HomeMy WebLinkAboutSAND LAKE #2 BLK 2 LT 17Sc►nd Lake #2
Block 2
Lot 17
#011-133-08
Municipality of Anchorage Page I of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 as Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number. SwgAn, d5 PID Number. - Milling
Name:
Wastewater System: 0 New G Upgrade
Michael A. Swanson
Adoress: 8116 Wilcox St Anch., AIC 99502
ABSORPTION FIELD
Phone. 243-6630 No. or Bedrooms:
1§ Oeep Tmncn C Shallow Trench C Bed C Mound ❑Other
LEGAL DESCRIPTION
Soil Rating:
Total Deoth from original grace:
Gp rs Ft.
'
Lot Block: Subdivision,
17 2 Sand Lake $2
Death to pipe bottom from ongin+l grade:
Gravel aeon beneath pipe
1
1 Ft
7' ct.
Township: Range:I Section:
Fill added above anginal grade:
Gravel umgm:
0 ct
'
41' Ft.
WELL: C New 0 Upgrade
Gravel width:,
Number of lines
F
giuTtlem v es
3 F.
1
Ft.
Cfasamcation (Prnals. A.B.CI: Total Depth:
Case* To:
I
Total aosorption area:
Pipe matanaf:
C Ft.
I
FL
SO Ft,
034. PV
Onner.
Oat* Dnuec:
Slane water Levert.
Installer.
Date installed:
FL
Acreage System
6/9,10/98
Y191c;Pump
Set at CaungmorgntAbowGround.*
TANK - Existing
GPM
fl. RL
SEPARATION DISTANCES
aseptic CHolding 0S.T.EP.
To
Swag I
Atnoretion I
Un I
me"
a
Manufacturer. Capacity In gallons:
From
Tanta
Raid
Station
Tame I
so w uiws
Well
>1001
>100
N/A I
N/A
>101
Matched Number of Compartments
Surface
>100
>100I
N/A
I N/A
I N/A
LIFT STATION- N/A
Water
Lot
Line
j[>5'
S'
N/A
N/A
>10'
Size in gallons: Manufacturer.
Foundation
>51
1
>10
N/A
N/A
I N/A
"Pump on" Wel bee -pump ofr level at
Nign water atann at
Curtain
Pump Make 1 florist Electrical Inspeenons penormed W.
Drain
None
on Lo
(
Remarks: New Absorption Trench Placed
BENCH MARK
Under This Permit.
Loabon+ndoescnpuon: Bottom Step North Side
Lot Line Waivers Issued for
of Deck.
New Trench. Septic Tank Verified
Assumed e«.twn 100
e.
for Continued Use.
ENGINEER'S SEAL
,fir. u�y _I'
�;' /
/*; 49TH */
Inspections performed by: MFA Dates: 1st r/4/9A
�%i;� L �. f
2nd -6/10198
/ MICHAEL E .A�DEfiSON ;� 00
� rte,•
i
rid H man S rvtc
�9B
4381•Eepa
ReviDew d cad pprovmentoed byealt
DatePprL /y
;2-0Ip ink 9.911 MOA 23
Municipality of AYich&age Page _7 o_3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number. SW980145 PID Number. 01111108
100.0
e
C5
150'
+I
f
r �,t9TH f�
f1 �;�. F,1iDIiA.�1. E. AIiD�SOti :�
438i-E
Three Bedroom Home
Existing Trench
A B
FS 50.6 ff497
C2 50.8
IT
59.0
C4
65.0
CS
48.7
100' Bad<
Exi3"t:ing0
hm Lot 1
Gallon Sep is
Tank
0
C Diverter VlveC3 1
IT I C4
41' Long X 7' Effecti
Utility Easement NOTE: Diverter,
\ New Absorption;T
Under This Permi
PLAN AS -BUILT
SCALE 1" = 10'
Depth
ve and
ch Placed
Municipality of Anchorage Page —I of'_
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number. GWg8A145 PID Number. 01113308
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PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW980145 DATE ISSUED: 6/02/98
DESIGN ENGINEER:ANDERSON ENGINEERING EXPIRATION DATE: 6/02/99
OWNER R SWANSON MICHAEL A
ADD
OWNER ADDRESS:8116 WILCOX ST c7.
ANCHORAGE, ALASKA 99502
PARCEL ID:01113308
LEGAL DESCRIPTION:
SAND LAKE #2 BLK 2 IT 17
LOT SIZE: 6750 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY: 717-111t, y`1�.�/1. DATE: G � l t
ISSUED BY��M.✓t/1 a / ✓"' :( DATE: 6- 2 -?8
T MunicipecdR T of Anchorage
Department of Health and Human Services
825 V Street
Rick Mystrom,• P.O. Box 196650 Anchorage, Alaska 99519-6650
Mayor
http://www.ci.anchorage.ak.us
June 2, 1998
Michael E. Anderson, P.E.
Anderson Engineering
PO Box 240773
Anchorage, Alaska 99524
Subject: Waiver Request for Lot 17 Block 2 Sand Lake 02
Waiver Request OWR980023, PID 0011-133-08, SW980145
Dear Mr. Anderson:
Your request for a waiver of the required 10 foot separation
between an on-site wastewater disposal system and a lot line has
been approved. The waived distance is 5 foot from the southern lot
line and 5 feet from the northern lot line.
This approval applies to the existing on-site wastewater disposal
system lot line separation only. Any future upgrade to the on-site
wastewater disposal system will require all separations be met or
another approval from this department.
If there any further questions or concerns regarding this waiver,
please call our office at 343-4744.
Sincerely,
5=. /r.
Daniel J. Roth
Civil Engineer
On-site Services
ljw 07
n n
• MUNICIPALITY OF ANCHORAGL
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet 1
WR# WR980023 PID# 011-133-08 HA# Permit #
Date Received: Juen 1, 1998
Legal Description: Lot 17 Block 2 Sand Lake #2
Engineer: Michael E. Anderson, P.E., Anderson Engineering
PO Box 240773 Anchoraee. Alaska 99524
Applicant: Michael A. Swanson
Waiver Requested: Lot line waiver of 5 foot of the southern lot line: 5 feet
of the northern lot line.
Criteria: 1. Geology: Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
2. Special Conditions:
3. Other:
Waiver is Granted: X Waiver is NOT Granted:
List Conditions or Reasons for above: SES ZKre-A
OF 7u5i/F/Cj47-/OA/.
Date: l -2 -98 By: 04AI
Name of Reviewer
Rec #: 03870 Amount: $ 115.00 Date Paid: June 1, 1998
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
5 563-5389
May 31, 1998
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject: Lot 17, Block 2, Sand Lake Subdivision No. 2
Lot Line Waiver Request
Dear On Site Services Engineer:
The existing absorption trench on Lot 17, Block 2, Sand Lake Subdivision No. 2 has failed and
must be replaced immediately. The attachedSite Plan shows the location of the new absorption
trench to be constructed on the subject lot. Due to the small size of the lot and the conflicting 100'
and 150' radii from adjacent wells it is necessary to encroach within 10' of both the northern and
southern lot lines. We are therefore requesting lot line waivers be issued allowing this
encroachment.
Lots in this subdivision are only 50' wide. Underlying soils have an absorption rate of .8 gallons
per square foot per day and consist of fairly clean silty sand. The effective depth of the designed
trench on this lot was 6.0'. With the 4.5' for placement of the distribution piping and the depth for
cover over the trench the total depth was 10.5'. The total length of the trench will be 47'.Since the
width of the lot is only 50' the trench will encroach within 10' from each lot line. No room
remains on the lot to reconfigure the trench to allow greater lot line clearance and maintain
separation from the existing trench.
Soils on the lot are very good for an onsite system. The subdivision is served by a community
well. Other wells in the area show no sign of nitrate content and none is found in the well serving
this lot. Placing the absorption trench within I' of the line will have no adverse impact on systems
currently in place or to be placed in the future. We therefore recommend a waiver be issued to
allow construction of the absorption trench to within /' of the southern lot line and ;t of the
northern lot line. 5 J s'
Please let me know if you have additional questions.
Sincerely,
Michael E. Anderson, P.E.
MICH.IEL E. hKDE'ir „0N ;.
4391-E * - i
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 FAX)
May 31, 1998
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject: Lot 17, Block 2, Sand Lake Subdivision No. 2
Septic System Design
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The absorption trench on Lot 17, Block 2, Sand Lake Subdivision No. 2 has
failed and is backing septic effluent into the house. An emergency upgrade
is necessary to prevent damage to property and eliminate a health hazard.
We are therefore applying for a permit to upgrade the system. The
attached site plan and backup documentation identify the size and location
of the new absorpiton trench to serve the home.
