HomeMy WebLinkAboutSAND LAKE #2 BLK 3 LT 17Sand Lake #2
Block 3
Lot 17
#011-134-08
Municipality of Anchorage ..+; .+•.
Development Services Department
Building Safety Division
4
On-Site Water and Wastewater Program, 4700 Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page of 'L
www.ci
anchorage ak.us (907) 343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL
INSPECTION REPORT
Permit Number. Su106o3 2p PID Number. 0l
Nam•
TIn,oFh E A� ela Porni Ff Wastewater System: ❑ New Upgrade
Aft*ss
P•G• 3ox 7Sl// Fnrr(,ankr Ak 99775- ABSORPTION FIELD
Phone
Nu of Beoroatw
y 71 ' 163 Z 351 D«p TnbnCh o Sha by Tr.nm D ase o swam D mn«
LEGAL DESCRIPTION So, Rating Total D.pm hunt w9nN gr.,e
O •
GPDrFt' IS-0 Ft.
9.� l 7 S.CCn+aron �/. Dspm b Ppa bonan barn p'Y+W 7aoe Gro" depth beneath pipe
San%! kC fl
V • Q FI. 10-0 FI
Townanp Raga 6eclwn F. eea.o above a'PnN grata�Gr" Length
0•.i•. Ft. -2114- /6 • + 39 Ft.
Well: H/• A . ElNew ❑ Upgrade Gr" mNh Nano dIms D.RNKebaN.N, nes
CWNhutan(PrtrNe.A.a.C) TNN Deem C„WN 2•J —� Ft. / �' FI
et. TVWW*oP wea Pope WlarNl
QQ `: P[/f'
FI. Fl %�!(f
Ff D•30iY HCrn- Op«F
GeNrData DNlaa SANK WN« L”Inalall«
Date mNNNO
rmaFL A-* A • ,{er✓r[g ID / /3 /06
Pump SM M Gs.p Hapm Above Grauer
GPM Ft. Ft TANK
SEPARATION
DISTANCES
7o Septic
Absorption
Lit Holding
05 Septic ❑ Holding ❑ S.T.E.P. ❑ Other.
•a-«
From Tank
Field
Station Tank
ubIWPnvate
Sewer Line
°p'O1y
,q,,,[%p TAA k
(GCJO Geri
Numoer ryrm
N Catme,
Sf[e/
2
Sut.n wn« > kv a
> 1,00
LIFT STATION J�• /}•
Lot Lne / •
Z 1
_ _
'a° .a✓«
G
Get
Farmatgn fJ / e
I
/7 6'
C
_ _
Pw•rq an' NvN N
'Pu w Nr NvN N
Hph wNN Nam N
in
In
Curtan Drrn _ � � _
in
PUT Ma,e 6 Maaal ENgnue msp.aana q.rlanNO M
Rem s
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BENCH MARK
'7t& t5G cell r14Lf IV "A1J1rA G""
Locauan Nm D.aa,N,m
Li"
74IG at S/,auan
OnA.a II,P�
ievalgn
/GO.QFL
wo wvr �/„u.,..r.
Inspections performed by: _ /elca fi6,o Tics Cc en Engineers Stamp
Dates: 1 ro//r/off
Development
Services Department Approval '•"'.'•• `'� to
f.,�:• 713• %�
Conditional Approval Date: Am * �' 9TH 1 0.
.. ...... 0.e..a... ...� Q
41
T V r • THEODORE F. 1ADORE �' 7
', CF-35x9
; •,
Reviewed anapproved by: `t'
d / Date:
tRa «m,) 0-2 3- t7 `.;, �, • .; o/o,�:'
•t �2. .. sn
PERMIT NO: SW060320
PID NO: 011-134-08 „G„
"V• NEW 1000 -GAL
1 SEPTIC TANK
1 �•
1 • 21'
=1 «F..
UI
z
1
F 1 ..E....D,. »C« ,.
Q
z1
�1
0 1 18'
t.l %
01
it 1
— I
a
6' SOIL COVER
C TANK
SEPTIC
18' SEGMENT
/—SOIL ABS. TR.
