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SAND LAKE #2 BLK 6 LT 8
Sand Lake #2 Block 6 Lot 8 #011-133-29 Municipality of Anchorage Community Development Department Page 1 of 2 On-Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650•http://www.muni.org/onsite•(907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181165 PID Number: 011-133-29 ❑ New [' Upgrade Name: ERINN STEFANICH ABSORPTION FIELD Address ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound 8317 SEAVIEW ST ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Ft. Ft. SAND LAKE #2 6 8 Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Lift Station Tank Line Ft2 Ft. Well N/A N/A N/A N/A N/A TANK ❑p Septic 0 S.T.E.P. 0 Holding 0 Other Manufacturer Capacity Surface Water 100+ N/A N/A N/A ANCHORAGE TANK 1000Gal. Material Number of compartments Lot Line 13.2 N/A N/A N/A Steel 2 NA Foundation 10.0 N/A N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain 50+ N/A N/A N/A Gal. Remarks Pump on level at Pump off level at High water alarm at TANK REPLACE ONLY i r-ck t t? ''"/ o-A Le-)AS c' Si; it in. in., in. L�G� d�-1 Pump make and model Electrical Inspections performed by akVIPO-CU 60 to PIPE MATERIAL House to tank 3034 Tank drainfield 3034 Installer JR'S SEPTIC Drainfield CO/MT Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 160ft Inspection1s, 7/9/2018 Location and description dates: 2w 7/9/2018 3rtl 41b SW BOTTOM HOUSE TRIM COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp �� �N\ l Conditional Approval: Date OF •'• 'd `v olorkty 11 **..1zP, 4.110 & ••Vteven •'. •Van•rlorae•ir Approved ;, 6.'Vt e- / Date 7/1 1 s 1l �A 4 I � �'OFE55t ,► Inspection Report_1-1-12.doc A (E) 1 i_ \ — _1 1 3' 6 1 1 9 00. 1 I SEPTIC AREA (E) 0 Ln / J / M /14 — 1 H — / I `.LL (E)� � 1 � - DECO ISSIONED EXISTING 1000. o O I \ SEP' C TANK PER MOA CODE H.IVEWAYv3l 3' 41=7ormin BDR B-1\. / 3' O ,.. 01 �� SFD e ,sa /ELL (E) O ,so DCO T1/ . T2 7 \ INSTALLED NEW 1000. SEPTIC TANK II 1 W/ DCO AFTER 1 6 O0 .1 / SEPTIC AREA (E)/ O A (E)/ 1—[1-1 H _ \ _ — — I Up 101 . 1 5 / . ,0 N,,,..., � � o w A B - - W _ T1 16.6 10.4 T2 13.3 16.3 O 11 / 4 Oa DCO 12.0 18.6 0 CY o a Ln Ln in I- I- D 0 0 D z z I,,O J W W m W J J O J U 0 OU O.G./F.G. _ _ — — 160 1 4.0 1 _ r 1 / 1000 g SEPTIC v., PROFILE 155.4 ;` TANK s,. 1.::).7 SCALE: l ''=10' NOTES: PANNONE ENG SVC, LLC ,�/ - Dote RECORD DRAWING P.O. BOX 102954 ANCHORAGE, AK 99510 4oF 07/11/18 PHONE (907) 272-8218 FAX (907) 272-8211 g\. Scale *; - -i .* 1" = 50' • •• ky�• '.I.D. NO SAND LAKE #2 B6 L8 ._ qhs►• �'�,`•; 011-133-29 ERINN STEFANICH . seven•A..Pannoiae PERMIT NO. DRAWN ACPCE 8149 8317 SEAVIEW ST OSP81165 SITE PLAN ANCHORAGE, AK °;,+'F ,-,` Sheet 20F2 • __ MUNICIPALITY OF ANCHORAGE On-Site Water&Wastewater Program PO Box 196650 4700 Elmore RoadA _ ..•cr ` Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax: (907)343-7997 ' _. 4 r c n http://www.muni.org/onsite Department � f' .��f kUe hE On-Site Wastewater Disposal System Permit Permit Number: OSP181165 Effective Date: 6/28/2018 Work Type: Septic Upgrade Expiration Date: 6/28/2019 Tax Code Number: 01113329000 Site Legal Address: SAND LAKE#2 BLK 6 LT 8 G:2224 Site Mailing Address: 8317 SEAVIEW ST, Anchorage Owner: STEFANICH ERINN D Lot Size in Sq Ft: 6750 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field ESI Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing' Special Provisions: The septic tank shall be a minimum of 10 ft from the building foundation or outside the soil bearing prism of the foundation (established by a 45 deg plane extending down and outward from the bottom outside edge of the footing or thickened slab edge). Fe\-- G-wtaA d AY-0-0N- feC aS aof, si-aw(C O 10. r l (ed t v e s Luv a,t ems' bei puortred d ?I-eta() Cam( .—"S t" t,� fk t' V�Y c9+ C-(2- i Received By Date: 1 1 Issued By: tabte64. C�li2{�-� Date: 2 F /8 6189 /07, 2 •� 11 Ali o �u� 1 MUNICIPALITY OF ANCHORAGE G Bo ,ati Community Development Department `_' � Phone: 907-34 - a Development Services Division Fax: 907-343-7997 On-Site Water& Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 011-133-29 Property owner(s) Erinn Stefanich Day phone Mailing address 100 E. Manor Ave. Anchorage, AK 99501 Site address 8317 Seaview St. Legal description (Sub'd., Block& Lot) Sand Lake #2 Block 6 Lot 8 Legal description (Township, Range & Section) Lot Size 6,750 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade ❑X Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ 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. kip (Signature of property owner or authorized agent) Permit/Rush Fees: 0215- -- Waiver Fees: Date of Payment: Cr2-1 J l Date of Payment: Receipt Number: 02.664,1-6 Receipt Number: Permit No. OS r IN 11,5 Waiver No. Permit App_ :•::...c Pannone Engineering Services [lc Steven R. Pannone, Principal Registered Professional Engineer E-mail:steve@panengak.com June 26, 2018 Subject: Sand Lake #2 Block 6 Lot 8 Tank Replace Permit Request Design Narrative This is a design narrative for a permit to install an upgrade 1,000g Septic Tank to replace an existing 1,000g Septic tank to be issued for this property. The existing tank is collapsing. It will be decommissioned per code. Currently the lot is developed. The proposed system will utilize a replacement 1,000g septic tank that will be connected to the existing drain field. The existing tank is located approximately 100'+ from the well. The proposed tank will be placed outside the existing well radius. All required separation distances will be met. 1. Upgrade Tank Design. A foundation clean out installed if needed. The tank will be located: 5'+ from any property lineCbuilding foundation or drain field 10'+from any water line 100'+ from any surface water 100'+ from any private wells 200'+ from any public wells The proposed installation will not affect the future development of the surrounding or existing lots. If you have any questions or concerns, please contact me at 907.272.8218. Sincerely, .•''�C� �F ALP* • to 0 •„% Steven R.Pannone : •„� CE 8149 ••• •••••.. ' i .......' Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 i • a o 70 /.{ ;i -ttlomeo Ftp -7-"A N tk tj•-- ye.Kt, i • �p2wt r— . Y } T3 �2 t''• . . .5 E.-PTt c TA,v r- (..2-) • -ept7,4-p * Fit t.'tif Cn,vcRX:ri• //3 °S ....'0o4 w /35, 00 Q, i:: i;,.,s.!...„, 675? i if 0. t i s • . 15.1-% l 0. 1a� ".J ...i•.4.......1"1:.) Z�. mums • NSG” N 8.- In k x "1 • • 4 i'..: �o• :::::5e V s ';'� L a " o • " 1I w' ro .. r • ' i �w x r x ,� x s. q• v p N8 / ' 'oo ''W 1.. ...5: 00 h 'l,- • • 1000 g se P'n c -rA.ot.0 Cp.) • I'`SP co A Fr't "TA NIL. } i A, 5-cu le: I " = 3' ,. co N,)ac-T -r-o(E� e'jG'-ric-bT2A w FreLD • `. R e c e r fi 4'(4 g -z8-8.q 01,k3-z9-yol. Y. 4 -3-Oi Z AS-BUILT NO CORNERS SET THIS DATE • oon.9o: si •,' c I hereby certify that I have performed a Mortagee's in- 4 °�* OF it L�kti� spection of the following described property: L--0 t 8) ,,r....st • •• • ....••.••••.....�= 7 Block 6� • S aracl 1- a ke Su 6 d. No. Z • 0i►��,• STEVEN R. 4 PANNONE;a��' : • :{ • _;� , 'sic Anchorage Recording Precinct,Alaska,and that the improve- 404,—.2)%, mprove- CE • ... . ., , ments situated thereon are within the property lines and do ♦ �•• ••Vim?" Ic/ r7 ' I 'not overla or encroach on the roperty lying adjacent there- e�'r•......