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Home My WebLink AboutSAND LAKE #2 BLK 5 LT 11Sand Lake Lot 1! Block ,5 #011-134-26 Municipality of Anch0rage Page 1 3 ~. DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 ~, Anchorage, Alaska 99519-6650 · Telephone: 343~4744 .On-Site Wastewater'DiSposal System and/or Well Inspection Report PermitNumbe¢- SW000274 PID. Number: 011 -134-26 N~ru-XCra.ft Builders . Wastewater System: ~New. [] Upgrade '. P.O.. Box '222135 Anc'h.; AK' 99522 -ABSORPTION FIELD. ' hree ' ~](DeepTrench ' " '' ' L ... "il ..... 5'- Sa~nd*L~b~e-No. 2 -.' -' "-' · 5 :'--' -":"- ~-u.~.~°'-.. ~:.:.. ""s'~.?...~.~'., .-,O" -:';~/~-_ . 'I¢/~...... .".... ¢. '. ,. -...:.., :~ . ~... .... .. ,-.., .-....-,--.:.....: ,.: ../...-: ..: _.:...;- .:-. -.':..... - ...... ':' '-.-~...:.... - .... '.-. -: .- ..: .' :/? -' ..~dq&: o'£~:-~spha%;tt;-'sd~de.watk:- a'6' ';- .. - .:L-.:,.. ;~.-: ~ ;.::: * :-.;~.--..;'... -.. -: ....:, ~..,. z.:.'- .-. .".', ..] -'--:"' ..... :" :-" ". 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Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O, Box 196650 - Anchorage, AK 99519-6650 - 343-4744 On-Site Wastewater Disposal System or Well Inspection Report Page 2 of 3 Permit Number SW000274 SEACLIFF STREET PID No. 011-134-26 O O S1 A B ' 18.6 30.9 S2- 25.4 35.2 C4 32.4 39.0 M1 37.4 34.9 C5 39.3 I 30.0 N 00'00'00" W 50.00' ® ~ ' S 00'00'00" W 50.00' PLAN AS-BUILT SCALE 1" = 20' Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAl- SERVICES DIVISION P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744 On-Site Wastewater Disposal System or Well Inspection Report Page 3 of 3 Permit Number SW000274 PID No. 011-134-26 96.0 90.4 3allon Sep. Tan 90 ~ 89 9 95.8 Geotextile Fabric Drainfield Rock X90.0 ~ 83. ~ 77.0-+ 17' 13' 1" = 10' PROFILE AS-BUILT PAGE 0~ Job No.: Drilling, 'rnc. +P_O. Box 110378+Anchorage, AK 99511 · +907-345-4000 · 90%345-3257 Fax· As-Built £o~ · Well Owner: Tm- Cra~ Builders * Use of Well:~ · Legal Description: S~rtd La}ce Subdjvis'iga ~;. 2, Lot 1 i, Block 5 8341 Scacliff- Anchorage · Size of Casing: 6" ·Depth of Hole: 300 ·Cased To: 296.47' *Staticwaterlevei 161,1 belowlandsurface. · Well Finish- Open end {X); · Screen/Perforation description: Node Screen ( ); eerfor~ted ( ) · Wellpumping test at 20 gallons per minute for of drawdown from static level- 3 hours with lOO' · Notes: ~ Dry ~outed~. 2 sacks- bentonite granuals. · Date of completion: 08-24-00 Well Lo~ . Depth in ~eet froa ................. Rround surface. Details of formations penet,rnt~d~ ~l~e of ma~terial~ color and hardness. .... 0 TO 2 _C_as_in~.st_ic_k_u_p 2 TO 3 .B__ro__.wn_~_~psoil 3 TO 10 __C__o_bble.t?~t~?l 10 TO 16 Sand: brown, mediura 16 TO 23 As above: da~_.l~..0~_c_a_si_gn_al 23 TO 27 Brown silt '---~- T--6-----~'~' Sand: Brown, raed~um to fine. .... 9~ ._?_ _~.0_7_ _~_ay. silt 107 TO 147 Gra~, sand with silt i~aterbeds 147 TO 252 ._SUt~..sand: ~.a_y_.._a~_.d dam£ ........................................ 252 TO 280 Gravely silt: slightly_ sandy, wet/soupy -~2-8-~'--T-~ ..... 2-9-2- Silt: gray, soft, gravely, less wet 292 TO 296 Water graveh slightly silty =96 ~o ~00 XS-~3~7;i'-~i;~-~¥~-; .......................... ,° TO .................................................... I~W~. TO ,, W Means Water~Il Receive~ Time Nov, 9. 12:08PM MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM ! WATER SUPPLY PERMIT Initial Date Issued: Aug 02, 2000 Expiration Date: Aug 02, 2001 Permit Number: SW000274 Legal Description: SAND LAKE #2 BLK 5 LT 11 Design Engineer: 0014 Anderson Engineering Owner Name: Doug Cohen Owner Address: PO Box 222135 Anchorage, AK 99522- Parcel ID: 011-134-26 Site Address: 008341 SEACLIFF ST Lot Size: 6750 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: ~ 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. July 19, 2000 Municipality of Anchorage Department of Health and Human Services 825 "L" Street Anchorage. AK 99502-0650 Subject: Lot 10, Block 5, Sand Lake Subdivision Addn. No. 2 Se ptic System Design and Permit Application mpacts to Adjacent Properties Dear Onsite Services Engineer: The owner of Lol 10, Block 5. Sand Lake Subdivision Addition No. 2 intends to construct a three-bedroom home on the et. We are therefore applying for a permit to construct a new well and septic system on the lot to serve the new house. The attached Site Plan and backup documentation identify the location and configuration of the new septic system and the parameters used in the design. It also shows the location of the proposed well and its proximity to the septic system on this and the adjoining lots. The well will be placed to allow a .minimum of 100' separation to all components of septic systems in the area. The owner has purchased the adjoining lot to the north to allow additional separation distance between the septic system and lots in the area. A test hole recently placed on the'lot at the location shown revealed poorly graded sand with some gravel with a percolation rate of 1 minute per inch. No groundwater was encountered during excavation and none was noted during the ensuing monitoring period. We are therefore proposing to construct a dee p trench system with a maximum depth of 10' below the original ground surface. The length of the trench will be 27' with an effective depth of 7'. The lot is Vew Small with a width of only 50' so separation distances between wells in the area are critica The ground surface on the lot is basically flat with only a smal drop from the home site to the location of the absorption trench. The new trench will be constructed parallel to [he contours in conformance with Municipal requirements. Substantial grading will be corn pleted during the house excavation and fill will be added over the absorption trench [o provide protection from freezing during winter conditions. If the system is constructed in accordance with our design the following statements apply: The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. The subdivision s currently served by the Municipal water system. Lot 11, Block 5, Sand Lake No. 2 July 19, 2000 Page Two 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments l-N I ~~PROPOSED 6 I9 1,9 N SPURKLAND ~ 0 50 188 150 ~00 SCALE; ~" 850 300 TOBBEN SPURKLAND 205 W 15TH. AVENUE ARCH. AK. 99501 (9077 £0Y'$ 10 AND 11 B£OCK 5 SAND lAKE//2 DOUG COHEN TRU-CRAFT BUILDERS SEPTIC SYSTEM DESIGN DATE: APRIL I0, 2000 SHEET: I/5 GRID: 2224 PERMIT # SW980XXX PlY9 # XX ,', '" SEACLIFF STREET o 0 o 0 Proposed Well N 00'00'00" W 50.00' 0'~!. Three Bedroom 0 AltCrD~te Site S 00'00'00" W 50.00' 0 z SITE PLAN SCALE 1" = 20' ;allon Tank Long X 3! ;Wide Effective Depth orption Trench LOT 11, BLOCK 2, SAND LAKE SUB. NO. 2 DESIGN FACTORS: SYSTEM REQUIREMENTS: Three Bedroom Home Perc. Rate: 1 Min./Inch Application Rate: 1.2 GPD/SF Deep Trench System 1,000 Gallon Septic Tank 7' Drainfield Rock 3 Bedrooms X 150 GPD / 1.2 GPD/SF = 375 SF of Absorption Area 375 SF/14 SF/LF = 26.7 LF Trench Length !herefore: Construct a New Absorption Trench 27' in Length With 7' of Drainfield Rock Beneath the Distribution Lateral. Distribution Lateral to Be Placed 3' Below Existing Ground. Total Depth of Trench to Be 10' from Existing Surface. Mound Over Trench to Provided Minimum Cover of 3'. .Fabric -Perforated PVC (Slots Down) Dfainfield. Rock . NOTE: TYPICAL WIDE TRENCH SECTION (NO SCALE), Grade Area Over Trench to Drain AwRy. Minimum 6' Separation From Bedrock. Minimum 10' Separation From Lot Line. Minimum 4' Separation From Groundwater. Minimum 100' Separation From Wells. Munlcl[.allty of Anchorage DEPARTMENT OF '~EALTH & HUMAN SERVICES 825 "L" Sl,'aet, A~mhorage~ Alaaka ~9502-0~50 SOILS LOG - PERCOLATION TEST Township, Range, Section; SLOPE 'r'.l o I I D)SCLAIMFR: Ardur, dwater, cJ~nn~ indicated ar~ f~r the dates ~ho~vn_~ly. Past and future presenc~ and/or depth of ~roundwater can not be p~edic~ed ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 10, BLOCK 5, SAND LAKE, ADDN. NO. 2 GENERAL: The scope of this project includes the procurement and placement of a new 1,000 gallon septic tank at the location shown on the Site Plan. It also includes the construction of a new 27' long X 3' wide X 7' effective depth absorption trench. Distribution pipe will be placed at 3.0' below the original ground surface. The total depth of the trench from original ground will be 10.0'. Mounding over the trench will be required to provide a minimum of 3.0' of protective cover. Care must be taken to assure the system is placed a minimum of 100' from the wells in the neighborhood. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION 1. The new 1,000 gallon septic tank must be procured from an approved source and installed at the location shown on the plans. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. Lot 11, Block 5, Sand Lake No. 2 July 19, 2000 Page 2 of 3 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trenches to drain away. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). Insulation shall De at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). Lot 11, Block 5, Sand Lake No. 2 July 19, 2000 Page 3 of 3 5. A permeable geotextite fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diamete[ with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel, A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and cOnstruction notes for use in preparing the certified as-built of the completed system. MUNICIPALITY OF ANCI-I® Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 011-134-26 1. GENERAL INFORMATION Complete legal description Expiration Date: 13 0 �C 1 SAND LAKE #2 BLK 5 LT 11 Location (site address) 8341 Seacliff Street Current property owner(s) Mailing address Real estate agent CALVIN STEVEN L owner 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 351-1120 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic E Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Date of Payment a A02 0' o Receipt Number 0 ° � 2g'6 COSA# Qscaol oq2 Date: Waiver Fee $ Date of Payment Receipt Number 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, b on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows tha on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the numb, bedrooms and type of structure indicated herein. I further verify that based on the information obtained fron- Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wasteu disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulatio effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitt Name of Firm NorthRim Eng. Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 4/26/21 ++� OF q_`k0 s'TH ��P��` 6. DSD SIGNATURE f . f,.. , -f�StSw Eng rvO System #1 Approved for -3 bedrooms #j CE -62M pp m System #2 Approved for bedrooms Y Disapproved Conditional approval for bedrooms, with the following stipulations: VVIAI CR M114LJ By: 96-w-4 aa_ r // Original Certificate Date: 5/13/ac),Q I The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only up( representations given in paragraph 5 by an independent professional civil engineer registered in the Slate of Alaska. The Municipality of Anchor, not responsible for errors or emissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Septic Svstem Advisory X Qtr et- T0.r�,� Nitrate Advisory Arsenic Advisory at, act V 1 Su2`) COSA Checklist Legal Description: SAND LAKE #2 BLK 5 LT 11 Parcel ID: 011-134-26 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑■ Well log is filed with Onsite (or attached) Well production at time of test 5+ gpm Date drilled $/24/00 Water storage tank volume 0 gallons Total depth 300 ft Well disinfected for coliform test? ❑ Yes [ii -I No Cased to 296 ft X Coliform bacteria is Negative ❑■ Sanitary seal is functioning correctly Nitrate mg/L ❑■ Nitrate less than MRL (ND) ■❑ Wires are properly protected Arsenic 30.8 ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) 24 in. Collected by NRim Eng Date of flow test for COSA 1/30/20 Date of Sample 3/31/21 Static water level at beginning of test 140 ft Comments Arsenic Treatment, Sample prior to treatment B. TANK DATA Age of tank(s) 8/00 years Tank type/material steel Measured operating fluid level in septic tank 52 ■❑ Standpipes/foundation cleanout per record drawing Date of pumping 3-26-19 D. ABSORPTION FIELD DATA 8/4/00 Which system tested (date installed) 8/4/00 ❑E ALL standpipes