HomeMy WebLinkAboutSAND LAKE #2 BLK 5 LT 12$ond Lc ke
Block 5
Lot 12
#011-134-25
Municipality of Anchorage Pa§e
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
P,O. Box 196650 Anchorage, AK 99519-6650
www.ci,anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW020334 PID Number: 011-134-25
Lee Runestead Wastewater System: -Nmu.- ~
8349 Seacliff Ave. Anchorage, AK 99516 ABSORPTION FIELD
248-0441 ~ D~t~-/-/~,~c~ ~
LEGAL DESCRIPTION ~~ ~
~,o~: t~: s~,~: 1-2 c.~ 10.5
5 12 Sand Lake No. 2 4.5 F,. 6
~ i F,. 31
Well: Existing c.,~ width;
3 ~.
Private ~. Ft. 372 Fe ASTM D3034 PVC
F,. Acreage Systems 9/18-23/02
~ . ~. TANK - NEW
SEPARATION DISTANCES ® Septic i-] Holding t-I S.T.E.P. 1-1 Other:
F~.,~ Septic Absorption Lift Hokting =ub~ic~Private uan~.cturer: capacny~n
,,, Tank Field Station Tank S,~U~ Anchorage Tank 1,000
w~ >100' >Z00' N/A N/A >25' Steel
Two (2)
s~,~w,., >100' >100' N/AN/A~ LIFT STATION - NONE ON LOT
t~u. >5'1' N/AN/A
-,.>,,. >,o. .,,, -----.:
c~,~o.~ None Noted ~&~
Existing Septic Tank Was Pumped, Crushed, BENCH MARK
Backfllled and Abandoned On ~ite. Bull gun Diverter ~ca,c~,,=
Valve Placed and Existing Absorption Trench Tied In Door Stoop at Side of House.
For Future Use.
Lot Line Waiver Issued For New Absorotion Tre, ch. 100.0
Engineer's Stamp
....
,,,' ~>"- A-"...'~ %
Inspections performed by: MEA Dates: ~" 9/18/2002 ~_ ?. .4.a!.h '~ '....~ ~
............
Department of Health and Human Servi_ces._approval ~'~;;~o. t
Reviewed and approved by: ~/~...~/ ~,Jk//, ~-')~ate: [0-2,-0:~.
Municipality of Anchorage Page 2 of 3
DEVELOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK 99519-6650 - 343-7904
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number SW020334 PID No. 011-134-25
Exi.~
Existi~
~g Well
!.~!i?'.'~'; Throe Bedroom Home
I
1%
LOT
M2
PLAN AS-BUILT
SCALE 1" = 30'
A B
S1 40.4 ; 37.2
S2 46.4 43.0
DV 53.6 5O.3
C7 67.3 65.4
M1 65,4 62.7
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On*Site Wastewater Disposal System or Well Inspection Report
Permit Number: SW020334
Page 3 of 3
PID No.: 011-134-25
96.3
......... ~G~o t e x_~rjLe. E.~ bc.~.
Dr'QinFie~d Rock
~ 77.0
85.
91.0
M-W Drilling, 'nc.
+P.O. Box 110378+Anchorage, AK 99511+
+907-345-4000 · 907-345-3287 Fax+
As-Built Zog
· Well Owner: Lee Runestad · Use of Well: Domestic
· Legal Description:_ 8349 Seacliff Drive- Sanl Lake- Anehoraee, AK
· Size of Casing:.. 6"
· Depth of Hole:... 280'
· Cased To: 275'
· Static water level 133 below top of caSing.
· Well Finish- Open end ( X);
· Screen~Perforation description:. None
Screen ( );
Job No.:_00-174
P~rmit No.:N/A
Perforated
e Wellpumping test at 6 gallons per ndnutefor 24 hours with 13'
of drawdown from static lever
* Notes: Old well reported at 265' but hit bottom at 238'-240'
· Date of completion: 09-15-2000
Well L~
Depth in fcct from
ground surface, i Details of formations penetratedt size of mnto~ial, color and hardnt~a
0 TO 2 Casing stick-~u_p
....... 2 TO 240 ?- Original well depth unknown- we werel~o_ing by feel
240 TO 270 Silt
270 TO 280 Silty Water gravel
TO
TO
TO
............... ~-OC~ .......
· o
TO ................
