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HomeMy WebLinkAboutSAND LAKE #2 BLK 2 LT 6Sand Lake #2 Lot 6 Block 2 #011-133-43 e 5(A C/? a� I 10 V p 'co L to p N EN .00 C O Q EN hi :00 :ice :W c0 :00 i C iN :N W rt n R a 0 000a�oo�oo ¢+ V i 1 ' 4 w w Ya ° I N Q► d., "U to 1 N N In 1v+ (Wn p~p x O O O O Q O O O O E Ev EW N C, N i N O+ a Ln Stn co i Ln C H :0 G to E cn r�I H: a r W i 6024-4 : r 1 i Co t.+ SOP C 06 ? C a rr rt 0 f oLa a o 0 0 0 0 :O ib O ?OD W iW N N OW+ iN N 4 o a •W :W r :W N ECT 'm N 9N t t 'o bs iA ! t = fA n rst w a `• a. E� :H !•t :rte W i ?tAl iN E rt c') rt Eh lu "C Eti EW 4'f EO w R GQ rD 0 b N rD t* K C -T a V i 1 ' 4 w w Ya ° I N Q► d., "U to 1 (fRCV UJ/VU 10) Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201261 PID Number: 011-133-43 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑® Upgrade Name ERIC & TANEISHA MCCOMB ABSORPTION FIELD ❑Deep Trench ❑Wide Trench El Bed El Mound Site Address 8055 SEAVIEW ST, ANCHORAGE AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot SAND LAKE #2 2 6 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width 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 Ftz Ft. Well 100'+ 25'+ TANK ❑® Septic I] S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1000 Gal. Surface Water 100'+ Material Number of compartments Lot Line 8.5' NA Plastic 2 Foundation10'+ LIFT STATION Manufacturer Capacity Remarks TANK INSTALLED IN ORIGINAL LOCATION Gal. EXTREME LIMITED SPACE IN AREA Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to drainfield 3034 Installer DAKOTA DIGGERS Drainfield CO/MT 3034 Inspector Pannone Engineering BENCH MARK (Assumed elevation) 100 g Inspectio im 8/21/20 8/26/20 Location and description 3rd 2„d 4'h Bottom House Trim @ C ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date �.••.. • • • H•• .... ... • Septic Syste anriotae CE 8i 49 Approved Date D ZU .• Note: this approval es not include well permit requirements. (fRCV UJ/VU 10) I (-) -';� -:� --i > 0--:E K z -0 0 CD co 0 icir)c > m 0 z * m ;:u ;r' CD > Cf) m -0 m --1 m 0 r- o x x < 0 c: m cf) > U) m jz:� C) X -< z F, 0 — :� z > --4 -u --I > i m ;0 cf) > oz:E C) 0 V) a: ;u �q o C) In o Mo 0 < m ..o Om -u ru pc rr'-, 0 Z --j c) cn cf) 0 C-4 'o -a' U) 0 O M, Z> z ::E m r- m 01 -< cf) > o t- m Lo> ;o C) 0 --1 m M rrl 02 to 70 C M U) m 1-1 ,,-u O;u 10 m M— :3 DOUBLE U) =3CLEANOUT D z MANHOLE 0 m M rm- K 0 00 n < M CLEANOUT I m 0 0 DO 0 m 0 q =3DOUBLE 00 =3CLEANOUT co �Q LO -00 m m 0 m 'u m -0 > 0 >k) M Z C) m o OZ I ---- m A co WON (A C4 c'j I-) p > 00 1 CO I CA 1 (14 1 N) I N) I CC) M 0 0) 41 41 CO -lj 0 0 SEAVIEW STREET i � 3 0 rl co CF ;U > 0;0— Ln x 7: m > co CO O NOTES: PANNONEENG SVCLLC SC.l. 1088) RECORD DRAWING P.O. BOX 1807 PALLIER, AK 99645 PHONE (907) 745-8200 FAX (907) 745-8201 SANDLAKE #2 B2 L6 DRAWN JRL ERIC & TANEISHA MCCOMB SITE: 8055 SEAVIEW STEET SITE PLAN ANCHORAGE, AK '10FAII91H i-*:-. CE 8149 REVISIONS JDATE 7/28/2020 CALE 1" = 40' .I.D. NO 011-133-43 ERMIT NO. OSP201261 HEFT co Municipality of Anchorage �D/1)r P.O. Box 196650 a 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 ® Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Proaram * * * * VARIANCE/WAIVED REVIEW * * * * Waiver#: OSV201050 COSA#: Permit#:OSP201261 PID#: 011-133-43 Legal Description: Sand Lake #2 Bilk 2 Lt 6 Engineer: Pannone Engineerinq Services Your request for a waiver of the required 5 feet horizontal separation from the septic tank to the absorption field has been approved. The approved separation distance is 2.5 feet. This waiver approval applies to the existing septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ............................................... ■ ............................. ■ 1 Waiver is Granted: X Waiver is not Granted: Date: Approved by: Name of Review ............................ ■ ............................. ■ ................. 1 **** VARIAN C E/WAIVER REVIEW **** Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panenpak.com 28 August 2020 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road P O Box 196650 Anchorage, Alaska 99519-6650 Subject: SAND LAKE #2 B2 L6 Variance Waiver Request Ladies and Gentlemen: We request a separation distance waiver for a newly installed 1000g GREER POLY septic tank to the lot line (8.5') and to the existing drain field (25). This is an existing drain field which was installed in 2008 with a total depth of —13' with an effective depth of —8'. The replacement tank was installed in the same location as the previous tank. The lots are extremely small and due the location of the existing septic and well the space available is limited. Granting this waiver is not likely to affect the health and safety of this lot or the surrounding lots now or in the future. If you have any questions or concerns, please contact me at 907.745.8200. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Lllailin-: P. . Box ;i 80-7; Palmer, AK 645 Biel +ie. (9 3) 745-8200 FAX: '907) 45-820 0 SO 0 CD Ln 17.2 - 26.2 V) ;�: 0 0 9 F- 17.2 LL 50.00. 0 0 L? 0 c L;j o 0 0 z 0 0 cv rn 00 Ga rn 0 4k H = I U Na 0 �o Z3 m a C\j C\j co 111 U) < (1) < ID C\l C\, C:) C\j �: co LL C\, od C\j CL am Cato to —14 to tip w I Cd to fti CQ co C) 0— MUNICIPALITY OF ANCHORAGE on -Site Water & Wastewater Program PO 196650-- 4700 343-7904 Fax �O7 343-7997 Anchorage, Alaska 99519-6650 Phone: (907) On-Site Wastewater Disposal System Permit Permit Number: {}GP201261 Work Type: SepticTank Upgrade Tax Code Number: 01113343000 Site Legal Address: SAND LAKE #2BLK 2 L 8 Ei2224 Site Mailing Address: 8055SE/YV|EVV8T,Anchorage owner: K8CCONBERIC T8TANBSHAF Design Engineer: PANNC}NEENGINEERING SERVICES El Disposal Field 0septic Tank [] Holding Tank []privy Effective Date: 7/28/2020 Expiration Date: 7/28/2021 Lot Size in Sq Ft: 6750 Total Bedrooms: a 0 Private Well 171 Water Storage All construction shall bainaccordance with: 1. The attached approved design. — All— requirements Wastewater Disposal Regulations u(18/\C72)and Drinking Water °'=y"'~~~'~ `1— - ' eve kzpment 3. The wastewater code requires inspectionsduring the installation. The engineer sheUnobfydh O Services Department per AMC 15'U5. Provide notification uycalling (9U7) 343-7904 (2417). ingweathm r 4. From October 15 to April 15, a subsurface soil absorption system under construction during freez shall beeither: o Opened and Closed onthe same day, Or b. Covered, sealed, and heated to prevent freezing Date: Received By: issued By: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201261, Rebecca Carroll, 07/28/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201261, Rebecca Carroll, 07/28/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201261, Rebecca Carroll, 07/28/20 Municipality of Anchorage Development Services Department r ` Building safety Division on -Site Water and Wastewater Program, 4700 Bragaw SL P.O. Box 196650 Anchorage, AK 99519.6650 Page 1 of 3 www cl.anchorage.sk.us 1907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SWO80217 PID Number: 011-133 43 Nur.; _ _ Wastewater System: ❑ New ® Upgrade Prime ABSORPTION FIELD N.m ,of Bedrom. ® Deep Trmgh p af.INnv Trento O Bed D Mwne O Omer LEGAL DESCRIPTION jDSP� oung Tet«D.pth ft m«gmet gnde S]«k �w s�Wma,n. 1.2 G-D/Ft' 13.2 2 6 b ppe Oof«n e,ege.l gnide Gfe depth W *M pe. T�.b' RSand Lake No. 2 5.2 Ft. 8 rtge 6egwrc ed ebMS mg," WeYr GrevN Lenplh0 Ft. 30 Well: ❑ New ❑ Upgrade wglrh Nun*erWalse. DntuhwWm eno- C4Nu,uWniF'meH.AB. C) T,W Depth Cued b: 5 Ft. 1 Exist'g Class C _ T°" °'°°°°^""_ PW. Me... of Sewer Line 75 no leaks observed. Tank reused. TANK ❑ Septic ❑ Holding ❑ S.T.E.P. ❑ Other: M«s,w v Gel Nunn,., of Ce.",~, LIFT STATION .. Gel 'Pump on- NMI" 'Pump of levet et Nqn wet« earn et In M ti. Pump M.N. b M,eel Ebancu Inep.