present per record drawing Total measured depth from grade 12.5 ft (max) Measured depth to pipe invert from grade 5 ft (min) ❑ N/A — pressurized field ❑� Monitor tubes go to bottom of effective. If not, state depth into effective Al Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: 3/31/21- No solids buildup in tank Adequacy test date 1/30/20 Results ❑✓ Pass For 3 bedrooms Fluid depth prior to test 6 in Water added 450 gal New depth 12 in Elapsed time 30 min Final fluid depth 6 in Absorption rate 450 gpd Any rejuvenation treatment (past 12 months) no If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' [j Yes Community Sewer Manhole/Cleanout > 100' 0 Yes if No ft 171 Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' 7/1 Yes if No ft Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' F� Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' Q Yes if No ft 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' E] Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 171 Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' [j Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10'✓❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10' 171 Yes if No ft Private Wells > 100' Water Service Line > 10' Yes if No ft Community Wells > 200' Surface Water > 100' 0 Yes if No ft ❑ Yes if No ft ❑ Yes if No ft F. ENGINEER'S COMMENTS Shed sitting on above -ground blocks over a portion of absorption field. Does not interfere with septic system. G. ENGINEER'S CERTIFICATION 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 COSA Checklist yellow sheet MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904 On‐Site Water and Wastewater Section Fax: 343‐7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Arsenic Advisory Certificate of On‐Site Systems Approval # OSC201042 Subdivision: Sand Lake #2, Block: 5, Lot: 11 A water sample revealed an arsenic concentration of 30.8 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. Septic Tank Advisory Certificate of On -Site Systems Approval #OSC201042 Subdivision: Sand Lake #2 Blk 5 Lot 11 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 20 years old. Typical replacement costs range from $8,000 to $11,000. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. If ' Ma�lingAtldress P� O Box 196650*Anchorage, Alaska 99519 6650 * wiuw muni org `� UMCIPALITY OF ANCHORAGE 0 .ru Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 011-134-26 Certificate of On -Site Systems Approval Expiration Date: I ',�'^ 2 6 20 1. GENERAL INFORMATION Complete legal description SAND LAKE #2 BLK 5 LT 11 Location (site address) 8341 Seacliff Street Current property owner(s) CALVIN STEVEN L pay phone 351-1120 Mailing address Real estate agent Owner Day phone r a 9 7 ry 2. TYPE OF DWELLING: A ❑ Single Family (w/wo ADU) :R! FEB 0 d _ ON ❑ Duplex A0 F1Multiple Dwellings (Single Family and/or Duplex) �� h /Z 01 g 8 L9C� 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Z Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee 15�(j Waiver Fee $ _ Date of Payment a �(e �o�o�� Date of Payment Receipt Number Q q Receipt Number COSA # 0 SC a 16 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm NorthRim Eng. Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng 6. DSD SIGNATURE System #1 Approved for __3 bedrooms By: System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: "JI) �m6,O)))1,. Original Certificate Date: 20 2"0 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 Septic System Advisory Well Flow Advisory COSA Checklist blue sheet X Nitrate Advisory Arsenic Advisory Other�.0 I Q Legal Description: SAND LAKE #2 BLK 5 LT 11 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 8/24/00 Total depth 300 ft Cased to 296 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 1/30/20 Static water level at beginning of test 140 ft. Comments Arsenic Treatment B. TANK DATA Age of tank(s) 8/00 years Tank type/material steel Measured operating fluid level in septic tank 52 " ❑ Standpipes/foundation cleanout per record drawing Date of pumping 3-26-19 D. ABSORPTION FIELD DATA $/4/00 Which system tested (date installed) 814/00 -1 11 ❑ ALL standpipes present per record drawing Total measured depth from grade 5 ft (max) Measured depth to pipe invert from grade 12.5 ft (min) Parcel ID: 011-134-26 Structure served by this system Well production at time of test 5+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ No /soliform bacteria is Negative Nitrate mg/L P Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by NRim Eng Date of Sample 3 a Z O C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 1/30/20 - - Results [D Pass For 3 bedrooms Fluid depth prior to test 6 in Water added 450 gal ❑ N/A — pressurized field New depth 12 in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 30 min depth into effective ❑ Code -required soil cover over field Final fluid depth 6 in Absorption rate 450 gpd ❑ System presoaked (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ED Yes Community Sewer Manhole/Cleanout > 100' r Yes if No ft M Yes if No ft Neighboring Tank > 100' ED Yes if No ft Private Sewer/Septic Line > 25' 17,71 Yes if No ft Absorption Field on Lot > 100' P71 Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10' Animal Containment > 50' 21 Yes if No ft M✓ Yes if No ft Yes if No ft Water Service Line > 10' M Yes if No Manure/Animal Excreta Storage > 100' —❑✓ If septic tank is under driveway comment below Community Sewer Main > 75' E Yes if No ft Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ED Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: 0 Absorption Field > 5' if No Yes if No ft Private Wells > 100'✓Q Yes if No ft Water Main > 10' F/I Yes if No ft Community Wells > 200'✓0 Yes if No ft Water Service Line > 10' M Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' M Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' D Yes if No ft Water Service Line > 10' El Yes if No ft Community Wells > 200' D Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS Shed sifting on above -ground blocks over a portion of absorption field. Does not interfere with septic system. 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 P Y MOA COSA guidelines in effect on this date. '_=; E N G I N E E W S 6 r",_SS W" COSA Checklist yellow sheet 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 CERTIFICATE OF HEALTH AUTHORITY' APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 011-134-26 !. GENERAL INFORMATION Complete legal descriPtion SAND LAKE SUBDIVI§ION #2; Expiration Date: LOT 11r BLOCK 5r Location (site address or directions) 8341 SEACLI#~ STREET * ANCHORAGE, AK. 99502 Current Prop6dy owner(s) Mailing address KARL HEIDELBACH 8341 S~ACLIFF STREET Day phOne 344-5927 ANCHORAGE, AK. 99,~02 ' Lending age'ncy Day phone. Mailing address. Real Estate A~ent Mailing address LARRy suITER w/ PRUDENTIAL VISTA . Day phone 4241 "B" STREET * ANCHORAGE, AK. 99503 562-6464 Unless othen/vise re~luested, HAA will be I~eld by ~)sD fo~ pickup. 2. NUMBER OF BEDROOMS: 3 TYPE OF WATJ~R SUiSPLY: '~'YJ~E OF WASTEWATE~ DISPOSAL: Individual Well I Individual On-site IndiVidual Water Storage [~ Individual Holding tank Community Class Well r'-I Community On-site Public Water System r-I Public Sewer The Municipality of Anchorage De~;elopment Services Department (DSD) Issues Certificates Of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 byan independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of titl~ (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 propedies served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. STATEMENT OF INSPECTION BY ENGINEER ~ As certified by my seal affixed hereto and a§ 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 wasfewater 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 t. he information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable MuniCipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 537-6179 Address /3701 E. TUDOR ROAD', SUITE 101 * ANCHORAGE, AK 99507 " Engineer's Printed Name jEFFREY A. GARNESS, P.E. , Date Engineer's Comments:- : . . · In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA system under the conditions encountered at the time of the test, and separation distances measurad to readily identifiable features. The operational life'of all well' and ~..