Unfortunately the lot is extremely small with very little room for a new
trench. The lot is only 50' wide so lot line waivers will be required on
each side. The length of the new trench will be 47' with 6' effective
depth. Several well radii encroach on the lot, but the new trench will be
constructed outside these radii. It appears the septic tank currently falls
inside the protective radius of the private well to the south. If the tank is
found unfit for continued use, it will be moved outside the radius. The
existing absorption trench will be abandoned in place.
The testhole placed on the lot revealed silty sands with a percolation rate
of 6.5 minutes per inch at a depth between 6' and 7'. The distribution
pipe will be placed at 4.5' beneath the surface and the total depth of the
trench will be 10.5'. Every attempt will be made to maintain a 12'
separation from the existing trench.
The surface of the lot is almost flat in the area of the new trench. A
fence will inhibit the construction of the new trench, but it appears the
work can be successfully completed.
Lot 17, Block 2, Sand Lake Subdivision
May 31, 1998
Page Two
If the system is constructed as designed the following statements apply:
1. The system, if constructed as designed, will have no adverse impact
on the wells in the area or those to be constructed in the future. The
subdivision is currently served by a Class C Well.
2. The system, if constructed as designed, will have no adverse impact
on existing septic systems in the area or those to be constructed in
the future.
3. The system, if constructed as designed, will have no adverse
impact on reserved space, either surface or subsurface, on any lots
located in the area.
4. The system, if constructed as designed, will have no adverse impact
on drainage patterns in the area. The current drainage pattern will
be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
rs?;t9J;_J•�
�� �,�+;;. 4381-E •„;�
LOT 17, BLOCK 2,
SAND LAKE SUBDIVISION N0. 2
it � 4' TO
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e` J 4331•E
<<1
WEST 80TH AVENUE
AREA MAP
SCALE 1" r 100'
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711
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AREA MAP
SCALE 1" r 100'
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Lot 18
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SITE PLAN
SCALE 1" a 20'
Private Well
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LOT 17, BLOCK 2, SAND LAKE SUBDIVISION
NO. 2
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Three Bedroom Home Deep Trench System
Perc. Rate: 6.7 MinJinch Verity Existing Septic Tank
Application Rate: .B GPD/SF jl� Drainfleld Rock
it
3 Bedrooms X 150 GPD / .9 GPD/SF = 562.5 SF of Absorption Area
562.5 SF/X SF/ LF of Trench = 47- LF Trench Length
w
Therefore: Construct a Deep Absorption Trench System With One Laterals
�W in Length withIlp' of Drainfleld Rock Beneath the Lateral.
Distribution Pipe in Trench Placed at 4.5' Below the Original Ground
Surface. Maintain 150' Separation from Class C Well.
Natural
Backfill
4' Geotextile
Fabric
6" S Maxn
91 fee �! PVC(Slots
nfield
3'
TYPICAL DEEP TRENCH SECTION
(NO SCALE)
NOTE: Grade Area Over Trench to Drain Away. 11.�
Minimum 3' of Cover over Septic System. t'.... ...
Minimum 4' Separation From Groundwater.
Maintain Separation From Wells in Area. <`'iP 4111-E
PERFORMED
LEGAL DESCR
Municipality of Anchorage
DEPARTMENT OF HEALTH 3 HUMAN SERVICES
825 OV Street. Anchorage. Alaska 99502-0650
SOILS LOG - PERCOLATION TEST
�i
e L
2
4
s
7-
8-
9-
10-
11 891011
12-
13-
144
213 14
X, 15 \
17
17
1S
19
20
7 T.rrV• DATE
Township. Range. Section:
f SLOPE
Z m C
WAS GROUND WATER
ENCOUNTERED?
IF YES. AT WHAT ��.•.
DEPTH?
"fir" wNhTe p,� 5197
4331-E
Rrdiny Date
Tum
Not
Tian
Watrm
Not
Drop
/
3.0
IV
LS
2.1.3
;Ov
r I
PERCOLATION RATE (m utevwwm) PERC HOLE DIAMETER
TEST RUN 8 I .— FT AND —7FT
COMMENTS - �'�� l��i • ��• t 0�/�
PERFORMED BY,%` 1 i r THAT IS TES�rTr WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE OATS
72 -NA (Rm. /,85)
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 17, BLOCK 2, SAND LAKE SUBDIVISION NO. 2
GENERAL:
1. The scope of this project includes exposing of the existing
1,000 gallon septic tank and verifying its integrity for
continued use. It also includes the construction of a new
47' long by 3' wide by 6' effective depth absorption trench
at the location shown on the site plan. The distribution
piping must be placed at 4.5' below the ground surface. Two
new post tank cleanouts will be required between the septic
tank and the new trench. The location of the trench i s
within 2' of an existing fence which may require its
removal and reinstallation.
2. Construction shall be in accordance with the approved site
plan, design drawings, Municipal Permit with any special
provisions or conditions, and all applicable State and
Municipal Wastewater Disposal Regulations.
3. The Contractor shall be
responsible
for
obtaining all
underground utility locates
and for the
layout
of the septic
system and verification of
the location
of all
lot lines.
4. Unless specifically agreed otherwise, the contractor shall
be responsible for final grading areas subsequently
depressed from soil settling. Property owner shall be
responsible for revegetation of affected areas unless
specifically agreed otherwise.
5. Contractors installing wastewater disposal systems must
be certified by the Municipal Department of Health and
Human Services for system installations. Owners installing
their own systems must receive prior approval from D.H.H.S.
before beginning system installation.
SEPTIC TANK INSTALLATION
1. A new 1,000 gallon septic tank must be procured from an
approved source and installed outside the 100' protective
radius from the existing well if the existing septic tank is
found unfit for continued use.
Lot 17, Block 2, Sand Lake Subdivision No. 2
May 31, 1998
Page Two
2. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts
for pumping access.
3. The septic tank shall be sufficiently bedded to prevent
settling or shifting of the tank.
4. All standpipes on the septic tank shall extend a minimum of
12 inches above final grade.
5. Tanks installed without 4' of cover shall have a minimum of
2" of direct burial insulation.
6. A foundation cleanout shall be installed one to four feet
from the building foundation. Two cleanouts are required
between the tank and the drainfield.
7. Final grading over the tank shall be such that a positive
slope exists away from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown
on the design. The bottom of the trench shall be within 2"
of level.
2. Distribution piping
must
be placed
level with perforations
down atop a level
bed of
drainfield
rock. Rock should then
be placed over the
pipe
to provide
a minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between
the drainfield rock and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the
locations shown on the design. The portion below ground
must be perforated.
Lot 17, Block 2, Sand Lake Subdivision No. 2
May 31, 1998
Page Three
5. Contractor shall verify the septic tank and drainfield are a
minimum 100' away from any private water wells in the
area, 150' from a Class "C" Well or 200' from any community
well.
6. Direct bury insulation must be placed over the distribution
system if less than 3' of backfill depth is available. Finish
grade over the trench must be mounded to prevent
settlement or depressions.
7. Grade area surrounding the absorption trenches to drain
away.
8. A minimum 2' of accepting soil is required below the
drainfield rock for a 5' wide trench. Contractor shall verify
this condition prior to placement of the rock. All pockets of
unacceptable materials must be removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a Municipally approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic
system installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C.
(perforated and solid), ASTM F810 or H.D.P.E. (perforated,
but not solid) and ASTM D2662 or A.B.S. (perforated and
solid).
3. Insulation shall be at least 2" thick extruded direct burial
polystyrene (Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
Lot 17, Block 2, Sand Lake Subdivision No. 2
May 31, 1998
Page Four
5. A permeable geotextile fabric (Typar, Mirafi or equal) must
be installed between the final drain rock layer and the
native soil layer. .
6. All drain rock shall be .5" to 2.5" in diameter with less than
3% passing the #200 sieve.
INSPECTIONS:
A minimum of two inspections are required by Municipal
Ordinance. These inspections must be conducted under the
supervision of a professional engineer registered in the State
of Alaska. The first inspection must be conducted after the
excavation of trenches, beds or pits and before the installation
of any gravel. A septic tank may be set in place, but may not
be backfilled.
The second inspection must be conducted after the placement
of the geotextile fabric, gravel, distribution piping,
standpipes, cleanouts and insulation. No backfill should be in
place at the time of inspection.
Contractor shall provide a copy of all field survey layout and
construction notes for use in preparing the certified as -built
of the completed system.
\ f"'N MUNICIPALITY OF ANCHORAGE r~
\ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street • Anchorage, Alaska 99501 Telephone 264-4720
\ ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME /
is O'v
PHONE
-3
7-63-ZY
NEW
UPGRADE ADE`tC.Ve.
MAILING ADDRESS
LEGAL DESCRIPTION y (�
1,O L 1� IJ Z SANG A KC �lp
LOCATION
OFM . ETWC u 0TW A),AO `SZ'L'O
NO. OF BEDROOMS
3
DISTANCE TO:
Well
.VpT IN
Absorption area
q
Dwelhng
No T' /,V
PEHMIT NO.
