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HomeMy WebLinkAboutSAND LAKE #2 BLK 4 LT 2Sand Lake #2 Lot 2 Block 4 #011-135-51 Deveiapment Services Department O " Building Safety D,ivisian e 'fin-Clte *.Icler 4 Wastewater praaraiTi 411 00 Bragaw 51 raee ' ` P.0 gag 196650 :L4ark aegrch ,Ancharage, Al' 99519-6650 Mayor www.muni.ora Jnnsite (?OTj 143-n)04 Pump Installation Log ell Drilling Permit Humber: SW_ ,reel Identification Number:_ gal Description I 7Z 1 , `, �-"Z mp Installation Date: _5'_ 1 g,_ IZ mp Intake Depth Below Top of Well Casing: - '%r feet mp Manufacturer's Name: uup Model: G A—r L I t tless , .d ptar Burial Depth: 10 feet dess ,.dapter Manufacturer's B =e: e& w less s dap ter lastaller. of A zil fis:nec.d =�oa=amc[er�ua" ='J !'�a imp Installer dame: P / Date of Issue: _ roperty Qwuer Name & Address: 1 RA -v I 5 L!dOA3 .sy7v w . 80` �4ve ttentia n- ,nc pump installershall provide a pump instatladan log to the DSD within 3a days of pump i*ncFallat7.on._ -..- 0 72-013 (Rev. 3/78) 1 — —I �° MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 1 ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE NEW O UPGRADE MAI LING ADDRESS TO. L Q -Z tT3 LEGAL DESCRIPTION �D� z 3 cCk I.ak(a, LOCATION `I'�, A�©�� LQ� -R j NO. OF BEDROOMS (501 it�Well G_ U Y DISTANCE TO: Orn morli t Absorption area Dwelling ��- f •• 1 IV PERMIT N0. _ F- Z UJ Manufacturer Material 6+eek No. of compartments Z ree� Liq. capacity in gallons W` IF HOMEMADE: Inside length _. Width Liquid depth Y �az DISTANCE TO: Well Dwelling PERMIT NO. = Z Manufacturer Material Liquid capacity in gallons w= DISTANCE TO: W II _ FVn atign Nearest lot line 1 PE NO r� M r INU i7 1 J w z F Z w CC No. of lines Length of each line Total length of lines Trench width �]]/�� Vinches Distance between lines Top finish cc of tile to grade / Material beneath tiley'D Z_ Total effective bso tion area O / inches Length Width Depth PERMIT NO. w t7 a H w ° Type of crib Crib diameter Crib depth Total effective absorption area y DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. J W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS A&Tm za SOIL TEST RATING 13�7 mii- reevodu4ed at 1z5 INSTALL -64 A EXe' -0 21 REMARKS 11JSUIAT160 NiffkAN b A/_w 16f0` 4 T o yFk clic' � to APPROVED4 DATE LEGAL Q 4 L0�2_. 72-013 (Rev. 3/78) 1 — —I MUNICIPALITY OF ANCHORAGE Department; `f Health and Environmenta' Protection 825 Street, Anchorage, AK. _9501 264-4720 Permit ## # # HANDWRITTEN PERMIT # # # WELL AND/OR ON-SITE SEWER PERMIT Applicant: ok"L 4� Mailing Address: �06 Location: Phone Number: Legal Description: Laf -Z QldC(K `' spnd kA[<,L-�f2 Lot Size: _ Type of Soil Absorption System Is: Trench: Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) /•2� The Required Size of the Soil Absorption System Is: DEPTH /1�� LENGTHS ( _ GRAVEL DEPTH S�SWIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ Z006 GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. # # # TWO(Z) INSPECTIONS ARE REQUIRED # # 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 a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper.installation. # # # ,PERMIT EXPIRES DECEMBER 31, 1 9 3 3 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. .(3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3 bedrooms. Signed: 0aA-G �, �,� Issued by: Applicant Date: �/2a%3 1)ccam. a -e C' SWP/024 (1/81) �iC g Z�9 3 PERFORMED LEGAL DESCRY FIDEPTH 1 2 faE At 3 e TQC 6 ®�Ap O O U 7 o O p O c n c;• 8 c 9 Sly a r vap 11 n c • � P 12 e � c 13-0 ° C J O 14 77K/�) 15- 16- 17- 18- 19- 20- COMMENTS 51617181920 COMMENTS PERFORMED BY: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST DATE PERFORM 72-008 (6/79) X0,9 4 NOISE NOISE NOISE ■■I.