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HomeMy WebLinkAboutSAND LAKE #2 BLK 2 LT 23Sandlake #2 Lot 23 Block 2 #011.- 133-02 Municipality of Anchorage Page of_ 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 Permit Number: '~VV' ~7 ~20~, PID Number: Name: ~'~,~ ~,? ~ ~ e~ ~ ~¢/ ~ ~/~ ~ Wastewater System: ~New ~ Upgrade Address: ~P ~ I/O~ ~~e ABSORPTION FIELD ;=hone: 7 ~ ~- ,~/~ ~ [No.o, Be~ooms: ~D~pTrench ~ Shallow Trench ~ Bed ~ Mound ~ Other LEGAL DESCRIPTION so~, Rating: TotalDe.th fromorigi.alg~de: Lot BI.k: Su~iv~iqn: ~pth to pi~ ~om from o~gi~l grade; Grail depth ~n~th pi~ Township: I Range: I ~ion~ Fill a~de~ above original g~e: , Gravel lengtB: WELL: ~ew U Upgrade Gravel width: Number of lines: Clarification (Private. A.B.C): Total Depth: C~ed To: Total absorption area: Pipe material: Driller: Date Drill~: S~ticWater Level: ~nstaller: Date installed: Yield: ~ GPM ~ Pump Set__at: Ft. ~ng Height~A~ve Ground:Ft. TANK SEPARATION DISTANCES ~s~.~ ~ Ho~.g ~ S.T.~.P. From Tank FieNd S~tion Tank ~? Lin. ~A U~O~e ~&~ WelP / ~ ~ / 0 2 ~ __ -- Material: ~ ~ ~ / Numar of Compa.men~: Sudace Water ...... LIFT STATION ~/~ Lot Size in gallons:~ Manuf~ure~ ~ ~ ~ __ _ "Pump on" ,~ve, at: I "Pump off" level at: ~ I High wate~ ala~ at: Foundation Cu~ain ~ Pump Make & Model ~ El~ri~l Ins~tions pedo~ by: Remarks: BENCH MARK Lo~tion and D~cd~tion: ~ ~ ~um~ Election: Depadment of Health and Human Se~ices approval Reviewed and approved by: ~~/ ~' ~ Date: //-I~' ? 72-013 (Rev. 9/91) MOA 25 Wilcox Street Water Well o[ I ,~x~'~''~' ,~.,-,, ,~,,- ~ "..,~'~ I I Swing ~e distonces (feet) Point A J scol 56.2 40.0 sco2 38.3 38.~ ~ I mt3 52.9 39.5 co4 42.6 42.1 tco5 43.5 43.9 I I tco6 42.g 46.8 1000 fco7 3.3 20.4 I gallon tank sca2 co4 Septic lrench j tco6 tco5 30 feet long by 7 feet deep I Nternate Septic J Trench I Lot ~ne 0 20 40 SC~E IN PID 011 13302 Permit Number: SW 97 0209 Crowther ~sociates Septic ~-Buitt Plate Ceotechnical Engineering So.ices Sand Lake Subdivision No.2, Block 2, Lot 23 Anchorage, Alaska ~ob ~o. 001.027 I ~le ~o. 001027p233 ~ Oote ~ovember Foundation Clean Out Clean Out Clean Out ] Cleon Out ...... I I '.'.'.'.'.',' Iii ..... I I ...... I I I I I I ...... I I '.'.'.'.'.'. ....... .. I I ..... I ...... I I ....... illI I I Clean Out taring Tube Cleon Out Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: (~°'/'PI~v~' LEGAL DESCRIPTION: 5~,"'1~/ /¢/,/";' C ~'~.. ~ ~ ~ ~ L~Z~ 1 2 3 4 5 6 7 8 9 10 11 12 13- 14 15 16 17 18 19 20- COMMENTS Township, Range, Section: SLOPE WASGROUND WATER /,'~ ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? ~ P O?Y, /~' ~'0 ~ PLAN 't E Oeplh to Water After . '~' Monitoring? {vP ~7 nalm ~' lC) ~,~ j Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ (m~nuteshnch) PERC HOLE DIAMETER TEST RUN BETWEEN __ FT AND __ FT PERFORMED BY: ~'~' G.,' <-'./;/ ".' ~' '-,-/,':'~ '~,~ ~ ,-~-~- ~"~/7'~; . ERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES iN EFFECT ON THIS DATE. DATE; ~ ~ ~ 72-008 (Rev. 4/85) PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW970209 DESIGN ENGINEER:G. SCOTT CROWTHER, OWNER NAME:RIVERS KEITH W OWNER ADDRESS:BOX 1605 PALMER, ALASI<A 99645 DATE ISSUED: 7/24/97 EXPIRATION DATE: 7/24/98 PARCEL ID:0t113302 LEGAL DESCRIPTION: SAND LAKE #2 BLK 2 LT 23 LOT SIZE: 6750 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM 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 (18AACS0) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 { 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AMD HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ENGINEER SHALL PERFORM AM ADDITIONAL SOILS TEST AT THE TIME OF CONSTRUCTION TO A TOTAL DEPTH OF 6 FEET BELOW THE BOTTOM OF THE ABSORPTION FIELD. RECEIVED BY:~ DATE: Rick Mystrom, Mayor M c pa .ty of Anch ra g¢ Department of Health and Human Services 825 "L" Street P,O. Box 196650 Anchorage, Alaska 99519-6650 July 29, 1997 G. Scott Crowther, P.E. Box 1605 Palmer, Alaska 99645 Subject: Waiver Request for Lot 23 Block 2 Sand Lake #2 Waiver Request #WR970033, PID #011-133-02, SW970209 Dear Mr. Crowther: Your request for a waiver of the required 10 foot separation between an on-site wastewater disposal system and a lot line has been approved. The waived distance is 0 feet from the south property line to the leachfield. This approval applies to the existing on-site wastewater disposal system lot line separation only. Any future upgrade to the on-site wastewater disposal system will require all separations be met or another approval from this department. If there any further questions or concerns regarding this waiver, please call our office at 343-4744. Sincerely, Daniel J. Roth Civil Engineer On-Site Services Program Rivers MUNICIPALITY OF ANCHORAGE Deparnmenn of Health and Human Services On-site Services Sectlon Waiver Revzew Worksheet WR~ WR970033 PID= 011-133-02 HA= Date Received: June 30, 1997 Legal Description: Lot 23 BLock 2 SAnd Lake #2 Engineer: G. Scott Crowther, P.E. Permit Box 1605 Palmer, Alaska 99645 Applicant: Keith Rivers Waiver Requested: Lot line waiver of 0 feet to south property line Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Othe, r: