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Home My WebLink AboutSAND LAKE #2 BLK 2 LT 9and Lake #2 Block 2 Lot 9 #011-133-40 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION \ 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAMEo r+Se Alu/fes PHONE 3 - 33 NEW ❑UPGRADE MAILING ADDRESS LEGAL DESCRIPTION -42 oCL LOCATION INO. S�Z .i� a .✓ OF BEDROOMS � .Y E DISTANCTO: Well Q} Absorption area 7 Dwelling 113 s PERMIT NO. 2-03.14 n a2 w F Manufacturer Material \_ VT No. of compartments Liq. capacity in alions IF HOMEMADE: Inside length g Width Liquid depth dtlZ DISTANCE TO: Well Dwelling PERMIT NO. xs-- Manufacturer Material Liquid capacity in gallons OI w= Well I QO Foundation , Nearest lot line i PERMIT NO. n LL Z NooImes [T'DfSfTANCEfTO: Length of each line,/s Total length of lines, Trench th� Distance between ImeGnches D othe ish grade 11 9 Material beneath the 17.0 inches Total effective absorption area a' w U Length Width Depth PERMIT NO. < F- wd Type of crib Crib diameter Crib depth Total ellecuve absorption area CA DISTANCE TO: Well Building foundation Nearest lot line .i _1 Class Depth Driller Distance to lot line PERMIT NO. i DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER Z lit PIPE MATERIALS C- P SOIL TEST RATING Z ' INSTALLER t REMARKS i — APPROVED / DATE LEGAL S�InMn6_'12L 72-013 (Rev. 3/78) TYPE OF SOIL AB=SORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING <50 FT/BR)= 280 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C•EF TH= 1- LEr IGTH= 51 GRF1� EL C�EF•TH= 1C� 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 (IN FEET). RECA LJ I F E=EC _•EF'T I r TFir4F< 'S I ."E= lLCOC CD C3FiLLC3r40 PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER: OF RESIDENCES THAT THE WELL WILL SERVE. --- TWAD c i2 > I r-d•SF•ECT I CDr,J�,= FiF:E F:EEtiiL1 I F:ELN --- SACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL 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 DIAGRAM'_ ARE AVAILABLE TO INSURE PROPER: INSTALLATION. F•EF F1 I T E`r;F' I F?E• — M11 1E4 •• I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I 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 CANT Hi LLPTOUI wT CONST `� i ISSUED BY__--_'��-!� -- - --- -------DATE_- �M--L V4. 0 t i LJ r,J I G I Ff L I T Y C3 E Fi r J r µ:i, F: n r E � DEPARTMENT HEALTH AND ENVIRONMENTAL ?OTECTION l/ � 825 'L' STREET, ANCHORAGE, nk 99501 264-4720 PERMIT OtJ—� I TE NO. C 820274 ) �Et•JEF: F•EF:t'1 I T APPLICANT HULTQUIST CONST 4761 MARS DR LOCATION SAND LAKE 344-9133 LEGAL L9 E2 SAND LAKE #2 LOT SIZE €750 SQUARE FEET TYPE OF SOIL AB=SORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING <50 FT/BR)= 280 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C•EF TH= 1- LEr IGTH= 51 GRF1� EL C�EF•TH= 1C� 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 (IN FEET). RECA LJ I F E=EC _•EF'T I r TFir4F< 'S I ."E= lLCOC CD C3FiLLC3r40 PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER: OF RESIDENCES THAT THE WELL WILL SERVE. --- TWAD c i2 > I r-d•SF•ECT I CDr,J�,= FiF:E F:EEtiiL1 I F:ELN --- SACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL 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 DIAGRAM'_ ARE AVAILABLE TO INSURE PROPER: INSTALLATION. F•EF F1 I T E`r;F' I F?E• — M11 1E4 •• I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I 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 CANT Hi LLPTOUI wT CONST `� i ISSUED BY__--_'��-!� -- - --- -------DATE_- �M--L V4. 0 M--'-•'='-T"A�w^-�rw_-a[r--•1T�-----_r..�•.1-.-.-_.__... ---_-�..'�..�--�•----'-•T�'.-.!•.,.rtti..•�wr—maw F i MUNICIPALITY OF ANCHORAGE �,r ��^; • •.+\ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION n PERCPERCOLATION �825 L. Street, Anchorage, Alaska 99501 264/720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: L]11 •�'1 L �1II _r C/Y IRC(. DATE PERFORMED: 5-- LEGAL DESCRIPTION: 14 Z /o I7 q-/ "o ab4� PERFORMED BY: 6 rt". l qer (( CERTIFIED B -V.• : �•"" Pgtli,e" :ri • DATE: ('-� ZZf- 8•t Y:' : •••%•' y. ni1. J , .y;'i!,••...• •.�� Yom'. 72-008 (4/79) •'..I/r'M.•.