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SAND LAKE #2 BLK 5 LT 5
Sand Lake #2 Block 5 Lot 5 #011-134-32 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP161284 Tax Code Number: 01113432000 Work Type: Septic Upgrade Permit Effective Dates: October 12, 2016 to October 12, 2017 'J: 3a Design Engineer: GARNESS ENGINEERING GROUP LTD Subdivision: SAND LAKE #2 Site Legal Address: SAND LAKE #2 BLK 5 LT 5 G:2224 Owner/Address: HOPKINS AMY M & BRIAN RAY 8245 SEACLIFF ST ANCHORAGE AK 995020000 Site Mailing Address: 8245 SEACLIFF ST, Anchorage Lot Size in Sq Ft: 6750 Total Bedrooms: 3 This permit is for the construction of: Y Disposal Field N Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Especial Provisions: Letters of non -objection from T&E to be provided prior to inspection. -X co, 1 Veb0.1 Gor-ONOS over �kone. l�eVise e��ecE ve de��h 40 (0.5 ��k. Qok4aY a� seg �e ��� C^ 1o.3. (Zev�se elf to �E�, 4--n 21 Received B� Issued By: Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** Waiver#: OSVI61116 COSA#: _ Permit#: OSP161284 PID#:011-134-32 Legal Description: Sand Lake #2 Block 5 Lot 5 Engineer: Garness Engineering Group Applicant: Brian Hopkins 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 5 feet. This waiver approval applies to the proposed 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 nonobjection 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 Granted: Date: 10 / 2 ?a 16 Approved by:a/}°/C �( da Name of Reviewer ............................................................................... **** VARIANCEMAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE Community Development Department Pho e: 907 343-7 4 Development Services Fa 997 On -Site Water & Wastewater Program I� Mayor Dan Sullivan On -Site Sewer/Well Permit Application P \ For A Single Family Dwelling Parcel I.D. 011-134-32 Property owner(s) BRIAN HOPKINS Mailing address 8245 SEACLIFF DRIVE *ANCHORAGE, AK 99502 Day phone 227-0916 Site address 8245 SEACLIFF DRIVE "ANCHORAGE, AK 99502 Legal description (Sub'd, Block & Lot ) SAND LAKE #2; BLOCK 5, LOT 5 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (®all that apply) Initial ❑ Single Family (SF) Absorption Field ® ® (w/wo ADU) Upgrade Septic Tank i Duplex (D) El❑ Renewal Holding Tank F-1 MultipleDwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: Distance: — I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: nr3 r�i� Waiver Fees: 3 Date of Payment: Date of Payment: Receipt Number:() Ll1+� 0 ?1Receipt Number: 05310 Permit No. (J s e1wrY - Waiver No. aSV 1 u j � �-D V �D \^_� (Rev. 01/11) �� C molesLK : GARNESS ENGINEERING GROUP, Ltd 14vanwdT Vn, t$pst� CIVIL & ENVIRONMENTAL ENGINEERS- D r September 19, 2016 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic System Upgrade for Sand Lake #2; Block 5, Lot 5 To whom it may concern: The existing 3 bedroom house is served by a Class C well and a private septic system. The drainfield is in a state of failure and needs to be upgraded. We are proposing to re- build the deep trench type drainfield and re -utilize the existing 1,000 gallon steel septic tank. We are proposing to excavate out all contaminated material, import MOA approved sand for leveling (to re-establish the bottom of the trench to an elevation equal to, or slightly higher than the existing trench), and re -build the drainfield (3' x 23', 8'). See attached waiver from ADEC for the encroachment from the Class C well on Lot 5 to the drainfield on Lot 5. An ADEC waiver has been requested for the encroachment from the Class C well on Lot 21. Comments regarding the design are summarized as follows: 1. SOILS: See the attached 1982 log which shows the soil classifications, groundwater monitoring, and the percolation test results. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface water concerns. 4. TOPOGRAPHY: The average topography around the proposed drainfield is relatively flat. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. P.E., M.S. 3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com Jeff Garness From: Jeff Garness Sent: Wednesday, October 12, 2016 11:12 AM To: 'Wockenfuss, Deborah M.' Subject: Sand Lake #2; Block 5, Lot 5 Testhole Deb & Rebecca, Based upon the historical soil data in the Sand Lake Subdivision, it is reasonable to believe that groundwater is low and that the percolation rate of 1.2 that is used in the design is a reasonable assumption. Thank you, Jeffrey A. Garness, P.E., M.S. President Garness Engineering Group, Ltd 3701 E. Tudor Road, Suite 101 Anchorage, Alaska 99507-1259 Ph: (907) 337-6179 Cell: (907) 244-9612 Fax: (907) 338-3246 Website: www,garnessengineering.com .l..il... �. .�.. ®! ! TUDOR FOR 1W.Mm"Winimm. -,�� . . PROJECT/LEGALPREPARED DESIGN CRITERIA: NUMBER OF BEDROOMS:3 GALLONS PER DAY (GPD): 450 GPD PERCOLATION RATE/S:'N/A PROPOSED APPLICATION RATE: *1.2 MINIMUM DRAINRELD SQ.FT.: 375 SQ. FT. 'EXISTING (PROPOSING TO RE -BUILD TRENCH) DRAINFIELD DESIGN: MAXIMUM DEPTH: LIMITED TO REMOVAL OF CONTAMINATED MATERIAL WIDTH: 3+ FEET (AS REQUIRED TO REMOVE CONTAMINATED SOIL) LENGTH: 23 FEET M.O.A. APPROVED SAND FILTER: LEVELING SAND TO BE EQUAL TO OR OR HIGHER THAN BOTTOM OF EXISTING TRENCH EFFECTIVE: 8 FEET REDUCTION FACTOR: N/A ACTUAL SQ. FT.: 376 SQ. FT. GEG, Ltd. HAS A 8 PAGE SPECIFICATION LETTER THAT PERTAINS TO THIS DESIGN. TO OBTAIN A COPY OF THE LETTER CONTACT GEG. BY PROCEEDING FORWARD WITH THIS INSTALLATION, THE ENGINEER, WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND CONDITIONS OUTLINED. 