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SAND LAKE #2 BLK 6 LT 9
Onsite File Sand Lake # 2 Block 6 Lot 9 #011 - 133 - 28 5VDMrI FAL - Municipality of Anchorage SEP 2-0 2018 - i Community Development Department Page 1 of 3 On-Site Water&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: OSP181308 PID Number: 011-133-28 0 New M Upgrade Name: GEORGE PEDERSON ABSORPTION FIELD Address: 0 Deep Trench 0 Shallow Trench 0 Bed P ound 8325 SEAVIEW STREET*ANCHORAGE,AK 0 Other Phone: No.of Bedrooms: Soil Rating: Total Depth from origlna - :de: (907) 301-1612 3 GPD/Sg.FL Ft Depth to pipe Invert from original grade. Grave .:pth beneath pipe: LEGAL DESCRIPTION Fl. Subdivision: Block: Lot: Fill added above original grade: '`� Gravel length. SAND LAKE#2; BLOCK 6, LOT 9 6 9 �-A Ft. Ft I ownship: Mange: Section: Gravel width: Beds Number of lines: Distance between lines: FL Ft. SEPARATION DISTANCES Total absorp area: Number of trenches Dist.between trenches: To Septic Absorption Lift Holding Public/Private From Tank Field Station Tank Sewer Lines SQ.Ft. Ft. • Well 100'+ - - 25'+ TANK • Septic 0 S.T.E.P. ❑Holding ❑Other - Manufacturer: Capacity. Surface Water 100'+ L,� - - ANCHORAGE TANK 1000 Gal. Material. Number of compartments: Lot Line 5+ - - N/A STEEL 2 Foundation 10'+ - - LIFT STATION Curtain Drain l I Manufacturer. C - - NONE KNOWN 11 Gal Remarks: 'OLD TANK FILLED WITH CONCRETE PER CONTRACTOR 'pump on"level at: 'Pump off level at: High water alarm at: Pump Make&Model. Electrical Inspections performed by: PIPE MATERIAL EXISTING/ Tank to EXISTING/ House to tank 03034 drainfield D3034 InstallerEXISTING/ WILCO EXCAVATION Drainfield EXISTING CO/MT 03034 Inspector GEG, Ltd. BENCH MARK (Assumed elevation) 100.00 Ft. Inspection Dates: 1st 9/10/2018 2nd Location and Description: 3rd - 4th - BOTTOM OF TRIM AT SOUTHWEST CORNER ENGINEER'S SEAL Community Development Department Approval oo�OopO 0 ,. °o Conditional approval: Date: QO Q'.-• , 1, 1- 4 • g1 Hig ••.�ADD D 0vA I,op V 74 E-7953 • oQ Approved: ( vteLI Date: S i LICENSE4�Q Professio�o� #AECC884 �ftOOO�o Inspection Report_t-1.12.doc PERMIT NUMBER: PARCEL ID NUMBER: OSP181308 RECORD DRAWING 011-133-28 A B ST1 27.8 12.7 ST2 33.5 19.8 1 DBL1 34.9 21.4 1 DBL2 34.2 22.2 SAND LAKE SAD•2; ,00 1 ------ BLOCK 5.LOT 18A �� `` AND LAKE S ,y (BLOCK 88,OTS . / Ob N GiP / \ SAND LAKE SID 02: / BLOCK 8,LOT 8 / NO WELL ON LOT PER MOA RECORDS VACANTLAKE SAD 82: I 7 WE BLOCK 5,LOT 17 / i / Us .....-4-- --------- ..---... . A SAN � . : LAKE wig- BLOCK 5. OTD18 I -•xa:-J_,;1?:::.A:'i e;"11 1}.-i: W F <;s, A'f' WATER VALVE LOCATION I ,DRIVEWAY •y,{:1• 111 ;.!,.P. s EXISTING 3 PER AS-BUILT SURVEY �,aa.r.c,�dr:f,2,M' BEDROOM HOUSE DBL2 ( / EXISTING DRAINFIELD DBL1 T2 r NEW FCO INSTALLED BY CONTRACTO- NEW 100`0 GALLON STEEL SEPTIC TANK i r / LI] NO WELL ON LOT PER MOA RECORDS \ LLJ VACANT I I \ 094° / SAND LAKE SID N2; (n BLOCK S,LOT 15 $1��,\' SAND LAKE SAD e2: 1C).-' • BLK 8.LOT 10 V LLJ \ ���� \I NO' _ \ \ • SCALE: ------------- ----- li) .��..\\M III,11 GARNESS ENGINEERING GROUP, Ltd 4'•.': • :..:=.: ;„w:�. -.,� ._ ENGINEERING 0 SALES.;CONSULTING r• w--7 - ..�. -,� -..,---- / 0 3701 E.TUDOR ROAD.SUITE 101•ANCHORAGE.AK 99507•PHONE(907(3376179•FAX(907)338-3246•WEBSITE www.9amesurpirroemy co t. y�- • PREPARED FOR: PHONE NUMBER: PAGE NUMBER: • sVa e : • rey - ess .• -J GEORGE PEDERSON 907-301-1612 2 OF 3 •� � . GCE-7953�) � LEGAL DESCRIPTION: DRAWN BY: 1 06 'D •.:'e• SAND LAKE#2; BLOCK 6, LOT 9 D.J.G. 4j'A�••,,__••••...........* •\, �•� TYPE OF WORK: DATE: LICENSE. * I U ESS\0\‘‘,t44.4 4 SEPTIC SYSTEM SITE PLAN RECORD DRAWING 9/18/2018 #AECC884 IIISIIS1 PERMIT NUMBER. PARCEL ID NUMBER: 0S15181308 RECORD DRAWING 011-133-28 FINAL GRADE=99.78-99.96 TOP OF TANK ST1 ST2 AT INLET=95.26 '=. o TOP OF TANK AT OUTLET=95.32 INVERT OF BUNG NEW 1000 GALLON SEPTIC TANK AT INLET=94.86 INVERT OF BUNG AT OUTLET=94.70 11 • GARNESS ENGINEERING GROUP, Ltd 9 Al 3701 E TUDOR ROAD.SUITE 101.ANCHORAGE,AK 99507•PHONE(907)337-6179•FAX(907)3383246'WEBSITE%t wi g•messenglneerng wm . _ •s ••/ 1 •• • • PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0 1 ,, e ..Game - •.c�- GEORGE PEDERSON 907-301-1612 3 OF 3 •��iJ.,: CE-7.53 /I LEGAL DESCRIPTION: DRAWN BY: t •e, i SAND LAKE#2; BLOCK 6, LOT 9 D.J.G. 1��FD p•9),131•A.,•••, .. TYPE OF WORK: DATE: LICENSE,"II ° EJJ1 .,4• SEPTIC TANK PROFILE 9/17/2018 #AECC884 III%WWI 1 PAL. MUNICIPALITY OF ANCHORAGE On-Site Water&Wastewater Program PO Box 196650 4700 Elmore Road Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax (907)343-7997 %• httpa/www.muni.org/onsite I)clwrtntt•nt 9 'CHOi On-Site Wastewater Disposal System Permit 6007(g Permit Number: OSP181308 Effective Date: 9/6/2018 Work Type: SepticTank Upgrade Expiration Date: 9/6/2019 Tax Code Number: 01113328000 Site Legal Address: SAND LAKE #2 BLK 6 LT 9 G:2224 Site Mailing Address: 8325 SEAVIEW ST, Anchorage Owner: PEDERSON GEORGE L Lot Size in Sq Ft: 6750 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field El 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 Received By: ..CGfG.