—_ perbnryd by BENCH MARK .ocean uhe Os«ulpuon Rear Windo Sill, North mw Nveu«h. 100.0 Ft. Inspections performed by: PANNONE ENG. SVC LLC Dates: 1" 10!3/2008 Development Services Department App ova0l312008 Conditional Approval Date: 2 Engineer's Stamp �*OF q"N a 4 4 � Al TH YC 't._ * I .Steven R. Po Reviewed and approved by: ' % L # No CE 81 (fn'•eGtd)Date: AW-LI1_0 DK #-". • 101� SEPARATION DISTANCES Absorption LIR Holding Field Station Tank Weil 100.1 JF*.�w.26 100+ 2.4 22 Cunan bran 1 50+ 50} R.m.rly Sewer Line 75 no leaks observed. Tank reused. TANK ❑ Septic ❑ Holding ❑ S.T.E.P. ❑ Other: M«s,w v Gel Nunn,., of Ce.",~, LIFT STATION .. Gel 'Pump on- NMI" 'Pump of levet et Nqn wet« earn et In M ti. Pump M.N. b M,eel Ebancu Inep.—_ perbnryd by BENCH MARK .ocean uhe Os«ulpuon Rear Windo Sill, North mw Nveu«h. 100.0 Ft. Inspections performed by: PANNONE ENG. SVC LLC Dates: 1" 10!3/2008 Development Services Department App ova0l312008 Conditional Approval Date: 2 Engineer's Stamp �*OF q"N a 4 4 � Al TH YC 't._ * I .Steven R. Po Reviewed and approved by: ' % L # No CE 81 (fn'•eGtd)Date: AW-LI1_0 DK #-". • 101� 24 'SWING TIES 10/06/08 CO A B 1l FG 16.2 •�teven .P"Pnnone' a 23 C1 23.8 43. 43.5 MT 25.3 44.8 1 OF 3 DC 41.1 37.3 T1 33.0 28.4 T2 39.0 34.7 21 20 ` k'XISTING �/�I EPTICS ILZ)AT�-zED AT 1 BAC,'LLC 18-20 18 w I— V1 w w 171 m Fel 2 WELL 3 2% 137.6 5 ' 2P' FTH TS1 EXISTING �� 2 EXISTING 2%-� LASS C 'ELL REMC 7 DIVE\ 143.2 EXISTING % VERIFIED CO CLASS 8 OF EXISTING C W L 8 TANK ADEOU REUSE. E RAVONG nA*T1�TO*TE ENG SVC' 7 7 r P.O. BOX 1104995:4 ANCHORAGE, AK 919.511.01• PHONE (907) 272-8218 FAX (907) 272-8211 Sand Lake #2 Block 2 Lot 6 Cody Carpenter 8055 Seoview Street Anchorage, AK 99502 3 EXISTING 22EXISTING SEPTIC CLASS C �EX ST'G FIELD IN WELL - FALURE REMOVED 21 A0 REPLACED E&ISTING W/NEW V/1 % 151.4 BANDONED EXIST'G FIELD PER CODE —` TH RJ 1 19 -�,0% 1D% 18 EFOR!'� STING j 1 7 1 6 JJ % e? / EXISTING i% PRIVATE WELL 1 %(�.' ::: •^�q '\� Shy*�) 10/06/08 �4 Sce TM '. 1l P.I.D. NO •�teven .P"Pnnone' a 11-133-4 CE 8149 j Irlcf•..� PERMIT NO. swxxxxxx 1��`y�a`ES90Np��G Sheet 1 OF 3 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS. 2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS. 3. SCOPE OF WORK: 3 -BEDROOM HOUSE, EXISTING SEPTIC TANK, REMOVE AND REPLACE EXISTING FIELD INSTALLED IN 2000. 4. GROUNDWATER IS NOT EXPECTED TO BE ENCOUNTERED DURING EXCAVATION, AS EVIDENCED BY THE SOIL TEST HOLE INFORMATION ABOVE 20 FT. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 14 FEET BELOW EXISTING GRADE, NOTIFY THE ENGINEER IMMEDIATELY. TH T¢1 97.8 C No groundwater monitored -19 BOH z U r f- f - F> no z Qz z z EXISTING 1000 go' 92,5 TANK INTEGkIIY Of TANK VERIFIED AND FOUND SOLID DESIGN PARAMETERS RESERVE SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) TANK SIZE: 1,000 gallon PERC. RATE: 2.9 MPI SOIL RATING: 125 gpd/SF AREA ROD: 375 SF SYS. TYPE: Trench WED. MIN LENGTH: 23.4 LF 1U : 30 L F x 3' W I D E, 8' E D.13' T D TOTAL AREA: 480 SF S12' COPPER 4"0 DRAIN PIPE rf=w TH �w 92.3 ^DRAIN ROCK 6" 0.5' \\tiY PIPE INVERT ..*ABOVE 8 vv"vv vvvv DRAIN ROCK BELOW 84.5 `3`v� PIPE INVERT DV DIVERTER VALVE FS FLOW SPLITTER REMOVED BIOMAT SECTION ALONG WALLS-TYP MIN. SLOPE S=0.0100 W M COPPER mo rf=w TH �w Z o 4"0 PERF. PIPE o 0 Z z'g `3034 PVC OR z L) o c/ F810 HDPE o f n n S=O.00GD M< U DEEP PROFILE ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT NO. M(/ MONITOR TUBE NO. R.I. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER & WIDTH 92.3 84.5 LEGEND —w`—w— WATER LINE/ WELL RADIUS — w — EXIST'G SEPTIC —'s —w — NEW SEPTIC 0CHAINLINK FENCE NOTES: PAMONE ENG SVC, LLC `` te P.O. BOX 102954 ANCHORAGE, AK 99510 � 4 .OF A. 4s�1 D10/06/08 PHONE (907) 272-8218 FAX (907) 272-8211 i%g�p �9�� Scale RECORD DRAWING j *: . * �� NTS .. . .... ..... P.I.D. NO Sand Lake y2 Block 2 Lot 6 1-133-4 Cody Carpenter �, teveCE�8149 nom PERMIT NO. 8055 swx Anchorage, Iew StreetAK 99502 /+��1 0�iorFs9ai� =G Sheetxxxx DESIGN NOTES g 3 0F3 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Oct 03, 2008 Expiration Date: Oct 03, 2009 Permit Number: SWO80217 Parcel ID: 011-13343 Legal Description: SAND LAKE #2 BLK 2 LT 6 Design Engineer: 0062 PANNONE ENGINEERING SERVI( Site Address: 008055 SEAVIEW ST Owner Name: CODY & SARA CARPENTER Lot Size: 6750 SO. FT. Owner Address: 8055 SEAVIEW Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE. AK 99503 - This permit is for the construction of: ❑✓ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date��C�O� Date: !O O Mmicipahiy of Anchorage CO. Mx 1!XWM - Awhnnkgc, A isk1 99711!) 6670 • 471MI Elmore U.m.] \� OOiec: (!X)71333-KV)1 •lire (!X17) 343 -KIM htlp://a���e.nund.orl; Mayor Mark Bcyich I)Cvclopn3cnt Scrviccs I)Lpartnlcnt October 3, 2008 Steve Pannone Pannone Engineering P.O. Box 102954 Anchorage, AK 99510 Subject: Waiver Request for Sand Lake #2, Block 2 Lot 6 Waiver Request WR#: 080068 Parcel ID # 011-13343 SW080217 Dear Steve Pannone: mcgt i �1 IVY -6 -ILA Department Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 2.4 feet. Additional waiver approvals include the proposed field being built over the existing field and the field having 12' of separation instead of the required 16' to an existing field which will be abandoned. 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. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Deb WockenfISS Civil Engineer On -Site Water & Wastewater Program Community, Security, Prosperity Municipality of Anchorage • -�1 Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 011— 133 43 345-634q Property owner(s) Cody I Sara Carpenter Day phone +223255 - Mailing address8055 Seaview Drive, Anchorage, AK Zip Code 99503 Site address 8055 Seaview Drive Zip Code 99503 Legal description (Sub'd., Block & Lot) Sand Lake No. 2, Block 2 Lot 6 Legal description (Township, Range & Section) Lot Size 6.750 Sq. Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field ID Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms THIS APPLICATION IS AN: Initial ❑ Upgrade ED Renewal ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. Pannone Engineering Services, LLC (Signature of property owner or authorized agent) Date of Payment: / 75 Date of Payment: q 4e7 ]g 0 165q Receipt Number: 300-3a Receipt Number: (Rev. 11105) Pannone Engineering Services, LLC P.O. Box 102954 Consulting Engineers Anchorage, Alaska, 99510 (907) 272-8218 (907) 272-8211 Fax September 29, 2008 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: Sand Lake S/D No. 2, Block 2 Lot 6 Septic System Permit Request Ladies and Gentlemen: I am writing in response to your comments dated September 5, 2008 concerning my request for a permit to construct an upgrade septic system permit be issued for this property. The comments are answered on the review sheets and incorporated into the revised site plan and detail sheet. The proposed systems will serve an existing three-bedroom house. Currently the lot is developed. There are currently two septic systems on this lot. Recent adequacy investigations indicate that they are both in failure. The only place left on the lot is to install an upgrade system in the location of the original septic system. It is the intent of this design to replace the original 2000 system with a new drain field of identical length and size in the same location. The lot is served by a community water wells that is located along the northern property line. The proposed upgrade septic system will be installed in the location of the 2000 septic system. The surrounding lots are developed and there are no water systems within 100 feet of the proposed septic system. 