TO
(2ertlf4ea*e ~To's. 814' & 973
I/Il/Heans H/ater///
MUNICIPALITY OF ANCHORAGE
Development Sen/ices Department
On-Site Water & Wastewater Program
4700 South 8ragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Sep 09, 2002
Expiration Date: Sep 09, 2003
Permit Number: SW020334
Legal Description: SAND LAKE#2 BLK 5 LT 12
Design Engineer: 0014 Anderson Engineering
Owner Name: Lee Runestead
Owner Address: 8349 SEACMFF
ANCHORAGE, AK 99502-4157
Parcel ID: 011-134-25
Site Address: 008349 SEACLIFF ST
Lot Size: 6750 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well
[] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 fo April 15, a subsurface soil absorption system under construction during freezing weather
must be either. A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions,
Septic tank must be moved outside the 100 foot well radius
Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St. ~
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(9O7) 343-79O4
ON-SITE SEWER/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 01 1 - 1 34-25
Permit Number SW 0 ,~ ~) ,~ 3 4.~
Property owner(s) Lee Runestead
Mailing address (1).8349 Seacliff Street Anchora.qe, AK 99502
Mailing address (2) Zip Code
Legal description (Lot, Block & Sub'd.) Lot t2, Block 5, Sand Lake Subdivision No. 2
Legal description (Section. Township & Range)
Lot Size 6,750 S¥ Acres/Sq. Ft. Number of Bedrooms Three (3)
Day phone 248-0441
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
[] Well Only []
[] Water Storage []
[]
[] Jacuzzi []
[] Water So?ening Unit []
I certify that the above information is correct. I further certify thatthis application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees:
Date of Payment:
Receipt Number:
(Rev. 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:
September 7, 2002
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject:
Lot 12, Block 5, Sand Lake Subdivision No. 2
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The existing absorption trench on the subject lot has failed and must be upgraded so a
Certificate of Health Authority Approval can be issued on the property. We are
therefore requesting a permit be issued for the construction of a new septic system to
serve the three-bedroom home on the lot. The attached site Plan and backup
documentation identify the location and configuration of the new septic system and the
parameters used in the design. Also identified on the plans are the existing well
location, existing absorption trench, test hole location and the locations of the well on
the adjacent property. Drainage arrows are also shown and current drainage patterns
will be maintained after construction.
The test hole placed near the location of the proposed absorption trenches indicated
clean fine sand with a minor amount of silt. No impervious layers were encountered.
The material absorbed water well with a percolation rate of 1 minute per inch in the
accepting layer. We are therefore proposing to construct a deep absorption trench
with a 3'
wide by 32' long trench with a 6'
effective depth. The distribution piping
depth will be 4' below the surface. Total depth of the trench will be 10'. A flow diverter
valve will be placed to tie in the existing absorption trench for possible future use.
The ground surface on the lot slopes at very shallow grades from west to east and
north to south. The absorption trench will be constructed parallel with the slope in
conformance with Municipal requirements. All components of the new septic system
will be constructed a minimum of 100' from the well on the lot. The system will also be
constructed a minimum of 100' from any surface water in the area.
If the system is constructed in accordance with our design the following statements
apply:
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.
.'Lot 12, Block 5, Sand Lake No. 2
September 7, 2002
Page Two
2. The .system, if constructed as designed, will have no .adverse impact on existing
septic systems in the area or those to be constructed mn the future.
3. The system, if constructed as designed, will have no adverse impact on reserve
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
15. 38
16 37
18
36
19 34
PO 33
P1 3P
22 31
23
24 29
25 -- 28
vACANT
26 27
135.00
E4
2 23
3 22
4 21
5 20
18A
(95-86)
17
9 16
15
11 14
~3
~ VACANT
AREA SYSTEM PLAN
SCALE 1" -- 100'
LOT 121 BLOCK 5,
SAND LAKE SUBDIVISION NO. 2
Exis
Existir
65'
ieng Well ~
IThree Bedroom Home
1% ..
Existin
New 3' Wide X 32' Long
X 6' Effective Depth
Absorption Trench
1%_
SCOPE OF WORK:
1. Expose Existing Septic Tank and Replace if Necessary.
2. Place 2 Post Tank Cleanouts and Bull Run Flow Diverter Valve.
3. Tie in Existing Absorption Trench for Future Use.
4. Construct New 32' Long x 3' Wide x 6' Effective Depth
Abso~13tion Trench.