� �W► Date: 7 D Issued By: ARM C Date: 1 I MUNICIPALITY OF ANCHORAG '')4y6� 8 9 70 /7 l.,tr. Community Development Department -c46. ` i- Phone: 90 343-7904 Development Services Fax: 90's' 3-7997 c. On-Site Water & Wastewater Program << �h Mayor Dan Sullivan QL 5 8 L 9 On-Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 011-133-28 Property owner(s) GEORGE PEDERSON Day phone 907-301-1612 Mailing address 8325 SEAVIEW STREET*ANCHORAGE.AK 99516 Site address 8325 SEAVIEW STREET`ANCHORAGE,AK 99516 Legal description (Sub'd, Block & Lot) SAND LAKE#2; BLOCK 6. LOT 9 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: ®all that apply) Initial ❑ Single Family (SF) Absorption Field ❑ (w/wo ADU) Septic Tank ® Upgrade Duplex (D) ❑ Renewal ❑ Holding Tank ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: l EL L SEPTIC TANK TO PUBLIC)Al##-I (WAIVER REQUEST WITH ADEC) Distance: - I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: n2 fJ Waiver Fees: �} Date of Payment: -` `50 Date of Payment: Receipt Number: //))(( Q Receipt Number: V Permit No. S l g1369 Waiver No. (Rev.01/11) • to. ..,,i.„. Quanics GARNESS ENGINEERING GROUP, Ltd AOvaMcd Treatment bVsfcn) ENGINEERING SALES CONSULTING Dealer August 30th, 2018 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage. AK 99507 Ref: Proposed Septic System Upgrade for Sand Lake#2: Block 6, Lot 9 To whom it may concern: The existing 3-bedroom home is served by a private (old Class C) well and a private septic system. The existing 1982 steel septic tank is compromised and must be replaced. We are proposing to decommission the existing septic tank per UPC and install a new 1060-gallon HDPE septic tank. The existing well on Lot 12 was previously classified as a Class A well, however, per ADEC correspondence (attached), the well was reclassified to a Class C/Private well in 1997. In short, the well on Lot 12 is believed to have a 100-foot protective well radius and it is our understanding that a waiver does not need to be applied for. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. e :ly, ..A i (nt- Kie / f 1 ffrey •. t.. n-.s, P.E., M.S. Preside t f U 3701 East Tudor Road, Suite 101 *Anchorage,Alaska 99507-1259 Phone: (907)337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com • c Z / / / SAND LAKE SID#2; / \LOCK 6, LOT 6 (-100'WELL RADIUS • SAND LAKE S/D#2; 130' WEILL RADIUS BLOCK 5, LOT 18A -- \ \ SAND LAKE SI.Q#2; SAND LAKE S #2; BLOCK 6, LOT 1 19 \ \ I /BLOCKOT7 Gj SAND LAKE S/D#2; / P` \J VACANT / BLOCK 6,LOT 8 / BLOCK'6 LOT 17 �\,\.� SW LAKE S/D#2; r � 0� BLO L T 17 100'WELL R k6IUS� N / SAND LAKE S/D#2; �- \ BLOCK 5, LOT 16 `l�8 SANDLA LOT #2; 1 vl/7 - l BLOCK 6, LOT 16 1 / L RADI 100' WELL 100' WELL RADIUS 11 CPQ AND LA S/D#2; I \/ / SAND LAKE S/D#2; BLOCKS, LOT 15 W SAND LAKE #2; -� B 615 BLOCK 6, LO RADIUS/ 6f.lv-c I SAND LAKE S/D J SAND E S BLOCK 6, LSJ)A4 / fi. W BLOC 6, LOT 1 ` -------- - SAND E S #2; _ I I LOCKLOT 1� AWWU WATER 100 WELL RADI S 'hij SAND KE /D#2; - E Imo100' WE\L ADIOS 7{ A BL K , L 13 c RECLASSIFIED TO PRIVATE WELL IN 1997 PER O / ADEC CORRESPONDENCE. BELIEVED TO \ / SERVED LOTS 6-12 SEE ATTACHED EMAIL S ALE: il\' . 1";,00 / 44-\t-- ------------ v.�1 GARNESS ENGINEERING GROUP Ltd f(' .; . ENGINEERING SALESCONSULTING - •. / , • - 3701 E.TUDOR ROAD,SUITE 101'ANCHORAGE,AX 99507'PHONE(907)337-6179'FAX(907)338-3248'WEBSITE:www.gamessengmeenng corn ;• •• , PREPARED FOR: PHONE NUMBER: PAGE NUMBER: O e` •. Garry ss 4/ GEORGE PEDERSON 301-1612 1 OF 2 O. • r CE- •53J ..I PROJECT/LEGAL DESCRIPTION: DRAWN BY: 3rr • SAND LAKE#2; BLOCK 6, LOT 9 D.J.G. ... ...•.. ••�•'• �• r..' p\, �41 TYPE OF WORK: DATE: LICENSE *4 44 1�i:PCI"`� .•• SEPTIC TANK UPGRADE 8/31/2018 #AECC884 J • /r \ 1 GEG,Ltd.HAS A 8 PAGE SPECIFICATION LETTER THAT PERTAINS TO THIS DESIGN.TO NOTE:THE CONTRACTOR WILL HAVE THE SOUTH AND WEST OBTAIN A COPY OF THE LETTER CONTACT LOT LINE,AND ALL WELL RADAII SHOWN FLAGGED BY A GEG.BY PROCEEDING FORWARD WITH THIS I REGISTERED LAND SURVEYOR.PRIOR TO CONSTRUCTION. INSTALLATION,THE ENGINEER,WELL DRILLER, IT SHOULD BE NOTED THAT GARNESS ENGINEERING WILL CONTRACTOR AND PROPERTY OWNER AGREE NOT PERFORM INSPECTIONS WITHOUT THE PREVIOUSLY THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE MENTIONED SURVEY WORK BEING COMPLETED. TERMS AND CONDITIONS OUTLINED. --•! SAND LAKE SiD 92: j00• I BLOCK 5,LOT 18.A / !l SAND LAKE SID/2; o �9 BLOCK 6,LOT 7 \ t, tS / / \ /ANDOCK LAKE6.LOT 8 S/D Y2; / NO WELL ON LOT PER MOA RECORDS � � \ VACANT / , /S LAKE VD 92; I /00,',vett / BLOC LOT 17 / / R/41)/US EXISTING DRAINFIELD \ / EXISTING SEPTIC TANK TO BE \....,----____ �� DECOMMISSIONED PER UPC SAND LAKE SiD#2; , K'� �'�'�' BLOCK 5,LOT 16 '-•4i/?:;T:'I^- ; '•.;' I WATER VALVE LOCATION ij C�� I ,L * EXISTING 3 PER AS-BUILT SURVEY ��_ isisi'�:sRer_ BEDROOM HOUSE \ / I = / \ ONFIRM INTEGRITY OF FCO PROPOSED 1060 TWO COMPARTMENT INFILTRATOR SEPTIC TANK INSTALL DOUBLE CLEANOUTS AFTER TANK / NO WELL ON LOT PER MOA RECORDS \ 1 VACANT I I N O\J5 / SAND LAKE S/D 92: BLOCK 5,LOT 15 S1���.