > N ML6 (6 co 3: x LU >% ca 0 64 LL i� O LL U) 0 8 U) 0 0 COSA Checklist.docx COSA Checklist Legal Description: SAND LAKE #2 B6 L21 Parcel ID: 011-133-16 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 2/13/82 Total depth 513 ft Cased to 513 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 9/5/24 Static water level at beginning of test 107 ft. Well production at time of test 3+ gpm Water storage tank volume NONE gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic 12.9 ug/L Arsenic less than MRL (ND) Collected by Date 8/29/24 Comments B. TANK DATA Measured operating fluid level in septic tank *NA Date of pumping *SEE MAINT REPORT DATE Required maintenance completed, if AWWTS Comments: *QUANICS MAINT REPORT C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: ____________________ D. ABSORPTION FIELD DATA Which system tested (date installed) 9/20/21 ALL standpipes present per record drawing Total measured depth from grade 10.3 ft (max) Measured depth to pipe invert from grade 4.3 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective (ED). If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced 2000 gallons 9/4/24 date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 9/5/24 Results Pass Fluid depth prior to test 0 in Water added 450 gal New fluid depth 8 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 64 in (MOA 5.35’ ED) Effective depth used 0 in (Final Fluid Depth) Effective depth (ED) remaining 64 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots & appears approximate with 5.35’ or 64”. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No *50+ ft Neighboring Tank > 100’ Yes if No **87+ ft Absorption Field on Lot > 100’ Yes if No *50+ ft Neighboring Absorption Fields > 100’ Yes if No **87+ ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No **2+ ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No *50+ ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No *50+ ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS *MAY MEET CONVENTIONAL SEPARATIONS, BUT SYSTEM MEETS CATIII/II SEPARATION DISTANCE REQUIREMENTS. **PREVIOUS MOA WAIVERS. G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 9/9/2024 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 9/9/24 MUNICIPALITY OF ANCHORAGE TMENT SYSTEM ADVANCED WASTEWATER TREA MAINTENANCE AND gFpAIR AGREEMENT NT, herein the "AGREEMENT" made and THIS MAINTENANCE AND REPAIR AGREEME of 20 by and between entered into as of this _5.t_ Day of 4 � + "ER," and the Municipality of herein the ,O "ER," in accordance with Anchorage Municipal Code Anchorage, herein the "M[JNIC ntained herein, the parties to this (AMC) 15.65.365. In consideration of the mutual covenants co Agreement agree as follows: ants permission to the 1. Advanced Wastewater Treatment S stems. The M ter Treatment System (AWWTS), Owner to utilize and operate an Advanced Wastewa described as fin. 1oL j located at (legal description) 2. Maintenance Re airs and Alterations. (Owner is required to read, understand and initial each section) IV Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. PW It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). AWOwner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. iW Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 1 �� may request records of maintenance and YOwner acknowledges that the Municipality Y repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030• Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonw aiver• The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Ame� ndme t. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. aeverabilitI. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 vi K, 2 _W 7 J Q U p 0 b W 0 m lz _ E o ami � YY7 W f0 N G N E d o_ D v s y^ m ❑ Z d❑ G O N O ❑ } Elo. N W y 0❑ Ca/ N � C ~ ~ O U O N Q. w V n m\ C'. �, o p O U C O❑ N .0 U v_ _o 4>) _ m El�' v V? is _�o v . o in U 0 �i U !�d o t � 32o. .� �' ❑ w El f- N O L O y a w a R CO c 3 E O N O E �� m i0 �. V .�.. O a V +++ Q to r. 0 ¢ w (n D U In Q va m m � m U Z7 N a r fV !h EZI o c� w N d aNi a aoh0000lo � 'CI C O � c ❑ O z N 1 t d c a. O � nci wcl- n C cx iii fa O M rn v o w Q. ¢ a ai M: 6 _ CO M WE 2' CD ❑ ❑ On iq Z W C � M a co co 0%0 rn en h o� r.. w.. u 0 IN IN Z' N N off u z Q Q o � KI G o o o u Z Z QI C c ti C C) N O m V '^ o 65 C Q In C U) f0 E o a > � m � N T > ,, o c � V C ::1 U N Q1 L) U CL) rn ro U O Q n U 'C N d z z° z ❑ ❑ ❑ z d N mai m c > > D O ❑ O 2 LL W 0 20 _o CL c O n Z Z Z ❑ ❑ ❑ r� F. - 5Z O o U CL O O U .w C C D y L T c O V m C o . E 0 i Q ❑ O CL n E E 0 m m +� > > a w iaJ y ,p L N CL !�► U � 0 O N O d N Y Q C F@ c -on U o m m f0 c ` ~ o' N C CL ai V b E a c 3 m LY LL t o m p w p 15 a ;; N C t1 cucn p E O O C O O OO v LL rL r z a a U- ►- w iT CL E E fp ,p U "O O — CA Lc Y _ a Cd r� F. - O O O �r 1� O o ❑ ❑ ❑ a� t L2. T V m C o . E 0 i Q ❑ CV N CL Y v m cM +� > > a w y ,p L N CL !�► U � 0 O N O d N Y Q C F@ c -on U o m m f0 c ` ~ � N :3C ?