5. Regrade All Disturbed Areas.
6. Revegetate Area As Required.
SITE PLAN
SCALE 1" = 30'
LOT 12, BLOCK 5, SAND LAKE
SUBDIVISION NO. 2
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Three Bedroom Home Deep Trench System
Peru. Rate: I Min./Inch Existing 1,000 Gallon Septic Tank
Avg. Application Rate: 1.2 GPDISF 6' Drain Field Rock
3 Bedrooms X 150 GPD / 1,2 GPD/SF = 375 SF of Absorption Area
375 SFI12 SFILF = 31.25 LF Trench Length
Therefore: Construct*an Absorption Trench 32' in Length by 3' Wide With 6' of Drainfield
Rock Beneath the Distribution Lateral. Distribution Lateral to Be Placed 4' Below Existing
Ground. Total Depth of Trench to Be 10' Below Existing Surface. Cover Over Septic Tank
a Minimum of 4' or 2" of Insulation and 2' of Cover, Place Bull Run Flow Diverter Valve and
Tie In Existing Absorption Trench for Futura Use.
3~6a
6~
6II
Natu~a~
Backfill
Geote~tile
~abric
40)
NOTE:
TYPICAL DEEP TRENCH SECTION
(NO SCALE)
Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 10' From Lot Line.
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Wells in the Area.
Minimum 10' Separation From Water Service Line.
MumcipalityofAnchomge ~ ..' Z-Dth
Development Serv,ces Department/On-Site Water and Wastewatar Program
4700 South Bragaw St. Anchorage, AK 99519-6650 ~ ~_~ U~CH^E~ E AUD[,SO.~ ... ~,
SOILS LOG - PERCOLATION TEST ~,~c~}.o No c~-4~
Date Performed' 9~3~2002
Performed
For:
Lee
L~al Description: Lot 12. Block 5. Sand Lake Subdivision NO, ~
OG
SLOPE SITE PLAN
7 SW
See Site Plan
8
Fine Sand
9
Some
10 Gravel
11
Was Groundwater
Encountered? No S
If Yes, What Depth? L
Depth to Water O
After Monitoring None P
Date: 9/9102 E
0% - 1%
·
12
13
14
15
16
17
18
21
D~
Loose
Boffomof
Hole
Reading Date Gross Net Depth To Net
Time Time Water Drop
1 3-Sap 12:05 0.875
2 12:15 10 Dry 9.5
3 12:16 1.000
4 12:26 10 Dry 9.375
5 12:27 1.000
6 12:37 10 Dry 9.375
7 12:38 1.000
8 12:48 10 Dry 9.375
Perc. Rate: 1 Min./Inch Perc. Hole Diameter: 6"
Test Run Between 5 Ft. and 6 Ft.
Comments: Percolation Cavity Presoaked Prior to Testing.
Performed By: MEA. I, ~J3Ae, LE~Le~:AI~ Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 9/9/02
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 12, BLOCK 5, SAND LAKE SUBDIVISION NO. 2
GENERAL:
The scope of this project includes the exposing of the existing 1,000
gallon septic tank. It must then be inspected and vedfied for continued
use. If it is found to be unsuitable the project will include the
procurement and placement of a new 1,000-gallon septic tank at the
location shown on the site plan and the construction of a new 32' long
by 3' wide by 6' effective depth absorption trench also shown on the
Site Plan. The total depth of the trench will be 10' below existing
ground and the distribution pipe will be placed at 4' below the surface.
A flow diverter valve will be required to tie in the existing absorption
trench for possible future use. All components of the septic tank and
absorption trench must be constructed a minimum of 100' from the
existing well on the lot and the adjacent lot. A minimum of 4' of fill
must be placed atop the septic tank and 3' of fill above the absorption
trenches. In lieu of fill 2" of direct bury insulation may be placed with 2'
of fill atop the insulation.
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.
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.
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.
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
pdor approval from D.H.H.S. before beginning system installation.
SEPTIC TANK INSTALLATION
1. The 1,000-gallon septic tank must be procured from an approved
septic tank manufacturer and installed at the location shown.
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.
Lot 12, Block 5, Sand Lake No. 2
September 7, 2002
Page 2 of 2
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.
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.
Contractor shall vedfy 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.
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 trench to drain away.
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 reck. 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 bUdal polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
Lot 12, Block 5, Sand Lake No. 2
September 7, 2002
Page 3 of 3
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Femco, or equal).
5. A permeable geotextile fabdc (Typar, Mirafl 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:
Municipal Ordinance requires a minimum of two inspections. 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 fabdc, 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.