� SAND LAKE SID a7: ` 4, ^As J / \ BLOCK B.LOT 10 t"' W VACANT Q I w \ \ SAND LAKE 5/0 12; \ _____ 1/' C.D BLOCK 6.LOT 11 N I -SCA.E� 1"=30' s': - '.4.�\\\\11, i 42. .V. c1:1 .a _ 1,•• 4,9i.o GARNESS ENGINEERING GROUP Ltd er • ENGINEFRING+SAI ES CONSULTING3701 E.TUDOR ROAD,SUITE 101•ANCHORAGE,AK 99507•PHONE(907)337-6179•FAX(907)338-3246 WEBSITE www.gamessengineming.com •PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ♦t'^ -y A. Garness •W GEORGE PEDERSON 907-301-1612 2 OF 2 ♦�J,';...f `C�,E 7 3�2 PROJECT/LEGAL DESCRIPTION: DRAWN BY: ♦♦ j/j3 1 I 1 V3." 4 SAND LAKE#2; BLOCK 6, LOT 9 D.J.G. ♦ (• 1 • TYPE OF WORK: DATE: 44 LICENSE II II SS*k •• SEPTIC SYSTEM DESIGN UPGRADE 8/31/2018 #AECC884 David Garness From: Brannan, Thomas W (DEC) <thomas.brannan@alaska.gov> Sent: Thursday, August 30, 2018 2:52 PM To: David Garness Subject: RE: PWSID# 215469 Can't tell for certain without jumping into the file, but I'd expect on block 6 Lots 6 to 12 to be served. -T.W. From: David Garness [mailto:David@garnessengineering.com] Sent: Thursday, August 30, 2018 2:50 PM To: Brannan, Thomas W (DEC) <thomas.brannan@alaska.gov> Subject: RE: PWSID#215469 TW, Are you able to see which lots are served by the well? I have been looking through the MOA records but haven't found the information at this time. Sincerely, David Garness, E.I.T. Consultant Garness Engineering Group, Ltd. 3701 E. Tudor Road, Suite 101 Anchorage, Alaska 99507 Phone: (907) 337-6179 Fax: (907) 338-3246 Mobile: (907) 632-4528 Website: www.garnessengineering.com Quanics, GARNESS ENGINEERING GROUP, Ltd --` cm.[NYIRONME NTA[EVGIHE[RS From: Brannan, Thomas W(DEC) <thomas.brannan@alaska.gov> Sent:Thursday, August 30, 2018 11:18 AM To: David Garness<David@garnessengineering.com> Cc:Jeff Garness<Jeff@garnessengineering.com> Subject: RE: PWSID# 215469 1 David Garness From: Brannan, Thomas W (DEC) <thomas.brannan@alaska.gov> Sent: Thursday, August 30, 2018 11:18 AM To: David Garness Cc: Jeff Garness Subject: RE: PWSID#215469 David, Yep. Here's their SDWIS info: 1 Public Water System Summary AK2215469 SAND LAKE#2 B 6 L 6-12 Public Water System Information Primary Facility Sei Local Name City Served Region Served Active Source Count PWS Type Conn SEAVIEW STREET ANCHORAGE ANCHORAGE A GW 3 NP Comments: Sanitary Survey Date: Surveyor. AK2215469 SAND LAKE#2 B 6 L 6-12 Estimated Use by Population Type Average Daily Population Annual Operating Annual Operating Effective Begin Effective End Count Type Period Starts Period Ends Date Date 24 R 1 /1 12/31 1/1/1997 AK2215469 SAND LAKE#2 B 6 L 6-12 Public Water System Facilities Facility Name Facility Code Active Water Type Available DS SAND LAKE#2 B 6 L 6-12 DS001 A GW P SS SAND LAKE#2 B 6 L 6-12 SS001 A GW P WL SAND LAKE#2 B 6 L 6-12 WL001 A GW P AK2215469 SAND LAKE#2 B 6 L 6-12 Sampling Points Src Facility Code Sampling Pt Code Description Type Type Active DS001 SPDS001 PC SAND LAKE#2 B 6 L 6 DS A DS001 SPDS001TCR SAND LAKE#2 B 6 L 6 DS A SS001 SPSS001 SAND LAKE#2 B 6 L 6 A WL001 SPWL001 SAND LAKE#2 B 6 L 6 RW A AK2215469 SAND LAKE#2 B 6 L 6-12 Administrative/Owner Information Owner Type Owner Name Address Phone Fax AC SAND LAKE SUBD WATER 8349 SEAVEW STREETANCHORAGE,AK 99502 907-245-5545 ASSOCIATION AC JOHNSON, PATTY 8307 SEAVEW STREET ANCHORAGE,AK 99502 My records indicate that#215469 (Sand lake#2 B 6 L 6-12) is classified as non-public serving 24 residential people per day. Let me know if you need any further information. Thanks, 2 • T.W. (Thomas) Brannan, P.E. • ' Engineer I,DEC Alaska Department of Environmental Conservation EH I Drinking Water Program I Engineering OFFICE 907.269.3076 I FAX 907.269.7650 555 CORDOVA ST. I ANCHORAGE,AK 99501 http://www.dec.state.ak.usiehidwiindex.hun From: David Garness [mailto:David@garnessengineering.com] Sent: Thursday, August 30, 2018 11:05 AM To: Brannan, Thomas W (DEC) <thomas.brannan@alaska.gov> Cc:Jeff Garness<Jeff@garnessengineering.com> Subject: PWSID#215469 TW, Per our conversations, you indicated that the subject PWSID (215469) may have been reclassified from "Class A" to "Private/Class C" in the late 90's.The well is located on Sand Lake S/D#2; Block 6, lot 12 and the 200' protective radius potentially encroaches on a septic tank replacement I am working on for Sand Lake #2; Block 6, Lot 9. In short, I am trying to determine if I need to request a waiver with ADEC for the proposed septic tank upgrade. Please call or email me if you need additional information.Thank you for your time. Sincerely, David Garness, E.I.T. Consultant Garness Engineering Group, Ltd. 3701 E. Tudor Road, Suite 101 Anchorage, Alaska 99507 Phone: (907) 337-6179 Fax: (907) 338-3246 Mobile: (907) 632-4528 Website: www.garnessengineering.com Quanics • C.IRNESS ENGINEERING GROUP, Ltd '"°y ^�- +CIVIL 6 ENVIRONMENTAL EN0114E04 . --+r Deane 3 . I'~ , / MUNICIPALITY OF ANCHORAGE ~, /' DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION ~ 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME IPHONE · ~ UPGRADE MAI LING ADDRESS LEGAL DESCRIPTION I~/' ~ Wel'.