15%�•'•P. DRIVEWAY e 0 7 El EXISTING (34 5 THE NORTH, EAST, SOUTH LOT LINES, AND ALL WELL RADII (150', 100', & VARIANCED DISTANCES) FLAGGED BY A PROFESSIONAL LAND SURVEYOR PRIOR TO BEGINNING CONSTRUCTION. Q GARNESS ENGINEERING GROUP, Ltd CMI- A FNVIRONMFNTAI-. FNGINFFRS, Tyr; ........_._a:..�.. ._..:.:: 3701E. TUDOR ROAD. SUITE 101- ANCHORAGE, AK 99507-PHONE(907)337-6179- FAX (907(3383246 -WEBSITE: .,ne .,[..enrq.mm PREPARED FOR: PHONE NUMBER: PAGE NUMBER' BRIAN HOPKINS 227-0916 3 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: SAND LAKE #2; BLOCK 5, LOT 5 PNB TYPE OF WORK: DATE: PROPOSED DRAINFIELD REBUILD 9/15/16 C/O'S j 10"RE( 0 0 1 m PRA 1. 2' 1 OFESS�� 0 OWN GARNESS ENGINEERING GROUP Ltd --. CIVIL&ENVIRONMENTAL ENGINEERS ...... October 4. 2016 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Lot Line Waiver Request for Sand Lake #2; Block 5, Lot 5 To whom it may concern: We are requesting a five (5) foot waiver request from the proposed drainfield re -build to the east lot line. This encroachment has existed for over 34 years without any known adverse impacts on the neighboring property. Furthermore, per MOA records, the drainfield serving Lot 20 (neighboring lot) has a separation distance of at least 12 feet to the shared property line. In short, with the encroachment in place the two (2) drainfields have a minimum of 17 feet of separation between them. We are unaware of any adverse impacts this waiver would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assisfince. Sincerely, 1, , P. E., M. S. 3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com THE S'1'A:1'E. "'ALASKA GOVERNOR BILL I'VALKER Jeffery A. Garness, P.E. Garness Engineering Group 3701 East Tudor Road, Suite 101 Anchorage, Alaska 99507-1259 Department of Environmental Conservation Division of Water _ Wastewater Discharge Authorization Program 555 Cordova Street Anchorage, AK 99501 Main: (907)269-7519 Pax: (907)334.2415 September 30, 2016 Re:. Anchorage -Sand Lake -Waiver Request for Sand Lake 42, Block 5 Lot 5 and a Class C Well on Lot 21- ADEC Plan Tracking Number 16 D W W 214 Dear Mr. Garness, On September 28, 2016 a plan request for a waiver of separation distances to a Class C public water system located at Sand Lake # 2, Block 5, Lot 21 to a replacement septic tank and onsite soil absorption system was submitted for review. You are recommending that the waivers reduced from 150 feet to 130 feet will still be protective of public health. A review of the resent samples and the well log and it's soil's information along with the past waivers located on this development have been evaluated. The following waivers based upon the engineer's recommendation is herein listed. The separation distances to the disposal field and the septic tank to be install are reduced from 150 feet to 130 feet per the requested engineers documentation and information. - These waivers are based upon the engineer's recommendation and the engineering controls established upon the lot which assures the protection of public health. Should it be found that the site conditions endanger public health or are a public health concern, the waivers will be rescinded. This approval does not imply the granting of additional authorizations not obligate any state, federal or local regulatory body to grant required authorizations. Any person who disagrees with this decision may request an adjudicatory hearing in accordance with 18 AAC 15.195- 18 AAC 15.340 or an informal review by the Division Director in accordance with 18 AAC 15.185. Informal review requests must be delivered to the Division Director, 410 Willoughby Avenue, Suite 303, P.O. Box 111800, Juneau, Alaska 99801, within 15 days of receiving the decision. Guidance information on the informal review process may be found at http://www.dec.state.ak.us/commish/Review- Guidance.htm. Adjudicatory hearings requests must be delivered to the Commissioner of the Department of Environmental Conservation, 410 Willoughby Avenue, Suite 303, P.O. Box 111800, Juneau, Alaska 99801, within 30 days of the decision. If a hearing is not requested within 30 days, the right to appeal is waived. Thank you for your cooperation. If you have any questions please do not hesitate to contact meat 269- 7519. RRespeccttfully, ✓ Q. f`" William R. Rieth, P.E. Environmental Engineer CONSTRUCTION AND ©PERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT P/llans for the construction ofe5 /o cdt `' 10 �2 I OT.:2 � r S — 13 .__ f � C c G� Z ��}- oy r1 C e Ag5 Ct public water system located in _ Arjc. (j O Alaska, submitted in accordance with 18 AAC 80.140 been reviewed.and are q approved, IJ conditionally approved isee attached conditions). TITLEDATE 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 fwntraa order no. Approved by. Date or aescrlptive raMrencej The "APPROVAL TO OPERATE" section mast be completed before any water is made available to the public. The construction of the KW11212 L -Z IC F S. j/J )3LO Ic' �� ublic water system was completed on 2— y S (date). The system is hereby granted interim approval to operate for 90 days following the completion date. TITLE - DATE As -built pians submitted during the interim approval period, or an inspection by the Department has confirmed the system was constructed according to the approved plans. The system is hereby granted final pproval to operate. / ry O "i u TITLE J .._� DATE \ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION / 825 L Street - Anchorage, Alaska 99501 Telephone 264-0720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE EW ❑UPGRADE MAILING ADDRE S a / t?44" too A LEGAL DESCRIPTION d4K z LOCATION