@N 00 C CL ai r� F. - L: i;� O W E 0 ro- Ln O'' 0 LM (U sh an E t C m a, co M10 O (3) Cl) R* mr M M � X LLI V Q CC TO i V z m W� ce- N Q W v 3 0 W +' U 3 v > *= W 0 v, c o F- L- L Z W 41O M a � E O au E W 41 in 3 0 0 3 N do � C C +' .c 4-0 in N L i L CD x X r O O coo an E ' CO 3 O E co cu -O — O QJ � -a N a +� v to 41 N N 0 07 N Q U Ql � t U i QJ > -,:tU cn Ln 4-j N N to pj m N cn--, t Y : +j O -� O_ M aJ N— in C Q L � +_O OJ m O a ca -C +� U U a ao o W > O ru tic cii v C Q p N N O _N u OD 0 � L U Q N v a "- � O C OU O cu >O U O UD N Q N w Q! O � Q u o Q 0" v LCn _O c -I } t O O t LA m � N � O N u N � >- O 4J m U -a o 3 c' cu mace v E + c c E -0 > W O _ o co N N L " O C O N o O � C v +! v O E cn a w m m 3 a O 4J C V) E N L T � O N O ; co Ln O c� LnC L 3 > U > N 4- J Q N � m +' E � i - 3 UO C > o a� o t U cn Q o U � t 4- CaS- MUNICIPALITY > s z� tii,f14 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 011-133-16 1. GENERAL INFORMATION Complete legal description SAND LAKE #2 BLOCK 6, LOT 21 Expiration Date: _) Z— 3C9 — Z I Location (site address) 8236 WILCOX STREET, ANCHORAGE, AK 99502 Current property owner(s) JANELL BRULOTTE Day phone Mailing address Real estate agent 8236 WILCOX STREET, ANCHORAGE, AK 99502 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distan Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ t 6 Waiver Fee $ Date of Payment go a d l a2/o� l Date of Payment Receipt NumberReceipt Number COSA# QSC;Z 1 �j Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 9/17/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory ��P• • • . :1 for current or future occupants or guarantee that no unseen encroachments, deficiencies or g••• '� �� discrepancies exist can be given by First Water Consulting & FW �S / *� -49 TH ••* 6. DSD SIGNATURE 1,91 �,• Curtis Huffman j System #1 Approved for bedrooms / t<`��;•• CE 128991 System #2 Approved for bedrooms 1ROF SS Disapproved Conditional approval for bedrooms, with the following stipulations: Y OF nm d`'`' o VA7 A I < T'U''ATE m P R o -- o ^ �l!SERV Original Certificate Date: � _S 0 —� The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory_ Well Flow Advisory Other N Legal Description: SAND LAKE #2 BLOCK 6, LOT 21 Parcel ID: 011-133-16 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _ A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 2/13/1982 Total depth 513 ft Cased to 513 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 1/26/2021 Static water level at beginning of test 111 ft. Well production at time of test 4+ gpm Comments B. TANK DATA — NEW TANK Age of tank(s) 0 years , Tank type/material QUANICS / HDPE Measured operating fluid level in septic tank ® Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA — NEW FIELD Which system tested (date installed) 9/17/2021 ® ALL standpipes present per record drawing Total measured depth from grade 10.4 ft (max) Measured depth to pipe invert from grade 5 ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate mg/L ® Nitrate less than MRL (ND) Arsenic 18.4 ug/L ❑ Arsenic less than MRL (ND) Collected by FW[; Date of Sample 7/8/2021..— C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date Results ❑ Pass For _ bedrooms Fluid depth prior to test _ in Water added _ gal New depth _ in Elapsed time min ® Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced gallons �;�, Comments/Deficiencies: E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes Community Sewer Manhole/Cleanout > 100' ❑ Yes if No *50+ ft ® Yes if No Neighboring Tank > 100' ❑ Yes if No **87+ ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ❑ Yes if No *50+ ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Surface Water > 100' Animal Containment > 50' ® Yes if No ❑ Yes if No **87+ ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes _ if No ft ®Yes if No ft ft ft ft ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ❑ Yes if No *50'+ ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells >100' _ El Yes if No *50+ ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No **2+ ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells >100' _ El Yes if No *50+ ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ❑ Yes if No 50'+ ft F. ENGINEER'S COMMENTS *PER CODE FOR CAT II/III WITH REMOTE MONITORING. **MOA WAIVERS G. ENGINEER'S CERTIFICATION I certify that l 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. TM Curtis HuffmanCE /s �F��F��l • 17/2921t®� } F� J... ��F�PROFESSIONP .,� Arsenic Advisory Certificate of On -Site Systems Approval # OSC211564 Subdivision: Sand Lake #2 ,Block 6, Lot 21 A water sample revealed an arsenic concentration of 18.4 micrograms per liter (ug/Q. 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. Ma�lirig Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org ` THIS MAINTENANCE AND REPAIR. AGREEMENT, herein the "AGREEMENT" made and entered into as of this �� Day of � V Pf.-*,6e,r of 202 ( , by and between Ab fZ y �w A A- � , herein the "OWNER" and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as QUANICS SYSTEM located at (legal description) 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) L_ Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). > Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page I of 3 As Owner acknowledges that the Municipality may request records of maintenance and A'S repairs from the manufacturer's representative or maintenance provider. A S Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. SOwner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. hS Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska. at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 STATE OF ALASKA ) ) ss - THIRD JUDICIAL DISTRICT ) The foregoin instrument w acknowledged before 20�, NOTARY PU�LIC FOR ALASKA My Commission expires: a By: _ /�/ (signature) (rev. 05/18/2018) Date: I 7 SY M me this I - day of � STATE OF ALASKA r4OTARY PUBLIC `x Jerrie R."Sta. Mada P4 Canwftsicn Date: _3 G �z (print name) Title: Page 3 of 3 CHUw- POWERING x October 4, 2021 Janell Loftus 4419 Lowry Circle Las Vegas, Nevada 89115 Subject: Letter of Non -objection for Fence in Easement Lot 21, Block 6, Sand Lake Subdivision No. 2 NW'/4 of Section 10, T12N, R4W, S.M., Alaska OB21027, Grid 2224, MOA I.D. #011-133-16-000 Dear Ms. Loftus: Chugach provides its non -objection to a fence along