~.--~ Absorption area Dwelling PER~T .O. DISTANCE TO: ~ ' Mater~ ~ No. of co~rtments ~ ~ Manufacturer ~ ~ Liq. capacity in gallons Inside length Width Liquid depth , ~,~ ~ IF HOMEMADE: ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O ~ ( Manufacturer Material Liquid capacity in gallons = finis rade ~ Material beneath tile Total effective absorption area o inches Length Width Depth PERMIT NO. < ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PiPE MATERIALS SOIL TEST RATIN~ INSTALLER REMARKS APPROVED DATE LEGAL 72-013 (Rev. 3/78) f"!R:,'; I.hlU!"l NLINE',EF': EIF: F: Er.' POr3M'% = E: '2:45 :;? C, 7 ;! ~7'50 SQURRE FEE:']" THE F.':E(:]U I RED :5 ! ZE OF THE :.30 ! L. F!DE:ORF'T i ON S?E;'TE:M i'5: THE LENGTH E-"!MEh!S!ON IS THE LENGTH ,::IN FEET> Of'- THE TRENCH OR DRF!iNFZEL.[:,. THE DEPTH OF' Fi 'TRENCFI OR PIT !'S THE DZSTRNC:E E:E::TiiEL<N THE !:]URFF~C:E OF' 'THE GF..'OUN[:, FIND THE E,'OTTOM Cfi:' THE E::.::CF!',,.-'F!T Z ON ,:: i N FEEET ). THERE IS N0 SET 14IE:,TF! FOR TRENCHES. THE GRR',,,'EL. [:,EPTH :IS THE hIINI. MUH [:,EF'TH OF' GRRVEL DE'THEEN ']"FIE OUTFF:~LL. PIF'E RND 'THE; BOT'TC~H OF THE EXC:FI',..,'FI]"Z ON ,:: ! N FEET ). F'ERM i T F!F'F'L. i CFiI'-,r'F I-IFiE; THE RE:E;PONS 18 TM Z T? TO ! NF'ORM TH T S [:,EF'RRTHENT L":,UR I N,'3 "*L~*:' Z NSTFIL. I_R'F Z ON '[ ~.,t'~ PECT Z (')N'5 OF RN'~.' HELLS FI[, 3'Fl::: ENT -f'0 THIS PROF'ERT'¢ RND THEE NUMBER OF RE:rE I DENr- E'::..:, THI::tT THE HF:'I I H ILL '-.m-E" '~" _.F:¢RI-:'FT-~. ....... TN':i OF FtN'¢ ::,?.:, E.I'I HITHOLiT F!NF~L. z.,:,r'~-.."~ '-'"~-F'"~ ]: ON ,,.~.~..-~::'t""~" RPF'RLP,"hL. E¢'¢ "r'L'~,'-' [:'EiF'F~RTHENT I'JiLL. E:E 'E;LEJECT T0 PR'Z:EEELTi0N. MINIMUM E:'!STF:!NCE ECETHE:E:N P'I HELL FIND FtN'¢ OM-:E;!'TE SEi.'.!f:!GE DISF'OSRL S'¢S'TEH Z% :tO,E~ FEET FOR Fi PRIVRTE HELL OR :t50 TO ;?.00 FEET FF:OH FI PUBLIC HELL. DEPENDING UPON 'i"I'-tE T"¢PE 01::' PUBLIC I.,.!ELL. i"!i.NiMU!'"I D!STI::INCE FRCff'I FI PRI',,,'RTE H,';£LL 'f'O FI PRIVR]"E SE!,.!ER LINE iS 25 FEET Ri'.,!D TO R COMMUNI't""? S!.E!4EF.: LZh,!E !S 75 FEET. OTHEF,' F.:EE.:!IJlF4::EHENT:~]; i"!R? RPPL.?. SF'EC:IFIC:RT~ONS RN[:, CONS]"F.'UCT!O,N DZRGRFff'i'_:_.; F!F::E R',,,'R t LRE,'L.E TO .i:i'-,tSURE PF.:OF'ER Z NSTRLLFiT I ON. ~. CEFtT'r~:¢;, . THF!T i Fff"l FFI!"1tL!F!R !.,.tiTH '.THE: ~'F:'i.':t TPr::HEi'.,q"::.; ~-r'd? ON-SZTE 'gFt.,.IF~":; ..... r HN,... HEL. L.S ~:~':: ,:,"""r FORTH EW ]'HE: .','I_i'.I)'iIF'FL't:T'¢ OF R!'.,IE:HORFIC~E. ;2:: i !4ILL INSTRL. L TFIE .L:;'¢STEM ........ TI'.,! R'":Cq~'DRH(':E !.,.!:[TMon-, THE ]:: ~ _ !~,![': E[;?'STRi",E' THFF!" 'T'NE .ON-S Z TE SEHER E;'¢'~;]'EH HR? REg!U I RE ENLF!RGEMEi'.,H' i F THE F.E.L:;ZDENCE ZS REHO[:,EL. ED TO .T. NrlLLD,'-~: HORE THF!N 3: ::31 GNE[:, ' FIF'F'L. I CF!NT T ';:. T CCINSTF;:t_!E:T t ON · '..? ,::..{. FJ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST SOILS LOG [] PERCOLATION TEST 1 2 3 4 5 6 7 8 SLOPE SITE PLAN 10 11 12 13 14 15- 16 17 18 19 2O COMM E N TS _..~'.¢ ,~ ~.¢ ENCOUNTERED? O IF YES, AT.WHAT DEPTH? Net Time Depth to Net Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEE,~ - FT AND ~ FT CERTIFIED BY: UHC CC °A L0 77 OF ' HCH o FI 0 s5� 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. 011-133-28-000 Expiration Date: Legal description SAND LAKE #2 BLK 6 LT 9 Site address 8325 SEAVIEW ST Anchorage AK 99502 Current property owner(s) YAMBAO CHRISTIAN MUNOZ & NANCY X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: E 12/20/2023 bedrooms, with the following stipulations: Original Certificate Date: 9/20/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory X Other COSA Approvaijune 2022 Development Sentices Department awn ` Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On-Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 011-133-28 Complete legal description SAND LAKE #2; BLOCK 6, LOT 9 Location (site address) 8325 Seaview Street *Anchorage Current property owner(s) Christian Yambao 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 382-6845 3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units X Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: Jfl Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: X Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 5 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench Q Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 515-0 Waiver Fee $ Date of Payment �� / 202 Date of Payment COSA # ,'�) C_ 2? 