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SAND LAKE #2 BLK 7 LT 23
Onsite File Sand Lake #2 Block 7 Lot 23 #011-132-14 Municipality of Anchorage - On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 4 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211366 PID Number: 011-132-14 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New On Upgrade Name MICHAEL BUSEY ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 8222 ENDICOTT STREET *ANCHORAGE, AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade C/O ARM SEPTIC - 317-9433 3 *3.0 GPD/SF 10.56 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade SEE DWG. Ft. Gravel depth beneath pipe 4 Ft. Subdivision Block Lot SAND LAKE #2; BLOCK 7, LOT 23 Fill added above original grade SEE DWG. Ft. Gravel length 15 Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines - Distance between lines - Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer I Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 150 FF 1 - Ft. Well _ _ I _ _ TANK ❑ Septic N S.T.E.P. ❑ Holding ❑ Other Manufacturer INIFILTRATOR Capacity 1530 Gal. Surface Water *50'+ *50'+ *50r+ Material Number of compartments Lot Line 5'+ *5'+ 5'+ NA HDPE 2 Foundation 1**4'+l 10'+ **4'+ I LIFT STATION Manufacturer Capacity Remarks `AWVJTS "SEE ATTACHED PROFILE DRAWING OF TANK TO FOUNDATION INFILTRATOR 500 Gal. OLD SEPTIC TANK WAS DECOMMISSIONED PER UPC PER CONTRACTOR Alarm location REMOTE MONITORING Electrical installed by Installer PIPE MATERIAL House to tank 3034 Tank to 1785 drai ARM SEPTIC SERVICES Drainfield 3034 coIMTMT 3034 Inspector GEG AND MOA BENCH MARK (Assumed elevation) ft Inspectdates:ion 15` 11/11/21 1 1/16/21 leR and de criptign �` V`seo 31d 11/16/21 41n 1 = v c3 ► Z, ^ `� ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's amp boo Conditional Approval: DateQo �� • ...... ..Po 0 o........ ... ................. Septic System Approved pp Date 10 X0,22 (/ J f r A. Gorn ss. p 4 pop ��� e • Nl. (• Z..�' �� O / �d Note: this approval does not include well permit requirements.p,0feSst°"oo� 4�0000�O 4AECC884 kRCV OJ/UG/ 10) PERMIT NUMBER: PARCEL ID NUMBER: OSP211366RECORD DRAWING 011-132-14 A B FCO 29.2 11.1 MHl 34.7 9.5 MH2 32.4 18.6 NEW DRAINFIELD; IT SHOULD BE NOTED THAT THE NEW FIELD IS LOCATED SLIGHTLY VP1 33.0 23.7 FURTHER NORTH THAN THE DESIGN DRAWING; HOWEVER, THE ENTIRETY OF THE Al 34.1 28.1 NEW FIELD IS WITHIN THE EXCAVATED AREA OF THE "OLD FIELD" FD 36.0 32.9 C01 40.1 48.3 EXACT LOCATION AND ORIENTATION OF EXISTING FIELD IS UNKNOWN. CONTRACTOR EXPOSED MT1 38.4 46.7 5' PAST NEW SEPTIC TANK TO CONFIRM 5' SEPERATION DISTANCE; IN ADDITION, A 5' DIRT PLUG CO2 46.2 41.9 WAS INSTALLED BY THE CONTRACTOR BETWEEN THE NEW DRAINFIELD AND THE EXISTING MT2 46.9 43.5 DRAINFIELD. A NEW CLEANOUT AND MT WERE INSTALLED AT THE NORTH END OF BOTH "LEGS" NOTE: PIPE LOCATIONS ARE AND A CLEANOUT WAS INSTALLED AT THE SOUTH END OF THE "WEST LEG" � SHOWN PER GEG SHOTS _ TAKEN WITH LEICA DISTO NO WELL ON PROPERTY S910 LASER DISTANCE METER. SWING-TIES TO HOUSE CORNERS WERE SAND LAKE #2; BLOCK 7, LOT 24 - NO WELL ON PROPERTY GENERATED IN AUTOCAD. SERVED BY SHARED WELL ON BLOCK 7, LOT 3 A DECK C CO I \ 01 M M z T1 ' EXISTING 3 iI 5'+ BEDROOM HOUSE w \ W _ C � 20 O ' 1 VP A FC NO WELL ON PROPERTY - SERVED BY 1 b SHARED WELL ON BLOCK 7, LOT 3 - LOCATION MH OF WATER SERVICE LINE IS UNKNOWN I MH NEW NS500 TREATMENT POD NEW TWO COMPARTiMENT IM-1530 INFILTRATOR SEPTIC TANK N SCALE: 1"=20' N..... _. Arr .� ? Ltd *� .....:...... ............ ......... :..... � ENGINEERING - SALES CONSULTING 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, ALASKA- PHONE (907) 337-6179 • WEBSITE: vnew. gamessengineering.wm ••. ••.• . . ....... •.•.••.•.•.•.S; !. 0 ♦ t't : ey mess :• 4d i •#��J' °� PREPARED FOR: PHONE NUMBER: PAGE NUMBER: C/O ARM SEPTIC SERVICES 907-317-9433 2 OF 4 ; CE-7 53 �♦ ••'•.•• y'T �� • PROJECT/LEGAL DESCRIPTION: DRAWN BY: SAND LAKE 2; BLOCK 7, LOT 23 D.J.G. tcQ.•P�, +�►� ' 44 TYPE OF WORK: DATE: `r ";� RECORD DRAWING OF SEPTIC SYSTEM 12/1/2021 #AECC884 I A = 33.5" 45° 4 FEET-►{ 55" PER INFILTRATOR BOTTOM OF THE FOOTER WAS EXPOSED DURING CONSTRUCTION - BOTTOM OF TANK ELEVATION IS CALCULATED FROM GEG TOP OF TANK INSPECTION AND INFILTRATOR LITERATURE (TANK HEIGHT) -- . ENGINEERING= SALES -CONSULTING. 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE. AK 99507 ' PHONE (907) 337-6179 - FAX (907) 338-3246' VVEBSITE: v ,garnessenglneenng.wm PREPARED FOR: PHONE NUMBER: PAGE NUMBER: C/O ARM SEPTIC SERVICES 907-688-9433 3 OF 4 PROJECT/LEGAL DESCRIPTION: DRAWN BY: SAND LAKE #2; BLOCK 7, LOT 23 D.J.G. TYPE OF WORK: DATE: �, RECORD DRAWING FOR TANK TO FOUNDATION DRAWING 1 12/16/2021 ♦♦�� � ,111 11 1 �...mnuo. .. .uw.u..u. i� J e . Garn s # :c �I�J, : CE- 3 1111•"�p��p��t,',��..'.�.. �P. �♦i LICENSE Iir� ESS #AECC884 ,��„' i XXXXXXXXXXXX XXXXX X X XOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHU OHUOHUOHUOHUOHUOHUOHUOHU/O7 /O7$ 3/$7 /O7 /O7 /O7℄(1',&O77675((7℄:1'$9(1U(('*(O)3$9(0(173$9(''5,9(:$<MBS 6H(' 5O:N00° 00' 00"E 50.00N90° 00' 00"E 135.00 S00° 00' 00"E 50.00N90° 00' 00"E 135.00 5(7$,1:$// G E /RW%ORFN 6DQG/DNH6XEGLYLVLRQ1R 6T)W (QGLFRWW6WUHHW 6WRU\:RRG)UDPHHRXVH :LWK$WWDFKHG&DU*DUDJH S SS SS SS SS S SSC SC SC 1O7( /O7,66(59('%< 6H$5(':(///O&$7(' O1/O7%/O&. PROFESSIONAL SEAL Date:Frontier Surveys, LLC Project No: 650 W. 58th Ave. Suite E Anchorage, Alaska 99518 As-Built Survey of: www.frontiersurveys.com Frontier Surveys, LLC I, Pierre Stragier, hereby certify that this Mortgage Inspection Survey was performed by me, or under my direct supervision on Plat:Grid:Ordered By: 907.460.1686 - info@frontiersurveys.com This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the existence of any easements, covenants, or restriction which do no appear on the record plat. Under no circumstances should this document be used for construction or for establishing a boundary or fence line. November 23rd, 2021. Legend: Scale 1" = 25' Gas Meter Electric Meter/Outside Power Deck Septic Telephone Pole Fence Mailbox Overhead Utility Lot 23, Block 7 Sand Lake Subdivision No. 2 General Notes: 1. This document is created for the purpose of a single property transaction and is subject to Federal Copyright Laws. 2. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey. 3. All measurements/setbacks are to the visual/apparent building footprint. 4. All dimensions to property lines are plus/minus 0.1ft. ARM Septic Services 21-866 11/30/2021 P-176 2224 Street Sign Pavers MBSTA T E O F ALA S K A49 TH ROYEVRUSDNALLANOISSEFORP DERE T S IGER Pierre M. Stragier NO. LS-9812 11/30/2021 G E S x SC Septic Riser Cover 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: OSP211366 Effective Date: Work Type: Septic Upgrade Expiration Date: Tax Code Number: 01113214000 Site Legal Address: SAND LAKE #2 BLK 7 LT 23 G:2224 Site Mailing Address: 8222 ENDICOTT ST, Anchorage Owner: BUSEY MICHAEL A& LETHA A Lot Size in Sq Ft Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: This permit is for the construction of: p�enr 0, rr �v Depa i- tInent 8/31/2021 8/31/2022 6750 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: Locate the beginning of the field to confirm that the 5' separation between the tank and field will be met. ** CO #1 A new field was added to the permit. Received By: Issued By: K4,4_1 Date: Date: D l 3 60 ,n 111011 [ Municipality ®f Anchorage S Uepal•tmen[ P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 o Fax (907) 343-7997 http://www.rnuni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV211087 COSA#: Permit#:OSP211366 PID#: 011-132-14 Legal Description: SAND LAKE #2 BLK 7 LT 23 Engineer: Garness Engineering Group Your request for a waiver of the required 8 foot horizontal separation from the absorption field to absorption field has been approved. The approved separation distance is 5.0 feet. In addition, the water line cannot be located therefore the separation between the waterservice line and septic system is approved to be 0 feet. See the engineers justification. This waiver approval applies to the 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. Waiver is Granted: X Waiver is not Granted: Date: g Approved by: 46Z1- �� Name of Revievy ........................................................... i................. ■ 1 **** VARIAN C E/WAIVER REVIEW **** 22 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. 011-132-14 Property owner(s) Michael Busey c/o ARM Septic Services Mailing address 8222 Endicott Street *Anchorage, AK 99502 Site address 8222 Endicott Street *Anchorage, AK 99502 Day phone 907-688-9433 Legal description (Sub'd., Block & Lot) Sand Lake #2; Block 7, Lot 23 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field [G] Initial ❑ Single Family (SF) ❑ Septic Tank M Upgrade Z (w/wo ADU) Holding Tank ❑ Renewal ❑ Duplex (D) El Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUES OR: N/A Distance: - I certify that the above information is correct/further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 0225 Waiver Fees: Date of Payment: 0 a 202 Date of Payment: Receipt Number: O°19 5 `1 G Receipt Number: Permit No. 0SP2 l ) 366 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc An g (j CC) _4t A NESS ENGINEERING U i Ltd ENGINEERING , SALES CONSULTING October 27th, 2021® � O ,q11 � Municipality of Anchorage j .49 T *+ Development Service Department 0 „ , y, On -Site Water & Wastewater Program 4700 Elmore Road / • •' •, . , .. yl¢f A. Garne s Anchorage, AK 99507 u . Ref: Change Order including drainfield upgrade for Sand Lake #2; Block 7, Lot 23 �\ To whom it may concern:AF� The existing 3 -bedroom house is served by a shared well located on Sand Lake #2; Block 7, Lot 3) and a private septic system. The existing drainfield is in a state of failure and must be upgraded. Due to the site constraints, we are proposing to install a new 1500 -gallon Greer HDPE tank, a Quanics NS500 treatment pod, and install a "5 -wide" trench over a portion of the existing field. One testhole was excavated on the property and the drainfield is designed within its 30 -foot radius. Comments regarding the design are summarized as follows: 1. SOILS: See attached 2021 testhole by Gayness Engineering Group, Ltd. which shows the soil classifications, percolation test and groundwater monitoring. 2. DRAINFIELD DESIGN/REBUILD: We are proposing to rebuild a portion of the field and extend it to the south. Per GEG measurements, the invert of the existing field is approximately 6.5 feet below grade. Per the MOA inspection report, there is approximately 4 feet of effective depth. In short, the existing trench is about 10.5 feet below grade and our proposed excavation depth is 11 feet. The existing field is 48 inches in width, and we are proposing a width of 5 feet (60 inches). In short, the proposed drainfield will be deeper and wider than the existing field. IF, during excavation it is noted that the existing field is "deeper' and/or biomat extends beyond the maximum excavation depth, than the proposed field, it will be excavated out and filled with MOA sand. 3. SURFACE WATERS: There are no surface water concerns. 4. TOPOGRAPHY: There are no topography concerns. 