HomeMy WebLinkAboutSAND LAKE #2 BLK 6 LT 2and Lake #2
Block 6
Lot 2
#011-133-35
j Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water and Wastewater Program, 4700 S. Bragaw SL
P.O. Box 196650 Anchorage, AK 9951M650 Page I of
www.cLenchorage.ak.us (907) 343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SWO40442 PID Number. 011-133-35
N». Melodie Jackson
Wastewater System: l] New ❑ Upgrade
Addreaa:
site: 8223 Seaview Street, Anchorage
ABSORPTION FIELD
pha : raa.w r B.dioww: 3
M Daap Tm h 0 shadow Twch ❑sed ❑Mand ❑ower.
LEGAL DESCRIPTION
sa wmy
3.0
Tar Dwm aom aip.r pole
GPol to
8,7 F,.
Bias: 6 La: 2 siedbi.id.: Sand Lake #2
Dept to pipe baron, ft. orgnr pada:
Gnvr dapn b«wMope:
2.2 Ft.
5.33 Ft
iow.anq: Raps: fieann:
Fa addM above enpl..i arae,:
Gravel Lenpm:
1.2 Fr.
15.0 Ft.
Well: [3 New [I Upgrade
2.5
a.a.ea i
aeoxt� .FL
A
CMaamgbui (Fundi,. A B. Ck
Tar Depot:
caaed W.
Tar abeappon.ne:
Ppe Mand.
Class C well on Lot 1
Fl.
FL
160 Ft'
ASTM D 30341 PVC SCh 40
Di .
ate era:sox
waw �:
anode:
AK Trailblazing
al. a,raaw:
8182005
FL
trod.Purrpsrn:
DaaMHWhtAbo.eGraaia:
TANK
GPM
FL
FL
:9
SEPARATION DISTANCES
144v
Septic []Holding ❑ S.T.E.P. Q Other.
To
I Septic
AbsorptionLilt
Holding
ublePrtvate
adiYvr
r
From
Tank
Field
Station
Tank
Sewer Lkie
Anchorage Tank & Welding
1500 Gr.
W04
106
100.5
NA
NA
102
steel
Ma2.racarormnae.
si.rad.wrar
100+
100+
NA
NA
LIFT STATION
Latin
7
16
NA
NA
. NA Gal
mow. Orenco
Foundation
9
18
NA
NA
'Pro W kvei ac
•Pa err ievei at.
How.nr elrm.i.
timer In
timer In
timer in.
cunt. Dra.i
NANA
NA
NA
Pune Make a Abdar
OSI 30-05-11
Elaco.al ln.p.xxna pa~,00 by.
MOA
na.rrb:
BENCH MARK
Ldfiiun.nd D..apwrt
back porch
ex
100.00 FL
En ' mp
gyp. �P
49TH 9
Inspections performed b Cindy W. Ellis P.E. r 7/26/05
P Pe Y' Dates: 1
*' 1k
.
8/8/05
_
717
�—a--- y�
tun
Development Services Department Approval
Cl dy W. Ellis...!
Reviewed and approved by: Date: III
CE • tos77 3
Dir. txml ! _ !
sio.....,Q.
I 150' well radius for
Sand Lake #2,
Based upon a survey i L— Blk 6, Lot 24
by Jeff Gastaldi, LS -6091 100' well radius for
September 27, 2005 Sand Lake #2,
d Blk 6, Lot 1 Well radii were marked
1D I I prior to construction
r
5
N 90.00'00"E 135.00'
Sand Lake #2 Block 6 Lot 2
Record Drawing of Septic Upgrade
Melodic Jackson
Parcel ID 011-133-35
Permit No. SW040442
Cindy W. Ellis, RE
November 15, 2005
Scale 1 Inch = 20 It
AdvanTex
1500 gal steel tank
with AX -20
Watkins Engineering, Inc
P.O. Box 110443
Anchorage, Alaska 99511-0443
Phone: (907) 349-1851, Fax: (907) 349-1934
30'
AS -BUILT
Water Line
I B
I
4.2
1 32.0
/
11.3
1 34.3
B
20.1
I
o
32.9
CO/
MT
33.2
G&tYEL DRIVE 3 bedroom
MT
1
house10TH
0
0
b
0
PoRCII
\
FCOMH
\
A
ST1 I
\
N 90.00'00"E
135.00'
Sand Lake #2 Block 6 Lot 2
Record Drawing of Septic Upgrade
Melodic Jackson
Parcel ID 011-133-35
Permit No. SW040442
Cindy W. Ellis, RE
November 15, 2005
Scale 1 Inch = 20 It
AdvanTex
1500 gal steel tank
with AX -20
Watkins Engineering, Inc
P.O. Box 110443
Anchorage, Alaska 99511-0443
Phone: (907) 349-1851, Fax: (907) 349-1934
30'
AS -BUILT
A
I B
FCO
4.2
1 32.0
STI
11.3
1 34.3
M11
20.1
37.7
CO
32.9
20.8
MT
33.2
22.3
Sand Lake #2 Block 6 Lot 2
Record Drawing of Septic Upgrade
Melodic Jackson
Parcel ID 011-133-35
Permit No. SW040442
Cindy W. Ellis, RE
November 15, 2005
Scale 1 Inch = 20 It
AdvanTex
1500 gal steel tank
with AX -20
Watkins Engineering, Inc
P.O. Box 110443
Anchorage, Alaska 99511-0443
Phone: (907) 349-1851, Fax: (907) 349-1934
30'
AS -BUILT
FINAL GRADE
FCO ST1 98.48
98.50
98.46
��� _Zj�ADVANTEX MAN -
93.93 AX -20 POD HOLE
2' PVC
STEEL ADVANTEX TANK
93.34 1500 GALLON
a
N.T.S.
