HomeMy WebLinkAboutSAND LAKE #2 BLK 6 LT 10and Lake #2
Block 6
Lot 10
#011-133-27
MUNICIPALITY OF ANCHORAGE
/ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 Estreat -Anchorage, Alaska 99501 Telephone 264-4720
ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME_/
^j'
/ 4 T Coll-��:i/GT701
PHONE
3YI�3C !b
ZNEW
❑UPGRADE
MAILING ADDRESS
g /q 36 A
LEGAL DESCRIPTION
LOCATION
NO. OF BEDROOMS
U
DISTANCE T0:
Wellny�//C
Y
Absorption area
Dwellm s
PEH fIT N0 /9 ,
Y
24
W 1..
Manufacturer6 r ��
Mat
No. No. of compaLtments
Liq. cap c0 gallons
00
1 IF HOMEMADE:
Inside length
Widthth
Liquid depth
fj Y
Jaz
DISTANCE TO:
Wen
Dwelling
PERMIT NO.
2
Manufacturer
Material
Liquid capacity in gallons
o=
W
DISTANCE TO:
Well�`�/,C
Foundation
Nearest line
PERMIT NO.
J LL Z
F- 2 W
No. of lines,
/
Length of each line
�_
Total length of lines
}
Trench idth
inches
Distance between lines
2 tc
~
�
Top of tile to finish gr�cle
Material beneath tile Z
inches
Total effes�i a absorption area
.S
W
Length
Width
Depth
PERMIT NO.
l7
a F
Wd
Type of crib
Crib diameter
Crib depth
Total effective absorption area
W
rn
DISTANCETO:
Well
'
Building foundation
Nearest lot line
J
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
W
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
2Ile
PIPE MATERIALS
�1 f
SOI L TEST RATING
�0
INSTALLER
REMARKS
t
A 11C- /710 de v., tet /2
%his •.ce �o(,c Iva f,K 4 6lADrr.
6
APPHOVED DATE LEGAL
LI—ay—s-Z. )�-Z ,f3G LSD
72-013 (Rev. 3178)
MUr,l ICI PHIL I TY OF= F4r-41r-H9--1 F* iC3E
DEPARTMENT HEALTH AND ENVIRONMENTAL r"iOTECTION
825 STREET, ANCHORAGE, AK.
264-4720
Or -J-1 I TE ' E:t-JEFL PEFtr•t I T
PERMIT NO. ( 220191 )
APPLICANT T & T CONSTRUCTION SPA BOX 4036 A 3452670
LOCATION
LEGA! L10 66 SAND LAKE SUB #2 LOT SIZE 6750 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER.. OF BEDROOMS = 3 SOIL RATING CSG FT/FR)= 100
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEPTH= g LEr-JC3T'H= :3L'-''.' GFRnVE:L_ DEPTH= ---I�
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TPENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
FLEGlU I FLED 5 EPT I r TFFr-JK SS I GE= ZOOO Gnt-t-0 N5
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DUPING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER.. OF RESIDENCES THAT THE WELL WILL SERVE.
--- TIDO < 2 ? I r45~PEr -r I Or -J' FiFZFEE F; EGlU I F; EP ---
BAM'FILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT I -JILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A 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'EFtr'I I T E: ;P I FLEA E>ECEMBEF _* 7�1.r 1S -+c c
I CERTIFY THAT
1: I AM FAMILIAR. WITH THE REQUIREMENTS FOR OH -SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS.
SIGNED
APPLICANT T & T CONSTRUCTION
ISSUED L---------DATE_Zf_GGlbL /! --- V4. 0
f t ! 1 Q' SOILS LOG
MUNICIPALITY OF ANCHORAGE
•� \ ❑ PERCOLATION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST
i1\ 825 L Street, Anchorage, Alaska 99501 2644720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR:7— f I / �.n NS �V a C4,, / DATE PERFORMED:: _/� n•�
LEGAL DESCRIPTION:
SLOPE QITC ct em
O _
EPTH / \ Pf of
(FEET) i J
210(G M)
3
6
s7- 9 ��utl
s -
10 -
:e#
it
12-
13- /1 W)
14 YV
15
16 507uf /s t✓; �F
17-
18
7 16
19
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
—0
Gross Net
Reading Date Time Time
Depth to
Water
Net
Drop
F�1
.►'pAN
•• ''• a�
,
a..
d Jr. ?
9 laroY ald. �
f •.• Hg .•'
10 PERCOLATION RATE (minutes/inch)
/�..�. 'TEST RUN BETWEEN FT AND FT `
COMMENTS < I/S ha (r'C/ CA ` % 0
PERFORMED BY: Dau < . ) e d R 0/7/(/f CERTIFIED BY: DATE:
72-008 (6/79)
L
•
•t Municipality of Anchorage MAY02 2 2018
On-Site Water and Wastewater Program ��I 4{- F'
(907) 343-7904 ALE T Y
C4
°l 6 r, Lg��
Certificate of On-Site Systems Approval
Parcel I.D. 011-133-27 `1 Expiration Date: r
1. GENERAL INFORMATION
Complete legal description Sand Lake #2 Block 6 Lot 10
Location (site address) 8333 Seaview St.
