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Home My WebLink AboutSAND LAKE #2 BLK 3 LT 19Sand Lake #2 Block 3 Lot 19 #011-134-06 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201423 PID Number: 011-134-06 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name KELSEY DEIMAN ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 8054 SEAVIEW STREET, ANCHORAGE ❑ 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 3 19 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 Ft' Ft. Well 100'+ -- 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1000 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 10'+ -- NA Foundation 10'+ __ LIFT STATION Manufacturer Capacity Gal. Remarks Alarm location Electrical installed by Tank to PIPE MATERIAL House to tank 3034 3034 Installer NORTHERN EXCAVATION d a of eld Drainfield CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspection 1M 11/12/20 11/13/20 Location and description 2�d 3`d 4`h BOTTOM OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVAL or— Conditional Approval: Date • • ' , ®W�Q•, TH • • •: Curtis Huffman Septic A pp rovedstem �'F�, •. CE 128991 Date1� abab ��F�,•.,11/13/2Q0•� FX QpROFESSI4NAC OF, WQ Note: this approval does not include well permit requirements. (Nev ubiuziiu) PID: 011-134-06 PERMIT: OSP201423 l I ASSUMED WATERLINE --- LOCATION —LOT SERVED BY PRIVATE SHARED WELL LOCATED ON LOT 22 -X X X X X X X M LOT 19 w A 46.2 BLK 3LLJ EXISTING rn U 3BR-HOUSE N EXISTING CO MH BM FIELD DCO C FCO B 46.2 21.2 W E � SHED ON CAR PORT 4%, A Q NEW 1000—GAL PIER BLOCK oo W HDPE SEPTIC TANK WITH NEW DCO ROOF FAVF A -C=25.8' B -C=12.7' A -D=28.3' B -D=17.1' A -E=30.7' B -E=19 6' SCALE 1" = 20' SEPTIC SECTION SCALE; NTS SAND LAKE #2 BLOCK 3, LOT 19 PREPARED FOR: KELSEY M DEIMAN 8054 SEAVIEW STREET ANCHORAGE, AK 99502 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 firstwaterAK@gmail.com SUPPORT,SERVICES: OF AL4 9 TH DATE: 11/13/20 I` -A rtis Huffman SURVEY: LANTECH il tri, CE 128991 DRAWN: FWCS 1 11/13/2020e,W SCALE: 1" = 20' \ CAR PORTSEAVIEW STREETLOT 19LOT 18LOT 20LOT 7LOT 6LOT 530'30'ROOF EAVEEXISTING HOUSEEAST 135.00'EAST 135.00'NORTH 50.00' NORTH 50.00' 26.2'46.2'26.2'46.2'5.3'5.7'6.7'6.5'18.1'SHED21.2'MANHOLE4%21.5'LOT 19, BLOCK 3,SAND LAKE ADDITION 2AS-BUILTLEGEND:NOTE:THIS DRAWING SHALL NOT BE MODIFIED FOR USE AS A PLOT PLANWITHOUT THE EXPRESSED WRITTEN CONSENT OF LCG LANTECH.DRAWN DATE:DRAWN BY:SCALE:CHECKED BY:11/13/2020SCAP1" = 20'PLAT:WORK ORDER: 20105P-176FB/PG: 819/21GRID: SW2224LEGAL DESCRIPTION:ORDERED BY: BRENT WESTERNSURVEY CERTIFICATION: LCG LANTECH, INC HAS CONDUCTED A PHYSICAL SURVEY OF THEPROPERTY AS SHOWN ON THIS DRAWING AND CERTIFIES THAT THE IMPROVEMENTSSITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO ENCROACHMENTS EXISTOTHER THAN NOTED.EXCLUSIONARY NOTE: IT IS THE OWNERS' RESPONSIBILITY TO DETERMINE THE EXISTENCEOF ANY EASEMENTS, COVENANTS, RESTRICTIONS OR RIGHT-OF-WAY TAKINGS WHICH DONOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCESSHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION, FOR ESTABLISHING PROPERTYLINES, OR FOR PLOT-PLAN PURPOSES.SEPTIC STANDPIPEWATER WELLFENCEAsphaltConcreteOverhangWood Deck250 H StreetAnchorage, Alaska 99501Survey DepartmentPhone 562-5291MainlinePhone 243-8985AECC 668ADDRESS: 8054 SEAVIEW STREET PARCEL #: 011-134-06-000REF: 2004L122 MU N ICI PAUTY OF ANCHORAGE O n -S ite Water & Wa siewater Program; PO Uvx 196050 Ona Elmore RuM Anew -age, Alwa a 9951IM550 PNM; (W 343-7004 fax; W?) 24? -7997 ir,m�,nlan�la On -Site Wastewater D i!a pawl System Permit Permit Nunnber. 0SP20142 work Type; Septfc7aik Upgrade Tax Cod* Number: 4111340000 5ito Legni Address: SAND LAKE 02 BLK 3 LT 19 x;2224 Site Mailino Address: 8N4 6MVI EVw ST, Anc}korage Owner: DFIrulAN KELSEY PVI Design EngInear. FIRST WATER QONSULTJ NG Th i s perm i t is to r the eonstru cti an of: M Disposal Fheid Q Septlo Tank 0 Holding Tank II Privy Effective Date; ra€pirabon Date: Lot Size In Sq Int.