and across the 10 feet (10') wide easement along the west property line as shown on the as -built survey of Lot 21, Block 6, Sand Lake Subdivision No. 2, provided for this request. Chugach has and existing overhead primary electric line within the easement running north -south along the west property line of said Lot 21. There is underground electric service to your home that crosses the north side of said easement. It must be your understanding that the installation of the fence within the easement area is at your risk, and Chugach's future use of the easement may require you to relocate or remove the fence to provide access to Chugach's facilities. This non -objection is given without prejudice to Chugach's full enjoyment of any and all rights it may have in and to such easement areas. Enclosed for your use and information is the 811 Alaska Dig Line utility locate call center card, and Chugach's What is an Easement? handout. If you have any questions, please call Claudia Roberts, Right -of -Way Agent III, at (907) 762-4646. Sincerely, Karen Keesecker Manager, Land Services Enclosures Chugach Electric Association, Inc. 5601 Electron Drive, P.O. Box 196300, Anchorage, Alaska 99519-6300 • (907)563-7494 Fox 19071562-0027 • (800)478-7494 mvv.1.chugachelectric.com • inio@chugochelectric.com 1204-1 OB Grid2224 EN21032 011-133-16-000 ENCROACHMENT PERMIT This permit is between Chugach Electric Association, Inc., an Alaska non-profit electric cooperative, (herein "Chugach"), whose address is P. O. Box 196300, Anchorage, Alaska 99519 and Janell Loftus (herein "Permittee''), whose address is 4419 Lowry Circle, Las Vegas, Nevada 89115. 1. Easement. Chugach is the grantee or user of an easement for the construction and maintenance of electrical facilities, as follows: Described in that certain written instrument, recorded on the 25`1' day of June 1982, at Book 746, Page 208 and at Book 746, Page 209, on file in the office of the District Recorder, Anchorage Recording District, Third Judicial District, Seward Meridian, State of Alaska, The West Ten Feet (W 10') of Lot Twenty-one (21), Block Six (6), Sand Lake Subdivision No. 2, according to Plat Number P-176, recorded on the 6°i day of April 1950, on file in the office of the District Recorder, Anchorage Recording District, Third Judicial District, Seward Meridian, Alaska. (herein "Easement") which pertains to the following described real property Permittee acknowledges the validity of the Easement. Permittee warrants and represents that Permittee is the owner of the fee simple interest in the land subject to the Easement and the following described real property to which the Easement is adjacent: Lot Twenty-one (21), Block Six (6), Sand Lake Subdivision No. 2, according to Plat No. P-176, recorded on the 6"' day of April 1950, on file in the office of the District Recorder, Anchorage Recording District, Third Judicial District, Seward Meridian, Alaska, (herein "Parcel") 2. Encroachment. Permittee has constructed the following improvements on or within the real property subject to said Easement: A shed that encroaches approximately seven feet (7') into the northwest corner of the easement for a distance of approximately ten feet (10'), and a well located in the southwestern corner of the lot is encroaching approximately one-half foot (0.5') into the easement, (herein "Encroachment"). Encroachment Permit - Page 1 of 4 3. Permit. Chugach hereby authorizes Permittee to continue the existence of the Encroachment in its existing location subject to the covenants set forth in this permit. 4. Indemnification. Permittee shall indemnify and hold Chugach harmless from any claims for personal Injury, property damage or other loss arising in any way from the continuation of the Encroachment. 5. No Expansion or Increase. Permittee shall not in any way expand or increase the extent to which the Encroachment occupies any of the real property encumbered by the Easement without the prior written consent of Chugach. Chugach has no obligation to provide such consent. 6. No Interest in Real Estate Acquired. Permittee hereby acknowledges that the Encroachment and any additions thereto, even if in violation of this permit, has not and shall not in the future give rise to any interest or estate in the real property subject to the Easement or any other real property. Without in any way limiting the foregoing, Permittee acknowledges that the Encroachment is not adverse to any interest of Chugach and its continuation is entirely with the permission of Chugach for purposes of the common law doctrine of adverse possession. This permit creates no interest in the real property subject to the easement. 7. Modification of Utility Facilities. If the electric utility facilities located within the Easement are upgraded, added to, replaced or reconstructed, Permittee shall pay that portion of Chugach's total costs for such modification which is reasonably attributable to accommodating or preserving the Encroachment. If such payment is not made within thirty (30) days of written demand for same, Chugach may terminate this permit in accordance with paragraph 9, below. 8. Covenants Running with the Land. The obligations of the Permittee arising from this permit shall be covenants running with the land which shall burden the Parcel and the Permittee's interest in the land subject to the Easement and shall benefit the Easement. 