Waiver is Granted: _ ~ List Conditions or Reasons for Waiver :LS NOT Granted: above: ~ ~&/~6F~ ~£~ Date: ¢-{7 Rec ~: 02776/0336 Amount: S 115.00 Name of Reviewer Date Paid: June 30~ 1997 001.027 CROWTHER ASS OC1A TES July 23, 1997 Municipality of Anchorage Department of Health and Human Services Environmental Services Division 825 L Street, Suite 502 Anchorage, Alaska Attention: Mr. Dan Roth Permit Application On-Site Wastewater Disposal Systems Sand Lake Subdivision/t2 Lot 23, Block 2 Anchorage, Alaska This letter presents Mr. John Colliander's of Colliander Construction request for a permit to construct an on site deep dralnfiald wastewater disposal system on Lot 23 of Sand Lake 'Subdivision Number 2, Block 2. Colliander Construction plans to construct a three-bedroom house on the lot during 1997 or 1998. The lot is south west of the intersection of Wilcox Street and 80th Avelme in Anchorage, Alaska as shown on Plate 1. Both Wilcox Street and 80th Avenue are 2-lane unpaved streets. The lots in Sand Lake Subdivi- sion #2 are 50 feet wide by 135 feet deep. Sand Lake Subdivision #2 is about 90 percent developed with two and three bedroom houses. Each house has an on-site septic system consisting of a deep dralnfield. The houses are serviced by class C community wells for their water supply. The location of septic systems and wells on adjacent lots are presented on the Vicinity Map Plate 1. For each existing well in the subdivision the Alaska Department of Enviromnant Conservation (ADEC) has waved its required sepmation distance to the nearest septic system from 150 to 100 feet. SITE CONDITIONS The subject lot is covered by spruce and alder trees. As shown on the Site Plan, Plate 2 the ground surface gent- ly slopes downward towards the southeast between Elevations 98 and 92 feet (Elevations are based on the assumption that the ground at the northwest comer of the site is at Elew~tion 100 feet). Table 1 presents a description of the deep soil profile and its geologic origin at the subject lot. The informa- tion presented in Table 1 is based beth on adjacent wa- ter well logs and septic system test pit logs. Table 1. Deep Soil Profile and Geologic Origin Depth Interval Soil Description and (feet below surface) (Geologic Origin) 0 to 2 silt (residual) 2 to 15 fine grained sand and sil~'- (alluvial) 15 to 100 sandy silt (glacial till) 100 to 260 gravely clayey silt (glacia'~' lacustrine) gravely clay (glacial drift) 260 to 390 390 to 410 Sandy Gravel (alluvial) Most existing wells in Sand Lake Subdivision #2 have a &inch casing. They have been drilled to about a 400 foot depth where they encountered an alluvial sandy gravel. The gravel contains an aqnifer that has an abundant water supply. The aquifers' static water level, which has been measured in the wells, ranges between 1 l0 and 120 feet below the surface. Pump tests per- formed at 20 and 35 gallons per minute respectively have drawn down the water level 3 and 6 feet in the wells. Laboratory tests performed on smnples of water from existing subdivision wells have historically not de- tected either coliform bacteria or nitrate, Page 1 P. O. Box l10854 /Anchorage, Alaska 99511-0854 Telephone (907) 349-2198 / Telecopy (907) 522-3885 001.027 CROWTHER ASSOCIATES WELL PERMIT On April 21, 1997 a class C well permit and a waver to reduce the required separation distance between the propesod well and septic systems from 150 to 100 feet was applied for at the ADEC for the subject property. As part of the application a water sample was obtained from the well on Lot 21. Laboratory test results indi- cate that both Nitrate-N and Total Coliform concentra- tious in the well water are at non detectable levels. Laboratory test surmnaries are presented on the attached sheets. Based on the above data the ADEC has approved a re- quest to install a clam C well at the location presented on Plate 2. They have also waved the required separa- tion distance between septic systems and the well from 150 to 100 feet. The location for a water line that will connect the house to the well ts shown on Plate 2. INVESTIGA~HON Subsurface conditions were explored at the lot by exca- vafmg a backhoe test pit at the location shown on Plate 2. The test pit was excavated to a 12 foot depth. Our engineer was on site to log the soil and groundwater conditions encountered. A log of the test pit is presented on the attached MOA Soils Log -~ Percolation Test form. The soil has been classified in accordance to the unified soil classification system. A percolation test was performed at the test pit in a 7- to 8-inch diameter hole, hand dug 12- to 18-inches deep. The hole was presoaked with water, winch seeped into the soil. The percolation tests was performed immediately after the presoak, The rate that water seeped into the soil was monitored and recorded. Parcolation test results are presented on the attached MOA Soil Log - Percolation Test form. SEPTIC SYSTEMS Lot 23 Test Pit 2 was excavated at LOt 23. Subsurface condi- tions encountered consist of 2 to 3 feet of sandy silt over sand to the 12.5 foot depth