FINAL GRADE = 98.02 MT1 CO1
N NOTE:
ORIGINAL GRADE _
96.42-96.82
0 PIPE
FILTER FABRIC 94.97
SEWER ROCK
89.29
94.62 89.37
NOTE: 15.0
RELATIVE DEPTH OF
TEST HOLE = 80.82 TRENCH
NO WATER N.T.S.
AS -BUILT
Sand Lake #2, Blk 6, Lot 2
900000
OF A C ��44
Record Drawing of Septic Installation
oo �...••••.••••••..qs, p
Melodie JacksonP
ParceIID:011-133-35
Watkins Engineering, Inc.
9 g'
0
o,O 4 9 T —H
Permit No. SW040442
0•••••••••••••••••• D
` 6 / 0
D . CI1Y W. ELLIS : O
Vol- ••. E - 10577
�'x
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CInd110443;
Alaska 99511-0443
November 15,
November 15, 2005
No Scale
Phone: (907) 349-1851, Fax (907) 349-1934
000000
From +19078308507 Tue Nov 29 10:19:43 2005 Page 1 of 1
INSPECTION REPORT
MUNICIPALITY OF ANCHORAGE, BUILDING SAFETY DIVISION
4700 SOUTH BRAGAW
INSPECTION INFORMATION &HELP: 333-7902
INSPECTION: VOICE 343-8300 INSPECTION: FAX (907)249-7777 www.muni.orgBSD/Inspectlons.cfm
NAME: Waylor�Knudsen PERMIT#. X5619681
ui ;'rp
COMPANY: Electric,' Inc / �= INSPECT DATE: 11/30,2005 PM
PHONE #: 884-1144 PHONE #: 277-1431 PHONE #:
ADDRESS:3322.SEp�AIADR
LOTZBLOCKS� SUBDIVISION: TUnNAGAINHOMES GRID #: SW1526
dN
COMME-WS or DIRECTIONS
Please call 1/2 hour prior to meet.
TYPE OF INSPECTION: Service Electrical
COMMENTS: (FOR INSPECTOR USE ONLY)
PRINTED NAME r,) t `�*'-'/�-"� DATE:
Municipality of Anchorage
Development Services Department
• +� Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET
To: Watkins Engineering
Legal description: Sand Lake #2 Subdivision. Block 6. Lot 2
The attached paperwork has been reviewed and is being returned for the following reasons:
❑ Original signature or stamp missing on
❑ Calculation error in design. _
❑ Additional soils information needed.
❑ Water monitoring results inadequate.
❑ Discrepancy in information submitted.
❑ Topographic information missing or inadequate. _
® Incomplete; missing maintenance agreement signed by buyer
® Incomplete; missing total depth on Inspection Report; lift station information on
Inspection Report and COSA checklist
❑ Additional adequacy test information needed.
❑ Water sample unacceptable. _
❑ Measured/proposed distances/dimensions missing. _
❑ Locations of all soils, percolation and water monitoring tests not shown.
❑ Proposed system too deep for soils information submitted.
❑ Well log required. _
❑ Omission in narrative. _
❑ Insufficient fill over tank or field._
® Other. Please explain how FCO will be accessed.
Name of reviewer: Julie Makela. P.E.
Date: 11/17/2005
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
• ; MUNICIPALITYOFANCHORAGE
Development Services Department
Onsite 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
Initial
Date Issued: Oct 20, 2004
Expiration Date: Oct 20, 2005
Permit Number: SWO40442 Parcel ID: 011-133-35
Legal Description:SAND LAKE 112 SUBDIVISION BLOCK 6 LOT 2'
Design Engineer: 0855 Gayness Engineering Group, LTD
Owner Name: MELODIE JACKSON
Owner Address: 8223 SEAVIEW STREET
ANCHORAGE. A 99502 -
Site Address: 8223 SEAVIEW STREET
Lot Size: 6750 SO. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of.
❑✓ Disposal Field Q 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.
Date:
Issued By.N/,J,� Date: e zo
I1
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. SII - 1'.33 -66 Ser Permit Number
Property owner(s) MELODIF JACKSON Day phone 948-7000
Mailing address (1) 3705 ARRTIIC� BOULEVARD * ANCHORAAGE eu
4Q14g address (2) g � Ct -Utica -;x_ 4-11 Zip Code 99516
Legal description (Lot, Block & Sub'd.) LOT 2. BLOCK 6: SAND 1 AKF SUBDIVISION 12
Legal description (Section,
Lot Size
bg5b
Township &6Ran N/A
Acre Number of Bedrooms 3
THIS APPLICATION IS FOR:
Sewer Only Well Only ❑
Sewer and Well Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
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.
GARNESS ENGINEERING GROUP, Ltd.
Permit Fees:
Date of Payment: 1 U f �q /Oy��11
Receipt Number. rJ9�o�o�
Waiver Fees•
Date of Payment:
Receipt Number.