••"• �� .,•,--, ' �� �•"�.7•` :t`.`; ''to that no im rovements on pro ert 1 ng adjacent thereto p P Y Yi tR j PROFESStO���,f „,::,;4 k• •encroach on the premises in question and that there are no <1Itta‘�� •. ,�� ,.i roadways, transmission lines or other visible easements on ,14•;:.' t`v :t' • said property except as indicated hereon. ��afL S��t G'<-rC1,v K i•�-• �'cv�� t5F vt,2 O,tIL,�,1 .. 'o�y•••.....••---o � Dated at Anchorage,Alaska i``OFESs10NM.t„„•'4, this 2 r! 'iay of /V O v 4. rr� b e�' ,19 87 EASEMENTS OF RECORD, OTHER THAN -%.',A-.m..11 THOSE SHOWN ON THE RECORDED • FRED WALATKA& ASSOCIATES PLAT ARE NOT SHOWN HEREON. Bt ; rW Engineers and Surveyors 1 r � MUNICIPALITY OF ANCHORAGE \� DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION �f ENVIRONMENTAL ENGINEERING DIVISION 825 L Street • Anchorage, Alaska 99501 Telephone 264-4720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE KNEW % 17f,9-'3470 ❑UPGRADE MAILING ADDRESS A �C Uylo36 �¢ LEGAL DESCRIPTION LOCATION NO. OF BEjf ODMS r✓ta.✓ vF� 8'o'inci DSLNDISTANkCETOV': Wel.✓b. Absorption areaPEHMI NO. �Z yPP MateriaNo. �[IF of compaents ons Inside length HOMEMADE: Width liquitl depth Z Well Dwelling PERMITNO. _? Manufacturer Material Liquid capacity in gallons w= DISTANCE TO: Well Foundation Nearest lot Ime J�✓Glc PERMIT NO. H Z W No. of lines Length of each ane Total len th of lines Trench width Distance between lines O H Top of tile to ofgrade Material beneath Isle inches s ! inches T ot2jeffntive absorption area r w Length Width Depth a PERMIT NO. 0 F W a Type of crib Crib diameter Crib tlepth Total ellective absorption area w DISTANCE TO: Well Building foundation Nearest lot line —1 Class Depth Driller Distance to lot line PERMIT NO. W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING /00 INSTALLER REMARKS T -P e,4 P , J IfoSe.a ✓tet✓ . t or z v {7 C v � APPROVED DATE LEGAL' 41-2)cf..c� 77-013 (Rev. 3/781 DEPARTMENT HEALTH AND ENVIRONMENTAL ,.-OTECTION 225 'L' STREET. ANCHORAGE, AK. 99501 *: 264-4720 tDr-i I TE SE4•!ER F='EF:zt•1 I T PERMIT NO. C 220140 > APPLICANT T & T CONSTRUCTION SPA BOX 403E A 3452670 LOCATION LEGAL L2 66 SAND LAKE SUB #2 LOT SIZE 6750 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MA`;IMUM NUMBER OF BEDROOMS = 3 SOIL EATING CSR FTIBR)= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: CHEF='TH= :ED t_Et-JGTH= _' '3F= ffVEL G�EF=TH= -I- THE THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DP..AINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOP. TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). F:EOU I F2'ELti `SEPT I c TFIt-.IFS S = I . _'E= �r���+ uRLLC�N� PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY I -JELLS ADJACENT TO THIS PROPERTY AND THE NUMBER: OF RESIDENCES THAT THE WELL WILL SERVE. --- TWO C 2 ? I "SPECT I Q FIFE FREGIU I FR. EI? BACY,FILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT I -JILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A I -JELL 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: LIFJE IS 25 FEET AND TO A COMMUNITY SEWER. LIFJE IS 75 FEET. OTHER. REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PEF?M I T E:XF• I RES EwEr_-EMBER 7�1.. 1S4: � ' I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I I -JILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER. SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED T F T CONSTRUCTION ISSUED ________ V4. 0 a f1 r P� • MUNICIPALITY OF ANCHORAGE ^•� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION l 825 L. Street, Anchorage, Alaska 88501 264-4720 SOILS LOG — PERCOLATION TEST a SOILS LOG ❑ PERCOLATION TEST PERFORMED FOR: 1 wj r nnCdvt b,4ruc((on DATE PERFORMED: If - 17r 13A LEGAL DESCRIPTION: -Let 8 O/or G Sa N./ Like Jl a - DEPTH SLOPE B179 Pi aer 1 2 3 I n T. 4- 5- 6- 7- 9- 12- 13- 14 5 67912 13 14 • 0 15 ••9 16 4. 0 0Q 17 , O 16 19 20 Km_ WAS GROUND WATER S ENCOUNTERED? _ N o L 0 P IF YES, AT WHAT E DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop �11� O ppAt00 NNebuN N• Leroy Re(d, Jr.',2 4 a, v PERCOLATION RATE``"' (minute./inch( TEST RUN BETWEEN FT AND FT D G'-htiA_/_ 1 t --- v/ 1n F PERFORMED BY: M; keI MCI C,I Lee, Ua.Ct 7.1+.11 CERTIFIED BY: DATE: /' Z-2) - T -7- 72-00a (6/79) c 11so � Municipality of Anchorage 7,40- c); On-Site Water and Wastewater Program �� I I< q, Iil (907) 343-7904 J U I . E fts. Certificate of On-Site Systems Approval �p Arm, Parcel I.D. 011-133-29 Expiration Date: / 0 -1 c(--1 1. GENERAL INFORMATION Complete legal description Sand Lake #2 Block 6 Lot 8 Location (site address) 8317 Seaview Street Current Property owner(s) Erinn D Stefanich Day phone Mailing address 100 E Manor Ave. Anchorage, AK. 99501 Real Estate Agent Day phone 2. TYPE OF DWELLING: • Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual El Individual Water Storage ❑ Holding Tank ❑ Community Class C Well Q Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received b • =AIM A _ APA Date: 1 l61 (t COSA to be released to the engineer,unless othe Ire quested by the engineer. • COSA Fee $ t 4O p,WoctS2— Waiver Fee $ Date of Payment t.P' $""� Date of Payment Receipt Number OtDa1 G Receipt Number COSA# OSC.t ' \2(pO Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are)in compliance with all applicable Municipal and State codes, ordinances,and regulations in effect at the time of installation. In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system.The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 6/7/2018 P C \k 6. DSD SIGNATURE System#1 Approved for •- bedrooms •S1'- •• . annone: 1.----- r6-0;•, CE-8149 ,�r� System #2 Approved for bedrooms 9� Zs'•. -1_� ��k� PROFESSI0=4, Disapproved 1\U.s..S cS Conditional approval for bedrooms, with the following stipulations: LAY 6' ••f v\IPS°EGRP\11 �� r .-<;. pRQ C ,r gy: /..--AOriginal Certificate Date: 7-i7 --t ? The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_[ '- . .. If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system I Certificate of On-Site Systems Approval Checklist Legal Description: Sand Lake #2. Block 6, Lot 8. Parcel ID:011-133-29 A. WELL DAT®Lz Class C td� 215469 Well type If A, B, or C provide PWSID# Well Log (Y/N) Date completed Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height(above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate ND mg/L Arsenic 15.2 ug/L Date of sample: 5/22/2018 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 7/9/2018 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N Date of pumping NEW Pumper N/A C. ABSORPTION FIELD DATA Date installed 4/24/1982 Soil rating (g.p.d./ft2 or ft2/bdrm) 100 SF/bdrm Deep Trench System type Length 26 ft. Width 5 ft. Gravel below pipe 6 ft. Total depth 7.6* ft. Eff. absorption area 312 ft2 Monitoring tube Y Depression over field N Date of adequacy test 7/12/2016 Results(Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 1 in. Water added 468 gal. New depth 7 in. Elapsed Time: 180 min. Final fluid depth 1 in. Absorption rate >= 450+ d. g.P. No Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements'? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation/ /C ' Property line 5+ Absorption field 0+ Water main 10+ Water service line 10+ Surface water 10 Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 0 Curtain drain 50+ Wells on adjacent lots 99.86 ** F. COMMENTS * Monitor tube only extends 4.2 ft into drain field. **See Sand Lake #2, B5, Ll 8A Septic predates neighbors well. Class 'C' well is located over 150' away on Block 6 Lot 12. Survey on file NI G. ENGINEER'S CERTIFICATION 411- OF At ‘‘‘4.9 i I certify that I have determined through field inspections and Al 3.• review of Municipal records that the above systems are in 0*:49 TH /\ •.* /� conformance with MOA COSA guidelines in effect on this date. d'• �• • �-. Engineer's Printed Name Steven Pannone •':S}ever `.'Pan 7/17/2018 � cg .. CE-8149 Date `r �ikZ ofts4al`--..4.' COSA canary sheet_2-6-15.doc MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 tt On-Site Water and Wastewater Section \ jFax: 343-7997 www.muni.org/onsite Arsenic Advisory Certificate of On-Site Systems Approval # OSC181263 Subdivision: Sand Lake #2 ,Block 6, Lot 8 A water sample revealed an arsenic concentration of 15.2 micrograms per liter (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On-Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. Mailing Address: P.O. Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org Parcel I.D. 011-133-29 Municipality of Anchoral On -Site Water and Wastewater Program (907)343-7904 A� JUL 2 6 2016 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: 1 l ✓ 1 L Complete legal description Sand Lake #2. Block 6, Lot 8. Location (site address) 8317 Seaview Street Current Property owner(s) Erinn D Stefanlch Day phone _ Mailing address 100 E Manor Ave. Anchorage, AK. 99501 Real Estate Agent 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual x❑ Individual Water Storage ❑ Holding Tank ❑ Community Class C Well El Community _ ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for:. Received by: U(,-� Date: 0 S 6 COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 52j Waiver Fee $ Date of Payment//�yy ll� Date of Payment L/ Receipt Number % 6646 Receipt Number COSA # 61YA X131 t Waiver # 5. STATEMENT'OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. - In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Alk. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Date 7/13/2016 NN1 j.....STM -'... .Steven R.'Pannone• �g� CE -8149` �¢ c6 \ Conditional approval for bedrooms, with the following stipulations: cst-SITE '�'� VVF, G� ANO Oma' By: �� .W\.— LzsOriginal Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA)based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible foremors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet f - '. c If more than 7 septic system is on the lot: COSA Checklist # + of Structure served by this system Certificate of On -Site Systems Approval Checklist - Legal Description: Sand Lake #2. Block 6, Lot 8. Parcel ID: 011-133=29 A. WELL DATA Well type Class C If A, B, or C provide PWSID # 215469 Well Log (Y/N) Date completed Sanitary seal (Y/N) _ Wires properly protected (Y/N) Total depth f.. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. 9,P,m, WATER SAMPLE RESULTS: 4se liform colonies/100 mL Nitrate O.10OLfng/L nic 2-6. ug/L Date of sample: D/ in Collected by: + 1 1 S B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 4/24/1982 Tank size 10002 gal. Numberof Compartments — Cleanouts (Y/N) Y' Foundation cleanout (YIN) Y Depression over tank MN) N High water alarm (Y/N) N Date of pumpingl& Pumper A/eMe _0>pi V t rcle�2 ° C. ABSORPTION FIELD DATA Date installed 4/24(1952 Soil rating100 S1r'/bdrm Deep'Trench (g.p.d./ftz or fizlbdrm) System type r_ Length 26 ft. Width 5 ft. Gravel below pipe 6 ft. Total depth 7.6 ft.a` Eff. absorption area 312 ftz Monitoring tube Y . Depression over field N Date of adgggAy t5"` '1'2/2016 Results (Pass/Faii) Pass For 3 bedrooms Fluid depth in absorption field before test 1 in. Water added 468 gal. New. depth 7 in. Elapsed Time: 180 min. Final fluid depth 1 in. - Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) No If yes, give date F. COMMENTS * Monitor tube only extends 4.2 ft into drain field d L 1/. z , r3 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 Steven Pannone Date 7/13/2016 COSA canary sheet 2-6-15.doe /yv I5A0 �, $s 'C.' well .60ccY"PLI -Ow. w� i 4�e D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer /septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation`' O Property line 5+ Absorption field 5+ . Water main. 10+ Water service line 10+ Surfacewater 100+ Wells on adjacent lots i'T /0r7 4 - ABSORPTION ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main -10+ Water Service tine `10+ Surface water 104# _. parking/vehicle storage - O Curtain 50+ adjacent ppDriveway, !'+ g �o i drain Wells on lots t !. F. COMMENTS * Monitor tube only extends 4.2 ft into drain field d L 1/. z , r3 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 Steven Pannone Date 7/13/2016 COSA canary sheet 2-6-15.doe /yv I5A0 �, $s 'C.' well .60ccY"PLI -Ow. w� i 4�e Municipality of Anchorage�' a !� = sr Development Services Department �il awn, Building Safety 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 # OSC161317 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 6, Lot 8 of Sand Lake #2 Subdivision. This inspection revealed an arsenic concentration of 20.8 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. Municipality of Anchorage Development Services Department / Building Safety Division On -Site Water and 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. _0 ( f - 133 - Z!D COSA # Expiration Date: - 3 - 0 G 1. GENERAL INFORMATION Complete legal description Loo -6 nle e i- 6 S«+ot 4ea #Z Location (site address) 93, 7 Sea of ew S's - Current Property owners) _WX,*M T Hr rnee Lee Day phone 301-yoo > Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 03117 Seg rA, d AMrAi 41- 9.1sno L Z �si,da�fi�f f-rn�Fc�9P Day phone FS 00 Day phone Unless otherwise requested. COSA will be held by DSD for pickup. 1'4z- 2. NUMBER OF BEDROOMS: 3 r[f� Co1,4 a/e .Yir E.'+n S/-cPan'rh or Inde✓: at3a-9Zaa 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site R] Individual Water Storage ❑ Individual Holding Tank ❑ Community Class "G " Well © Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation, based on procedures outlined In the Certificate of Onsite 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 Finn Flee T,-cAneea/ Servo« Phone �yS-r3s's- Address rys30 Ecyw Canyos' Ro( Engineer's Printed Name 1j A&A aec, re r-'. r -f a -w Date l 20iG y T tF+•:y +p6`+-� a r. °� ��' 1 • .i r 1} 5. DSD SIGNATURE Approved for bedrooms. '' -• �` 3jP MRS , r Disapproved.'