1. Soils. Three test holes have been excavated on this lot in the area of the septic systems. The 1981 test hole was excavated to 16 feet and had a percolation rate of 4.4 minutes per inch (MPI). The test hole excavated in 2000 to a depth of 19 feet had a percolation rate of 5.0 MPI.1 performed a percolation test this year at a depth of 10 feet and obtained a percolation rate of 2.9 MPI. Ground water was monitored in all the test holes and remained dry during this period. Bedrock was not encountered in any of the test holes. It is my opinion, based on the results of the percolation tests and overall soils appearance; an application rate of 1.2 gallons/day/square feet should be used, using a conventional treatment system. 2. Reserve Soil Absorption System Design. a. Percolation Rate: 1-5 Min Per Inch b. Application Rate: c. Design Flow: d. Min. Absorption Area: e. Total Depth: f. Effective Depth: g. Width: h. Minimum Length: i. Design Length: j. Effective Absorption Area: k. Septic Tank Size: 1.2 gpd/sf 450 gallons per day 375 sf 13 feet 8 feet 3.0 feet 23.4 feet 30 feet 480 sf 1,000 gallon Septic Tank. Tank Integrity verified. 3. Surface Water: There is no surface water within 100 feet of the proposed system. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. Page 2 of 2 4. Topography: The average topography in the area of the proposed septic system is approximately 1-5 percent based on topographic information. The proposed installation will be greater than 50 feet from the shoulder of the steep slopes. 5. Waiver Request: I request the following waivers: The proposed installation will need to be installed closer than the required ten feet to lot -lines. I request a waiver be granted to allow this system to be installed a minimum of 2.4 feet to the nearest lot -lines (the lot -lines to the north.) I request a waiver to an existing septic system from 16 feet to 12 feet. This request is a renewal of a waiver granted in 2000 when the new system was installed. The new system will be installed in the same location of the 1981 system. The soils are good percolating soils (3 mpi) and the effluent from one field will not affect the second field. 6. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On -Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, 9.29.08 Steven R. Pannone, P.E. Owner/Civil Engineer Attachments: W:\PES Work Files\Letters\Sand Lake 2 B2 L6 001.doc x2l 2, 3 2 X= EXISTING CLASS C WELL / 3 22 I EXISTING EXISTING / SEPTIC i CLASS C EXIST' G FIELD IN WELL FAJILURE REMOVE 21 i I i �� 1 ARID REPLACE �21 137.6 1 kISTING W/NEW I 2% x39'x5'ED FIELD 20' I 1 ; \ � 0 5 10% 2% 1 151.4 TH TS1 2 4 BANDON EXIST'G ��� k/! -� FIELD PER CODE 1<STING o -�, /4 ;SEPTICS IV 100.1 V �\\/ •�' I 19 / LOCATED AT y i ' ��; ! \ TH RJ 1 % BACKS LOTS EXISTING 3 X12 0 ��ll \ j-10% / 19 18-20 I -_ - BR 1 - EXISTING 1 Q I EXISTING 2% i \ ' SEPTIC V I ui ELAS C REMOV(= E ST G 10% 18 V)DIVERT6 Vr�LVE w 143.2 /- i;a EXISTING % VERIFIED CON �10 -'- N r CLASS 8 OF EXISTING '00 gq j g%/`tel 1 7 1 C W L v TANK ADEQU "E FOR . / 111 ' I / REUSE. E ]STING / / 7 1 I / 16, EXISTING " 9 PRIVATE WELL 1 1 NOTES: PAMONE ENG SVC, LLC ��OF A . Dote P.O. 80X 102954 ANCHORAGE, AK 99510 . c ..••. Lgsl�l oa/z9/os ISSUED FOR CONSTRUCTION PHONE (907) 272-8218 FAX (907) 272-8211 iaj�p' ' :�y�j stole TH. • * // 1'.50' "' ' • P.LD. NO Sand Lake #2 Block 2 Lot 6 ••_� 11-133-4 Cody Carpenter / ? to CE 8149 ^o^e% PERMIT NO. 8055 Seoview Street l���cs.,� Swxxxxxx PLAN Anchorage, AK 99502 I��oi[s4.= Sheet 1 OF 3 TEST HOLE 1 SLOPE I CITE PIAN i OR TOPSOIL 1 I 1D2 2% 3 ML Brown SILT4 j7Av TEST I o S HOLE SM Silty SAND 1 ,I 7- 8— SP I 2% 10 I F t1 BOH 7 12 2% 13 WAS GROUND WATER SLOPE 14 ENCOUNTERED? N IS IF VES. AT WHAT DEPTH? .0.1 TH 1 16 17 DEPTH TO WATER AFTER MONITORING? -Dry- Ig DATE: 9-24-08 WATER 19 READING DATE CLOCK NET TIME LEVEL NETDROP READING 20 1 80908 12M 2 89' N.'A 2 12 X_ IOMIN 846' 557- 3 1236 242- X. 4 1246 IOMIN 686' 356- 6 1246 242• X. 8 1266 IOMN 585' 343- 7 1266 4Y X. 6 1306 IOMN 680' 336' 9 1306 242' X' 10 1318 10M!N 681' 339' 11 1]18 242' 12 1328 IOMIN 682' ]IO' PEROLATION RATE 2.95 (minAnch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 10 FT AND 11 FT COMMENTS: Test hole excavated by Owner Test Hole was presoaked before perc test. PERFORMED BY: Steven R. Pannone, P.E. 1 CERTIFY THATTFIIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OFTFIIS TEST. NOTES:�N' \N\ Date PANNONE ENG SVC, LLC - OFA /- st 9/24/08 P.O. BOX 102954 ANCHORAGE, AK 99510 4 ISSUED FOR CONSTRUCTION PHONE (907) 272-8218 FAX (907) 272-8211 % ,��P. TH,9 0�// scale NTS " • "' • Sand Lake #2 Block 2 Lot 6 � P.I.D. NO /- a� Cody Carpenter even none / PERMIT N0. CE 8749 ew Street. Eti sw...... DESIGN NOTES Anchorage, 'IAK 99502 ��'ll \qE"`?- Sheet 2 OF3 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS. 2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS. 3. SCOPE OF WORK: 3 -BEDROOM HOUSE, EXISTING SEPTIC TANK, REMOVE AND REPLACE EXISTING FIELD INSTALLED IN 2000. 4. GROUNDWATER IS NOT EXPECTED TO BE ENCOUNTERED DURING EXCAVATION, AS EVIDENCED BY THE SOIL TEST HOLE INFORMATION ABOVE 20 FT. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 14 FEET BELOW EXISTING GRADE, NOTIFY THE ENGINEER IMMEDIATELY. DESIGN PARAMETERS RESERVE SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) TANK SIZE: 1.000 gallon PERC. RATE: 2.9 MPI SOIL RATING: 125 gpd/SF AREA ROD: 375 SF SYS. TYPE: Trench 8'ED, MIN LENGTH: 23.4 LF USE: 30LFx3'WIDE.8'ED,13'TD TOTAL AREA: 480 SF NOTES: IISSUED FOR CONSTRUCTION I DESIGN NOTES ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE TH 4"0 DRAIN PIPE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# 5' M(/ MONITOR TUBE NO. R.I. RIGID INSULATION DCO DOUBLE CLEAN OUT l� DIVERTER VALVE FS FLOW SPLITTER : DRAIN ROCK 6" 0.5'xvABOVE (F— PIPE INVERT DRAIN ROCK BELOW PIPE INVERT No groundwater monitored REMOVE BIOMAT SECTION ALONG WALLS-TYP -1 BOH Zm 0 m 0 <O O O _1O m v ? w n w 4"0 z o PERF. PIPE O U O V v 0Op 0 W z 3034 PVC OR z 0 F810 HDPE 0 L) a 5=0.0000 EXISTING I oon qm TANK MIN. SLOPE s. INTEGROY OI S=0'0100 _ TANK VERIFIED AND FOUND DEEP TRENCH, LENGTH & WIDTH PER PLAt• SOLID PROFILE DESIGN PARAMETERS RESERVE SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) TANK SIZE: 1.000 gallon PERC. RATE: 2.9 MPI SOIL RATING: 125 gpd/SF AREA ROD: 375 SF SYS. TYPE: Trench 8'ED, MIN LENGTH: 23.4 LF USE: 30LFx3'WIDE.8'ED,13'TD TOTAL AREA: 480 SF NOTES: IISSUED FOR CONSTRUCTION I DESIGN NOTES ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT NO. M(/ MONITOR TUBE NO. R.I. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER PANNONE ENG SVC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 LEGEND w—w— WATER LINE/ WELL RADIUS — u — m — EXIST'G SEPTIC NEW SEPTIC —0-- CHAINLINK FENCE Sond Lake #2 Block 2 Lot 6 / �......tevenR. P.. Cody Carpenter �� �. or CE 8149 8055 Seaview Street Anchorage, AK 99502 09/29/08 NTS 9. NO Swxxxxxx iheet 3 OF3 Oct 2 2008 11:33 STAI TEOFALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION DIVISION OF WATER WASTEWATLR DISCS ARG6 AUTHORIZATION PROGRAMS October 2, 2008 Steve Pannone, P.E. Pannone Engineering Services, LLC P.O. Box 102954 Anchorage, Alaska 99510-2954 P. 02 555 CORDOVA ANCHORAGE, AIC 99501 Phone: (907)269-7519 Fax: (907) 269-3487 hapJ/www.atate ak.eu/decl Re: Sand Lake S/D No. 2, Block 2, Lot 6 -Anchorage -Waiver of Separation Distances from Class "C" Source Wells and the Wastewater Collection System-ADEC Plan Tracking Number 7415 Dear Mr. Pannone: On September 15, 2008, the Department received an engineering request to establish waivers for the planned reconstructed of the onsite Wastewater soil absorption (shallow trench type with effective depth of 5 feet) on lot 6, Block 2, Sand lake S/D. No. 2 and the Class "C" Source Wells on Lot 3, Lot 6 and lot 8 of the same Subdivision and Block. You have checked and determined the existing 1,000 gallon: two compartment septic tank is sound and operational. The onsite soil absorption system will serve a single family three bedroom home, which the Municipality of Anchorage's Onsite Program must review for approval. Tile waivers you are recommending are based upon the well logs indicating that the well is a deep well (400 feet) with layers of clay and silt material at (approximate 110 feet), water samples taken also resulted in non detect levels for nitrates as nitrogen and fecal coliform bacteria (August 8. 