September 7, 2002
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Su~e~:
Lot 12, Block 5, Sand Lake Subdivision No. 2
Separation Distance Waiver
Absorption Bed to Lot Line
Dear On Site Services Engineer:
We hereby apply for a lot line waiver to allow construction of a replacement absorption
trench on Lot 12, Block 5, Sand Lake Subdivision No. 2to be constructed within 1' of
the east property line as shown on the attached as-built drawing. The existing
absorption trench has failed and very little surface area remains on the lot for a
replacement site. Field investigations recently completed found this area to have clean
fine sand with some silt. This matedal is excellent for the treatment and disposal of
septic effluent. The property to the east is currently vacant, but sufficient area is
available for a septic system to be constructed in the future.
No conflicts were noted between this absorption trench and septic systems or wells on
adjacent lots. The lots to the south and east are currently vacant. We therefore
recommend the lot line waiver be issued allowing the bed to be constructed within 1' of
the east lot line.
Sincerely,
Michael E. Anderson, P.E.
M~icipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water ~nd Wastewater Program
4700 Bragaw $~eet
P.O. Box 196650 Anchorage, AK 99519-6650
www.¢i.anchorage.ak.us
(9O7) 343-7904
Waiver Review Worksheet
WRY: WR020068 PID~: 011-134-25 HA#:
Date Received: ~/9/I)2
Legal Description: Sand Leke #2 Block 6 Lot 12
Engineer: - ichael . -nde ;~n_PE
,a, nderson Enolneerlno
Applicant: Lee Runestead
Waiver Requested: I fqot fi.om ebsorotlon field to lot line
Criteria: Geology
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Permiffi:
Points:
Total:
Waiver is Granted: J Waiver is not Granted:
List Conditions or Reasons for above:
Date: a] -q_ a' .2_
Rec~: 25274 Amount: $150.00 Date Paid: Ipl912002
* 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 PHONE
VIAILING ADDRESS ~)~ ~(~ ~-,
LOCATION ~[~ ~"'~ ~N~ ~'.~f~. ~3 NO. OF BEDROOMS
_o, DISTANCE TO: IW'" ~OO I'°rpt'-- D--.ng PER,TNO.~
~; Manufacturer ~:~ Material <~"~:~--- L-~ No. of compartments ~.~
~.~ IF HOMEMADE: ~[~ Width ~i~)~
~ ~ ~ DISTANCE TO: WelJ Dwelling PERMIT NO.
~--~, Manufacturer ~ / ~tf Material Liquid capacity in gallons
~' DISTANCE TO: Well ~ ~O Foundation Nearest lot line ~ PERMIT NO.
· inches Total effective ,~t.~3n ,rl~eaJ I~
I-~ Top of tiJe to finish grad, .~[ ~1~ M.~=,;a; beneath tile G~O inches
~ Length Width Depth PERMIT NO.
~1- Type of crib Crib dia~ ~
;k- e Crib depth Total effective absorption area
f~ WeJl
DISTANCE TO: Building foundation Nearest lot line
.I Class ~ Depth Driller Distance to Jot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
SOIL TEST RATING ·
INSTALLER
REMARKS
( (-~ ~.
?'
': ..............
72-013 (Rev. 3/78)
14ELL FIND
PERMIT NO. < 780~m22 )
RPPLIC~T
LOCRTION
LEGRL
..~ MU. NICIt'- tL!T¥ OF RNCHL~RGE
~.. ~PRRTMENT ~ HERLTH MD E~I~ENTRL PROTEC?ION
~5 "L/ STREET.. RNC~RRGE~ RK.
264-4728
ON--SITE 5EWER
PRUL ROSELRND
84TH/SflND LRKE RD
4-1324
L12 ~ ~ND L~E
LOT SIZE 6?50 SQURRE FEET
TYPE OF SOIL RBSORBTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS
SOIL RflTING (SQ FT/BR)= 1~
THE REQUIRED SIZE OF THE ~OIL RBSORPTION SYSTEM
DEPTH== lB LENGTH= 34 GRRVEL DEPTH=
T~ LENOTH D]~]~ ]~ THE LENOTH <IN FEET:) OF THE TRENCH OR
T~ ~PTH ~ ~ T~NCH OR PIT ]~ THE ~]ST~NCE BETWEEN THE SURE,CE OF T~
~D ~ T~ BOTTO~ OF THE E~C~RTION <IN
T~RE IS NO SET WIDTH FOR TRENCHE~.
T~ GRR~L DEP~ I~ T~ MINIM~ ~PTH ~ GRRVEL BETWEEN THE OUTF~L PIPE
fiND THE BOTT~ ~ THE ~flTI~ (IN FEET).