NO. OF BEDROOMS S Uy s-2 W Q N~ DISTANCE TO: Absorption area Owellin Material PER 067 No. of2compartments Manufacturer ,£/L 4q. capactty jn gallons O CJ IF HOMEMADE: Inside length g Width Liquid depth dOZ DISTANCE TO: Well Dwelling PERMIT NO. _ FQ- Manufacturer Material Liquid capacity in gallons W = -1 LL Z p. M DISTANCE TO: No. of lines / W engt of each line ?c> r Foundati1 1 Nearest lot lin y PERMIT NO� ar0�% Total length of lines U r Trench Width inches Distance between lines — 0 y- Top of the to finish grate [/� 7 Materiel beneath the inches Total effective absorption area W U Length Width Depth PERMIT NO. d F W d Type of crib Crib diameter Crib depth Total effective absorption area w DISTANCE TO: Well Building foundation Nearest lot line j w CI Depth Driller Distance to lot line PERMIT NO. 3 DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS r SOIL TEST RATING DU l c/F INSTALL R ,C d O Illy REMARKS awm';'l air/ [ y ro' L APPROVED DATE LEGAL ` MUNI C I FIL I TY OF= 19r-FCHA9F2FIGE DEPARTMENT HEALTH AND ENVIRONMENTAL _'OTECTION • 825 'L' STREET, ANCHORAGE, AK. 99501 r 264-4720 AJAn � J O N- S I T E SEWER PERM I T PERMIT NO. < 821067 APPLICANT DOUGLAS N JENSEN 2111 CHANDALRR DR 337-1 r LOCATION LEGAL L585 SANDLAKE #2 LOT SIZE 999999 SQUARE i TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SO FT/BR)= THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH= 1.2 LENGTH= 1.0 0F2nWa:L_ DEPTH= C M FEE n,7 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF R 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 TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION <IN FEET). FZEQU I FZEO SEPTIC TFiNFC S I ZE= 1000 GnLLONS 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 14ILL SERVE. -- TWO C 2? I NSPECT I Or�FS F=lFZE FZEGlU I FZEO --- BACKFILLING 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 R COMMUNITY SEWER LINE IS 75 FEET. OTHER. REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PEFZM I T EXP I RES D>ECEMF?EFR 311 1 52 I CERTIFY THAT 1: I AM FAMILIAR, WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS fly 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 CLUDE MORE THAN 3 BEDROOMS. SIGNED:_ _ 6tir,_.:.�- - ---------- APPLICANT DOUGLFiS N JENSEN ISSUED BY PERFORMED FOR LEGAL DESCRIPT 17 18 19 20 SOILS LOG t MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG — PERCOLATION TEST 4�/'a/7 DATE PERFORMED: (J SITE 01- Reading Date Gross Time Net Time ve it Net Drop / WAS GROUND WATER /V L ENCOUNTERED? O P IF YES, AT WHAT E DEPTH) Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) PERFORMED BY: - L{ zS _ 72-009 (6/79) . x X j - / Z �• 7.% cep 74 c a'S 37>,�'nn DATE: CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION . PUBLIC WATER SYSTEM i APPROVAL TO CONSTRUCT r Plans for the construction of r% "= C " y', f i _i ) public water " p system located in }' " Alaska, submitted in accordance with 18 AAC 80.100 by �.y r i i �J , : '1 I = f� 1 - have been reviewed and are ❑ approved. ❑ conditionally approved (see attached conditions). BY DATE 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. or oescrlptiw reference) Approved by Date The "APPROVAL TO OPERATE" section must be completed before any water is made available to the public. APPROVAL TO OPERATE The construction of the public water system was completed on (date). The system is hereby granted interim approval to operate for 90 days following the cpmpletion date. TITLE DATE As -built plans submitted during the interim approval period, or an inspection by the Department has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to operate. By TITLE DATE Municipality of Anchorag( On -Site Water & Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS Parcel I.D. 011-134-32 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Real Estate Agent Expin SAND LAKE #2: BLOCK 5. LOT 8245 SEACLIFF DRIVE -ANCHORAGE, AK 99502 BRIAN HOPKINS Day phone 227-0916 8245 SEACLIFF DRIVE *ANCHORAGE, AK 99502 2. TYPE OF DWELLING: N Single Family (w/wo ADU) ❑ Duplex. ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 !lli�J»�T�'P/rf�i I�JJ7AII Day phone TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class C Well Community On-site ❑ Public Water System ❑ Public Sewer ❑ W aiverNariance request for: Received by: /10 Date: //Z/�Zk COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 42-q - Lo 10 Waiver Fee $ Date of Payment 10/ 211 ?Z1 b4 Date of Payment Receipt Number 03215c, Receipt Number COSA# OSC4016I)- Waiver# Distance: 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. 1 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 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 `ANCHORAGE, AK, 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date l 0 2 Engineers Comments: In conducting this evaluation, GEG provided an engineering evaluation of the well andlorseplic system in accordance with the .'*,&`X%► jj4 � guidelines andregula(ions established by the Municipally o/Anchorage and Indus(ryp2dices. The reportedresutts describe the �� OF q� 4�� condition of the sysm/s leon the dolels of the evaluation. Separation distances were measured to real ilyidentifiable features. �• P, , q (l 1 Hidden defects or encroachments may ewst that were not identified during the evaluation. The operational life of all wells and septic 41'�♦ systems depend on a variety of variables including, but not limited to, soil conditions, groundwater levels (that may flucluate during "J the year), quality of construction (maledals and workmanship), and the water usage of the family utilizing the systems. These * •� conditions can vary, and are outside the control of GEG. Satisfactory test issues do not guarantee future performance of the i ,,,,;,,,, , 49 0 sys(ems; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. � � GEG makes no representation whether an alternative well or septic system can be installed on the pmpertyin the event either of the ;�. .......... ...........