•! �r� &UE O a n sm STEVE COWPER, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION/ SOUTHCENTRAL REGIONAL OFFICE 3601 C STREET, SUITE 1334 ANCHORAGE, AR 99503 (907) 563-6529 June 29, 1990 - -Robert E. Dowers Seaview Homeowners Association 8125 Seaview Street Anchorage, AR 99502 Dear Mr. Dowers: Re: Lot 9, Block 2, Sand Lake 12 Water System Approval PWS 1216156 Based on a review of recent correspondence and of the records, the Department finds that your water/waste system is in compliance with applicable regulations. A waiver granted in -1982 is still in effect for the separation distance between the well and the closest septic tanks. A recent analysis for potential nitrate contamination indicates that there has not been a measurable deterioration of the groundwater. This letter supercedes other correspondence written on this property. If you have any questions, please contact me at 563- 6529. Since ely, ✓rte Arthur D. Ronimus, P.E. Environmental Engineer Drinking Water/Wastewater Program ADR:rlw cc: AWDO MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION WN 2 91980 RECEIVED v��::v:.,..LL:'�w':Lw�:.a:�'—Y•.'.(_�'.:��.�:::�iai:i'.�.sw..ua�r�..a:ra.a.,.,w:laK:.rw�•Iw•ir...r.:y:..�w,w.•..r..—..u..��—........� __ .. CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT Plans for the construction of Sfi lel n !_ A -k Sal l? P ToLs iDrl) 12 R16r L 2 Lotri- l:l i o lab [ A0 a Oell f - F74- f Ot public water system located in17A,- L, k4 le- Alaska, submitted in accordance with 18 AAC 80.100 by have c F�cTFtt ..r r.s have been reviewed and are Fes' approved. ❑ conditionally app oved (see attached conditions). / r4.trtvunN,r)tf�{! �If7rr+rr� ��-1SAi If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. APPROVED CHANGE ORDERS Change (contract order no. . Approved by Date or descriptive reference) The "APPROVAL TO OPERATE" section must be completed before any water is made available to the public. APPROVAL TO OPERATE The construction of the Teeite( (4 kr S i/ L rb, k If— f .,fS %— / Z public water system was completed on 47 It ff r /c! (date). The system is hereby granted interim approval to��erate for 90 days following the completion date. �ii., �;• C- (/s..t�l.� �— �[/-'.��%�� f:. > v<re�li� 1 C -n :, r>,�� v 'TILE 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 f al approval to operate. �1r;Cc' 7 -7— it✓1 /�— /iM l! Ivc: �.. tLtYf �Tu/ �61 r� 1•r a'r� By TITLE DATE E f;d';i). 'aw DEPT. OF ENVIRONMENTAL CONSERVATION/ ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 June 1, 1990 Mr. Bruce Corwin Corwin & Associates, INC. 1000 E. Dimond Blvd., Suite 205 Anchorage, AK 99515 STEVE COWPER, GOVERNOR 563-6775 SUBJECT: Request For Waiver For A Three Bedroom Home Approval On Lot 9, Block 2, sand Lake No. 2, Anchorage (9021 -WA -023) Dear Mr. Corwin: Die have reviewed your waiver request for the subject property and cannot give approval. The water system certification condition that only allows two bedrooms per home on the water system was intended at the time of its issuance as a waiver for allowing a local community well to exist within a relatively high density populated area for homes with on-site wastewater disposal. The Department does not issue a waiver on top of another waiver. We suggest that the home be converted back to two bedrooms to comply with water system conditional approval. If you have any questions, please contact me at our Anchorage Western District'Office. HPL: bas cc Bruce Erickson, AWDO I JdFn Smith, DHHS Sincerely, Michael P. Lewis, P.E. Environmental Engineer (73A13D38 n 8 lint; NaU310,yd 'h'LVlWNObb1N3 a0VbCT H dO 03 &n VdIDI" •� � n 5(� O 2 n� n� M nSTEVE COWPER, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCIIORAGE WESTERN DISTRICT OFFICE 563-6775 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 FOR: CORWIN & ASSOCIATES Attn: Bruce Corwin May 2, 1990 PWSID: 9216156 According to the records on file in this office, the Sand Lake 92, Block 2. Lot_2 Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, U rC,{t Cti �. VERA E. CRAIG Environmental VEC:bas (�VArI• �'t'�l��inde. LP Field Officer CS "rcvp \ Municipality of Anchorage • Development Services Department Building Safety Division i On -Site Water and Wastewater Program A a T 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. n11 -1B3-46 COSA# Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 