2008). Pervious waivers have been established in the past without a public health incidence being reported. . The waiver's requested are established as follows: 1. The separation distance of 150 feet between the existing class "C" Source Well on Lot 8 to the planned shallow trench type soil absorption field on Lot 6 is reduced to 142 feet. 2. The separation distance of 150 feet between the existing class "C" Source Well on Lot 8 to the existing septic tank is 133 feet and is herein established at the existing distance. Oct 2 2008 11:33 P.03 3. The separation distance of 150 feet from the existing class -C- Source Well on Lot 6 to the planned shallow trench type soil absorption field on Lot 6 is reduced to 100 feet. 4. The separation distance of 150 feet from the existing class -C- Source Well on Lot 6 to the existing septic tank is 101 feet and Is herein established at the existing distance. 5. The separation distance of 150 feet from the existing class `C" Source Well on Lot 3 to the planned shallow trench type soil absorption field on Lot 6 is reduced to 137 feet. Should a threat to public health develop and be associated with this onsite wastewater system, all waivers may be rescinded. This approval does not imply the granting of additional authorizations nor obligate any state, federal or local regulatory body to grant required authorizations. Any person who disagrees with this decision may request an adjudicatory hearing in accordance with 18 AAC 15.195- 18 AAC 15.340 or an Informal review by the Division Director in accordance with 18 AAC 15.185. Informal review requests must be delivered to the Division Director, 555 Cordova Street, Anchorage, Alaska 99501, within 15 days of receiving the decision. Adjudicatory hearings requests must be delivered to the Commissioner of the Department of Environmental Conservation, 555 Cordova Street, Anchorage, Alaska 99501, within 30 days of the decision. If a hearing is not requested within 30 days, the right to appeal is waived. Thank you for your cooperation. If you have any questions please do not hesitate to contact me at 269-7519. Respectfully, William R Rieth. P.E. Environmental Engineer Enclosure: As stated cc: William Smyth, WW, w/o enc. Municipality of Anchorage Page --L—of--5 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number. 5&"-o I&] PID Number: Oil— 133— u Name: Wastewater System: ❑ New ,Upgrade � V 1 r7 C Address: S0 &S S tfAv — 121vL- ABSORPTION FIELD Phone: No. of Bedrooms: , Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: Total Depth fromoriginalgrade: GPD/Sc. Ft. Lot: Block: Subdivision: — Z Depth to pipe bottom from original grade: `J Gravel depth beneath pipe rL i0 c�SAN Ft. 0 Ft. Township: Range: Section: Fill added above original grade: Gravel length: 3 % .0 Ft. C� Ft. WELL: ❑New ❑Upgrade Gravel width: f Number of lines: 1 cebn lines: Distanetwee Ft. Ft. Classification (Private, A,B.C): Total Depth: Cased To: Total absorption area: Pipe material: Ft. Ft. 90 SC. Ft. ID �? 1 4 F,61 D Driller: Date Drilled: Static Water Level: Installer: Date installed: �%/ zC? Ft. (�CJ G/✓t Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES ❑ Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Tank Sewer LinesMaterial: WeIF- 'L '-- —SurfaceN .1 ��j t Number of Compartments: 1 oU iV Itation N� r✓� 0 LIFT STATION WaterLot 7 Size in gallons: Manufacturer: Line (J Foundationn „' f7` LI ( "Pump on" level at: "Pump off' level at: High water alarm at: Curtain N Pump Make &Model Electrical l nspections performed by: Drain BENCH MARK Remarks: Location and Description: _ ST 1 N 6 TA, M1 INSP—G I 0 ?3OTTDH SNWC. Abp Fou Nb sou NO Assumed Elevation 100 ENGINEER'S SEAL > p Inspections performed by: S Dates: is X71 G 2nd r Department of Health and Human Services approval , Cl/, /�e�7r7 //-o 0 Reviewed and approved by: Date: 72-013 (Rev. 9/91) MOA 25 -� Well 4 21 I I I I SWING TIES: AB MO FT AC 33 5 20 BC 25.5 AD 42 BD 36.6 STA RD SEPTIC SYSTEM AE 24 1000 L SEPTIC TANK BE 7.6 STANDAR TRENCH 30 FT LON 13 FT DEEP 8 FT SEVIER CK E 6 ti w A O W � BENCH MARK oB C ..D Well BILLRUN DIVE.' 7 18 fir;..••- .,� �� I f ••S 8 17 /. .::... •, TDB EN •SPURKLAN' _ ''............ ..•''F�i ASSUMED EV. 100.00 FT TORRFN SPURKLAND P.E. SEPTIC SYSTEM AS BUILT 203 W 15TH. AVENUE LOT 6 RK 2 SAND LAKE 112 ANCH. AK. 99501 8055 SEAVIEW STREET DATE: JULY 6, 2000 (907) 279-3916 ERVIN HOPPE SHEET; 2/3 GRID: 2224 PERMIT # SV000187 PID # 011-133-43 SLK02062, WG VA. Standard Trench Si( t 8.0 ft of Effective P' Wide 30' L ong 13' Deep 8.0' Sever rock 5' Co ver i O O �E 1000 gal Septic tank �o EXISTING D3 w 0 m ° 49th TOBBE9J SPURKLAND O •�rfT NO. CE -2225 ND SCALE.. ♦`♦♦'jj4ft FESS 19L'' ivu oc MEE BENCH MARK: BOTTOM SIDING ASSUMED ELEV. 100.00 FT TOBBEN SPURKLAND P.E. I I LOT 6 BK 2 SAND LAKE 12 I I SEPTIC SYSTEM SCHEMATIC 203 wroth Ave 8055 SEA VIEW STREET DATE JULY 6, 2000 Anchorage Ak 99501 ?79-'391 F. ERVIN HOPPE SHEET: 3/3 GRIDz 4 PERMIT j SW000187 PARCEL ID 011-133-43 SLK02063.DWG MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW000187 Legal Description: SAND LAKE #2 BLK 2 LT 6 (.JWJU,: /7.0-" (rl')-Voop loo, 4/ Date Issued: Jun 22, 2000 Expiration Date: Jun 22, 2001 Parcel ID: 011-133-43 Design Engineer: 0007 Tobben Spurkland, PE Site Address: 008055 SEAVIEW ST Owner Name: Ervin Hoppe Lot Size: 6750 SQ. FT. Owner Address: 8055 Seaview Dr. Total Bedrooms: 3 Permit Bedrooms: 3 Anchorage , AK 99502-4166 This permit is for the construction of: Disposal Field 0 Septic Tank Holding Tank Privy Private Well Water Storage All construction must 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 engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: c Date: ( `9-3 — oy) Date: !o-22-00 Municipality of Anchorage+ Department of Health and Human Services 825 "1" Street Rick Mystrom. P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor http://www.ci.anchorage.ak.us June 22, 2000 Tobben Spurkland 203 W. 15th Ave., Suite 203 Anchorage, AK 99501 Subject: Waiver Request for Sand Lake 92, Lot 6, Block 2 Waiver Request #WR000039 Parcel ID #011-133-43 SW000187 Dear Mr. Spurkland: Your request for a waiver of the required 10 feet horizontal separation from the on-site wastewater disposal system to property line has been approved. The approved separation distance is 5.0 feet. This waiver approval applies to the existing on-site wastewater disposal system to property line 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 343-4744. fSincerely, Daniel J. Roth Civil Engineer On -Site Water Quality Program T.S ltiOKL ANN"1J P.E. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907)279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 6 BLOCK 2 SAND LAKE 42 ERVIN HOPPE Municipality of Anchorage Department of Health and Social Services 825 L Street Anchorage, Alaska 99501 June 13, 2000 We are submitting an application for the upgrade of the septic system for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic system design is based on the following : No Ground Water or Impervious Layer to 19 ft. Use Standard Trench Soil Rating. From Testhole 06/01/00 5 min/in = 1.2 gal per sq.ft/day No. of Bedrooms 3 Required Area per Bedroom: 150/1.2 = 125 sq.ft. Total area required: 125 x 3 = 375 sgft Testhole depth 19 feet Bottom Rock At 13 feet Top Rock At 5 feet Rock Depth 8 feet Total Trench Length 375 / 16= 23.4 FT USE 30 LF SYSTEM CONFIGURATION STANDARD TRENCH TOTAL LENGTH 30 FT TOTAL WIDTH 2 FT TOTAL DEPTH 13 FT ROCK DEPTH 8 FT COVER 5 FT SEPTIC TANK REPLACE 1000 GAL The installation of this septic system will not prevent development of adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. 