�0 current systems fail The content of this report is /or the sole benerd of the personlparty who retained GEG. Reliance upon the informationprovidedin this report byanyotherperson orparty, includingbut notlimeedto subsequent propertypurchasers, isnot 0#" y mess ;_j authorized. In short, GEG disavows anylegal duty to anyoneotherthan the persomnarty who paid farthis report. �7—,- C 795 6. DSD SIGNATURE ���pROFESS CNP.�� LICENSE ,1�11t"wL** System #1 Approved for bedrooms. #AECC884 System #2 Approved for bedrooms. ? Disapproved. \\\��\QPy��Y OF,gN (ikt ` G x r� Conditional approval for bedrooms, with the following stipt�`ns: ON-SITE � WATFR Amr) m Original Certificate Date: /C7 _3 The Municipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations 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. ATTCHMENTS COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other (Rev. 10/17112) 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: A. WELL DATA Well type C Date completed Total depth ft. Date of test Static water level SAND LAKE #2; BLOCK 5, LOT 5 COMMUNITY WATER If A, B, or C provide PWSID# 216295 _ Sanitary seal (Y/N) Cased to ft. !IMM WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 0-381 mg./L. Arsenic: 29.7 ug./L. Date of sample: 9/1/16 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1000 " gal. Number of Compartments 3 Parcel ID: 011-134-32 Well Log (Y/N) Wires properly protected Casin above ground) in. AT INSPECTION ft. g.p.m. Collected by: GEG, Ltd. Date installed 10/25/82 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) Date of um in Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATA BELOW FINAL GRADE Date installed . 10/19-20/16 Soil rating .p.d./ r ft%drm) 12 Length 29 ft. Width 3+ ft. System type Gravel below pipe N/A TRENCH 6.5 ft. Total depth '10.35+ ft. Eff. absorption area 377 ft2 Monitoring tube YES Depression over field NO Date of adequacy test NEW Results (Pass/Fail) PASS For 3 bedrooms Fluid deptti in absorption field before test = in. Water added =gal. New depth in. Elapsed Time: = min. Final fluid depth m in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date 34 YEAR OLD STEEL SEPTIC TANK IS APPROACHING THE END OF ITS USEFUL LIFE. TANK WAS PARTIALLY EXPOSED AND INSPECTED DURING THE DRAINFIELD INSTALLATION AND NO LEAKS WERE ENCOUNTERED. D. LIFT STATION Date installed • Size in gallons Manhole/Access (Y/N)— "Pump on" level at in. "Pump off" level atwa er alarm level at Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM 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 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 551+ Absorption field 5'+ Water main 10'+ Water service line 101+ Surface water 100'+ / Wells on adjacent lots '100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line '"51+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage ' 10'+ Curtain drain NONE KNOWN Wells on adjacent lots '100'+ F. COMMENTS 'ADEC APPROVED WAIVERS - 100 FEET TANK & DRAINFIELD TO WELL ON LOT 5 AND 130 FEET FROM DRAINFIELD TO WELL ON LOT 21. "5 FOOT WAIVER TO EAST LOT LINE. �' P f� R I,O( COf,I/MN SUp�OrG7^76 � 1N t�+v0wtr IS O�rF/L ar.itc. 5> A [-c+�—D G. ENGINEER'S CERTIFICATION 1 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 10176 I/6 LICENSE a AECC884 (Rev. 10/12/12) a Ve r. LAorness; W CE -1i ass /'ROFES51��.•� .R.A.unicipaiity of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 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 Parcel I.D. 011-134-32 COSA# L C�/ 1. GENERAL INFORMATION Expiration Date: G `-' l z 1 Complete legal description SAND LAKE #2; BLOCK 5, LOT 5 Location (site address) 8245 SEACLIFF STREET *ANCHORAGE, AK 99502 Current Property owner(s) GEORGE MASSEY Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing address 8245 SEACLIFF STREET *ANCHORAGE, AK 99502 Unless otherwise requested, COSA will be held by DSD for pickup. Day phone Day phone 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class C Well 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 5. As certi`red by nay seal affixed hereto and as of the validation date shown below, f 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 337-6179 Address _3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. 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 Date Lt other person or party is not authorized, nor will it confer any legal right whatsoever. - - - . OF ,, DSD SIGNATURE ``���.`�' • ��.a`��• Approved for s_ bedrooms. Jam: ON-SITE •••' Disapproved. `X : WATER AND : R°` y WASTEWATER Conditional approval for bedrooms, with the following stipulations: d•.• PROGRAM ••* s-.._ Attachnnents: COSA Checklist �/ Arsenic Advisory G Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By:— Original Certificate Date: (Rev. 11/05) Municipality of Anchorage af......Q P... • Development Services Department w: <ii`' " .. . x Building Safety Division °' ..T S A . E T Y' On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SAND LAKE #2; BLOCK 5, LOT 5 Parcel ID: 011-134-32 A. WELL DATA COMMUNITY WATER Well type CLASS C If A, B, or C provide PWSID# 216295 Well Log (Y/N) Date completed Sanitary seal (Y/N) Total depth ft. Date of test Static water level Cased to FROM WELL LOG WATER SAMPLE RESULTS: Coliform colonies/100 ml Arsenic:33' 1 ug./L. B. SEPTIC/HOLDING TANK DATA ft. Wires properly protected ft. CasingiJukillt1above ground) in. AT INSPECTION ft. Nitratei 10 mg./L. Other bacteria 0_colonies/100 ml. Date of sample: 3/8/11 Collected by: GEG, Ltd. 