explored. Groundwater was not encountered in the test pit. A percolation test was performed in the sandy silt at a 6 foot depth below the surface. Based on percolation test results we conclude that a deep trench septic system on LOt 23 should be designed for a percolation rote of 1 minute per inch and an application rote of 1.2 gallons per day/square foot (glXl/s0. For that application rate we conclude a deep trench septic system for a three bed- room house should have a 7 foot effective depth and be 27 feet long. Calculations for the septic system depth and length are attached. The recommended location for both primary and replacement systems are presented on Plate 2. Recommended details for a drainfield are pres- ented on Plate 7. Tins septic system location is outside of the 100 foot ra- dius for both the existing and proposed wells. Tins location does not encroach on the required separation distances of existing septic systems and wells. It will not impact the performance of existing or future septic systems and wells. Septic Tanks A 1,000 gallon septic tank will be installed on each lot. Locations for the septic tanks are presented on Plate 2. Septic Piping Septic piping connecting the house to the drainfield will be installed with cleanouts as shown on Plate 7. They will be 4-inches in dian~eter and sloped to drain at 1 to 2 percent. Installation Requirements Both the deep drainfields and the septic tanks will be installed in accordance to the "Typical Deep Trench Re- quirements and Specifications" presented in the An.. chomge Municipal Cede section 15.65. Page 2 P. O. Box 110854/Anchorage, Alaska 99511-0854 Telephone (907) 349-2198 / Telecopy (907) 522~3885 O01.027 CR 0 WTHER A SSO CiA TES Installation Exploration and Monitoring The following exploration and monitoring will be per- formed dm:ing construction: A test pit will be excavated to a 14 foot depth to check the soil type and for groundwater. A PVC pipe will be installed in file test pit as a ground water monitoring robe. Ground water moni- toting will be performed fei' 7 days after the PVC pipe is installed. WAVER REQUEST The MOA requires that drainfields be setback 10 feet from property lines. To install a deep trench dmintield on the lot it will need to be inside oftbe required 10 foot setback of the south propexB' line. So we request that the south property line 10 foot setback requirement be waved for the druirdield. We trust this provides the information that you require. Please call if you have any questions. Your very truly, G. Scott Crowther, P.E. Civil Engineer 6491 Attachments: Plate I Vicinity Map Plate 2 Site Plan Soils Log - Percolation Test Deep Trench Calculation Sheet Plate 3 Deep Trench Details ADEC Letter of June 11, 1997 Page 3 P. O. Box l10854 /Anchorage, Alaska 99511-0854 Telephone (907) 349-2198 / Telecopy (907) 522-3885 West 80th Avenue ~ 100 foot , .~?~oFi~ss~~ West 82nd Avenue ~ Existing Septic System Trench 0 100 2~0 ~ Proposed Septic System Trench ~ SCALE IN FEE'r ~ P Proposed Well Crowther ~sociotes ~cinity Mop Plote Geotechnicol Engineering Se~ices Sond Loke Subdivision ~2, Block 2 Anchoroge, Alosko Oob ~o. 001.027 I File ~o. 001027~g I ~ote dune 1007 Edge of West 80th Avenue --,,/100' Right of Way ~ ~ : -~..___~' Lot Line ~¢" '~ -- 8 ~ , ~ OFA ~ . . ...... , / ~ ...~ / Lot Un /~ ~ ~,:~ /,' Existing Well Lot Line ~~ __ _ ~ ..... Woterline Piping ~ Septic Piping ti[ 1000 golllon 0 30 60 Septic Tonk I ~ I ~ ~ Auxilio~ Septic droinfield SCALE IN FEET ~ Test Pit Locotion droinfield 5 feet wide TP-1 ond Number A Iocotion ond o 7 foot Note: Contours ore hosed on the ossumptlon effective depth thor the ground ot the no~h west corner of the ~ Proposed Well ~ site is ot elevotion 100 feet. CroWbar ~sociotes Site Plon Plate 6eotechnicol Enginee~ng Se~ices Sond Loke Subdivision ~2, Block 2, Lot 2~ Anchoroge, Afosko ~ dob ~o. 001.027 ~ ~le ~o. 001027~3 I ~te dune 1007 I --,,/100' Right of Woy . A -- /100' Rodius for / ~ ~ fProposed Well / , /100' Radius of / ' Existing Well Lot Line II II II II II II II II II II II II II II II ..... II II II Clean Foundation Clean Out Clean Out Clean Out m ~ Monitoring Tube Cleon Out Clean Out Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST · / LEGAL DESCRIPTION: ~'~t'lr~/~/~ 1 2 3 4 6- 7 8 9 10 11 12 13 14 15 16 17 18 19 20 ~'~.',~ r/'/Vl¢/~,~ ¢~ 'rownship, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SITE PLAN Oeplh Io Waler Alter Monitoring? /~'/F Date: Gross Net Depth to Net ~eading Date Time Time ~, ~ Water Drop O,'3p 7~ 5~15 7~ 17 PERCOLATION RATE . (mrnute~mch) PERC HOLE DIAMETEF~ ~// TEST RUN BETWEEN ~__ FT AND 7 FT COMMENTS PERFORMED BY: .'"~- -~'J'~ ~ ' .--~' -~ ~'~e/ .-- ACCORDANC~ WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. 