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HomeMy WebLinkAboutSAND LAKE #2 BLK 5 LT 1Sandlake Block 5 Lot ! · /;fO 11 -134- 36 Jun 13 22 06:39p Anchorage Well & Pump Ser 9072430742 p.1 MUNICIPALITY OF ANCHORAGE Development Services Department ®' '4l4 Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: Date of Issue: Parcel Identification Number: 011 134 36 Legal Description Block Lot Property Owner Name & Address: HART TROY D & LISA A SAND LAKE #2 5 1 5336 W 82ND ANCHORAGE, AK 99502 Pump Installation Date: 05 - 27 - 2022 Pump Intake Depth Below Top of Well Casing: 250 Pump Manufacturer's Name: RED JACKET Pumas Model: CN 12S23 Pump Size: 2.0 feet Pitless Adapter Burial Depth: 12 feet Pitless Adapter Manufacturer's Name: MARTS NSON Pitless Adapter Installer: Well Disinfected Upon Completion? X Yes Method of Disinfection: PELLETS Comments: EWM Pump Installer Name: ANCHORAGE WELL &PUMP SERVICE Company: 7640 KING STREET p Y ANCHORAGE, AK 99518 Mailing Address: _ 907-243-0740 City: State: Zip: Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. ti v-i.ji9 -TO MUNICIPALITY OF ANCHORAGE oent�� ��(1PAL�7Y �,��.- — o� 111 @ n(� S / On-Site Water&Wastewater Program -o /`4 .,,,,,e't PO Box 196650 4700 Elmore Road a Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 `' ? ' *� http:/lwww.muni.orgtonsite Q H /: ,./ epar ment 'NC f,08^GF On-Site Wastewater Disposal System Permit Permit Number: OSP191456 Effective Date: 10/22/2019 Work Type: Septic Upgrade Expiration Date: 10/21/2020 Tax Code Number: 01113436000 Site Legal Address: SAND LAKE#2 BLK 5 LT 1 G:2224 Site Mailing Address: 5336 W 82ND AVE, Anchorage Owner: HART TROY D & LISA A Lot Size in Sq Ft: 6750 Design Engineer: C & M Engineering Total Bedrooms: 3 This permit is for the construction of: Ear Disposal Field Q 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 `'F Special Provisions: l 1. The Engineer needs to do al test hole prior to the construction of the septic field. A percolation test is to be performed in each strata that is used for the field. Construction may proceed at your own risk before the 7 day water monitoring is complete. Please submit stamped and signed results with the As-built Inspection Report. If the results require a design change, construction of the system will stop pending On-Site review and approval. 2. If the existing field is connected with a diverter valve, an encroachment permit with Chugach Electric will be required if the field is within the electrical blanket easement. CO 4'1 J7e ;o A e �eA GLe to (1:.C .efen-t y0',l5- Mw 1144/ t/ / .----,--- Received By: Date: 10/23/19 Issued By: , -)/1-", -(1 / . �___. Date: //ZA 7 Municipality of Anchorage „/ Department P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.orq/Onsite Development Services Division On-Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** Waiver#: OSV191087 COSA#: Permit#: OSP191456 PID#: 011-134-36 Legal Description: Sand Lake#2 Blk 5 Lt 1 Engineer: CM Engineering Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 5 feet to both the southern and northern property lines. Per Change Order#1, the tank may be 90' from the well. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: /42,1 / Approved by: ! l'a/s Name of Re/Wer **'k* VARIANCE/WAIVER REVIEW **** ERNA MUNICIPALITY OF ANCHORAGE Development Services Department `r i Phone: 907-343-7904 On-Site Water & Wastewater Section -- Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 011-134-36 Property owner(s) TROY AND LISA HART Day phone 980-9533 Mailing address Site address 5336 W 82ND Legal description (Sub'd., Block & Lot) SAND LAKE#2 BLOCK 5 LOT 1 Legal description (Township, Range & Section) Lot Size 6,750 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field E Initial ❑ Single Family (SF) ❑ ❑ (w/wo ADU) Septic Tank ❑ Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: DRAINFIELD TO LOT LINE Distance: 5 I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. C&M