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 installed 1982 Cleanouts (Y/N) YES High water alarm (Y/N) N/A Date of pumping __ Pumper ONE STOP SERVICES C. ABSORPTION FIELD DATA *BELOW EXISTINGGRADE Date installed 1982 Soil rating (g.p.d./ftZo 2/bdr 100 System type DEEP TRENCH Length 20 ft. Width 3 ft. Gravel below pipe 8 ft. Total depth ** 14 ft. Eff. absorption area 320 ft2 Monitoring tube **YES Depression over field NO Date of adequacy test 3/9/11 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test **78 in. Water added 450 gal. New depth **88 in. Elapsed Time: 1055 min. Final fluid depth**LESS THAN 70 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date **MONITORING TUBE ONLY EXTENDS 26" BELOW INVERT OF DRAINPIPE. TOTAL DEPTH AND LIQUID LEVELS CALCULATED BASED UPON INVERT OF DRAINPIPE AND EFFECTIVE DEPTH. D. LIFT STATION Date installed Size in gallons Manhole/Access WN "Pump on" level at in. "Pump off' levelAt High water alarm level at in. E. SEPARATION DISTANCES Cycles tested Meets alarm & circuit requirements? CLASS "C" COMMUNITY WELL. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot *100'+ On adjacent lot, Absorption field on lot *100,+ On adjacent lots Public sewer main Sewer /septic service line ment areas manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots *100'+ PRIVATE & 100'+ CLASS 'C' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots *100'+ PRIVATE & 100'+ CLASS 'C' F. COMMENTS *THERE ARE A.D.E.C. WAIVERS TO CLASS 'C' WELLS G. ENGINEER'S CERTIFICATION 1 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 Printe Na7e JEFFREY A. GARNESS Date 1 // 1UX� 1 11. COSA Fee S �T �� J Waiver Fee $ Date of Payment 3, � 0 l 1 1 Date of Payment Receipt Number d --3q c) Receipt Number (Rev. 11/05) .4 1. Nfe From: s holt To: Re/Max Date: 10l2510D Time: 10:57:54 AM Page 2 of 31 1 D S O D 1 X �op m C -N! O D m -wiz 3 ..1 -n myz O WA. mog T On Egin M Ac O f1 11TT�� 'X m/O Mn 41 mfl ^�^ my O i0o m0 J. �z m m o Z o, �S1 O j M m AI O py y N� oz o O Z Mm: z ak Z g m Z u 'O o -4 � O + O m C Z y' o � om0 T � O O� O. x M N j5 10 0 m o z�n :2 Z Z gyr � N m A 2 M v -'0 9;R mDiOD =a�A < OO� rtp200 61 rt OAM o�� o D <ZO 8 �m (J o= Z, 5 n y Co �mz Zio w mmD N 2 m T •d O 6\a •!1` �V �� co _: w 1; Y'm: -n co 00L2 -8S2 -G06 133bl1 S d -4m vas N 0`07'23'IN 50.02' (PROP) i� kV0 . h; M W 0o S 0°0723"E 50.02' ( PROP. ) 4�:� 93M S311018UH0 WU21 : T T o0oa 9i? ' ��0 e Municipality of Anchorage �E $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 # 111075 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 5 of Sand Lake #2 Subdivision. This inspection revealed an arsenic concentration of 33.1 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.# 1110821001 Allowable Method Container ID Limits Prep Analysis Date Date Init Client Name Gayness Engineering Group, Ltd Printed Date/Time 03/14/2011 15:03 Project Name/# Sand Lake 42 BS, LS Collected Date/Time 03/08/2011 11:00 Client Sample ID Sand Lake 42 BS, LS Received Date/Time 03/08/2011 11:25 Matrix Drinking Water Technical Director Stephen C. Ede PWSID 0 Sample Remarks: 450ONO3-F - Total Nitrate/Nitrite - MS recovery is outside of QC criteria. Refer to LCS for accuracy requirements. Parameter Results LOQ Units Allowable Method Container ID Limits Prep Analysis Date Date Init Metals by ICP/MS Arsenic 33.1 * 5.00 ug/L EP200.8 C (<10) 03/08/11 03/10/11 SCL Waters Department Total Nitrate/Nitrite-N ND 0.100 mg/L SM20 450ONO3-F B (<10) 03/10/11 AYC Microbiology Laboratory E. Coli Negative 1 100mL SM20 9223B A 03/08/11 DLC Total Coliform Negative 1 100ml- SM20 9223B A 03/08/11 DLC Invoice One S+ -"P sew,74ces., INC A nl.� � P4)lor Az;e Date Invoice # 7.,� �. ,. Anchorage, AK 99504-1930 1,. .,, j 3/11/2011 2837 Fax 907-338-5564 Harness Enzneering 3701 E Tudor Rd. Ste 101 Anchorage. AK 99507 Fax = 338-3246 Item pump truck P.O. No. Terms Due on receipt Thank you for your b-Lisiiicj5. Total S165.00 Hn7'nr) I 1 71 IPJAI Description Rate Amount Quantity Job Site: 8245 Seacliff St 1 pump septic 1000 gallons 165.00 .165.40 i I R r A a i r Thank you for your b-Lisiiicj5. Total S165.00 Hn7'nr) I 1 71 IPJAI 11'Iunicipality of Anchorage 6 • Development Services Department \ Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Boil 96650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 t?064,t i . qty = CFRTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING .. Parcell.D. 041 —134'32 HAA# 05Wg2— Expiration Date: 6 —/ % - O $_� GENERAL INFORMATION C . Co r✓Hr✓� Complete legal description L -OT rotat ot-K c�R�vD t!-A►ct~ *4 ?