~.~.. ..:l .~}~J.?t. .. '~.. ~ septic systems depend on the local soils condition, .groundwater levels that may ..... fluctuate during the year, and the water usage Of the family being served by the system. These conditionsareoutsidethecontroloftheeva/uatorofthesystem. Satisfact°rytest results do not guarantee future performance of the system, nor do they guarantee that any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for '~F,~rofe~ .... e ss.to~,==~\ ,,'~ the sol~ benefit of the owner listed above. Any reliance upon or use of this report bY any other person or party is not authorized, nor will it confer any legal right whatsoever. DSD SIGNATURE Approved for ~' Disapproved. Conditional approval for bedrooms. ' ' bedrooms, with the fllowing stipulation~. · ' ' ~ · '~; ON-SITE ~ WATER AND ! WASTEWATER ': ~.-- ; PROGRAM , ~.~..'.- ..... .. ~ ~JJl)Jl lit)~ Attachments: ., HAA Checklist Septic System Advisory Well FlOw Advisory Manitenance Agreements ~. Supplemental Engineer's Reort Other Original Certificate Date: '~/~ (" //?~// 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 Legal Description: A.. WELL~ DATA : -~ Well t~Pe PRIVATE_ . . IfA, B, or C provide PWSID# . N/A Date c~mpleted 8/24/2000 SanitarY"seal(Y/N) YEs` ~ Total 'depth 300 ft. 'Cased to 296.47ft. ' ' · , -i,.. "'.FROMWELLLOG Date ~f test 8/24/2000 Static~ ~Water level 161.1 ft. : Well~i0duction: .~,,. ;. 20 g.p.m.' WATER SAMPLE RESULTS: .Coliform~ 0 colonies/100 mi. Nitrate 0.1- mg./L. ' N/A rog.IL. Date of sample: 5/05/2004 B. SEPTIC/HOLDING TANK DATA ..... Co HEALTH AUTHORITY APPROVAL CHECKLIST SAND LAKE S/D #2; LOT 11~ BLOCK 5~~ Parcel ID: 011-134-26 Well Log (Y/N) Wires properly protected (Y/N) Casing heigl~t (above ground) AT INSPECTION 3/15/2004 141 5,5+ Other bacteria Collected ~by: Date installed YES' YES '24 in. .ft. g.p.m. 0 colonies/100 mi. GEG~ LtD. Tank~ T ~l~e/Material STEEL 8/04/2000 T~nk si:;~ 1000 gal. Number of Compadments 2 CleanoiJts'(Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date'ofl~umping" 3/02/2000 Pumper ; MC 90NA~D'Si',PUMPING ABSORPTION FIELD DATA ~*BELOW EXISTING CRADEI i ~ Date installed. ~/04/2000 Soil rating ~r fl~bdrm)! 1.2 System {yPe TRENCH , Length ~ ' ' ' .-30 ft. Width :3 ft. Gravel below pipe 7 ft. Total depth '12.75 ft. Eft. 'absorption area 420 Monitoring tube YES Depression over field NO Date of ~aldequacry test 3/15/2004 Results (Pass!F.ail) PASS For. ,.3 bedrooms Fluid de in absorption field before test "0 in. Water added .622 gal. New depth 2 in. Elapsed Time: 7 min. Finalfluid depth. 0 in.'" Absorption rate >= 450+ g.p.d. Any rejuvenation t~eatment (past 12 mo.)(Y/N & type): NONE KNOWN If yes, give date - D. LIF~ STATION Date installed "Pu~P on" level at in. SI~AI~'~ION DISTANCES sE~A~:~TI~N' Di~,~,'I~I(~ ~,OU W'I~LL bN ~O~ . Size iff [~lloiis ~' ' ~ ',Pump"bf~' ' .... in;' : High water ~lai-m level at ' '. in. 'CyCles tes{~d Meets alai-~n g. ~:ircuit requirements. 100% SePtic {an~lift siati~)'n oh 10t Abs~)i-ption'field on 10t ' 100'+ Pul~lic sewer ~in N/A sewer/septic service li~e 2~'-F 0~ a'~lj~c~nt Io~s 1 'on ~djac(~nt 16t~ ,I. .. lOO'+ Publi'c S~Wer ~h=anh~)'le/(~le~ahbu{ Holdir~g tank" !:: 'N/~A' sEP.~,~,TIoN DiSTANCEs' ~:ROM ~Eis'fid/~lbLDl~; ¥~hK ON LoT.To: * · .. :.Sui'face water. Wa{er main · N/A W~,~ei: ~rvice lifie 16'+ Su~ac~ Waie~ ;i bO'+ Pr6pert'y line Water set, iCh iinb *;l'b~+ curtain drain N~' KNOWN c0MMEN-j-S .' .. Weft{ oh ~ijac~h~ 'lots '106'+ loo,+ 10'+ N/A Driv'ew~y. pa~kihg/vehicie storage ,..G. · ENGINEER'S CERTIFICATION , ~er~ifY 'that/'have d&tormined 'throui~ '~eid ~nspecti6h'~ a~d review of Municipal rec6rds that the above 'systems are in conformance wi~h MOA HAA guidelines in effect on this date. Enginebr,slSrihte~l'l~ai~e JEFFREY A. GARNESS HAA Fee$ L~.