ENGINEERING (Signature of property owner or authorized agent) Permit/Rush Fees: 45 Waiver Fees: ?JI- Date of Payment: 11514/19 Date of Payment: Il 9 Receipt Number: 63 a51 Receipt Number: O'8a5? Permit No. O S PNI t-157 Waiver No. 05 v i 91 OB- G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc CO- C&M ENGINEERING SERVICES Ph: 907-854-5558 Municipality of Anchorage Onsite Water&Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Proposed Septic System replacement for Sand Lake#2 Block 5 Lot 1 —CO#1 Dear Reviewer, We recently excavated at testhole at the subject property to a depth of 20 feet and found the soil conditions to differ from anticipated and those documented in the area and on the lot. The soils were found to be moist fine grained silty sand with a percolation rate of 24 minutes per inch. We are proposing to change the design to a deep trench type system in order to fit the system on the site. Due to separation distance requirements between the existing trench and the proposed trench, the new tank will be pushed into the 100 foot radius. We are requesting a waiver of the well to tank separation distance to a distance of 90 feet. The waiver is justified as the new tank is plastic and will be resistant to decay and corrosion and leaking. The well log for the subject property shows a brown silty sand with clay layer between 100 ft and 148 ft. This layer should help protect the water quality as the static water level is documented at 147 feet. A copy of the well log is attached. Thank you for your time in reviewing this request. Please do not hesitate to contact me at 907-854-5558 or by email cgbalzarini(a gmail.com with any questions or concerns. Sincerely, Charles Balzarini, PE 4Air 4°F ,1 t 11/20/19 % t � A� `CHARLES G BALZARINI CE13854 �`4/� V�ci � r ' � �: `PROFESS6v-„." Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE CONPLIAN( OSP191456,Deb Wxkenfuss, 10'2 C&M ENGINEERING SERVICES Ph:907-854-5558 Municipality of Anchorage Onsite Water&Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Proposed Septic System replacement for Sand Lake#2 Block 5 Lot 1 Dear Reviewer, The above referenced property is currently served by an older,failed septic system.The owner would like to replace it with a new septic 3 bedroom system. We are proposing to install a new septic tank and a new drain field. The old tank will be demolished per moa requirements. Our review of available documentation and field investigation show that this project will not adversely impact any nearby wells, wastewater disposal systems, replacement disposal sites, or drainage flowing onto and off of the subject property. A new testhole will be excavated on the subject property and a percolation test will be conducted. The soils in the area are characterized as well draining sands. The soils in the area have been extensively investigated and we do not anticipate unforeseen soil conditions. In the event of unforeseen soil conditions, the design may be switched to a deep trench. The new field is sized based on a 4' effective depth.The existing drainfield will remain as a reserve site. Although optional, connection to the old field with a diverter valve is recommended. In the event that the connection is made, the OWNER must seek an encroachment permit with Chugach electric since the old trench falls within the boundary of the blanket easement for overhead lines. A drainfield to lot line is requested we are requesting a separation distance of 5 feet to both the North and South property lines. Due to the size of the lot, we believe this waiver is necessary and is least impactful to this and adjacent properties. Included with this letter is a permit application and design package,including plans, and calculations. Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854- 5558 or by email cgbalzarini(a�gmail.com with any questions or concerns. Sincerely, Charles Balzarini, PE � 4:7:4°F l 10/15/19 CHARLES G BALZARINI' 1 t�'�' 0E13854 �`�% 1l(W PROFESS1W4� ice 1 C&M ENGINEERING SERVICES 907-854-5558 Septic Design Calculations Residence: Sand Lake#2 Block 5 Lot 1 RESIDENCE/LOT INFO number of bedrooms 3 br Water usage/bedroom 150 gpd/br Water Usage 450 gpd CALCULATIONS ARE FOR REFERENCE PURPOSES ONLY USE DIMENSIONS SHOWN ON PLANS DRAINFIELD type: deep Application Rate 0.6 gpd/sqft required absorption area 750 sqft width (W) 3 ft minimum effective depth 9 ft Min Required Length: 42 ft MOA Sand Depth 0 ft MAX Excavation Depth: 14 ft TO BOTTOM OF ROCK Min Cover: 3 ft Insulation: 2" blueboard Effluent Pipe: 4" ASTM 3034 CALCULATIONS ARE FOR REFERENCE PURPOSES ONLY USE DIMENSIONS SHOWN ON PLANS Calc By: CGB Date: 11/20/2019 .....-•c' ,,... .A4•4164 Alee .j —.Fir 0#1 i* � ! M. �' * 9 % a /T1 pj `CHARLES G BALZARINI` r��9‹ 0E13854 �,(c``�/ 4�,kFD PROFESS\ONp��► s1v _`\\\ , OF A•kgs'l1 W4 I .- TM Al *•:v �0 0 / j>/:. .4:2 ' g ---------- .., ,, CHARLES G BALZARII, .i., _ j w Oa Fci - •CE-13854 -•• ��� \ 1 FAcc •••,10/..2[:)/.1.q.•���� U k1,lIF0PROFESS\ ' . ..,L...,,,-,‘7,-,,,,REMOVE OLD TANK PER MOA \ APPROX. BLANKET Q cc REQUIREMENTS REMOVE CONTAMINATED EASEMENT FOR 0 MATERIAL AND BACKFILL WITH MOA SAND 3'x42'x9'EFF. OVERHEAD POWER o TRENCH OWNER MUST OBTAIN eo • W.82ND DUAL COs EACH MAX EX. DEPTH 14' ENCROACHMENT PERMIT !' w SIDE OF TANK ‘ Z FOR OLD SEPTIC BEFORE / – � z \ , - IT MAY BE USED. H g Q _J rn a SANDLAKE#2 BLOCK 5 LOT 1 I DRIVEW.Ak \ ti (/) Y I- U- 1 ", �� ` Q SANDLAKE#2 BLOCK 5 LOT 23,24 UO 26N 4 ` la TESTM OLE m ~ co ! , 11' V / * p • 3BRHOME L �� 1 a / Y 1 co w •� 1C1 0 „ f {E z _ — rn " ABANDON OLD 4 PRIVATE WELL `� DRAIN/FIELD z SERVING 7O , IN PLACE FOR 0 LOT 1 AND 2 O!b NEW 1000 GALLON POLY TANK / ' POSSIBLE FUTURE USE a NF(‘ W/INSULATED RISER AT ,p_ FIRST CHAMBER \w��Cis INSTALL PER MOA o \ AND MANUF'R Q w REQUIREMENTS / u. z cc w N / Ca-' O N P cn Li. W SANDLAKE#2 BLOCK 5 LOT 2 v' _0 LEGEND ` 0_ LU Q CLEANOUT / 1 Li) co 0 Lo • MONITOR TUBE / Z 9 D' � NOTE: W o`no THE PROPOSED SEPTIC SYSTEM MUST Z o BE INSTALLED GREATER THAN: iZ N � rn 100'FROM ANY PRIVATE WELLS / 200'FROM ANY PUBLIC WELLS / \ LU 100'FROM ANY SURFACE WATER \ 2 06 10'TO ANY PROPERTY LINE OR FOUNDATION 0 5'TO ANY TEST HOLES \ 10'TO THE HOUSE FOUNDATION • I . • • +. y • � .r rt . * \ : • • 7 4--- , ' . JC�G�L .7 1 se . .. . . --4.i • 11 . fil . ��tl ° oh - � '4i ' •. • • mNV . • .9 14 69 r{-� 4 ,—-� I / 't rev ��` 44P • eC, b//• t 48: • • 13 o, -JD , �1 / ,3 Z �' :1. N , b SDR �'S� 4'?� ri� 96 ,y ' 11' 1' ,tee I ,4 • -- n 1-1:) _NI ti v lr e9 2-pri.:6-• wt• • • 1 . 2 4' • 5�t� �t . , 9TH . _ P. ' 4 - 0 • Z lames Karl Dowling • c'9', • • 1564.5 .•:4t..,.• . I /(�'�,•.�• �.••.•4 ' .. •• •• . �0 . �%%"°rESSIONJ:�tiiAII. ' . is the responsibility of the owner.to determine theiteyte_., . .. • istencc of any easements, eovennnls or restrictions NOTEFt;rlch do not appear on the recorded subdivision plat. ider no circumstances should any data hereon be AsBuIL T EASE S Or RECORD,OTHER 7NAN THOSEcdfor construction or for establishing boundary or 1 SHO N TH[RECORDED>�LAT,ARENOT. nee lines. The surveyor takes responsibility for thc SHOWN HEREON.Mat transaction only.' • LEC;F.N1 OT 1 BLOCK CD BRASS CAP MONUMENT . 5,4-/L 0 L 4 W Ai o . 2, • (PLAT NO.: ) • 0 IRON PIPE • - • MAR CORNER FOUND NCHORAGE RECORDING DISTRICT p HUB AND TACK • I' / . .r REPARED BY: 9,4 / ,f D/OL7atoei7 DOWLING & ASSOCIATES -R,-o.-fri , 1,/Ph+ ^d .5e, a, • 1426 Ryder Street • . Anchorage,Alaska 99501 REVISIONS DATE BY )ATE: • BY: d I SCALE: WORK ORDER: FIELD BOOK: GRID NO.: • • . •• g STATE OF ALASKA 31241 DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING, LAND &WATER Alaska Hydrologic Survey •� .