- Location (site address or directions) 8245 5 r-Ae-wr-vc ST, J}wyob¢a4 , 4K , ,jj567 Current Property owner(s) U FI.12V ( Cc K Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address goo LAA, k+e946n, f},c q i 64)3 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class C Well Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site 9 Individual Holding tank ❑ Community On-site ❑ Public Sevier Cl 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. CerJficates of Health Authority Approval are required for the transfer of btle (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 dale 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 8 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 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 S & S ENGINEERING Address EagleRtrer Alaska "S" Engineer's Printed Name Rbe¢R% C- CowA,• 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Phos: &q,41-}977 Date 3 It r-1 o J' T� a eOBERT G COWAN c • CE -8801 I+t+t�JrCicSS1J Conditional approval for bedrooms, with the following stipulations: Additional Comments ON-SITE •m Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other gy;a Original Certificate Date: 3 - O S )Rev OM) 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: LTSi&PeesG5A4ub LPNLE 2 parcel Ib: 0((—(3q -3Z A. WELL DATA Well type �' "�If A, B, or C provide PWSID # AI 6A9j Well Log (YIN) Date completed = Sanitary seal (YIN) = Wires properly protected (YIN) _ Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level Well production g.p.m. _ g.p.m. WATER SAMPLE RESULTS: Coliform b colonies/100 ml. Nitrate 0-1 mg./I. Other bacteria (n colonies/100 ml. Arsenic: mg./l. Date of sample: 3/06/05 Collected by: :54-5 B. SEPTIC/HOLDING TANK DATA / Tank Type/Material 0, Date installed I9$.91 Tank size _1000 gal. Number of Compartments 7-- Cleanouts (DN) Foundation cleanout $?N) rr5 Depression over tank (Y® h)O High water alarm (YIN) Date of pumping 5 t O Pumper Akx NoQ� CE-SS�L 7006 r Pl IOW C. ABSORPTION FIELD DATA DL`15-P Date installed 2 Soil rating (g.p.d./ft2 o � l00 System type TR,15413c44 Length 20 r ft. Width 31 ft. Gravel below pipe ia I ft. Total depth 12-' ft. Eft. absorption area 3SQft2 Monitoring tube st-, Depression over field 14-30 Date of adequacy test I 23 Oz' Results as ail) FA, -S I For 3 bedrooms " n Fluid depth in absorption field before test �� in. Water addedgal. New depth 68 in. Elapsed Time: min. Final fluid depth in. Absorption rate >= � ��% 'f' g.p.d. Any rejuvenation treatment (past 12 mo.) (Y& type) ty o If yes, give date = D. LIFT STATION Date installed "Pump on" level at _ in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump off" level at = in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot * / 00 1- " 1 Absorption field on lot 1&04 Public sewer main Manhole/Access (Y/N) High water alarm level at Meets alarm 8 circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout -r I � Sewer /septic service line 455 4 Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r ) Building foundation J� '- Property line J6 I _ Absorption field S + Water main Wells on adjacent lots I -a O �.�- Water service line o + Surface water /O(D 1+ in. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10 r + Building foundation 1 �d {' Water main I r ' Water Service line It) -t- Surface water ! 00 4- Driveway, parkingNehicle storage i O i Curtain drain NCNL-4A9CwA)Wells on adjacent lots •00 't F. COMMENTS r D*l G. ENGINEER'S CERTIFICATION 1 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. , 1/ R03ERT C. COWAN �`^.• Engineers Printed Name �Oi3f.t' C CO��� lj c; CE -8801`-; Date HAA Fee S L/ 3 Date of Payment Receipt Number O G (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number UG 6. LY LUuu ♦.. .ra ... ..... ...__ . M I 3 I Y rdMd)♦ZO'04 MIXIO.014 • — SEACLIFF STREET 1 tr1 a LL•: �Ij �:W{• :II Y 9 N MUNICIPALITY OF ANCHORAGE • '� 1 DEPARTMENT OF HEALTH & HUMAN SERVICES Mti Division or Environmental Services Onsite Services Section P.O. Box 196650 Anchorage, Alaska 99519.6650 (907) 3434744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING Parcel I.D. # 011-134-32 HAA # 1IFY)C 1 P i ^-1- 1. GENERAL INFORMATION Complete legal description SAND LAKE 021 LOT 5. 91 OCK 5 Location (site address or directions) R745 SEACLIFF DRIVE. ANCHORAGE AK 99502 ProgerLy owner MELINDA MILES Daee Mailing address 8945 SFACLIFF QRrVF. ANCHORAGF- AK 99502 Lending agency Mailing address Day phone Agent CHARLOTTE SCHI O=FIN w/ REMAx Day phone (907) 275-0106 Address 2600 CORDOVA ANCHORAGE. AK 99503 Unless otherwise requested, NAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well xxx Public water NOTE: If community well system, provide written confirmation from State ADEC attest - Ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xxx Holding Tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC ing to the legality and status of system. 72-025 (Rev. 1191) Front MOA #21 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $910.00 at, or prior to, closing for the engineering services provided. 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system Is safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I 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 r�i State codes, ordinances, and regulations in effect on the date of this inspection. //// Name of Firm Phone (907) 337-6179 Engineer's Signature ( Date _L7 C� In conducting this evaluation, AWWC, !nc att m1countered d to pro d a thorough, conscient ous engine ring analysis of the system In accordance with ADEC and M A HGuidelines& Regulations. The reported results described the performance of the system under tine conditions 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, ground water levels that may fluctuate during the year, and the waxer usage of the family being served by the system. These conditions are outside the control o 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. AWWC, Inc. can therefore not provide any warranty for future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DHHS. 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. 6. DHHS SIGNATURE Llf Approved for 3 bedrooms Disapproved Conditional approval for Additional Comments 0 bedrooms, with the following stipulations: Date 1 �L -11 -00 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 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. 