Current Property owner(s) Allison & Sean Hovanec Day phone
Mailing address 8333 Seaview St. Anchorage, AK 99502
Real Estate Agent Day phone
2. TYPE OF DWELLING:
O 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
Individual Water Storage ❑ Holding Tank ❑
Community Class C Well Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: Date: (c /,
COSA to be released to the engineer,unless otherwise retested by the engineer.
COSA Fee $ , Waiver Fee $
Date of Payment 6--/a3//8 Date of Payment
Receipt Number 0Yea 051 Receipt Number
COSA# CSC1VP-96 Waiver#
•
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
WELL ON LOT TO:
Septic tank/lift station on lot 100+ On adjacent lots 100+
Absorption field on lot 100+ On adjacent lots 100+
Public sewer main 75+ Public sewer manhole/cleanout 100+
Sewer/septic service line 25+ Holding tank 100+
Animal containment areas 50+ Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO: , �
,
Building foundation X+ Property line %, L Absorption field 5+
Water main 10+ Water service line 10+ Surface water 100+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+ Water main 10+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+
Curtain drain 50+ Wells on adjacent lots 100+
i F. COMMENTS
( *Monitor tube only extends 27in into a 72in field. vkwo `un •1 �' .
G. ENGINEER'S CERTIFICATION ..."..1- 9F,\q' i
AC��I �
I certify that / have determined through field inspections and ��y'`Q.. 4` '�.v
review of Municipal records that the above systems are in j*; , _ /\ •.*'
conformance with MOA COSA guidelines in effect on this date. I••• ••• '4••• • •••• 0
Steven Pannone �� .• •/
Engineer's Printed Name r• S1even R. •onnone
Date 5/22/2018 I .•• CE-8149 ,., moi
^r
!!>;'�\\s•em •'
COSA canary sheet_2-6-15.doc
If more than 1 septic system is on the lot:
COSA Checklist# 1 of 1
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: Sand Lake #2 Block 6 Lot 10 Parcel ID: 011-133-27
A. WELL DATA
Well type Class C If A, B, or C provide PWSID# 215469 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 ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate ND mg/L
Arsenic 20.4 ug/L Date of sample: 5/8/2018 Collected by: PES
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 4/24/1982
Tank size 1000
gal. Number of Compartments 2 Cleanouts(Y/N) Y
Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N/A
Date of pumping 2/26/2018 Pumper A+ Home Services
C. ABSORPTION FIELD DATA
Date installed 4/24/1982 Soil rating (g.p.d./ft2 or ft2/bdrm) 100 SF/BORN System type TRENCH
Length 25 ft. Width 5 ft. Gravel below pipe 6 ft.
Total depth 6* ft. Eff. absorption area 300 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 5/8/2018 Results(Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 0 in.
Elapsed Time: 180 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d.
N
Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date
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
WELL ON LOT TO:
Septic tank/lift station on lot 100+ On adjacent lots 100+
Absorption field on lot 100+ On adjacent lots 100+
Public sewer main 75+ Public sewer manhole/cleanout 100+
Sewer/septic service line 25+ Holding tank 100+
Animal containment areas 50+ Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANKON LOT TO:
4.4
Building foundation X+ �' Property line y`+ ,+ Absorption field 5+
Water main 10+ Water service line 10+ Surface water 100+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+ Water main 10+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
*Monitor tube only extends 27in into a 72in field. U I\/Q L`D1/ ( j .
G. ENGINEER'S CERTIFICATION • +• oF ,��I
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in 0*; • I\ ••* 9
conformance with MOA COSA guidelines in effect on this date. I• •• ��••1 •••• 0
.„�
Steven Pannone
Engineer's Printed Name r••.S{even W. •Mr;orie:
Date 5/22/2018 �� 4�• CE-8149 Ail
COSA canary sheet_2-6-15.doc
�LIy P�lfr
j-- Municipality of Anchorage »r s.
On-Site Water and Wastewater Program c
P.O. Box 196550 4700 Elmore Road
r.
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 ear
\,,:: .-_,,a-7 http://www.muni.org/onsite Nitoi &` "`
4^'CH0-R-0, De pa r tm nt
Review Comments
Engineer: PANNONE ENGINEERING SERVICES 5/29/2018
Legal Description: SAND LAKE#2 BLK 6 LT 10
Parcel ID: 01113327000
Permit: OSC181225 WellSeptic
Report Type: COSA Completed By: T.Ecklund
The application has been reviewed and the following comments have been generated. These are to be satisfactorily
addressed prior to MOA approval:
1. Please verify Field to lot line#
c2 0..i (,S (-A '
2. Please verify Field to foundation#
3.After a field visit operating level in the tank was 30"which indicates the tank may be in failure. The tank was pumped in
Feb so pumping shouldn't be a factor
2 M.700 D Z/?.._4,/to,
�' - -- M.}l a A.,�-�.. . . (4-e, s SJR S` QA./
Log.
icyI (‘A,)(-- ---iTh s k.N 0 15 - C3.5 lo f3 �2ic
Y w 7'0scoz '7 5 p(1J
6-7.F
.50t)i) / !P)
?7161-rtn-
i
LOT 9 LOT 16
30.0'
-xT. Y,Y_Y N90'00'00"E 135.00' I.
I— 46.3 I t
1.1
J t p •0 N o
0= I • a p
I--- to ® Si EXISTING HOUSE co `"
w o ::: 24.1 LOT 10 o LOT 15
. ..GRAVEL•:.•.•.: , o
5 O .. : N 45.7 O
1.1J 2 SHED N
V) .....