137.0 '7.'..5—
!SwtOY
;:Z
Manufacturer P N Pyr
Ma erigI C G /
C
No. of compartments
Z
N~U
Liq. capacity in gallons
O O O
IF HOMEMADE:
Inside length
Width
Liquid depth
tj Y
Jt72
DISTANCE TO:
Well
Dwelling
PERMIT NO.
_ F
Manufacturer
Material
Liquid capacity in gallons
D
W =
DISTANCE TO:
Well
T !N
Foundation
No T /N
Nearest lot line
S
PERMIT NO.
g �Cy 7 !
H Z W No.
of lines I
Length of each Ii
't'8
Total Total length of lines
48
Trench width
SO inches
Distance between lines
cc f
o
Top of the to finish grade /
�(
Material beneath tile��
? 2 inches
Total effective absorption area
S '5—
W
(7
Length
Length
Width
Depth
PERMIT NO.
n F
W a.
Type of crib
Crib diameter
Crib depth
Total effective absorption area
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
3
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption areas)
OTHER
5
3
PIPE MATERIALS
v c r
to
SOIL TEST RATING(?
L b0 t3 �
1
INSTALLER
IF XC.A.vA 1 CP N CO
W
REMARKS
t IV,(Wt—�R VV
'
t
O
e O
J
APPROVED DATE LEGAL
/0^Z7-3z Lai t- 171 13'Z j S t'LC . 57' /0
72-013 (Rev. 3/78)
t'1�1t 1 I iv I f fL_ I TY r,F FiF�r= F� .7Rf Ir E
DEPARTMENT( HEALTH AND ENVIRONMENTAL .tOTECTION
825 'L' STREET, ANCHORAGE, AK. 99501 nJ
264-4720
lDr4—�- I TE SEWEF=: F='ERt•1 I T
PERMIT NO. ( 820715 )
APPLICANT STEVE CARLSON 7801 ARLENE ANCHORAGE 263-2453
LOCATION
LEGAL L17 62 SAND LAKE S/D #2 LOT SIZE 999999 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (50 FTtBR)= 180
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
C•EF'TH= �JLE+ L -EZ" TH= 4!tZ; 0Fz-: n •ElL OEF= TH= w-,-
THE
=
THE LENGTH DIMENSION IS THE LENGTH CIN 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 CIN 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 CIN FEET).
F<:E Li I REO 'SEF„T I C TRt-4K - I =E= iGRL-LCD -I�-
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DUPING THE
IN=TALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
--- T1+lO C ;Q ? I t-a•SF=*ECT I iCl" HE:E RE=0U I REO ---
BACKFILLING OF ANY SYSTEM WITHOUT FINAL IN'=PECTION AND APPROVAL BY THIS
DEPARTMENT WILL EE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN R WELL 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.
F=•EE:tom! I T EXF' I RE OECEr1E ER = 1s 2.r+fi�
I CERTIFY THAT
1: I AM FAl•IILI l•IITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE P Jhl CIPALITY FH ICHOF.'AGE.
2: I WILL INS AL THE SY EPt I ACCORDANCE WITH THE CODES.
3: I UNDERST ND THAT T�f ON— ITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS F' pIODELJ TO I !;"IDE MOPE THAN 3 BEDROOMS.
SIGNED
ICRNT STEVE CARLSON
ISSUEC> B4' ¢I[1�---------DATE—��_7/�'=3------ V4. 0
solLs Loc
Q� MUNICIPALITY OF ANCHORAGE
�I DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCTESTOLAnON
825 L. Street, Amhwage, Alaska 89501 264-4720
_. SOILS LOG — PERCOLATION TEST n v
PERFORMED FOR: Tlw, K.YGcionkirn c'nrApnry —DATEPERFORMED:
LEGAL DESCRIPTION: 5r`i--ciKP.L�7 s U1OCV Z
PERFORMED BY: GMen CERTIFIED
72-008 (6/79(
DATE,
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 011-133-06
1. GENERAL INFORMATION
COSA # CSC dA MAO
Expiration Date: % -- I G - / ?-
Complete legal description Sand Lake Subdivision No. 2, Block 2, Lot 17
Location (site address) 6116 Wilcox Street Anchorage, AK 99502
Current Property owner(s) , Federal Home Loan Mortgage corporation
Mailing address
Lending agency
Mailing address
400 National Way Simi Valley CA 93065
Real Estate Agent
tr si.' Y
Mpping Address
Unless o6rwlse requested, COSA will be held by DSD for pickup.
O BER9 BEDROOMS Three (3)
Day phone
Day phone
Day phone
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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.
&. -TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
❑✓
Individual Water Storage
ElIndividual
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 On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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 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 Anderson Engineering
Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date
..
G1•
17
S. DSD SIGNATURE rlc��y CE4381
Approved for bedrooms. p4�
0FCSSt0*0';
Disapproved. �j��`®�'®
Conditional approval for bedrooms, with the following stipulations:
Attachments
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date: ? l
(Re 11ro5)
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot 17, Block 2, Sand Lake Subdivision No. 2 Parcel ID: 011-133-08
A. WELL DATA
Well type Class C If A, B, or C provide PWSID # 215299 Well Log (Y/N)
Date completed _ Sanitary seal (Y/N) _ Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level
Well production g.p.m. 9-p M.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate N/D mg/L Other bacteria 0 colonies/100 mL
Arsenic: 52.8 ug/I Date of sample: 4/3/2012 Collected by: M Anderson
B. SEPTICIHOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 10/29/82
Tank size 1,000 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) N
Date of pumping 4/5/2012 Pumper Denali Pumping
C. ABSORPTION FIELD DATA
Date installed 6/9-10/98 Soil rating (g.p.d./ft2 or ft2/bdrm) .6 SF/BDRM System type Deep Trench
Length 41 ft. Width a ft. Gravel below pipe 7 ft.
Total depth 11 ft. Eff. absorption area 574 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 4/4/12 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 611 gal. New depth 22 in.
Elapsed Time: 1.440 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
u
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at _ in. "Pump off" level at _ in. High water alarm level at in.
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
1:k +,QF A
On adjacent lots
Absorption field on lot
G. ENGINEER'S CERTIFICATION
On adjacent lots
Public sewer main
1 49M * e4
Public sewer manhole/cleanout
Sewer /septic service line
conformance with MOA COSA guidelines in effect on this date.
Holding tank
Animal containment areas
®...uIICHat1.,A@mFltsoN
O® CE '4381 .\���
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5'
Property line >5'
Absorption field >5'
Water main >10'
Water service line
'10' Surface water '100'
Wells on adjacent lots 97'**
SEPARATION DISTANCE FROM ABSORPTION FIELD
ON LOT TO:
Property line 5'•"
Building foundation >10' Water main >10'
Water Service line >10'
Surface water >100'
Driveway, parking/vehicle storage 5'
Curtain drain None Noted
Wells on adjacent lots
>100•
F. COMMENTS: —WRO 10090. —
See Lot Line Waiver.
1:k +,QF A
G. ENGINEER'S CERTIFICATION
1 certify that I have determined through field inspections andr'
1 49M * e4
review of Municipal records that the above systems are in
0. • • • ••••®
conformance with MOA COSA guidelines in effect on this date.
9 •••;=--:..
♦ � ::
Engineer's Printed Name Michael E. Anderson, P.E.
®...uIICHat1.,A@mFltsoN
O® CE '4381 .\���
•
Date s/sfzplz
COSA Fee $ 1 c) Waiver Fee $ _
Date of Payment'" i (� Date of Payment
Receipt Number 0 ae I G Receipt Number.
(Rev. 11/05)
Municipality of Anchorage �.
Community Development Department
Development Services Division sin „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 # 121106
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 2, Lot 17 of
Sand Lake #2 Subdivision. This inspection revealed an arsenic concentration
of 52.6 micrograms per liter (ug/L) for the property's well water sample.
The Enviromnental 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.