3 1 22 4 I I I 5 20 s � i I I — I y 1 !s I .. q�gS4O �# .. 49t h.....a.i' TOB BEI SPURKLAN➢ A ♦ C °; lkvklks 50 0 50 100 150 200 250 300 SCALE, 1° = 100 FT. 22 Well _ Y rT- 5 120 TOBBEN SPURKLAND P.E.SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE LOT 6 BK 2 SAND LAKE J2 ANCH. AK. 99501 8055 SEAVIEW STREET 11 DATE: JUNE 73, 2000 (NCH) 279-3916 ERVIN HOPPE SHEET: 113 GRID: 2224 PERMIT # SW000XXX PID # 011-133-43 SLK02061.DI✓6 I Well h " 21 I I 5 20 I STA RD SEPTIC SYSTEM 1000 SEPTIC TANK t STANDAR TRENCH 30 FT LON 13 FT DEEP 8 FT SEWER CK VA I I I 15 0 15 30 45 60 75 90 SCALE: 1" = 30 FT Well 7 V.. 49th ' ....................... .. �� 17 �'; TOB EN •SPURKLAN �'W j T,. No. CE -2225 � • 1 ♦� ttt.PROFESSI�N�i�•� TOBBEN SPURKLA 9P, LOT 6 BK 2 SAND LAKE j/2 SEPTIC DESIGN I G (907) 277 999-391166 203 W AK. 0 NUE 8055 SEAVIEW STREET SEPTIJUNE 73, (NCH. FR VIN HOPPE SHEET: 2/3 GRID: 2224 PERMIT # A100*XX PID # 011-133-43 SLK02062DWG Standard Trench 2' Wide 30' L ong 13' Deep 8.0' Sewer rock 5' Cover 8.0 ft of Se Effective O O �E 1000 gal Septic tank EXISTING 'o a a m P ° 49th to TDBBFh SPURKLAND , O ••ICrf �., No. CE -2225 -•` Na SCALE •♦♦♦♦...... ••' /VU JUMLC TOBBEN SPURKLAND P.L.SEPTIC SYSTEM SCHEMATIC 203 w15th Ave LOT 6 BK 2 SAND LAKE #2 Anchorage Ak 99501 8055 SEA VIEW STREET DATE, JUNE 13, 2000 a� £RVIN NGPPE SHEET: 3/j GRID! 2224 PERMIT j SWOOOOXX PARCEL 10 3 011-1323-43 SLK02063.DWG .. j yieae.n,�'�tj- Fit ' Munl:Ipallty of Anchorage DEPARTMENT OF iEALTH & HUMAN SERVICES EQeu ��Fj 825 "L" Street, Anchorage, Alaska 99502-0650 0� J), CE -2225 SOILS LOG — PERCOLATION TESTI,:°, z °p,eer<gP1 PERFORMED FOR: YY un DATE PERFORMED: LEGAL DESCRIPTION: KI Township, Range, Section: DEPTH SLOPE SITE PLAN (FEETT) 1 2 3 T t 4 r 5 6 7 r T. 8 a s 9 IV 10 11 (' 12 ` y\ 13- 14 16 16 17 — 16 ` K 19 SA.t/li'-vy h91 -r '1Ldsi3d %- 76 U( J& [RI • . ■.■■■N■■■■ ■Nf NNEMONENEMENNEMONONE E -M MENEM, IF YES, AT WHAT D,'PTH? :lo Water Alta Monitoring? r P � Mo�ilorinp7 Dale: jy ading Date Gross F lit.. Time Net Time Depth to Water Net Drop Vi� Sb lL / eo o l � i a ea , z I�UITc WI �1= zo {lull PERCOLATION RATE �J— (mmutesnnch) PERC HOLE DIAMETER / TLST RUN BETWEEN FT AND SFT DISCLAIMER• Groundwater rpnditinns indicated are for the dates shown only. Past and future presence and/or depth of grotndwater can not be predicted romese o se a ions. Y: PERFORMED B�-S __.— I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUI: ELINES IN EFFECT ON THIS DATE.. DATE: 1a quj'-� 72.008 (Rev, 4/85) 72-013 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE ® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE J /� ,�[/ �� �%f "!5� �S"Jy`�C-i7c�.—///% ❑UPGRADE MAI LI NG ADDRESS 9 /� /-� ` J � / 7'� vl 2 -" c �/ !'e LEGAL DESCRIPTIO F-. %N �` { / �7 el?�v. L -Ti[ G - LOCATION NO. OF BEDROOMS ��yy 56 7r1 4- S)2 2-'✓/ e'j - 3, Well r A sorption area Dwelling PERMIT NO. _ U Y DISTANCE TO: /(%O �Mr„ O ?.S a Z Manufact er Materials. No. of comprytments wF S1� to Lig. apaci y in gallons Inside length Width Liquid depth 06 IF HOMEMADE: 0 �'DISTANCE TO: Well Dwelling PERMIT NO. -r0Z O Z Q 2_F Manufacturer Material Liquid capacity in gallons D Well Foundation Nearest lot line PERMIT NO. w= DISTANCE TO: LL Z No. of lines Length of each ine Total len th of lines Trench width Distance between lines Z w inches CC— ¢ l.- Top of tile t finish grade// / 6 Material be eath tile Total effective absorption area / p Z , inches i� ,0 Length Width Depth PERMIT NO. w 0 Q F Type of crib Crib diameter Crib depth Total effective absorption area wLU 1 y Well Building foundation -Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. W W � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING 5-D 7A INSTALLER {/� REMARKS/ If `�v J Sh ZL ii 9' Ag#e p /6 a''/pp& F / b — z j/ — sr� res oe AV? 0 74� f l✓r /S� !�c/e✓� APPROVED DATE LEGAL / j� a -Z ice # 2 72-013 (Rev. 3/78) IM E -_E P -°E I C~ x r-_, IP -1 E__ I -T` %-A Cl F- FA E° -.a E--1 -_' ,�° � � H -31' E'' DEPARTMENT �_ HEALTH APIE:l EtJ IRONMEt'4TAL . .OTEC:TION 5 `L` STREET, ANCHORAGE, AK. _?w 501 264-4720 a•° -E a a_._ a_._. F"-11 a°4 Co a°_4 I ~ T- E.:.. '. a -°..a a= FR a'_.•, E_ F;? 1M I -T APF'L I CAt•dT FIULTL-'4U I ST• CONSTRUCTION 7324 T•ANAGA CIRCLE" 333-1119 —_111._: LOCATION SEAVIEW L..Et:IFIL. L 6 B 2 SAND LFiF•'•.E #2 LOT SIZE 6750 S,L;!I_ ARE FEET TYPE OF SOIL AB ;ORF'"f I ON SYSTEM IS: TRENCH NUMBER OF' BEDROOMS =• _ SOIL. RATING SO FT;:BR )= :150 THE REQUIRED `S'IZ'E OF THE. SOIL. ABSORPTION : T,sTEt'1 I S : a r-� a:.� a`° -a- a_' -s -_�: �a� �:.� �_. ��,. a°-� a ��� -a- a ---a =— --- •=:�. �::� a�� �= =� ^°„a a-:: �__ ar-A a �- � =° _a-- a'_ -a = :_ THE LENGTH D I ME NS I CIN IS THE LEP--lGTH 'IN FEET? OF THE TRENCH OR EIRA I NF I ELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE. OF THE GROI,-ItID Fl I[) THE BOTTOtl OF THE: E:e-, F'I'v'ATION (IN FEET::. THERE I'S NO SET WIDTH FOR TRENCHES. THE 13RFIVEL DEPTH IS THE MINIMUM MUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AP•M THE: BOTTOM OF THE E;<;C:AVATION 'IN FEET). F;.1 E:= Gi a__E T: r JE—_ U> E-* F F=" -T" I C, --E-- F-1 a° -A a - _ I _IL �-n 02-4 IL -91 C -A !F=l a_._ a _ CH PERMIT APDL. I C:AP•41' HAS 'THE RESPONSIBILITY TO INFORM M TH I DEPARTMEP,IT DURING THE :LI'45T'AL.L.ATION, IhISPEC:TICiNS OF AP'lY WELLS AD:TACEhIT TO THIS, PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. -T- E -°-a d-) < �- ..a 1 E a ° E=° F-- C: --a-' .a: CH P-J'u==-9 ary=" F-: F- Er G! U 1 FR' EE E=fl -- BACKF I L.L I t -1 OF ANY SYSTEM U I THou'r FINAL I t' SPE:C:T I OP•1 AND APPROVAL_ BY THIS DEPARTMENT WILL BE '_;LJB:7ECT TO PROSECUTION. M I N I I'1UM DISTANCE: BETWEEN A WELL FIND ANY �: it'd --SITE SEWAGE D I := POSAL SY TEM is :100 FEET FOR H PRIVATE WELL OR 1.50 TO 2000 FEET FROM A PUBLIC C: WE.L.L DEPENDING I_IPON THE TYPE OF' PUBLIC WELL. MINIMUM DIS-f'ANCE FROI''1 A PRIVATE WEL.L_. TO A PRIVATE SEWER LINE I'S 25 FEET FIND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL. LOG.,:*:". ARE REQUIRED FIND MUST BE RE:TLIRt•,IED TO THE DEPARTMEP•dT WITHIP'd 30 DAYS OF THE WELL COMPLETION. O'f HER REQUIREMENTS MAY APPLY. SPEC IFI CAT I CANS AND C OkIS,TRUCTI ON DIAGRAMS FIRE AVAILABLE TO INSURE PROPER I NSITALLA'T' I ON. 7" - e E_=° :C Ems.^ E__ ° E FE a,'S: El a -°-E F- I CERTIFY THAT 1: I AM FHIl I L. I FIR WITH THE REQUIREMENTS FOR ON—SITE SEWER_; FIND WELL'_ AS SET FORTH B'T' THE 11Ut4I C I F'HI_. I TY OF ANCHORAGE. 2. I WILL INSTALL THE: SYSTEM IN ACCORDANCE WITH THE CODE-'--. _ . I l!t' DER.'. TAt'dl; THAT THE Cita--'SITE SEWER SYSTEM MAY REQUIRE ENLARGiEt'IENT IF' THE RESIDENCE. I'_; REt OF,,-EL.ECl TO INCLUDE MORE THAN - BEDROOP'& SIGNEEi:_-.._____._.___._. ___.___ _ __-_. ___________._.__.__-___.__ APPLICANT Hut..ToU I ST CONSTRUCT I ON T';S IE.E: , V E;•r__._____._._._____.._.___._.___._.____.__._____.__I�:�FITE �.�.�� ��J_._._._.__._ 4. 0 U JU-Lt LUU MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION �( PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: D/i�V �' tyU �=( l� �S`f' DATE PERFORMED: 7 ^ -2— LEGA L LEGAL DESCRIPTION: "A- Block Z U 13L7\ V \St o ti.l t i SLOPE SITE PLAN 2 i r l • 51L.'t NO -P 5►�) 1 15, a 4 • C 1 6 7 8 9 10 i S1LT`� SL�N� �sNX) WAS GROUND ,Sb 45 ( ENCOUNTEREDWATER , 1 — SO `� P IF YES, AT WHAT E DEPTH? COMMENTS Reading Date Gross Time Net Time Depth to Water Net Drop Allis I -4y 3v 30 �n it WI&V 4a 12;oS $b rtp car` 3" Go 10 I' I,11 ��11 PERCOLATION RATE 64 (minutes/inch) TEST RUN BETWEEN 6 FT AND -Z FT PERFORMED BY: ColyT2gc't I N& c7m6lmsEe-s CERTIFIED BY:_ZMOPIA TOkGEL.r DATE: 72-000 (6/79) ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT Plans for the construction of 'S 11112 L AK� " f! 12, i i 1 U � "; 10,10 % , f cuff 7_11Klg 6, �_'.E 1 ��. f public water system located in fir-, 1,) r titC T d)o'f - Alaska, submitted in accordance with 18 AAC 80.100 by ��f �� Z jl JJ 1, Y 1 F have been reviewed and are Pk approved. O conditionally approved (see attached conditions). F f/ 7 // P>; :F-� TITLE DATE If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. APPROVED CHANGE ORDERS � � /Sv` � o jao Pik, 02,x, Change (contract order no. Approved by Date'"` r G� or descriptive reference) E The "APPROVAL TO OPERATE" section must be completed before any water is made available to the public. APPROVAL TO OPERATE The construction of the public water system was completed on (date). The system is hereby granted interim approval to operate for 90 days following the completion date. 