REGUIRED SEPTIC TRNK SIZE-- ieee
PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE
INSTFILLRTION INSPECTIONS OF RN~ HELLS RDJRCENT TO THIS PROPERTY RND THE
NUMBER OF RESIDENCES THRT THE HELL WILL SERVE.
------ TWO (2) IN:~;PECTIONS lIRE REQUIRED
BRCKFILLING OF RN¥ SYSTEM WITHOUT FINRL INSPECTION RND RPPROVRL BY THIS
DEPRRTMENT WILL BE $AJBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETHEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS
188 FEET F~ R PRIYRTE HELL.: ~
150 TO 208 FEET ~ R ~LIC HELL ~NDING UP~ T~ T~E OF P~LIC WELL.
WELL L~5 ~E REQUIRED ~ ~T BE RET~NED TO T~ DE~TMENT WITHIN ~8 DflYS
~ T~ ~LL ~LETI~.
OT~R REQUIRE~NTS ~Y tiPPLe. S~CIFICRTION~ RND C~T~CTION DI~RRMS RRE
RVflIL~LE TO I~E P~ER' INSTflLLRTIO~
PERHIT E~PIRE~ DECEHBER ~i~ 1978
I CERTIFY THRT
1: I tim FRMILIRR WITH THE REQUIREHENTS FOR ON-SITE SEWERS fiND WELLS tis SET
FORTH BY THE MUNICIPRLIT¥ OF RNCHORRGE.
2: I WILL IN~TRLL THE S~TEM IN RCCORDRNCE WITH THE CODES.
~: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MR¥ REQUIRE ENLRRGEMENT IF THE
RESI~NCEISREMODELED TO INCLUDE MORE THRN ~ BEDROOMS.
flPPLIC~T ~ R~ELR~
ISSUED
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION [] PERCOLATION
TEST
Pouch ~.~50, Aneho~le, Alaska 99502 276-2221
SOILS LOG - PERCOLATION TEST
PERFORMED FOR:~~~k~ DATE PERFORMED:~
SLOPE SITE PLAN
%: 8 ',,,,','~ ::.':.'~,..,,c,~ ~;~v~-
,...,,.1.0
11
20-
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Oate Time Time Water Drop
PERCOLATION RATE
(m nutes/inch
TEST RUN BETWEEN FT AND FT
PERFORMED BY: CERTIFIED BY~~~~
~a,~ t°/
,,,, on.,, .~'~-"--~ /~--"~"-~--~ ,,,r*,, ...,it,
Well location: (address g P ~ _ -~ ~ - ~
Finish of well: (o~ screen, perforated, open-hole, o~hsr).
Describe intervals and size:
Well yield teated by (pumping, bailin8, air) at ./~ iai/min.
for *~' hours with ~ ft. of drawdown from static level.
HOWARD TEAL
344-0498
DEPT. OF HEAL
WATER WELLS E~'~,ON~ 4r.qt pn,:.~
~SW.B?d,A,e,,e NOV 6 19~
WELL CONSTRUCTION
DRILLER'S WATERIAL LOG
Depth below land Dive description cf strata penetrated
surface in teet (size of material, color, hardness of drilling, and matPr content)
to
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MuniciPality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Road
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
Parcel I.D. 01 1-134-25
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 #2; BLOCK 5, LOT 12
8349 SEACLIFF STREET *ANCHORAGE, AK 99502
GREG STEVENSON Day phone
PO BOX 110058 *ANCHORAGE, AK 99511
727-4279
Day phone
UWIL BATUCAN W/ REAL ESTATE BROKERS OF AK Day phone
2960 C STREET #202 *ANCHORAGE, AK 99503
2509196
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 5
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well · Individual On-site ·
Individual Water Storage [] Individual Holding tank []
Community Class 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 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. 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 557-6179
Address 5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Date
Engineer's Comments:
In conducting this evaluation, GEG, LtD. 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.
DSD SIGNATURE
bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Attachments: COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
(Rev. 11/05)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
"~0_~~ Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 EImore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
CHECKLIST
LegalDescription: SAND LAKE #2; BLOCK 5, LOT 12
WELL DATA *WELL DEEPENED FROM 258' TO 280'
Well type PRIVATE IfA, B, orC provide PWSID¢ N/A
Date completed .9/15/2000 Sanitary seal (Y/N) YES
Total depth *280 .ft. Cased to 275 ft.
Parcel ID:
ON 9/15/00
Well Log (Y/N) YES
Wires properly protected (Y/N)
Casing height (above ground)
011-1.34-25
YES
12+ in.