`•8�� ' QomX, Conditional approval for bedrooms, with the following stipulations;,,, Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: — Original Certificate Date: (R•v. 71105) Municipality of Anchorage ••, Development Services Department i Building Safety Division ` On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 L www.muni.org/onsite ( (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: LvP b, Q facie 1Z fwAal teCke +'s Z Parcel ID: o // - 13 3 - 29 A. WELL DATA Well type �atl 'G'" If A, B, or C provide PWSID # 2is 969 Well Log (YIN) Date completed Total depth ft. Date of test Static water level Well production Sanitary seal (YIN) _ Cased to ft. FROM WELL LOG WATER SAMPLE RESULTS: f3 Coliform O colonies/11x1 mL Nitrate 40. / mg/L Arsenic: L2,A ppb date of sample: 7/rr/o6 B. SEPTICIHOLDING TANK DATA Tank Type/MaterialSon /+ - / S/+! l Wires properly protected (YIN) Casing height (above ground) in. AT INSPECTION ft. Other bacteria 0 colonies/100 mL Collected by: F/whb,. -r cALvc, Date installed 'Y/24/82 Tank size 14wgal. Number of Compartments'_ Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (YIN) fJ High water alarm (YIN) N..1,. Dale of pumping 7/7-5/0i< Pumper C. ABSORPTION FIELD DATA Date installed N/36y/62 Soil rating (g.p.d./ft2 orft2lbdrm)14w a' System type 7' -enc/, Length 26 ft. Width S ft. Gravel below pipe G ft. Total depth to ft. Eff. absorption area 312 ft2 Monitoring tube `f Depression over field ta Date of adequacy test Y / M / OS' Results (Pass/Fail) Pw/i For 3 bedrooms Fluid depth in absorption field before test 2 in." Water added 731 gal. New depth ZLY in. Elapsed Time: jW_ min. Final fluid depth 33 h in. Absorption rate >= ly4w g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) Nn�t 1en&440., If yes, give dale N. 4. it Floc'o/ .dlp/4v a/e ryftrlu A- /'fie 1Jrf/r.e &A M! /6a5! wr ich "1 35" lstl«w }At In«ir`1..f- *Ae %erta�/`/ %yr! D. LIFT STATION N•'►• 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 levet at Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: IV.?. Septic tank/iift station on lot On adjacent lots Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas in. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: >y' J=rten dwtlrl� - osc�er rnf fe 9enr�P Building foundation tri avw•e.rnF Property line Fay Absorption fields Oe- vo rrre�� Water main > 10' Water service line "),, 10' Surface water i 1ua Wells on adjacent lots *-1, 100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: ,, du trr1; whir 1uww1( fldl/e'rrn f lo.�e t o ->060 f W J Property line 1' / r 66 �uilding foundation sra avl ~,v Water main �0 ea' Water Service line > 10' Surface water > I &a* Driveway, parking/vehicle storage d(e/rr �o✓d � (S.t..sAaw ►y Oro) pa• -6T nr". 77.! 011f•r-jt 1n0. Curtain drain Neerlr srr^ __ Wells on adjacent lots 100' de/H• 4, t8" a AA dAce-lot ryr...de Lao N1 Crohc Mnbe t Fran verb o/a�r /trah4af� $a1�. t'o1f row r for' fr+tt �s.vf�i.ho . F. COMMENTS tat 1 ,,, per ewe Ao r ,rVYr�1�I�l� e'"h'CF 1ir1,erly Me1f n p2 rah.'• if rwe fenrr un dal^114 M- 9erefr MAXX URM' psi'ha.n 04a Mr C"Xa-phr» i+eACA •dfeeen/t crud d w.r-arrarya cf the .f flit septiesC•pwi,yrfc�, hal G. ENGINEER'S CERTIFICATION rtrtwe.r t /er.e" hF?A rirt./+er./1y s.n►�. J1ii�-: 1 certify that I have determined through field inspections and / =:.gTt ' review of Municipal records that the above systems are in n ira conformance with MOA COSH guidelines in effect on this dale. D1•• a •«.•••• •......%.•. * �r Engineer's Printed Name -7-hoo eewe r P'co o -P 1, • • r.0 •Y �. i . THCODOCE F. AYJORE . .• di Date=�'•., CE -3589 ?r bfa ,.: -I� COSA Fee $ H z o Waiver Fee $ Date of Payment Date of Payment p Receipt Number gy�6 �Mk/ Receipt Number (Rev. 11/05) m 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.ek.us (907) 343-7904 t7 0 -7 �4i,k?A /J c- `? CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. Oil —173-7-13 HAA # 05D/14y Expiration Date:% — l — O -S 1. GENERAL INFORMATION Complete legal description Le f- 60 t3 /oc k , SanoC 6.c: ke C /0 -Ar7, 1 I Location (site address or directions) Sca vrsc..w St. g9501 Current Property owner(s) Cru ly HwMA 4 el •1 Day phone 2.<9 —"r It zG Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 77.i0 Amb&- 130,y Lpcy_ Anein n e 49-- 94S�S" Day phone rX ae) Day phone Unless otherwise requested, HAA will be held by DSD for pickup. Plea -re to /l a c..ne r @ 269 -r/ Z,G 2. NUMBER OF BEDROOMS: 3 `' A°n HW,4 neoofy f�� P"k -4r 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ CommunityClass "C" Well © Community On-site ❑ Public Water System ❑ Public Sewer ❑ * fo tc : well war o �'? rn a f/y sc Glue✓ i4" wt//, l,./ u now c lcv✓ 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 verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the information obtained from the Municipality 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. S<e .I+-^— J9&hV �A cIa/u tAee h Name of Firm F[uFA�,r Phone 3vs-�ass— Address lN_S30 e:eo Sf., e - Engineer's Printed Name Date 5. DSD SIGNATURE __Z Approved for bedrooms. Disapproved. ,° c� ; . ? 'ti;• p ENGINEER'S e >> 0 STAMP . riEODCME F. YDORE ; rf .�:,� CE.3589 1! is .• 14 4r d• Conditional approval for bedrooms, with the following stipulations: Additional Comments :•. PROGRAM 11 Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date: (Rev. 12m) 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: 4o k 8F /316f 4 !2� Sand 4ok,- OZ Parcel ID: A. WELL DATA Well type Chu "C" If A. B, or C provide PWSID # 20SY07 Well Log (YIN) Date completed _ Total depth ft. Date of test Static water level Well production Sanitary seal (YIN) _ Cased to ft. FROM WELL LOG WATER SAMPLE RESULTS: ft. Coliform 12colonies/100 ml. Nitrate <a.1 mg.A. Arsenic: mg.A. Date of sample: Y/'f/oS B. SEPTIC/HOLDING TANK DATA Wires properly protected (YIN) Casing height (above ground) in. AT INSPECTION ft. Other bacteria 7 colonies/100 ml. Collected by: 7 -eel, Sr.e Tank Type/Material LC4Re /.Vve/ Dateinstalled 1/2-Y/62 Tank size IOOG gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (YIN) 14 High water alarm (YIN) A/. 41 Date of pumping Pumper /4 * C. ABSORPTION FIELD DATA Date installed y/ iY /62 Soil rating (g.p.d./ft2 or ft2/bdrm) loo 0% System type 'ireneh JOR'r Length 2l� ft. Width S ft. Gravel below pipe G ft. Total depth 10 ft. Eff. absorption area 3_Z_ft2 Monitoring tube Y Depression over field Iv Date of adequacy test H / If /GS Results (Pass/Fail) Pier For 3 bedrooms Fluid depth in absorption field before test 2 in, x Water added 731 gal. New depth 7J/y in. Elapsed Time: 5'6_ min. Final fluid depth 33 VO in. Absorption rate >= HS/� g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NOne k w W^ If yes, give date M.A. iw F/u,o! 4-1, At are rel'erenc.n�! io 44e 40'41. ' al^ IAe .noAlla� /.a5e whtc.h 'IS 36" 401e.41 Ae lAt"frf o/ 7"*e Ae�rtQ., /./ dua�.�S�frenr j,e D. LIFT STATION N• 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: N• h - Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line ManholelAccesS (Y/N) High water alarm levet at Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank in. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: >64 f+ dwclr,'-erf/acwoi 't",9'e!J'� Absorption field S' !, w o++` Building foundation S.e cu+.n end Property line Zr�' P A Water main > 10' Water service line > /e' Surface water > rao Wells on adjacent lots > 106' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: wellwe ,v+d0 Awf(Vrw/ /- Oa Property line r' u / Building foundation See cl -mml Water main 1> lo' Driveway. parking/vehicle storage Under no.