I24.7
21.4 V'
+u
v v v v Y--v_Y- -.rY �Y-�Yr
N90'00'00"W 135.00' oo-F Atp 1
�� OFq�q�p4 )
30.0' 10<c in
or✓i: 4gTHHW ''•90
LOT 11 D� f 0� LOT 14
0
Doo Dowd 14. Dreyer I
00% ;`$
LS-10392 G
til„x, '...s.....' bc,ek LEGEND: SET IND
'ikte,4i ppo 5/e'RB w/cAP 0 Sir Re O
OHLI
::;;' ;
LEGAL DESCRIPTION6 property as thi
shown on s*owing end that the improvements situated thereon , DECKS- —�
LAND h CONSTRUCTION SURVEYORS-PLANNERS-ENGINEERS ore with:, the property Ines and no encrooC n.nts e.ist other thou noted. coNti,sr_ I .. -t
440 WEST BENSON BLVD. g 103 SAND LAKE SUBDIVISION NO 2 EXCLUSION NOTE: It Is the owner,responslbmty.to determine the aistenee ASPHALT_ 1
ANCHORAGE. ALASKA 99503 552-5291 (fox)561-6626 of any easements.covenants.or restriction' touch do not captor cn the CRAWL- I I
.. I,r.c.' ti�F endow wove n.."..0 recorded subQYhlon pot NOTE Unger no csrevnrionees ahold dry eoto SEPTIC STANOPIPEs-®
na non• � W1).1 7774 I t 1: I 516/JS I P-176 hereon be used for construction or for establishing property Inn. WATER WELL-
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT • 14 � 907-343-7904
On-Site Water and Wastewater Section Fax: 343-7997
www.muni.org/onsite -/
Arsenic Advisory
Certificate of On-Site Systems Approval # osc181225
Subdivision: Sand Lake #2 , Block: 6, Lot: 10
A water sample revealed an arsenic concentration of 20.4 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.
Mailing Address: P.O. Box 196650 *Anchorage,Alaska 99519-6650 *www.muni.org
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT • Jr ', 907-343-7904
On-Site Water and Wastewater Section ' Fax: 343-7997
www.muni.org/onsite
Septic Tank Advisory
Certificate of On-Site Systems Approval # OSC181225
Subdivision: Sand Lake #2 Block:6, Lot: 10
The septic tank for this property is 36 years old. The average life for a steel septic
tank is 20 years. Typical replacement costs range from $6,000 to $9,000.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
' ti• :A
' 1' "s ' '');57'7:4> .' i. ' ' '4., 11.1 Ilk 2... •'''.''''' I" •s'
Ct a,,, - ;
y.& , '3 '� i to
•
. t. ',.� „ g- �Cf :" r, 13,x}
Mailing Address: P.O. Box 196650 * Anchorage,Alaska 99519-6650 *www.muni.org
RUSH
Municipality of Anchorage
jA On -Site Water and Wastewater Program
-- (907)343-7904
Parcel I.D. 011-133-27
Certificate of On -Site Systems Approval QJ
Expiration Date: /
1. GENERAL INFORMATION
Complete legal description SAND LAKE #2; BLOCK 6, LOT 10
Location (site address) 8333 SEAVIEW STREE *ANCHORAGE, AK
Current Property owner(s) JESSICA CHERRY
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
Day phone 317-8187
8333 SEAVIEW STREE *ANCHORAGE, AK
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
Individual Well
❑
Individual Water Storage
❑
Community Class C Well
lid
Public Water System
❑
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual
Holding Tank
❑
Community
❑
Public Sewer
❑
Waiver/Variance request for: DRAINFIELD TO FOUNDATION & AMEND WAIVER Distance: 5'& 2'
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 524 �rf
Date of Payment �D! �i 1,5, ('l-07"-
Receipt Number 0
COSA 9 'O5G 5 12(ook
Date:
Waiver Fee $ a15
Date of Payment b (015 -
Receipt Number NO R �°
Waiver# osv 151 b53
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Garness Engineering Group, Ltd. Phone (907) 337-6179
Address 3701 E. Tudor Rd., Suite 101, Anchorage AK. 99507-3246
Engineer's Printed Name Jeffrey A. Garness Date
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic
system in accordance with the guidelines and regulations established by the Municipality of
Anchorage and industry practices. The mooned results describe the condition of the system/s
on the date/s of the evaluation. Separation distances were measured to readily identifiable
features. Hidden defects or encroachments may exist that were not identified during the
evaluation. The operational life of all wells and septic systems deoend on a variety of variables
including, but not limited to, soil conditions, groundwater levels (that may fluctuate during the
year), quality of construction (materials and workmanship), and the water usage of the family
utilizing the system/s. These conditions can vary, and are outside the control of GEG.
Satisfactory test results do not guarantee future celfonnance of the systems; therefore, GEG
makes no warranty (exoress or imolfed) regarding the future performance of the well orseotic
system. GEG makes no representation whether an alternative well or septic system can be
installed on the orooerty in the event either of the current systems fail. The content of this report
is for the sole benefit of the oerson/oarty who retained GEG. Reliance Donn the information
orovided in this report by any other person or party, including but not limited to subsequent
oroperty purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other
than the verson/party who paid for this report
6. DSD SIGNATURE 2
System #1 Approved for bedrooms
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
bedrooms, with the
��������pPLITY(pFf flfr.