72-~8 (Rev, 4/~) CI-;RTIFY THAT THIS TEST WAS PERFORMED IN DATE: ~ Z '~ q ~ TONY KNOWLF. s, GOVEI?NOR DEPT. OF ENVIRONMENTAL CONSERVATION AuNCH©PJ~.OE/~ZESTEI~dN PUBLIC SERV~CE ©FFIlCE 555 Cordova Anchorage, Alaska 99501 269-7519 (fax) 269-7506 11 June 1997 Crowther Associates P.O. Box 110854 Anchorage, Alaska 99511-0854 Dear Mr. Re:Sandlake Subdivision #2, Block 2, Lots 22,23 & 24 ADEC ~ 9721-DW-111-111; 9721-WV-111-045 Crowther: Your plan submittal for an on-lot disposal system with waver on the above listed lots have been reviewed. Please proceed as you have proposed. Attached you will find approval to construct documents for the class "C" drinking water well and the on-lot disposal systems for your wastewater needs. Inspection and sign-off of as-built plans shall be performed by a professional engineer registered in the State of Alaska. Arrangements for this work are the responsibility of the developer. Tile "Certificate to Operate" for the water system will be issued when the Department has approved the applicant's as-built plans. If construction or operation have not begun within two years after issuance of the plan approval, the approval is void, and plans must be resubmitted to the Department for review and approval. Respectfully, William R. Rieth Environmental Engineer ~. 1 P 2¢ P o > 10 15 12 13 Wes~ 82nd Avenud ~ Exw~ng Septic System T~ench ~ 0 100 200 ~P~ Rropo~ed SepUc System Trdnch Existing Weli T ~ SCALE :N FEET R Rropo~ed Cro~he~ ~socWtes Site RWn Plot~ Oeotechn~col Engineering SedUces Sond Ldk~ SubdMsWn ~2, Block 2 Anchorage, Job No. 001.027 J ~le No. 001027P1 J Date March 1997 001.027 April 21, 1997 Alaska Department of Environmental Conservation 555 Cordova Street Anchorage, Alaska 99501-2617 Attention: Mr. Mike Lu Well Pe~xuit Application Sand Lake Subdivision #2 Block 2, Lots 22, 23, and 24 Anchorage, Alaska This letter presents Mr. John Colliander of Coltiander Construction request for a class C well permit m~d a waver to reduce the required separation distance be- tween the proposed well and septic systems. Colliander Construction plans to construct three-bedroom houses on lots 22, 23 and 24 during 1997 or 1998. The three lots are south west of the intersection of Wil- cox Street and 80th Avenue in Anchorage, Alaska as shown on Plate 1. Both Wilcox Street and 80th Avenue are 2-lane unpaved streets. The lots in Sand Lake Sub- division #2 are 50 feet wide by 135 feet deep. Sand Lake Sulxlivision #2 is about 90 percent developed with two and three bedroom houses. Each house has an on- site septic system consisting of a deep absorption trench. The houses are sen, iced by class C community wells for their water supply. For each existing well in the subdivision the Alaska Department of Environment Conservation (ADEC) has waved its required se~ pamtion distm~ee to the nearest septic system from 150 to 100 feet. SYI'E CONDITIONS The three subject lots are covered by a demse growth of spruce and alder trees. The ground surface gently slopes downward towards the southeast between Eleva- tions 160 and 150 feet. Locations of existing wells and septic systems within the vicinity of the subject lets are presented on Plate 1. Table 1 presents a description of the soil profile and its geologic origin at the subject lots. The information presented in Table 1 is based both on adjacent water well logs and septic system test pit logs. CROI~/THER ASSOCIATES Table 1. Soil Profile and Geologic Origin Depth Interval Soil Description and (feet below (Geologic Origin) surface) 3 to 2 silt (residual) 2 to 11 frae grained sand (eolian) with some runoff seepage at 11 feet 11 to i00 sandy silt (glacial till) 100 to 260 gravely clayey silt (glacial lacustrine) ~60 to 390 gravely clay (glacial drift) 390 to 410 sandy Gravel (alluvial) Most existing wells in Sandlake Subdivision//2 have a 6-inch casing. They have been drilled to about a 400 foot depth where they encountered an alluvial sandy gravel. The gravel contains an aquifer that has an abundant water supply. The aquifers' static water level, which has been measured in the wells, ranges between 110 and 120 feet below th~ surface. Pump tests per.. formed at 20 and 35 gallons per minute respectively have drawn down the water level 3 and 6 feet in the wells. Laboratory tests performed on samples of water fi.om existing subdivision wells have historically not teeted either coliform bacteria or nitrate. PROPOSEDWELL The proposed locations for a new well and three septic system trenches on lots 22, 23 and 24 are shown on Plate 1. The proposed well will have the following fea- tures, which are similar to other wells in the subdivision. , The well will have a 6-inch casing and be drilled to about a 400 foot depth. A well-screen will be installed on the lower 20 feet of the well. A bento~fite sanitary seal will be placed around the well casing between the ground surface and a 20 foot depth. The well casing will extend 12 inches above the ground surface. The ground surface within 10 feet of the well will be graded so that it slopes downward. Page 1 P. O. Box l10854 /Anchorage, Alaska 99511-0854 Telephone (907) 349-2198 / Telecopy (907) 522-3885 001.027 The well will be designed for a 24 gallon per minute (gpm) discharge. A 3 horsepower pump will be set at a 160 foot depth with in the well casing. A 1.25-inch diameter galvanized pipe will connect the pump to the surface. A pittess adapter will be attached to the galvanized pipe at a 10 foot depth below the surfaco. One inclh