■ t■fmm WAS GROUND WATER S ENCOUNTERED? L 0 P E IF YES, AT WHAT DEPTH? If SOILS LOG ❑ PERCOLATION TEST ,7/// ED: / 19 le': 1 SITE PLAN Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT r CERTIFIED BY: (Y—r93 l ) X DATE:F—� L--6 LOCATION OF WELL ! i (Please complete either to, Ib of Ic.) WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological & Geophysical Surveys Drilling Permit No. A.D.L. No. U. Borough Sub d'vision „r�i Lot L2 Block Ib. 1/a�gtrs. ._ofe'gf Section No. Township N ❑ Range E ❑ Meridian of �. S❑ I W❑ 3. OWNER OF WELL: r, gyp. j Address:- ,f.,a ft:S ,iR/ IC DISTA{10E AND DIRECTION FROM ROAD INTERSECTIONSI .. Street Address and Area of Well Location 2. WELL LOG Material Type Feet Below Surface 4. WELL DEPTH; (final) 5. DATE OF COMPLETIOfJ op Bottom - 6. AJ Cable tool [:]Rotary ❑Driven Dug Auger Jetted ❑ Bored ❑ Other: r'"s'+te• ,R``n - �,•.: r� -� �' 7.U,SE: Q Domestic 0 Public Supply ❑Industry Irrigation 0 Recharge 0 Commerical ❑ Test Well ❑ Other: El ,tel n~lL -" ,.•�'yif�' u;.' ] _ ,�, _.-. t, .r_v „a� �� �.... 8 CASING: Threaded, Welded x, dlam.l (?b In.to--..`:,; ft. Depth Weight .' f,, tbs./it. diam. in. to ft. Depth Stickup •fit -- ft. '0-3 144 11- ' ��'..�.., ,>�.,* >_K 9. FINISH OF WELL: , k Type: Diameter: I Slot/M sh Size: Length: iI Set bet been ft. and ft. Backi11.1ing - Gravel Pack ,r ,d' �°a.«m•• ,a. -+..-k:_; rr is 'ti ..1 .�r 4,'� I , 10. STATIC WATER LEVEL: /Ei <`..� H.�/ a e D t ❑ Above or ,Q Below land surface Equipment used: <..£'... 1 .. ,•�----`� i P � - i ! ' I, II. PUMPING LEVEL below land surface and YIELD ft. after .,}4 hrs. pumping I o2 g. P. M. r� —_ ft. after hrs. pumping g.p.m. II' ! 12.GROUTING Well Grouted: ❑ Yes 0 No c Material: D Neat Cement Ej Other: I 13, PUMP: (if available) HPIF Length of Drop Pipe ft. capacity 9 -P.M. [dSub.. ❑ Jet Contrifical Other 1 I I',' 14. REMARKS: 16. WATER WELL CONTRACTORS CERTIFICATION:' This well was drilledd�; and e�frf!'m/Ourisdictlon and this i i report . is true to the best Contract 15. Water -temperature _o F C o{ m knowledge and belief;. License Number IV Registered, BusiJne ss Name s addres. P `? Signed: Authoriz .d Representative I Form 02-WWR (11/81) - 'Copy Distribution: Date: , '�' 1 *H1TE-Stole DGGS, PINK -Driller, CANARY -Customer Municipality of Anchorage • '�� Development Services Department y •''` Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw Sit P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. _O 1 I — 135— t HAA _ U"1 C 1 1. GENERAL M: INFORMATIO Expiration Date: s 1/ , Colnpte(e legal description"'' LoT i31� y SAtV fl ate �_ 2 - Location' Location (site address or directions) 5ILI '7 o IV-., A,411 A v c Curreht Property owner(s) Q WjDay phone _.Zy�t3— 854 n Mailing address Lending agency 54 70 1.& 8(2' 41 Mailing address Real Estate Agent tA 111,1 Lex t., b Mailing Andress Unless otherwise requested, NAA will be hell by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class °C_" well Public Water System Z Day phone Day phone _3LgB a�&,D 346— 5045 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-sitewastewater 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. (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 welts or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions In the professional engineer's work TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site g ❑ Individual Holding tank ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-sitewastewater 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. (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 welts 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 seat 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. l 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 I 0 bb,eH SD uri<l Address 12-0 3 X)�i t 5l'f" d Engineer's Printed Name i o bbeH 5. DSD SIGNATURE Approved for _� bedrooms. Disapproved. Pl L . Phone A -7q-39 16 Conditional approval for bedrooms, with the following stipulations: - - Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: (R". Dim) Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water & Wastewater Program ° 4700 South Bragew St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchmage.ak.us (907) 343-7904 -HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT 2 'BL-O[.K. 1a SkNfl LAV"Sk 2 Parcel ID: 011- 1-55- 5 1 A. WELL DATA h Well type _I0 If A, B, or C provide PWSID #x(8581 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 9.p -m. 9— p.m-WATER SAMPLE RESULTS: Coliform -0--colonies/100 ml. Nitrate N D mg../L Other bacteria /_ colonies/100 nnml. Arsenic: hl/ mg.A. Dateofsample: It'20104 Coliecedby: _I Sev�k1«�arC B. SEPTIC/HOLDING TANK DATA Tank Type/MaterialSe 12 L e 1 SDate installed 116S Tank size I vve> gal. Number of Compartments 2 Cleanouts (Y/N) Foundation cleanout (Y/N) -;— Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping _ 7 0%0 3 Pumper _ 1Ze t o 1Zo o ? a✓ C. ABSORPTION FIELD DATA Date installed V183 Soil rating (g.p.dJftz or ft2Axirm) _;5 System type 5 - tai Length q4 it. Width 5 ft. Gravel below pipe 3.5 ft. Total depth 8.5 ft. Eff. absorption area 4 c 7 ftZ Monitoring tube Depression over field _'_ Date of adequacy lest _112.010 4 Results (Pass/Fad) P For 3 bedrooms Fluid depth in absorption field before test 4 in. Water added gal. New depth in. Elapsed Time: -4 min. Final fluid depth 4- in. Absorption rate >= Lf 15 O g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date ✓ D. LIFT STATION Date installed "Pump on" level at _in. Datum • , E. SEPARATION DISTANCES S/e in gallons Eter le/ (YIN) ,Pump oIP level at _ in. aIarm level at In. Cycles tested & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot I D D Absorption field on lot 1 0 0 + Public sewer main NIA Se war /septic service line 7 5 t On adjacent lots i 1 D Z> On adjacent kris A o -fl Public sewer manhole/cleanout N%A Holding tank t-1 /A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 14 Property line 5 { Absorption field 12- Water main 16,04 Water service line Surface water N I C) Wells on adjacent lots *> 100 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 5 Building foundation 13 Water main I eso Water Service line AS t Surface water N) o Driveway, parking/vehicle storage 10+ Curtain drain N j o Wells on adjacent lots '>10-0 F. COMMENTS NXIat- a G. ENGINEER'S CERTIFICATION I 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. pp Engineer's Printed Name i obbeH SnurltL4uc.0 Date 11•Lt.10%q HAA Fee 3 4 36' Date of Payment 11m4 - Receipt Number t2 ON Tl (Rev. 12101) Waiver Fee $ Date of Payment Receipt Number 01-25-04 C1:3IPI1 FROM-CTIF ESI. SGS ENV SERVICES 9CTSEI5301 T -10E P.03/03 F -ISS .__-SGS_. �ELwrou Drinking Water Analysis Report for Total Coliform Bacteria READ INSTRUCTIONS ON REVERSE SIDE QEFORE COLLECPING SAMPLE V PUBLIC WATER SYSTEM I.D. d G PRIVATE WATER SYSTEM D Sold Rnmus ❑ Snmdlaratcr F571 .n .a.a .+ws • -u.a. w. SAMPLE DATE: . LW Je p ❑ Send Ream" O Srrdlawl" . P rY Comments: 200 W. Potter Drive Anchorage. AK 99618.1608 TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: V/Satisfxtory ❑ Unsatisfactory D Sample over 30 hours old, results may be unreliable ❑ Sample loo long in transit; sample should not be over3;Vhours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received 1-2o'yy Time Received -/q-z2 Analysis Begin 1• jd• GU4 1? -:So Analytical Method: !-Membrane Filter ❑ MMO-MUG 1 . t.:,....t. s....7.,..:�.nno fill. Result* Analvst 1040388 014 � jV c I p Jun Faxed Da¢:JL A4 Tina. 1Ci0-,7 '( Cliententitled of unsatisfactory results: El Phoned Dar BACTERIOLOGICAL WATER ANALYSIS RECORD atMQMUG Result: Tutal Csllfarvs E. Cott Spokewith Time: litembrane Filter. Direct Count Z, C Q Ak Cofr Colonleslloo all 11 Faxed Verification: LTB. BGB _ CDLIFMN rvrr•a.ra,.m..r.cw.r fecal Coliform Confirmation Final Mend; rae e Filter Results ca � l>"/ Coliform/100 ml Repaned By p� - Date /-P-Qt} Time ,�i�- To bra Oa . a... a.arn. imiq.rox,eal:Si:n'e:lw 203vhst Porte, Drvt lir haasa,AKS'B51ade0 