STEWIDm=
Blowil�l���'\�
Original Certificate
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 engineers work.
7. ATTACHMENTS:
COSA Checklist �� Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSAbluesheet 91-12doc
If more than 1 septic system is on the lot:
COSA Checklist # _of_
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: SAND LAKE #2; BLOCK 6, LOT 10 ParcellD: 011-133-27
A. WELL DATA CLASS C WELL
Well type C If A, B, or C provide PWSID# 215469 Well Log (YIN)
Date completed Sanitary seal (Y/N)_ Wires properly protected
Total depth ft. Cased to ft. Casing h ' above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level
Well D wn a.D.m. c:D.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate ND mg./L. Collected by: GEG, Ltd.
Arsenic: 21 ug./L. Date of sample: 5JI -1Its
B. SEPTIC/HOLDING TANK DATA STEEL SEPTIC TANK (33 YEARS OLD) IS
APPROACHING THE END OF ITS USEFUL LIFE.
Tank Type/Material SEPTIC/STEEL Date installed 4/24/1982
Tank size 100.0 ,gal,- Number of Compartments 3 Cleanouts (YIN) YES
Foundation cleanout (Y//N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping S/ty' I- Pumper ��5� r
C. ABSORPTION FIELD DATA
Date installed 4/24/1982 Soil rating (g.p.d./ftibrljjbdrm100
Length 25 ft. Width 5 ft.
System type TRENCH
Gravel below pipe 6 ft.
Total depth *6.63 ft. Eff. absorption area 300 ft2 Monitoring tube *ES Depression over field NO
Date of adequacy test 5/12/2015 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 3 in. Water added 1005 gal. New depth 2_5 in.
Elapsed Time: 15 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE If yes, give date —
**ELEVATION OF INVERT WAS NOT APPARENT; FILTER FABRIC COULD BE SEEN AT A JOINT IN THE
VERTICAL MT PIPE. IT IS ASSUMED THE INVERT IS 6" BELOW THE FILTER FABRIC; IT APPEARS THAT
THE MT ONLY EXTENDS APPROXIMATELY 45" BELOW THE ASSUMED INVERT ELEVATION.
D. LIFT STATION
Date installed
"Pump on" level at in.
E. SEPARATION DISTANCES
Size in gallons Manhole/Access
"Pump oir level at_-- ins High water alar level at in.
Cycles tested Meets alar $ circuit requirements
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAi t station on lot On adjacent
Absorption field on lot On adjacent lots
Public sewer main
Sewer /septic service line
Animal
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 *101'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line **2' Building foundation ***5'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parkingivehicle storage 5'
Curtain drain NONE KNOWN Wells on adjacent lots *101'+
F. COMMENTS
*DEC WAIVED IN 1982 **5' PER 1982 INSPECTION REPORT/SEE REQUEST TO AMEND WAIVER
rr�9212W,70kvi21V
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Pri Name JEFFREY A. GARNESS
Date �S
(Rev. I IMM
Municipality of Anchorage E
• "� Community Development Department
Development Services Division
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 # OSC151269
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 10 of
Sand Lake #2 Subdivision. This inspection revealed an arsenic concentration
of 21 micrograms per liter (ug/L) for the property's well water sample. The
Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 ug/L for public drinking water systems.
While private wells are not subject to this regulation, EPA standards are
based on existing health information and can therefore be used to gauge the
relative quality of water from private wells. Information on arsenic is
available from the On -Site Water and Wastewater Program website
(www.muni.or /og nsite) or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
Municipality of Anchorage
Development Services Division
On -Site Water and Wastewater Program
Ment 3
�QP
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epartment
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSVI61053 COSA#.,OSC151269 Permit#:
PID#: 011-133-27
Legal Description: Sand Lake #2. Block 6. Lot 10
Engineer: Carnes$ Engineering Group
Applicant: Jessica Cherry
Your request for a waiver of the required 10 feet horizontal separation from the absorption field
to the building foundation has been approved. The approved separation distance is 5.0 feet..
Your request for a waiver of the required 10 feet horizontal separation from the absorption field
to the property line has been approved. The approved separation distance is 2 feet.
This waiver approval applies to the existing absorption. field only. Any future upgrade to the on-
site wastewater disposal system will require all separation distances be met or another approval
from this department.'
❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
Notarized letter(s) of non -objection have been received from the owner(s) of the affected
adjacent property.
Adjacent properties are not affected by this waiver.
............................. ..................................................
Waiver is Granted: X Waiver is not Grante
Date: cf Approved by:
ame of Reviewer
GARNESS ENGINEERING GROUP, Ltd`s
�
CIVIL & ENVIRONMENTAL ENGINEERS +.�+��.�_�---�-�^^ '� � " �
�
May 18, 2015
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
Ref: Waiver Request for Drainfield to Foundation and Waiver Amendment from Drainfield
to Lot Line; Sand Lake #2; Block 6, Lot 10;
To whom it may concern:
The existing drainfield currently serves the existing 3 -bedroom house. An addition was
built onto the front of the home and the separation distance between the drainfield and
the building foundation is 5 feet. The portion of the foundation encroaching on the
drainfield is slab -on -grade garage floor, so there is no potential for effluent to adversely
impact the structure.