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. TITLE Water Source Engineering Kcport water `>ystco: for Lots 1 thru 6 Block 2 Sand Lake Suhd. (all lots single family dwellings) PCC OF `y CO � EY r. f� �� • •• Ralph L. Jokcla J, v V� NO '! I ' tib. _ ... well #1 located on lot 6 to serve lot 5 and lut 6. Well is 6" sl_cel casing 4t;b !WV L deep with a static water level of 112 fect. Test pumped at 20 GPM, Well A2 is located on. lot 3 and is proposed Lo serve lot 1,2,3, 0 6. Well is 6" steel casing 410 feet deep with a static water level of 118 feet. 'fest pumped al 30 GPM. Wells shall be installed with a pitless adapter at a minimum depth of, 10 feet. An approved water tight sanitary seal shall be installed on rhe well. The top of the well casing shall extend a minimum of 12" above ground with drairthne sloped away from the well for a minimum of 101. Due to the der;Lh of the well and sni_Is conditions, the well casing should nor require grouting. Also due to the conditions noted above, it is proposed char- He protective radius for this well be reduced from 150' to 100' required to on-site sewer systems. water Distribution Proposed distribution system shall comply with e'awl, standards. pipe shall be Type K copper with sizes as indicated on attnched nketch• Pipe shall be buried a minimum of 10 feat. All underground splices shall 1_,e flare fitr.ings. W-ai ur pumps We! 1 1x'1 : Using a depth of 3J0' to the neud loss is as follows: he= hl=375 L.F. of 1" pipe= 20 psi minimum discharge Tool head loss= pump and an assumed drawdown of 2^;r; Wt. toLnl 200 47 pressure-- 66, ?`.t3 I. ak demand for 2 dwelling units is 840 GPH, Use l'; H.P. pump. l:Pion,,er sdb,ersible Nodv l A-18 or equivalent) (See attached performance curves) lelaid2 d g a depth of 300' to the pump and an assumed drawdown of 200 feet total loss is as follows: he= 200' hf=425 L.F. of 1" pipe= 103' 20 psi minimum discharge pressure= 46 Total head loss= 349' Peak demand for 4 dwelling units is 1260 OPII, Use 3 11.11. pump (1)i_onc(!r submersible Model A-35 or equivalent) Water S[oraee Water storage shall be accomplished with a diaphram type storage tank (42 gallon capacity) in each dwelling unit. Tanks shall be precharged to 20 psi and will preclude the necessity of air volume control. Shut—off valves will be located in each dwelling unit served. 7-1,,V G ,• � j r� Ranh F,. Jokolo MA-� -KAY -;)G- .SJ o OEVAU57RIA March 2, 1973. AHMORAGE 9955i Mr. Thomas Leong 3411 Cope Anchorage, Alaska Dear Mr. Leong: `U "^ Sand Lake Subdivision, Lots 5 & 6, Block 2. I no Insve reviewed yonr s!twa7!cn 1P ;:S�7 C! 7nZ 40500 Sq. Ft. -20,03 S:. Ft. recalrizont =7ta;noc in Soo -lc-. AAO 72.510 of the Rpvr7=7 57- Ovnsvrva7;0� vns--'� Over 0>471ons. it is 0�- �:ncinj 7n17 Einca yoo C. Seo of the !ot on or before Febr.ary 5, 1173 n7s twt yoj :n7w�w 7�, Wn=-07 a PKV670 rOS Wnll Mr VOAr 00-IMai LN-'' ThIt 7A!a 01-7:7, Seo7;on of Ke Waste Water 07z&.-jans v 2c- OPP!Vabln :; Y507 Z.2.. Wa would howeveraavise you that. 07 co"oss aK existKI W -Cru --n Reguiations are in effact hoc arz applicoLm in a:! casc5QOCP-.- Where STate requiraments are more s?r;rgnnv. Oars Truly, CEnvironoGn7w, cc: GAN -DQ 0 IMIUMCIPAUTN'Llf OF ANCHORAGE 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. 011-133-43 1. GENERAL INFORMATION Complete legal description Sandlake #2 132 L6 Location (site address) 8055 SeavieW St Expiration Date. all O fL rjol� i5x191'Mg !2//6*zo Current property owners) ECIC McComb Day phone Mailing address Real estate agent 2. TYPE OF DWELLING: Fx_1 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Private Well ❑ Water Storage ❑ Community Well 0 Public Water System ❑ Day phone TYPE OF WASTEWATER DISPOSAL: Private Septic E Holding Tank ❑ Community ❑ Public Sewer ❑ Waiver request � 0 Distance: L L _ S Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $I r� `J 0 ( �} f i� - �)i \ Waiver Fee $ Date of Payment 2 010 Date of Payment R1,2 9 /,-Z 0�2_ 0 Receipt Number 0� 1 C- Receipt Number 1 Ci COSA# C,SC2 vlr]� Waiver# 0SN D01 060 C®nJ44onc,� - �Z.17. 50 Cou 10 L,d 9/rol(2a2o p ��� �F0715gG 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. � l I aPp (OVA 9 rftiA'�'e� DSD SIGNATURE q �16/i0 VSystem #1 Approved for 3 bedrooms ystem #2 ApprovAd for Date 20200828 Conditional approval for 3 bedrooms, with the following stipulations: W ON-SITE `9 NNS 1ASTI� v,AATER oz PROGRAM \� By: Original Certificate Date: Ct.zloka The Municipality of Anchora 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 Septic System Advisory Well Flow Advisory COSA Checklist blue sheet X Nitrate Advisory Arsenic Advisory Other CSA Checklist Legal Description: Sandlake #2 B2 L6 Parcel ID: 011-133-43 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments Class C Well B. TANK DATA Age of tank(s) new years Tank type/material poly Measured operating fluid level in septic tank 48" 01 Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 1=312008 0 ALL standpipes present per record drawing Total measured depth from grade 13.1 ft (max) Measured depth to pipe invert from grade 5.8 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 7-3 Code -required soil cover over field Q System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 2000 gallons Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ® No X31 Coliform bacteria is Negative Nitrate mg/L X Nitrate less than MRL (ND) Arsenic 553 ug/L [:]Arsenic less than MRL (ND) Collected by PG Date of Sampled )Pmu/ IIer P,�55 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 7/9/2020 Results Q✓ Pass For 3 bedrooms Fluid depth prior to test 7 in Water added 500 gal New depth 70 in Elapsed time 1440 min Final fluid depth 7 in Absorption rate '450 gpd Any rejuvenation treatment (past 12 months) No If yes, enter date 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' E✓ Yes Community Sewer Manhole/Cleanout > 100' Q Yes if No ft ❑✓ Yes if No Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' E] Yes if No Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' FV1 Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' ❑✓ Yes if No F/1 Yes if No ft if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft n Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' Property Line > 5' Fv1 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' [:1 Yes if No 2.5 ft Private Wells > 100' ft ft ft ft ft ❑✓ Yes if No ft ✓❑ Yes if No ft Water Main > 10' M Yes if No ft Community Wells > 200' R] Yes if No ft Water Service Line > 10' F/� 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' E✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No 2.4 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 ft F. ENGINEER'S COMMENTS 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. 20200828 COSA Checklist yellow sheet Arsenic Advisory Certificate of On -Site Systems Approval # OSC201474 Subdivision: Sandlake #2, Block: 2, Lot: 6 A water sample revealed an arsenic concentration of 49 micrograms per liter (ug/L) in 2017. 