F
mr
PAGE 2OF2
LOT 17, BLOCK 3 Z
SAND LAKE #2
R=100'
PLAN VIEW
SWING TIES:
SCALE: 'I" = 20'
FROM:
COR. "A"
COR. "B"
TO:
S.T. C.O. "C"
49.5'
44.5'
S.T. C.O. "D_
54.5'
S0'
DBL. C.O. "E"
56.5'
52'
VALVE "F"
58'
52.5'
TR. C.O. "G"
50.5'
27,5'
TR. M.T. "H"
47'
28.5'
TR. M.T. "1"
40'
55.5'
TR. C.O. "J"
42'
58'
OLD TR. "K"
56.5'
69.5'
,
OLD TR. "L"
72'
58'
TOTAL 39 -FOOT LONG
SOIL ABSORPTION TRENCH
ilii; I I
iiii E;�_ I I
ELEV.84.0 '
CROSS-SECTION
NOT TO SCALE
I ,
„
I ,
, I
„
„
BOTTOM T.H. #1
ELEV. 79.5'
NO GROUNDWATER \:
FROM qtr vma r, L
HOUSE �t(G Or A4 t5
�'- i' = .-�a '•:+fit" 6
or 491—H
a .....................1 #.1
•. DOR9 F. MOORE
CE -3589 • .fir.
LOT 17, BLOCK 3, SAND LAKE SID #2
SEPTIC SYSTEM UPGRADE
AS -BUILT INSPECTION REPORT
FLATTOPTECIINICAL SERVICES
SCALE: AS NOTED
14530 ECHO CANYON ROAD DRAWN BY TFM
ANCHORAGE, ALASKA 99516 OCTOBER, 2006
MUNICIPALITY OF ANCHORAGE
Development Services Department
Onsite Water d Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Oct 02, 2006
Expiration Date: Oct 02, 2007
Permit Number: SWO60320
Legal Description: SAND LAKE #2 BLK 3 LT 17
Design Engineer: 0019 FLATTOP TECHNICAL SERVICES
Owner Name: TIMOTHY & ANGELA PORRITT
Owner Address: 8118 SEAVIEW STREET
ANCHORAGE. AK 99502-4167
Parcel ID: 011-13"8
Site Address: 008118 SEAVIEW ST
Lot Size: 6750 SO. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
Q Disposal Field r7j Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specked in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
7:'I
Date: /o /'f /C
(J
Date: /° Z G
Municipality of Anchorage
D�74:I1. lwtx l!Mi(Lill•.lnc6:tmgq.\Lska!NRiI!1Iil iFM1•lilophnn[(!Nli)7ii74FN11•Fas (!Mli)alatS'_INl
471M) Ilrny;na $trccl • .\nchorn9c„11;taut !tlRilli
a���c.numLury;
,llayor Mark Ileyicil IlttililinO Safer• DMS1011
October 2, 2006
Ted Moore, P.E.
Flattop Technical Services
14530 Echo Street
Anchorage, AK 99577
Subject: Waiver Request for Sand Lake #2 Block 3 Lot 17
Waiver Request WR#: 060061
Parcel ID # 011-134-08
Dear Ted Aloore, P.E.:
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 1.0 feet.
This waiver approval applies to the existing absorption field 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 department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
or
\JJoe Goodall
Civil Engineer
On -Site Water & Wastewater Program
Co111111unity, Security, Prosperity
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.ci.anchoragc.ak.us
(907)343-7904
Waiver Review Worksheet
WR#:060061 PID#:011-134-08 HA/Permit#
Date Received: October 2, 2006
Legal Description: Sand Lake #{2 Block 3 Lot 17
Engineer.
Ted Moore, P.E.
Flattop Technical Services
14530 Echo Street
Anchorage, AK 99577
Applicant: Timothy Perritt
Waiver Requested:) foot lot line waiver from septic absorbtion to north property line.
Criteria: Geology Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
..........................................................................