It has also come to our attention that the drainfield is 2 feet from the west property line
(existing waiver is for 5 feet). We request that your department amend the existing waiver
to two (2) feet.
Based upon the aforementioned facts, it appears that there is minimal risk associated
with the granting of the 5 foot separation distance waiver and amending the existing
waiver down to two (2) feet.
, M.S.
3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com
e licit I _2
DEC Sta e o Ata5ka
4Ju:er S-ysR:m Details
l*.x li.kLYFiy.i4 `k e%4i�h 'i� F.IRA
_ ":,�%�BC.2:45�Cc._:. ✓:ov vviL J:r7i//��i /'JY/c:e'S;dam?.'.iS�ci�il.JSi�?u' �n!5...
Water System Facilities Source Water Assessment ResLdis
ColifortnlMicrohial Samale Resulfs Souse Water .Assessment Web Map
- -- Coliform Sample slimman,-Results Lead And Copper Sample Summary Results
Sample Schedules Site Visils Milestones
Non -Coliform Samples/R.esuhs
Non -Coliform Samnles/Results by Anaivte
Violations/Enforcement Actions
0-5469
Systema .–;.� r y ^ e,<
Water System No.: AK2215469 Federal Type iNPS;` '"�� Iti, ✓�
Water System Nmne : SAND LAKE #2 B 6 L 6-12 State Type : e
Principal County Served: ANCHORAGE Primary Source: GW
Status : A Activity Date : 01-01-1997
Pouts VC `1,G5t1 26
M1IW_.mP iPten -L ACFP IvinP .uTAoaP A _wCS al'pnufii
^1onfJ, nrrT ,: A' !NCNOIZdGE. Not A"'ail-b1c
�;uv: fl•. d tie oWs a 'Gvas :ttaoaa Served Service a—nect3®n-
S€ar€ Mouth Stat Dey End Month End Day Population Type Population Served Type Comsat Meter Type meter Size Measure
1 1 12 31 R ` 24 RS 7 UN 0
SService.a:eas
Sources Qa` water
Code Name
Name Type Code Status Availability R RESIDENTIAL AREA
WL SAND LAKE 92 B 6 L 6-12 WL A P
RES TAuxANT
cti-z.... Kct_d_.asas
J?i,Pr WaCP' 9va talo, eve ma;naa r¢I 4..'eP P !1 � 6f^•Z r?. N— 9: T.- _
a l.O�nlpiSSIOIlCr
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Reeplafions
Stamt^s--
Of
- - 5/18/2015 1:12 PivI
Municipality of Anchorage •-
• Development Services Department °
Building Safety Division .. -
On -Silo Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650 /
Anchorage, AK 99519-6650
www.muni.org/onsite �?
(907)343-7904 v
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 13,5'a —4 COSA#
1. GENERAL INFORMATION Expiration Date:
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
SAND LAKE f2• LOT 10 BLOCK 6
8333 SEAVIEW STREET • ANCHORAGE, AK 99502
BRETT do ANGELA BURKHART Day phone 245-5124
Day phone
MARY COX w/ REMAX PROPERTIES Day phone 257-0118
110 W. 38th AVENUE SURE 100 • ANCHORAGE. AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well ❑
Individual Water Storage ❑
Community Class "A" Well 0
Public Water System ❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
0
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Onsite 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 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. /further verify that based on the
Information obtained from the Municipality ofAnchorage riles and from my investigation and inspection, the
onsite 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 CARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD. SUITE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date o t b G
Engineer's 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 B 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, groundwaterlevels 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 Mute 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
l�Approved for _. 3 bedrooms.
Disapproved.
®mrQoa®�
Conditional approval for bedrooms, with the fllowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
By. �
(Rev. lift)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Reort
Other
MiTTe I rAN
VK
ON-SITE
WATER AND
WASTEWATER
PROGRAM '
0'
VIA
Original Certificate Date: /0 —23—D6
Municipality of Anchorage
Development Services Department
FJ Building Safety Division ,. .
O"Ke Water 6 Wastewater Program
4700 Sregaw Street
P.O. Box 196850
Anchorage, AK 99519-6650
www.muni.arglonslte
(907)343.7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: SAND LAKE #2: LOT 10, BLOCK 6 Parcel ID: Oil- 13 3 -27
A. WELL DATA
Well type tem "A•
Date completed _
Tohail —
Date of test
Static water level
Well production
If A, B, or C provide PWSIDp12 5469
Sanitary seal
to R.
FROM WELL LOG
WATER SAMPLE RESULTS:
Coliform colonies/100 ml.
Arsenic:
B. SEPTIC/HOLDING TANK DATA
fl.
g.p.m.
Nitrate mg./L.
ate of sample: _
Well Log
property protected (YfN)
Casing height (above ground) in.
AT INSPECTION
FOM Itr�"'PA
R.
g.p.m.
Tank Type/Material SEPTIC/STEEL Date Installed 4/24/1982
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A
Date of pumping 10/10/2006 Pumper McDONALDS PUMPING
C. ABSORPTION FIELD DATA
Date installed 4/24/19a2 Soil rating (g.p.d./ft'o<E� 100 System type DEEP TRENCH
ml.
Length
25 fl. Width 5 ft. Gravel below pipe 6 ft.