• Totarl Iladroo= 1011M020 1011 W2021 6750 1173 Private wow 0 VMtsr Storage ,All ronstnmflan shall ibe is accordance wift. 1. The alkached appro"d n- 2. AEI requirements speolfJed In Anchorage Municipal code Chapter 16.55 ar<d 16,65 and the Slate of Alaska Wastewater Disposal Regulafions (I8AAC; ) and 1}NnMng Waw Regulations 0 t3AAD80) 3, The weetewster code requires inspections during the bgtelW ori. The Anginaer shall notify the bevelopmenl -Services Department per AMC 15.8& (Provide noff oalion calling (407) 043-7@04 (2417). 4, From Olotbar 15 to April 16, a subsu-Nue sail absorplfan Gystern undef wnsiruaCian during freezing wealh er shall be either_ a- Opened and Ckooed on the same d au, or h- Covered, sealed. and heated tD !p reverit fr-PcAing 1011912020 Recaiuml By, Data, issued �{ Date; 0 3 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com October 10, 2020 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: SAND LAKE #2 BLOCK 3, LOT 19 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1000-gallon HDPE tank per the attached design to serve the existing 3-bedroom residence. The lot and area are served by shared private wells. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201423, Rebecca Carroll, 10/19/20 FIRST WATER CONSULTING SAND LAKE #2 BLOCK 3, LOT 19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201423, Rebecca Carroll, 10/19/20 MUNICIPALITY OF ANCHORAGE ANAMEP. l DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage., Alaska 99501 Telephone 284-4720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT 1 PHONE U 1I/Js aVt �trL MAILING ADORES s9 71 LEGAL DESCRIP ION >Ei Z f f DISTANCE TO:Absorption NO. OF g' ^ PEHMI'� "'•"" NO. Ofcompartments 2y �f Witlih tQ W ManufacturerGre 1.7 N f PERMIT NO. Liu. cap a in g, Ions IF HOMEMADE: Inside lent JOOY Z DISTANCE TO: Well Dwelling I-4 Manufacturer Tr ch width / W = Well DISTANCE TO: J 4 Foundatioi FZ W No. of lines Length of eat Total lengt H Top of the to finish grade Material be O � W Length Width Depth tl mdabon o. a Typo of Crib Crib diameter Crib de ih P W W DISTANCE TO: Well Building fo J J Class Depth Driller W DISTANCE TO: Building foundation $ewer line OTHER PIPE MATERIALS SOILTE RATI�e� z INSTALLER REMA KS as r I S �s to l9 s to Z ( fe 2� 2 -real- s LAPPHOV FD NO. OF g' ^ PEHMI'� UPGRADE I iii* unit Q� LEGAL I ) [, -7 p /- "'•"" NO. Ofcompartments th Witlih Liquid depth PERMIT NO. Material Liquid capacity in gallons Nearest lot Im P�IT NO. I of hap 7 IfP Tr ch width / 7- t7o Durance between Imes aches .,� Beath tie 57 1 inches Total it t eat sorp .r l PERM i NO. Total effective absorption area mdabon Ncarest lot line UPGRADE I iii* unit Q� LEGAL I ) [, -7 p /- '.. t'1�JFa I C ;r-�•qL I TY OF t�taG!~rRRGE L DEPARTMENT .,F HEALTH AND ENVIRONMENTAL PROTECTION, 825 'L' STREET, ANCHORAGE, AK. 59501 254-4720 Ot l—t I TEENIER PERty I T PERMIT NO. ( 820200 ) APPLICANT HULTQUIST CONST INC 4761 MAPS 99507 LOCATION 349-9133 LEGAL L19 E3 SAND LAKE #l2 LOT SIZE 6500 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BP,)= 312 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C4EF•TH= LEt�r� i F-1= ?1 133;. I% •:'EL C EP TH= c: THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A 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 (IN FEET). REnLt I REG SEF T I C TRt IFS I LE= ZrJiC, �HLL�t.I 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 14ILL SERVE. BACKFILLI GJ ' OF AN SYSTEM WITHO TE IF RL INSPECTIO AFD A PROVALJBY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A 14ELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERM I T EXF=* I RES L>ECEME'EF: �21: 1S+v:a I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I (JILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: 1 UNDERSTAND THAT THE ON-SITE SEWER, SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED HULTOUIST CONST INC ISSUED BY- ��C�-�DRTE_��j�� V4. E$ SOILS LOG MUNICIPALITY OF ANCHORAGE "•.. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION IN PERCOLATION • 925 L. Street, Anchorage, Alaska 99501 2644720 TEST SOILS LOG — PERCOLATION TEST PERFORMED FOR: v +-- h'oe l',D 1'150 DATE PERFORMED:_ LEGAL DESCRIz.PTION:_ L ots I � 1I Block 3 Sand- Lake .5uL,rr. 2 12 COMME PERFORMED Sander Sit (-6ml) I Silt '� f"Ine Sart (ML) I WAS GROUND WATER '1 /v ENCOUNTERED? VVV Sift ML-, IF YES, AT WHAT DEPTH? 3/2 i rom 1 -to g; f. Readmg Date Gross Time Net Time Depth to Water Net Drop z0 Y-- 2 of:00 -61 O, 5$ l :l /0 mill 0q9 0 a :20 10 min. O.Y O, 02 + Ne7 "f;Z0 20 0 55 .t¢ :30 n O.SZ 0,03 Flo 1 /O nt/ii O, of 0. 03 i Z o 6, -a 01-55 -O- r It., -50 to iL 0.59 0, OZ 5:00 0,03 PERCOLATION RATE J C7 (minutes/inch)��Q�`e e TEST RUN BETWEEN FT AND FT •Os}\"� ae 72.000 46/791 6 'UFESSNI`"ti" r CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT Plans for the construction of 561`20 LASE. 5tjP?l21QJ: < i620 -12 Leak- � Lc)f t /ei— _Qtf4 (//'opt / N %L2(— FA — I c S ) public water system located inR111e� I ^ v Cl 40 Alaska, submitted in accordance with 18 AAC 80.100 yf by b�0ld r [t ch rtl� Eh$; (NECK have been reviewed and are )�I, approved. ❑ conditionally approved ee attached conditions). c/ 4t"Li !It ed / ell 4(hPrK� CE.[ U B 7i7 LE AT 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 Change (contract order no. Approved by Date or deurlptiw reference) The "APPROVAL TO OPERATE" section must be completed before any water is made available to the public. APPROVAL TO OPERATE The construction of the <,el G71dc k '�2 /_r'fr &=�4Jpublic water system was completed on �S 'T� C. �`L (date). The system is hereby gra d interim approval to operate for 90 days following the completion date. .: � �liirltYOtn MP��c� �l� r7 V TIT Q GATE 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 fina approval to operate. //� T'Il�r+wtPK fnc1 Eta ♦ 7 TLE 19 DATE �9w Time Time :1 �' .le Date Date Date Inspector Inspector Inspector Comments 1 1. Conditional Approval E30drooms Approval � Date Sewer Installed Permit No. Septic Tank Size Holding Tank Size Soils Rating - Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner fio ir,'U" wp;t. Phone li Mailing Address h761 11m Dr 3`Iri-�(33 Buyer Address Lending Institution Phone Address Realty Co. BAgent kiflt, rT'r 'lct+txrp UIf 171 Phone Address g 4t{,'c /;/1'd 3111-0soi Legal Description ��j 3 (,,µ,(.44pt 4' Street Location ,.y`.'G„iz Type of Residence L4 Single Family OMultlple Family No. of Bedrooms ❑ Other Water Supply ❑ Indlvldual - tS Community ATTACH WELL LOG. A well log Is required for all wells drilled since June Cl Public Utility 1975. For wells drilled prior to that date, give well depth (attach log If available. Sewspe Dlsposal K. Individual F2- • Public Utility Year Individual Installed: When Connected to Public Utility ❑ Holding Tank NOTE. THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Development Services Department r' On -Site Water &Wastewater Section Certificate of On -Site Systems Approval Parcel I. D. 011-134-06 1. GENERAL INFORMATION Complete legal description SAND LAKE #2 BLOCK 3, LOT 19 Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date:.S r ' - Z 02t Location (site address) 8054 SEAVIEW STREET, ANCHORAGE, AK 99502 Current property owner(s) KELSEY M. DEIMAN Mailing address Real estate agent Day phone 8054 SEAVIEW STREET, ANCHORAGE, AK 99502 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Private Well ❑ Water Storage ❑ Community Well "C" Public Water System ❑ Day phone TYPE OF WASTEWATER DISPOSAL: Private Septic Holding Tank ❑ Community ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ (-112,50 GOV( Q Date of Payment >+ 1 Ig •C o?o Receipt Number 0/02 f VY Waiver Fee $ Date of Payment Receipt Number COSA # 0!5G2_0162_6 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 11/1012020 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory g�Q:. • •,9 �)} for current or future occupants or guarantee that no unseen encroachments, deficiencies or ff discrepancies exist can be given by First Water Consulting & F4![.5 � *� ili .