Waiver Is Granted: X
List Conditions or Reasons for above:
Waiver is not Granted:
Date:/9 27/06 By: Joe Goodall -
Name of Reviewer
Rec#: 86681 Amount: $j75 Date Paid: 10
Municipality of Anchorage
'
Development Services Department �°'
Building Safety Division
On -Site Water and Wastewater Program y „ IT'
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orglonsite
(907)343-7904
ON-SITE SEPTIC/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. (3 1 1 - 13 Y - OS
Property owner(s) T mo it+y E A Pete, p�'"c'f� —Day phone 0,0:z) Y, -r f -Jo3 Z
� Zip Code 9977s -
Mailing address F-45..
Site address 6 115 Sop v ew S1f
_Zip Code
Legal description (Sub'd, Block &Lot) --,4vf �? t3�oc4
Legal description (Township, Section & Range)
Lot Size Qqjb Sq. Ft.
THIS APPLICATION IS FOR (®all that apply)
Absorption Field
Initial
Septic Tank
19
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
Number of Bedrooms
3
THIS APPLICATION IS AN:
Initial
❑
Upgrade
Renewal
❑
certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: H60 Waiver Fees:
Date of Payment: 9 j 2 y laeL Date of Payment: 9/L11/47C
44
Receipt Number: _
oLO Receipt Number:
(Rev. 11/05)
12,
FLATTOP TECHM L SERVICE4 ..
CIVIL E ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS
TED MOORE, P.E. 14530 ECHO CANYON ROAD
PH./FAX: (907)345-1355 ANCHORAGE, AK 99516
E -Mail: tgmoore@gei.net September 27, 2006
M.O.A. DSD
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sirs:
The purpose of this letter is to provide the required design narrative in support of our application
for a permit to upgrade the wastewater disposal facilities on Lot 17, Block 3, Sand Lake S/D #2, located
at 8118 Seaview Street. We are requesting a lot line waiver allowing the trench to be located as close as
1 foot from the north property line. We are also requesting approval for the new trench to be located as
close as 10 feet from the original trench and for the bottom of the new trench to be 4 feet above the
bottom of the test hole. Soils logs, perc test results, a site plan, design drawings and specifications are
enclosed for your review.
The proposed system will be constructed in the vicinity of test hole # 1. As can be seen from the
soil log, the native material between 2.5 and 15.5 feet below ground level is a fine sandy silt with a
measured perc rate of 23 minutes per inch. Using the soil application rate of 0.6 gpd/sq. R. specified in
the wastewater ordinance, this 3 -bedroom residence requires a total absorption area of (3 x 150)/0.6 =
750 square feet. The proposed 42 -foot long trench design has a total absorption area of 840 square feet,
allowing extra absorption area to compensate for the tee junction. To further enhance the longevity of
the proposed system we plan to install a "Bull Run' diverter valve allowing future reconnection to the
original trench as needed in the future.
The topography of the lot in the area of proposed construction slopes down towards the east at
5% to 15%.
Due to the very small lot size, proximity of the Class "C" well on the adjoining lot, and the
location of the existing system, the area available for septic upgrade construction is extremely limited.
We were fortunate to be able to dig the test hole as deep as 19.5 feet. The native soil below 15.5 feet is
a fine dry sand, and is significantly cleaner than above. The well log indicates that no water was
encountered above 180 feet. On September 201 spoke with Dan Roth about the constraints affecting
construction and he concurred that it would be appropriate to allow the bottom of the trench to be 4 feet
above the bottom of the test hole instead of the normally required 6 feet. This will allow a significantly
shorter trench.
The lot line waiver is necessary in order to allow necessary room for the backhoe to sit south of
the trench while excavating it. Granting the waiver will have little impact on the ability to construct
future septic upgrades on Lot 18 to the north where significantly more room is available due to the well
being at a greater distance. As shown on the enclosed poor copy of the operation certificate DEC
reduced the protective radius around this well from 150 feet to 100 feet in 1982.
We are also requesting your approval for portions of the new trench to be as close as 10 feet
from portions of the original trench as is necessary in order to fit the trench onto the lot. Fortunately the
native sandy silty soil allows stable sidewalls and provides for excellent filtration so l do not anticipate
any potential adverse impact due to trench proximity.