Total depth •6.92 ft. Eff. absorption area300 R' Monitoring tube "YES Depression over field NO
Date of adequacy test 10/10/2006 Results (Pass/Fall) PASS Forbedrooms
Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 7_5 in.
Elapsed Time: 7 min. Final fluid depth 0 k1. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN 3 type) NONE KNOWN If yes, give date
**MT EXTENDS ABOUT 50" BELOW INVERT.
D. LIFT STATION
Data installed Size in gallons Manhole/Access (Y/N
"Pump on' level at _in. 'Pump off"le High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankfllft station on lot
Absorption field on lot
Public sewer main
Sewer /septic service
COMMUNTIY WATER
On adjacent
On adjacent
sewer manhole/deanout
Holding tank
nAnToMaL4e=1nrnen1 areas Manurelanimal 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 *l01'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 5' Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 1006+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots .101'+
F. COMMENTS
•D.E.C. WANED 101' IN 1982.
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 COSH guidelines in effect on this
date.
Engineers Printed Name JEFFREY A. GARNESS
•
Date I e rlr 1. /ol
COSA Fee SV96-06
Date of Payment O/19 J d(.
Receipt Number 5 —1 9
(Rw. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
SRP
Development Services Department
Building Safety Division
Onsite Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ek.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING rr (( Z
Parcel l.D. 011-133-27 HAA # Q�0" t O( J
Expiration Date: I n — 6 — O 4-
1. GENERAL INFORMATION
Complete legal description Lot 10 Bk 6 Sand Lake #2
Location (site address or directions) 8333 Seaview Street, Anchorage, AK 99502
Current Property owner(s) Bryan Bazemore
Day phone
244-3227
Mailing address 8333 Seaview Street,
Anchorage. AK 99502
�e genes US Inspect/Evens Duclair Day phone
703-293-1529
Mailing address 3650 Concorde Pkwy
#100. Chantilly. VA 20151-1129
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, NAA will be held by DHHS
for plckup. HAA picked up by.
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 ell ®
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) on properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also Issues HAAs upon request to home owners. 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 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.
(w. nese)
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 Health Authority Approval Guidelines for 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 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 applicable Municipal and State
codes, ordinances, and regulations in effect at the time of Installation.
Name of Firm _Pannone Eno. Svc.
Phone 272-8218
Address P.O. Boz 102954 Anch AK 99510
Engineer's Printed Name Steven R. Pannone P.E.
Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientiousDate ',
engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. she �� (� A/ ��
reported results describe the performance of the system under the conditions encountered at the time of ♦�••�P� "'•••..... 44
the test, and separation distances measured to readily identifiable features. The operational life time
wells and septic systems depend on the local soil condition,levels_� �•' •• - '••�� �1
during the year, and the water usage of the family being sc ground
by the atter systet� conditions fluctuate
lue s are '
outside the control of the evaluator of this s tem All i ....f 4�3 ni y r}
do not )s systems eventually fail and satisfactory test results 0' '•'••"••••••••••••....L•••
guarantee future perforrtance of the system, nor do they guarantee that there arc no hidden defects 0
or encroachments. PFS can therefore not provide any warranty for future performance nor give any '7 . R. '
estimate of how long the system will continue to meet the operationalrequirements 1 5 Steven R. Ponnone
MOA DSD. The content of this report is for the sole benefit of the o listed above. My rUeliancc upon EC or•1� +'
♦ No. CE 8149
or use of evthis report by any other person or party isnot authorized nor will it confer any legal right 1 ••'• d�
whatsoever.
6. DSD SIGNATUREEc
✓ Approved for _ bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
_7WO. i YOFgp0y2
Additional Comments `��`V�� • •••04
tea: A'rERAND
_ :WR.
Attachments: • S
HAA Checklist X Maintenance Agreements 'J/',/����»fltttt``` `•
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By. � Original Certificate Date:_/ t7 - C - Q 3
Expiration Date:
Reissue Date:
(mw. roast
Municipality of Anchorage e,.•
• Development Services Department
Building Safety Division 4
On -Site Water and Wastewater Program s
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.cl.anchorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 10 Block 6 Sand Lake #2 Parcel I.D.: 011-133.27
A. WELL DATA
Well type # Iq' If A, B, or C provide PWSID # 215469 Well Log jy
Date completed _Sanitary seal _ Wires properly protected _
Total depth ft \ Cased to ft ng height (above ground) in.
FROM
\VpLL LOG AT INSPECTION'
Date of test
Static water levet Xft ft
Well production _
WATER SAMPLE RESUL
Coliform
ml Nitrate mgll
Date of sample: '
B. SEPTIC/HOLDING TANK DATA
Collected by.
bacteria
9 -p.m
colonies/100 ml
Tank Type/Material Greer Steel
Date installed 4/24111982 Tank size 1000 gal Number of Compartments I
Cleanouts Y Foundation cleanout Y Depression over tank N- High water alarm N/A
Date of pumping 10/1512002 Pumper Roto Rooter
C. ABSORPTION FIELD DATA �I.J�
Date installed 1� 21 411982 Soil rating (g.p.d.M2 or fflbdrm)1Q System type Deep Trench
Length.' ft Width 5 ft Gravel below pipe SL- ft
Total depth 9 ft Effective absorption area ,'{QQ We Monitoring tube Y Depression over field N -
Date of adequacy test 9/1912003 Results (Pass/Fail) Pass For,.1 bedrooms
Fluid depth in absorption field before test Q in Water added4M gal. New depthl7 in.