� WATER WELL LOG Revised 08/18/2016 Drilling Started: / / Completed: 6 / 9 / 1983 Pump Install: / / City/Borough Subdivision Block Lot Property Owner Name &Address Anchorage SAND LAKE 2 B5 L01 K ROSENAU Well location: Latitude Longitude Meridian S Township 012N Range 004W Section 10 NE 1/4 of SW 1/4 of SW 1/4 of NW 1/4 BOREHOLE DATA: (from ground surface) Drilling method:DAir rotary,Qable tool,0Other Suggest T.M. Hanna's hydrogeologic classification system* Well use:DPublic supply,❑Domestic,❑Reinjection,❑Hydrofracking https://mv.ngwa.orq/NC Product?id=a 185000000BYub3AAD Depth ❑Commercial,❑Observation/Monitoring,❑Test/Exploratory,❑Cooling, From To El Irrigation/Agriculture,❑Grounding,❑Recharge/Aquifer Storage, brown loose gravel 0.0 38.0 0 Heating,DGeothermal Exploration,❑Other brown sand 38.0 118.0 Fluids used: brown silty sand with clay 118.0 148.0 Depth of hole: 280 ft Casing stickup: ft Casing type: Casing thickness: inches gray sandy clay/gravel (damp) 148.0 188.0 Casing diameter: inches Casing depth: 280 ft gray clay (damp) 188.0 238.0 Liner type: Depth: ft Diameter: inches gray silty sand (wet) 238.0 276.0 Note: FULL CASE water bearing gravel 276.0 280.0 Well intake opening type: Open end,❑Open hole,00ther Screen type: , Screen mesh size: Screen start: ft, Screen stop: ft, Perforated❑YesONo Perforation description: Perf from: ft, Perf to: ft, Perf from: ft, Perf to: ft Gravel packed❑Yes❑No Gravel start: ft , Gravel stop: ft Note: Static water(from top of casing): 147 ft on / / Artesian well[J Pumping level&yield: feet after hours at 25 gpm Method of testing: Development method: Duration: Recovery rate: gpm Grout type: Volume Depth: From ft, To ft Include description or sketch of well location(include road names, Final pump intake depth: ft Model: buildings,etc.): Pump size: hp Brand name: Was well disinfected upon completion?JYes J No Method of disinfection: Was water quality tested?EIYes No Water quality parameters tested: Well driller name: WAYNE E WESTBERG Company name: M-W DRILLING Mailing address. PO BOX 110378 City: ANCHORAGE State: AK Zip: 99511 Phone number: (907 ) 945 - 3287 AS 41.08.020(b)(4)and AAC 11 AAC 93.140(a)require that a copy of the well log be submitted to the Department of Natural Driller's signature: Resources within 45 days of well completion.Well logs may Date: / / be submitted using the online well log reporting system Anchorage Municipal Code 15.55.060(1)and North Pole Ordinance 13.32.030(D)require available at: that a copy of this well log be submitted to the Development Services Department/City https://dnr.alaska.cov/welts! within 30 days of well completion. City Permit Number: OR email electronic well logs to Date of Issue: / / dnr.water.reports(a alaska.gov Parcel Identification Number: - Guide for Using the Hydrogeologic Classification System for Logging Nater Well Boreholes by Thomas M.Hanna NGWA Press ~ 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 7/~I PHONE I~NEW LEGAL DESCRIPTION LOCATION NO. O~ BEDROOMS Well / Absor p~:~ Dwellings, S PERMIT NO. I ' ' ~(~ Z Manufacturer ~~ Mateda]~.~ ~ No. of compartm~s Liq./c~t~, gallons IF HOMEMADE: Inside ,..gt.NA Width ~A Liquid depth m~Z~ ~ DISTANCE TO: Well A /~ Dwelling PERMIT NO. O Z < Manufacturer [ V [ ~ Material Liquid capacity in gallons Q Well Foundatiovo ~ DISTANCE TO: /~,/ . P E ~ ~0~ ~1 ,~ NO. of lines Length ~, Total ,~0tb of li~s Tre width. Distance b~, Pines -- Mai, rial beneath tile ~O*O ~-~' ~ Total e~ab~ptio n area ~ ~ Top o~ tile t~f~ish grade Length Width ' Depth PERMIT NO. ~ ~ Type of crib Grib diamet Grib depth Total effective absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE T0: Building foundation er line Septic tank Absorption area(s) OTHER SOl L /~oTEST RATI¢~NG ' / .~~ I INSTALLER ~ A o Pno Z6A,'' , .... APPROVED DATE LEGAL 72-013 (Rev, 3/78) P~rmit .