SGS Ref.#
1121035001
Client Name
Anderson Engineering
Project Name/#
8116 Wilcox St
Client Sample ID
8116 Wilcox St
Ntatrix
Drinking Water
Sample Remarks:
Parameter
Metals by ICP/MS
Arsenic
Waters Department
Total Nitrate/Nitrite-N
Microbiology Laboratory
E. Coli
Total Colifoi in
Page 2 of 4
Resales LOQ
52.6 5.00
ND 0.100
Negative I
Negative I
Printed Date/Time
04/10/2012 8:58
Collected Date/Time
04/03/2012 11:25
Received Date/Time
04/03/2012 11:40
Technical Director
Stephen C. Ede
Allowable Prep Analysis
Units Method Container ID Limits Dale Date [nit
ug/L
EP200.8
C
(<10)
04/04/12 04/05/12
ACF
mg/L
SM21450ONO3-F
B
(<10)
04/05/12
LCE
100mL SM219223B A
100m1, SM219223B A
04/03/12 DLC
04/03/12 DLC
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
1 '
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. /)( i - 1 3� COSA#
1. GENERAL INFORMATION Expiration Date:' oZ 3- 0
Complete legal description SANDLAKE SUBDIVISION N2• LOT 17 BLOCK 2
Location (site address or directions) 8116 WILCOX STREET • ANCHORAGE AK 99502
Current Property owner(s) C/O RALPH NOBREGA Day phone
Mailing address
Lending agency Day phone
Mailing address
Real Estate Agent RALPH NOBREGA W/PRUDENTIAL VISTA Day phone 727-6903
Mailing address 3801 CENTERPOINT DR. SUITE 200 • ANCHORAGE AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 2
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well Individual On-site 0
Individual Water Storage ❑ Individual Holding tank ❑
Community Class •C• Well 0 Community On-site ❑
Public Water System ❑ Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered In the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems
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 samples. (Certificates maybe 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, 1 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 riles and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(aro) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm
GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD, SURE 101 • ANCHORAGE, AK 99507
Engineers Printed Name
JEFFREY A. GARNESS, P.E. Date IB LO(,
Engineers Comments:
In conducting this evaluation, GEG, LfD. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described 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 soils condition, groundwater 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 the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party Is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
t/ Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the fllowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
—� Arsenic Advisory
Manitenance Agreements
Supplemental Engineers Reort
Other
(VtIV OF�;Ii'
P�� i6.
--t9iv}StTE�,
WATER AND
rXSTEWA=:
PROGRAM : c
By: Original Certificate Date: to
(R". UP01)
Municipality of Anchorage
Development Services Department
�J Building Safety Division
On -Sita Water b Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 995196650
www.cl.anchorege.ak.us
(907) 3437904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: SANDLAKE SUBDIVISION 12• LOT 17 BLOCK 2 Parcel ID: 0 11 - 1'9'3 - O $
A. WELL DATA
Wen type "C"
Date completed
Date of test
Static water level
Well production
If A, B, or C provide PWSID# 21 299
Sanitary seal
Cased to ft.
FROM WELL LOG
ft.
g.p.m.
Well Log
property protected (YIN)
Casing height (above ground) in.
AT INSPECTION
ft.
—
9 -p.m -
WATER SAMP SULTS:
Collfdrm eolonies/100 ml. Nitrate O. 1 mg./L. Other bacteria _0olonies/100 ml.
Arsenim'4-1& r ff.4. ?4> 6 : Date of sample: 1 10/2006 Collected by: GEG. LTD.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL Date instaned — 10/29/1982
Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping - 1/18/2006 Pumper DENALI PUMPING
C. ABSORPTION FIELD DATA
Date installed e/9-10/1998 Soil rating OE�Obr ft=Ibdrm) 0_8
Length 41 ft. Width 3 ft.
"TESTED 1998 TRENCH.
System type DEEP TRENCH
Gravel below pipe 7 ft.
Total depth 010.7 ft. Eff. absorption area 574 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test"" 1 /9/2006 Results (Pass/Fail) PASS For 2 bedrooms
Fluid depth in absorption field before test DRY in. Water added 1520 gal, New depth 68 in.
Elapsed Time: 1340 min. Final fluid depth DRY in, Absorption rate >= 300+
g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date N/A
HOUSE VACANT FOR APPROXIMATELY 6 MONTHS PRIOR TO TEST. NO PRESOAK
DONE. DRAINFIELD ABSORBED 1500+ GALLONS IN LESS THAN 24 HOURS.
D. LIFT STATION
Date installed
'Pump on" level at _in.
E. SEPARATION DISTANCES
Size In gallons
High water alar level at
Cycles tested Meets alar 8 circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAlft station on lot
Absorption field on lot
Public sewer main
Sewer /septic service
areas
COMMUNITY WATER
On adjacent lots
On adjacent lots
sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line
5'+ Absorption field 5'+
Water main
10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots •97'+/150'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property'+ line ••5'+ Building foundation 10Water main 10'+
Water service line
10'+ Surface water 100'+ Driveway, parking/vehide storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that 1 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. t ey arness.
JEFFREY A. GARNESS •'
Engineer's Printed Name � s• '•.• �-7g53
Date 1/l ProreeiWA
COSA Fee S y' 3 O
Date of Payment I " I �— O
Receipt Number -7 �-7 (0 V
(Rev. 1210 1)
Waiver Fee $
Date of Payment
Receipt Number
FROM : .7IMBO FAX NO. : 3480881 Apr. 08 2002 10:07AM Pl
Ea: ..r j
D J ��5. CoQ + •t�, ;, •� t
0",
fiG b
I F�Sr no
pF..A t_ qS II
i :491u �. x
11 /� /.... ...::.
'r'a:: 1q�cf1,�,(r ✓t�orj¢al (�o be 7"Kr'..,, /
James Karl Oowlinp '..
d(Off,THIS ASBUILT IS NOT TO BE USED FOR ANY SUBMITTAL TO THE MUNICIPALITY OF ANCHORAGE (l a AAOFfsS10NI&�*a r
It H the responsibility of she owner to slacmdne dw
"LsU nee or any easements. covenants or restrictions
wbich do not appear on 0te secordcd subdivision plat R T T NOTES: '
Under no nseu coon ei should any data bacon be A S .V V IL .l
used for construction or for tttabtishiny boundary or EASEMENTS Of RECORD, OTHER THAN THOSE
[corn lines. The surveyor sakes responsibility for the SHOWN ON THE RECORDED PLAT• ARE NOT
initial trause t:on only. • SHOWN HEREON.
LF.C:FND
LOT_ BLOCK .Z m BRASS CAP MONUMENT
_5.4AIL-14 5 ,2 (PLAT NO.:' � O MONPIPE
ANCHORAGE R:ECORDI GDISTRICT • REBARCORNERFOUND
Q HUB AND TACK
PREPARED BY:
DOWLING & ASSOCIATES
1426 Hyder Strec( .
AnchoraCe, Alaska 99501 REVISIONS DATE BY
i DATE: BY:SCALE: WORK ORDER: FIELD BOOK: GRID NO.:
,X3 /•t 9.S -1y_sh/ I 9-.7 -7i/
wqi
SCS Ref.N
1060174001
All Dates/rimes are Alaska Standard Time
Client Name
Garness Engineering Group, Ltd.
Printed Date/Time
01/17/2006 11.32
Project Namc/N
Lot 17 Block 2 Sand Lake SD
Collected Date/Time
01/10/2006 12:00
Client Sample ID
Lot 17 Block 2 Sand Lake SD
Recetred Date/Time
01/10/2006 15:17
lllairis
Drinking Water
Technical Director
Stephen C. Ede
PWSID
0
Sample Rcmarks:
Allowable Peep Analysis
Parameter
Results
PQL
Units
Method Container ID
Limits Date Date
Mit
Nitrate -N
0.100 U
0.100
mg/L
EPA 353.2 B
(<=10) 01/11/06
JC
Metals by ICP/MS
Arsenic
48.0
5.00
u8/L
EP200.8 C
01/12/06 01/13/06
TK
Microbiology
Laboratory
Total Coliform
0
cot/l00mL SM209222B A
(<=I) 01/10/06
TLF
Municipality of Anchorage
• Development Services Department
Building Safety Division
Onsite Water & Wastewater Program
4700 South Bragaw St
P.O. Box 196650 Anchorage, AK 99519-6650
www.d.anchorage.akus
(907) 343-7904 h7�z'0�
.
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLINGI /
Parcel I.D. 011-133-08 HAA# #14 6o?D�a 1
1. GENERAL INFORMATION Expiration Date: :7-11-0`2—
Complete
7-1/"O2
Complete legal description SAND
LAKE SUBDrOSION 112: LOT
17, BLOCK
2.
❑
Individual On-site
Location (site address or directions)
8116 WILCOX STREET *
ANCHORAGE.
AK
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
GLORIA RHODES Day phone 337-1223
8116 WILCOX STREET * ANCHORAGE. AK 99502
Day phone
MARK SOOUEr w/ WHY USA SOOUEr REALTY Day phone
561-1616
4155 TUDOR CENTER DR., SUITE 208 " ANCHORAGE, AK 99508-5915
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
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 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single family on-site wastewater disposal andlor
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of
up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B
wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the
professional engineer's work
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, orprior
to closing for the engineering services provided.
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 ofAnchorage 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 lime of installation.
Name of Finn ALASKA WATER & WASTEWATER CONSULTANTS. INC. Phone
Address 6901 DEBARR ROAD, SUITE 28 • ANCHORAGE, AK 99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineers Comments:
In conducting this evaluation, AWWC, inc. attempted to provide a thorough,
conscientious engineering analysts of the system In accordance with ADEC and MOA
DSD Guidelines 6 Regulations. The reported results described 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 soils condliton, groundwaterlevels that may
fluctuate during the year, and the water usage of the famfiy being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. AW KV Inc. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report Is for
the sole benefit of the owner fisted above. Any reliance upon or use of this report by any
other person or party Is not authorized, nor w7l k confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for _ bedrooms.