FRANK H. MURKOWSKI, GOVERNOR
555 Cordova St.
DEPT. OF ENVIRONMENTAL CONSERVATION Anchorage, AK 99501
Phone: (907)269-3076
Fax: (907) 269-7650
DIVISION OF ENVIRONMENTAL IIEALTH Sarah Rv hPdec state ak us
DRINKING WATER PROGRAM
h"p://www.state.ak.us/dec/deh/
October 12, 2004
Mr. Jeff Gamcss
Gamess Engineering Group
3701 E Tudor Road, Ste 101
Anchorage, Alaska 99507
Mr. Gamess:
File: Sand Lake S/D N2 Lots 2, 3, & 4 Blk 6
PWSID: proposed Class C
On October 7, 2004 this office received your submittal regarding your request for two 100 -foot
blanket separation distance requirements to both existing and proposed septic systems for a proposed
Class C well located on Lot 1 Block 6 Sand Lake S/D k2 and an existing Class C well located on Lot
21 Block 5 Sand Lake S/D #2. The proposed Class C well (located on Lot 1 Block 6) will be
converted from an existing private well. According to its well log, the depth is 256 feet below ground
surface (ft bgs), the static water level is 127 ft bgs, and the aquifer is confined by approximately 87
feet of clay. A well log was not included for the existing Class C well located on Lot 21 Block 5.
Other well logs in the area indicate well depths range from 243 to 500 ft bgs, static water levels range
from 113 to 140 ft bgs, and confining layers do exist above the aquifer. Water samples collected on
8/2/04 from both wells indicate neither coliform nor nitrates were detected. Based on the information
submitted, these two 100 -foot separation distance waivers are granted.
The ADEC recommends both quarterly coliform and annual nitrate sampling of both of these wells
based on the number of septic systems and increased development in the area as well as the number
of wells penetrating this aquifer.
Please also be aware that Class C wells are expected to be reclassified as private wells in the new
regulations package. This expected change will reduce the required separation distance from I50 feet
to 100 feet. Class C well registrations are still being accepted but without the associated fee, and will
be completed on a low -priority basis (the fee will be accepted if the registrations are reviewed).
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
St., Anchorage, Alaska 99501, within 15 days of the permit decision. Adjudicatory hearing
requests must be delivered to the Commissioner of the Department of Environmental Conservation,
410 Willoughby Avenue, Suite 303, Juneau, Alaska 99801, within 30 days of the permit decision. If
a hearing is not requested within 30 days, the right to appeal is waived.
L: Prirt,J un R: c�clod Pesti
Waiver Approval, Sand Lake N2 Class C wells
If you have any questions, please call me at 269-3076.
Thank you,
V
Sarah Rygh
Environmental Engineer Assistant
cc: Jamie Stain, ADEGEI ID W Program
ll:\Engineer_Correspondence\sr04 SandLake2Lots234Bk6 Waiver.doc
(1ARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS
October 1, 2004
Municipality of Anchorage
Development Service Department
Building Safety Division
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Proposed Septic System for Sand Lake Subdivision #2, Lot 2, Block 6,
To whom it may concern:
The proposed 3 bedroom house will be served by a community well and a private septic system.
One test hole was excavated on the property. The drainfield will be designed around the 30 foot
radius of this test hole. We are proposing that a new 1500 gallon Advatex system and a deep
trench type drainfield be installed. Comments regarding the design are summarized as follows:
1. SOILS: See the attached log which shows the soil classifications, groundwater monitoring,
and the percolation test results.
2. TRENCH DESIGN:
a. Percolation Rate: 2.5minutes/inch
b. Allowable Application Rate: 6.0 gallons/day/ft2
c Proposed Application Rate: 3.0 gallons/day/R2
d. Number of Bedrooms: 3
e. Design Flow: 450 gallons per day
E Minimum Absorption Area: 150 R2
g. Tota] Depth: 10 feet (max.)
h. Effective Depth: 5.feet
i. Width: 2.5 feet
j. Minimum Length: 15 feet long total
k. Effective absorption area = 150 R2
3. SURFACE WATERS: There are no surface waters within 100+ feet of the proposed septic
system.
3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507
Ph: (907) 337-6179 • Fax: (907) 338-3246 • Website: gamessengineering.com
4. TOPOGRAPHY: As can be seen on the attached design drawing, the average topography in
the area of the proposed drainfield is approximately 10-15% running northeast to southwest. In
short, there are no slope concerns.
5. WELL WAIVER: We have requested from A.D.E.C., a 100 foot well waiver from the
proposed class "C" well on Lot 1, Block 6, to the proposed drainfield on Lot 2, Block 6. Copies
of this requested waiver will be provided to you as soon as we obtain it.
I am unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact us at 337-6179. Thank you for your
assistance.
I.S.
NOTE: Attached is a site plan drawing, a design drawing, a topography site plan, a soils log,
and a 7 page construction specification letter which are all part of the design package for this
septic system.
3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507
Ph: (907) 337-6179 • Fax: (907) 338-3246 • Website: gamessengineering.com
♦^
• LOT N. RC
SND LAKE 2
LOT 11. BLOCK 7: �• • • / / i SAND(LAKE S�/D %2
SKID LAKE OS/DCK 32
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WEST 82ND AVENUE
IXISTING PRIVATE WELL 1
TO BE CONVERTED TO A
CLASS 'C' WELL AND
SERVE LOTS 1, 2, 3, h / I
4 BLOCK 6
I ),a.