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. Mailing Address p=O Box 196650 Anchorage, AlaskP51g 6650 ui►uvw muni org 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on -she 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 Phone 272-8218 Address P.O. Box 102954 Anchorage AK 99510 Engineer's Printed Name Steven R Pannone P.E. Date 10/14/08 Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water ���� QF A[aa�a�aa♦ levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and `9 # satisfactory test results do not guarantee future performance of the system, nor do they guarantee that P q rH �. there arc no hidden defects or encroachments. PES can therefore not provide any warranty for future i00 ; performance nor give any estimate of how long the system will continue to meet the operational _ _ 3 _ requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed ♦ Steven annone. above. Any reliance upon or use of this report by any other person or party is not authorized nor will it 0��o. CE 8149 confer any legal right whatsoever. 5. DSD SIGNATURE �44; ----- •� Approved for '— bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: _ __-__COSA Checklist . - ._. -_ X Septic System Advisory Arsenic Advisory _.- Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: A. AAA��Qz Original Certificate Date: 3 (Ray. 11A Municipality of Anchorage ' Development Services Department Building Safety Division ' On -Site Water & Wastewater Program ' 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Sand Lake No. 2. Block 2 Lot 6 Parcel ID: 011.133.43 A. WELL DATA Well type Class C If A. B, or C provide PWSID k _ Well Log (Y/N) Date completed _ Sanitary seal (Y/N) ym Wires properly protected (Y/N) Yes Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft, ft Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate �41-) mg/L Other bacteria =O—colonies/100 mL Arsenic: X8.2 ug/I Date of sample: 1011312008 Collected by: SRP B. SEPTIC/HOLDING TANK DATA Tank Type/Material SeoticlSteel Date installed 1013111981 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 711512008 Pumper ISSACS C. ABSORPTION FIELD DATA - Date installed 1013/2008 Soil rating (g.p.d./ft2 or fi (bdrm)1.2 System type Deep Trench Length 30 ft. Width -5 ft. Gravel below pipe 8.0 ft. Total depth 1L2 ft. Eff. absorption area 480 ftz Monitoring tube Yes Depression over field N Date of adequacy test A QW2008 Results (Pass/Fall) Pass For 2 bedrooms Fluid depth in absorption field before test New in. Water added_ gal. New depth_ in. Elapsed Time:_ min. Final fluid depth _ in. Absorption rate >= g.p.d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Datum E. SEPARATION DISTANCES Size in gallons NIA Manhole/Access (Y/N) "Pump off"level at _In. High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 101.7 On adjacent lots 100+ Absorption field on lot 100.1 On adjacent lots 100+ Public sewer main NIA Public sewer manhole/cleanout NIA Sewer /septic service line 75 Holding tank 75+ Animal containment areas 100+ Manure/animal excrete storage areas 140+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 26 Property line 10 Absorption field 10 Water main 25+ Water service line 25+ Surface water 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 2.4 Building foundation 22 Water main 25+ Water Service line 25+ Surface water 100+ Driveway, parkingivehicle storage 25+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in : 0 491" conformance with MOA COSA guidelines in effect on this date. ""'" Engineer's Printed Name Steven R Pannone, P.E. �0�r�-}sie�none ♦ k No. CE 8149 •rfy�, Date 1011412008 eie " ., COSA Fee $ 7 W Date of Payment Receipt Number (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage • Development Services Department p p Building Safety Division On -Site Water and Wastewater Program s "` 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsitc (907)343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # 080365 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 6 of Sand Lake #2 Subdivision. This inspection revealed an arsenic concentration of 58.2 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.or /og nsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. CL 1]]U S »]ay]S b J- I 0 — 5o m Noo 0o m" ƒr @ >CL oX, CO 63 6 of az k I gk § } §§ 6 }ee 5D m Ct -._,_._._.—.—•- \ | 0 | k @ G \ Municipality of Anchorage of •Development Services Department s+' Building Safety Division r On -Site Water and Wastewater Program 4700 South Bragaw St. S A Fc r r 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. _Olt 0--� — 4?� HAA Expiration Date: % - 3 O - C� 1. GENERAL INFORMATION Complete legal description ICT CO gL:oLk- 2-- 5h( Ij LA k � Location (site address or directions) cg0�r--;, 56WL0jj 57 - Current Property owner(s) _12AWl l�.c Day phone P43 - Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Day phone Day phone 5';97— 3. TYPE OF WATER SUPPLY: '. TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class I Well � Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties 'served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (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 of Firm n �"1— P �fkTo�(► P "APhone -32 Address Engineer's Printed Name Date �Jr� 5. DSD SIGNATURE l� Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the foil Additional Comments YYNDiGrrn�.-�� • oo vG,RAM---' Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other BY: �4� t Original Certificate Date: g (Rev. 01=) Municipality of Anchorage • Development Services Department f` a Building Safety Division a a On-Site Water & Wastewater Program ' 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us I: 'i (907) 343-7904 ' HEALTH AUTHORITY APPROVAL'. CHECKLIST Legal Description: LoT `ln - �l-oGiL Parcel ID: A. WELL DATA Well type ilf A, B, or C provide PWSID # Well Log (Y/N) Date completed Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth '" ft. Cased to ft. Casing height (above ground) in. i, a FROM WELL LOG AT INSPECTION Date of test' Static water level Ift. ft. 1 Well Or i duction k g.p.m. 9— p.m-WATER SAMPLE RESULTS Coliform) colonies/100 ml Nitrate mg.& Other bacteria I colonies/100 ml. Arsenic �' 'a mg./I. Date of sample:'✓ a3 Collected byZP�1a"i- BSEPTIC N6-TANK DATA TankType/Material - ` Date installed 10'"'- g Tank 'size!1Db : gal. Number of Compartments 2-- Cleanouts (YIN) �GS Foundation cleanout (Y/N)�S Depression over tank'(Y/N) 0 High water alarm (Y/N) 110 Date`of pulmping �✓ -OS=O� Pumper S"C's C. ABSORPTION FIELD DATA(((- Ss 7 .k k :. 2 C Date installed Soil rating (g.p.d.lft2 or ft2/6drm) ��- System type I Width ft.Length Total de th I'k ft. - Eff. absorption area ft Monitoring tube Depression over field 1110 Date of adequacy test S�D i Results (Pass/Fail) I', For drooms Fluid depth 'n absorption feel p I in d before testa in. Water added gal. New epth in. I I r ��II2 Elapse time. min. Final fluid depth `-Y;/ in. Absorption rate >= g.p.d. Any rejuvenation' treatment (past 12 mo.) (Y/N & type) ' ND If yes, give date II f D. LIFT STATION - 00f,16�7 Date installed "Pump on" level at in. Size in gallons =gh :E!Lr-rip-of at in. ater alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot too r Absorption field on lot `0 Public sewer main KJOPC Sewer /septic service line -I5 r On adjacent lots ®2 -- On adjacent lots Public sewer manhole/cleanout Holding tank t' -10'0C SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line ' Absorption field Water main OOK16 Water service line ��5 Surface water 000t; f Wells,on adjacent lots % 00 SEPARATION DISTANCE FROM ABSORPTION FIELD ON FT TO: r Property line �J Building foundation Water main 1 f Water'Service line '��� Surface water ►�� Driveway,'parking/vehicle storage I Curtain drain �t?1•�� Wells on adjacent lots CO F. COMMENTS P 44--� -, ©ep-ABLE TQC irT "f1YvL� DF •t�S'AIJ� sc� .. iSR)LL7''0e.l:F(( J jl�'LtJEi� Gb( �PP&MP�R--/�TIf�F((►.