The proposed project will have no significant impact on present or future water supply and
wastewater disposal systems serving adjacent properties, nor will it have any significant impact on
reserved space -surface and subsurface, or on drainage.
Please give me a call at 345-1355 if you have any questions on this submittal.
Sincerely,
Ted Moore, P.E.
INSTALL NEW 1000 -GALLON SEPTIC TANK
w. DBL. C.O. & DIV. VALVE TO OLD TRENCH
CONSTRUCT NEW 42 -FOOT LONG
- SOIL ABSORPTION TRENCH
w. 10.0' GVL. BELOW DIST. PIPE
LOT 10 1 11 LOT 18
O SEPTIC
SEPTIC
AREA O O AREA 0
o 14'
0
LOT 9 LOT 16
SEPTIC SEPTIC
AREA AREA O 0
,
o
DECOMMISSION
EXISTING 1000 -GAL
SEPTIC TANK
PER CODE
TREE CLUMP
LOT
1 i,�� ,
`�(.,,Y..•:;,�� ,��
U1 • "I
'•�
wI
1
SEPTIC
k
AREA
Q 1 " ' T.H.
#1
.....
r.&
THEODORE F. MOORE,! 0
(Z—i
9 1
,, CE - 3589 � �c A
ob
;
0
LOT 9 LOT 16
SEPTIC SEPTIC
AREA AREA O 0
,
o
DECOMMISSION
EXISTING 1000 -GAL
SEPTIC TANK
PER CODE
`�(.,,Y..•:;,�� ,��
LOT 17, BLOCK 3, SAND LAKE S/D #2
'•�
SEPTIC SYSTEM UPGRADE
49TII /y ,` *'�
SITE PLAN
....................
--- -- -- — -- -- .._.
FLATTOP TECIMICALSERVICES 1INCH =30 FEET
.....
r.&
THEODORE F. MOORE,! 0
14530 ECI IO CANYON ROAD DRAWN BY TFM
,, CE - 3589 � �c A
ANCHORAGE, ALASKA" SEPTEMBER, 2006
ey •"' �� �w
NOTE: THIS IS NOT A SURVEYED PLAT.
ALL LOCATIONS SHOWN ARE APPROXIMATE.
15.5
10.5110
4' DIA. F-810 PERF. PIPE
C.O.
NEW 1000 -GALLON
SEPTIC TANK
14
DOE UBLE CLEANOUT
BULL RUN DIV. VALVE
ORIGINAL TRENCH PERF. PIPE
PLAN VIEW
SCALE: 1" = 10'
CLEANOUT
MONITOR TUBE
MOUND BACKFILL 6"
ORIGINAL GROUND
FILTER FABRIC
4" DIA. F-810 PERF. PIPE
2112" SEWER GRAVEL
s
BOTTOM OF EXCAVATION
CROSS-SECTION "A" - "A"
SCALE: 1" = 5'
NEW 42 -FOOT LONG
SOIL ABS. TRENCH
C.O. w. 10.0' EFF. GRAVEL
BELOW DIST. PIPE
M.T.
28
C.O.
4" D-3034 WASTE
LINE FROM HOUSE
OF A4,, ti,
9��.._.� .• .• • .� Ute.
'. THEODORE F. MOURE
CE -- 3509 t
FLATTOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
TEST HOLE # 1 SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION:
Lot 17, Block 3, Sand Lake SID #2
DATE PERFORMED: _ __
September -19, 2006
PERFORMED FOR:. __
__Timothy and Angela Porritt --
DEPTH
(feet)
I'
2-
3-
4-
5-
6-
7-
8-
9`
10
11
12-
13-
14 -
15-
16-
17"
18 -
20
i
COMMENTS:
SM Sandy fill material
Pt. Original topsoil
SM Reddish sandy loam
ML/SM Fine, sandy silt
Damp, soft digging
SP Fine, slightly silty sand
Dry, fluffy
B.H.