9. Termination. Chugach may terminate this permit after the giving of thirty (30) days written notice of such termination if. a. The Encroachment is enlarged, increased or extended within the real property affected by the Easement. b. The Encroachment is damaged by any means to an extent of more than thirty percent (30%) of its replacement cost at the time of destruction. C. Permittee fails to make the payment described in paragraph 7, above. 10. Term. This permit shall, if not sooner terminated by Chugach, expire forty (40) years from the date hereof. Encroachment Permit - Page 2 of 4 Il. Entire Agreement. This written permit constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all other prior or contemporaneous agreements, oral or written, between the parties. No modifications, amendments, deletions, additions or alterations of the permit shall be effective unless in writing and signed by all of the parties hereto. CHUGACH ELECTRIC ASSOCIATION, INC. PERMITTEE By: By: Karen Keesecker, Land Services Mgr. Janell Loftus Chugach Electric Association, Inc. Date: Date: Encroachment Permit - Page 3 of 4 STATE OF ) ss: The foregoing instrument was acknowledged before me this day of 2021, by Janell Loftus. Notary Public in and for the State of My commission expires: STATE OF ALASKA ) ) ss: THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this day of , 2021, by Karen Keesecker, Land Services Manager of Chugach Electric Association, Inc., an Alaska corporation, on behalf of the corporation. Notary Public in and for the State of Alaska My commission expires: AFTER RECORDING RETURN TO: Chugach Electric Association, Inc. P.O. Box 196300 Anchorage, Alaska 99519-6300 Encroachment Permit - Page 4 of 4 APPROXIMATE LOCATIONS OF CEA FACILITIES cr,> r� cu 3 I I i 1 Lot 3 p I Lot 22 I I I i 30.0' in PED 21 i ( NFENCE _ r -` S 89'55'00"E 135' st�Ep o • 50.6' ` CJ 28.2' E 12.2' ASPHALT U) N U. o cV R.A.P V / Lot 4 0 $ s o w a.o' _ X Lot 21 j ( 6.750 S.F. n N W nMANHOLES u! o o j m � : WELL 28.2' ' , ; p rn ___ ;,. —1 sfl. N 89'S5'00'W 135' ;; 10' C.E.A. EASEMENT I- A wcaaEr3 FENCE �' (D.C. No.o ;aSEanC-� 198-036680-0) �� / PIPES Lot 5Lot 20 NOTE: THERE ARE NO BEARINGS ON THE RECORD PLAT. BEARINGS SHOWN HEREON ARE FROM THE BLM PLAT OF SECTION 10, T12N, R4W. SEWARD MERIDIAN, ALASKA, ACCEPTED MAY 12, 1952. DISTANCES ARE HELD FROM THE RECORD PLAT No. P-176. PLOT PLAN AS BUILT X SCALE 1" = 30' GRID SW 2224_ Project No. 21-365/62 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Long & A s s o c i a t e s, i n c. (907) 522-6476 Phone (907) 522-4625 Fax cam•� Professional Land S U rV e o rS ken®longsurvey.com c"{ OF A ( ' tk Y Jonathan 0langsurvey.cam v'`�! '' "� I hereby certify that I have surveyed the following described property: LOT 21, BLOCK 6, SAND LAKE SUBDIVISION No. 2 (PLAT No. P-176) p 49TH**' 9TH p�4Q Anchorage Recording District, Alaska, and that the Improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed A• • • • • • • •• . • • • • • • • • • • . promises and that there are no roadways. transmission lines or other visible Y KEN ' LANG'. easements on sold property except as Indicated hereon. �O�y y at Anchorage, Alaska�S-5202. �o Dated this the Day of ;5L�P��t�+ i�+�- �'bt � '�ROFfiSSIQ>�+ti tAa It is the responsibility of the owner to determine the existence of any easements. ��QO4a" covenants, or restrictions which do not appear an the recorded subdivision plat. AECC963 Parcel I.D. 011-133-16 Municipality of Anchorage n On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Location (site address) Expiration Date: I - 2 S- - / T Sand Lake #2, Block 6, Lot 21 8236 Wilcox Street Current Property owner(s) John Fredrick LaUrion Mailing address Real Estate Agent PO Box 7151 Nikiski, AK 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual i] Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request Received by: �'�� -� � Date:- COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ yl'o ^ Waiver Fee $ Date of Payment ID t a1 �13 rl�, Receipt Number QLA hkDG COSA# aSC l31 ply Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Alk. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIG ATURE DSD #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Phone (907)272-8218 Date 6/28/13 Conditional approval for bedrooms, with the following stipulations: By: D Original Certificate Date:_ / 0 -2 5 — / '3 The nici " ity chorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA bluesheet E c If more than 1 septic system is on the lot: COSA Checklist # 1 of i Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Sand Lake #2, Block 6, Lot 21 Parcel ID: 011-133-16 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 2/13/82 Sanitary seal (Y/N) Y Total depth 513 ft. Cased to 513 ft FROM WELL LOG Date of test 2/13/82 Static water level 118 Well production 25 WATER SAMPLE RESULTS: ft. g.p.m. Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 24 in. AT INSPECTION 6/27/13 112 ft. 5.7+ g.p.m. Coliform/ J_ ecolonies/100 mL Nitrate N mg/L C Arsenic ! 9. a ug/L Date of sample: o /7 13 Collected by: /" p ri S B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,000 gal. Number of Compartments 2 Date installed 10/1/81 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N / High water alarm (Y/N) N Date of pumping �oiS�r3 Pumper A,cu ,,d 44 Clock C. ABSORPTION FIELD DATA Date installed 10/1/81 Soil rating (g.p.d./ft2 or fe/bdrm) 85 SF/BR System type Deep Trench Length 31 ft. Width UNK ft. Gravel below pipe 5 ft. Total depth 7 ft. Eff. absorption area 310 ft2 Monitoring tube Y Depression over field N Date of adequacy test 6/27/13 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 25 in. Water added 436 gal. New depth 35 in. Elapsed Time: 1320 min. Final fluid depth 25 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) No If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons Manhole/Access (Y/N) in. "Pump off' level at in. High water alarm level at Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot *88' On adjacent lots *87' Absorption field on lot 100+ On adjacent lots *87' Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer /septic service line 25+ Holding tank 100+ Animal containment areas 100+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line **61 Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS * WR#020044 ** Approved HAA 3/9/1984 G. ENGINEER'S CERTIFICATION l certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 6/28/13 COSA brown sheet 10-10-12.