+loe Ioperte yy are�. 7Ae o/uf. PP, Inv, 60-4 ,SAevro<n+v. oOe Su ff' to,r co,,. jre+! J�rvri pwlrehw. Water Service line >10' Surface water „��> Curtain drain Ntone teen Wells on adjacAnt lots 8044 ty f*G /qn A- G/eetn ovlf art /ueal4•cf F. COMMENTS x 1.t' f.sr• t”! &P"!*^fra9r W,4,CA ,mr114e Mef a /10 rfian o M! }we a.l.torp han /rtinCh ,1 �oC A/ cxf,reerenHy 2><U � lhuny yia� aweC dot! G. ENGINEER'S CERTIFICATION vjC /Ae tepAle ty1/41+. F}10 eer-Afecar1w r"Itee 1+4/wl/9r/1Ln . 1 certify that 1 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 -rAec-.V(0 Rr F "*Va e Date Aiy r, ( 13 20dS HAA Fee $ 'y 30 0451 Date of Payment Receipt Number (Rev. 12/01) ', ej l+r! 9L_'or»9C! pn el Mui 4A p0 rr/on of �unclafVwn . 7i.it lan F'+ uta %ran �vJ +7U/' s/Ililrfe/xLf /,SLs, �lr�SrwtUnf� 7•A:j ty,lf,r+ar�ev^ret4ri+ec! 5� //!•.ri.- ter.: v •: ' ;+/'r`f S"� •• 4 �TKOOORE F. A. -GORE ` A � • CE -3569: •;�?� 1fGnQ '. Waiver Fee $ n ti—a Date of Payment Receipt Number HOUSE :DRIVE , , WELL , , , LOT 18A BLOCK 5 LOT 11, BLOCK 5 `• (VACAN'n tW ----------- LOT 1$ WELL OUSEBLOCF 5 J ,COT 15 BLOCK 5 ii'0*b LOT 6 BLOCK LOT 7 ILI LOT 8 100, LOT 9 BLOCK 6 LOT 10 BLOCK6 gLocic(o : RfiRDtN1 (I) �y$6� LZ too. 12i' OnAo (Aolece 11DJ *w P"fd.+l p'' e j -rke eh q - -I I -iir Ivi 7``4 . To,- Lo.. ?efcr' 5+.-f,.;. . AV �E.�F :4Lq,1��� *' 491n�4 • '; *� ........................ THE000RE F. MWRE CE -3589 P �c j ♦ate •••....•• .foil LOT 8, BLOCK 6, SAND LAKE SID 02 SEPTIC SYSTEM WAIVER SITE PLAN FLATTOP TECHNICAL SERVICES 1 INCH = 50 FEET 14530 ECI10 STREET DRAWN BY TFM ANCIIORACE, ALASKA 99516 APRIL, 2005 NOTE: THIS IS NOTA SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. i 57C;(4 le: 30 W "AZa•: o ;:Sep 6070/1 i ' I I 3 °SS'Oo""GL' /35.00 S :1 w 7-1 1 .:e, a se h S `` Wr u r -9- 00 W hi Recerfi%,•ed 6-z8-B913-2950(!%�' 4-3-oldyf! AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortagee's in- Lot n- �Q4 s%ction of the following described property: LO t •••..hariy� 8lock 6. Sg,•,rl Lake Subd. No. Z .r, . •• A W Anchorage Recording Precinct, Alaska, and that the Improve. �A W.... ; ments situated thereon are within the property lines and do 77�� '' ' not overlap or encroach on the property lying adjacent there- V� 1 s *67' : - to, that no improvements on property lying adjacent thereto Z. 1k 1 ' encroach on the premises in question and that there are no r•" roadways, transmission lines or other visible easements on said property except as indicated hereon. i, C W oF+ ,• ««•=' , Dated at Anchorage, Alaska 316`Ffssion��� thtayot Noye.nber 19 e97 EASEMENTS OF RECORD, OTHER THAN ��'►�-'`�"'� THOSE SHOWN ON THE RECORDED FRED WALATKA & ASSOCIATES I PUT ARE NOT SHOWN HEREON. Engineers and Surveyors Municipality of Anchorage • -� Development Services Department Building Safety Division OnZte Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. Of I - 1 33 - 29 1. GENERAL INFORMATION 1_1_1� Y_0"� HAA# r)) 002A Expiration Date: Complete legal description Lit 6. r3/c+c 1' 6 sc"., � /-a bce S iD -# z Location (site address or directions) 0 31 7 Seer vied S'i4. Current Property owner(s) C(sn f e �ean,e Fw< rl -!, Day phone 297 - 0 311s- Mailing 11s- Mailing address Lending agency Mailing address Real Estate Agent Mailing Address e31� Sea�recv Sf., i3y+L6r0r4gP, ii`� 99sOz Itm k. Day phone t1,cAe 1& G4,,(rA, 3yl w T�doe /act; axec"A +/ /F�* Day phone At -,995-0 510 —Z220 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site IR Individual Water Storage ❑ Individual Holding tank ❑ Community Class A Well 0 Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal 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 verify that my inSestigation, 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. Sea c!A ec- Name of Firm Ticljn ;cul S er-a rel Phone 3'15'-13f5_ Address y5'-135,$— Address 1yS30 actio S} fM,,oP hk 99s�� Engineer's Printed Name Thtcclol-e F. 1-10o'25- Date r / 2-3/ zoo r 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. _ :n••....+• .., a z, b-. '•:' +t' ENGINEER'S CT.N -A t•}� STAMP • THZDDOR- F 7.F L'COnE ••e CE - 3589 %^4 Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date: (Rev. 77/00) Municipality of Anchorage • ;' Development Services Department Building Safety Division On-Stte water S Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ek.us (907) 3437904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 1-4o t 6o at k. 6. Su tid %,r4, k a S/© *L- Z Parcel ID: 01/ - 133- 29 A. WELL DATA Well type class ..A„ fv. ftrni l'y Date completed _ Total depth ft. If A, B, or C provide PWSID #z /sy6i Well Log (YIN) Sanitary seal (Y/N) _ Cased to ft. FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Colfform colonies/100 ml. Date of sample: B. SEPTICIHOLDING TANK DATA ft. 9 -p.m - Nitrate mg.A. Collected by: Wires property protected (Y/N) Casing height (above ground) in. AT INSPECTION Other bacteria ft. 9— p.m- colonies/100 ml. Tank Type/Material Yge t<l c / She e l Date installed h' / 2.y /S 2 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) �1(_ High water alarm (Y/N) N• A- Dateofpumping 1/2-3/81 Pumper A+ h4wne 5*er-w#e',t C. ABSORPTION FIELD DATA Date installed ZY 2 Soo rating (g.p.d./ft= or ft /bdrm) ruo 11'3/40'fSystem type _ 7"reAc 4 Length _ 2"I ft. Width S ft. Gravel below pipe (5� ft. Total depth 2,C_ ft. Eff. absorption area 912 ft Monitoring tube r Depression over field N Date of adequacy test I /19 / ze-0I Results (Pass/Fad) Poor For I_ bedrooms Fluid depth in absorption field before test Q in.A Water added-20gal. New depths in. Elapsed Time: _min. Final fluid depth -(L in. Absorption rate >= H S 5 g.p.d Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) N o m e bcnaw— If yes, give date N.A. ""Flufa( e%r t%.f ant erlcertmeobe % *♦ bmtla`. aF I-Ae rem-j�vn 7Lr,5t WAIL, is 39" below 7Me rnutrrt of i<e Aorrzc� "6/ b., 76" D. LIFT STATION N• A . Date installed Sve in gallons 'Pump on" level at _ in. 'Pump ofr level at _ in. Datum Cycles tested Marholo/Access (YIN) High water alarm level at _ in. Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: N. h. Septic tankAift station on lot - On adjacent lots Absorption field on lot - On adjacent lots Public sewer main - Public sewer manhole/cleanout Sewer /septic service line - Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: ;,$# Jror Qewellrn Building foundation 5*e coMw gn Property line Absorption field S-1 Water main > to ' Water service line > la' Surface water > t au r Wells on adjacent lots >I&0* SEPARATION DISTANCE FROM ABSORPTION FIS ON LOT TO: f+vr Property line Building foundation See m�.^ i Water main t o r Water Service line > to' Surfacewater > t Go ' Driveway. parkinplveNcle storage t (nder oo ngci"rn a✓'et. Curtain drain Nv^t Sr -f^ Wells on adjacent lots 7 lid , VO /36:t SAao la pro..fe. F. COMMENTS f3.}fi Sepht •lea^k clwaner.h art• iota eve l.s•' fro. i4=19V^ -jy.+nda/•ran� t�h.ch twrl.�� iwwf •• eve 00n/r u.ndwrtreY 44e- prrp'!