�ij i{aW� etX1L17 or -lc -c i r -M -c, m vr� V? oFF WAS Fp;57-50r4 V -.:5J 2c��o c -r �t,t.�[ S A -#4 E> G. ENGINEER'S CERTIFICA ON 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA in this'date. �oo�000��pS o,y•r �� = guidelines effect on ; Dpi p �,a r Engineer's Printed Name) Date HAA Fee, $ Date of Payment `I Receipt Number El�i (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number amw 1 r. LAWN N CE -9126" OO s� SEAVIEW STREET 5.9 5.9 U MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Aelm Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # oil- 133 LI3 CS HAA # 1112 Uod 2L) 3 1. GENERAL INFORMATION Complete legal description `-DT (o 1131!- SAN lb l.,_ArV-F_ Location (site address or directions) Ll 06 S G t�EIAVUt-o!s Property owner I- 9-V I t-1 46 Day phone Mailing address 968S b (L - Lending agency Mailing address. Agent Add ress Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 77. 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank — Community on-site Public sewer — NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1191) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that niy investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedroonis 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 code::3, ordinances, and regulations in effect on the date of this inspection. Name of Firm 103�GN S�U21V1,1A-Nth t� L Phone JL7 I- Address p "s & I'ai-_L, 14 � Engineers signature g z Date — 7/c' 6. DHHS SIGNATURE (� Approved for 3 Disapproved. Conditional approval for Additional Comments bedrooms. , 3 1 bedrooms, with the following stipulations: Date _-2. %' b O _ 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 acourtesytopurchasers ofhome�s and their lending institutions in order to satisfy certain federal and state requirements. Employees of DFIHS do riot conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is riot responsible for errors or omissions in the professional engineers work. 72-M (Rev.1/91) Beck MOA 021 Municipality of Anchorage • Department of Health and Human Services iC L C LC I V E 0) I Division of Environmental Services '— On -Site Services Section 825 "L" Street Room 502 ill 06 2000 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us MUNICIPALITY OF ANCHORAGE (907) 343-4744 "Inr)NIMENTALSERVICB niw° HEALTH AUTHORITY APPROVAL CHECKLIST ,)II Legal Description: j_o T (<, 3L. 2. '5AiNf) LAV. . H 7--- _Parcel I.D.: i-3a-_4.iS A. WELL DATA Well type C, If A, B, or C provide PWSID # Date completed _ Sanitary seal Total depth ft Cased to ft FROM WELL LOG Well Log Wires properly protected Casing height (above ground) _._ in. AT INSPECTION Date of test _ Static water level ft ft Well production g.p.m _ 9 -p.m WATER SAMPLE RE=SULTS: Coliform colonies/100 ml Nitrate til I) mg/I Other bacteria N l%colonies/100 ml Date of sample: r%7 D Collected by: `I B. SEPTIC/HOLDING TANK DATA Tank Type/Material 5anTic T1: L. Date installed Io -30 -9t Tank size 1 gal Number of Compartments Cleanouts _Foundation cleanout Depression over tank High water alarm Date of pumping Ma �Zv 2i4xv Pumper C. ABSORPTION FIELD DATA Date installed 6 ' t,&) Soil rating (g.p.d./ft2 or ft2/bdrm) Z 'Z System type 6,ey4c-6 _ Length 30 ft Width 3 " ft Gravel below pipe —1 ft Total depth i 3 ft Effective absorption area qb`D ft2 Monitoring tube Depression over field-. Date of adequacy test µi4 Results (Pass/Fail) i For `> bedrooms Fluid depth in absorption field before test ✓ in Water added gal. New depth in. Elapsed Time: y/' min Final fluid depth I,/ in Absorption rate >.= r/ , g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) -If yes, give date _, 72-026 (Rev. 01/00)' D. LIFT STATION Date installed Size in "Pump on" level at in "Pump U Manhole/Access at in High water alarm level at in tested Meets alarm & circuit requirements E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100 On adjacent lots > / V-0 Absorption field on lot t D 2 On adjacent lots > /&tD Public sewer main Public sewer manhole/cleanout toml� Sewer /septic service line > 60 Holding tank I -VA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation L oZ3 Property line >/t) Absorption field - Water main i`t/ft Water service line > 15D Surface water Drainage t t Wells on adjacent lots > /-�o SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 3 Building foundation A L Water main "/A tJ Water Service line > 3 Surface water l"I i D Driveway, parking/vehicle storage 7 Curtain drain N /n Wells on adjacent lots /X0 F. COMMENTS In � �. �•...>�... , G. ENGINEER'S CERTIFICATION r` a; I certify that I have determined through field inspections and y M1NGINEE R'' . �a review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. �;•,n'aben Engineer's Printed Name i alo�e� fav* tela L' f`, CE -2225 Date HAA Fee $ -2100. 02::' Date of Payment %,6-e0 Receipt Number DGL�a ( %145 ) 72-026 (Rev. 01/00)* Waiver Fee $ Date of Payment Receipt Number Time APPLIC� AT FILLS OUT UPPER FIAT - -LY Property Owner P , t - - -/- - :._% r%, Phone s� Mailing Address ;. ,;" / ;%/ ,j i-- �' kJ - Zip Code Buyer ,J;r%�';�i;j r!�>✓� f�_ Date Address c iy r�� Zip Code Inspector Lending Institution ;�%, %;;_f r - - , c ;;-_ ,:_-� k' 5 ' All) or Crl Phone `10 "? Field Notes: /� \`'" - Zi Code f_ p Address f fi ff= >P ; ,rJ i' 4 Realty Co. & Agent CEPT. OF=i! Ti l Phoney ENV IRONJ,`_NTAL PROTECTION Address _ Zip Code m o v Legal Description i ,T Street Location RECEIE APPROVED BEDROOMS Type of Residence 'CONDITIONS OF APPROVAL ) Chi T Single Family ---' ---,_ ❑ Multiple Family No. of Bedrooms ❑ Other DDVV - Water Supply ❑ Individual - - A CH WELL LOG. A well log is required for all wells drilled since June 1975. [;,k.Community-� ;9/';'�'� K— For`,wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal Date Sewer Installed Year Individual Installed: �- Well To Absorption Area ` ©� 7-f EVIndividual -❑ Public Utility �� VC�L When Connected to Public Utility: Well to Tank / 0 15 ❑ Holding Tank `-NOTE: THE INS C ION FEE MUST ACCOMPANY -EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time ....-..`Time.-.-"_--.'" TimeTime Date Date Date Date, t --D Inspector Inspector Inspector Inspector Inspector Field Notes: MUNICIPALITY MUCIPALITY 0= ANCHORAG CEPT. OF=i! Ti l ENV IRONJ,`_NTAL PROTECTION m o v RECEIE APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) DI NAL APPROVt*3 DATE Z DDVV BY: i.= SoilsR�Singi Date Sewer Installed Well To Absorption Area ` ©� 7-f Well Log Received l `' `'' l e - 3 C) -- ,¢ 1:1 Well to Tank / 0 15 Septic Tank Size 72023 (3/82) ` - DATE RECEIVED INSPECTION APPOINTMENTS .1 2 re TIME TIME - TIME DATE DATE�. 1 v DATE INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION • ENVIRONMENTAL SANITATION DIVISION NOV 9 1981 Telephone 264.4720 f � REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWERVA `+ DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER PHONE A t1. ❑ PUBLIC UTILITY MAILING ADDRESS I-1 F PROPERTY RESIDENT (If different from bove) PHONE 2, BUYS Al6Qr PHONE MAILIN6,ADDRESS 3. LENDING INSTITUTION Ifo PHONE Q -M MAILING ADDRESS - 4. REALTOR/AGENT PHONE �j rj MAILING ADDRESS- �F'r� 5. LEGAL DESCRIPTION � Lot, �f .1 2 re STREET LOCATION Y 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ One ❑ Four ❑ Other X SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY ❑ INDIVIDUAL* /� \ ��' "QA ) CH WELL LOG. A well log is required for all wells drilled ® COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM 1K INDIVIDUAL/ON-SITE** 07 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) �oT� l��s �`�� �>✓ s�ae� � rig well � �o� � THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELLTO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line - Absorption Area to nearest Lot Line 5. COMMENTS 4L/APPROVED FOR J BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED i DATE % BY 72-010 (Rev. 6/79)