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 10+ in. Municipality of Anchorage p Community Development Department Development Services 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 # 131554 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 21 of Sand Lake #2 Subdivision. This inspection revealed an arsenic concentration of 18 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. \ Municipality of Anchorage Development Services Department - < Building Safety Division On -Site Water and 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 Parcel I.D. *S-133-16 HAA #1%�o�2`7 7 Expiration Date: /0 — 1-5-- O -7- 1. GENERAL INFORMATION Complete legal description Lot 21, Block 6, Sand Lake Subdivision No. 2 Location (site address or directions) 8236 Wilcox Street Current Property owner(s) Troy Scheuner Day phone 243.2619 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 8236 Wilcox Street Anchorage, AK 99502 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 Three 3 Day phone Day phone TYPE OF WASTEWATER DISPOSAL: ® Individual On-site El ❑ 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 5 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 sample results less than 30 days old. (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 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 or Firm Anderson Engineering Phone 522.7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 6130/2002 G Fi, p �-a ' ENTG NEER'S._' ' 5. DSD SIGNATURE �d� s'. CE -4331 •: _1z Approved for 3 bedrooms. avrQ j PQO�FSS10"� < Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory w'ArGTEi"A'T' ER PROGRAM . Maintenance Agreements Supplemental Engineer's Report Other By: 0. � /,/ J — Original Certificate Date:��- )Rev. 17/00) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: _Lot 21, Block 6, Sand Lake Subdivision No. 2 Parcel ID: 011.133-06 A. WELL DATA Well type Private N A. B, or C provide PWSID # _ Date completed 21`1311982 Sanitary seal (YM) Y Total depth 513 ft. Cased to 513 ft. FROM WELL LOG Date of test 2=982 Static water level 118 ft. Well production 25 9 - p.m -WATER SAMPLE RESULTS: Coliform 0 coloniesl100 ml. Nitrate .233 mg./I. Well Log (Y/N) Wires property protected (Y/N) Y Casing height (above ground) >24 in. AT INSPECTION lirm002 117 ft. 6.5 g.p.m. Other bacleria 0 colonies/100 mi. Date of sample: 6M4/2002 Collected by: MEA B. SEPTICIHOLDING TANK DATA Tank Type/Material SeptidSteel Date installed 10nn981 Tank size 1.000 gal. Number of Compartments 2 Cleanouts (YM) Y Foundafion cieanout (YIN) Y Depression over tank (YIN) N High water alarm (YM) N Date of pumping 7!312002 Pumper Old MacDonatd's Pumping C. ABSORPTION FIELD DATA Date installed 1011M981 Soil rating (g.p.d./ft= or ft'/bdrm) 85 SFBdrm System type Deep Trench Length 31 ft. Width ft. Gravel below pipe 5 ft. Total depth 8 ft. Eft. absorption area 310 ftMonitoring lube Y Depression over field N Date of adequacy test 612912002 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0 in. Elapsed Time: 0 min. Final fluid depth 0 in. Water added453 gal. New depth0 in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N if yes, give date D. UFT STATION Date installed Size in gallons Manhoie/Access (YIN) `Pump on' level at _ in. 'Pump off" level at _in. High water alarm level at in. Datum Cycles tested Meets alarm b circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 86' On adjacent lots 6i Absorption field on lot MW Public sewer main Sewer /septic service line >25' On adjacent lots Public sewer manhole/cleanout Holding tank WA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >S Absorption field >S Water main WA Water service line >10' Surface water >100' Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 6' Building foundation >10' Water main MW Water Service line '>10' Surface water >100' Driveway, parking/vehicia storage >25' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS Well to Septic Waivers were apparently previously granted acowding to archived documentation. G. ENGINEER'S CERTIFICATION `E, :.;iL�'i � r ti I certify that I have determined through field inspections and * �• o review of Municipal records that the above systems are in ,,. , • conformance with MOA HAA guidelines in effect on this date. tip Engineer's Printed Name Michael E. Anderson. P.E.E-43 1 Date 6129101 HAA Fee $ JI c_ Waiver Fee $ Date of Payment c _ _ Date of Payment Receipt Number S Receipt Number (Rev. 72/00) 3 �2 S moss• c ff •a (':Cop DECt: Q u 1.5• AEOVC G?.��nlp t 1` YJt7a;, LACK .t. 1.5 • PE�vE � GKy�UNp H 8a'._=s• w 1:3 oo t F_ArrrC 20 F—,R Grti•StTc ��FiIC SYL—. l ONE- LEVeL WOOD =RA7N': Fes. QN1 CO -IX. 6.1 0c r tzx.s•:Dr�ly�y �RRFIAP95—PMT-. KEW ChtLDPEZ' ,45—BUILT k; y'' III •` MY ` scam i�L. ij, pse lsOR oawate lwrgW the Idlwinq OF��'�� . . LOT 21 :L?C K {I yt,4'�•'""''1•(�'��°` o M;+FcGli 12.Ict S aBnp �a c, is tem ttr r r!_•%(7,: m 00 ..+rr, w& -v ...a am . rer ge o•w:y, dn- C9a ,. �. �,. ae �...�,�, ., .�.� .. m. ,ra,vt„ Mev m�-q ., �cmn In•rw tta ro Ilna o�erIKM1 m t lam•t a dMW Ig '''L -?