W I
PROPOSED WATER I l I
C LINE LOCATION
C � �
INSTALL ALTERNATE /
FOUNDATION / 10'+
CLEANOUT SITE �/ �
W PROPOSED / ; 1L j1 INSTALL
Li3 BEDROOM , DOUBLE
ry :,":. •'. HOUSE / I 1 100 CLEANOUTS
a I
LL) �-1C
A TRENCHOTHAT IS 10 FEET DEEP
\ \ / PROPOSED 15(10 MAX. BY 2.5 FEET DEEP BY 13
Q CALLON ADVANTIX\ FEET LONG ADD 5 FEET OF CLEAN I
w / WASHED SEWER ORAINROCK. I
U)
100' WELL RADIUS FROM
WELL ON LOT 21, BLOCK 5, NOTE: THE NORTH, SOUTH,
SAND LAKE S/D j2 AND EAST LOT LINES, AND
ALL SHOWN WELL RADII SHALL
BE FLAGGED BY A REGISTERED
LAND SURVEYOR PRIOR TO
CONSTRU ON
DATE:
10/01/2004
DRAWN BY: p .(� •..... �/�4�
GARNESS ENGINEERING GROUP, Ltd.R.A,L. !
�7'•
CONSULTANTS d GENERAL CONTRACTORS SALE: vJ'A ,
—
3701 E. T1p09 POGO. SUITE 101 • eNCuOPeGE. AK 99507 • MOeE (00))131fi1)9 • FAX (907)358.32L61 30 .......... ....... .......... — 0
PREPARED FOR: PHONE NUMBER: PACE NUMBER:
MELODIE JACKSON (907) 248-7000 2 OF 4 le A Gar ss.- O
LEGAL DESCRIPTION: Qp ° —79 eQQ
SAND LAKE SUBDIVISION #2; LOT 2, BLOCK 6,
TYPE OF WORK: 4° �
DESIGN FOR PROPOSED WELL CONECTION AND SEPTIC SYSTEM 'go, ro.T.e<°.so�' S
lAdvanTex Treatment System
AX Series -Mode 1 a o
One (1) 40x96 Pod
INLET�
6" JIM CAP
-TYP.2)�
FINAL GRADE
6" PVC PUMP—OUT
(TYP.2) —�,,
u
1500 GALLON
STEEL ADVANTEX
TANK
AX20 POD
10/01/2(
WN BY:
GARNESS ENGINEERING GROUP, Ltd. R.A.L.
� CONSULTANTS I GENERAL CONTRACTORSSCALE:
3701 E. TUDOR ROAD. SUITE 101 • ANCHORAGE. AK 99507 • PHONE (907)337-0179 • FAX (907)336-3146 N.T.S.
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
MELODIE JACKSON (907) 248-7000 3 OF 4
EGL DESCRIPTION:
SAND. LAKE SUBDIVISION #2; LOT 2, BLOCK 6,
IYPE OF WORK:
PROFILE DRAWING OF PROPOSED 1500 GALLON ADVANTEX TANK
NOTE: THE BOARD INSULATION TO BE
INSTALLED OVER THE SEPTIC TANK do 4'
BEYOND ON ALL SIDES EXCEPT UNDER
THE ADVANTEX FILTER. THIS WILL ALLOW
FOR HEAT TO ESCAPE FROM TANK do
RISE TO THE FILTER ARM/F 7T
FROM TANK
TO POD
DISCHARGE
FILTRATE
30 INCH
INSULATED
11
-ORENCO
BIOTUBE
SCREENED
VAULT
EFFLUENT
PUMP
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS b GENERAL CONTRACTORS
701 L lYOgt Moo. RM 101 ' M1G10•IOL MC 119507 • 9110.4 90 )-!1)11 • FK 1907 32445 • YF85fIL yan,Mq,ywYpcwn
SOIL LOG — PERCOLATION TEST
LEGAL DESCRIPTION: -. SAND LAKE SUBDIVISION /2: LOT 2, BLOCK 6.
PERFORMED FOR: MELODY JACKSON DATE: 9/9/2004
DEPTH =_
(feet) TEST HOLE #1
1=�= ORGANCS
2
5
6
==ff
DRY
SOIL
CLASSIFICATIONS
9/20/2004
CL
OL
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15 •' ••••
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17
18
DEPTH TO
GROUNDWATER
DATE
DRY
9/9/2004
DRY
9/20/2004
9/10/2004
1
9:25
-
vhlY►xl
J ff A. G ness.
f es slot`o� c�
DATE
READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
9/10/2004
1
9:25
-
6'
_
2
9:35
10
1 318-
4 1/8-
8'3
3
9:35
-
6•
-
4
9:45
10
1 318-
4 1/8"
5
9:46
-
6•
-
6
9:56
10
1 15/16"
4 1/16-
16'7
7
9:56
-
6•
-
8
10:06
10
2'
4'
9
10:07
-
6'
-
10
10:17
10
2'
4'
11
10:17
-
6'
_
12
10:27
10
2'
4'
19� PERCOLATION RATE 2.5 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 6.0 FT. AND 7.0 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: 0 YES NO
SOILS LOGGED BY: SUSAN OSWALT PERCOLATION TEST PERFORMED BY: SUSAN OSWALT
COMMENTS:
PERFORMED BY GEG, Ltd. I, JEFFREY A GARNESS, CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 9/20/2004
MUNICIPALITY.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. 011-133-35
1. GENERAL INFORMATION
Expiration Date: - a,,/)
Complete legal description Sand Lake Sub #2, Block 6, Lot 2
Location (site address) 8223 Seaview Street
Current property owner(s) Trent Merritt Day phone (907) 947-8870
Mailing address 8223 Seaview St, Anchorage, AK 99502
Real estate agent Day phone
2. TYPE OF DWELLING:
Q Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
❑
Private Septic
0
Water Storage
❑
Holding Tank
❑
Community Well
❑®
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for:
Distance:
Received by:
Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 550
Date of Payment 6�.5Az1
Receipt Number.