1 2) 35 Waiver # COSA Applicadon_June 2022 qJ COSA Checklist Legal Description: SAND LAKE #2; BLOCK 6, LOT 9 Parcel ID: 011-133-28 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _ 4 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test Date drilled Total depth ft Water storage tank volum gallons Cased to ft Well disinfec r coliform test? ❑ Yes No o � ❑ Sanitary seal is functioning correctly iform bacteria is Negative _T M ❑ Wires are properly protected Nitrate mg/L 0 Nitrate less than MRL (ND) Casing height (above ground) Arsenic 23.0 ug/L ❑ Arsenic less than MRL (ND) Date of flow test for COS Collected by GEG, LTD Static water I beginning of test ft. Date 8/10/23 ents PRIVATE WELL (SERV!GES MULTIPLE LOTS) - LOCATED ON SAND LAKE #2; BLOCK 6, LOT 12 S 6'V_v B. TANK DATA Measured operating fluid level in septic tank 49 Date of pumping 8/23/23 Q Required maintenance completed, if AWWTS Comments: - D. ABSORPTION FIELD DATA Which system tested (date installed) 4/24/82 M ALL standpipes present per record drawing Total measured depth from grade 8.33 ft (max) Measured depth to pipe invert from grade 4.0 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. El Monitor tubes go to bottom of effective. If not, state depth into effective 4.33' n Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced *2011 oallons 8/24/23 date Any rejuvenation treatment (past 12 months) NONE If yes, enter date N/A C. LIFT STATION ❑ Required maintenance corn Age of lift station ears Lift station m rial Adequacy test date 8/25/23 Results Q Pass Fluid depth prior to test 0 in Water added fi09 gal New fluid depth **7 in Elapsed time 75 min Final fluid depth 0 in Absorption rate 450+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 72 in Effective depth used 20 in Effective depth remaining 52 in Comments/Deficiencies: *15" OF LIQUID IN SUMP AT END OF PRE-SOAK **THERE WAS 4" OF LIQUID IN SUMP AFTER INTRODUCTION OF FIRST 198 GALLONS COSA Checklist June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Clea _ 100' ❑Yes if No ft N Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Private S eptic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft olding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ❑ Yes if No ft if No ft Manure/Animal Excreta Storage > 100' Community Sew > 75' ❑ Yes if No ft ❑ Yes if No ft ❑■ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' FniI Yes if No ft Surface Water > 100' [—]Yes if No ft Tank to Property Line > 5' g Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑ Yes if No *4 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' Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *PER 1982 INSPECTION REPORT FILED WITH MOA OLD TANK DECOMMISSIONED PER CONTRACTOR IN 2018. SINGLE SEPTIC PIPE ASSOCIATED WITH OLD TANK STILL REMAINS. G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Gamess Engineering Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Gayness Date In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. COSA Checklist June 2022 ZEAE (C884 • • • GE aO Municipality of Anchorage On-Site Water and Wastewater Program (907) 343-7904 SAFETY Certificate of On-Site Systems Approval Parcel I.D. 011-133-28 Expiration Date: ` / — 1. GENERAL INFORMATION: Complete legal description SAND LAKE#2; BLOCK 6, LOT 9 Location (site address) 8325 Seaview St.*Anchorage,AK 99502 Current Property owner(s) George Pederson Day phone 240-3788 Mailing address 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 Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ® Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: /Z/f7A COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ ggie Waiver Fee $ Date of Payment !2/i /i2 Date of Payment Receipt Number 6157a5-67 Receipt Number COSA# a5 C I$'I( y0 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. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101-Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: i 71141/ 0000000�0 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system � 0 F A C �� in accordance with the guidelines and regulations established by the Municipality of Anchorage and ' 4s 0 industry practices. The reported results describe the condition of the system/s on the date/s of the 457C. evaluation. Separation distances were measured to readily identifiable features. Hidden defects or •I i � •. OV encroachments may exist that were not identified during the evaluation. The operational life of all wells / * • • *V and septic systems depend upon a variety of variables, including but not limited to, soil conditions, Q groundwater levels (that may fluctuate during the year), quality of construction (materials and . workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and j'. .../.. . are outside the control of GEG. Satisfactory test results do not guarantee future performance of the O • •'f ey orness. system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of (//1n1; C —7 53 • QQ the well or septic system. GEG makes no representation whether an alternative well or septic system VV 4,i, • .I z �r 6 •• °ems can be installed on the property in the event either of the current systems fail to perform adequately in (I4 P, • .�/ .