type K copper pipes will be connected to the pifless adapter and service the houses. CR O IfiI'HER A SSOC1A TES WELL PERMIT WAVER The ADEC requires that a class C well be separated at least 150 feet fi.om all existing and proposed on site septic systems. As shown on Plate 1 one existing and the three proposed septic systems are within a 150 foot radius of the proposed well. So we request that a waver be given to reduce the required separation distance fi.om 150 to 100 feet for the proposed well. This request con- forms to previous wavers granted for other class C well permits in the subdivision. We trust this provides the information that you require. Please call ffyou have any questions. Yours very truly G. Scott Crowther, P.E. Civil Engineer 6491 Atlachment: Plate 1 Site Plan Page 2 P. O. Box 110854/Anchorage, Alaska 99511-0854 Telephone (907) 349-2198 / Telecopy (907) 522-3885 ' •� _� Municipality of Anchorage ° On-Site Water and Wastewater Program a .!-:01111( (907) 343-7904 6.� ' ' ,, • Certificate of On-Site Systems Approval t, l JUN 2 S 2018 i Parcel I.D. 011-133-02 Expiration Date: 1. GENERAL INFORMATION: 01 6 9 Complete legal description SAND LAKE#2; BLOCK 2, LOT 23 Location (site address) 8020 Wilcox Street*Anchorage 99502 Current Property owner(s) Rick Sheppard Day phone 907-250-3228 • 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: (6 Date: 7/3fr COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 52� Waiver Fee $ Date of Payment 1 I a f ) Date of Payment Receipt Number 0511 ✓ `t Receipt Number COSA# ()SCAl ?the 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: oa000OpO In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o OF A %44 in accordance with the guidelines and regulations established by the Municipality of Anchorage and o , .. S `O� industry practices. The reported results describe the condition of the system/s on the date/s of the 0�• .•• 4 evaluation. Separation distances were measured to readily identifiable features. Hidden defects or /� ��� T encroachments may exist that were not identified during the evaluation. The operational life of all wells ,' * 4- 1� •.,7*VQ 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 / VA workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and I—. • . 4 Q are outside the control of GEG. Satisfactory test results do not guarantee future performance of the , • ff :, -ss: 4 system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of O • • CE-7953 �QD the well or septic system. GEG makes no representation whether an alternative well or septic system Q 9' c�O can be installed on the property in the event either of the current systems fail to perform adequately in 4p Pr l').1( • �/ ; the future. The content of this report is for the sole benefit of the person/party that retained GEG to �4a p``r��o�`r ess 011oma perform the evaluation. Reliance upon the information provided in this report by any other person orOOOoo=• party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved �;�;� Or.AittA/G Conditional approval for bedrooms, with the following �fi3pulaiiTE G . WATER AND 2 WASTEWATER o PROGRAM By: .4 �, C Original Certificate Date: 7 - -" 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 Advisory 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: SANDLAKE#2; BLOCK 2,LOT 23 Parcel ID: 011-133-02 A. WELL DATA Well type CLASS•C" If A, B, or C provide PWSID#218621 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. - production g.p.m. g.p.m. WATER SAMPLE RESULTS: r ', Coliform O �o� ies/100 ml. Nitrate/n"‘Omg./L. Collected by: 6—Oki/? e S _S Arsenic:5S.( ug./L. Date of sample: 6'// 5/ 1 Y3 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 5/18/98 Tank size 1000 gal. Number of Compartments 2 Cleanouts(Y/N) YES Foundation cleanout(Y/N) YES Depression overt tank(Y/N) NO High water alarm (Y/N) N/A Date of pumping 642-0 Pumper 1q1- f-f-o^'1& S&vi C. ABSORPTION FIELD DATA 'BELOW EXISTING GRADE AT MONITORING TUBE Date installed 5/18/98 Soil rating .pd./ or ft2/bdrm) 1.2 System type DEEP TRENCH Length 30 ft. Width 2 ft. Gravel below pipe 7 ft. Total depth *11+ ft. Eff. absorption area 420 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 6/12/18 Results(Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 25 in. Water added 461 gal. New depth 53 in. Elapsed Time: 120 min. Final fluid depth 42 in. Absorption rate>= 450+ g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) NONE KNOWN If yes, give date - D. LIFT STATION Date installed Size in gallons Manhole/Access(Y/N) •"Pump on" level at in. "Pump off'level at • wa er alarm level at in. 9 - Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: COMMUNITY WELL 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'+ (ASSUMED) Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+PVT&"100'+CLASS"C" SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line **0 Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+PVT&'100'+CLASS"C" F. COMMENTS *SEE SCOTT CROWTHER'S.P.E.PROPOSAL ON FILE WITH MOA (APPROVED BY WILLIAM RIETH ON 6/11/97) ••WR#970033 •44_ OF ' q/4 4/ G. ENGINEER'S CERTIFICATION P:••''•''' •,j I certify that I have determined through field inspections and ; 4 nit • & \* vo, review of Municipal records that the above systems are in .,� •• conformance with MOA COSA guidelines in effect on this •""^ , A :tr• date. ♦t^ ,dddde �- Ga ness::== Engineer's Printed Na e JEFFREY A.GARNESS �� ,!