5. WATER LINE: The water line cannot be located (see attached email from Deric Hart — former employee of One Stop Services and current owner of Arctic Effluent). In short, we cannot ensure the proposed drainfield and tank adequately meet the required separation distance to the existing water line. We are requesting that your department issue a variance from 10' for tank and drainfield to the water service line down to 0 feet. It seems likely that the water line runs north parallel with the west (from Block 7, Lot 3 where the well is located) and then east paralleling the north lot line, (and meets the required separation distance), however, it cannot be verified. Justification for granting this variance is as follows: • Since the water line cannot be located, there does not seem to be a "reasonable" alternative but to grant a waiver. • The existing septic tank is steel and at the end of its useful life. Installing an HDPE septic tank will be a significant improvement on the existing situation. • We are proposing to utilize an AWWTS. The effluent quality will be "better' in terms of BOD, TSS and coliform bacteria than that of conventional treatment. • We are proposing to rebuild a portion of the existing field with an extension. It is reasonable to believe that some care was taken during the initial installation of the drainfield and water line so as to ensure proper separation. If so, it is possible that the existing field meets the required separation to the water line. 6. WAIVER: The proposed drainfield will be less than 8 feet from the existing field. Due to there not being a cleanout and/or monitoring tube at the end of each "leg" of the existing field, the exact separation distance is unknown. However, we are requesting that your department issue a 5' variance from drainfield to drainfield. If it is found to be closer during construction, a change order will have to be requested. Justifications for granting this variance is as 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com GO -91l Page 2 of 2 follows: • Unless the existing system is completely decommissioned, there does not appear to be a viable alternative for meeting the required separation distance of 8 feet. • We are proposing to rebuild a portion of the existing field. This encroachment has existed for the life of the system. • We will be installing a dirt plug between the proposed field and the existing field with a diverter valve. Only one leg of the drainfield will be operational at a time. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for vour assistance. , M.S. ._2 J L Z uav-,-- � z, k's- 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www. garnessengineering.com DESIGN CRITERIA: NUMBER OF BEDROOMS: 3 GALLONS PER DAY (GPD): 450 PERCOLATION RATE/S: 10.6 GPD/FT' PROPOSED APPLICATION RATE: 3.0 MINIMUM DRAINFIELD SQ.FT.: 150 FTI DRAINFIELD DESIGN: MAXIMUM DEPTH: 11 FEET WIDTH: 5 FEET LENGTH: 15 FEET EFFECTIVE:4 FEET REDUCTION FACTOR: 0.5 FEET ACTUAL SQ.FT.: 150 FT= i I I I T- # O I Y J LQ - -----r \ Z U O U)m 1 SAND LAKE #2; IBLOCK 7, LOT 2 APPROXIMATE LOCATION OF TESTHOLE—""� SAND LAKE #2; BLOCK 7, LOT31 GEG, Lid. HAS AN 8 PAGE SPECIFICATION LETTER THAT PERTAINS TO THIS DESIGN. BY PROCEEDING FORWARD WITH THIS INSTALLATION, THE ENGINEER, WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND CONDITIONS OUTLINED. U GD-'2;2�-I CONTRACTOR TO HAVE WEST EASEMENT/POWERLINE OFFSET AND SOUTH LOT LINE FLAGGED BY PLS PRIOR TO CONSTRUCITON ------- I NO WELL ON #2; <ROPOSEDLOCATION OF UPGRADE OXIMATE LOCATION OF 10' OFFSET FROM POWERLINE PROPOSED DRAINFIELD 7, LOT 24 NG FIELD TO BE USED AS RESERVE SITE; INSTALL CLEANOUT AND MT AT EACH END OF FIELD APPROXIMATE LOCATION OF WATER LINE ENTRY IN CRAWLSPACE '1 DECK I 5' OFFSET FROM EXISTING FIELD AND DECK POSTS TO T///4 PROPOSED SEPTIC TANK / EXISTING HOUSE O ,3L1a2 FIELD TO BE EXPOSED `-PROPOSED 1500 GALLON HDPE GREER TANK TO BE USED AS STEP TANK O' OFFSET FROM FOUNDATION ( INSTALL V DIRT PLUG / WATER SERVICE LINE FROM WELL TO HOUSE IS UNKNOWN. EXACT SEPARATION FROM PROPOSED DRAINFIELD AND PROPOSED TANK TO SERVICE LINE IS UNKNOWN. BASED UPON THE EXISTING SEPTIC TANK AND TRENCH LOCATION, IT IS REASONABLE TO BELIEVE THE WATER LINE MAY TRAVEL ALONG THE WEST AND NORTH LOT LINE AND ENTER 712 i OFF THE NORTH SIDE OF THE HOUSE.- ` Z WJ,Int ;.........•.......• ..................•. ENGINEERING SALES CONSULTING .-..-• M y_.: 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, ALASKAPHONE (907) 337-6179 - WEBSITE. %ww.gamessengineenng.wm7�03.i.• • .... ......•...... y...; PREPARED FOR: PHONE NUMBER: PAGE NUMBER: >> Cri -Ga Bess c4C1C1 C/O ARM SEPTIC SERVICES 907-688-9433 1 OF 1 �j�� :1 C 79 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: �♦,� `'•, ;q 'V •,•• SAND LAKE #2; BLOCK 7, LOT 23 D.J.G. �� FD '•,•,••••••.'" ..4W pp TYPE OF WORK: DATE: LICENSE , P rO ESS\ SEPTIC SYSTEM DESIGN UPGRADE 10/20/2021 #AEcC884 GARNESS ENGINEERING GROUP, Ltd ENGINEERING -SALES -CONSULTING 3701 EAST TUDOR ROAD. SUIT 101 'ANCHORAGE, ALASKA' PHONE (907) 337.6179' WEEBSITE: www.garnessengineenng.com SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: SAND LAKE #2; BLOCK 7, LOT 23 PERFORMED FOR: C/O ARM SEPTIC SERVICES DATE: 10/11/2021 DEPTH (feet) OR G TEST HOLE #1 I E 7 8 9 10 11 12 13 14 15 16 17 18 SM WITH POCKETS OF ML SP SOIL CLASSIFICATIONS DEPTH TO GROUNDWATER DATE DRY 10/11/2021 DRY 10/19/2021 Gr) 14t SITE PLAN Pc' 5 DATE GW 111111111ML •' WATER LEVEL READING (INCHES) Ilrlllll CL %/% NNII 111111111 • .:'. ,W. " . - %////. 