* �r / . ... .. ......... / 6. DSD SIGNATURE / Curtis Huffman . System #1 Approved for bedrooms �,sf..,cE 128991 �l F�F�P OFESSIONP�'�' System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: llll(I(((( �F OSI -SITE WATER A ST ,. i Z ._ 0 ROGE, AM J r s B Or Original Certificate Date: 2- 6r a 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 Legal Description: SAND LAKE #2 BLOCK 3 LOT 19 Parcel ID: 011-134-06 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _ A. WELL DATA – CLASS "C" SHARED PRIVATE WELL LOCATED ON LOT 22 ❑ 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 B. TANK DATA Age of tank(s) NEW years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank NEW ® Standpipes/foundation cleanout per record drawing Date of pumping NA D. ABSORPTION FIELD DATA Which system tested (date installed) 6/7/1982 ® ALL standpipes present per record drawing Total measured depth from grade 11.3 ft (max) Measured depth to pipe invert from grade 4.5 ft (min) ❑ N/A – pressurized field ❑ Monitor tubes no to bottom of effective If not state Well production at time of test _gpm Water storage tank volume_ gallons Well disinfected for coliform test? ® Yes ❑ N M Coliform bacteria is Negative Nitrate mg/L ® Nitrate less than MRL (ND) Arsenic 55.7 ug/L ❑ Arsenic less than MRL (ND) Collected by_ FRES & AWPS Date of Sample 10/7/2020 & 11/25/2020 C. LIFT STATION ❑ Required maintenance completed Age of lift station —years Lift station material Comments: Adequacy test date 10/7/2020 Results ® Pass For 3 bedrooms Fluid depth prior to test 2 in Water added 450 gal New depth 26 in depth into effective •6.8' INTO THE 10'E . D Elapsed time 110 min ® Code -required soil cover over field Final fluid depth 2 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date Fw`cs Comments/Deficiencies: *PER TANK / MT MEASUREMENTS AT TIME OF TEST. E. SEPARATION DISTANCES F or rrri ivate Well on Lot to: (Please enter distances if less than required or if community well) NA - SHARED WELL Septic Tank/Lift Sta i-,,on.�Lot > 100' Community Sewer Manhole/Cleanout > 100' ``t;•� Ye,�s` if No ft ®Yes if No Neighboring Tank > 100' ® Yes ` iif-N�o �e Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft `KeJ ng Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Animal Contain me t> 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 01M Community Sewer Main > 75' ® Yes if No ft ® Yes it'd From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No _ Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: ® Yes Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No _ Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No _ Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' - ❑ Yes if No **7 ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if'No *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 Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *MOA waiver. **Original 1982 IR notes 8.5', but measured at 7' (see attached as -built) with no known issues. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Curtis Huffman �� F'••• CE 128991 4`4� ft ft ft ft ft ft ft ft Arsenic Advisory Certificate of On -Site Systems Approval # OSC201626 Subdivision: Sand Lake #2, Block: 3, Lot: 19 A water sample revealed an arsenic concentration of 55.7 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. , �, �..' �a�ligA res�s�0�h �eAIs�Ca 9196 muorg `�, • rt Municipality of Anchorage =p E On -Site Water and Wastewater Program (907) 343-7904 s A E T Y" CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 011-134-06 1. GENERAL INFORMATION Complete legal description SAND LAKE #2 BLOCK3, LOT 19 Expiration Date: 7__ /3 _/ Location (site address) _8054 SEAVIEW STREET ANCHORAGE AK 99502 Current Property owner(s) WARREN & JANE COX Day phone Mailing address Real Estate Agent 2. TYPE OF DWELLING: 8054 SEAVIEW STREET ANCHORAGE AK 99502 ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class C Well Public Water System ❑ Day phone TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ Received by (;; �i ,r` L r 1 ?., Date: COSA to be released to the engineer, unless ofe equested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment a f ��3 Date of Payment Receipt Number ' Receipt Number COSA # QsC >!