• ! C? 95 C���.: a 1�FF �p�Z P�' �� (��2 1 f • 44 ROFES ��. Date LICENSE ,�\u„`�1� i*AECC884 (Rev.10112/12) MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT j`• ` 907-343-7904 On-Site Water and Wastewater Section \ jJ Fax: 343-7997 www.muni.org/onsite Arsenic Advisor Certificate of On-Site Systems Approval # OSC181306 Subdivision:SandLake ,Block 2, Lot 23 A water sample revealed an arsenic concentration of 55.1 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 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. Oj/- 1,,~- 07-- GENERAL INFORMATION Complete legal description Location (site address) ~O7--~ Expiration Date: '-~- / '~-'~ - /i Current Property owner(s) ~'C---5¢~' ~/)£¢'.~ L;,~Z~/)~i~ //f,~¢p~¢$ Day phone Mailing address Lending agency Day phone Mailing address Real Estate Agent Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: ,,~ TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class ~ Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of 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 Pannone Engineering Services, LLC Phone 272-82:1.8 Address P.O. Box loo2~.7, Anchorage, AK 995zo Engineer's Printed Name Steven R. Pannone, P.E. Date Engineers Comments: In conducting an adequacy test, ! attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water _~(~)~-'~ a~. levels that may fluctuate during the year, and the water usage of the family being served by the system. ~,~ .................... ~/~_~% These conditions are outside the control of the evaluator of this system. All systems eventually fail and .,~ satisfactory test results do not guarantee future performance of the system, nor do they guarantee that ~ there are no hidden defects or encroachments. PES can therefore not provide any warranty for future ~....~,-~:.-,,~ performance nor give any estimate of how long the system will continue to meet the operational requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized nor will it '~... ~o. confer any legal right whatsoever. "~ 5 DSD SIGNATURE :~.~ Approved for '~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory / Arsenic Advisory Maintenance Agreements Supplemental Engineer'S Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: WELL DATA ](J:Z ~L4¥../4 'Z.. , ¢-o-r Z-~5 Parcel ID: Well type ~ Date completed Total depth ~07_. FROM WELL LOG Date of test Static water level ! I_h fr. Well production ~ g.p.m. WATER SAMPLE RESULTS: If A, B, or C provide PWSID If ~-1~6Z.( Sanitary seal (Y/N) ~ Cased to ~.o'Z- ft. Well Log (Y/N) ~ Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION Coliform ,¢6-G- colonies/100 mL Arsenic: ~-1,7 ug/I SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size i OOO gal. Number of Compartments__ Foundation cleanout (Y/N) Date of pumping ,~/7_.3/ Nitrate /OD mg/L Date of sample: ,~/Z:l/z~ IJ Depression over tank (Y/N) Pumper ,~r-~' C. ABSORPTION FIELD DATA Date installed ~'-/1~'/1~ Soil rating Length '~O fr. Width ~- Total depth i0,~ fr. Eft. absorption area L~:2 ft2 Date of adequacy test $1z-I/z~) Results (Pass/Fail) Fluid depth in absorption field before test (~ in. (g.p.d./ft2 or fr2/bdrm) .. ... .... r bcct~ri& Collected by: ~-~ Date installed ~'"/l¢/ir-i~{¢ Cleanouts (Y/N) ~ High water alarm (Y/N) ~ Monitoring tube ~/ For Water added ~ -/'/gal. Elapsed Time: ~0 min. Final fluid depth ~¢--'¢ in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Ax/ ~pd/¢/-Z-System type Gravel below pipe 7,0 Depression over field /'~ -~ bedrooms New depth Absorption rate >= ~,!T,O If yes, give date in, g.p.d. D. LIFT STATION "Pump on" level at__ in. Datum Size in gallons Manhole/Access (Y/N) "Pump off"~ water alarm level at in. Cycles tested Meets alarm & circuit requirements .~?'--'------ E. SEPARATION DISTANCES NCES FROM WELL ON LOT TO: Septic tank/lift station-"0n--teL._ On adjacent lots Absorption field on lot ~OnOn adjacent lots Public sewer main ~nhole/cleanout Sewer/septic service line Holding tank Animal containment areas Manure/animal excrete storage areas -'""~'~'----~. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line ~J ,O ~ Absorption field Water main io + Water service line ~,0 Surface water Wells on adjacent lots J O°o SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 0,~' -.~ Building foundation Water Service line ,~0 Surface water ] OO Curtain drain .~"O~- Wells on adjacent lots Water main Driveway, parking/vehicle storage F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Date Steven R. Pannone, P.E. ~,,~ ~\'~ ..... , '-.../-J ,-.,~.. ....... ..... · . .......... .......~ COSA Fee $ o, Rece,pt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Community Development Department Development Services Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Arsenic Advisory Certificate of On-Site Systems Approval # 111103 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 23 of Sand Lake #2 Subdivision. This inspection revealed an arsenic concentration of 51.7 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On-Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. .