3 - 12/16" 001111 • - 6" - DEPTH TO GROUNDWATER DATE DRY 10/11/2021 DRY 10/19/2021 Gr) 14t SITE PLAN Pc' 5 DATE READING NET TIME WATER LEVEL READING (INCHES) NET DROP (INCHES) 10/12/2021 1 - 6" - 2 10 3 - 12/16" 2 - 4/16" 3 - 6" - 4 10 4 - 14/16" 1 - 2/16" 5 6" - 6 10 4 - 15/16" 1 - 1/16" 7 - 6„ _ 8 10 4 - 15/16" 1 - 1/16" 9 - 6" - 10 10 5 - 1/16" 15/16" 11 - 6" - 12 10 5 - 1/16" 15/16" 19 PERCOLATION RATE 10.6 (MIN./INCH) PERC. HOLE DIA. 6 TEST RUN BETWEEN 5 FT. AND 6 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES ® NO SOILS LOGGED BY: DAVID GARNESS, PE PERCOLATION TEST PERFORMED BY: DAVID GARNESS, PE COMMENTS: ABSORBED ALL 6 INCHES IN LESS THAN 30 MINUTES PRIOR TO STARTING 10 MINUTE READINGS PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PE FORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: eo Zo , (INCHES) 4of m L;i in N cta V) 0'6 - OHU- OHU- OHU- OHU- OHU- OHU- OHU- 41 lim 1 NO Q) 0 u LO C/-) Eial I CL LL 0 Q CL %+- 0 0 8 .0 LV "a c 0 cc (h C: 0 0 m C: 0- C -0 CL o CL :3 c 0 w 0 = CL CO 0 , Co :3 0 0 cc CL 4) CL 0 Co 4) 0 %+- -0-MO 0 - 0 C C: CD 0) L- E 0 0 0 0 o C: 0 z o — -o E w 4) 0 X F- W < C\i cvi 4 c m . .. . .. . .. . .. . cce fit cVJ fi 0 E m E 0 0 -C > — p " 0 t: CL E 0 uj 0 L wans.- > 0 uj .4 m 0 16 c 4) c -c "2 CL Q CL 0 0 >1 C 0 0 r*4 > Oo • m CO 0 V) 4) c CL :) 0.2 in N cta V) 0'6 - OHU- OHU- OHU- OHU- OHU- OHU- OHU- 41 lim 1 NO Q) 0 u LO C/-) Eial I CL LL 0 Q CL %+- 0 0 8 .0 LV "a c 0 cc (h C: 0 0 m C: 0- C -0 CL o CL :3 c 0 w 0 = CL CO 0 , Co :3 0 0 cc CL 4) CL 0 Co 4) 0 %+- -0-MO 0 - 0 C C: CD 0) L- E 0 0 0 0 o C: 0 z o — -o E w 4) 0 X F- W < C\i cvi 4 c m cce fit cVJ 0 E m E 0 0 -C > — p " 0 t: CL E 0 0 L > 0 40� .4 m 0 16 c 4) c -c "2 CL Z o CL 0 0 >1 C 0 r*4 > c w 0 0 0 m m CO 0 V) 4) c CL :) 0.2 z 0 4--1 o C: 0 m c .0 c 0 CC 0 7 -0 *F W co (A > c c 0 0 Z c > m .0 * to mL lao C) r -i f) (3) +- 0 (o 70 >% 0 c 0 M t 0 4-4 0 E: E 4-# E E 0 c tA 0 CO CD ® 0 4-J 4-4 0 ca L. m -C to > lit "a C: © J"1 ice•c0— 4-J < =3 W 0 0 i> m > 0 t 4-J < 0 *4— 0-0 - Al Ln .0 < r- E uj 00 cr (U ) V; @ 0 E CL o >- E 4-J > > E < 00 o m 0 V) 4-1 � ►0 4) 0 0 V) Ln 0 .0 c: o HE OJ idi:3 0 4-J 0 0 c > s- Ln C) x = c cr) MUNICIPALITY OF ANCHORAGE j DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION d l 7 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ��- ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REP6RT� NAME PHONE NEW t L`–HV/ 4= (`i'�–i TYPE OF SOIL ABSORPTION iNa SYSTEM IS.: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (50 FT,'BR)= 150 THE REQUIRED SIZE O SOIL ABS•ORPTI, -IN• -'"_=TEN IS: THE LENGTH D.T.N'iEP.JSIOI'•d IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINdFIE:LD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE E;-=CAVATIONa (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRA'V'EL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). F;=` 1= ®_a LJ I P,° F="n =° E_ F=� _1F 14== ""I-' F:� 6'-°I F="° I I_ - C-1 C`4 rZi C`e Fl I_. 0 a o I" -°k =° PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATIONa INaSPECTIONaS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SER'V'E. — — — -I" I -°-I a-1 a:_ I I' -°I ` = F:="#= ®7. -F I Ca "!ES; 9=i R' 9= F° F= 9-7E U I I•'=_ F= r- BACKFILLIN•aG OF ANY SYSTEM WITHOUT FINdAL INaSPECTIONa AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINdIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS. 100 FEET FOR H PRIVATE WELL OR 150 TO 24=0 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINdIMUM DISTANCE FROM A PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE I S. 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE -DEPARTMENT WITHIN 2:0 DAYS, OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPEC:IFICATIONdS, AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INdSTALLATIONa. F=°I=F-fr-I I "T- Ee-eF=° 11_x=° 2:1 - -1 I CERTIFY THAT 1: I AN FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELL'S AS. SET FORTH BY THE MUNdICIPALITY OF ANCHORAGE. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND D THAT THE ONd-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. APPLICANT EN•Ih A JEANd THOM SON ISSUED B'r'_______ ___________ _ --_--__GATE____--'4.E_; - L• tt'Ht; i P1tCd i HEHL. I H 5 'L ' STREET, HNO ENVIRONMENTAL OTEC T I ON•d ANCHORAGE, AK. _ _-atiol 264-4720 PERMIT NaCl: (; 820084 'l APPLICANdT EMMA JEAN THOMPS.ONa 2211 E. NORTHERN LIGHTS 279-8486 LOCATION LEGAL LGcf 87 SAND LAKE #2 LOT SIZE 999999 9 SQUARE FEET TYPE OF SOIL ABSORPTION iNa SYSTEM IS.: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (50 FT,'BR)= 150 THE REQUIRED SIZE O SOIL ABS•ORPTI, -IN• -'"_=TEN IS: THE LENGTH D.T.N'iEP.JSIOI'•d IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINdFIE:LD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE E;-=CAVATIONa (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRA'V'EL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). F;=` 1= ®_a LJ I P,° F="n =° E_ F=� _1F 14== ""I-' F:� 6'-°I F="° I I_ - C-1 C`4 rZi C`e Fl I_. 0 a o I" -°k =° PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATIONa INaSPECTIONaS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SER'V'E. — — — -I" I -°-I a-1 a:_ I I' -°I ` = F:="#= ®7. -F I Ca "!ES; 9=i R' 9= F° F= 9-7E U I I•'=_ F= r- BACKFILLIN•aG OF ANY SYSTEM WITHOUT FINdAL INaSPECTIONa AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINdIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS. 100 FEET FOR H PRIVATE WELL OR 150 TO 24=0 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINdIMUM DISTANCE FROM A PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE I S. 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE -DEPARTMENT WITHIN 2:0 DAYS, OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPEC:IFICATIONdS, AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INdSTALLATIONa. F=°I=F-fr-I I "T- Ee-eF=° 11_x=° 2:1 - -1 I CERTIFY THAT 1: I AN FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELL'S AS. SET FORTH BY THE MUNdICIPALITY OF ANCHORAGE. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND D THAT THE ONd-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. APPLICANT EN•Ih A JEANd THOM SON ISSUED B'r'_______ ___________ _ --_--__GATE____--'4.E_; - a J c (t a\ i_ \� J POUCH 6-650 ANC`aORAGE. AI-ASKA 9950-0650 (907;264-4111 o "J0V'/EES. t�TV,�ENF09 1;i;k!