••'• c°o the future. The content of this report is for the sole benefit of the person/party that retained GEG to �Qed pro fessio'°" perform the evaluation. Reliance upon the information provided in this report by any other person or ��O0000�d party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. • #AECC884 6. DSD SIGNATURE System #1 Approved for —S bedrooms System #2 Approved for bedrooms \'‹ Disapproved J\�� Conditional approval for bedrooms, with the following-§tipuj?t ESSITE VVVV RAND m '2 WASTEWATER z PROGRAM 9 rc- By: Original Certificate Date: 1 Z j 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 �›C Nitrate Advjgriy- • Septic System Advisory Arsenic Advisory ,, Well Flow Advisory Other °' ` • COSA blue sheet 10.10-12.doc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: SAND LAKE#2; BLOCK 6, LOT 9 Parcel ID: 011-133-28 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# C Well Log (Y/N) Date completed Sanitary seal (Y/N) Wires properly protected Total depth _ft. Cased to ft. Casin• • (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. A - production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 ml. Nitrate ND mg./L. Collected by: GEG,Ltd. Arsenic: 22.8 ug./L. Date of sample:11/28/18&12/7/18 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 9/10/18 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout(Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) Date of pumping N/A Pumper NEW C. ABSORPTION FIELD DATA -BELOW EXISTING GRADE AT SUMP Date installed 4/24/82 Soil rating (g.p.d./ft2o t/bdrrr 100 System type DEEP TRENCH Length 25 ft. Width 5 ft. Gravel below pipe 6.0 ft. Total depth *9 ft. Eff. absorption area 300 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 8/15/18 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 861 gal. New depth 6 in. Elapsed Time: 100 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO If yes, give date - 2004 GALLON PRE-SOAK WAS PERFORMED ON 8/14/18 SUMP ONLY EXTENDS 59 INCHES BELOW THE INVERT D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at .• wa er alarm level at in. _ _• Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES PRIVATE (OLD CLASS) C SEPARATION DISTANCES FROM WELL ON LOT TO: LOCATED ON BK6, L12 Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main '•• . sewer manhole/cleanout Sewer/septic service line Holding tank - containment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+TO PRIVATE AND 200'+TO COMMUNITY SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line '4 Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 0' Curtain drain NONE KNOWN Wells on adjacent lots 100'+TO PRIVATE AND 200'+TO COMMUNITY F. COMMENTS *PER 1982 INSPECTION REPORT FILED WITH MOA S-JS OLD TANK DECOMISSIONED PER CONTRACTOR. SINGLE SEPTIC PIPE REMAINS (SEE ATTACHED PHOTO) vovaiku� .' OF 4i44 G. ENGINEER'S CERTIFICATION �P,,.•••' ii,S��1�♦. l certify that I have determined through field inspections and AI•I. ..* •/ review of Municipal records that the above systems are in 4/ • conformance with MOA COSA guidelines in effect on this • • .� ey 'mess •k Engineer's Printed Name JEFFREY A. GARNESS .•• ' if Sj•. CE-79 . ��: Date /ivl •4 4FESS 4* LICENSE alIiim"ivoil, #AECC884 (Rev. 10/12/12) MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENTif• F r 907-343-7904 On-Site Water and Wastewater Section \ l Fax: 343-7997 www.muni.org/onsite —/ Arsenic Advisory Certificate of On-Site Systems Approval # 0SC181640 Subdivision: Sand Lake #2, Block 6, Lot 9 A water sample revealed an arsenic concentration of 22.8 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. Mailing Address: P.0. Box 196650 *Anchorage,Alaska 99519-6650 *www.muni.org LOT 16 N 00°02'00"W 50.00' UTILITY POLE - ED* EDS EN- EON- COI.-- COWL (OH- SHEDWATER VALVE X U LOT9 LL x= 6,750 sq.ft. I - 5.6' 28.0' I I I b o I M I IM I LOT 8 w ' I A 1-STORY o I x LOT 10 b 27-c2°' FRAME 4 H I o r BUILDING In I cn I w z Ix 28.0' .J —�5.6'_• 16.4' .:CONCRETE •.' I SEPTIC ••r• I STANDPIPES • :, t 0 10' 20' GRAVEL 111111.11 DRIVEWAY ' y S 00°02'00"E 50.00' • OF • q�qsll'' *.Q J-II — — — — —SEAVIEW STREET — — - c'• Buku Sall /i r'• LS-14839 • _ �'�9e • meg_ I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: EASEMENTS OF RECORD,OTHER THAN THOSE SHOWN ON THE LOT 9,BLOCK 6.SAND LAKE SUBDIVISION No.2 RECORDED SUBDIVISION PLAT(P-176)ARE NOT SHOWN HEREON. ANCHORAGE RECORDING DISTRICT,ALASKA AND THAT THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE AND IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT WITHIN THE PROPERTY LINES AND NO VISIBLE BOUNDARY SURVEY MAY DISCLOSE. ENCROACHMENTS EXIST EXCEPT AS INDICATED. UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA DATED THIS 15th DAY OF OCTOBER,2018,AT HEREON BE USED FOR CONSTRUCTION OF FENCES, ANCHORAGE.ALASKA. IMPROVEMENTS.OR FOR ESTABLISHING PROPERTY BOUNDARIES. FIXED HEIGHT, LLC AS-BUILT NO CORNERS SET THIS DATE SCALE 1"=20' Land Surveying Services 907.290.5949 W W W.FIXEOHEIGHTCOM J08010122 Parcel I.D. 1. Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www. oi.