Disapproved.
Conditional approval for
337-6179
Date —s -AS -10Z
bedrooms, with the filowing stipulations:
:F: WATERAND •:
WASTE�M ATER
PROGRAM
O �2
Attachments: HAA Checklist Manitenance Agreements JJJ'J�I"Fj9 wkj\5
Septic System Advisory Supplemental Engineer's Reort
Well Flow Advisory Other
By: / L� UJ �r+t/1 Original Certificate Date: — I J - 4 Z
Mw. 12M)
v�sr�
Municipality of Anchorage
' Development Services Department
Building Safety Division
On+SR9 Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196680 Anchorage, AK 995198850
www.d.anchorage.ak.us
(907)343.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: SAND LAKE SUBDIVISION /2: LOT 17, BLOCK 2. Parcel ID: 011-133-08
A. WELL DATA
Well type V if A, B. or C provide PWSID# zl5299 Well Log (YM)
Date completed Sanitary seal YM es property protected (YM)
T 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- —
9 -p.m -WATER SAMPLE RESULTS:
Conform 0 colonies/100 ml. Nitrate 0.5 mg./L. Other bacteria 9 colonies/100 mi.
11/1/2001
Arsenic. 0.0136mg,/L, Date of sample: -37572002 Collected by: AWWC. INC.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL Date instatted 10/29/1982
Tank size 1000 gal. Number of Compartments 3 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (YM) NO High water alarm (YM) N/A
Date of pumping 8/8/2001 Pumper A + HOME SERVICES
C. ABSORPTION FIELD DATA
Date installed 6/9-10/1998 Sob rating .p.d r ftjbbdrm) 0_8 System type DEEP TRENCH
Lente 41 It. Width 3 ft. Gravel below pipe 7 ft.
Total depth 10.7 ft. Eft. absorption area 574 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 10x(5/2001 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 29.5 in. Water added 530 gal. New depth53_25in.
Elapsed Time: 25 min. Final fluid depth 51.5 in. Absorption rate >: 450+ g,p.d.
Any rejuvenation treatment (past 12 mo.) (YM & type) NONE KNOWN If yes, give date —
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at —in.
E. SEPARATION DISTANCES
High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO: CLASS "C" WELL
Septic tank/lift station on lot 150'+ On adjacent
Absorption field on lot 150'+acent
Public sewer main
service line
2A
Public sewer manhole/deanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 097'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line '•5' Building foundation 100+ Water main 10'4-
Water
0'+Water service line 10'+ Surface water 100'+ Driveway, parking/vehide storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
• stwoalaaoa ►�
G. ENGINEER'S
I certpy that I have determined through held inspections and * !
review of Municipal records that the above systems are in """
conformance with MOA HAA guidelines in effect on this date.
s .....
ro urn
as.-
Engineer's Printed Name
JEFFREY A GARNESS • 79
d�oz _
Date 1 f•'•d P• .___. nd �c
HAA Fee $
Date of Payment
Receipt Number
(Rw. 12/00)
Waiver Fee $
Date of Payment
Receipt Number
FROM : JIMBO FAX NO. : 3480881 Apr. 08 2002 10:07AM P1
sV C
C-tQSr I�F5.6a
' OTYS f f� .�pu✓C Q .
e(Q-THIS ASBUILT IS NOT TO BE USED FOR ANY SUBMITTAL TO THE MUNICIPALITY OF ANCHORAGE
. li_g the responsibility of the ownd to datcmltne the
tu•
iC
v -i
' 30
(_1
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i 49TH 01
V"jomat Korl DowIln; '
I �Fy t• ' 4JPr
WRAlrssloNt.���.a.
existence of any easements• covenants or M tom RR .
whish danotappear umstaonthe
ouldarecorded subdivision plat. AS.iJUILT ,
Under. no circumstances' should any data hereon be ���'(SOFRECORD,O'fl{L•RTNANTHOSE
used for construction or for establishing boundary or SHOWN ON THr RCCORDM—'hAT, ARENOT
'. fence,Ilnes. The surveyor takes responsibility for the SHOWN HCRCON.
initlal transaction only.' TYCF.ND
LOTS_ BLOCK 2 BRASS CAP MONUMMIrr
PE
' 544 Ae 7 - �XZ s�2, (PL.ATNO._) O • RCBARMAltMON CORNER
;'ANCHOFLAGEFLECORD19GDISTFUCT 0 HUD AND TACK
PREPARED BY: ---�—
DOWLING & ASSOCIATES
1426 Hyder Strect .
Anchorage, Alaska 99501 REVISIONS D CE BY
DATE: BY: SCALE: WORK ORDER: FIELD BOOK' GRID NO.: t
7"7
I
4,
A .
{
(#4
0
y
lac•
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C-tQSr I�F5.6a
' OTYS f f� .�pu✓C Q .
e(Q-THIS ASBUILT IS NOT TO BE USED FOR ANY SUBMITTAL TO THE MUNICIPALITY OF ANCHORAGE
. li_g the responsibility of the ownd to datcmltne the
tu•
iC
v -i
' 30
(_1
I ^`
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V"jomat Korl DowIln; '
I �Fy t• ' 4JPr
WRAlrssloNt.���.a.
existence of any easements• covenants or M tom RR .
whish danotappear umstaonthe
ouldarecorded subdivision plat. AS.iJUILT ,
Under. no circumstances' should any data hereon be ���'(SOFRECORD,O'fl{L•RTNANTHOSE
used for construction or for establishing boundary or SHOWN ON THr RCCORDM—'hAT, ARENOT
'. fence,Ilnes. The surveyor takes responsibility for the SHOWN HCRCON.
initlal transaction only.' TYCF.ND
LOTS_ BLOCK 2 BRASS CAP MONUMMIrr
PE
' 544 Ae 7 - �XZ s�2, (PL.ATNO._) O • RCBARMAltMON CORNER
;'ANCHOFLAGEFLECORD19GDISTFUCT 0 HUD AND TACK
PREPARED BY: ---�—
DOWLING & ASSOCIATES
1426 Hyder Strect .
Anchorage, Alaska 99501 REVISIONS D CE BY
DATE: BY: SCALE: WORK ORDER: FIELD BOOK' GRID NO.: t
7"7
Municipality of Anchorage *A4
Development Services DepartmentBuilding Safety Division
On-SiteWaler and Wastewater Program 4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519.6650
www.ci.anchomge.ak.us
(907)343.7904
Waiver Review Worksheet
WR#: WR010090 PID#: 011-133-08 HAM Permit#:
Date Received: 10130101
Legal Description: Sand Lake #2 Block 2 Lot 17
Engineer. Michael E. Anderson. PE
r'. IT, UT :,.:,..I
Waiver Requested: 97 Feet from Well to Septic
Criteria: Geology Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
Waiver is Granted: �_ Waiver is not Granted:
List Conditions or Reasons for above: SEE Air^-CNeO
Date: 11— 9- o� By: Jpml
Name of Reviewer
Rec#: 12083 Amount: $828.00 Date Paid: 1013012001
11/9/2001
Municipality of Anchorage
George P.IViterch,Mayor Depart men - or
Public Works
Btd1ditlgv Safety Divisioll
P.O. Box 196650 • 4700 S. Bragaw Street
Anchorage, Alaska 99519-6650 • (907) 343.8301
li ttlr.//wi%iv.ci.anchomgc.ak.us
Michael E. Anderson PE
Anderson Engineering
PO Box 240773
Anchorage, AK 99524
Subject: Waiver Request for Sand Lake #2 Block 2 Lot 17
Waiver Request #WR010090
Parcel ID #011-133-08
Dear Mr. Anderson:
Your request for a waiver of the required 100 feet horizontal separation from the
septic tank to private well has been approved. The approved separation distance is 97.0
feet.
This waiver approval applies to the existing septic tank to private well 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,
Daniel J. Roth
Civil Engineer
On -Site Water &
Wastewater Program
xss
MHry
�+rn
wAIvFR 1 ower FOR S�q�vo LAkE'*Z &ocH Z Lor /
WAIVER 14EQu65r Numozw w1Qo/OOyo
wA/vER 1PEpuE5f FAR WPIrE1Q WELL alv LeT It, Ta SbpTrC TNAi1C
ON L mr /7 of 97 FfEr.
S F Prlc WA —
TRE SEPUC TANK ON LOT /7 t..pf COA/ST/eucrrp /N 19bg2. Er
157 BuIQ/E0 IN ritE TYPICr9-4L DRY l.4w'0 LA*f tr9.40P rAeC rlAW
/NrE6f21Ty t,As civfcmEp IN TUNE 1998AND FOu�D GcOo. Ulm
WEST
rI(E SPPTIL TH.vK IS telATEP 7-,P THE' Of THIE "IL
/N QuESTIP" 4291W ANVV Ar rK S%/.KEAPPRox��urarF_ Et6v�9)
711E SA,vO LAKE AKE.4 15' R LArIvELY FLAT.