_1 1; r,!oEINV nRONNIC Tni_r;-orecTi0N (Permit #: 821128 January 31, 1983 TO: Permit Appicant Subject: Lot.2-e Block 7 Sand Lake Subdivision #2 A permit issued by this department for an individual well and/or on-site sewer system has expired as of December 31, 1982. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log needs to be sent to this department for documentation of the installation date and to close the permit. If a private engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files and documentation. If there are any further questions, please call this office at 264-4720. Sincer7p"t�- Q Robert C. Pratt, R.S. Acting Program Manager Sewer and Water Program RCP/ljw enc: Copy of Permit SWP/057 �� ^ ��u���c� t ���I -r *-e �F= F���0 �`J �n �3 � . DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ^ 825 /L/ STREET, ANCHORAGE, HK. 99501 - 264-4720 ^L4F=# I PERMIT NO. ( 821128 ) APPLICANT EMMA JEAN THOMPSQN 2211 E NORTHERN LIGHTS 279-8486 LOCATION LEGAL L20rB7 SAND LAKE #2 LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = I SOIL RATING (SQ FT/BR)= 150 THE REQUIRED SIZE OF 'THE SOIL ABSORPTION SYSTEM IS. �F. I —r-5 CNF:F�'-F"� :3 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (%N FEET). �=C--1UlF-_'F=E-s ���C-1 PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. — — — _y, L-A r_-1 <;2 > I P-4 �. F=l 1= I_-- I CD r-j:E3 F=l F__l F7, F_Z F= C_� U T F -f F= E_. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY OM -SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR 8 PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM 8 PRIVATE WELL TO 8 PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F="EEFRM I -F ���I F;?F=!SF. I CERTIFY THAT 1: I GM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. / �_ ~~ SIGNE 26 - W( ���� /�mr/r�ym �� �- ^ �/) ISSUED BY---�_����~ ����_���� V4.0 u � �[�w-�'� ��� �\Luc� J" }� PERFORMED FOR: LEGAL DESCRIPTI 11, 4 6 7 8 9, / --10' ,r 11 12_ 13 14 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST S1 L.1 �H VP+lir-��M r I►�a�. 5��1� ISO A JUI LJ LUU ❑ PERCOLATION TEST S ® N) DATE PERFORMED: 10 17. 7- 1 R i t3c> TO m v l- 4bLE WAS GROUND WATER � r ,� S ENCOUNTERED? 1� j L O P IF YES, AT WHAT E DEPTH? 15 Date OF Al, 16 Depth to Water o� 49TH 17 1 .... i 18- �N 2225-E• ^: J E 25. 1971 i .••• . •.,) as f. 20-1 l• it COMMENTS PERFORMED BY: 72-008 (6/79) - SITE PLAN v Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN CERTIFIED BY (minutes/inch) FT AND FT �S DATE: /� Z•� L Os .10 (D o 0 0 0 0 0 0 0 0: 0. rz 10 o wi tQ t.) W! 00c" H; (0: cn Ol CR 1 0 i Ol Ni --J CY1 10 : 00 0 b v+ Oc+ 0 0 0 0 0 0 0 0 0 0 0 0 t -j 0 0 (0 1 w .Y fLO t ®R 0 -,1: 00 GO (n OCA 0- Q,: cn = J Fb rl;, co 4 Ct (D '71 H 'Tj hl '71'TJ ri 0 tN cr 0 ca (D 4 f41 (D i c+ (D '(D I C+ :C+ C+ C+ 0 0i Oro 0 0 0 0 0 V tr 10 1-1 c) g (D 10 1 (D 4 I 13, O).i'0 i 0 (D I,< 1 .4 If CL a (D :Z 4 7m, - Os .10 (D rz 10 o 00 0 b v+ Oc+ 0 0 0 0 0 t -j t -i co 4 Ct (D '71 H 'Tj hl '71'TJ ri "l M pn 0 0i 0 0 0 0 (D O).i'0 i 0 (D (D Fj F-4 cl �Dnth(D C -f 4� fiq (D F1 F.A rz cl �Dnth(D C -f 4� fiq (D F1 F.A 10 o GE d • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 S ;. I E: T Y Certificate of On -Site Systems Approval Parcel I. D.011-132-14 1. GENERAL INFORMATION: Expiration Date: !V oq 1 (P, aha J Complete legal description SAND LAKE #2: BLOCK 7, LOT 23 Location (site address) 8222 ENDICOTT STREET *ANCHORAGE AK Current Property owner(s) C/O ARM SEPTIC SERVICES Day phone 907-688-9433 Mailing address Real Estate Agent 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: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Shared Well ® Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $_ �5'0 Waiver Fee $ _ Date of Payment _ r' a 3 a D� Date of Payment Receipt Number 01 0 2 SG Receipt Number COSA # OS C2.1 1.6'7 6 Waiver # tM `i 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: Gamess Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, an are outside the control of GEG. Satisfactory test results do not guarantee future performance of th system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance o the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE _% System #1 Approved for 3 bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the J J/ f �i �I V .. J f �e`ye,ness: �E-795� z 0 P,OfeS�iOn G� gnO'��pc� #AECC884 WHO, P u 991 11 LPMEW b J By: Original Certificate Date: IO 070 07 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 COSA Checklist Legal Description: SAND LAKE #2; BLOCK 7, LOT 23 Parcel ID: 011-132-14 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system AWELL DATA SHARED WELL LOCATED ON BLOCK 7, LOT 3 . ❑ Well log is filed with Onsite (or attached Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functi ng correctly ❑ Wires are proper rotected Casing height ( ve ground) in. Date of flo est for COSA StaticXter level at beginning of test ft. ents B. TANK DATA Age of tank(s) NEW years Tank type/material SEP"""°P' Measured operating fluid level in septic tank N/A 0 Standpipes/foundation cleanout per record drawing Date of pumping NEW C11W-11 �7 tiC��iI L 1 7 Which system tested (date installed) 11/16/21 Q ALL standpipes present per record drawing Total measured depth from grade 13.06 ft (max) Measured depth to pipe invert from grade 7.68 ft (min) ❑ N/A – pressurized field n Monitor tubes go to bottom of effective. If not, state depth into effective ❑■ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test �tereg�'T' n c volume gallons Well disinfected for coliform test? ❑ Yes ❑■ No n Coliform bacteria is Negative Nitrate mg/L W Nitrate less than MRL (ND) Arsenic 23.1 ug/L ❑ Arsenic less than MRL (ND) Collected by GEG Date of Sample 11/10/21 C. LIFT STATION 0 Required