~. Date of Payment Receip~ Number -~, ~ m ~"~'~"~ (Rev. 12/01) ._ , ,, : waiver FeeS i,, Date is'f Pa~,m~h~ ' ReceiPt Nu ,rnb~r Municipality of Anchorage Department of Health and Human Services Divisioo of Environmental Services On-Site Services Section 825 %" Street Room 502 P.O, Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 011 -134-26 1. GENERAL INFORMATION Complete legal description Expiration Date: Lot 11, Block 5, Sand Lake Subdivision No. 2 Location (site address or directions) Seac!iff Street and 84th Avenue Current Properly owner(s) Mailing address Tru-Craft Builders Dayph0ne 727-6767 P.O. Box 222135 Anchorage, AK 99522 Lending agency Mailing address Day phone Real Estate Agent Mailing Address Day phone Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Three Well (3) TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank Community On-site Public Sewer The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Cer[ificates 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. 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 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. 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 Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. NameofFirm Anderson Engineering Address P.O. Box 240773 Anchorage; Engineer's Printed Name Michael E. Anderson, DHHS SIGNATURE 1.,-"" Approved for '~ bedrooms. Disapproved. Conditional approval for Phone 522-7773 AK gg~24 P. E. __ Date ~_/6 ,/0 0 bedrooms, wiih the following stipulations. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Date: ~ ' Et- C o Original Certificate Date: Reissue Date: 75 025 cRev 31 Legal Description: " Municipality of Anchorage R E C E I V Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 NOV 0 ? 2000 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.ancho rage.ak.us MUNICIPALITY 0¢ ANCHORAGE (907) 343-4744 I~NV!RONMENTAL SERVICES DIVISION HEALTH AUTHORITY APPROVAL CHECKLIST Lot 11, Block 5, Sand Lake Subdivision No. 2 Parcel I.D.: If A, B, or C provide PWSID # __ Y Nitrate Collected by: A. WELL DATA Well type Private Date completed 8 / 24 / 0 0 Sanitary seal __ Total depth 300 ft Cased to 296.5 011-134-26 Well Log Y Wires properly protected Y ft Casing height (above ground) 24 in. AT INSPECTION FROM WELL LOG Date of test 8 / 24 / 00 Static water level 1 61 ft Well production 20 g.p.m WATER SAMPLE RESULTS: Coliform 0 colonies/lO0 mi .5 mg/I Date of sample: 10/31/00 MEA B. SEPTIC/HOLDING TANK DATA Tank Type/Material Date installed . 8 / 3 / 00 Tank size Cleanouts ¥ Foundation cleanout ¥ Date of pumping New Construction C. ABSORPTION FIELD DATA ft g.p.m Other bacteria 0 colonies/100 mi 1,000 gal Number of Compadments 2 Depression over tank N High water alarm Pumper Date installed 8/4/00 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 Length 30 ft Width 3 ft Gravel below pipe 7 Totaldepth 12 ft Effective absorption area 1.2fF Monitoring tube Date of adequacy test New Const. Results (Pass/Fail) Fluid depth in absorption field before test in Water added__ Elapsed Time: min Final fluid depth in Any rejuvenation treatment (past 12 mo.) (Y/N & type) N N System type Deep Trench ft Y Depression over field N For bedrooms gal. New depth in. Absorption rate >= __ g.p.d. If yes, give date N/A 72-026 (Rev. 01/00)* D. LIFT STATION - N/A Date installed "Pump on" level at __ in Datum E. SEPARATION DISTANCES Size in gallons "Pump off" level at Cycles tested in SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot > 100 ' Absorption field on lot > 100 ' Public sewer main N/A Sewer/septic service line > 25 ' Manhole/Access High water alarm level at in Meets alarm & circuit requirements On adjacent lots > 100 ' On adjacent lots > 100 ' Public sewer manhole/cleanout Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Building foundation > 5 ' Property line 5 ' Water main N/A Water service line > 10 ' Drainage >100' Wellson adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation >10 ' Surface water > 100 ' Wells on adjacent lots > 1 co ' Property line > 10 ' Water Service line > 10 ' Curtain drain None_ Noted COMMENTS N/A Absorption field >,5' Surface water >100' Water main N/A Driveway, parking/vehicle storage__>.1_0 ' _ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson ~ P.E. Date 11/6/00 HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 01/00)* Waiver Fee $ Date of Payment Receipt Number