-~ ur ~ ,~. Robert E dohns ssoc ~o, ~, ~> ¢ ........ ~.~ 5~, ' ' ' ' ,~,~,~,~ ~x,... .... ~-~ Professional Land Surveyors ~'"~ E F jgth~ --3 ~ Scoie: R~. Lot S.F. R,c. Plot F,¢ No. F~NDA~ AS-BUILT ' SET REBAR~-----~ DRAINAGE ~ ASPHALT ~ RNAL S~UC~ ~--BUlLT ~ PLOT P~N... ~8UILT... LOT~... ~HY O FOUND REBAR~ ~WO~ ~NCE ~ CONCRE~ ~i ~U~LT . . . N~ ~ ~T ~ ~~ ~T . . . ~ ~ ~ ~ ASSUMED ELEV. X ~ X METAL ~NCE ~ WOOD DECK ~T ~S a LOT ~E~ NO~ IT IS ~E RESPONSIBILI~ OF ~E BUILDER OR O~ER, PRIOR TO ONLY THOSE 1MPRO~MENTS ABO~ ~ROUND AND VISIBLE ~LL BE CON~UCTION, TO ~RIFY P~OPOSED BUILDING GRADE rELATl~ SHO~. FENCES, ~LLS, SEP~C CLEANOU~, SIDEWALKS, DEI~WAYS, TO FINISHED GRADE AND U~LI~ CONNEC~ONS AND TO DE~RMINE ETC., ARE SHO~ IN ~EIR APPROXIMA~ LOCA~ON, ONLY. SNOW THE EXIS~NCE OF ANY EASEMENTS, CO~NAN~ OR RES~IC~ONS MAY PRE~NT SOME IMPRO~MEN~ ~OM BEING SEEN AND LOCA~D. WHICH DO NOT APPEAR ON ~E RECORDED SUBDI~SION PLAT. AbL DI~TAN~~ ~ RECORD UNLESS o~ErWiSE NOTED_ UNDER NO CIRCUMSTANCES SHOULD AN AS--BUILT BE USED FOR CONS~UC~ON ~ FOR ESTABLISHING BOUNDARY OR FENCE LINES. ~E SUR~YOR TAKES RESPONSIBILI~ FOR ~E INI~AL ~ANSAC~ON ~LY AND ASSUMES RNANCIAL LIABILI~ ~LY F~ ~E COST OF ~E SURLY. LIS~D DISTANCES PREVAIL O~ SCALING. R~RODUC~ON MAY CAUSE ERRORS IN SCALE. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.OI COSA# .. · ',1 Expiration Date: 1, GENE~L INFORMA~ON Complete legal description Lot 23, Block 2 Sand Lake No.2 Location (site address) 8020 Wilcox Current Property owner(s) Ms. Dimitri Tsamis Mailing address Lending agency Mailing address Day phone. (702) 821-8392 8020 Wilcox Dr, Anchorage, AK 99502-4150 Day phone e Real Estate Agent Mailing Address Un/esS otherwise requested, COSA will be held by DSD for plckup. NUMBER OF BEDROOMS: 3 Day phone TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Well Public Water System TYPE OF WASTEWATER DISPOSAL: Indiv!dual On-site Individual Holding Tank The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paregreph 4 by an independent professional civil engineer registered in the State of AJaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of 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(ara) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services, LLC Phone 272-8218 Address P.O. Box 102954, Anchorage, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date 1-3-07 Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of thc system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water . levels that may fluctuate during tho year, and thc water usage o f thc family being served by the system. ,,," ~'~ "'"'"'~'~....'~4'4',. These conditions are outside the control of the cvaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of thc system, nor do they guarantee that there are no hidden defects or encroachments. PES can therefore not provide any warranty for future performance nor give any estimate of how long thc system will continue to meet the operational requirements oftbe MOA DSD. Thc content of this report is for thc sole benefit of thc 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. 5. DSD~GNATURE ~ Approved for 75' bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulati?,,n,s,:,. .. .... '. -:. . WATER AND :m: By: (Rev. 11)05) Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other / / Original Cedificate Date: ///?'/c."[ / Legal Description: WELL DATA Wall type Class C Date completed 9/19/1997 Municipality of Anchorage Development Services Department Building Safety Olvtsion On.-Slte Water & Westewater Program 4700 Bragaw Blreet P.O. Box 196650 Anchorage, AK 99519-6650 www.munLorg/on$1te (;07) 343.79o4 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST ~Dt I- 1'~-O2. Lot 23. Block 2 Sand Lake Ng, :~ Parcel ID: ~ If A, B, or C provide PWSID # 218621 Sanitary seal (Y/N) ~ Total depth 41;I] fl. Cased to 402 fl. FROM WELL LOG Date of test 9/19/1997 Static water level 110 Well productkm 3') g.p.m. Nitrate 0,100ND mg/L Date of Bampte: 12/18/200{, Number of Compartments 2 Depression over tank (Y/N) No Pumper A+ HomeServlces WATER SAMPLE RESULTS: Collfo~n 0 colonles/10OmL Amonic: $9.2 ugA B. BEF'FIC/I.IOLDING TANK DATA Tank Type/Material Septic I Steel' Tank size 1000 gal. Foundation cteanout (Y/N) Yes Date of pumping I/?/2007 C. ABSORPTION FIELD DATA Well Log (Y/N) Wires properly protected (Y/N) y~ Casing height (above ground). AT INSPECTION 12/1812006 7..I. g.p.m. Other bacteria {) colonies/150 mL Collected by: S,R, Pannone Date installed ~/15/1998 Cleanouta (Y/N) Y~ High water alarm (y/N) System t3~3e Trench ft. Gravel below pipe 74) Monitoring lube Yes Depression over field No Pass For 3 bedrooms Date installed $/18/1998 Soil raUng (g,p.dJft2 or ~rodrm) 1.2 Lengttt 30 ft. Width ] Total depth ll),Q ft. Eft. absorption area 420 ft2 Date of adequacy test 12/18/2006 Results (Pass/Fall) Fluid depth in absorption field before test Dr~ in. Elapsed Time: 68 min. Final fluid depth Dr~ in. Any rejuvenation treatment (past 12 mo.) (y/N & type) No fi* Water added515 gal. New deptht6 in. Absorption rate >= $15+ g.p.d. If yea, give date D. UFT STATION Date installed 'Pump on' level at in. Datum E. SEPARATION DISTANCES Size in gallons NIA *Pump ~ level et .