Elapsed Time: 1440 min Final fluid depth Q in Absorption rate >= 4W g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date
(Rev. 11199)
D. LIFT STATION t, I ,yam
Date installed Si in gall l 9
'Pump on" level at_ in"Pump o e fat —in
Datum Cycles tested
E. SEPARATION DISTANCES
Manhole/Access
High water alarm level at _ in
Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELLiaetiOT i& 4 a,
Septic tankflift station on lot 120+"
Absorption field on lot 125"
Public sewer main
Sewer /septic service line
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 10' Property line 1S' Absorption field 5'
Water main 100'+ Water service line 25'+ Surface water 100'+
Drainage 100'+ Wells on adjacent lots 120'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line _5' Building foundation 20 Water main 100'+
Water Service line 25'+ Surface water 100'+ Driveway, parking/vehicle storage 5'
Curtain drain None Observed Wells on adjacent lots 1201+
F. COMMENTS yU� I
-•- -- - - -1-) —41 101_1A1q$7—
G.
,:
I certify that 1 have determined through field Inspections and . 497- .•�'�
►.....i. �...
review of Municipal records that the above systems are in �
conformance with MOA HAA guidelines In effect on this date ,rm..'9 ..................:...
_..:.
# (�E%teven R. Pennon j
Engineers Printed Name Steven R. Pannone. P.E. Irv -
8141
,'
Date Bei'"..�
HAA Fee ;7175.
G57 . �z ,
Date of Payment ` O- ' I rv� f
Receipt Number C
(Rev. 11/99)
Waiver Fee $
Date of Payment
Receipt Number
E
70NYKNOWLES, GOVERNOR
Lj (WjV ,
1
i
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN PUBLIC SERVICE OFFICE (907) 269-7505
555 CORDOVA STREET
ANCHORAGE, ALASKA 99501
May 6, 1997
Mr. Ross Clay
8317 Seaview St.
Anchorage, Alaska 99502
SUBJECT: Lot 6-12, Block 6, Sand Lake #2 Subdivision, 8317 Seaview Street
Class "A" Public Water System, PWSID # 215469
ADEC Project No. 9736-0201-WJ-209
Dear Mr. Ross :
I have completed a review of this office's files concerning the monitoring status of the above -
referenced Class "A" Public Water System and found the following:
The last satisfactory Total Coliform Bacteria Sample results were submitted to this
Department on April 9. 1997. This dS meet the provisions of 18 AAC 80.200(a)
of the State Drinking Water Regulations.
2. The last inorganic Chemical Contaminants Sample results were submitted to this
Department on October 5. 1995. This d= meet the provisions of 18 AAC
80.200(a) of the State Drinking Water Regulations.
a.) The last nitrate sample result was submitted to this Department on April 19,
1M. This d= meet the provisions of 18 AAC 80.200(a), of the State Drinking
Water Regulations.
3. The last Radioactive Contaminants Sample results were submitted to the
Department on July 6. 1993. This d4SS meet the provisions of 18 AAC 80.200
(a), State Drinking Water Regulations.
4. The last Organic Chemical Contaminants/Volatile Organic Chemical (VOC) were
submitted to this Department on January 4. 1996. Based on analysis of the
previous VOC samples, results ham been satisfactory. This d= meet the
provision of 18 AAC 80.200(a).
k
A
Mr.- Clay 2 May 6,1997
The issuance of this letter does not imply that the above -referenced Class "A" Public Water
System is in compliance with other provisions of the State Drinking Regulations. Unless
otherwise noted, this letter is valid for 30 days and is for the specified legal description noted
above only.
We have attached an invoice (!/203538) which indicates the necessary fee. Please make payment
to this office at above address. Submit the white copy with payment and keep the yellow copy
for your records.
If you have any questions on the above information, please do not hesitate to contact this office
at 269-7505.
Sincerely,
,��,Z-'_'
Michael Lu, E.I.T.
Environmental Engineer
Attachments
MLU/ph
C:%.rd.utl"W..Nu.%..dUCM
CONSTRUCTION AND OPERATION CERTIFICATE
ALASKA DEPARTMENT
OC WATER NMENTAL CONSERVATION
BLI.
APPROVAL TO CONSTRUCT
Ce
Plans for the construction of
f3LOGk (o LOTS �— 12 �'A}UA
�' , r i 1 Q (� S f public water system located
0 a- A. C le =. Alaska, submitted in accordance with 18 AAC 80.100
in
7 r �p 1� have been reviewed and are
If approved.
conditionally approv d (see attached conditions).
UV
tlr��
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 (at &Kr orCH afa
Approved by Date
or MIcr1DrM nipenu) q .
-Wek rPe IS -0 it GVeg+�ic btSTe HCP
to
The "APPROVAL TO OPERATE" section must be completed before any water is made available to
the public.
APPROVAL TO OPERATE
The construction of the &If 1� — public
water system was completed on t 1 " 12:9-L. $1- (date). The system is hereby
granted interim approval to operate for 90 days following the cpmpletion date.