maintenance completed Age of lift station NEW years Lift station material HDPE Comments: QUANICS AEROCELL SYSTEMS Adequacy test date N/A Results ❑✓ Pass For 3 bedrooms Fluid depth prior to test in Water added - gal New depth in Elapsed time - min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) _ If yes, enter date - E. SEPARATION DISTANCES SHARED WELL LOCATED ON BLOCK 7, LOT 3 From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No Neighboring Absorption Fields > Yes if No ft if No ft Private S ptic Line > 25' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No ft Animal Containment > 50' ❑ Yes if No ft �,�/ Q✓ Yes if No ft Manure/Animal Excreta Storage > 100' a Property Line > 10 -4 lty- CgW.We Sewer Main > 75' ❑ Yes if No ft Water Main > 10' ❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Water Service Line > 10' ❑ Yes Building Foundations > 10' ❑ Yes if No *4'+ ft Surface Water > 100' ❑ Yes if No ""*50+ ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5'✓❑ Yes if No ft Private Wells > 100' ❑ Yes if No """50+ ft Water Main > 10' ❑ Yes if No ** ft Community Wells > 200' 0 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' Q✓ Yes if No ft If absorption field is under driveway comment below a Property Line > 10 -4 ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ** ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100' ❑ Yes if No ""`50+ ft F. ENGINEER'S COMMENTS *SEE ATTACHED PROFILE DRAWING OF TANK TO FOUNDATION "WATER SERVICE LINE/MAIN LOCATION IS UNKNOWN, SEE 2021 DESIGN IN MOA RECORDS ***CAT II AWWTS G. ENGINEER'S CERTIFICATION 4_7�... F, I certify that l have determined through field inspections and review n of Municipal records that the above systems are in conformance with 4 MOA COSA uidelines in effect on this date. of e yy A' ess,* p04, CE -793 COSA Checklist yellow sheet 4Pd pr o f es sl00 #AECC884 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904 On‐Site Water and Wastewater Section Fax: 343‐7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Arsenic Advisory Certificate of On‐Site Systems Approval # OSC211696 Subdivision: Sand Lake #2, Block: 7, Lot: 23 A water sample revealed an arsenic concentration of 23.1 micrograms per liter (ug/L). 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 ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this V-" Day of SANuARy of 202-2 , by and between C14-\ST\AN NAQP-IS , 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 (,9,Z.Evz- QS5©O TRS-nr,r PoD located at (legal description) L -OT 23 (3L OLK 5/� ND �1?tE 2 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) G u 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. C-0 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). -L_L4_ 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. Q-0 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 C V� Owner acknowledges that the Municipality may request records of maintenance and 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. C li Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. C I Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. C H 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 ANWTS. cH 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 OWNER: By: ' — -�— (signature) C-\-w-\5-TN AN NAs.6-l5 (print name) STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument wa acknowledged before 202L, by . LU"(� jj, p,<, NOTARY EUBLIC FOR ALASKA •� My Commission expires: Date: 01 / NO 1202 2 me this ) )Dday of MUNICIPALITY: By: ��e�t�;C� (signature) R4LfC4L"6? 6k-i—,o C ( (print name) (rev. 05/18/2018) �•,�,,,,, 4,1411,,,,,,,,, L Des,�o�,,,, �OTAR� 'ss 'FOF A?'^ 5` � 9J '•,�� Expires PJ '''1111111111411\\\ Date: / /0 .20,7 2 Title: Page 3 of 3 MUNICIPALITY OF ANCHORAGE U r DEPARTMENT OF HEALTH & HUMAN SERVICES{�?G1J�a3 DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date 12-� �Z 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) / (b) Property Owner 14E.' Mailing Address— (c) ddress(c) .Lending Institution Mailing Address' •GGl R (d) Real Estate Company and Agent Address '3 (D cc 4 Telephone 56—%G Telephone: Home /,=.) O Business (e) Mail the HAA to the followina address: or: Check here if hold for pick up. List contact person and day phone number below. wki sir s -z e-Iry Y� - 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms 3. WATER SUPPLY Individual Well 11Community4 Public Elr' Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (Rev 8/86) Front 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION A As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site waters upply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm f� !" C S f� Telephone Address Date Airce A7 �e� �•a yeu o e•;f��tY as •• V s �'. $ '•A_ T V •'��' 'v �ve•• .. o.eoyQe••e i•ee + OY C. REID, JR. e@g's ��g4 �.'• ,per i .0 .• ti •.......•• s� t*r►ur+►+•� DHHS APPROVAL Approved for L`G bedrooms byZ_,e_Z_ Date •47 /�lv Approved Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 _ 72-0251Bev 8/86) Back MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCHORAGHEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL SERVICES DIVISION CHECKLIST - FEBRUARY 1984 264-4744 'SLC = 1987 Legal Description: L A. WELL DATA RECEIVED ��N r2'/,v 5'10 Well Classification If A, B, ,, .E.C. ApprovedrYN) Well Log Present (Y/N) Date Completed Yield — Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on CasKg (YIN) — Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected Water Sample T Results Com B. SEPTIC/HOLDING TANK DATA Wellhead (Y/N) — ; On Adjoining Lots — On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot r ; Date Date Installed 3" J- ' " Size Ir ele"I No. of Compartments 2- Standpipesd 1) Air -tight Caps Y/�N) Foundation Cleanoout /N,) Depression over Tank (YL"" Date Last Pumped Pumping/Maintenance Contract on File (Y/N) A) Z"" ; for ! Holding Tank High -Water Alarm (Y/N) 1�z Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well ��' r) To Building Foundation i To Property Line, `Z �' To Disposal Field i— To. Water Main/Service Line 7 To Stream, Pond, Lake, or Major Drainage .Course Comments Page 1 of 2 72-026 (Rev. 8/86) Front C. ABSORPTION FIELD DATA i Soils Rating in Absorption Strata SZ, C7 !