ti"MIX2-2343 119015513117 v s0sen+iarnereatran F571 ® 1V 141 SAMPLE DATE: . Month Day Year TYPE: -SA/MPLE II Routine ❑ Treated Water ❑ Repeat Sample (for routine seen It U/ Untreated Water with tab ref. no. ❑ Speelal Purpose Time Collected SAMPLE LOCATION Collected By ` 'y Seca) -J.. ,S- eka.rne Comments: 200 W. Potter Drive Anchorage. AK 99618.1608 TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: V/Satisfxtory ❑ Unsatisfactory D Sample over 30 hours old, results may be unreliable ❑ Sample loo long in transit; sample should not be over3;Vhours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received 1-2o'yy Time Received -/q-z2 Analysis Begin 1• jd• GU4 1? -:So Analytical Method: !-Membrane Filter ❑ MMO-MUG 1 . t.:,....t. s....7.,..:�.nno fill. Result* Analvst 1040388 014 � jV c I p Jun Faxed Da¢:JL A4 Tina. 1Ci0-,7 '( Cliententitled of unsatisfactory results: El Phoned Dar BACTERIOLOGICAL WATER ANALYSIS RECORD atMQMUG Result: Tutal Csllfarvs E. Cott Spokewith Time: litembrane Filter. Direct Count Z, C Q Ak Cofr Colonleslloo all 11 Faxed Verification: LTB. BGB _ CDLIFMN rvrr•a.ra,.m..r.cw.r fecal Coliform Confirmation Final Mend; rae e Filter Results ca � l>"/ Coliform/100 ml Repaned By p� - Date /-P-Qt} Time ,�i�- To bra Oa . a... a.arn. imiq.rox,eal:Si:n'e:lw 203vhst Porte, Drvt lir haasa,AKS'B51ade0 ti"MIX2-2343 119015513117 v s0sen+iarnereatran 01-23-04 01:3281 FR011-CTSE ESI, SGS EW SERVICES SGS ReLM 1040388001 Client Name Tobben Spurkland P.E. Project Name/00 214 Sandlake K2 Client Sample ID 214 Sandlake 112 Matrix Drinking Water PWS1D 218581 Smnp:e Rcmark3: 9CME15301 T-196 10.02/G3 F-159 All Dates/Tlmn are Alaska Standard Time Printed DateMnse 01232004 17:05 Collected Date/Time 01202004 12:00 Received Date/Time 01202004 14:27 Technical Director Stepbm .Pale Released By�/ PeruResults PQL Units Meehad cmfumer0 ALLimits uwobDuele mte: Prep Matyeu Dsre Iai: Waters Department Nnrato-N O.I001.1 0.100 mP%1. EPA 300.0 13 (<-10) 01/21!04 215 Microbiology Laboratory TotalColifomt 5ONNoCO3 cot/100ml. SMIS9222S A (<-1) 0120104 DKC From: Judy Lamb To: Tooben Spu idand DAN: 1272014 711" A7b4 AM I . For 4 c11 • 01/26/20a1 IE:01 2728738 HILDOi•ET1 PAGE 01 SCALE 1"..• .._.:.. ,. .::1::. i 1 �. �E . P. y .��� eAjv .z of c, 0. Q W 44.0 C s 98Y:53' Io`ty 1.35:44 ,. SE Fr. IC • .5Z'3TE" I .., :15 IOQ'i. fCGM .tV - ..THE INFOFWATION kAEON•�•fOri THE USE OF UNDINOANOTITUTIONS SPECIFICALLY .TO'SHOW EASEMMM OF RECORD. OTKM THAMANY OONPUC.TA VETWEIN EXIVINO STAVCTURES . ' " AND PLATIW. LOT UNE6.0R .EASGUINTS Aril 13 PLAT. $M.QWk.OK:TMEii4�LORDED,:; N0T.T0.EE U49040A D061TIONIN0.AD0MOUL PLAT, AtiB NOT SHOWN 1'jEREON.`' ; '.. . ' "STRUCTUMI OA FENCFAACS. . . r' :.:.; ..'.::' ...A99iy11L4T.",.:':: 1,• No.46iTgF� tit. ..600k `rru. P4 4AV bF AIt t hv,OYL•M*j alit FhM SWFW 111�1okwin9 dit�Ci *O-p►rb L01•�- EJock. �Y 4M`T b.4LG� {.EKE-:. atJ�Q.�2. jyoNSj1 r�0�dfllp Oiitri6l'Alafkt Md •Uy4.IME' �GJ't�'•:N' !•�.�i't�J . . +Qrgn+nt+� ivauQjh.�ne ke vnlhM mFpn oo•14* ikndao na ov.r+t Oft"'A r�'R f4 tel. R i1 Ih�o�,y���V`'�yUrkq lil yM,.��I4�1�U nL1M,p./.O.YMIjN-daw�MA..Fa<bW.9.Ya.�Ii'}yam g4 24 • .NM. r N.« w• •IP•�.P�N.wQV•RwR��x v.N.�r�t^'^�i<'cvlN.lk♦�IVI'1{t /1 •HIS -N •• «.Nr«7�:.�. -►61�..+s.q�w� on wa i�opi�r �t y+rlgkl.h tws«i. � � s - ,aM. 7,.wd;.. F f � a,•a M. lsobi �s' . 2G AN: �I f��i a�.4. e.�4•0 A�d►ax•o• MNk• W6 �t'��ru;pnilt MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING Parcel I.D. # 011-135-51-000 HAA #_,f S-/' 1. GENERAL INFORMATION Complete legal description SAND LAKE SUBDIVISION #2 LOT 2- BLOCK 4 Location (site address or directions) 8013 SAND LAKE ROAD ANCHORAGE AK I 9!5 Ld-,, Property owner HARI FY EADS Day phone 273-7207 Mailing address C/O DEBBIE KESSLER PRUDENTIAL VISTA REAL ESTATE ANCHORAGE, AK. 99502 Lending agency Day phone Mailing address Agent DEBBIE KFFSLER W/ PRUDENTIAL VISTA Day phone 273-7207 Address PRUDENTIAL VISTA REAL ESTATE ANCHORAGE AK 9502 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 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. 