Date of test
FROM WELL LOG
9/15/00
AT INSPECTION
8/22/11
Static water level 1 33 ft.
140 ft.
Well production 6 g.p.m.
3.75 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi.
Arsenic:3, . I ug./L.
Nitrate)~J [~) mg./L.
Date of sample: 8/22/11
Collected by: GE(:;, Ltd.
SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Tank size 1000 gal. Number of Compartments 2
Foundation cleanout (Y/N) YES Depression over tank(Y/N) NO
Date of pumping ~' c~ .// Pumper
Date installed 9/18-23/02
Cleanouts (Y/N) YES
High water alarm (Y/N) N/A
MCDONALDS PUMPING
ABSORPTION FIELD DATA I'BELOW EXISTING ORADEI
9/18-25/02 1.2
2r
Date installed 11/1978 Soil rating (g.p.d./ft o ~. 1 33 System type DEEP TRENCH
31 5 6.0
Length 34 ft. Width .5 ft. Gravel below pipe 6.0 ft.
372
Total depth*9.8-10.4-1ft. Eft. absorption area 408 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test *.8/22/11 Results (Pass/Fail) PASS
For 3 bedrooms
Fluid depth in absorption field beforetest 0 in.
Elapsed Time: 120 min. Final fluid depth 0
Any rejuvenation treatment (past 12 mo.) (YIN & type)
**2002 TRENCH TESTED ONLY.
TO GET A LIQUID READING.
Water added 900 gal. New depth 8 in.
in. Absorption rate >= 450+ g.p.d.
NONE KNOWN If yes, give date -
1978 TRENCH HAD ROCK & DIRT IN THE SUMP WE WERE UNABLE
D. LIFT STATION
Date installed
"Pump on" level at
in.
Size in gallons ManholelAccess ~/_..~_)~ J
"Pump off" level_~. High water alarm level at
Cycles tested Meets alarm & cimuit requirements?
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
100'+
Septic tank/lift station on lot
Absorption field on lot 100'+
Public sewer main N/A
Sewer/septic service line 25'+
Animal containment areas. 50' +
in.
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout
Holding tank N/A
Manure/animal excrete storage areas
N/A
100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+
Water main N/A Water service line 10'+
Wells on adjacent lots 100'+
Absorption field *5'+
Surface water. 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line * 1 '+
Water service line 10'+
Curtain drain NONE KNOWN
COMMENTS
· EXISTING WAIVER
Building foundation. 10'+
Surface water 100'+
Wells on adjacent lots 100'+
Water main N/A
Driveway, parking/vehicle storage
10'+
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date ',0J & II,
COSA Fee $ ~-~ C) ~
Data of Payment JO - ~-\\
Receipt Number Oct ~ Olo ~
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
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 # 111376
A Certificate of On-Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 5, Lot 12 of
Sand lake #2 Subdivision. This inspection revealed an arsenic concentration
of 32.1 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.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.# 1113962001
Client Name Garness Engineering Group, Ltd Printed Date/Time 08/25/2011 16:01
Project Name/# Sand Lake 2 BSL12 Collected Date/Time 08/22/2011 14:10
Client Sample ID Sand Lake 2 B5LI2 Received Date/Time 08/22/2011 14:30
Matrix Drinking Water Technical Director Stel~hen C. Ede
Sample Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic 32.1 * 5.00 ug/L EP200.8 C (<10) 08/23/11 08/25/11 NRB
Waters Department
TotalNitrate/Nitrite-N ND 0.100 mg/L SM20 4500NO3-F B (<10) 08/24/11 AYC
Microbiology Laboratory
E. Coli Negative I 100mL SM20 9223B A 08/22/11 DLC
Total Coliform Negative 1 100mL SM20 9223B A 08/22/11 DLC
8364N
m
(g_. m o_,,
_
SEACLIFF STREET
NOO°O2'OO"W 50.00
0
0
N00°02'00"W 50.00
O
~lOct, 7, 2011
Enaineerina Group, Ltd,
No.2006
P. 1
5432 E. Northern Lights Btvd, State
Anchorage, A, iaska 9950g
(907) 338-4476 or (907) 830491
Invoice # ,~ 5 7"
Septic tank pump,ed , ~-' '
Sludge in tank : ......
Leach treatment .....