SLOPE
^t
Lam! -OF F'o4�bt„4
erg',' ••"• � �' ' <y� ; �►
rr ; `9 —
THECDOR: F. MOORE ; 1
CE - 3589 t
•t r. r f f ��t. �Yi' ♦ 4.nS•�
SITE PLAN
Depth to Groundwater
No Grouridwater
Monitor tube dry _
Date
9/19/06__
9/26/06 _
Net Time
(minutes)
Percometer
Reading
Net Drop
(inches)
9/19
_
—
12" Presoak
_Start _ 4:31:30—
#123
#1 _5:01:30—
_Add water 5:01:45
ii2 _ _5:31;45
_Add water 5:32 _ _
15%
1 0%
Date
Reading Clock
Time
Net Time
(minutes)
Percometer
Reading
Net Drop
(inches)
9/19
_
—
12" Presoak
_Start _ 4:31:30—
#123
#1 _5:01:30—
_Add water 5:01:45
ii2 _ _5:31;45
_Add water 5:32 _ _
_
12,--
—23-1/2--
7/16
1/8 _
_—_— --
__ _
_ _
30__.1/8
_
30 _
—_30___221/8
__ 13/8—
_ 1 5/16
_ 15116 _
PERCOLATION RATE_23,_ (minutes8nch) PERC HOLE DIAMETER _6._—
TEST RUN BETWEEN 6.75 FT AND 7.25 FT
PERFORMED BY FLATTOP TECHNICAL SERVICES. I__��� " /s'La.aq—_— CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
(Thttop 7echnicalSemvices
14530 Echo Canyon RpaQAnchorage,AX 99516
Tbne (90) 345-1355
Lot 17, Block 3, Sand Lake #2
8118 Seaview Street
Wastewater disposal system installation
Specifications
1.0 General:
1.1 The scope of the project consists of abandoning an existing 1000 -gallon septic tank and
installing a new 1000 -gallon septic tank that discharges effluent into a new 42 -foot long soil absorption
trench containing a total of 10.5 feet of sewer gravel. Due to the small lot size and other constraints
extreme care will be required during construction. Access to the construction area is between the
house on this lot and the !rouse on the lot to lire north which are located only 9 feel apart, exclusive of
the gas meter. The owner of the /rouse to the north has kindly granted permission for the contractor
to gain access to the back yard through this route, however great care will be required to avoid
damage to either residence. Upon completion of work the contractor shall regrade any disturbed
areas between the two residences to a similar configuration as was encountered at the start.
1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor
deviations from these drawings may be allowed or required by the engineer conducting the inspections.
All construction procedures and material specifications shall conform to Municipal and State
requirements. All separation distances shall be in conformance with Municipal requirements, unless
specifically waived.
1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work
around any buried utilities.
1.4 Unless agreed otherwise, the contractor shall be responsible for any tree clearing and
grubbing necessary to complete the project.
1.5 The contractor shall provide adequate cover material and rough grading over all system
components to ensure that proper drainage is achieved after settlement and that there are no residual
depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas.
1.6 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading
after the soil is compacted, as well as placement of topsoil and reseeding all disturbed areas.
2.0 Septic Tank:
2.1 The existing 1000 -gallon septic tank must be properly abandoned by thoroughly pumping,
removing the top and backfilling with soil.
2.2 The new 1000 -gallon, 2 compartment septic tank shall be Municipally approved and shall be
set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and
a 4" cleanout. The new tank will have to be located on the west side of the new trench and configured
as shown on the design drawings.
2.3 All pipe connections to the tank shall be equipped with waterproof mechanical couplings.
The waste line from the residence to the septic tank shall have a minimum slope of 1/4"' per foot, and
the waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per
foot. A cleanout shall be installed 1 - 4 feet from the building foundation, and a double cleanout shall be
installed within 5 feet downstream of the septic tank. A "Bull Run" diverter valve shall be installed
downstream of the double cleanout allowing future reconnection to the original trench.
3.0 Soil absorption system:
3.1 The soil absorption system shall be constructed by excavating 42 lineal feet of trench as
shown to a depth of no greater than 15.5 feet below ground level in the vicinity of the test hole.
3.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be
raked to allow proper infiltration.