72-025 (Rev. 1191) Back MOA #21 Computer Version Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division US V Street, Rm 502 Anchorage, Alaska 99501 (907) 3434744 Health Authority Approval Checklist Legal Description: SAND LAKE N2: LOT 5. BLOCK 5 Parcel I.D.: 011-134-32 0. WELL DATA F Well Type CLASS "C" It A. B, or C, attach ADEC letter. ADEC water system number 216295 Log porn (YIN) Date completed Total depth FROM WELL LOG height (above ground) Wires property protected (YIN) AT INSPECTION Date of test Static water level Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform 0 Nitrate 0.5 ma/L OQrer bacteria 0 Date of sample, 11/1/2000 Collected by: A.W.W.C.. INC. B. SEPTIC/HOLDING TANK DATA Date Installed 1982 Tank eine 1000 Number of Compartments 2 Cleanouts (YIN) YES Foundation deanout (Y/N) YES Depression (YM) NO High water alarm (YM) N/A Date of Pumping 10/30/2000 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA Date installed 1982 Soo rating (g.p dAt2 or f12/bdrm 100 System type TRENCH Length 20' Wkflh 3' Gravel thkkness below pipe 8' Total depth 12' Effective absorption area 320 SO Fr Monitoring Tube present (Y/N)Y Depression over field (YM)NO— Date of adequacy test 10/30/2000 Results (Pass/Fah) PASS For 3 Bedrooms Fluid depth in absorption Held before test Qn.y 0" Immediately atter 1841 gal. water added (In.r 9.5" Fluid depth 0' One) Minutes later. 1094 Absorption rate . 450+ Perwdde treatment (past 12 months) (YIN) NONE KNOWN ff yes, give date ----- r"20 pt.v. 3mer compuar Ver" D. LIFT STATION Date installed Size High water alar E. SEPARATION DISTANCES *Datum ar "Pump off' level ar SEPARATION DISTANCES FROM WELL ON LOTTO: • 100' ADEC WAIVER Septidholding tank on lot ;100'+ On adjacent lots Absorption field on Public sewer main sewer manhole/deanout LIR Station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property One 5'+ Absorption Held 5'+ Water main/service One 10'+ Surface wateddrainage 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water maln/senAce One 10'+ Surface water 100'+ Driveway, parking/vetdde storage area 10'+ Curtain drain F. ENGINEER'S I car* that I 1 ofMunldpal n with MOA HA4 Engineer's HAA Fee S -gyp . © O field Inspections and review systems are In conformance Dn this date. Date of Payment f a2-� Ulf Receipt Number 45664©� g77 63,74 1 72-M Mn. 3188)' Caryulx VWWM Wells on adjacent lots 100'+ Waiver Fee $ Date of Payment Receipt Number ;h - - 133?l1Sd�17Od3S N 0.0723'W 50.02' (PROP.) 50.02' ( PROP. ) 10 Icc N N m J W 01 rX m n J z i•d OOLZ-092-L0G 63M 53110188 H3 WHZi=ii 0002 92 '100 74 -gi 0y, - - 133?l1Sd�17Od3S N 0.0723'W 50.02' (PROP.) 50.02' ( PROP. ) 10 Icc N N m J W 01 rX m n J z i•d OOLZ-092-L0G 63M 53110188 H3 WHZi=ii 0002 92 '100 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 I.D. # C l 1 — 1 ?.a 'A • _, r l HAA # - NA (-\qo OnR 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include tot, block, subdivision, section, township, range) Location (address or directions) 0 4 ;• t~ •. �x SaYT Sete /.F! (b) Property owner Mailing Address 3 ;zc y C (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone .��'el'�flii�+e : (home) Telephone (e) Mail the HAA to the following address: (or check herejf if hold for pick up.) List contact person and day phone number below: 5 az 7g-rrr3 2. TYPE OF RESIDENCE Single -Family Number of bedrooms 3. WATER SUPPLY Business Individual Well ❑ CommunityX Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. ' 4. SEWAGE DISPOSAL On-sitet'j Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (R«.7/88) Page 1 of 2 Z 1 Z a6ed fore IS z,"U) SMLL ,Mjom s,jaaul6ua leuo!ssa;ad ay1 u! suo!ss!wo jo sionajol elq!suodsai lou s! 96ejogouV;o A3!led!olunpy a41 •panssi s! aleo!puao a ajo;aq eiep ezAleuejo suopoodsu!lonpuoolouopSHHO;osa, Aoldw3•s3uswaj!nbaj9;eispug Iejapalu!eliaoA;sueso3iapiou!suo!inl!3su! 6u!pual I!ay; pug sawo4;o siase4and of Asalinoo a se S!43 saop SHHO 041 •g�lsely;o elmGLI) ul paia3s!6ai jaou!6ua leuo!ssa;ad luapuadapu! ue Aq anoge S 4dei6eied u! u9A!6 suo!leluasajdaj 043 uodn A1uo paseq pa;eo!luao lenaddVA;uo4;nV yl!e9H sanssl (SHHO) saolAjeS uewnH pug 411eaH10;uawliedaO a6ejo4ouV;oA3!led!o!unlN 941 No11fiVO Ienaddy Iguo!3!puoO 10 swja1 Ieuo1;!puoO panaddes!O - panaddV _ Z / OWC3Aq swoapaq £ Jo; panaddV !' IVAOaddV SHHO •9 a;eO e aV Vssa'PPV £11J— cZ° euo4da!a1 7 S�. wJIj109weN "uolloadsui s!43 ;o elep a4; uo loa;;a ui suo!;eln6ai pup 'saougulpio'sapoo elelS pug ledlo!uny,I Ile yl!m eoue!Idwoo ui si wa;sAs lesodslp jaluma;sem jo/pue Alddns ialem ells-uo ey3'uo!ioadsul Pug uo!3e6!isanu! Aw woj; pug sal!; 06ejoyouV ;o A3!Ied!o!uny4 e4; wa; pau!elgo uol;ewjo;u1 e41 uo paseq 1e41 A;uaA ja4un; 1 uiajaq polewpui ain;onus;o adA; pug swoojpaq;o jagwnu a43 jol elenbape pug leuolloun; 'a;es si walsAs lesods!p ialemalsem io/pue Alddns jalem el!s-uo a41 ig41 smo4s IenoiddV A;uo4;nV 1411e9H s!yl;o uo1;e61;sanu! Aw legl A;uaA I'molaq umo4s alep uo!lep!leA a43;o se pug oiaJa4 paxl1;e leas Aw Aq pa!;!ljao sV NOI1VWUOdN1 CNV V1V0'HOUM 3lid'S1S31'SNO11O3dSNl VNIOIAOHd WU1:1 ON11133NION3 'S ioao��S�oa �° 7 - MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval J,`p�sy CHECKLIST - F FEBRUARY 1984) 343-4744 Legal Description:_ 3AIJDLAKE SUBD.