� . Ixen mer'tla aeoaen on tn. p rm •es�i. w.•to�n !� •. M0.31431 ..�� tt,w s u. ro rwe-�c trors+nic m 6na a slot w»o4 ks.+n.eA a ..; P OW7 acryr o rrdr�u6 q�'�F� ••�•.......�•r 'r Mraen. _ ►� to.o�nr C. _..�Ar'Y� i7—� sia SSfOf,'A �vB�� ' i00fm Buil am M. MI2M MIA Mor9sa TT:ST 90/a/90 III K =o i�L. ij, pse lsOR oawate lwrgW the Idlwinq OF��'�� . . LOT 21 :L?C K {I yt,4'�•'""''1•(�'��°` o M;+FcGli 12.Ict S aBnp �a c, is tem ttr r r!_•%(7,: m 00 ..+rr, w& -v ...a am . rer ge o•w:y, dn- C9a ,. �. �,. ae �...�,�, ., .�.� .. m. ,ra,vt„ Mev m�-q ., �cmn In•rw tta ro Ilna o�erIKM1 m t lam•t a dMW Ig '''L -?� . Ixen mer'tla aeoaen on tn. p rm •es�i. w.•to�n !� •. M0.31431 ..�� tt,w s u. ro rwe-�c trors+nic m 6na a slot w»o4 ks.+n.eA a ..; P OW7 acryr o rrdr�u6 q�'�F� ••�•.......�•r 'r Mraen. _ ►� to.o�nr C. _..�Ar'Y� i7—� sia SSfOf,'A �vB�� ' i00fm Buil am M. MI2M MIA Mor9sa TT:ST 90/a/90 Municipality of Anchorage Municipality Y George P. 11'uerch. Mayor Btxildiner Stlfety Dhision P.O. Dux IM650 • 4700 S. Bragaar Street Anehnrage. Alaska W519.6650 • ((N)7) 343.8.301 h up://aa�a�c.ei.unrhnr.��culc.uz 7/15/2002 Michael E. Anderson, P.E. Anderson Engineering PO Bos 240773 Anchorage, AK 99516 Subject: Waiver Request for Sand Lake #2 Block 6 Lot 21 Waiver Request #WR020044 Parcel ID #011-133-16 Dear Mr. Anderson: Your request for a waiver of the required 100 feet horizontal separation from the septic tank on subject property to private well on subject property has been approved. The approved separation distance is 88.0 feet. The approved separation distance from the absorption field on the subject property to the well on lot 22 is 87 feet. This waiver approval applies to the existing septic and absorption field to wells 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, n Daniel J. Roth Civil Engineer On -Site Water R 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#: WR020044 PID#: 011-133-18 HAM HA020297 Permit#: Date Received: RAZ Legal Description: Sand Lake Subdivision #2 Block 8 Lot 21 Engineer. Michael E. Anderson. PE Anderson Enaineerina Applicant: Troy Scheuner Waiver Requested: 88 feet from well to Septic and 87 feet from well to neighbor's septic and absorption field Criteria: Waiver is Granted: x Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Waiver is not Granted: List Conditions or Reasons for above: SEE fir4cl4E10 Date: /-f ZO2 By: a*} V Name of Reviewer ..............................................................................� Rec#: Amount: — Date Paid: 7/1012002 wAlvEle REQUEST FOR 5,010 LAKE Z SUOA 17L4PC/f L 40T 1/ Wl4/VER IgEQKEST r(/uM9El( 1v1g02004¢ tovmvER igaQuF Sr Fox OP -L or wPTE/f imul. rONE/6HBOM v AoxoRPT/o.v' FIELD OF EXISTING SEPT/G frSMAI WOf CONfr/euc7ZP /N /98/. rlltE SoIj S rl'(,E SYSrF_iy IS fovrr.t..crEO /N ORE 6w So/L AY/c/{ rrPIcoo C. "'~ WILL HAVE A )04RC01A7-/oN R/4rE Of O -S ��'vu�S�/v[N, Tl!/S �K == SOIL 6vA•,S C*LLSO A SAANOY (TRA✓EL. SANP L AKE SuOP/VIS/ON "Of AAA �vaa Lor$ of SnuO TYPICAttY rHus DASEO PN SuxRouivP/A'lr PROPERr/ES So TES7T CALLINk our 5AA/P PREPOa/NE.vrL)' Ir/S SAFE r0 ASftlA1E 777 SAA4E FOX rMIJ PROPdRTY, TN/f fAAV LgKF SAN19 wits rYPi"tcY TREAT fLrPrIL r#NK l3 A wEmy SKoRr !7/JrANGE. 'w S ,y 84LA w,FLL PAM THERE - THERE ARE Two &AttS 1N Qua;ncA, LOT' 2/ * L or ZZ. BpTK CS ,4,?E RELAr/vELY PEEP Ar 3'/1 ' / 220' /ecSP0StrlVe,-y A6b/�/A, tM/S /S ry,*/ c,91- Fvie SA.vo GAkE, r10E w6LLS AMC CoNfrRKC7-9rD OR/144R/LY rHROUGN S#NP IINr/L Ov4r6R /S ENCOuA,7-6-Ary Ar 220fE r SrrFrlc w*rER Lrva;r OvE ALSO PEEP Ar /00* F6lET. SAvG LAME /S R6L/4rIvELY tLAr Iti 7H/S RREA, r7{F_ wporE/Q Iv/:LL oAv Lor Z/ /3 L etwrzv Paz wssror- M& SE✓nc rAN,p ivHIL6 r<!F_ 1y!'ELL o.✓ Lot 22 Ill ON THE %OpAjo HYAR/4944[/c CoA+rowR nj rieZ 14LlSotpTiati FIEL./i. A CoNSfty, rive A/uMOE/e ma of —j */o tole 14. 4r/s* rA/DLF (Ht0DRAkL/c) GRAP/frT. W,4r6R SAXpj.6f /yO/C*rr Al'rIQATE3 Ar .293 /%ylr NP DACrffelA, of C. S. Q W. G, for 51 C. K. V. PO/NTS �1 worffR TAME 8�lEliic p:/Ti/ - �/7 �SIVL •. n. l�� W W SO/L SO,eIiT/oN PREoowwwrte Sp,v fieo" (,xow..p SuRsncsro WATER 2.0 CSS �r _n. rn� �� Sp�6 as pvu✓F /. S /� W),�rrrt rAoce GRnD/zwr 'S °/p co,vSbKvl*Tivf_ O phi z oA/r.qL 871 (ovCLuS/oN Cr1er}Nr lv/¢/✓EQ• GRaNv rvnaL z.s �z ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) July 10, 2002 Municipality of Anchorage Building Safety Division On -Site Water and Wastewater Program 4700 S. Bragaw Street Anchorage, AK 99507 Subject: Lot 21, Block 6, Sand Lake Subdivision No. 2 Separation Distance Waiver Septic Tank to Wells Dear On Site Services Engineer: The septic tank and absorption trench on Lot 21, Block 6, Sand Lake Subdivision No. 2 was originally constructed in October of 1981. The as -built on file for the system indicates the septic tank is 100' from the well on the lot. The well was apparently not constructed until February of 1982 at a distance of 88' from the septic tank. The absorption trench was also constructed only 87' to 90' from the well on the neighboring Lot 22. Documentation in the Municipal records indicates waivers were apparently granted in the past allowing the septic tank and absorption trench to encroach within the 100' protective radii of these wells. No justification for the waivers was found in the records. The wells are located at the same elevation as the septic tank and absorption trench. The soil under the house and septic system is primarily a silty sand which percolates at between 1 and 5 minutes per inch. The well log for Lot 21, however, indicates clay layers between the water aquifer serving the well and the bottom of the septic