9 Block 2 Sand Lake #2 Location (site address) -.9125 Se- ctrl ew Z>�- . Current Property owner(s) Colin Roth Day phone 727-1191 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 7551 Randamar Place, Anchorage, AK 99507 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 Day phone Day phone 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site El 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 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 Onsite 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, 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 files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services, LLC Phone 272-8218 Address P.O. Box 102954, Anchorage, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date 6118/07 Engineers Comments: In conducting an adequacy test, l attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water •••�� QF aaaaa• levels that may fluctuate during the year, and the water usage of the family being served by the system. .•.`p,,,.�'"""" •j 'Riese conditions arc outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that re there are no hidden defects or encroachments. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed ♦ Steen R nnone above. Any reliance upon or use of this report by any other person or party is not authorized nor will it ��/,7� N.. E 1114 confer any legal right whatsoever. 1a0e-'O .�,�,,,,,,. 5. DSD SIGNATURE 4'. •• ,SZ' Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Well Flow Advisory Nitrate Advisory Maintenance Agreements Supplemental Engineer's Report Other By: � / R Original Certificate Date: 7-11-0-7 tae. „zest Municipality of Anchorage • Development Services Department Building Safety Division On -Sita Water & Wastewater Program 4700 Bragaw Street P.O. Box 196850 Anchorage, AK 99519-6650 www.muni.org/onsfe (907) 3437904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lail) Block 2 Sand Lake f12 Parcel ID: 0 I 1 - f 3 3 '1� O A. WELL DATA Well type ft completed Total de ft. O� Data of test Static water level Well production WATER RESULTS: If A. B, or C provide PWSID R JIM Well Log (Y/N) Sanitary seal (Y/N) Cased to ft. WELL LOG g.p.m. _.Q __cwlonies/100 mL b0_Z mgA B. SEPTIC/HOLDING TANK DATA Protected (Y/N) Casing height (above ground) In. AT INSPECTION Nitrate mg/L Other baked Date of sample: 0tv'AF67 Collected by: ft. 9.p -m. oolon"100 mL rte_.. PA,1n" E Tank Type/Material 0mr6teel Date installed GI M982 Tank size 1000_ gal. Number of Compartments j Cleanouts (Y/N) Y Foundation cleanout (Y/N) + Depression over tank (Y/N) N High water alarm (YIN) NIA Date of pumping 58212007 Pumper McDonalds Pumping Service C. ABSORPTION FIELD DATA Date installed 0128/1982 Soil rating (g.p.d.A1e or fe/bdrm) jV__ System type Deep Trench Length 54 ft. Width 3 to 4 R Gravel below pipe 10 ft. Total depth 14 ft. Efl. absorption area 1Mfe Monitoring tube Y Depression over field N Date of adequacy test 444 n Results (PasslFail) Pass For j bedrooms Fluid depth in absorption field before test in. Water added4 + gal. New depth in. Elapsed Time: io min. Final fluid de _ in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date STATION Date Instaffkl-�- 'Pump on' level at Datum Size in gallons "Pump off" level E. SEPARATION DISTANCES SEPARATION DISTANCES FROM Septic tank/IIR station on lot Absorption field on lot alarm level Meets siarm b arcuil requirements? O On adjacent On adjacent lots in. Public sewer m ' Public sewer manhole/cleanout Sewer c service line Holding tank mal containment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTICfHOLDING TANK ON LOT TO: Building foundation 5+ Property lineJQ+ Absorption field 10' Water main nr) 'k'� Water service line 25+ Surface water 100+ Wells on adjacent lots 1411 LZ)o, wd �iy Dom. `5ee le i IA P- LQ da4ed (p 09/q 6 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 5 Building foundation 10+ Water main :,moi f Water Service line 25+ Surface water _100+ Driveway. park VIvehide storage `s Curtain drainoN ne Observed Wells on adjacent lots 200+ F. COMMENTS G. ENGINEER'S CERTIFICATION••.. 