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Expiration Date: GENERAL INFORMATION Complete legal description Lo'~' Location (site address or directions) Current Property owner(s) ,P(: Mailing address Lending agency Day phone Day phone Mailing address 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 _/z!N, Public Water System Well 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 Cedificates 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. 72-025 trey 0100V 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 inciicated 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 SIate codes, ordinances, and regulations in effect at the time of installation. NameofFirm I © ~.~ ~ :u ,- ~'~.tz~,t~ I~ Phone Address ~.- c .~ ~,/.Y-- t ~T ~ I~ ~.,:, _~ Engineer's Printed Name I~ibb , ¢,. -.~ ,.~ .- V'...,,,~, ~. Date DHHS SIGNATURE ~ Approved for ~ bedrooms. Disapproved. Conditional approval for__ ENGINEER'S STAMP f ~, bedrooms, with the following stipulations. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Reissue Date: 75-025 ~Rev 01 ('-~Municipality of Anchorage~'-J Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 RECEIVED 1 MUNICIPALITY OF ANCHOP-.~GIE ; JVIRONMENTAL SERVICES DIVISIC HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~..~3'~ ¢{ ~J~.L ~ ,._~::[~-~I;.C~/..~-.~ ~ 7_. Parcel I.D.:OII-Ij~-Zi~ A. WELL DATA Well type ~ Date completed __ Total depth ft Cased to FROM WELL LOG If A, B, or C provide PWSID # ,~.! ~ ?b~/ Well Log. Sanitary seal Wires properly protected __ ft Casing height (above ground) AT INSPECTION ' in. Date of test Static water level fl ft Well production WATER SAMPLE RESULTS: g.p.m g.p.m Coliform colonies/100 mi Nitrate __ mg/I Other bacteria__ colonies/1 O0 mi Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Date installed [ ~ ~ ~- Tank size cleanouts ~'/ Foundation cleanout y Date of pumping C. ABSORPTION FIELD DATA Collected by: ~0 gal Number of Compartments Depression over tank I"-I High water alarm Pumper "l~'.l.l,~t(-~' --~,*o-v-~' J4~.~c Date installed ) ~] ~' Z- ' Soil rating (~'t~ or ft2/bdrm) I ,~ o System type Length ~'- ft Width ,~ ft Gravel belOw pipe ~ ft Total depth I 0 ft Effective absorption area ,~O ft~ Monitoring tube__,~_ Depression over field Date of adequacy test '~'/,5/~ Results (Pass/Fail) ":J>--For ~ bedrooms Water added ,~4'/z) gal. ~/N"ew depth '~'" in. ~ in Absorption rate >= /../z¢~O g.p.d. If yes, give date ~ Fluid depth in absorption field before test ~ in Elapsed Time: ---'- min Final fluid depth Any rejuvenation treatment (past 12 mo.) (Y/N & type) 72-026 (Rev. 01/00)* D. LIFT STATION Date installed "Pump on" level at in Datum E. SEPARATION DISTANCES Size in gallons J "Pump off" level. J,.a~in cycles,,~s~d/ Manhole/Access High water alarm level at __ in Meets alarm & circuit requirements SEPARATION DISTANCES FROM WELL ON LOT TO:j,/'''/ Septic tank/lift station on lot ~.~.ad~nt lots Absorption field on lot J On adjacent lots Public sewer main ..-,'"/~'Public sewer manhole/cleanout Sewer/septic service lizjpe/"/' Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Property line Water service line Wells on adjacent lots Building foundation Water main ~)~ Drainage SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ,,~.- Surface water I'J I O Wells on adjacent lots Property line Water Service line Curtain drain F. COMMENTS Absorption field Surface water Water main ~> /~ Driveway, parking/vehicle storage 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 '~'"-~ ~ ¢~ ~ ~ ~ V..L~_ ~2 Date ~ IOI ¢.0-¢-O HAA Fee $ ~D~, Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 01/00)* CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPRO/CC~A- OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY .., ,,, Parcel I.D. 1. GENERAL INFORMATION (~ust be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) [,o~ 9; ~ock 6; San~ ~ake Su~$vLs$on ¢2 Location (address or directions) 8325 Seaview, Anchorage, Alaska (b) Property owner Edwin Ramos Mailing Address 8738 Fairview Road, Telephone:(homf?04)8) 366-2471_ Business (704) 359-4915 Charlotte, North Carolina 28226 (c) Lending Institution NORTHLAND MORTGAGE Telephone 274-5150 Mailing Address 2605 Denali, Anchoraqe¢ Alaska (d) Real Estate Company and Agent FORTUNE PROPERTIES/Mary Helen Rockwell Address 3000 A Street, Anchorage, Alaska 99503 Telephone 562~7653 (e) Mail the HAA to the following address: (or check here [% if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING/694-2979 17034 Eagle River Loop Road, Suite 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family:~ Number of bedrooms R 3. WATER SUPPLY Individual Well L% Community ¢ Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site I~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, Iverifythat my investigation of this Health Authority Approval 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. Name of Firm _ ~ 7:;'::;4 ;-::~;:jie Riv.