1/91) 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 inspee(ion, the on-site water supply and/or wastewater disposal system is in compliance with all MuStateState codes, ordinances, and regulations in effect on the date of this inspection. , , Name of Firm Address Engineer's Signature Phone (907)337-617 _ In conducting this evaluation, AWWC, Inc. of{krr}pt1t to provide a thorough, conscientious engineering' analysis of th system in accordance with ADEC and MOA H S uidelines & 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, 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 000p0 o the evaluator of the system. Satisfactory test results do not guarantee future performance �F ......... qS�4 of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. therefore not any warranty for future estimate of how long the can provide T 1 l 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, 0 ',-"e nor will it confer any legal right whatsoever. d0 y A. il. / CE --7953 ness;' w% 6. DHHS SIGNATURE � Approved for 3 bedrooms Disapproved Conditional approval for M /'rofes sion o' bedrooms, with the following stipulations: Date—/1- -q-0 b__ �� a ' 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. 1/91) Back MOA 921 Computer Version 1% L- V d A V L_ LLIF NOV 0 6 2000 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SER(I 94ITyOFANCHO Environmental Services Division ENVIRONMENTAL SERVICESD 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744 Health Authority Approval Checklist Legal Description: SANDLAKE #2 LOT 2; BLOCK 4 Parcel I.D.: 011-135-51-000 A. WELL DATA Well Type CLASS C If A, B, or C, attach ADEC letter. ADEC water system number 218581 Log present Total depth Date completed Cased FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RE ULTS: Coliform X height (above ground) Wires properly protected (Y/N) AT INSPECTION g.p.m. 9.p -m. • 9j M Nitrate (� Other bacteria X Date of sample: r 10/31/00 Collected by: A.W.W.C., INC. B. SEPTIC/HOLDING TANK DATA Date installed 9/26/83 Tank size 1000 Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression �/N) NO High water alarm (Y/N) N/A Date of Pumping 10/31/00 Pumper DENALI SEWER & DRAIN C. ABSORPTION FIELD DATA Date installed 9/26/83 Soil rating (g.p.d./ft2 o bdrm 137 System type TRENCH Length 44' Width 5' Gravel thickness below pipe 3.5' Total depth 8.33' Effective absorption area 407 SQ FT Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO Date of adequacy test 10/31/00 Results (Pass/Fail) PASSED For 3 Bedrooms Fluid depth in absorption field before test (in.); 0 Immediately after 1182 gal. water added (in.): 0 Fluid depth 0 (ins) Minutes later: N/A Absorption rate Peroxide treatment (past 12 months) (YIN) N/A If yes, give date 72-626 (Rev. 3/86)' Computer Version D. LIFT STATION Date installed Manhole/Access (Y/N) "Pump on" level at* High water alarm level at* Cycles E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 100'+ Absorption field on lot 100'+ Public sewer main — 75' Sewer/septic service line 75'+ in gallons off' level at* _On adjacent lots 100'+ On adjacent lots 100'+ _ Public sewer manhole/cleanout 100'+ Lift station 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Absorption field —UNKNOWN__ Water main/service line 10'+ Surface water/drainage 100'+ Wells on adjacent lots _ 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line__5.+* Building foundation Surface water 11111III1111111 Water main/service line 10'-I _._ Driveway, parking/vehicle storage area _ 10'+. _._ Curtain drain NONE KNOWN Wells on a /A *PER 1983 INSPECTION REPORT F. ENGINEER'S 1 certify that I/ of Municipal rrro with MOA H Signature_ Engineer's field inspections and review i systems are in conformance on this date. A. GARNESS HAA Fee $� Date of Payment . 