�U3Y/ Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 2/1/2013 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen',&- - O R encroachments, deficiencies or discrepancies exist.'` _ �+�' 6. DSD SIGNATURE 0 The 3 System #1 Approved for, bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Original Certificate Date: 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory _ Well Flow Advisory Other COSA blue sheet 5 1-i2 dor If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: SAND LAKE #2 BLOCK3, LOT 19 Parcel ID: 011.134.06 A. WELL DATA—PUBLIC WATER Well type C If A, B, or C provide PWSID # 218614 Well Log (Y/N) Date completed Sanitary seal (Y/N) Y Wires properly protected (Y/N) 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 NEG colonies/100 mL Nitrate ND mg/L Arsenic: 49_9 ug/L Date of sample: 113012013 B. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (YIN) Y Depression over tank (Y/N) N Date of pumping 1129113 Pumper Isaacs C. ABSORPTION FIELD DATA Collected by: Arcterra Date installed 617/1982 Cleanouts (Y/N) Y High water alarm (Y/N) N Date installed 61711982 Soil rating (g.p.d./ft2 or ft2/bdrm) 312 System type TRENCH Length 57 ft. Width 3.5 ft. Gravel below pipe 10 ft. Total depth 15 ft. (Measured 1130/13) Eff. absorption area 1140 ft Monitoring tube Y Depression over field N Date of adequacy test 1130113 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 500 gal. New depth 2 in. Elapsed Time: 5 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at —in. Datum Size in gallons "Pump off" level at —in. Cycles tested Manhole/Access (Y/N) _ High water alarm level at Meets alarm & circuit requirements? E. SEPARATION DISTANCES - CLASS C WELL LOCATED ON LOT 22 WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas SEPTIC/HOLDING TANK ON LOT TO: On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 1001+ ABSORPTION FIELD ON LOT TO: Property line 4' ` Building foundation 101+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 104 Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 1001+ F. COMMENTS 'MOA waiver issued in 2004 (#WR040031) G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name KENNETH M. DUFFUS Date 21112013 COSA brown sheet 9-1-12.doc in. E � � fr s `Ssra�1' SGS Ref.# 1130349001 Client Name ArcTerra Engineering and Surveying Printed Date/Time 02/06/2013 10:30 Project Name/# Sand Lake 2 B3 L19 Collected Date/Time 01/30/2013 14:25 Client Sample ID Sand Lake 2 B3 L19 Received Date/Time 01/30/2013 14:45 Matrix Drinking Water Technical Director Stephen C. Ede PWSID 218614 Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Ina Metals by ICP/MS Arsenic 49.9 * 5.00 ug/L EP200.8 C (<10) 02/01/13 02/04/13 SCL Waters Department Total Nitrate/Nitrite-N ND 0.100 mg/L SM214500NO3-F B (QO) 01/30/13 AYC Microbiology Laboratory E. Coli Negative I 100ml- SM21 9223B A 01/30/13 LCE Total Coliform Negative 1 100mL SM21 9223B A 01/30/13 LCE Page 2 of 4 Municipality of Anchorage Community Development Department ` Development Services Division s E, On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # 131034 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 3, Lot 19 of Sand Lake #2 Subdivision. This inspection revealed an arsenic concentration of 49.9 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.or /og nsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Municipality of Anchorage a4 • -� Development Services Department Building Safety Division On -Site Water and Wastewater Program r 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 011 - 131/ - 06 HAA #Ou Q ?