COSA# 05C al 3),1
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Forge Engineering Phone (907) 522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503
Engineer's Printed Name Benjamin Schiller Date 6/14/21
� TH
6. DSD SIGNATURE"
Y System #1 Approved for bedrooms .44 g
entam 5chl ler
System #2 Approved for bedrooms CE 12592 low®
Disapproved
Conditional approval for bedrooms, with the following stipulations:
l
CBy: 9Original Certificate Date: tv a2 C} of
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description:
Sand Lake Sub #2, Block 6 Lot 2
If more than 1 septic system on lot: COSA Checklist # of
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
Parcel ID: 011-133-35
Structure served by this system
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic 82.7 ug/L ❑ Arsenic less than MRL (ND)
Collected by Forge Engineering
Date of Sample 6/7/21
Static water level at beginning of test ft.
Comments well (previously labeled as "Class C") is on neighboring Lot 1 and shared by agreement
B. TANK DATA
Age of tank(s) 16 years
Tank type/material Advantex/Steel
Measured operating fluid level in septic tank n/a
®❑ Standpipes/foundation cleanout per record drawing
Date of pumping
D. ABSORPTION FIELD DATA Deep Trench
Which system tested (date installed) 8/8/05
❑® ALL standpipes present per record drawing
Total measured depth from grade 8.4 ft (max)
Measured depth to pipe invert from grade 3.2 ft (min)
❑ N/A — pressurized field
Fm -1 Monitor tubes go to bottom of effective. If not, state
depth into effective
❑® Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
C. LIFT STATION
ON Required maintenance completed
Age of lift station 16 years
Lift station material
Comments:
Adequacy test date 6/1/21
Results Z Pass For 3 bedrooms
Fluid depth prior to test 2 in
Water added 509 gal
New depth 8.5 in
Elapsed time 1440 min
Final fluid depth 2 in
Absorption rate >450 gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
E. SEPARATION DISTANCES
From Prr ell on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on
100'
Yes
Community Sewer Manhole/Cleanout > 100'
ft
Wells on Adjacent Lots:
if No ft
❑ Yes
if No ft
Neighboring Tank > 100'
❑ Yes
if No
Private Sewer/Septic Line > 25' ❑ Yes
if No ft
Absorption Field on Lot > 100'
❑ Yes
if No ft
Hol i k > 100' ❑ Yes
if No ft
Neighboring Absorption Fields
> 100'
if No
Animal Containment > ❑ Yes
if No ft
❑ Yes
if No ft
Manure/Animal Excreta Storage > 100
Community Sewer Main > 75'
❑ Yes
if No ft
❑ Yes
if No t
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'✓0 Yes if No ft Surface Water > 100' ❑✓ Yes if No ft
Property Line > 5'
❑✓
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
✓❑
Yes
if No
ft
Private Wells > 100' 0 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 ft If absorption field is under driveway comment below
Property Line > 10'
❑
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'✓❑
Yes
if No
ft
Private Wells > 100' ❑✓ Yes if No
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
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.
COSA Checklist yellow sheet
SOF �����
49
• ` � Benja4rie5chiller t'
�� ?'F��•. CE 12592.•�_O w
'�lF' • 6/14/21 . •'�G�,r
PROFESSOkNP
ft
ft
ft
ft
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904
On‐Site Water and Wastewater Section Fax: 343‐7997
www.muni.org/onsite
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org
Arsenic Advisory
Certificate of On‐Site Systems Approval # OSC211327
Subdivision: Sand Lake #2, Block: 6, Lot: 2
A water sample revealed an arsenic concentration of 82.7 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.
05/0612021 16:19 Ant horage Tank
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/annual Ins :)ectien
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8223 Seavievi IS reet, Anchorage AK: 99502
Ax Sh IV 11 CnJ'Ay ID �
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i.'omtllEttTS _ —
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Larry Betts
P.0011001
AncherageTank
907-272-3543
�,nnt ct Ptmno
(907) 947-T774
Fod R F N I/UL A Dee :A I.Nrt In9:p6d n
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Inspect
inspect
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f=loats
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Inspect Clean In7woct Ciesn
DIsinTctticn Equlpmc It "V,. l`'' Di.tScrasl Laterals/Oeific'es/
obse*valien---; -^------.....-_---------- .------------------ --------
Additiongi Sewvices ri- d
(� Circned tcxtil Sr eetn� (-- Rcpittea:r UV !terra?
i j RcG!ecedJU3-8rd Utller Items?