40 / nn Receipt Number 57 ,�a/ 72-026 (Rev. 3/98)* Computer Verslon Waiver Fee Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section cam P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 011-135-51-000 HAA # 1. GENERAL INFORMATION Complete legal description Lot 2; Block 4; Sand Lake Subdivision #2 Location (site address or directions) 8013 Sand Lake Road Anchorage, AK Property owner Cindy & Gary Satterfield Day phone 243-7859 Mailing address 8013 Sand Lake Rd. Anchorage, AK 99502 Lending agency '` Day phone Mailing address Agent Dan Wolf/ emax Properties Day phone 276-2761 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 - 3. TYPE OF WATER SUPPLY: Individual well Community well XX 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 XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA e21 5. 6. 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 and State codes, ordinances, and regulations in effect on the date of this inspection. Alaska Water & Wastewater Phone 3? 1' 6 /7c Name of Firm , . Address 7120 East Chester I -Its. Circle Anchorage, Alaska. 99504 Date— Engineer's signature ALASKA WATER & WASTEWATER CONSULTANTS, INC. a;(f OF < IS TO BE PAID $800.00 AT CLOSING FOR ENGINEERING SERVICES PERFORMED, Aez!�"1'24� By: •��A. Go S� E-7953 ••; ��� DHHS SIGNATURE F9 •� •......•••'• `��� I/ Approved for _THR�76 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date LL/G-15? The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy t0 purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 72-M (Re .1191) Back MOA 021 Municipality of Anchorage OCl DEPARTMENT OF HEALTH & HUMAN SERVICE;ZNrursurYUFArv&nv f Environmental Services Division "/I°oNMENraLSERViCEs C i 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Legal Description: A. WELL DATA Well type _ reset Total depth COrP�t (Y/N) Sanitary seal (Y/N) Date of test Static water level Well Dr ctod>T ion Health Authority Approval Checklist LoY ; lqk4i 5440 lsvl[� " Parcel I.D.: O 11 - ( 35 51-000 If A, B, o(@attach ADEC letter FROM Date completed Cased to .. PtJS�D F� ADEC water system number Na Jo�laSroNiG� prSSI(je;D 1o�iz/9g . # 2159/ C g height (above ground) Wires properly protected (Y/N) AT V,� JA - WATER SAMPLE RESULTS: Coliform Nitrate 14" Ot (v x Other bacteria CY Date of sample: ���Z/98 Collected by: /4 w C B. SEPTIC/HOLDING TANK DATA Date installed Z(, g.3 Tank size /000 Number of Compartments Z Cleanouts (Y/N)- Foundation cleanout,.(Y/N) _ Depression (Y/N) Nb High water alarm (Y/N) Date of Pumping /0 -Z °J$"`,. Pumper 4 S1-=QV16Ef- fi_. s '4 C. ABSORO-TION FIELD DATA Date installed Z4 LB3 Soil rating (g1 rd7ft2 or ft2/bdrm) 3 -7 System type Length s' "`F"g Width S Gravel thickness below pipe 9' Z Total depth g 33 Effective absorption area 4"Q -7 Monitoring Tube present (Y/N)--Y-- Depression over field (Y/N) Date of adequacy test /D 2 9g Results (Pass/Fail) ftS For 3 bedrooms Fluid depth in absorption field before test (in.); _ Immediately after65gal. water added (in.): Fluid depth _ (ins) Minutes later: Absorption rate = `f g.p.d. mo - POZ Peroxide treatment (past 12 months) (Y/N) r-firra ow�� If yes, give date A/4 72-026 (Rev. 3/96)"` D. L TION Date installed Manhole/Access (Y/N) High water alarm.level at* *Datum Size in gallons "Pump off" level at* Cy ed Sulzvf�r� S►+aT wouc-O (E eiscgviaeD 7-,o E. SEPARATION DISTANCES` v�n��y. 5F --r= 44W C4 D�"' SEPARATION DISTANCES FROM WELL ON LOT TO: (C�AzS nc " (-U 1 1- I= Septic/holding tank on lot tionr i - Absorption field on lot Public sewer main Sewer /septic service line /+ 14- %s /t On adjacent lots I, DID f On adjacent lots 10(y 4 - Public sewer manhole/cleanout I cc Lift station 100 14 - SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 51+- t. Property line 5 Absorption field Water main/service line / O f{" Surface water/drainage /0011- Wells on adjacent lots 106 f SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 5` Building foundation IC)14- Surface water I Oo !t' Water main/service line Driveway, parking/vehicle storage area 10 { Curtain drain �^� D` `fit` 1 Wells on adjacent lots /Z)o F. ENGINEER'S CERTIFICATION ,A PIfL 19 3 /�►SPo�_ n ��' I certify that I in conforman inspections and review of Municipal -s in effect on this date. Signature N \, 17`� Engineer's Named Date /O /z m HAA Fee $ 5 C ' Date of Payment Receipt Number��% 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt: Number _ are Alaska WVattt;etr & Wastewater ewattter cConsuulltratunt s, 11ini co 7320 East Chester Heights Circle — Anchorage — Alaska 99504 (907) 337-6179 — Fax (907) 338-3246 Consulting Engineers October 12, 1998 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Health Certificate for Lot 2, Bk 4, Sand Lake #2. To whom it may concern: The existing 3 bedroom house is served by a community well and a private septic system. Based upon our review of the MOA and ADEC records, it appears that the septic tank location my have been modified since the original installation. According to the inspection report (9/26/83), the septic tank was 13 feet from the trench, however, based upon our field measurements, it appears that the septic tank is very close to the drainfield. Attached is a copy of a letter, prepared by ADEC, in which they rejected a request to grant a separation distance, less than 100 feet, between the class "C" well and the septic system on Lot 2. No documentation was on file at ADEC indicating that the problem was ever corrected; however, attached is a copy of the 1983 survey, and a CADD drawing which shows the current location of the septic tank pipes, which indicates that the septic tank was relocated. Based upon our swing tie measurements, it appears that the septic tank is very close to the 100 foot radius of the well. It appears that the separation distance has been meet, but it would take a surveyors instrument to be absolutely certain. Please provide direction from your department. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you for your assistance. Sincerely M.S. President V -- 4o 7 osuMfo olia..s ►-. op ?�V �QaYf� ad l.oc-Aortol AsSUr+r:--D c.o" of Nty-yg : ' 1�-tiS I S NoZ- A S Ui¢.vFi�j l.oC�i1o,.1 Al2$ B�H� uPo�l LEGAL DESCRIPTION: SAND LAKE #2, LOT 2. BLOCK 4 TYPE OF WORK: SEPARATION DISTANCE FROM WELL TO SEPTIC TANK Q PREPARED FOR: PHONE NUMBER: GARY SATTERFIELD 243-7859/249-1577 10/7/98 1 J.A.G. 1 1 = 30' 1 1 OF 1 ;,`F:••' � '•dpi 49TH ............................... Jeffrey A. Garness; CE -7953 m� V�e \ eco @a ,P�o f esslo� o 0 N 1 V -- 4o 7 osuMfo olia..s ►-. op ?�V �QaYf� ad l.oc-Aortol AsSUr+r:--D c.o" of Nty-yg : ' 1�-tiS I S NoZ- A S Ui¢.vFi�j l.oC�i1o,.1 Al2$ B�H� uPo�l LEGAL DESCRIPTION: SAND LAKE #2, LOT 2. BLOCK 4 TYPE OF WORK: SEPARATION DISTANCE FROM WELL TO SEPTIC TANK Q PREPARED FOR: PHONE NUMBER: GARY SATTERFIELD 243-7859/249-1577 10/7/98 1 J.A.G. 1 1 = 30' 1 1 OF 1 ;,`F:••' � '•dpi 49TH ............................... Jeffrey A. Garness; CE -7953 m� V�e \ eco @a ,P�o f esslo� o 0 N , VVV LLL L.a11U1\ LilidLlll Pi- ave 100 0 3Q' ___.. �`�`S7Q12Y QVER1 L41w6'' ; Wirt'"..T �nrgcr o� Ps .. STOjEY a o r 3 ►rao i r- w� au�rg;. , LOT 5t uNr so 50 Lu►� Q�rtitr av�ra" ' _ if !' 3 8109% 10"' W15. 44 WA -r r. �-jN.t- IVvtF-tyr. -:huC-AVIea&1: t¢R.��rr�it,> B�P.�_ ���.ti,ar , i.. `JT JO ==_9xt 140149 G� /3 L oa.4 Two 1,,-4 T!fL G.4oe,+ 6E CERTIFICATE 4F SURVEY n- n 1 hareby certify that I harm s wvvvW the falknAng described property: 1 07a A _ " 5 U I LT_ — 4 a sid:V ;, A 56: _ i t'.1, C], "VEY TITLE Sale I _ 2c' Book No. S3 0- kra dh rap Rewrdiry District, Almaka, end chef the improvements situated d wean am pr~ by J F G pyckw by 8 w"vin the poperr/ Ikw and do nor otwrlap or snrroech on the property Ivirti adjacent fweto, that no irnpcoo rnents on property IvinS adjmwnt thereto enaosch on the premises job No. 83 -91 Grid No. e224 n question and that there an no roaepwys, wansrnission lines or athr visible eesernents on Revisions: mid property exempt as indicated hereon. Uteo at Ancftorryt. Alnka, this _$_ 6y of i$_ km IARNARD ENGINEERING 'f-.