� anit w>` t poI-f'Iun of fws a,r C+to rty iT oma+ yt-rt^cA jJ aolf wr•eni A& {wuIto(w on.TAV ton urs wn •✓ aPN'ecN / txv v r•n.wny year�and at~ G. ENGINEER'S CERTIFICATION n e l' a dw erse y a fAec l •yee !'*'—fo .en en cc o F 7"gt solo l+c sled. I certify that I have determined through field inspecdons and<; _ review of Municipal records that the above systems are in 4r conformance with MOA HAA guidelines in effect on this date. ENGIf:• • •' • ; ^+, •; SPP Engineer's Printed Name -('A er+ do. e F. -foo-c_ Date HAA Fee $ 300 -M Waiver Fee $ "��' CE- 35J9 Date of Payment Date of Payment Receipt Number Receipt Number (Rev. 12/00) MUNICIPALITY OF ANCHORAGE Ail • DEPARTMENT OF HEALTH ti HUMAN SERVICES Division of Environmental Services low On -Site Services Section P.O. Boz 196650 Anchorage, Alaska 99519-6650 X343-4744 CERTIFICATE OF HEALTH AUTFPRITY APPROVAL FOR A SINGLE FAMILY DWELLING \ Parcell.D.# o1L=133-24 HAA#_ 1. GENERAL INFORMATION Complete legal descriptionLAK S/N f rel- Z_ Location (site address or directions) Property owner BE!- s ccylY Dayphone 248-/4Z3 Ing to the legality and status of system. Mailingaddress Ce3l? SLAVIC. tA(-,l s -r, Anf`C4. AV_ g9 0 Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMSER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Day phone Day phone 0 Community well Public water' _ .... _ .. `.. NOTE: If community well system, provide•written confirmation from State ADEC attest - Ing to the legality and status of system. 4. OF WASTEWATER DISPOSAL: _ .TYPE Individual on-site_ _; 0., Holding tank - Community on-site v Public sewer. NOTE: If community.wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72M3(A.. iNl) From MOA n1 S. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system Is safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my investig?tion and Inspection, the on-site water supply and/or wastewater disposal system Is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm -57-LOP-Al 27�1,o.tyr„ c + R. es Phone Zz2 -l�2-r Address T-0•T.oK trK-025,Anic cgAc,c K 9°) -S -/v Engin eer's signature 1� Date i 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for Additional Comments bedrooms. 0:.8149 bedrooms, with the following stipulations: -zz .B)i:. ., Date ¢ "97 �-CAUTION ;the Municipality ofchorage Department of Health and Human Services (DHHSj issues Health Authority 'Approval Cer`tificatoi:based only upon the representations given In paragraph 5,above by an Independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data Ibefore a certificate Is issued.•The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. nrxsm...wir e.a ►aim Municipality of Anchorage ""'V E DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division APR 2 1997 825 L Street, Room 502 • Anchorage, Alaska 99501 • (90710z44 of Anchorage Dept. Health & Human Services Health Authority Approval Checklist Legal Description: i.23,"R` SANT,LAKP_*k'Z Parcel l.D.:ot'f- 133-05 A. WELL DATA Well type -0-0 e" myy rr-Y' If A, B, or C, attach ADEC letter. ADEC water system number Log present (YM) Total depth Sanitary seal (Y/N) Date of teal Static water level Well production WATER SAMPLE I :07; le-_ Date completed Cased to W6 FROM WELL LOQ g.p.m.' Nitrate Collected by: B. SEPTIClHOLDINti TANK DATA Casing height above ground) protected (YM) AT INSPECTION Other bacteria g.p.m. Date installed 4/' 2 `I-82 Tank size /o 0,Q Number of Compartments -e- Cleanouts (Y/N) Y Foundation cleanout (Y/N) `t' Depression (Y/N) 1-1 O High water alarm (Y/N) Data of Pumping 312.W V iz Pumper A'r Nom casrar.vre& C. ABSORPTION FIELD DATA Date installed 'q -74-S?- Soil rating (g.p.dAF r fN/bdrm) / �_ System type -T-a izn r t µ Length '2& r Width S Gravel thickness below pipe _724 Total depth Y•Sr Effective absorption area 3 ! 2 5 F Monitoring Tube present (Y/N) �f Depression over field (YM) rte( O Date of adequacy test 312 4 / 4'*- Results (Pass/Fail) '5)A ss For 3 bedrooms Fluid depth in absorption field before test (in.),_tjf?Y _ Immediately after440 gal. water added (in.): Z a Fluid depth't�2Y (Ins) Minutes later: 'ZOow. Absorption rate = G'r I4Go a.p.d. Peradde treatment (past 12 months) (Y/N) V 4 If yes, give date 72-026 (Rev. 3196)• D. LIFT STATION Date installed Manhole/Access (YM) High water alarm E. SEPARATION DISTANCES *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption Held on lot Public sewer main Sewer /sentie-Orvioe line Size in gallons "Pump otr level at* On adjacent adjacent lots Public sewer manhole/cleanout Litt station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r Foundation c Property line AV l t Absorption Held S Water main/service line _L&.:Surface water/drainage 1cla T Wells on adjacent lots 100 'r SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: S a a rs'v4m 0&&A- Property line Building foundation /&-V Water main/service line f C t 'Fr.Co:s tocw-rb%b Surface water ! vo Driveway, parking/vehicle storage area ADswen.rc' •nU Curtain drain ! ao -r Wells on adjacent kris 10, r-? .-r F. ENGINEER'S CERTIFICATION I car* that I have determined thru field inspections and review of Municipal records that ft above systems are in contormence with MOA HAA guidelines in effect on this date. Signature, Engineer's Name Date 3 /24[47 HAA Fee $ S CXR •C -A-) Waiver Fee $ _ Date of Payment L \ - -i Date of Payment Receipt Number O a t O ��t U l� Receipt Number 72-028 (Rev. 3/98)• r MUNICIPALITY OF ANCHORAGE • ^� Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF Ofd -SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel l.D. # nil -1 1,11-,Q°I HAA ff lJ Qq rpt 91 ., 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) La'f 8 7"Wek 6 - sA�1��AxE 'ty -7 /o Location (address or directions)` t�j/7 fE/�i✓ltl+f '%.' is . (b) Property owner /SFr: Telephone: (home) Business 7-74` Mailing Address ".=�Ox '/0/07-i (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent V1f7A et 67i41 Address --'TO7J r✓ y'' Telephone SG s • G'/L 2. TYPE OF RESIDENCE Single-Familyg . Number of bedrooms 3 3. WATER SUPPLY Individual Well ❑ .- Community Public ❑ Note: If community well system; must have written confirmation from the State Department of Environmental" ` ' ConierVation attesting to th legality and status: 4 SEWAGE DISPOSAL On-site( Public 13! :.Community ❑ :+ Holding Tank ❑ Note: If community well system must have written confirmation from the State Department of Environmental ' C66servatl6ri'att'estin9 to•the legality andstatus 72425(A". 7/aa) Page oft ir.r•. , .' . .. .. .. . is (e) Mail the HAA to the following address: (or check here if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Familyg . Number of bedrooms 3 3. WATER SUPPLY Individual Well ❑ .- Community Public ❑ Note: If community well system; must have written confirmation from the State Department of Environmental" ` ' ConierVation attesting to th legality and status: 4 SEWAGE DISPOSAL On-site( Public 13! :.Community ❑ :+ Holding Tank ❑ Note: If community well system must have written confirmation from the State Department of Environmental ' C66servatl6ri'att'estin9 to•the legality andstatus 72425(A". 