~ L~:cation: ~o~ i ~(~Ff~5-- ,~-~ ~-A-/<~; ~/() Phone Number: Department :- = Health and Environmental ~rotection 825 ' ~. ~ ~ / Street, Anchorage, AK. 264-4720 * * * HANDWRITTEN PERMIT * * W:E~41-,A~ ON-SITE SEWER PERMIT La,al Description: ~/D~ ~cO ~e¢~ /~. Lot Size: ~ T~pe of Soil Absorption System Is: Trench: ~/ Drainfield: Seepage Bed: Holding Tank: M~ximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) /3~c3~ The Required Size of the Soil Absorption System Is:' DEPTH LENGTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /O o© GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of:residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 3t~ I 9 8 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3 bedrooms. S~gne~: .~/.~~~f 5 _F~~ Issued by: App 1 ic an t Date: SWP/024(1/81) S & S~ENGX~ERS. XNC 712.5 Old Seward Hwy. 'Ancho~agel~laska /j~ SOILS LOG PERCOLATION TEST PERFORMED LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14- 15- 16- 17 18 -19 - 20- COMMENTS SOILS LOG - PERCOLATION TEST ~,I L-BY'/l, fll L~Y 6~,~I-S o~ SLOPE 'lO, 0 ~'' .2.2, ~)/ WAS GROUND WATER ~AJ~.~ VJ/TRA(~E ENCOUNTERED? ~ ~ ...... IF YES, AT WHAT ~ I~D ~ 0 ' ~1PO~CYDEPTH? V. F~N6 ~ F//JE No s~ 0 P E OATE PEREORME,): ~/9/~3 SITE PLAN Gross Net Depth to Net Reading Date Time Time W,a t~z~ ~,~.~.~.~. Drop ~_~-~'~ OF, ~ ~, ~ ............................ ~ ........ ~ ..... .~ _ ,,. _0 i'r, ~'.;;~' "~'~'oo~_~" .................... ~:__~? ~ ~op)}~~.-- PERCOLATION RATE V/I ~ [..,),~ L.- (minutes/inch) TEST FIUN BETWEEN /0 FT AND / ~ , FT DATE: 72-008 ~6/79i MEMORANDUM DATE: TO: FROM: SUBJECT: October 21, 1983 Sewer and Water Staff and Files Cory Willis, R.S. Sand Lake Subdivisions As of this date all on-site installation permits issued for lots in these subdivisions can be for no more than 2 bedroom, single family residences. This has come about per the request of Bruce Erickson, State DEC due to the large amount of high density development and the requests for waivers on Class "C" well requirements. CW78/ej/E2 9~-0~0 (5/78) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O, Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343~7904 CERTIFICATE Of HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. O t1-13¥- 3 (= 1, GENERAL INFORMATION :' Complete legal desgi.ption Expiration Date: Lot ] Blnek 5 .~nr]l.k,~ ~!r) #? .... t~ocation (site address~or directions) Current Property own. er(s) -,. Mailing address Lending agency Jim Edens 5336 W.82 Ave Anchoraget AK 99502 248-0087 Day phone Anrhnr.~ AY qq~N~ Da~phone Mailing address Real Estate Agent Van Pettig~n/Prucl~,nt~,l Dayphone 563-5500/&40-7885 Mailing Address 320! C Street Suite 200 Anchorage A:¢ 99503 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage 'Community Class c Public Water System Well 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 Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage flies 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 instaIlation. NameofFirm S & S Engineerin~ Phone 694-2979 Address 17034 N. EaEle River Lp Suite 204 EaEle River, Ak 99577 Engineer's PrintedName Robert C. Cowan P.E. Date_~U'G,· --'7, 2001 5. DSD SIGNATURE I."" Approved for ~ Disapproved. Conditional approval for bedrooms. %.~[.~. ...(25~ bedrooms, with the following stipulations: .Additional Comments Attachments: HA;, Checklist Septic System Advisory Well Flow 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 SOum Sragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ct.onchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescdptlon: LOT' I 13L~c.< ~- ~'/~,.~ /..~,<¢ ~'Z. · ParcellO OIl-I 3~/ A. WELL DATA : Well 't~ ~ ff A, B, or C provide PWSID # Well~ Date completed Sanita7 seal (Y/N) ~,~ protected (Y/N) Total depth ft. Cased lo ~R. /,.,,.,../ Casing height (above ground). Date of test FROM WEy AT INSPECTION Stefic water I~/''''''/ fl. ft. Well p,.~gdu~on g.p.m, g.p.m. in. WATER SAMPLE RESULTS: Coliform 0 .colonies/lo0 nd. Date of sample: ~'/a.I B. SEPTIC/HOLDING TANK DATA Nitrate O, 5"" mg./I. Collected by: Other bacteria ~ ) colonies/lO0 mi. $ · $ ENGINEERING 174X14 Ei~qle R~ver Loop Road NO. ~ Eagle R~, Aladm ~$77 TenkTyp~laterial; J4,,~nc /$ r'~.