1 car* that I have determined through field inspectbns and?' review of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. �q�!ee♦ y `. j,, • Engineer's Printed Name Steven R. Pannone. P.E. Date L :Steven . Pannone ' �� `• rya. rr 1.4q 1._ Fti,�...;;rr4 d COSA Fees 4"30 — Date of Payment —(-0) jqIn-+ Receipt Number —1 LQ I ---fl (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number Jun 10 07 06:00p Colin Rath 907-245-1126 P,1 03/10/1996 03:05 2720738 HILDONEN PAGE 01 i ' QRArIL':Dt.. 'a c ;�. 1 .. • IF.J.0 OU old, I Nd 9• ?6' .79..W i J3S OG WEWTS. OF 0MORPi OTHER THAN ! 1 i 7HOSEGSHOIV4.ON Trot RECOR3'b • ♦: b4�ti.. PiAT� /1RE •NOT SFi0WN .HEREON. i i+:' Comws, i.i iTp.:pa� .I�-.. ac ; ►►r :Ma• 1S - . { Mnlby an:lreir 1 rwgnr yw tdbriA Oe>wN+e pprrq, Lw.Z•hwY 2 . • 4 oi"e . . •�AMo. to"rp 346D,'wo. 2' .A�I�ery+,epa/Iw/ R1ei�iq ��. •:ie.tM' , i y.\S` �' • .. IM inNrew1WAWd Mrw w w+Ml. ,00 P"00" .Yw M/. tb IML M M • 'V on' tti i .. , ro..•?r, _kw, �� r1.,..u. ti:w �. �.aewwn aI ; bwnw: � • ' 19 • :: �. '►,Pe IIrO M:M�, r�iwlnl )n'�w.ebn sMjtlw tnr rd wiw uw w !W wr�N MI MN �!eM�1 MpM #Mno h�sn, ! : '/�CZi�v2TiFFE 2l '41my..:2000 i e �►•� ' SCS RcEN Client Name Project Name/N Client Sample ID Matrix PNVSID Sample Remarks: 1072917001 Pannone Eng. Srv. 8125 Seaview 8125 Seaview Drinking Water 0 All Dates/Times are Alaska Standard Time Printed Date/Time 07/102007 15:12 Collected Date/Time 06252007 11:05 Received Date/time 06252007 11:17 Technical Director Stephen C. Edt Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Metals by ICP/FIS Arsenic 50.2 + 5.00 ug/L EP200.8 C (<10) 0627/07 07/09/07 TK Waters Department Total Nitraic/Nitrite-N Microbiology Laboratory Total Coliform ND 0 0.100 mg/L SM20 4500NO3-F D (<10) coVI00mL SM209222B A (-Cl) 07/03/07 JDS 0625/07 DLC \ Municipality of Anchorage • l Development Services Department Building Safety Division , au ar. On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # 070195 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 9 of Sand Lake #2 Subdivision. This inspection revealed an arsenic concentration of 50.2 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On -Site Water and Wastewater Program website (vr,vw.muni.org/onsite or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. MUNICIPALITY OF ANCHORAGE !/ Department of Health & Human Services w 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. # d�/-/3 3 -¢O HAA # 1&f1f76zsA 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (includebl lot, block, subdivisio/n,, section, township, range) Location (address or directions) ��'��9y ,�i,� (b) Property owneru4�eeX Telephone: (home) ��1Business � Mailing AddressylZs S�A(/1 �u (c) Lending Institution � Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here List contact person and day phone number below: 2. TYPE OF RESIDEN 3 Single -Family Number of bedrooms6 3. WATER SUPPLY Individual Well ❑ Community Public ❑ hold for pick up.) Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DI t O AL 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. 72-02S (A". 7/88) 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 regu}ations in effect on the date of this inspection. Name of Firm Telephone 2-7f Address e)- &)X' 9 306U4? 6�,GL�� Oi AF ��Ct��/tet 7rrjS23—CG�� Date ✓1Z/ ,( W r�, f• u�,w Engineer's Seal 6. DHHS APPROVAL /� // Approved for bedrooms by �// W �r4/� DateAm-� Approved.1k. Disapproved Conditional Terms of Conditional Approval / �vs,*s c�Ca Tiilv[� .tD/i/2d�` rs-Z /zo,-L A�,;ITr 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 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. 72a025 (A.". 71881 eek Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) • Health Puthorlty Approval (HAA) LITv of n CLy 9YAT - FEBRUARY 1984 E ENTAL St._ I - ' 343-4744 MAY 21990 Le al Description: A. WELL DATA RECEIVED &C, Well Classification r�If A, E.C. Approved (Y/N)Well Log Present (Y/N) � Date Completed a%t&f�a" Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhe /N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ; On<Joining Lots - i To Nearest Edge of Absorption Field on djoining Lots To Nearest Public Sewer Line To ar lic Sewer Cleanout/Manhole To Nearest Sewer Service Line on Water Sample Collected by ; Date Water Sample Test R is Comments B. SEPTIC/HOLDIN�GjTANK