7/aa) Page oft ir.r•. , .' . .. .. .. . is Z jo Z e6ed rc.e (BB/L'/•M) smu •JIJoM s,Jaaul6ua Ieuolssajad a43 ul suolss!woJosJoJJaJojelq!suodsaJ lousl 96eJ043uy joA1!ledlolunrj ey1•penssl sl eleolplJao a eJojaq elep WjeueJo suolloadsul lonpuoo lou op SHHO jo sa9Aoldw3 •sluawaJlnbaJ ajels pue IeJapal ulejJao Ajs!les olJapJo ul suollnlllsul 6ulpual Jla4l pue sawoy jo sJaseyoJnd of AsalJnoo a se s141 saop SHHO 841 •eMselV jo e3elS ayl ul paJajs16aJ Jaoul6ue leuolssalad juapuedapu! ueAq enoge g 4deJ6eJed ul uaA!6 suolleluasaJdaJ a4l uodn Aluo paseq paleolj!Jao IenaddV AjIJo4lnV ylleaH sanss! 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Nounvo lenaddV ieuolj!puoa jo swja1 Ieu0lilpu00 panoJddesla ,•, paAo ddV _ _ elea Aq swooJpaq� JO; panoJddy O VAOHddV SHHO '9 f --::------ fib• �� . _. .. - -- ...__...__ - �,6-3S; •. ••,.aye +� %, b -dw 9J_OA ssol PPV FfSS'S« . ouogdalal WAA joeweN 'uolloadsul s143 jo elep ey3 uo loajja ul suollelnbaJ pup'saoueulpJo'sapoo elelS ' pUE IEd101UnlA4 Ile y31M 60Uelldwoo ul sl WalsAs ILsodslp JeleMalsem Jo/pUE Alddns JaleM ells-uo 84j'U011oadsul pue uolje61jsanul Aw LuoJj pue sallj e6eJo4ouV jo Ajlied!olunyy eqj woJj pouleigo uollewJojul ey3 uo paseq le4l AjIJeA Jay3Jnj 1 •ulaJay paleolpul oinlonJjs to edAl pue swooJpaq jo Jagwnu eyl Joj e3enbope pu¢ Ieuollounj 'ejES SI WalSAS IeSOdSlp JajEMajSEM JO/pUE •�(Iddns,.JajeM ells-uo ey3;1e43 smoys,(enaddV Al!Jo4 V WPM SM jo uol3e6ljsanu� Aw je4l Aj!ian I'Molaq UM04s e3EP uopeplleA e43 10 se pue o3aJay Pax!jje leas Aw Aq paiplJaosV ' NOIIVWHOdNI (INV viva'HOHV3S 3l1d'S1S31'SNOLLOUSNl ONIaIAOHd WHI.A ONIH33NION3 *9' �hiCtPALI�t o�tAAppHORGE oval(HAA)OA) owVterna�NE i8i�BRUARY 1984 343-4744 MAY 2 5 1990 . RECEIVED Legal Description: L 8 6 ✓o 5/f JhZ' iKz_ Tz.J Z4J ir2 io A. WELL DATA Well Classification Co*f/1• I(� B, C, D.E.C. ApproveddqN) "?-iS69 ell Log Present (Y/N) Total th Cased to Static Water Casing Height Above Date Completed Electrical Wiring in Conduit (Y/Fry, SEPARATION DISTANCES FROM To Septic/Holding Tank on Lot Depth of Grouting 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 Comments Yield Pump Set At Sanitary Seat on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearestl blic Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed -z -8Z Size /e"T No. of Compartments Standpipes ()N) Depression over Tank (Yo Air -tight Caps&N) Foundation Cleanout(&N) Date Last Pumped Pumping/Maintenance Contaqon File (Y/N) ��/� ; for A1119 Holding Tank jrlgh`'•�(lIetr•!R1rN) Temporary Holding Tank Permit (Y//N) • .-.•• .p SEPARATI�ISTA ROIuf2PTIC/HOLDING TANK: . t'w, • To Water-5upp1yV%I Mf••••••-� ;;,Y To Building Foundation To Property Lire "'•••••-•.J.� • .� To Disposal Field To Water Matrt�Win lri'e� 14r . ° -/ .. 1 .. - • /c9 t To Stream, Po L�.1�jOr�fainag a Course Comments 72-M (Rft. T/U)Front Page 1 of 2 .!Sr i-8 8t slc�y C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed `l z �y Length of Field Z Width of Field 3 Depth of Field % 5 Gravel Bed Thickness C4 Square Feet of Absortion Area 9/Y Statndpipes Present Y N) Depression over Field (Ye Date of Last Adequacy Test j'13 -% Results of Last Adequacy Test , ADE4 urtTE SEPARATION DISTANCE FROM ABSORPTION FIELD: i To Water -Supply Well Zoa t To Property Line To Building Foundation Al Lo To Existing or Abandoned System on Lot J1A ; On Adjoining Lots /y�r To Water Main/Service Line /0 To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments -1` y✓A/tEf cr/ fitE. D. LIFT STATION e Installed Size in Ga "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access(Y/N) "Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. certify that I have checked, verified, or conformed to all MOA and HAA Inspection. l Signed v fA Company /¢FG S 06 4 S a> Date MOA No. err Z i� Receipt No. 21 // 2- /�� �� Receipt No. _ Date of Payment S' Z $--�70 Waiver Fee: $ — Amount: $ % 7,-7. Date of Payment 72-M (Rev. 7/88) Beck Page 2 of 2 on the date of this yY G mwJ cE-�1•�1'� W� Seal r` r'1 MUNICIPALITY OF ANCHORAGE O 33 / DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date 7- —lr-51 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range; SEc /C Location (address or directions) S317 (b) Property Owner All fe' Telephone: Home Business Z7G 'Ssi 7 Mailing Address_L (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent ✓1ST/1 [' fhb ,rx1C3 Address Telephone (e) Mail the HAA to the following address: or: Check here ❑, If hold for pick up. List contact person and day phone number below. 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms 3 3. WATER SUPPLY Individual Well ❑ Community, Public ❑ Note: If communitywell system, must havewritten confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite 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. Page 1 of 2 72.075 u+n, 8.861 From .we (sere •+er szoac Z to Z e6ed *Nom s,iaaul6ua leuo!ssalad ayl up suo!ssiwo jo siaja jol alq!suodsoi lou s! a6ejo14ouy to giled!olunpq a141 •panssl si alewpvao a aiolaq elep aztleue jo suoiloodsul lonpuoo lou OP SHHO 10 saa (oldw3 s)uawaiinbai alels pue lejapal uiepao /ysges of Japio ui suoilnpisut bu!pual i!ayl pue sawoq to siase14oind of Rsaunoo a se siyl saop SH HO a141 •eNsely to a1elS ayl ul paialsi6ai jaaul6ua leuoissalad luapuadapul ue (q anoge S 4dei6eied u1 u8A16 suoileluasaidai 0141 uodn Aluo paseq saleolplYao lenaddy Al!joyiny 141IeaH sanssl (SHHO) saolMaS uewnH pue 1411eaH to luawliedao a6ejo14ouy to Apled!olunyy e141 6g -z— oleo r J��CUolsulmd� S f; ar •alas NOunVO lenaddy leuo!llpuoO to swia1 leuo!1!PuoO panaddeslo ------- 3?— Panaddy (q swoapaq sol Panaddy IVAOIiddV SHHO eleo %Kd•L J� �'1 inl J.� �£� (y c�2/ ssajpPV /'fir euo14dala1 wild to eweN •uo!loadsu! siyl to elep 0141 uo 13911a ui suo!1eln6ai pue 'saoueu!pio'sapoo eleiS pue led!oiunpy Ile yl!m soue!ldwoo ui si wals is lesods!p jalemalsem jo/pue Ajddns jalem el!s-uo 0141 'uo!loadsui pue uo1le61isanu1 (w waaJ pue sal4 a6ejo14ouy to Al!led!oiunpy 0141 wal pau!elgo uo!lewiolu! eyl uo paseq leyl AluaA JayUnl l •u!aja14 paleoipu! einlonjls to edA; pue swoapaq to jagwnu eyl jol alenbape pue leuoilounl'ales si walsAs lesodsip lalemalsem io/pue Alddns jalem al!s-uo 01411e141 sm0142 lenaddy (1uo141ny 141IeaH S1gl10 uoile6115anu! (w le141 A1uaA I'molaq umo14s elep uo!lep!leA a141 10 se pue o1aja14 pax!lle leas Aw (q paipliao sy U NOIIVWUOdNt ONV VIVO'HOUV3S 311d'S1S31'SNO11O3dSNl •JNIOIAOHd W1lId DNIH33NION3 'S —Z -r �Vi--rgr44 717.S'7 ... n ITY OF ANCHORAGE (MOA) MgtytCl?)4: OER D SEON HEALTH ALUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 ET1y1RONNE�� 264-4744 { EB 2� 1988 Legal Description: l�fi BLOCK '0L Tiz-•/ .� �/�J Jr� /o A. WELL•DA%EC- UV ED Well Classification deLfM I A>_ C. D.E.C. Approve(Y ) /b 'lull Log Present (Y/N) Date Completed Yield Cased to Static Waterl) Casing Height Electrical Wiring in Conduit (Y714 Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole — Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA _ Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) _ Depression Around Wellhead (Y/N) On Adjoining Lots On Adjoining Lots — To Neares blic Sewer To Nearest Sewer Se ' e Line on Lot — Date Page 1'of 2 : •" ,ti M 72-0% IPn P BBI Front Date Installed Size le" No. of Compartments 7 - Standpipe&N) Standpipe &(N) Air -tight Caps/ J) Foundation Cleanou&) t' Depression over Tank (YO Date Last Pumped Z'S /3Mt.5 Pumping/Maintenance Contract on File (Y/N) _� A ;for A VA ' Holding Tank High -Water Alarm (Y/N)Temporary Holding Tank Permit (Y/N) 411i Separation Distances from Septic/Holding Tank: / To Water -Supply Well 7,�y To Building Foundation To Property Line,. /0 To Disposal Field To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage * • Course - •`- /00 r�- ComrPents - Page 1'of 2 : •" ,ti M 72-0% IPn P BBI Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata O D Type of System Design Ttictl `' Date Installed 7 ^2" •^82' Length of Field ?