BV TITLE DATE
As -built plans submitted during the Interim approval period, or an inspection by the Department has
confirmed the system was constructed according to the approved plans. The system is her granted
fina pproval to operate.
a —
TITLE ATE
�e�
� n
MUNICIPALITY OF ANCHORAGE
SERVICE$
DEPARTMENT OF HEALTH & HUMAN
Division of Environmental Services 91
- On -Site Services Section
P.O. Box 196650 Anchorage. Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcell.D.# OICHAA it !-IAg5�o3S
1. GENERAL INFORMATION
Complete legal description %c G /D i31< to La-Z
Location (site address or directions) LE" S' Zv i '.
Property owner �r�a�N� V1/l�� Dayphone a266 -72A7
of __-1 90A/.r_
Mailing address
Lending agency
r,
Day phone X56 y— O;LS7
Mailing address t 0 f^'IS°''1 1!� !!1{
Agent -"��° c Day phone26
Address
Unless otherwise requested, HAA wilt be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well
Community well e--.
Public water hIf'/StD 5
NOTE: If community well system, provide written confirmation from State ,4I '(' ,
Ing to the legality and status of system. I. 1. f .N
4. TYPE OF WASTEWATER DISPOSAL'
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
naum.•.+A+� FmM MOAni
5.
STATEMENT OF INSPECTION BY ENGINEER r'
As certified by my seal affixed hereto and as of the validation date shown below, l 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. l furtherverify 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 ofFirrrr moi, �a r(� (Qc�dl Phone -A%_9 -3f/(0
Address 3 ! Y/
Engineer's signature
6. (._DHHS SIGNATURE
Approved for_
/ Disapproved.
Addit
By:42'
////,, :� •'° 'x'1'0
- y
bedrooms.
Conditional approval for bedrooms, with the following stipulations:
ilComments
1.:
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 orderto 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
naa m••• w+) 9.a uo„ m
Municipality of Anchorage
Department of Health and Human Services
® HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: No,Sy- L, Sa�nDl,+Lr'�`L-_Parcel t.D. 1?
A. Well Data
Well type ' 6�If A, B. or C, attach ADEC letter. ADEC water system number
Log present (YIN) Date completed Driller
Total depth Cased to
Sanitary seal (YIN)
FROM WELL LOG
Date of test
Static water level
Well flow
Pump levell
SEPARATION DISTANCES FROM WELL TO:
Septictholding tank on lot
Absorption field on lot
Casing height
,Wires properly protected (YIN)
AT INSPECTION
g.p.m. 9.00
rn �• q
N�a
Public sewer main Public sewer manhole/cleanout
Sewer service line Petroleum tank
WATER SAMPLE RESULTS:
Coliform Nitrate Other bacteria
Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed y'.2q . A,�- Tank size 190 Compartments .2
Cleanouts (Y/N)_Foundation cleanout (Y/N) Depression (YIN) tJ
N
High water alar (Y/N) N�A Alarm tested (YM) �A
Date of pumping
101q I qPumper At t4ome SeLr• ES
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Weil(s) on lot 11114 On adjacent lots i -20-0 Foundation 7.
To property line '> / D Absorption field .5 Water main/service line > 1 D
Surface water/drainage No h r✓
CONTINUED ON BACK PAGE
72.WS PP' Fmrrt
l_
C
rn
w
�
�K
m r
<_
On adjacent lots n1
`^
On adjacent lots
c
Public sewer main Public sewer manhole/cleanout
Sewer service line Petroleum tank
WATER SAMPLE RESULTS:
Coliform Nitrate Other bacteria
Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed y'.2q . A,�- Tank size 190 Compartments .2
Cleanouts (Y/N)_Foundation cleanout (Y/N) Depression (YIN) tJ
N
High water alar (Y/N) N�A Alarm tested (YM) �A
Date of pumping
101q I qPumper At t4ome SeLr• ES
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Weil(s) on lot 11114 On adjacent lots i -20-0 Foundation 7.
To property line '> / D Absorption field .5 Water main/service line > 1 D
Surface water/drainage No h r✓
CONTINUED ON BACK PAGE
72.WS PP' Fmrrt
C. LIFT STATION N/A
Date Installed Manufacturer
Size in gallons Manhole/Access (Y/N)
Vent (Y/N) 'Pump on' level at 'Pump off" Level at
High water alarm level Cycles tested
Meets MOA electrical codes (YM)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date installed Soil rating (GPD/Ft') t9O System type �.v . G
n o
Length Width 5 r Gravel thickness t Total depth I
Total absorption area 3 trrc Cleanout present (Y/N) y Depression over field (Y/N) 1J
Date of adequacy test I ��t.� �4 5 Results (passlfail) }� for 3 Bedrooms
Water level in absorption field before test IDAftertest
Peroxide treatment (past 12 months) (YRV) ISI `" If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot Mia On adjacent lots > 2 0-0 Property line
To building foundation AD To existing or abandoned system on lot
On adjacent lots > 2,0 Cutbank /tel o r Q Water maintservice line I D
Surface water No r7 e, Driveway, parking/vehicle storage area O '=
Curtain drain NO Mr
E. ENGINEERS CERTIFICATION
1 cer* I hat 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature
Engineer's Name 660 S'n., �\4_ln K e -R ;mss
Date
`��� X45
� . - '•., cc .... s
') • SIJ
HAA Fee $ Waiver Fee $
Date of Payment ��I��9�� Date of Payment
Receipt NumberReceipt Number
7226 t=)' Back