�/z Type of System Design /7C ^ r Date Installed T �'� Length of Field �� r �iS1�-I z ' Width of Field Depth of Field Gravel Bed Thickness Area Standpipes PresentcA) Square Feet of Absorption Depression over Field (Y/ //,, Date of Last Adequacy Test �Z,--7 Z Results of Last Adequacy Test <- e fL.2_z1`e Separation Distance from Absorption Field: To Water -Supply Well To Property Line �b To Building Foundation To Existing or Abandoned System on Lot None_ On Adjoining Lots /Lc „ c To Water Main/Service Line %/n / To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course ? /o t) To Driveway, Parking Area, or Vehicle Storage Area > ee , z 7-� s z ` _e_ C'/L/,/l %y 5� s /e � Comments " ,yl � /00 b /� O 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/Accu' *Vent Level at (Y/N) ** Check Permitted Bedroom Rating Against HAA Request ** Pumping Cycles during Adequacy Test. Meets MOA I certify that I hav i1e, e% veriP d, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed �`" Date ��s 7. Company �j c c.s MOA No. 0-23 Receipt No. /0 y / � d/CJ Date of Payment Amount: $ Page 2 of 2 72-026 (Rev 8'861 Back 0V yoyy00000yyc ,wr •Q9,�,e y �r,��f�O/,p ldtx da T14 u•®�`sC �y oy,y s eal o �� o0 Goods ypy/ Yon. YyROYCC. R^EID, .JR. a Ye 1"Q e CL 24J1 e Qys:A;y f 0 y N. h AA AA STEVE COWPER, GOVERNOR U E L OF DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 563-6775 3601 "C" STREET, SUITE 1334 ANCHORAGE. ALASKA 99503 61V "'JIVIC��TA� oRq�Cy��p D/VI ,0 _,AVO � `V�� DATE: Dec. 29, 1987^ PIJSID #: Class C Well To Whom It May Concern: According to the records on file in this office, the Lot 23, Block 7, SAND LAKE #2 Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, i_ Ronald S. Klein Environmental Field Officer *NOTE: Per verification by Steven W. Eng, PE, District Engineer CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION . PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT Plans for the construction of wA1'V 1 � t ,4 4 2_ !> f W� - � i � S`_� 1 r r public water system located in, Alaska, submitted in accordance with 18 AAC 80.100 by11hr, J, ,T r_s+t C r1 c� f • have been reviewed and are CK approved. conditionally approved (see attached conditions). - TITLE ^^rte If construction has not started within two years of the approval d plans and specifications must be submitted for review and approval I APPROVED CHANGE ORDERS Change (contract order no. Approved by or descriptive reference)PF U7 Date cri and new TO.OPERATE" section must be completed before any water is made available to The "APPROVAL the public. ' APPROVAL TO OPERATE The construction of the y.71J Ci (- r r- ';; _. f- 2!j �blic water system was completed on J " ` ' (date). The system is hereby F. granted interim approval to operate for 90 days following the cpmpletion date. BY TITLE DATE As -built plans submitted during the interim approval period, or an inspection by the Department has confirmed the system was constructed according to the approved plans. The system is hereby granted final "approval to operate. BY TITLE DATE q.q CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 8 STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE Client PO# : VERBAL Req #: Client Smpl ID: SAND LAKE #2 LOT 23 BL% 7 Sample Rec'd : DEC 31 87 Ordered By : CINDY LOVELACE Send Reports To: AECS 1200 W 33RD AVE, STE B ANCHORAGE, AP. 99503 Special SAMPLE COLLECTED 12-31-87 BY L REID Instruct: Chemlab Ref #: 8730 Lab Smpl ID: i Matrix: Water Work Order No. : 4541 Client Account : AKECSRP Date Report Printed: DEC 31 87 9 13:21 Released By : 21Q61/ Reports Address #2 Allowable Parameter Tested Result/Units Method Limits ---------------------------------------------------------------------------------------------------------- NITRATE-N ND(0.10) mg/1 10 /ll MUNICIPALITY OF ANCHOR,4 ae DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION JAN E 998,9 RECEIVED Sample ROUTINE SAMPLE Remarks: ANALYSIS COMPLETED: 12-31-87 G� LABORATORY SUPERVISOR: STEPHEN C. EDE.(' 1 Tests Performed See Special Instructions Above ND= None Detected xx See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Greater Than 1a Time APPLIC_ AT FILLS OUT UPPER HAL ,.,ONLY Time Property Owner Emma Jean Thompson/Bruce J. Ki essl i ng Phone Mailing Address 2211 E. Northern Lgts. Blvd., Anchorage, Ak. Zip Code 99504 279-8486 Buyer Emma Jean Thompson and Bruce J. Kiessling Address 2211 E. Northern Lgts. Blvd. Anchorage, Ak. Zip Code 99504 Inspector Lending Institution Alaska State Bank Phone 310 E. Northern Lgts. Blvd., Anchorage, Ak. 99503 277-5661 Address �, n Zip Code Realty Co. & Agent None Phone Address (� Zip Code p n 9- -k - dcj, ad ID) orb i[/� p Legal Description Lot 9Bl k 7, Sand Lake #2 A Street Location —8222 Endicott c-) it ( j) APPROVED BEDROOMS Type of Residence ( ) DISAPPROVED EX Single Family 3 .... 2 2 ❑ Multiple Family ;�� No. of Bedrooms DATE ❑ Other /�"' BY: I Water Supply Date Sewer Installed Well To Absorption Area- J D a ❑ Individual oc- 0 'pec •- (�'.1'� ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. }� Community i For wells drilled prior to that date, give well depth (attach log if available). L'1 Public Utility Sewer Disposal 19€' [X 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. Time Time - Time Time Date Date Date Date Inspector Inspector Inspector Inspector �, n Field Notes:�- �i MUNICIPALITY OF ANCHORAGE <: DEPT. OF H`.ALTH p n 9- -k - dcj, ad ID) orb i[/� p /fin ! 