~, L Tehk size /g~eO g~.'L Number of Compartments ~- ," Foundation cteanout (~/N) W,J Depression over tank (Y/~ -~O High water alarm (YII~ ' Date of pumping /k,/el Pumper ~0 I.. O C.. ABSORPTION FIELD DATA Date Instalted ~/io/~.7 Soil rating (g.p.d./fl~ o~ Length 30 fl. W~th L.) - ~ fl. Total depth J ¥ fl. Eft. absorption area 4/g,O ft: Monitoring tube Date of adequacy test e~/ao/OI Resuits~Fail) PA,tJ' Fluid depth in absorption field before test 3 '~ 'in. Water added l¥7fi1 gal. Elapsed Time:~ 3o min. Final fluid depth'/'9 "in. Absorption rate >= Date installed ~'//o / g' 3 C~eonouts (~1~) Ye; Any rejuvenation treatment (past 12 mo.) (Y/N & type) System type "7/f ~,~ c. ~ Gravel below pipe ~:~ ft. __ Depression over field ~vP For 3 bedrooms New depth ~ I-~ In. ~/~rD g.p.d. °s~"*r*c~'¢a,t · Eyes, give date 7/Iq/0 I UFT STATION Date installed 'Pump on' level et Datum in. Pump off' lev~ et ~+~,~,~--"~.water alarm level at . _ . ~ Meets alarm & cimutt raqulraments? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanldllff station on lot ~,~ ~ ¢,~,.,¢.,,,a,~ ~,,~,v~4. ¢'~.~,~n~,.) On adjacent lots Absorption field on lot / Oo t~ ('lo/, ~//~.~ ~,~,,,~a) On adjacent lots Public sewer main /V/A Public sewer manhole/cieanout Sewer Iseptlc sewtce line (0.~'/~'O~c k,~.? '~ .'~ _, .%Holding tank,~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Curtain drain .N~.,L F. COMMENTS ",, .'"' . Building foundation 5" Water main / O / 4- Wells on adjacent lots I o O/'~' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ti/fw4,ve.~ t~(~"'~lw~) ' ~.0 Building foundation Water Service line /0 ~ 4- Surface water /0 0 Wells on adjacent lots 10o Property line I / ('~,4,v~4 l~sorpaon hmo / / Water service line / 0 'ff' Sun'ace water ~ 0 0 4. Water main / 0 '~- Ddveway, parkJngN~hicte storage HAA Fee $ ,..~0,~. ¢"= " Waiver Fee $ Date of Payment cf/-//0/ Date of Payment Receipt Number O 0 q '7 ~'1/' Receipt Number (Rev. 12/00) G, ENGINEER'S CERTIFICATION ~ ~~, AUG. 24,2001 1:02PM USKH- ANCHORAG~ N0.4530 P. I/1 Augfist 24, 2001 Michael N. Anderson, P.E. Structural/Civil Engineering ' 4640 Shoshonl Ave. Anchornge, Alaska 99515 Phone $45-$377 Fa~345-1391 .' ':" Attn: Bob Cowen S & S Engineering 17034 North Eagle River Loop Suite 204 Eagle River, Alaska 99577 Fax 694-1211 Re: Jim Edens Residence, 5336 West 82m Ave. Dear Bob: On August 4, 2001 the above referenced project ~ excavated down to the existing septic tank to fix a broken clean-out on the first compartment of the tank. The tank appeared to be in good condition with no leaking of septic effluent. If you have any questions concerning this inspection please call me at 345- 3377. ..~_,.--~x.x~,. ~"x,',~./~:/:/ .... ,...~ ~¢.. ^t:.:.'. . . 1" = 40' WAIVER REQUEST SITE-PLAN SEACLIFF STREET 0 om SHED o ~o o ROBERT C. COWAN, P.E:. Ausust 27, 2001 CMLEHGINEE~ (907) 894-2979 FAX (907) 694-121 DEPARTMENT OF ENVIRONMENTAL CONSERVATION Anchorage/Western Public Service Office 555 Cordova Street Anchorage, Alaska 99515 REFERENCE: Lot 1, Block 5, Sand Lake S/D//2 Request you amend a 100 foot svaiver granted on April 13, 1984 to a 93 foot waiver from the existing septic tank to the existing Class 'C' weft located on the referenced property (see attached site plan). On August 4, 2001 the septic tank was verified to be in good condition wi{h no leaking of septic effluent as confirmed by the attached letter from Michael N. Anderson, P.E. Also attached are satisfactory water sample results indicating that the above requested waiver should have no Impact on emst,ng water quality to the surrounding properties. If we may be of further service please contact us. Sincgrely, Robert C. Cowan, P.E. 17034 NORTH EAGLE RIVER LOOP ' SUITE 204 * EAGLE RIvEn. ALASKA 90577 555 CORDOVA STREET ANCIIORAGE, AK 99501 htr p://www.state.ak, us/dec/home/ht m TONY KNOWLES, GOVERNOR Telephone: (907) 269-7696 Fax: (907) 269-7650 September I 8, 2001 Robert C. Cowan, P.E. S & S Engineering 17034 North Eagle River Loop, Suite 204 Eagle River, Alaska 99577 Subject: Lot 1, Block 5, Sand Lake Subdivision, #2;Wastewater