system. The well logs for Lots 21 and 22 are enclosed and vary in depth from 513' to 220' with casing the full depth. The static water level was recently noted at 117' below the top of casing or 115' below the surface in the well on Lot 21. The well log for Lot 22 states the static water level was at 140' at the time the well was drilled. Since both wells are approximately the same distance from the septic system and the soil conditions and topography are virtually the same for both wells only one analysis is provided for both wells. The analysis is as follows: Separation Distance Waiver Guidelines Lot 21, Block 6, Sand Lake Subdivision No. 2 Separation Distance Waiver July 10, 2002 Page Two Soil Type Sand with Silt/Clay Lenses 2.5 Permeability Sand with Silt and Gravel 1.0 Water Table Gradient 0% 2.9 Horizontal Separation 87' 2.5 Total 16.1 The conclusion based on the aforementioned point totals is that almost surely no form of contamination can be expected from household sewage. It is therefore recommended the waiver be approved to allow the existing septic tank to be 87' from the existing well on Lot 21 and 87' between the absorption trench and the existing well on Lot 22. A recent water sample taken from the well on Lot 21 indicated very little concentration of Nitrates (.233 mg/Liter). It is apparent that neither the absorption crib nor the septic tank are influencing the quality of the water from the well. Sincerely, / Michael E. Anderson, P.E. Attachments ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522.6779 (FAX) June 29, 2002 Mr. Troy Scheuner 8236 Wilcox Street Anchorage, AK 99502 Subject: Lot 21, Block 6, Sand Lake Subdivision No. 2 Well and Septic System Inspection, Testing and Certification Dear Troy: At your request we inspected the well and septic system on the subject lot to determine if they met the requirements for certification by the City. Prior to the inspection we inspected the Municipal records and found the septic system was originally constructed in 1981 and was composed of a 1,000 gallon septic tank and a 25' long by 3' wide by 5' effective depth absorption trench. The well was also constructed the same year and is 513' in depth with 6" steel casing the entire depth. The septic system was originally constructed 90' from the neighboring well and 90' from the well on the property. A Certificate of Inspection issued by the City on March 8, 1982, appears to allow the placement of the system within the 100' protective radius of the two wells. This approval is reiterated on a Certificate of Health Authority Approval issued on April 3, 1984. We probed the monitor tube/sump at the end of the trench and found nearly 14" of soft sludge at the bottom. No water was found. We then injected 453 gallons of water into the bed and the water was apparently totally absorbed as no water was noted at the monitor tube/sump. We conclude from this test the trench is capable of absorbing more than the required 450 gallons of water per day and meets Municipal requirements for certification. It must be noted the septic system even though it is functioning adequately at this time Is more than 20 years old and has an accumulation of sludge, which could impact the future usefulness of the system. The static water level in the well was originally measured at 117' below the ground surface. Water was allowed to run freely from the well through a hose bib and through a 5/8" hose with a volumeter. Flow was measured at an average rate of slightly more than 6.5 gallons per minute with the static water level in the well dropping to 180'. Once flow from the well was stopped the static water level returned to its original level in an hour. The well is therefore capable of producing in excess of the required 450 gallons per day. A sample from the water system was found to be free of coliform and other bacteria with only a trace of nitrate content. The well and water are therefore eligible for Municipal certification. Sincerely, Michael E. Anderson, P.E. Attachments MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICA'T'ION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE % /a 1. General Information Application Date /??./ " (a) Legal Description (include lot, block, subdivision, � n,section, township, range) Location (address or directions) (b) Applicants Name Applicants Address t til di o }� (c) Applicant is (check one') Lending Institution ; Owner/bu-il-der DKI Buyer F___T ; Other � (explain); (d) Lending Institution � ALASV�A PAQt -=IC F34N%_Teleohone IF(s 2.-& 169 0 Address I LP 9 P4 5C) kid PS LVV—> (e) Real Estate Co. & Agent Address Telephone 2 . Type of ire s ide nce Single -Family Multi -Family Number of Bedrooms 3. water Supply Other (describe Individual 6+ell Community Public Note: If ccmmnity well system, must have written confirmation from the State Department- of Environmental Conservation attesting to the legality and status. ° Is the well adequate for the number of bedrooms specified in this HAA 'YIN) 4. Sewage Disposal OnsiterK Public Community Holding Tank Is the wastewater disposal system adequate for the number of bedrooms (Y/N) [Page 1 of 21 2-15-84 5. Enrireerirg Firm Providing Inspections, Tests, Data and Infc ..aticr. I certify that I have checked, verified, or confonred to all M0JA FAA Gui.dalires in effect on the date of this inspection. Signed Nam of Firm a to -e o �!e a VJ1 Address X10 t � ✓� �% Sigr>ed by Date (ENGINEER SEAL) 6.DHEP Approval n ` A- owed for '.� bedroom. Approved f- T Disapproved Terms of Conditional Approval Date 31 4-y ®� 9/A �e,.e= �®q� .:,�t'®F At -XII /�,...9.'...�..... 2225- E JUIE 25, 1971 tee.:.. . LJl`L Yate `� .