~' Loop/icad No, 204 Address ~ '- p;-,:,~ :'~la.;k~ 99577 Date Telephone 6. DHHS APPROVAL Approved for_ -~ Approved v/'~L__2_ __ bedrooms by ___ Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph S 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 satisfycertain federal and state requirements. Employees of DHHSdonotconductinspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsibleforerrorsoromissions in the professional engineer's work. 72-025 (Rev 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Health Authority ApPrOval (HAA) CHECKLIST - FEBRUARY 1984 ~--~--~ 343-4744 Legal Description: [.~;:~ ~ Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ~Z::2C2"A~ 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.~esults Comments ¢ .~,,~, lP, ~ Date Completed Depth of Grouting If A, B, C, D.E.C. Approved (~N) Yield Pump Set At Sani,tary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ¢..¢~t,~ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed '~¢/~;::~'~- Size \~ No. of Compartments Standpipesd~N) y Air-tight Caps~[~!~N) k( ~/~ Fo u n dat~.~lea n out ¢~N) *;/' Depression over Tank (Y,t~ r~ te Last Pumped · /,¢~. ;for--' Pumping/Maintenance Contact on File (Y/N)t,~ Holding Tank High-Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ~ t.j¢. To Building Foundation To Property Line ~ c;>~ Jr'- To D. isposal Field To Water Main/Service Line I¢'~ I ..~ To Stream~.nd, Lake or M, ajor Drainage Course ~ 42~c:~1 Comme.ts' 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorpt!o~/,~trata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y~ Results of Last Adequacy Test \~ ~/'/'t~ Type of System Design Length of Field '~-~ ~ Depth of Field ~,~'~ .~ravel Bed Thickness ~,' %%¢='/f2-z~ Statndpipes Present ¢~/N) " Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well -- -- ~¢:~c:~ ~'- To Property Line ~'~ To Building Foundati~q///~ [ 1 t'4~- To Existin~ or Abandoned System on Lot ; On Adjoining Lots ~ ~ ,/ To Water Main/Service Line / ~ [J~ To Cutbac,k (if present) To Stream, Pond, Lake, or Major Drainage Course / ¢'~/ / To Driveway, Parking Area, or Vehicle Storage Area 4:~ ---- Comments "~ ~ .~l-~\/-,Jt~ 4:::~r,./ [ D. LIFT STATION Da~ Dimensions Size in tal.!o.n~ Manhole/Access (Y/N) "Pump On" Level at ~ "Pump Off" Level at High Water Alarm Level at ~_ Vent (Y/N). _ ~ Pumping Cycles during Adequacy Test. Tested for Meets MOA Electrical Codes (Y/N) ~ Comments ~~ **Check Permitted Bedroom Rating Against HAA Request** I certify that have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed '~ ' -'' ';';:~':~:~;' MOA No. ¢~ ¢0 ~ ~ ~ Receipt No. ~ Date of Payment · Amount: $ /~0 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 STEVE COWPER, GOVERNOR 563-6775 December 14, 1990 FOR: S & S Engineering Attn: Roger PWSID: ~215469 My review of the records on file in this office reveals that the Sand Lake ~2 Class A Public Water System which serves Lots 6, 7, 8, 9, 10, 11, and 12, Block 6, Sand Lake ~ 2 is not in compliance with the provisions of 18 AAC 80.060, State of Alaska Drinking Water Regulations. It appears that the necessary check samples have not been collected as reqwuired by 18 AAC 80.060 (d). If you have any questions, please do not hesitate to contact me. Keven K..Kleweno Environmental Engineer KKK:pf DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 Walter J. Hickel _ _, GOVERNOR 563-6775 December 20, 1990 Mr. Roger Shafer S & S Engineering -17034 Eagle River Loop, Suite 204 Eagle River, Alaska 99577 Subject: Sand Lake ~ 2, Class A Public Water System, PWSID Number 215469 Dear Mr. Shafer: My review of'the records on file in this office reveals that the Sand Lake ~t2 Class A Public Water System which serves Lots 6, 7, 8, 9, 10, 11, and 12, Block 6, Sand Lake 9 2 is now in compliance with the provisions of 18 AAC 80.060, State of Alaska Drinking Water Regulations. If you have any questions, please do not hesitate to contact me. Sincerely, Keven K. Kleweno Environmental Engineer MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PR ,O~ION RECEIVED ApPLIC. ;%IT FILLS OUT UPPER HAL, /ONLY Pro pe~ t y o~vn ~ r ,~ ~'" L/~).~ .~,~- '~'c~ . Phone Mailing Addre~ ~/~A /~0~ ~ 7~ ~ Zip Code ~ ~O ~ ~Y~ ~ ~O Buyer Address Zip Code Lending Institution Phone Address Zip Code Realty Co. & A~nt Phone Address Zip Code Legal Description /O~ ~ ~/ ~ ~ ~ ~~ '~ ~ Street Locati~ Type of ResJ~nce ~ingle Family ~ ~ Multiple Family No. of Bedroo~s ~ ~ Other Water Supply ~ Individual A~ACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975. ~Community For wells drilled prior to that date, give well depth (attach Icg if available). ~ Public Utility Sewer Disposal ~ ~, .~x ~lndividual Year ~d~v~dual Installed: ~ ~ ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time ~t Date Date Date Date Inspector Inspector inspector Inspector MUNICIPALITY OF ANCHORAGE Field Notes: DFPT C:r ;'='LT:! P, I~NVIR:3; fi',:cr, ..'-~,.; ,.,.). ZCTION 2 3 '1982 ( '~,~) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received ~ ~ ,..f- ~ ~ L Well to Tank Septic Tank Size 72-023 (3182)