ftris Used; I'M -- WMtrn'ry, R (V aPPMR11 tic. se10Cti4ITj
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t' T*3r+itold reconnected; IRr7t+ elves 1-10MW fff ;nntrot lkrn,! re]ciEvr I -td
auTi- nar3/Racorn menda#ions
n Sysl:err perfottr,irtg; no tur;hrr sedan rt+>e.tec! L__ TE1nK tze!:ds pum{r,i:is1
I Ceti for 4f,nilno !- fTtrhrr9
Date.,
Fax>sompiated form. to 1-866-384-404
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this Day of ' A u m c of 20 i , by and between
arc via y i ctm e c herein the "OWNER," and the Municipality of
Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code
(AMC) 15.65.365. in consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as Advantex
located at (legal description)
Sand Lake #2 Block 6 Lot 2
2. Maintenance, Repairs and Alterations.
(Owner is requirdto read, understand and initial each section)
Throughout the term of this Agreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative, The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
It shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically $400 to $600).
Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018) Page 1 of 3
Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 14.60.030.
Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendor/installer and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owner's AWWTS.
Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska sball govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018) Page 2 of 3
o R:
By: ti (signature) Date:
--� (print name)
STATE OF ALASKA )
ss.
THIRD JUDICIAL DISTRICT )
The forego: g irfstrume t was-ackngwledged before me this
20,21 , bye,-�' c SA c'
�fUv
N TA LIC' FOR ALASKA
My Commission expires: 1 V
MUNICIPALITY:
1
By:
at/N- vu signature)
Rebe- cc.C-1-a) rr& (print name)
I C.I day of c}-7,n—
Off-
,
Date: to /20a T
Title:
(rev. 05/18/2018) Page 3 of 3
"W10cial Seal"
`=c;l
Notary Public
Cnmm,zsfon
Lakiesha Pleasant
ate,Of Alaska
m,,,
wires 77/13/2023
Date: to /20a T
Title:
(rev. 05/18/2018) Page 3 of 3
• Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
Certificate of On -Site Systems Approval
Parcel 1. D. 011-133-35
1. GENERAL INFORMATION
SESSAWITTAL
WAY 2 15
S_
��{y
NGq
lam` er
liq T
Expiration Date: 3 '-,2- (0 " X
Complete legal description Sand Lake #2, Block 6, Lot 2
Location (site address) 8223 Seaview St
Current Property owner(s) Richard and Annie Mack Day phone
Mailing address 3223 Seaview St Anchorage, AK 99502
Real Estate Agent Day phone
2. TYPE OF DWELLING:
I] Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual
El
Individual Water Storage
❑
Holding Tank
❑
Community Class C Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance
Received by: 1 VIJI/✓`� Date:
COSA to be released to the 4neer, unless otherwise requested by the engineer.
COSA Fee $ 5240- Waiver Fee $ _
Date of Payment 5AI115 Date of Payment
Receipt Number 00117 14 Receipt Number
COSA# d5G 151231 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.
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.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone
6. DSD SIG ATURE
System #1 Approved for —3— bedrooms
System #2 Approved for bedrooms
Disapproved
Date 04/29/2015
e #2. Jnr e e t
CE -8149 .-:9;:
Conditional approval for bedrooms, with the following stipulations:
By: iljoOriginal Certificate Date:
The �rp,,!,enge Development Services Division (DSD) issues Certificates of Onsite Systems Approval (COSA) based only
upon thgivenin paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet < '- ]. c
If more than 1 septic system is on the lot:
COSAChecklist# + of 1
Structure served by this system I
Certificate of On -Site Systems Approval Checklist
Legal Description: Sand Lake #2, Block 6, Lot 2 Parcel ID: 011.-133-35
A. WELL DATA
Well type Class 'C'
Date completed
Total depth ft.
Date of test
Static water level
Well production
If A, B, or C provide PWSID #.
Sanitary seal (YIN)
Cased to ft.
FROM WELL LOG
ft.
am
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground) in.
AT INSPECTION
ft.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate�204 mg/L
t12� 20
Arsenic $� • S ug/L Date of sample: ! L Collected by: P e S
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Advantex/Steel
Tank size 1500_ gal. Number of Compartments 2
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N
Date of pumping
Pumper
Date installed 08/08/2005
Cleanouts (Y/N) Y
High water alarm (YIN) N
C. ABSORPTION FIELD DATA
Date installed 08/08/2005 Soil rating3.0 g.p.dJsgft Deep Trench
(g.p.d./ftz or ftz/bdrm) System type
Length 15 ft. Width 2.5 - ft. Gravel below pipe 5.3 ft.
Total depth 8.3 ft. Eff. absorption area 150 ft Monitoring tube Y Depression over field N
Date of adequacy test 04/28/2015 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 489 gal. New depth 5 in.
Elapsed Time: 1 10 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date
D. LIFT STATION
Date installed
Size in gallons
Manhole/Access (YIN)
"Pump on" level at in.
"Pump ofr' level at
in. High water alarm level at in,
Datum
Cycles tested
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
WELL ON -LOT TO:
Septic tank/lift station on lot
On adjacent lots
Absorption field on lot
On adjacent lots
Public sewer main
Public sewer manhole/cleanout
Sewer /septic service line
Holding tank
Animal containment areas
Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+
Property line 5+
Absorption field 5+
Water main 10+
Water service line.