� ; Width of Field S Depth of Field �es Gravel Bed Thickness Square Feet of Absorption Area 3iz- Standpipes Presen (Y/ ) Depression over Field (YQ Date of Last Adequacy Test 5�8� Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well Z� o ",t To Property Line To Building Foundation To Existing or Abandoned System on Lot On Adjoining Lots O To Water Main/Service Line yo i To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area /JG.yf, f�Xt er 9at?idGa %iry, Comments D. LIFT STATION Da tailed Size in Gallons "Pump On" Level at — High Water Alarm Level at Tested for Electrical Codes (Y/N) — Comments Dimensions Manhole/Access (Y/N) — "Pump Off" Level at •" Check Permitted Bedroom Rating Against HAA Request •• Vent(Y/N) Cycles during Adequacy Test. Meets MOA Icertifythatlhav� ec�/ d,vefified,orconformedtoallMOAandHAAguidelinesineffectonthedateofthisinspection. Signed G�� �V4� Date Z /SSS Company C -f MOA No. O A It Receipt No. ZU G l D 0 1.6 Date of Payment �a o Amount: $ ctG )tqwZ zl Fo . Page 2 of 2 72-076 Mev SM Sxk r ��•....., 0 *�� 49TH :9 ••••• .+iv RMA...:r� v C. REID, JR. ArCE-22510� t%i p".� Pmlesslay�e ALASKA 0I11011MEnTAL COnTROL Engineerinq E Environmental Studies Municipality of Anchorage Department of Health & Human Services 825 L Street Anchorage, AK. 99501 SCRUICES, Inc. MUNICIPA�ITy OF gNC}IORAOE DEPT. OF WEALTW d ENVIRONMENTAL pROTECTION February 18, 1988 Re: Lot 8, Block 8, Sand Lake t2 Subdivision Waiver Request — Lot Line FEB 2 51988 RECEIVED A Health Authorit ins ection was - ' y- p _performed on 2/5/88. he dis{once from the'�� t4rehch ao.the'.west:lot.line is,l,Poot.`� This lot line borders Seaview Street with no utility easements present. 'The northwest and southwest lot corners were located to verify the trench location. There are no other sewer systems, wells or private property affected. We request that you grant a lot line waiver of 1 foot. If you have any questions, please call. Sincerely, Alan C. Wien Engineering Technician Approved by: M 46 k s , e 4 S Y c. PuD, iR. ': 6 C=•2251 �.• ff 1200 West 33rd Auenue. Suite B • Ancharoge. Push 99503. (907) 561-5040 Municipality of Anchorage Department of Health and Human Services Tom Fink. 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 March 8, 1988 Alan C. Wien Engineering Technician Alaska Environmental Control Services 1200 West 33rd Avenue, Suite B Anchorage, Alaska 99503 Subject: Waiver Request for Lot 8 Block 6 Sand Lake #2 Subd. Waiver Request Number WR88-010 Dear Mr. Wien: Your request for waiver of the required 10 foot separation distance from a portion of a septic system to a lot line has been approved. This approval is valid for the 1 foot separation distance of the standpipe at the end of the trench to the lot line fronting Seaview Street. Because the encroachment is to a lotline fronting a 60 foot right of way, there should be no chance of conflicting with another well or septic system. This approval applies to the existing standpipe to lotline separation only. Any future upgrade will require all separation distances be met or another approval from this department. Sincerely, -81� f f-tz Daniel J. Roth Civil Engineer On -Site Services cc: Gus Andress, P.E., Manager On -Site Services/Water Quality Programs Scale: I" -3p, n AI S `l aS5 X00"W � C-�ry�ef • , 21? O i"Dr1vt ; ot:orprf S/� zr' f 24•� I 0 O v'yeA $ePi;c -7- ka 135.00 46 ap 54V P-erm CO N Hse N -8- 46° ke ^ � =.=q__ .. te:,.iou NB 9 `is ' 00 F;f E•`14.�E11{ • i,..: 1': e': ria .. I •� '•, W O. 3255.3 EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. -9- NOTE: This As-bullt shall not be used for any purpose other than financing requirements. Under no circumstances should any data hereon be used for construction or for establishing boundary or fence lines. AS -BUILT NO CORNERS SET THIS DATE R 13 V\ I hereby certify that I have performed a Morta eels in- spection of the following described property:�—O 8, - Bloc.k 61 Sa- ��kd—Na• 2- Anchorage Recording Precinct, Alaska, and that the improve- ments situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent there- to, that no Improvements on property lying adjacent thereto encroach on the premises to Question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated 9at Anchorage, Alaska th, Z1 s4 day of NoVem6er 1967 FRED WALATKA do ASSOCIATES Engineers and Surveyors SV n E OF n L8398 STEVE COWPER, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE WESTERN DISTRICT OFFICE 563-6775 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 May 24, 1990 FOR: ALASI:A ENVIRONIdENTAL CONTROL SERVICES Attn: Dr. Leroy C. P,eid, Jr. PWSID: (7.15469 According to the records on file in this office, the Sand Lake 41, Rlk 6. Lot B. Water System is in compliance with the State of Alaska Drinking Water Regulations. Since ely, VERA E. CRAIG Environmental Fiel Officer DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 3601 "C" STREET. SUITE 1334 ANCHORAGE. ALASKA 99503 DATE: _ 2_ 16_ 88---- PWSID #: To Whom It May Concern: 215469 STEVE COWPER, GOVERNOR 563-6775 According to the records on file in this office, the Block 6, SAND LAKE SUBDIVISION __ ___________________ Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely. Michael P. Lewis Environmental Engineer MPL:pkk Time APPLI"�NT-FILLS OUT UPPER HA- ONLY Property Owner �� r�i,✓ 5'f'. �j Phone Mailing Address Sq.4 Arx x% .3 3YS`z6 T� Zip Code 9 95,u Z Buyer Cit-, Date Date Date Address bq Zip Code Lending Institution Inspector InspectoF� t2 Phone Address - Zip Code Realty Co. d Agent t'0V23193? Phone Address (3) APPROVED BEDROOMS Zip Code ( ) DISAPPROVED Legal Description z d -t O Q / ` SR, rti Street Location ff—adr 151— Type of Residence BY: Single Family [EoI;Rallng DateA of Installed ❑Multiple Family No. of Bedroom ❑ Other Well to Tank Septic Tank Sill c7 Water Supply ❑ ndividual ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. Community For wells trilled prior to that date, give well depth (attach log It available). ❑ Public Utility Sewer Disposal (, !Individual Year tndivideel Installed: Zi LI Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REGUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Cit-, Date Date Date Date Inspector Inspector Inspector InspectoF� t2 Field Notes: MUNICIPALITY OF ANCHORAGE - OFDT. C'I'P'r.T;l F. ENVIk j; L'.:_f,:A._().:-TION t'0V23193? RECEIVED (3) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL - ff—adr 151— DAT BY: [EoI;Rallng DateA of Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Sill c7 72W3 CUeT