=-V100!Cl� `���' �Zi �`�� SHo i :v.�Tg+e TrS,VKS lett Wert 16th Ave 6-40wap, Alma 1 74.6I35 :OP: -M-ItE (NZULAT)ZZiV CO. MAi?K 81ZI NrOtV _. fhhJ .r,-. Time APPLIC FILLS OUT UPPER HALE ONLY Time -AT Date Date -Property Owner -- Date Phone . 'Address Inspector -% Mailing U7! 1 Zip Code y, Buyer (( {( 1 I s� [ ��jy/v (� 11 E. Address Zip Code Lending Institution Phone I4 Cx,�l;?/,•I l'Yt{� �;I /'v: Address Address LF - Zip Code Realty Co. & Agent APPROVED BEDROOMS 'CONDITIONS OF APPROVAL Phone rI `) CONDITIONAL APPROVAL' Address�'�_; DATE I — q '`8 t_( I Zip Code Legal Description l r" ,�tl a � k - Soils Rating Street Location V. 2 12 Well Log Received "$ Type of Residence Well to Tank EY'Single Family ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply ❑ Individual ATTACH WELL LOG. A well log is required for all -wells drilled since June 1975. Ly Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal t V Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date ca - Inspector Inspector Inspector Inspector 11 E. Field Notes: OF ANCHORAGE DEPT. OF HF/,LT; l i'; ENVIRONd:i=NTAL PROTECTION -v RECEIVE® I fol APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED `) CONDITIONAL APPROVAL' DATE I — q '`8 t_( I BY: c`x " �-n ,—, g�l) Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received "$ t L S Well to Tank Septic Tank Size ]2023(3/82) December 23, 1983 Mark D. Brinton 8023 Seacliff Anchorage, AK 99502 Subject: Lot 2, Block 4, Sand Lake #2 Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: ° Before Health Authority approval can be granted it will be ,�- ,,��//� necessary to contact the Department of Environmental (fC Conservation at 274-2533 and obtain approval to operate your � co7mnunity well. Please notify this Department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, Jim Roberts Associate Environmental specialist Jit15/e j/i1 CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION . PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT / A- ' Plans for the construction of eT' a� 3 n�k S ` L414 -L— FA-FA- c ? a C'- 0 public water system located in A ti'cJ\- e A k Alaska, submitted in accordance with 18 AAC 80.100 by C a-) 4-4 A . have been reviewed and are r \d!�\ approved. 0 conditionally approved (see attached conditions). BY TITLE 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. Approved by Date or descriptive reference) Loi L'L_Iy Y_Z/— l S'L. l Ci> .i `!f �'� 1� i '�� ��.1 t J 12 - The Z. The "APPROVAL TO OPERATE" section must be completed before any water is made available to the public. APPROVAL TO OPERATE The construction of the t Q f S 3 m 4k A public water system was completed on %��Q t (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 toope ate, BY TITLE DATE Sfb v . CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION . PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT / A- ' Plans for the construction of eT' a� 3 n�k S ` L414 -L— FA-FA- c ? a C'- 0 public water system located in A ti'cJ\- e A k Alaska, submitted in accordance with 18 AAC 80.100 by C a-) 4-4 A . have been reviewed and are r \d!�\ approved. 0 conditionally approved (see attached conditions). BY TITLE 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. Approved by Date or descriptive reference) Loi L'L_Iy Y_Z/— l S'L. l Ci> .i `!f �'� 1� i '�� ��.1 t J 12 - The Z. The "APPROVAL TO OPERATE" section must be completed before any water is made available to the public. APPROVAL TO OPERATE The construction of the t Q f S 3 m 4k A public water system was completed on %��Q t (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 toope ate, BY TITLE DATE