Disposal System Waiver Request from existing Class C Public Water System; Review Dear Mr. Cowan: This is response to your letter received in this office on September 18, 2001 in which you the Departr~ent to grant a separation distance waiver for the distance between the existing septic tank and the Class C public water system source well both located on Lot I, Block 5, Sand Lake Subdivision #2. I have completed my review of the files on this property and have found that there was some concern regarding the true separation distance between the septic tank and the source well when the waiver was first issued in 1983. Based on the information that has been provided, the existing septic tank is in good condition and does not leak, it appears that the submlned waiver request is reasonable. You requested that the Department waive the minimum horizontal separation between the Class C public water system source well serving three lots in this subdivision and the private sewer line and septic tank serving the single family home on Lot I, BlockS, Sand Lake Subdivision, #2. As noted above, l have found that the waiver is reasonable. Therefore, in accordance with the Drinking Water Regulations, the following waiver is being granted: The horizontal separation distance between the Class C public water system source well serving Lots I, 2, and 3, Block I, Sand Lake Subdivision, #2 and the septic tank on Lot I, Block 5, Sand Lake Subdivision, #2, serving a single family home has been waived from 150 feet to 93 feet. The horizontal separation distance between the Class C public water system source well serving Lots I, 2, and 3, Block I, Sand Lake Subdivision, #2 and the private sewer line from the home to the septic tank on Lot I, Block 5, Sand Lake Subdivision, #2, serving a single family home has been waived from 75 feet to 60 feet. The above noted distance was taken from your submittal. If the proposed wastewater disposal system fails or needs to be upgraded, this waiver becomes invalid. Thank you for your cooperation with this office. If you have any questions, please do not hesitate to contact me. ~~~~_~Sincet ly, Keven K Kleweno, P.E. Environmental Engineer RC)BERT C. COWAN, RE, ROBF_F~A. SHAFER, RE. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 March I I, 1998 MUNICIPALITY OF ANCI IORAGE Devclopmcut Services Department P.O. Box 196650 Anchorage, AK 99519-6650 REFERENCE:Lot I; Block 5, Sand Lake//2 Subdivision Request you grant a waiver on the referenced property for the horizontal separation distance between: l) the leachfield and the east property line at 4 foot, 2) the north property line at 6 feet, and 3) the septic tank and the norlh property line at I foot. We do not anticipate any adverse effect on Ihe adjacent property. Ifyou require additional information, please contact us. Sincerely, RCC/bc 17034 NORTH EAGLE RIV~R LOOP ,* SUITE 204 · EAGLE RNER, ALASKA 99577 Municipality of Anchorage Development Services Department Building S~fe~y Division On-Site Wa~r and Wasleweler Pmgnun 4700 Bragaw P.O. Box 1966:~0 Anchorage, AK 99519-6650 www.ci.~nchomge.~c.us (907) 343-7904 Waiver Review Worksheet WRY: W1;;1)10075 Date Received: 9/7/01 Legal Description: I k Enalneer: Robert Cowan P.E, - S & S Enaineerin~ PID~: 011-134-36 HA~: HA010483 Permit~: 171)34 Eaale River LoDe Road. Suite 204 Eaale River. AK 995/7 Applicant: ,,lira Edene ,,,,. ,-'rD Iof Waiver Requested: 4 feet from tank to lot line Cnteda: Geology Points: A, Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Waiver is Granted: ~ Waiver is not Granted: LIst Conditions or Reasons for above: Reo~: ~?