-- In. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station off lot N/A Absorption field on lot -- Public sewer main ~ Manhole/Access (Y/N) High water alarm level et. Meets alarm & circuit requirements? Sewer/septic sewice line Animal coflteinment areas On edJecent Iote W{dl on lot 24 On adjacent lots ~ Public sewer manbele/c~eanout B Holding tank -- Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 4~ Properly line ~,~ Absorption field .~ Water main N/A Water service line (KI Surface water 1~)0+ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line (I,~; Building foundation 47 Water main N/A Water Sewice line 60 Surface water 100+ Driveway, pafldng~ehlcte storage 50+ Wells on adjacent lots 102 Curtain dmtn F. COMMENTS Lot Line Waiver on file/Seoarafion Distance Waiver on file G. ENGINEER'S CERTIFICATION I cerUfy that I have determined through field inspections and review of Municipal records that the ebove systems are in confo;mance with MOA COSA guidelines in effect on this date, Engineer's Printed Name Steven Date 1/;~12o07 Waiver Fee $ Date of Payment. Receipt Number COSA Fee $. Date of Payment Receipt Number (Rev. 1t/05) in. !~ (50.0o R£C) .... · ' ''; ,~,d d d' , .: ...... , ..,..;....,,. ~~ I 0 ~ ~ ~ ~ _, ' ' . ~",o'~'~ ~.~' ("~'1 ~ o o ~ WILCOX STREET , _ ' m { ; ~ ~ ~ ~ ~ ~ m m m; m ~ = MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D., # 0// ; ..... 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner j1'¢,/~,~ ~'¢'///4,~¢/¢k, Dayphone z~.¢ - ~12 Lendi~g agency Day phone Mailing address· -~ Agent '-- Day phone _. Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ TYPE OF WATER SUPPLY: NOTE: TYPEOF WASTEWATER DISPOSAL: Individual on-site Individual well Community well K' Public water If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. .. Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~25(Rev, 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~'rO4,~'//~¢~ ,,~¢5'~'c,~,~e.5 Address ~ ¢, × I/C~ ~ ~ /~'/~ ~.~¢~,e~ Engineer's signature '~'¢M-. ~ '~,,:.~, hone - Date DHHS SIGNATURE Approved for 3 Disapproved. Conditional approval for bedrooms, bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DH HS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~25 (Rev. 1/91} Back MOA~21 MUnlCl h ' · 'pa 'ty of Anchorage ~,~ DEPARTMENT OF HEALTH & HUMAN SERVICES Fnvironmental Services Division 825 L Street, Roo~-502 · Anchorage, Alaska 99501 · (907)_~¢~ Health Authority Approval Checklist :)ate of test Static water leve Well oroduction A. WELL DATA Well type ~ Log present (Y/Nj Total deoth_ 4C2 Sanitary sea (Y/N) WATER SAMPLE RESULTS: Coliform /~/,~/~ Date of sam)le: _// 2 ¢/ El. SEPTIC/HOI..DING TANK DATA Cased to FROM WELL LOG Nitrate /V ~ Other bacteria '~ / Iqqq Collectedey: ~_~ ¢~.,~,/"'/¢ UWO~'~bhe.~'* Date installed E /5 q~C~_ Tank size .J/ ~'¢~'/¢ Foundation cleanout (WN) _ yes Date of Pumping C, ABSORPTION FII=LD DATA Date installed ~" //~ Length '~ ~ Width Z Effective absorption area Date of adequacy test_ Fluid depth in absorotion field before test Fluid oepth (~ns) Minutes ater: Peroxide treatment (past 12 months) (Y/N) 72-026 ~ Rev. 3/96)" If A, B, or C, attach ADEC letter. ADEC water system numeer ~ate comoleted '¢ / ~/' ,~ "2 '¢~ '2. Casing height (above ground.) Wires proper~y nrotectee (Y/N',, g.p.m g.p.m Number cf Compartments Z AT INSPECTION /,,,¢ Z~ _ParcelI.D.:_,¢// Depression [Y/N) /f/'¢ High water alarm (Y/N') Pumoer ~' Sell rating (g.p.d./ft2 or fF/bdrm,. /, Z Gravel thickness below pipe Monitoring Tube eresent (Y/N)),/ _ Resulm (Pass/Fail) mmediately after Absorption rate = If yes, give date ____ Cleanouts (Y/N) _ System type -7 / Total depth Deeression over field (Y/N) /f/¢ For bedrooms gal. water added (in.): .g.p.d. ,.egal Descriotion: _~,~,,/~/~e $~,$ #Z/)~/¢dq 2 D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* "Pump off" level at* High water alarm level at* *Datum Cycles tested SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: / Septic/holding tank on lot /0(,2 Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots l~O ~ ~/~ On adjacent lots /~¢ ~ /~¢ Public sewer manhole/cleanout ~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ~,~'/ Property line ~/' Absorption field Water main/service line /¢¢ .,/¢//,4¢_Surface water/drainage Wells lots .//?~2 ~/,¢.~ on adjacent Property line Surface water Curtain drain SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: ~ ~' / Building foundation '~ 7 / _ Water main/service line [/'2¢2 / ,¢/¢/~ Driveway, parking/vehicle storage area / .... /(7¢ % Wells on adjacent lots F, ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections in conformance with MOA HAA guidelines in effect on this date. Signature Engineer's Name ~ ~'c ~',Z~ ~'~'~ &~//~/,Cv" Date ~ ~c ~ ~ /~ ~ ¢ are 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number