T14C t•-ArER wELt 1" 47" F srrO.� IS S'/O fEfT PEEP 7Hit 4641w /r
rypicot of TkC- SaA AP L/4. -E ARM. AS &,/TH Hofr &.ELLS /N rwe
ARCA, NuIvsKOtS LRYERS OF r)l#C/t GtACiiaL Tilts ( C4t,9rf AlfE
PENArleArEO pR/elc 7-0 REACH/Orb n-ilt AT Of FtEr
to4mic fI►µPLE /Nioltr4 a ND N/rRoras OETEcTHDLE ANO Na
COLI r -MA BAC r5 Ier.4.
5. of A. A E. C. S. 0. W Cr. for 5. C.
� WAeipflP 7/9 BLE
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494 0 = 0
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IvE1 reF 4w/lr6K wt GL Twk1 HowEvEK
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HoRimoNTi9L S EPRRs►rio,v
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12
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
October 30, 2001
Municipality of Anchorage
Building Safety Division
On -Site Water and Wastewater Program
4700 S. Bragaw Street
Anchorage, AK 99507
Subject: Lot 17, Block 2, Sand Lake Subdivision No. 2 t' I bs' oil- f 3 3'b c�'
Separation Distance Waiver
Septic Tank to Neighboring Well
Dear On Site Services Engineer.
The septic tank on Lot 17, Block 2, Sand Lake Subdivision No. 2 was originally placed
on the lot in October of 1982. At that time the well on Lot 16, immediately to the south
had been in place for nearly a year. Apparently the distance between the well and the
septic tank was not measured correctly as the tank cleanout is only 100.4' from the well.
A very small portion of the tank therefore encroaches into the 100' protective radius of
the well. We are therefore requesting a waiver be issued allowing the tank to remain in
its current location with a portion of the tank being approximately 97' from the well.
The septic system on Lot 17 was upgraded in 1998. At that time the septic tank was
exposed and inspected for structural integrity. No deficiencies were found and no
leaking detected. It was determined at that time the tank was suitable for continued
use. The distance between the tank and the well was also measured at that time, but
without the benefit of sophisticated surveying equipment. Several impediments
between the well and the septic tank apparently affected the accuracy of the
measurement, because it was determined the septic tank was outside the 100'
protective radius.
The well is located approximately 3' upslope from the septic tank with the surface
drainage of the area from east to west at shallow grades approximating 5%. The total
depth of the well is 510' with casing thought to extend the entire depth of the well. The
static water level in the well was originally measured at 132' below the surface. Soil
strata encountered during the drilling of the well includes extensive layers of clay with
sand, silt and gravel. The clay material will slow and possibly stop the migration of any
septic effluent should a tank leak occur.
Lot 17, Block 2, Sand Lake No. 2
October 30, 2001
Page Two
Separation Distance Waiver Guidelines
Water Table
120' Below Tank
7.1
Soil Type
Clay and Sand Equal
4.5
Permeability
Silt or Sandy Clay
2.0
Water Table Gradient
0%
2.9
Horizontal Separation
97'
2.9
Total
119.4
The conclusion based on the aforementioned point totals is that almost surely no
form of contamination can be expected from household sewage. It is therefore
recommended the waiver be approved to allow the existing septic tank to be 97' from
the existing well.
Enclosed is a copy of the log from the neighboring well along with the original as -built
for the septic tank as well as the original test hole documentation from each lot. A
drawing showing the well in relation to the septic tank is also included for your
consideration. Please review this information and let me know if additional
information Is required to approve this waiver.
Sincerely,
-Aua-L C a4'1
Michael E. Anderson, P.E.
Attachments
c-
ANDERSON ENGINEERING
P.O. Box 240773
ANCHORAGE. AK 99524
(907) 522-7773
Cell (907) 441.4000
roe Lot 17, Block 2, Sand Lake No. 2
Well to Septic Tank Waiver
SHEET NO. OF
CALCMATED BY MEA DATE 10/30/01
WALE
1"=30'
DATE
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MUNICIPALITY OF ANC W ANCHORAGE
❑ PERCOLATION
• DEPARTMENT OF HEALTH AND ENVIRO(dh18NTALP'40TEC'n ON •1
TEST
835 L. Street, Anchorage, Alaska 89501 364J730
) J 1962
SOILS LOG —PERCOLATION iES
`< RECEIVED
PERFORMED FOR: lC7 A )—APr /�1r�iJ,sa DATE PERFORMED: Q
LEGAL DESCRIPTION:_ �,7(�in,,/LevA,,o �/ qInrk 2 /nf Iln
1
2
3
4
5
6
8
9
10
11•
12-
13-
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2-
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16
17-
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21. -
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SITE
WAS GROUND WATERNO Lmff
ENCOUNTERED?
O
P
IF YES, AT WHAT E
DEPTH?
Reading
Date
Grote
Tints
Not
Time
Depth to
Water
Not
Drop
PERCOLATION RATE (minuteetinch)
TEST RUN BETWEEN FT AND FT
PERFORMED BY: rBE)ih CERTIFIED
72-006 (6/79)
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I
WATER AND WASTEWATER CONSULTANTS,
6901 DEBARR ROAD, SUITE 2B. ANCHORAGE. AK. 99504
PHONE: (907) 337-6179/FAK: (907) 338-3248
SANDLAKE SUBDIVISION #2, LOT 17, BLOCK 2 G
TYPE OF WORK:
WELL TO SEPTIC TANK SEPARATION
GLORIA RHODES 337-1223
10/16/01 1 JAG 1 1= 40' 1 1 OF 1
41000
� serrlc
i
i
e Mf
OCT J3-01 10:23 FROM -CUE ENVIROMENTAL SRV
CT&E Environmental Services Inc.
L �r r�r�rrirrrrri��rrs�
Cf&E ReLA
1016826001
Client Name
AK Water & Wastewater Consultants Inc.
Project Name/M
L17, D2 Sand Lake #2
Client Sample ID
8116 Wilcox
Matrix
Drinking Water
Ordered By
10/05/01 SCL
PWSID
0
Sample Remarks
9075615301 T-735 P.02/03 F-204
Client PON
Printed Date/fime
Collected Date/time
Received Date/time
Technical Directtor�
Released By Ale
I0/11/2001 9:10
10/0512001 8:27
10/05/2001 11:25
Stephen C. Ede
Parameter Resole
PQL Units Method
ARoWable
Limits
Prep Amlysis
Date Date /nit
Waters Department
Nitrate -N 0.500 U
0.500 mg/L EPA 300.0
(<10)
10/05/01 SCL
Microbiology Laboratory
Total Coliform 24 O0, No Coli
coVI00mL SM18922211
(<1)
10105/01 KAP
LIAR -I1-02 03:30PU FR011-CUE ENVIRONIENTAL SRV
AL. CUE Environmental Services Inc.
CUE Reto
1021138001
Client Name
AK Water & Wastewater Consultants Inc.
Project Name/N
Sand Lake p2 L17; B2
Client Sample ID
Sand Lake N2 L17; B2
Matrix
Drinking Water
Ordered By
PWSID
0
Sample Remarks:
9075615301 T-893 P.02/03 F-601
Client PON
Printed Date rime 03/11/2002 15:05
Collected DateMme 03/05/2002 9:24
Received Date rime 03/05/2002 11:30
Technical Director Stephen��7�_
Released B I�//�����'
Allowable Prep Analysis
Prometa Results PQL Units Method Limits Date Date Init
Metals Department
Arsenic
Microbiology Laboratory
Total Cohrorm
0.0136 �/ 0.00200 mg/L EPA 200.9
9OB,NoColi col/100mL SM189222B
E
0]/08/02 IMP
03/05/02 KAP
to ppb
Ftf7- Ita.,(?I. c LA -r c.c.s
NOV-08-01 09:05AM FRO KT&E ENVIROMENTAL SRV
ME Environmental Services Inc.
9075615301 T-987 P.02/02 F-632
ME Re[N
1017650001
CtlentPON
CllentName
AK Water& Wastewater Consultants Inc,
PrintedDate/Time
11/082001
9:01
Project Name/N
Sandlake 82 Lot 17, B2
Collected Date/time
11/012001
14:40
Client Sample 1D
Sandlake 02 Lot 17. B2
Received Date/fime
11/012001
15:00
Metric
Drinking Water
Technical Director
Stephen C. Ede
Ordered By
Released By
PWSID
0
Sample Remarks:
Allowable
Prep
Analysis
Paametcr
Results PQL Units
Method Limits
Date
Date Init
Metals by ICP/Y8
Arsenic
41.1 1.50 ug/L
EPA 200.8
11/07i01 KGF
— PRELIMINARY -
Y
L�j2FJT
1
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES �.