Bi~-nqat in t acn ....... --- --
Water level in leach '
Cap on Stand 15i8.es :
Total:
2% mtere.ct v, AI1 be cha~ged m__ojlkh~ aa m~paid b/lis undl paid.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program ~"~
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cl.anchorage.ak.us
(907) 343-7904
Parcel I.D.
'1.
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
01 - 34-25
GENERAL INFORMATION Expiration Date: / O
Completalegaldescription SAND LAKE SUBDNISlON 1~2; BLOCK 5~ LOT 12
Location (site address or directions) 8349 SEACLIFF STREET * ANCHORAGE, AK. 99502
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
ROBERT AND JUANITA POOLE Day phone 243-3225
8349 SEACUFF S3REET * ANCHORAGE, AK. 99502
Day phone
MARK UTI'LE W/ ASSIST TO SELL Day phone 338-2482
8001 PIONEER DRNE * ANCHORAGE, AK. 99504
Unless otherwise requested, HAA will be held by DSD for pickup.
NUMBER OF BEDROOMS: 5
3. TYPE OF WATER SUPPLY:
Individual Well ~r~
Individual Water Storage
Community Class Well ~
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
Community On-site
Public Sewer
The Municipality of Anchorage Development Services Department (DSD] Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties sewed by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval ara valid for 90 days from the date of issue for properties sewed by a private or Class C well end may
be reissued with new water samples. (Certificates may be reissued for a pedod of up to one year with valid
water samples.) Certificates ara valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorago 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 vedfy that my
investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(am) 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.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Phone, 337-6179
Date
Engineers Comments:
In conduch'ng this evaluation, GEG, Ltd. e~fampted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The mporfad results described the performance of the
system under the conditions encountered st the #me of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the loc, al 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 evalustor of the system. Satisfactory test
results do not guarantee futura performance of the system, nor do they guarantee that
there ara 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 requirarnents of the ADEC or MOA DSD. The content of this raport is for
the sole benefit of the owner listed above. Any reliance upon or use of this repert by any
other person or party is not euthodzed, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for ~ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the fllowing stipulations:
WATERAND :
= WASTEW E :
z
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
(Rev. 12~01}
Original Certificate Date:. ~ 7 - l z/_ o '-/-
Municipality of Anchorage
Development Services De partment
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, Al( 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Legal Description:
A. WELL DATA
Well type PRN^~
HEALTH AUTHORITY APPROVAL CHECKLIST
SAND LAKE SUBDIVISION ~2; BLOCK 5~ LOT 12 Parcel ID:
*WELL DEEPENED FROM 258' TO 280' ON 9/15/2002
If A, B, or C provide PWSID~ .
Date completed '9/15/2000 Sanitary seal (Y/N) YES
Total depth *280 ft. Cased to 40+ ft.
FROM WELL LOG
Date of test 9 - 15-2002
Static water level 153 ft.
Well production 6 g.p.m.
N/A
Well Log (Y/N)
Wires propedy protected (Y/N)
Casing height (above ground)
AT INSPECTION
**9/29/2002
139 ff.
5.57 g.p.m.
WATER SAMPLE RESULTS: **WELL TEST DATA BY MICHAEL E. ANDERSON, P.E.
Coliform '{~ colonies/100 mi. Nitrate O, tC3 mg./L.
Arsenic: N/A mg./L. Date of sample: 6/23/2004
SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL
Tank size 1000 gal. Number of Compartments 2
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO
Date of pumping 6/24/2004 Pumper
011-134-25
YES
YES
24+ in.
Other bacteria 'L~ colonies/100 mi.
Collected by: GEG~ LtD.
Date installed 9/18-23/2002
Cleanouts [Y/N) YES
High water alarm (Y/N) N/A
MDONALDS PUMPING
ABSORPTION FIELD DATA PSELOW ~l~No G~:)E]
9/2002 Or ft~/bdrm).l ,2 &: 133 Systemtype DEEP TRENCH
Datsinstalled &: 11/t978 Soilrating
Length 31/34 ff. Width 3,0/3,0 ft. Gravel below pipe 6.0/6.0 ff.