� Expiration Date: 1. GENERAL INFORMATION Complete legal description 1.a F 19 r3 /c -C 1r 3 1« V*' 2 Location (site address or directions) Sos-Y S v t ve e w SA Current Property owner(s) C l,ar 1;e lzi.IJo., Day phone Gab -a 223 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address IZO30 /IRM% C)4.1 /}nes 4k 99Srx' Day phone _Non a Day phone Unless otherwise requested, HAA will be held by DSD for pickup. P/tcvC Ca // O e 5 S.s c l 2. NUMBER OF BEDROOMS: 3 3'1S' -7112S- uAen YAA 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site N Individual Water Storage ❑ Individual Holding tank ❑ Community Class C 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. NameofFirm_ F(et kor T•ctin.ca/ SC✓v.ta. Phone Sys- )_?Xsr Address !ys gei Eck St. , flnchorea a A-ic 99sV Engineer's Printed Name 'TAaoznev.r F. r-,cc.i+ Date MUv +8, Zoe,-/ 490 n : • - IF """"""'"-""" 5. DSD SIGNATURE �nimo T.E F. WOORE : A ✓ Approved for 3 bedrooms. ; . �CE' 3599�•� �f �Y A1C �fs.y •••sa••• ft4�.�. Disapproved. nr.t *� „� Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: 0-Y (Rev. 01101) r__.. j Municipality of Anchorage e • Development Services Department ' Building Safety Division j On -Site Water 8 Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us j (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lof 19, f31ac 1- 3, Sano{ I -a ke **Z Parcel ID: Orr - 13Y- 06' A. WELL DATA Well type Glatt °°G Date completed _ Total depth ft. If A, B, or C provide PWSID #?/86/Y Well Log (YIN) Sanitary seal (YIN) _ Cased to ft. FROM WELL LOG Wires properly protected (YIN) Casing height (above ground) in. AT INSPECTION Date of test Static water level i Well production g.p.m. g.p.m. I WATER SAMPLE RESULTS: Coliform O colonies/100 ml. NitrateO.S// mg./I. Other bacteria Q_colonies/100 ml. I Arsenic: — mg./I. Date of sample: 1173 10Y Collected by: F /cr )'kg TecA Sic B. SEPTICIHOLDING TANK DATA Tank Type/Material SwItc / 0 -,-el Dateinstalled 6/ 7/&2 Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN) L Date of pumping & / 16 / O 3 Pumper Sscr a c r C. ABSORPTION FIELD DATA Date installed (7/f 2, Soil rating (g.p.d./fe orft2/bdrm) 33/Z & System type i ce�c4 I `ORM Length !;7 ft. Width 13-S ft. Gravel below pipe 10 ft. Total depth 16-- S ft. Eff. absorption area LLtQ ft2 Monitoring tube Y Depression over field N Date of adequacy test Y / 2 3 /o'/ Results (Pass/Fail) i'ucy For'_ bedrooms Fluid depth in absorption field before test -2_ in. Water added 82Y gal. New depthlL in. Elapsed Time: 10 min. Final fluid depth D in. Absorption rate >= HSri g.p.d. i Any rejuvenation treatment (past 12 mo.) (YIN & type) None Lcno e . v If yes, give date N. A. D. LIFT STATION N. A. Date installed "Pump on" level at _ in. Datum E. SEPARATION DISTANCES Size in gallons Manhole/Access (Y/N) _ `Pump off" level at _ in. High water alarm level at Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: N• A. Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Meets alarm & circuit requirements? ( wt f/ if ort LOttZ) On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 9 Property line I -7 ' Absorption field 16 r Water main �> lo' Water service line > (o' Surface water > trio' Wells on adjacent lots > i00' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line N Building foundation 9-S- Water main rc,' Water Service line t> ( o ' Surface water > r c n I Driveway, parking/vehicle storage 6o ' Curtain drain Non[ Sons Wells on adjacent lots > 1co ' 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 conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name 'TAeo atb,,n t=. 1,1&& r+ Date I& -200V HAA Fee $ Y 30 !