D T Date Installed _/ « izee ZOO No. of Compartments Standpipes (Y/N)_Air-tightCaps (Y/N)FoundationCleanout (Y/�I) Depression over Tank (Y/N) A-/ ' n Date Last Pumped $z�D /�tItL�S Pumping/Maintenance Contact on File (Y/N) for Holding Tank High -Water Alarm (Y/N)��Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well _ �J�O To Building Foundation S To Property Line To Disposal Field To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Comments 72-026 (Ray. 7/W) Front Page 1 of 2 C. ABSORPTION FIELD DATA per, Soils Rating in Absorption /$ptrata G° Type of System Design Date Installed ! %8 Z I%.R�� Length of Field / Width of Field ?ce _a4b Depth of Field Gravel Bed Thickness Square Feet of Absortion Areav /10' /Z� Statndpipes Present (Y/N) Depression over Field (Y/N) Date of Last Adequacy Test ✓�,/ /� %� JI Results of Last Adequacy Test ./-rz / /✓ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well 15-69 /_/_ To Property Line To Building Foundation To Existing or Abandoned System on N/ Lot A,"9 A— ; On Adjoining Lots To Water Main/Service Line �� / To Cutback (if present) N//¢ To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at — High Water Alarm Level at Tested for or Vehicle Storage Dimensions Manhole/Access Level at Vent(Y/N) Meets MOA Electrical Codes (Y/N) Comments "Check Permi I certify that I Inspection. Signed Company � Date MOA No. — Against HAA Request" , or conformed to all MOA and Receipt No. a /95-0 / 13r 3 Date of Payment J ,Z--`�0 Amount: $ 1%D -X) 72-M (Rw. 7M) Beck Receipt No. _ Waiver Fee: $ Date of Payment Page 2 of 2 Pumping Cycles during Adequacy Test. L tceab C6S1=3 on the date of this Engineer's Seal !/ MUNICIPALITY OF ANCHORAGE Department of Health &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 l.D.k__nt1 1 -217 -LIQ HAA# SR 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, Location (address or directions) W (b) Property owner range) (' (home 3 Z Business Mailing Address ��Z Ss JPZWeCC% r� (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here List contact person and day phone number below: 79- 2. TYPE OF RESIDEN Single -Family Number of bedrooms 3. WATER SUPPLY Individual Well ❑ CommunityPublic ❑ hold for pick up.) Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE D OSAL 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. 72-M5(A". 7M) 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 regulptions in effect on the date of this Inspection. Name of Firm Address Date _5 Telephone 2 7f—M6 Engineer's Seal 6. DHHS APPROVAL Approved fof bedrooms by Date Conditional Terms of Conditional Approval 674zlzze kJoiilr f//iFC ,�'dr �!x Na /i*llrcnNe t,_ eMiinl? L`/aJr �C aeYs/.,i T all Ris >/<ar Tlu9 a�roo , i77a�Y�i+vus o 0,q 7-44; �aYC! l Coca'/`rib�t.a/ AD�IOUd < i J 9f�Q�r '��Clvr >� ✓u/1� is �i9�• • ,:r_. .... .,.. < . : CAUTION • ... :; � , l . 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 order to 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. 72-025 (Rev. 7168( Back Page 2 of 2 Time I APPLIC'' NT FILLS OUT UPPER HAL��ONLY 1 1 Property Owner HK//llIlpw� r a,d • aC Date Mailing Address M% P,1 Zip Code [7h;18 �+-9/33 Buyer 4 Inspector Address ZIP Code Inspec/(p�r Lending Institution d 8 C 1( 4 l Phone Address Zip Code Realty co. a Agent 1?e�l 7 Ce;.1e. Int. ENVh nUsa..A. f;0 E'.ti_.1 Phone Address i l l(� 1, I^�1,. ct[ h' . zip Code 11,I �'17 r Legal Description ( ) DISAPPROVED ( ) CONDITIONAL APPR9VAL- DATE Street Location Br Soils Rating Type of Residence Well To Absorption Area Well Log Received Septic Tank Size /(9 '06 Single Family Well to Tank Multiple Family No. of Bedrooms 3 ❑ Other Water Supply ❑ Individual ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. Community For wells trilled prior to that date, give well depth (attach log If available). Public Uglily Sewer Disposal V Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date 4 Inspector Inspector Inspector Inspec/(p�r 1\�v,�0 ,-Ai Field Notes: MUNICIPALITY OF ANCHORAGE rrpT c- H: 11.1-4 P. ENVh nUsa..A. f;0 E'.ti_.1 AUu 2 q 1982 RECEIVED (. ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPR9VAL- DATE Br Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size /(9 '06 Well to Tank 1x423IWI