372/ 2
Total depth*l 1,5/lo,o ft, Eft. absorption area 408 _ ff Monitoring tube YES Depression over field NO
Date of adequacy test - Results (Pass/Fail) ~
· n~tion treatment (past 12 mo.) (YiN & type) - If yes, give date -
**SYSTEM LESS THAN '1~'O YEARS OLB ***WATER LEVEL IN NEW TRENCH AT 11,5" ON 6/23/2004
Date installed Size in gallons
"Pump on" level at in. "Pump
Cycles teste(~.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot100'+
Absorption field on lot 100%
Public sewer main N/A
Sewer/septic service line 25'+
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout
Holding tank N~/A
N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+
Water ma~n N/A Water service line 10'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Absorption field 5'+
Surface water. 100'+
Property line '1'+ Building foundation 5'+
Water service line 10'+ Surface water 100'+
Curtain drain NONE KNOWN Wells on adjacent Jots 100'+
F. COMMENTS
· Water main N/A
Driveway, parking/vehicle storage 10'+
*WAIVER GRANTED
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name
Date
JEFFREY A. ~ARNESS
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12/01)
54G ql
Waiver Fee $
Date of Payment
Receipt Number
in.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 011-134-25
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
H A# H,9
Expiration Date~
02.05-0?
Lot 12, Block 5. Sand Lake Subdivision No. 2
8349 Seacliff Street
Current Property owner(s)
Mailing address
Lending agency
Lee Runestead Day phone 248-0441
8349 Seacliff Street Anchorage, AK 99502-4157
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
NUMBER OF BEDROOMS: Three (3)
TYPE OF WATER SUPPLY:
Individual Well
individual Water Storage
Community Class
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[] Individual Holding tank []
[] Community On-site [~ .
[] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 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 and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results 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.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verity 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 disposat 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 En,qineerin.q
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
5. DSD SIGNATURE
~ Approved for _~
Disapproved.
Conditional approval for
bedrooms.
Phone 522-7773
Date 913012002
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HA& Checklist
Septic System Advisory
Well Flew Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
(Rev.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage. AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 12, Block 5, Sand Lake Subdivision No. 2
A. WELL DATA
Well type Private
Date completed .'1'1/311978
Total depth. 280 ff.
Date of test
Static water level
Well production
Parcel ID: 011-134-25 ~-
If A, B, or C provide PWSID #
Sanitary seal (Y/N) Y_
Cased to 58 ft.
FROM WELL LOG
14/3/1978
83 fl.
10 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/lO0 mi.
Date of sample: 9/24/2002
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Tank size 1,000 gal.
Foundation cleanout (Y/N)Y_
Date of pumping
C. ABSORPTION FIELD DATA
Nitrate ..2 mg.fl.
Collected by: MEA
Number of Compartments 2_
Depression over tank (Y/N) N_
Pumper New Construction
Soil rating (g.p.~: ~2 or ft~/bdrm} 1.2 GPDISF
ff. Width 3 ff.
Eft. absorption area 372 ft2 Monitoring tube Y_
Results (Pass/Fail)
Fluid depth in absorption field before test in. Water added
Elapsed Time: __ min. Final fluid depth in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N
Well Log (Y/N) ¥
Wires properly protected (Y/N) Y
Casing height (above ground) >24
AT INSPECTION
9/2912002
139 ft.
5.57 g.p.m.
Date installed 9/'2.2/2002
Length 31
Total depth 11.5 ft.
Date of adequacy test
in.
Other bacteria t colonies/10(] mi.
Date installed 9H8/2002
Cleanouts (Y/N) Y
High water alarm (Y/N) ~1
System type DeepTrench
Gravel below pipe 6
Depression over field N
For
gal.
Absorption rate >=
New depth
If yes, give date
bedrooms
in.
g.p.d.
Date installed
"Pump on" level at __ in.
Datum
E. SEPARATION DISTANCES
Size in gallons
"Pump off level at in.
Cycles tested
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
Go
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot >100'
Absorption field on lot >t00'
Public sewer main N/A
Sewer/septic service line >25'
On adjacent lots >t00'
On adjacent lots >100'
Public sewer manhole/cleanout NIA
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line >5'
Water main NIA Water service line >10'
Wells on adjacent lots >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 1'
Water Service line >10'
Curtain drain None Noted
COMMENTS
Building foundation >10'
Surface water >100'
Wells on adjacent lots >100'
Absorption field >5'
Surface water >100'
Water main >10'
Driveway, parkingh/ehicle storage >25'
Lot Line Waiver Granted. Well Deepened From 258' to 280' on 9/15/2000. Well ProductiOn At Tha
ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect :~n this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 9129102
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12/00)
Waiver Fee $
Date of Payment
Receipt Number
Z
CERTIFICATE OF SURVEY
orage Recording Distrie~ Alaska. and t~at the improvement/ situated tl~,~
to. that It~ improvements on pti?perrY lying adjacent thareto enc~oactt on the ~remlses
~operty except as indicated hereon.
NARD EI~IGINEERING