Division of Environmental Services ,
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D.# _01113308 HAA# h�LSS,C)\-0
1. GENERAL INFORMATION
Complete legal description r.nt 1 7, R1 nrk 9, Rand T.akP Nn 9
Location (site address or directions) 8116 Wilcox Street
Property owner Michael A. Swanson Day phone 243-6630
Mailing address 8110 Wil cox 4frpet Anchorage, Ax 99509
Lending agency Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: mhrraASk__(3k )
3. TYPE OF WATER SUPPLY:
Individual well
Community well xx
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site xx
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(R".1/91) Fool MOAF21
S. 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 of this Health Authority Approval application shows that the on-site water supply:
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I Iurtherverify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm nnAPrann rnginPnrinq Phone 522-7773
Address - _ P.O. Box 2407773 %Anchorage, AK 99524
Engineer's signature —Date 6/17/98
nTFI t y p,�
6. DHHS
SIGNATURE f 4131-E i
Approvedtor -. bedrooms. i��ak F�l-_rcl 2P -
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
By; , Date —/9—
% -
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given In paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasersof homes
and their lending institutions In order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-=(/4+.1/91) 6. MOARl
Municipality of Anchorage
. DEPARTMENT OF HEALTH & HUMAN SERVICES I V E D
Environmental Services Division ( ) (� F
i 825'L Street, Room 502 • Anchorage, Alaska 99501. 907 �7hrt
JUN 18 1998
Health AuthorityApproval Checklist Municipality of Anchorage
PP Dept. Health & Human Services
Legal Description: Lot 17, Block 2, Sand Lake Parcel l.D.:01113308
No. 2
A. WELL DATA
Well type C ICA, B. or C. attach ADEC letter. ADEC water system number
Log present (Y/N) Date completed
Total depth Cased to Casing height (above ground)
Sanitary scat (Y/1) Wires properly protected (YIN)
FROM WELL LOG AT INSPECTION
Date of test
Static water level
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 Nitrate Non Detect Other bacteria 3
Date of sample: 6/12/98 Collected by: MEA
B. SEPTIC/HOLDING TANK DATA
Date installed 10/82 Tank size 1 , 000 Number of Compartments 2 Clcanouts (Y/N)__L_
Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) N
DatcofPumping 6/9/98 Pumper Old McDonald's
C. ABSORPTION FIELD DATA
Date installed 6/10/98 Soil rating (g.p.d./R' or fl%drm) .8 System type Deep Trench
Length 411 Width 3' Gravel thickness below pipe 71 Total depth 12'
Effective absorption area 574 SF Monitoring Tube prcsent(Y/N) Y Depression over field (Y/N) N
Date of adequacy test New Const. Results(Pass/Fail) pass For 3 bedrooms
Fluid depth in absorption field before test (in.); Immediately after_ gal. water added (in.):
Fluid depth Minutes later: (in.) Absorption rate z _
Peroxide treatment (past 12 months) (YIN) If yes, give date
D. LIFT STATION — None on Lot
Date installed
Manholc/Acccss (Y/N)
High water alarm level at"
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
'Pump on" level at*
'Datum
"Pump off' level at'
SEPARATION DISTANCES FROM WELL ON LOT TO: — No Well on Lot
Septic/holding tank on lot
On adjacent lots
Absorption field on lot , On adjacent lots
Public sctr•cr main
Scwcr /septic service line
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPIIC/HOLDING TANK ON LOT TO:
Foundation >5' Property line >51 Absorption field > 5'
Water main/scrvicc line > 10 ' Surface water/drainage > 100 ' Wells on adjacent lots > 10 0 '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation >10' Water main/servicc line >10'
Surface water >100' Driveway, parking/vchicic storage arca >50'
Curtain drain None on Lot Wells on adjacent lots >100,
F. ENGINEER'S CERTIFICATION _71
I certify that I have determined thru field inspections and review of Afunicipdrre�grds tha the agtoi, sA tems are
in conformance with AfOA ILIA guidelines in effect on this date. '�'��• ��" �1
/► ice o� �.i. �. ( �.�C �, '%* Er�7 TH"
Signature
Engincer'sName Michael E. Anderson, P.E. 1T.9%'0PP£01i:J j
Date 6/17/98 1 `�'•.
1 G° • 43?1 E ;C i
HAA Fee S CLI. t `�� Waiver Fee S
Date of Payment C 5 q Date of Pavmcnt
Receipt Number n �`� 1L� I 1 �� "/� Receipt Number
Rev. 8/95 OSS: haa.wk.doc
MUNICIPALITY ANCHORAGE
O Department of Healthth &Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY' DWELLING
Parcel I.D. # n. i I - t 1 S -(')S. HAA # t \ A 9r) f Y-11
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 17: Block 2: Sand Lake 02
Location (address or directions)
8116 0/•itcox Stiteet
(b) Property owner H.U.D. #111-019859-203 Telephone: (home) Business
Mailing Address cnc N .+ ert Auanua Aneftehaga, Ak 9950;
(c) Lending Institution
Mailing Address
Telephone
(d) Real Estate Company and Agent MA cTON PROP RTi S ATTN- Tnhn Huhox
Address 4501 Tunnaga.in Anchmage. Ah. 99503
Telephone Z -8- I117
(e) Mail the HAA to the following address: (or check here j�( if hold for pick up.)
List contact person and day phone number below:
S & S ENGINEERING
17034 Eagle River Loon Road No 904
Eagle River, Alaska 99377
2. TYPE OF RESIDENCE
Single -Family XX Number of bedrooms 2
3. WATER SUPPLY
Individual Well ❑ Communityx Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72m5 (RN. 7158) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and
Inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
Name of Firm
Address
Date
Telephone
5 & 5 ENGINEERING
up+a r,,nI6 River Loop Road N -204
Eagle River, Alaska 99377
6. DHHS APPROVAL c�
Approved for 2 bedrooms by ijd r� Date Ll� z �d
Approved—Disapproved Conditional
Terms of Conditional Approval
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
Institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
oranalyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72a2s (R", 7M) Beck Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
• Health Authority Approval (HAA)
\4�5�ON CHECKLIST - FEBRUARY 1984
OF ' 343-4744
MJr��F E�P`SE0.v\
A. WELL DATA
Well ClassificatQr1G
Well Log Present (Y/N)
Total Depth Cased to
Static Water Level
Casing Height Above Ground
Date Completed
Electrical Wiring in Conduit (Y/N)
Legal Description: Lne i 1-7�--
Depth of Grouting
SEPARATION DISTANCES FROM WELL:
If A, B, C, D.E.C. Approved 4VN)
Yield
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
To Septic/Holding Tank on Lot On Adjoining Lots
To Nearest Edge of Absorption Field on Lot 1SoI4— ; On Adjoining Lots
To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot
Water Sample Collected by 15S ��� I�lr—moo ;Date 2--1k0—_A0
S. SEPTIC/HOLDING TANK DATA
D
�v1�—
Date Installed , h gy Size t E;V� No: of Compartments
Standpipes&N) yAir-tight CapscrPN) _Foundation Cleanout (Ydo —r -t
Depression over Tank (Yo - Date Last Pumped 2'2� �`i c
Pumping/Maintenance Contact on File (Y/N) ; for
Holding Tank High -Water Alarm (Y/N) - Temporary Holding Tank Permit (Y/N) f'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
t t
To Water -Supply Well 15a -1 To Building Foundation 23
To Property Line (o To Disposal Field $t
t�
To Water Main/Service Line 10
To Stream, Pond, Lake or Major Drainage Course 1 cel
Comments its` Pt.Js
72-M(Rev. 7/88)Front Pagel of.2 1 t,k_90c01
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 43J�fst•.ki Type of System Design
Date Installed 2"I - Length of Field 40
Width of Field 5 Depth of Field
Gravel Bed Thickness b1
Square Feet of Absortion Area S7 Statndpipes Present (P/N) �J
Depression over Field (Y/V +J Date of Last Adequacy Test
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well IS t , To Property Line
To Building Foundation
Lot �
I�
To Exis inn Y or Abandoned System on
I{_
On Adjoining Lots 30
To Water Main/Service Line t c To Cutback (if present) Q
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area foo —
Comments law,- Fy,uw� —Vgzen •
i
D. LIFT STATION
Date Installed
Size In Ga\llons
"Pump On" L�
High Water Alarm Level
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
_ Dimensions
Manhole/Access (Y/N)
"Check Permitted Bedroom Rating Against HAA Request"
"Pump Off" Level at
Vent(Y/N)
Pumping Cycles during Adequacy Test.
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in
Inspection.
Signed a a S ENGINEERING
Company 17034 Eagle River Loop Road No. 204
age
Date
MOA No. C G q0' 005
Receipt No. �/ 7,' �Z `'6 V 7J
Date of Payment CP _,,L G v
Amount: $ /:2 6- ac
Receipt No.