3.3 A total of 10.5 feet of approved sewer gravel shall be placed in the bottom of the excavation
with the perforated distribution pipes laid level such that the pipe inverts are no less than 10.0 feet above
the bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 30,o
passing the #200 sieve.
3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown
on the design drawings.
3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. A
minimum of 3 feet of soil cover is to be placed over the filter fabric.
3.6 The top surface of the cover material shall be raised a minimum of 6 inches higher than the
surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill
slopes shall be no steeper than 3:1.
3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to
have the site finish graded after the backfill material has stabilized, and for placement of adequate
topsoil and seed to promote rapid revegetation of all areas disturbed by the construction.
4.0 Inspections:
4.1 A total of 4 engineering inspections will be required during the course of the project: (1)
initial stakeout with the contractor to establish the location of the system and to discuss the plans,
specifications and construction procedures, (2) after the native material has been excavated to expose the
infiltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test
information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected
up to the septic tank, but prior to placement of insulation or filter fabric, and (4) after rough backfill and
grading is complete. The septic tank requires one inspection after it is set level and the piping
connected, but prior to backfill. This inspection may be incorporated with any of the above inspections.
5.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far
in advance to ensure the availability of the engineer.
"�P JC�
15.,
v.).75a `If
'APPROVA CONSTRu
ia i i's or-theclonst'..M;or M.
'4
laskp,s6mitt
4
:'.ij appeoved. T.,,
Jw
Cl conditionally.
S
—Sy
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siw
TF]
APPROVALITO OPERATE
It
`_Theconstr'uU!'WbjA6e;l-`'^i'
Vilt(:l 'Y,Lcm Was C9 pieted.
fj.j;ac-j intorlm ap'ol. va fo'operat4,fo.r,�%
A<. -built pla6iiubinitte.d.'durihg.tliO.int r
confillnud'Oe system i�as'pp
dstr6cfeV.4(
final appruval 10.0perate,
oo
by
72-013 (Rev. 3178)
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
PHONE
NEW
(�
-1 e_ r r 5��G r\
24
ADE
MAILING ADDRESS !1 r
orcin be rr " :5--, /`icli
�1
, ak ' '1`502—
LEGAL DESCRIPTION
LOCATION
NO. OF BEDROOMS
�_D r� �' � c Lj D
:3
Well
Absorpti area
Dwell
PE MIT NO.
Uy
DISTANCE TO:
—4 f
II Ly ('
F Z
ManufacturerMaterial,
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REMARKS
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APPROVED DATE LEGAL
72-013 (Rev. 3178)
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HAS
-V W" 1:110, 001 PNJ k -T F-1 W lot AV all E0--
DEPHRTMEONT
H�HLTH
F�D ENVIRONME�THL�^�OTECTION
'
825
STREET,
HNCHORHGE/ HK� -,V
1
�
264~4720
hi E":: 1.. 1- all 04 in.
w
R�.q —
j� v
PERMITP-qO. ( 811204 )
HPPLICHNT JER�Y STOCK
684� CRHNBERRY ST
24]~2851
LOCHTION SEH VIEW
�C( 02-p
LEGHL LOT 17 BLK ] SHN1)-464�4:
SUB
#2 LOT
SIZE 6750 SQUHRE FEET
TYPE OF S8IL HBSORPTION SYSTEM
IS� TRENCH
MHXIMUM NUMBER OF BEDROOMS �
]
SOIL RHTING (SQ
FT/BR)� 165
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
1-1 Eo- 1", -T, 1-1 --- -1.171 K.. M TKI 13 -1-1-9 -4- -2, C]l BE L- �EE 4F:;;� -11-u-p. ----:
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD.
THE DEPTH OF H TRENCH CR PIT IS THE DISTHNCE BETWEEN THE SURFACE OF THE
GROUND HND THE BOTTOM OF THE EXCHVHTIQN (IN FEET),
THERE IS NO SET NIDTH FOR TRENCHES.
THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRHYEL BETWEEN THE OUTFHLL PIPE
HND THE BOTTOM OF THE EXCHVHTION (IN FEET).