10+ 100+
Surface water
100+
�. ---�--
Wells on adjacent lots
ABSORPTION FIELD ON LOT TO:
Property line 10+
Building foundation 10+ Water main 10+
WaterService line 1.0+
Surface water 100+
- Driveway,-parking/vehiclestorage 10+
Curtain drain 50+
Wells on adjacent lots
100+
F. COMMENTS
As -Built on file
Field Clean out had 1" of sludge sifting. in pipe prior to test
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and T
review of Municipal records that the above systems are in- * '
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Steven R. Pannone ":§}even l lSorinuris•
Date�
04/29/2015 CE 8'149
COSA canary sheet -2-6-1 5.doc
Municipality of Anchorage c"GE
Community Development Department =T: ft-a�,
Development Services Division s'a ` E'r;
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 # 151231
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 6, Lot 2 of
Sand Lake #2 Subdivision. This inspection revealed an arsenic concentration
of 81.8 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.
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ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
BETWEEN MUNICIPALITY OF ANCHORAGE
ANDJCP A MQ d- � 0%v\,a M[ 6Ck
THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this
Day of of 204T by and betweenTg,;i PAe Mqi + MC�Jn
herein the "OWNER,/and the Municipality of Anchorage, herein the
"MUNICIPALITY." In consideration of the mutual covenants contained herein, the
parties to this Maintenance and Repair Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. Municipality grants permission to
Owner to utilize and operate an Advanced Wastewater Treatment System
(AWWTS), described as
& AX -aa
located at (legal description).
SaMd uak2 # 2 , g1k G i l.ot -2-
2.
2. Definitions.
Alteration. Any change to the design or function of an AWWTS that
includes the installation or removal of any parts, components or pieces not
included in the original construction permit and design.
Certificate of On -Site Systems Approval (COSA). An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with Anchorage
Municipal Code (hereinafter, "AMC') 15.65. These approvals certify that
the systems are adequate for the homes that they support and meet the
codes that were in place at the time of system construction.
Damage. Any man-made or natural change in a system that would inhibit
the system from performing as designed.
Maintenance and Repair. The scheduled and as needed replacement of
existing parts, components and pieces of an AWWTS that were included
in the original design which would allow the AWWTS to continue to
perform as designed.
Permit. An On -Site Wastewater Disposal Permit as required by AMC
15.65 to construct and operate an AWWTS.
3. Term. The term of this Maintenance and Repair Agreement shall begin on the
date of approval by the Municipality to operate the installed system or issuance of a
COSA, and shall continue while the AWWTS is in use or is operational or until the
property is sold or title is transferred by the owner and a new COSA is issued to the
new owner or transferee of the property.
4. Alterations. Installation and Removal of Additional Equipment. Prior to
performing any alterations to an AWWTS, the owner agrees to obtain an On-site
Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65.
5. Maintenance and Repairs.
A. Throughout the term of this Maintenance and Repair Agreement, the Owner shall
maintain their AWWTS in a satisfactory condition capable of producing treated
septic effluent in accordance with the equipment's approval for operation in the
Municipality. The owner shall enter into a service agreement with an AWWTS
service and maintenance provider approved by the municipality and the
manufacturer of the AWWTS for the entire term of the AWWTS. In addition, it
shall be the responsibility of the Owner during the term of this Maintenance and
Repair Agreement, and any renewals thereof, at the owner's sole expense, to pay
for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement
costs, and (5) inspection costs.
B. Owner agrees to comply with all applicable ordinance, laws, regulations, rules
and orders for the AWWTS.
C. Upon request by the Municipality, the owner agrees to provide the Municipality a
written schedule of routine maintenance and repairs which have been performed
on the system. When a record of maintenance is documented and maintained by
the system vendor, the owner agrees to allow the Municipality access to this
information.
D. Owner acknowledges that the fine for failing to maintain and repair an AWWTS
may be assessed in accordance with AMC 14.60 for improper discharge.
E. Owner agrees that only maintenance and repair personnel approved by the
Municipality will inspect and make any necessary maintenance, repairs or
permitted alterations to the system.
F. Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS upon 24 hours written notice.
G. Owner agrees that any sale or transfer of title of the property will not occur
without a new Certificate of On -Site Systems Approval.
H. Owner agrees that the AWWTS installation and maintenance requirements as
provided by the AWWTS vendor/installer and approved by the Municipality are
the governing guidelines for the construction, maintenance and repair of the
Owner's AWWTS.
I. Owner agrees to provide and maintain a telephone connection to the AWWTS as
required by the AWWTS approval.
6. Nonwaiver. The failure of either parry at any time to enforce a provision of this
Maintenance and Repair Agreement shall in no way constitute a waiver of the
provisions, nor in any way affect the validity of the Maintenance and Repair
Agreement or any part hereof, or the right of such party thereafter to enforce each and
every provision hereof.
7. Amendment.
A. This Maintenance and Repair Agreement shall only be amended, modified or
changed by a writing, executed by authorized representatives of the parties, with
the same formality that this Maintenance and Repair Agreement was executed
with, and such writing shall be attached to this Maintenance and Repair
Agreement as an amendment.
B. For the purposes of any amendment modification or change to the terms and
conditions of this agreement, the only authorized representatives of the parties
are:
a. Owner:
b. Municipality: Director, Community Development or designated authority
C. Any attempt to amend, modify, or change this contract by either an unauthorized
representative or unauthorized means shall be void.