~tl Amount: $116.00 Date Paid: 9110/2001 Municipality of Anchorage P.O. Box 19C'650 · 4700 S. Bra#aw Strcct Anchorage, Alaska 99519-6650 · (007) ~13-8301 h ttp://www.cl.anchoragc.ak.us 9/18/2001 Robe~ Cowan S & S Engineering Subject: Waiver Request for Sand Lake Subdivision #2 Block 5 Lot 1 Waiver Request #WR010075 Parcel ID #011-134-36 HAA#010483 Public Wo rios DearEngineer: Your request for a waiver of the required 10 feet horizontal separation from the on-site wastewater disposal system to property line has been approved. The approved separation distance is 1.0 feet. This waiver approval applies to the existing on-site wastewaterdisposal system to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this depa~hnent. If there are any further concerns or questions regarding this waiver, please call our office at 34.a-7904. Sincerely, Jeffrey W. Poet Engineering Technician On-Site Water & Wastewater Program APPLIC, ,, IT FILLS OUT UPPER HAL...UNLY Property Owner .Z~//~ ..~.~ L/ &./.~../~,~..~.~ ~-/..~?- ~-.~ Phone Buyer , . ///~ /~/~/~.~.: ~ //~" /~ ~/ ~. ~_.-. ~ , - · Zip Code~ Address ~;; ~ ~Tz..:, ~/ ~/ -~- ' Lending Institution .?' .- ¢%¢2 /] Z~; //~%/-//.: [ F &. ~ ~"/./~( Phone Address ~Z? /~., :_. ~ / ~- /-~_~.:: ,:;- / ~ / r~,'~-/~.~ . _.~ Zip Code :~-J ~'%-: z. ~- ~ . . Address /.{¢ ~.. ~;:.. ~;~ '~ ' ' . Legal Description ¢/ ¢ 7-' :/ /~¢~ ~ ¢/;' ~ ~,4 /¢ ~) ~ -D,~-& ' Street Locati~ ¢5~. ,~---5 . , .... ~.,~/.. ,~ ":~. ~-' ¢~' c i /: .~ Type of Resi~nce ~¢_.Single Family ~ Multiple Family No. of Bedrooms ~ Other Water Supply ~ Individual A~ACH WELL LOG. A w¢l Icg is required for all wells drilled since June 1975. ~'Community 4; /. /i i:; ::; ,Z~' /~-¢~ EL For wells drilled prior to that date, give well depth (attach log if available), ~ Public Utility Sewer Disposal ~ .Individual Year Individual Installed: ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: "~ ( ~ APPROVED BEDROOMS ~ ~,~~~~~ .~~ ( ) DISAPPROVED Soils Rating Date ~wer Installed Well To Absorption Area /~ Well Log Received Well to Tank 72-023 (3182) & ENGINEERS, INC. S 7125 OLD SEWARD HIGHWAY * ANCHORAGE, ALASKA 99502 February 6, 1984 Milby Concepts 941 Strawberry Anchorage, Alaska Re; Health Authority Approval Inspection for Sand Lake Subdivision #5, Lot 1 Block 5 To Whom it May Concern: On February 6, 1984, S & S Engineers, Inc,, was requested to inspect the subject lot for Health Authority Approval, This letter certifies that the septic system:,as-built for the three bedroom house was varified in the field by meas- uring the distances between the existing standpipes ~or the septic system. The well casing projects above the ground surface by more than the required 12", A water sample was taken on January 27, 1984 and was analyzed by Chemical and Geological Laboratories of Alaska, Inc. The test (see attached) was satisfactory. The results of the water sample and this letier should be taken to the Department of Health and Environmental Protection at 825 "L" Street,'and the Health Authority Approval form should be .filled out. Should you have any questions regarding this matter, please do not hesitate to contact us at 349-6561, Very Truly Yours, E, .Richard Rahaim Engineering Geologist WASILLA ANCHORAGE 1907) 376-3770 ~(907) 349-6561 CONSTRUCTJON AND OPERATION CF. RTJF CATE APPROVAl . FO CON8'I - , ....} ...... ,:{ .................. public water system located ir, ....... ~Z.ZL_~:~::~.:.(Z~.Jf~.-,~(:tZ ...................... Alaska, submitted in accordance with 18 AAC 80,100 approved, conditionally approved (see ~tacl'ted conditions). DATE' If construct on has not star,ed within two years of the approval date, this certificate is void and new plans 8nd specifications must be submitted for review and approval before construction. APPROVED CHANGE ORDERS Change (contract order no, App!'o,ved by Date or de~crll)tive reference) . .Z~.~ The "APPROVAL TO OPERATE" section must be completed before any water is made available:to granted interim approval to operate for 90 days foltowm~l the completion date. 8Y TITLe; DATE" As-built plans submitted during the interim approwl period, or an inspectio~ by the Department J~as confirmed the system was constructed according to the approved plans. The sy~te.m is hereby:g.ran~ed fna approve to operate ~