1 Lim OlLoE,os ENVIRO\•RENTAL PROTeCT10N A QED ( j) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CQtDITIONAL APPROVAL' .... 2 2 DATE /�"' BY: I Soils Rating Date Sewer Installed Well To Absorption Area- J D a Well Log Received - y� �•-2'.;-� Y; � Well to Tank ! ` / lei°3 ��aw�-� i Septic Tank Size 72023 (3182) una-„�,an iniwIlpson 12.i.il(:i ._,.c)r. i i)ez l Liylits 81vd Anc7i:UY_ago, A'C 9,9504- ;,t's_.)jec t:, f�ot:s 2..i, 1'4, . c`t 3, ii 3.i)C=G� 7, ::�F�Y1C1 •,,ua r'1:)prc)'•J<t1 SC)'s: isiii''. in(lividuc11 S?S.'c'.1,: ani:i i?at:er cannot is?t? Lc11l t: �;.1 until. :71 s= 1.:OJ_1 )Ciitl:� it;t m"i have ?)eE'?1 v�C'lx l_�a t: (, Cie j_.._ vOUL”' i:?)ii11:1U:1].tl t'i�?1�. :1tl:-it: i7t'_ .: pt.—)3^C ved `:)�' C. `: %ai',(-% iJL Alas}: tepart;filent o.1: C-oIj,:cr a.ti.C)n, Mr. fiik-'. i'_attilt"'.`;is. 1ease notify 1.$1]." 3 (3paY'tntent: for a reiristPection when the i"IOt ed t. lisCY_'C3paricies Dade )een COk rest cd . If there ar anY �UY_t',her .guest:.i_oris, t)lease C,'a- - i:li office at, 2G41-4720. Cv41 1.2/e,J/ !',' ' 1 �. L11•.. Yi .1. i t i- s, R. J e '*XICIPALITY OF LNTCUORaGE DIVISION OF EN'l1RON' EN AL HEALTH DEPARME T OF HEALTH AND ENVIROPi,�fENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE I. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) 11J"i 3 X31 �xlC6AJ6 LAKE _5(,fii7 -r!- _2_ -- Location (address or directions) 31 tAK G_ (b) Applicants Namusiness Applicants Address (c) Applicant is (check one) Lending Institution Owner/builder cfz; Buyer ; Other (explair.); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mai]. the HAA to the following address: 2. Type of Residence Single -Family Multi -Family Other (describe) Number of Bedrooms Z 3. [dater Supply - Individual Well E-1 Community id Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite Public Community Folding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information - As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm- a J�} �/�/t� � ��]� Telephone .34/ � 6 gam% Address / Date 1(9,5L—L;07- 6?41 D r C(,MA L)A) t I Lj,%[ Z- e-' (ENGINEER SEAL) 6. DHEP Approval Approved for-.:3bedrooms By Approved Disapproved T.ertas-o Canditiana:l- Approval i4z: CAUTION 49�1c' 0 ° o �'Yo. 00000°o�°°s Conditional THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRON`1ENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. TF17, MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 O S R. Sid I.II Conditional THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRON`1ENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. TF17, MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIF:ONIMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) SEP ! ' I-"- CHECKLIST - FEBRUARY 1984 _m I �$ t A. WELL DATA Legal Description: ' ,Lock-- Well Classification rLpyU1 /1rUrLl If A, B, or C. D.E.C. Approved(Y/N) Well Log Present (Y/N) Y(�_-s Date Completed Yield j2L9_M Total Depth 5/( ` Cased to Depth of Grouting%! Static Water Level 13 2 Pump Casing Height Above Ground �S Set At Sanitary Seal on Casing (Y ) Electrical Wiring in Conduit (Y/N) 2,.57' Depression Around Wellhead (Y/N),A) p Separation Distances from Well: To Septic/Holding Tank on Lot 1,:5-0 " ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot 14Z On Adjoining Lots To Nearest Public Sewer Line /%//A To Nearest Public Sewer Cleanout/Manhole N/A To Nearest Sewer Service Line on Lot Water Sample Collected By CAifo i ; Water Sample Test Results B. SEPTIC/HOLDING TANK DATA Date Date Installed -,:;)2,-31,94 Size /,2,20 No. of Compartments Standpipes (Y/N)� S Air -tight Caps (Y/N) VE -S Foundation Cleanout (Y/N) \/ Depression over Tank (Y/N) i110 Date Last Pumped Pumping/Maintenance Contract on File (Y/N)UI ; for A) /6 Holding Tank High -Water Alarm (Y/N) 101A- Temporary Holding Tank Permit (Y/N) A Separation Distances from Septic/Holding Tank: To Water -Supply Well /5� / To Building Foundation 15 To Property Line /0 To Disposal Field 5 To Water Main/Service Line J To Stream, Pond, Lake, or Major Drainage Course w Comments (Page 1 of 21 t (A 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata )0 --Oh IBe Type of System Design %L2_tt __ Date Installed �Z23 % Length of Field r, Width of FieldDepth of Field 0/ ' Gravel Bed Thickness 4_1 Square Feet of Absorption Area 41 E 1—C) Standpipes Present (YM) 14 1-,.S Depression over Field (Y/N) A)(D Date of Last Adequacy Test JL4 Results of Last Adequacy Test N 1rA Separation Distance from Absorption Field: To Water -Supply Wbll 2 1 ._�- To Property Line J C� To Building Foundation ILS tl To Existing or Abandoned System cn Lot 6) ZA ; On Adjoining Lots 5O ":�7 To Water Main/Service Line AJ LI- To Cutbank(if present) A) IA - To Stream/Pond/Lake/or Major Drainage Course A) To Driveway, Parking Area, cr Vehicle Storage Area > .5 Comments D. LIFT STATION MOT 41 PPI- I CA G (- Date Installed Dimensions Size in Gallons Manhole/Access (YM) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signe Date /O SC7Wi >. 7U ,ANG /�C, MOA No. SS OC)- e J CO Company £' C S � I Rs x 'i90 a oeeo oh0,90 000... �a KBl/d5/s m oe coo °°° °o„�- o THO AS SMITH ri00 ^`+�� IG' r�I ^® P ® 0,0900 0000 Oo� [Page 2 of 21 2-15-84 00 I t BILL SHEFFIELD, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION P Telephone: (907) t,. Address: SOUTHCENTRAL REGIONAL OFFICE 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 274-2533 DATE: PWS I.D. # `0 To Whom It May Concern: According to records on file in this office the a A £�7S , 3, -3r 4q Water System is in compliance with the State Dr i ni ing Water Regulations Sincerely,