� GLY Conditional The Municipality of Anchorage Department of Health and Environmental Protection does not guarantee the continued satisfactory performance of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date shown above, based on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional unLtional for the number of bedrooms and type of structure, indicated. (DHEP SEAL) 7. Mail the HAA to the following address: KB2/d5/s [Page 2 of 21 2-15-84 MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA)ENVIRONMENTAL PROTECTION; CHECKLIST - FEBRUARY 1984 MAR ;. 2 A. WELL DATA RECEIVED Well Classification ?`1.1VAT1= If A, B, or C. D.E.C. Approved(Y/N) Well Log Present (Y/N) FeliE Date Completed Yield a6gr__ Total Depth /� Cased to :5/3 Depth of Grouting --77—� Static Water Level 1 / P) Pump Set At Casing Height Above Ground o2 Sanitary Seal on Casing (Y/N) Electrical Wiring in'Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: ),I-/ - To septic/Holding Tank on Lot �' ; On Adjoining Lots 7 J , To Nearest Edge of Absorption Fie on Lot �n� + On Adjoining Lots (3 To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole/ To Nearest Sewer Service Line on Lot N/A Water Sample Collected By T S. Date 9• & Water Sample Test Results S Q T1 S Af$ c 7'0 9.4 Continents B. SEPTIC W TANK DATA Date Installed 0/1 - �f l Size 1000 No. of Compartments Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/e N) Date Last Pumped e2 2 [ 8-7 Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from.Se tic Tank: To Water -Supply WD11 To Building Foundation To Property Line To Disposal Field To Water Main/Service Line • To Stream, Pond, Lake, or Major Drainage Course Commnts [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA r e o#4 f 4 U N I G t PA L. R i - c Soils Rating in Absorption Strata Type of System Design lite.4 Date Installed !°Irk l Length of Field Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area © Standpipes Present (YIN)®0 Depression over Field (Y/N) ` Date of Last Adequacy Test Z7 ! J Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well / ob To Property Lire To Building Foundation To Existing or Abandoned System on Lot -- On Adjoining Lots so � To Water Main/Service Line r To Cutbank(if present). To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area / Q Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Comments Dimensions Manhole/Access (YM) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or, conformed to all MOA HAA Guidelines in effect on the date of this inspection. / Signed � -Date Company e' p v i �te�{ MOA No. S'` g y n! I KBl /d5/s (Page 2 of 21 � P�� OF AI�� A~ • •�) Q� 5"d . w Y F.+ ,1% o. 2225-U 5. r UNE 25, 1971 • 2-15--84 Time APPLIC..NAT FILLS OUT UPPER HAL, ---,,ONLY Property Owr,.?.,r (,j( Time Date Phone Mailing Address X Zip Code Inspector Buyer Address Inspector Zip Code Lending Institution Phone Address Zip Code P: Realty Co. & Agent Phone APPROVED BEDROOMS *CONDITIONS OF APPROVAL DISAPPROVED Address Zip Code Legal Description C/ r%' ro S k-, Street Location Well To Absorption Area Well Log Received Septic Tank Size Type of Residence CA Single Family E) Multiple Family No. of Bedrooms El Other Water Supply Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. Community For wells drilled prior to that date, give well depth (attach log if available). 0 Public Utility Sewer Disposal Individual Year Individual Installed: Public Utility When Connected to Public Utility: 0 Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REOUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: MUNICIPALITY 0r' P: RECEIVED APPROVED BEDROOMS *CONDITIONS OF APPROVAL DISAPPROVED CONDITIONAL APPROVAL' DATE BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size Well to Tank 72023 (3182) rr Time ie Date D/ate Date IS n Inspector Inspector Inspecto C\wr Comments Conditional Approval 7 CL- I r -V -C Date Sewer Installed ` Permit No. Septic Tank Size Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank% APPLICANT FILLS OUT LOWER HALF ONLY Property Owner Mailing Address Buyer Address Lending Institution /1/,# 15 AAI& �v o Address Realty Co. & Agent Phone Address Legal Description/0- Street Location ,4 ,IAIW W.XC-aX Typeesidence rSingle Family ❑ Multiple Family No. of Bedrooms ❑ Other Water,8tipply CC55 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. Sewapd'Disposal / ❑ 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. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION Environmental Sanitation Division 825 L Street - Anchorage, Alaska 99501 Telephone 254-4720 CERTIFICATE OF INSPECTION SEWER AND WATER FACILITIES 1. PROPERTY OWNER Danny Caroland MAILING ADDRESS Box 10-1682 Anchorage AK 99511 2. LEGAL DESCRIPTION Lot 21 Block 6 Sand Lake #2 3. TYPE DWELLING 6 SINGLE FAMILY RESIDENCE O OTHER (Describe) 0 MULTIPLE FAMILY RESIDENCE 4. WATER SUPPLY In .INDIVIDUAL ED COMMUNITY/PUBLIC 5. SEWAGE DISPOSAL M INDIVIDUAL/ON-SITE 0 PUBLIC UTILITY 0 . HOLDING TANK (Maintenance Required) 0 APPROVED FOR three BEDROOMS PI CONDITIONAL APPROVAL (See Attached) See reverse side for conditions. E--] DISAPPROVED DATE BY (TI T E) ®� // ® 1� 72-014 (3/78) Conditional approval if: A portion of the sewer system absorption trench must be relocated 90' from the niehgboring well by may 30, 1982. The relocation consists of: utilizing 191 of the original 26' of trend and removing the remaining 12' of trench closer than 90' from the. 17' j. 41Ct F i CititC=ni c s> o' frGr-i nefg iboring we is or have a local engineering firm test the remaining 19' for adequacy to support a 3 bedroom residence which meets D.H.C.F. approval. 0