` Date of Payment _ S -/A/ /o'- Receipt Number (Rev. 12/01) ..................:t...z TLLWQ).E F. AILCY,1 r" CE.3509 • .' v ti Waiver Fee $ ('1. L.) 17S - Date 7SDate of Payment S -/Z/ /0Y Receipt Number in. SGS Ref.# 1042037001 Client Name Flattop Technical Srv. Project Name/# N/A Client Sample ID 1,19, B3, Sand Lake S/D #2 Matrix Drinking Water PWSID 0 Sample Remarks: All Dates/Times are Alaska Standard Time Printed Date rime 04/29/2004 14:29 Collected Date/time 04/232004 11:15 Received Date/time 04232004 12:45 Technical Director Shep C. Ede Released Parameta Results PQL Units Method Container ID Allowable Prep Analysis Limits Date Date Inil Waters Department Nitrate -N 0.511 0.100 Microbiology Laboratory Total Coliform 0 mgfL. EPA 300.0 B (<=10) 0424/04 JJB coVI00mL SM189222B A (<=1) 0423/04 DKC ; FLAT OP `TECHNICAL-: SERV ESQ_ ::yw......;.. ��'�v •'L:.i ei.LwPa.rH n. CnTL& ENVOtONMENTAL ENGLNEERLNG • ENERGY CONSERVATION @ ANALYSIS T1{EODORE F. MOORE, P.E. 14530 ECHO ST. P11: (907) 345-1355 May 18, 2004 ANCHORAGE, ALASKA 99516 M.O.A. DSD P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: By means of this letter I am requesting issuance of a lot line waiver allowing the existing soil absorption system serving the 3 -bedroom residence on Lot 19, Block 3, Sand Lake S/D #2 to remain within 4 feet of the north property line instead of the normally required 10 -foot separation. An as -built lot survey as well as copies of the two affected soil absorption systems is enclosed. When the absorption system on Lot 19 was installed the engineer reported the separation distance to the north lot line as 10 feet, however a recent as -built survey shows the northeast monitor tube to actually be 6 feet from the lot line. The waiver request to 4 feet is to allow for possible underground projection of the trench a little closer to the lot line. Because only this end of the trench is close to the north lot line it will have little or no impact on the ability to construct replacement trench systems when needed on Lot 20. Therefore, I recommend that you grant the requested waiver. This same end of the trench is also reported as being 8.5 feet from the building foundation, instead of the normally required 10 feet. This separation distance was apparently approved at the time the system was installed and obviously hasn't caused any problem in the ensuing 22 years. Please give me a call if you have any questions on the requested waiver and/or IIAA certificate. Sincerely, Ted Moore, P.E. cc: Charlie Wilson Muni TAnchorage lgl(trk Begich, Magor Building Safety Dh ision PA. Dix M3650 ® 4700 I3rngaw Street Anchontgc, Alaslax 99519-6CZ0 ® 0307) 343-8301 9 FILM (907) 3 3•Ei`.'.t)t) It t tj>://��ztlr.tttun i.nr}; 5/26/2004 Flattop Technical Services 14530 Echo Street Anchorage, AK 99516 Subject: Waiver Request for Sand Lake 42 Block 3 Lot 19 Waiver Request #WR040031 Parcel ID #011-134.06 HAA 040205 Dear Mr. Moore: Your request for a waiver of the required 10 feet horizontal separation from the Field to Property Line has been approved. The approved separation distance is 4 feet. This waiver approval applies to the existing Field 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 343-7904. Sincerely, Jeff Poet Engineering Tech On -Site Water &: Wastewater Program *11�a2 o"P�aro�e � 3arCA�-0,-\ uvxd_a--o 0 ,_+ TO L4A f(f IGS ac'zC) Municipality of Anchorage Development Services Department • +� Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchoragc.ak'.us (907)343-7904 WR#: 040031 PID#:011-134-06 Date Received: 5/26/2004 Waiver Review Worksheet HA#:040205 Permit#: Legal Description: Sand Lake #2 Block 3 Lot 19 Engineer. Flattop Technical Services 14630 Echo Street Applicant: Charlie Wilson Waiver Requested: 4 Font tot Line Waiver separation distance from Field to Prooertv Line Criteria: Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Points: ..................,...//......................................................... 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