8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance
and Repair Agreement shall be brought in the Superior Court for the Third Judicial
District of the State of Alaska at Anchorage. The laws of the State of Alaska shall
govern the rights and obligations of the parties under this Maintenance and Repair
Agreement.
9. Severability. Any provisions of this Maintenance and Repair Agreement decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining
provisions of the Maintenance and Repair Agreement.
OWNER:
By: V► W/+,r (Cftignature)
IRM Merl -ti k Wtjo. tAg0A (print name)
STATE OF ALASKA )
) ss.
THIRD JUDICIAL DISTRICT )
Date: 19
Atc-lkl u u6e�,q
/VUOk 111461zlI
The foregoing instrument was acknowledged before me this ! Ixyy+.
MO 4
20�C, by : �QC4N ...... 44 ry r
TA*zz tq;.- PAY
PBLIChOR ALASKA y ; / "V x;
&V
My Commission expires: Q�
�� P
P•
M ��Nti960 �►.@ as
MUNICIPALITY:
By: (signature) Date:
name) Title:
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onshe
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 011-133-35
1. GENERAL INFORMATION
HAA# 050CPIa
Expiration Date:
Complete legal description Sand Lake #2, Block 6, Lot 2
Location (site address or directions) 8223 Seaview Street, Anchorage
Current Property owner(s) Melodie Jackson Day phone
Mailing address
Lending agency Day phone
Mailing address
Real Estate Agent Christy Rush / Prudential Day phone 441.6202
Mailing Address 3801 Centerpoint Drive, Suite 200, Anchorage, AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well ❑
Individual Water Storage ❑
Community Class C Well Q
Public Water System ❑
Individual On-site
0
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given In paragraph 4 by an Independent professional civil
engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water 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 Watkins Engineering, Inc. Phone 349-1851
Address P.O. Box 110443, Anchorage, AK 99511-0443
Engineer's Printed Name Cindy W. Ellis Date
5. DSD SIGNATURE
—1L Approved for bedrooms.
Disapproved.
11-17-05
Conditional approval for bedrooms, with the following
Additional Comments
i Y OF,
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X Maintenance Agreements
Supplemental Engineer's Report
Other
KAM
� �, . oma � � � E
(Pev 01M)
Original Certificate Date:
Municipality of Anchorage
• ~" Development Services Department
Building Safety Division
On -Site Water 6 Wastewater Program
4700 South Bragaw St.
P.O. Box 196550 Anchorage, AK 995196650
www.muni.org/onsite
(907) 343.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Send fake #2 Block 6, Lot 2 Parcel ID: 011-133.35
A. WELL DATA
wen type C
Date completed
Total depth ft.
Date of test
Static water level
Well production/
If A, S, or C provide PWSID # _
Sanitary seal (Y/N)_
Cased to ft.
FROM WELL LOG
WATER SAMPLE RESULTS:
ColUorm o colonies/100 mi.
Arsenic: NA mg.A.
B. SEPTIC/HOLDING TANK DATA
ft.
9.p.m.
Nitrate 0 mgA.
Date of sample: 77H0w
Tank Type/Material steel AdvanTex
Tank size 1500 gal. Number of Compartments 2
Well Log (Y/N).l
Wines properly protected (Y/N)
(above ground) in.
AT INSPECTION
ft.
g.p.m.
Omer bacteria 0 oolonies/100 mi.
Collected by: Rocky Trainor
Date Installed 618/05
Cleancuts (Y/N) Y
Foundation deanout (Y/N) Y Depression over tank (YM) N High water alarm (Y/N) Y
Date of pumping NA - new Pumper NA
C. ABSORPTION FIELD DATA
Date installed 8/6/05
Length 15 ft.
Son rating (g.p.dAY or fe/bdnn) 3_0
Width 2.5
ft.
Total depth 8.7 ft. Eft. absorption area 160 ftr Monitoring tube Y
Date of adequacy test NA - new Results (Pass/Fall)
Fluid depth in absorption field before test _ In.
Elapsed Time: _ min.
_ in.
Any rejuvenation treaypenY(past 12 mo.) (Y/N &type)
System type deep trench
Gravel below pipe 5.33 ft.
Depression over field N
7"r71M "M
gal. New depth_ in.
Absorption rate >= g.p.d.
If yes, give date
D. LIFT STATION
Date installed NA
'Pump on' level at _ in.
Datum /
E. SEPARATION DISTANCES
Size In gallons
Cycles tested
at In.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot NA
Absorption field on lot
Public sewer main
Sewer /septic servicg.Ane_---�
Manhole/Access (Y/N) _
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots
IM
Public sewer manhole/deanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 9
Water main 75
Wells on adjacent lots 100+
Property line 7 Absorption field 5
Water service line 50 Surface water 100+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property fine 18 Building foundation 18 Water main 80
Water Service fine 50 Surface water 100+ may, parldrUNshide storage B5
Curtain drain NA Wells on adjacent lots 100+
F. COMMENTS
Waiver to 100 ft to Class C well on Lot 1.
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and'fir 4 9
review of Municipal records that the above systems are in `
conformance with MOA HAA guidelines in effect on this date.
Engineers Printed Name Cindy W. Ellis ~' Ci dy W. EIAs
CE. roan
Date_
HAA Fee $ 67 � r y0
Date of Payment _ j T-,i�OJ
Receipt Number 7 304
(Rev. 17/01)
Waiver Fee $
Date of Payment
Receipt Number
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