-#Z LOT S 131-OGK 5- A. A. WELL DATA Well Classification -yc-C t AS.S If A, BI�.E.C. Approved (Y/N) Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Date Completed Electrical Wiring in Conduit (Y/N) Depth of Grouting SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) On Adjoining Lots On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole —;Date o7Zc�,97 Lrle'e,d /Vz,/TT, , Commentsr—lrS,F r G,lP // A er_ "Zao/rZ B. SEPTIC/HOLDING TANK DATA Date Installed 82- Size 1000 No. of Compartments 2 - Standpipes (Y/N) _Air -tight Caps (Y/N) —y Foundation Cleanout (Y/N) -y Depression over Tank (Y/N) 1U Date Last Pumped Pumping/Maintenance Contact on File (Y/N) N ; for Holding Tank Hi h -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N)n ,!EP_;$A7ti�QJ DISTANCES FROM SEPTIC/HOLDING TANK: Is r' t'•'�T-�^ater SU%Well -1 US To Building Foundation t + ; ..••To.rrope Litth To Disposal Field • To Water Main(S2rvice Line SSU' �....................... Jo StreaA P *Lake or Major Drainage Course 72-M(A v.VN)From Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 100 Sq �/r Type of System Design ' / C7y Date Installed 9 82 Length of Field 20 7 Width of Field -131 Depth of Field Gravel Bed Thickness 8k Square Feet of Absortion Area 320 S!% Statndpipes Present (Y/N) Y Depression over Field (Y/N) N Date of Last Adequacy Test b 489 Results of Last Adequacy Test SfFTI S FAGTO �Y SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well 100 -1- To Property Line ) 5 7 To Building Foundation 2 (o To Existing or Abandoned System on Lot new ; On Adjoining Lots To Water Main/Service Line To Cutback (if present) n�a- To Stream, Pond, Lake, or Major Drainage Course n/0 -- To Driveway, Parking Area, or Vehicle Storage Area 2 5 Comments -k (! Cln cJ QC `7 at /l " A 111,t7'_ D. L STATION Date Inst Yl /�- Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments "Check Permitt7 Bedroom certify that h / e checke inspection. Signed 14 Company -1 - / Date MOA No. Z4 Dimensions Manhole/Access (Y/N) . — "Pump Off" Level at Against HAA Request" Vent(Y/N) Pumping Cycles during Adequacy Test. or conformed to all MOA and HAA Receipt No. �:21" U C9 r �r Date of Payment6 Amount: $ _7501 O 72-M (Aw. 7/88) Back 4 /I In effect on the date of this 'ne aM1T •• �......».•._ •• .•. •. H.. •Ht eNa J. dor .xk ! W l N •. CE33 `4y •.. 28 •.. ......•..•/ �, c •. s V�/ 0• Y G REID, JR. tj / VV®��Di?Ocw.`.1• MA�,4� �+ �. CE -2251 �e Receipt No. .aT.>+ fa a 09.040 J'VCSSlOAL --a Waiver Fee: $ *���..•• Date of Payment Page 2 of 2 SE or & STEVE COWPER, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE WESTERN DISTRICT OFFICE 563-6775 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 December 29, 1989 Dr. Leroy C. Reid, Jr. Alaska Environmental Control Services P.O. Box 240668 Anchorage, AK 99524-0668 PWSID: #216295 According to the records on file in this office, the Sand Lake #2, Lot 5, Block 5 Subdivision Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, 2L d' Y VERA E. CRAIG Environmental Field Officer VEC:bas ;LEGAL �..�••,,i ! %:JlJ ull L\�a as.« a,.t. L c J ,- C«svllinQ EM�sen TIME,GALLONS TOTAL GALLON PER MINUTE SEPTIC TANK DEPTH INCHES INCHES LEACH FIELD DEPTH MER in Ki I A� `t'7-- po ,1;, „ 5'D aa L� 7 4 N 0 yl N E955�00 C✓ /3�•DO 1 i 0 r5 •J�'r J K 110 � � E'e T•WAtt N 5'0�� _ 1/!.� z 1 0 h � WO.I.eu'WA//7.I0 II II Deo!. G•aaave _ _ _ _ 3o II NOT61 BEA?INf,S A,PC dfSED IJoO•{/ GL Mr .V6`3 s5•oo „/ i �E/•�/db .d�•r/6 Tt/E 6-L✓ f� CF 7a',< £tz TroA/ O r,VG7/1 ,rjGLillEi 73/EAIGZT LJ.✓E ac TlAt- sc_ r.7 -r%41 Aldo eE"f'- ✓mts q yl/oaJd o•<CO2/6. /lWreP-/74,) LEGEND � 0 lth,ary araanun/ nrnwrod • lrw No• oad/a rAW. recovered o 1S/B0s JO' near sN IAAr wrwy PREPARED FOR, 12�A • � " �tFSS10N A� "� D W BH hl -<S I Aar, 7L B:p I scar. Ir 3o SHEETNLL of CNCKD BYr ,6e lwama I F9. NO. 91 GR/D 1214 AS -BUILT LOTS BGoz -4- 5 l hereby crtily that on ecavrots survey o/ the follow/ng desermed propr/y- GoTS. BC ocCS Cat/D_IACE d ,6 .4/0' Z Mos orad# on 71-4ZeT and that the brpmroments e7tsated thereon on r/lhb the property /AM* and do nal orortep or a*CrooCh on Me property Yyng aefacwt thanlo Mot no Improvements on properly l/bg ad/ocval Iherom encroach on the prem/ass /a prestbm one that there " 00 rood6wv, Iraasadss/m /bee or other v/s/Am easements w sold property awcepl or bd/coled heroo". polod a Anchorage, Al a, th/LiZA day, Of L.S No.4/09S PREPARED BY CORWIN & ASSOCIATES 1000 E. DIMOND BLVD. SUITE 205 ANCHORAGE, ALASKA 99515 (9071 522-1311 •�� moi. /In n M1n:iC1/�� �- Time APPLI( NT FILLS OUT UPPER HAI ONLY Prop,. _ -- `� ✓, ,::.; � . � � j i� �-� \151_t�� �S�'� — Phone ( rte( C M Z- 0_" IL.. Mailing Address r' ::;:- % ;J Zip Code Buyer Date Address rte? s�_->''�'" i' -C- �- Zip Code Lending Institution Inspector Phone Address "_ )C> �. Ws 1;�E'«-`_,�_�,--., '� Zip Code Realty Co. & Agent `, 1„ Phone Field Notes: ENVIRu,d;..=,',.;>.-. 'LTION Address .u. Zip Code -..�f�`• Legal Description1-c.�%-'"�, fCIE Street Location - , >e' (Ii`,; -_ Type of Residence ❑ Single Family *a Multiple Family No. of Bedrooms ( DISAPPROVED ❑ Other (K) CONDITIONALAPPPROVAL' Water Supply El Individual _ ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ♦ l Community «' <= `- For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Well To Absorption Area Sewer Disposal :J Individual Septic Tank Size (' 11 Year Individual Installed: ' 0 �' ❑ Public Utility Well to Tank When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. •�� moi. /In n M1n:iC1/�� �- Time Time Time � n Time - 0\0_"Z 0\ ( rte( C M Z- 0_" IL.. Date Date Date Date Inspector Inspector Inspector Inspector MUNICIPALITY OF NCHORAGE Field Notes: ENVIRu,d;..=,',.;>.-. 'LTION .u. c � " fCIE Coal APPROVED BEDROOMS _ _. -'CONDITIONS OF APPROVAL - - ( DISAPPROVED --------- (K) CONDITIONALAPPPROVAL' DATE ' r ! ~ 83 Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size (' 11 / �� Well to Tank 72023 (3182)