Waiver Fee: $
Date of Payment
72-M(Aw. 7/88) Back Page 2 of 2
ou this
i14 J
bed A. Shvk-
ra. tins : M
STEVE COWPER, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE WESTERN DISTRICT OFFICE 563-6775
3601 C STREET, SUITE 322
ANCHORAGE, ALASKA 99503
S & S Engineering
17034 Eagle River Loop, Suite 204
Eagle River, Alaska 99577
FOR: ROGER
February 23, 1990
PWSID: 1215299
According to the records on file in this office, the Sand Lake #2.
Lot 17. Block 2 Water System is in compliance with the State of
Alaska Drinking Water Regulations.
Sincerely,
C/ •CitRJ'.
VERA.E. CRAIG&tA
Environmental Field Officer
VEC:bas
CONSTRUCTION AND OPERA
ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION
PUBLIC WATER SYSTEM
APPROVAL TO CONSTRUCT
Plans for the construction of—g 4N D t•.q XI OA
r
St • Lois /v,f,�; c :i 1 (71 r4 �oSt1_F,�/�6�blic water system located
in p , Alaska, submitted in accordance with 18 AAC 80.100
by_<_�•fe—QPt-1 have been reviewed and are
X approved.
O conditionally approved (see attached conditions).
v uo F.r,urvoil sc+vtJeff
F,Ncruoei
T
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 (contact order no. Approved by Date
or d•uriptiw r0•r.nc•) .
The "APPROVAL TO OPERATE" section must be completed before any water is made available to
the public.
APPROVAL TO OPERATE .'
The construction of the ' @ tc'LcJra•cr 431a, 01..3 - Sa: @' /.ntc
water system was completed on /e' ` /�/ r -2-- (date). The system is hereby
granted interim approval to operate for 90 days following the cpmpletion date.
BV TITLE DATE
As -built plans submitted during the interim approval period• or an inspection by the Department has
confirmed the system was constructed according to the approved plans. The system is hereby granted
final approval to operate.
By TITLE --- _- DATE
j
��
s
ib
;� V
a. ��
', S
io
�I �
`� r
I
0 4 k ;
�„� u �
CHEMICAL & GEOLOGICAL LABORA71DRIES OF ALASKA, INC.
I 5833 8 STREET ANCHORAGE, ALASKA 99578 TELEPHONE (907) 562234J
FEDERAL TAX ID M 82-0040440
A41LI3:3 REPORT It SAMPLE for Work Crder i 19916
Data Report Printed. IEE 20 90 0 15:25
Client Semple ID:117, 12 SAN: LAE! 12
P&3ID :Uk
Collected FHS 16 9G l 17:30 hre.
Received 191 16 90 1 15:00 hre.
Pretarved with :13 REQUIRED
Analysis Completed :1!E 19 90
Laboratory Supaxrisat .'v.:EPRIN C. L^_C
Released Ey :
...........................................
Special
Instruct:
Client Name : 3 & S INGR
Client lcct SNSENGP
P.O.t UN: RECEDED
Req i
Ordered By : R.1.3.
Saul Reports to:
1)3 & 3 INZ
2)
......................................................................
Chemlab Ref I: 900141 Lab Smpl ID: 5 k'atriz: NATER
Illovable
Parameter Tested Result Unite Method Limits
---------------------------------------------------------------------------------------------------------------
NIIP.AI!-N KO(D.10) s5l1 EPA 351.2 10
1�
Sauple RCOIINE SWLL
Remarks: SIMTI COLLECTED EI R.J.S.
..............................................................................................................
1 Teets Performa Sea Spaplal Instructions Above UA -Unavailable
L9- Noce Detected " See !ample Ra:miks Above
NA. Not Analyzed LT -Loss Tran. C:•Greater Than
Municipality of Anchorage
Department of Health and Human Services
Tom Fink. 825 "L" Street
Mayor P.O. Box 196650 Anchorage. Alaska 99519-6650
343-4744
March 29, 1990
Robert Shafer, P.E.
S & S Engineering
17034 Eagle River Loop Road
Suite 204
Eagle River, Alaska 99577
Subject: Waiver Request for Lot 17 Block 2 Sandlake S/D #2
Waiver Request #WR900071, HAA# HA900071, PID #011-133-08
Dear Mr. Shafer:
Your request for waiver of the required 10 foot separation
between a septic system and a lot line has been approved. The
waived distance is 8 feet.
This approval applies to the existing septic system lot line
separation only. Any future upgrade to the septic system will
require all separations be met or another approval from this
department.
Sincerely,
A�v . /fiorif
Daniel J. Roth
Civil Engineer
On-site Services
ljw#7
Concur:
John Smith, P.E.
Program Manager
On-site Services
it.
blanch 26, 1990
ROBERT SHAFER, P.E.
ROGERSHAFER
CIVIL ENGINEERS
(907) 694-2979
FAX 694.1211
HEALTH AUTHORITY
APPROVALS
MunicipaEity o6 AnchoRuge
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ATTN: Dan Bottes
825 L Strteet
SEWER&WATER
MAIN EXTENSIONS
P.O. BOX 196650
Ancho4age, Alaska 99519-6650
REFERENCE: Lot 17; Bloch 2; Sand Lake 02
SEWERAWATER
INSPECTION
Dean Dan,
At youa Lequezt we have neaampted wate4. 6nom .the watea ayatem seay.ing
the ae6mnced pnoputy. See sample neauM attached..
ENGINEERING STUDIES
ANDREPORTS
pI
We aEso Legeust an "o661c.ia " waiver be panted Jon the dc6tance
between the aepti.c teach6ieCd and the north. pnopenty .Eine at a di.atance
o6 5 it. a6 indicated on the septic system inspection nepott dated
OctobeA 29, 1982., Attached is a a4te plan and an as -built aunvey 6oa
WELLINSPECTION
the pnopenty.
A FLOW TEST
A tetteA of non -objection wa6 not obtained Jaom the ownea o6 the
neighboring Lot 18, a.ince thein aeptic 6y6tem also encnoachea upon the
aame lot .Eine according to the aept<c .inapecti.on neportt done on Lot 18
SITE PLANS
on OctobeA 29, 1982. Theae6oce, they would unqueationabty not object..
Granting th.ia wai.veA wilt not a66ect the neighbon.ing pnopetty Jnom
e6tabtiah.i.ng an atteanate a.cte 6o2 thein aeptic 6yatem.
ROAD DESIGN
16 you %equ,iae additi.onat .in6aunation 6o2 your aev.iew, pteabe contact
U6.
SOIL TEST
S.incehety,
PERCOLATION
� RT A. SHAFER, P.'E.
TEST
^ ,
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
WASTE WATER
DISPOSALSYSTEM
DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
SCALE
u
a O r
r � a
i Z r
n
x
0
G
_ ►tf
a
4,8 C
Time
APPLIC NT FILLS OUT UPPER HAL'-�ONLY
Property Owner S7GtJE
H2L50 /1` F Tn-)-.-C�))')f �-L
Ph(��Zy53.
Mailing Addren
p F, Zip Code S 13
<' - � ell,
Buyer
Date
Date
Address
Zip Code
'S
Lending Institution
/
���r lz-i /%rL( TNL i X.S %UNF7
Phone
Address
Zip Code
7t - Z Sj
Realty Co. d Agent
e -ci/ t4iR, w/ in)FS, 6�"c �SoI)
Phone
Address. O
z `.zr 7< Zip code
Legal Description
iYJ ey) 1�L
OCT 2 1 1982
Street Location
RECEIVED
( Yl APPROVED BEDROOMS 2.e
Type of Residence
(/�) DISAPPROVED
( ) CONDITIONAL APPROVAL'
��'f
.Single Family
BY:
❑Multiple Family No. of Bedrooms
Solis Rating
❑ Other
Well To Absorption Area
Well Log Received
Water Supply
Well to Tank
O Individual
ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975.
Community
For wells drilled prior to that date, give well depth (attach log
if available).
Public Utility
Sewer isposal
Individual
(� /� �-„
Xap116 - Year Individual Installed:
❑ Public Ullity'
❑ Holding Tank
1 tI /I�� When Connected to Public Utility:
n py fLm- d CIS . � V l .U.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
4,8 C
Time
Time
Time
Time
f
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
0","
Field Notes:
V110Oi/1 -
MUNICIPALITY OF ANCHORA
C°PT. Ce j ---1T1- F.
ENVIRJ:Jt.:`L:A_ ::.V S -TION
OCT 2 1 1982
RECEIVED
( Yl APPROVED BEDROOMS 2.e
'CONDITIONS OF APPROVAL
(/�) DISAPPROVED
( ) CONDITIONAL APPROVAL'
��'f
DATE
BY:
Solis Rating
Date Sewer Installed
Well To Absorption Area
Well Log Received
Septic Tank Size
Well to Tank
72423 0b