���:7a ��—19 * 1 R+_-_,- -0- 2--,m I E- :1 FID "'D 0-- L q. -Dl t,-4�
PERMIT HPPLICHNT
HAS
THE RESPONSIBILITY TO INFORM
THIS DEPHRTMENT DURING THE
INSTHLLHTION
INSPECTIONS
OF HNY WELLS ADJACENT TO
THIS PROPERTY HND THE
NUMBER QF RESIDENCES
THAT THE WELL WILL SERYE.
�~_ "T", 14 W �---- 1 P. -A! IS -71 F:D2 E--- -N- '- !C' -'H P -1-i K ES: W �rc�-!; 11-3 1 E`�;----,, �- ir
BHCKFILLIPICA OF HNY SYSTEM WITHOUT FINAL INSPECTION HND HPPROVHL BY THIS
DEPHRTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEB1 H WELL HND HN� 0N -SITE SEWAGE DI -;PO! ---;HL SYSTEM IS
100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPEWDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTHNCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET HND
TO H COMMUNITY SEWER LINE I� 75 FEET.
WELL LOGS HRE REQUIRED AND MUST BE RETURNED TO THE DEPHRTMENT WITHIN ]0 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MHY HPPLY. SPECIFICHTIONS HND CONSTRUCTION DI
HVHILHBLE TO INS 1-10 P-4.
�
� ���
��F�o���X-� KS Ey F17 1C1: Eli 1-1 ED M Fv! 0: J�^
I CERTIFY THHT
1� I HM FHMILIHR WITH THE REQUIREMENTS F -OR ON-SITE C.;EWERS HND WELLS HS SET
FORTH BY THE MUNICIPALITY QF HNCHORHGE
& L THE SYSTEM IN SC?CORDANCE WITH THE CODES.
]� I UNDERSTHND THHT THE ON~SITE SEWER SYSTEM MHY REQUIRE ENLHRGEMENT IF' THE--
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS.
SIGNED
PLICFiM, STOCK
SOILS LOG
1
MUNICIPALITY OF ANCHORAGE
• ac DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION * PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264.4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: STOCK CONSTRUCTION COMPANY DATEPERFORMED:�/li/R1
LEGAL DESCRIPTION: LOT 17, BLOCK 3, SANDLAKE SUBDIVISION #2, Anchorage, Alaska
Frozen to 1.0'
Brown SILT, ML
trace sand, moist to wet
WAS GROUND WATER NO
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Brown SILTY SAND, SP
w/silt & sand seam
moist
Reading
Date
Gross
Time
Net _
Time (pin,
Depth to
Water
Net
Drop
12/12/81
9:55
-
110.5
-
2
1110:25
30
113
It
3
111
2
"
4
1110:55
2
104.25
5
[111:25
30
107.5
3-1/411
6
It
11:55
30
110.75
3-1/411
1112:23
28
113.5
2-3/411
8
12:25
2
101.0
-
10
"
12:55
30
1
107.5
3-5/811
'- Brown SILT, ML
20 11
moist
TOTAL DEPTH OF PERCOLATION RATE 10 (minutes/inch)
BORING - 21.0' TEST RUN BETWEEN 5 FT AND �_ FT
COMMENTS Lot is wooded with 6.0" Birch trees. Lot appe
medium to good drainage. Percolation test per
PERFORMED BY: PUC pipe., ilza'f L I � CERTIFIED BY:-
72-008 (6/79)
Y ,
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135.4'
16
LEGEND
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i
I
Brass or Al. Monument
-
-�—
Iron Pipe
Rebar
o
Hub 13 Tack
■
a
Nail
0
0
Easements of record, other than ttase shown on recorded plat arW, not
shown hereon.
CERTIFICATE OF SURVEY
I hereby certify that I have surveyed the following described property:
1_OT 17F DLOCK 3 SAND LAKE S ID 140 1
Anchorage Recording District, Alaska, and that the improvements situated thereon are within
the property lines and do not overlap or encroach on the property lying adjacent thereto,
that no Improvements on the property lying adjacent thereto encroach on the premises in
question and that there are no roadways, transmission lines or other visible easements
on sold property except as indicated hereon.
Dated at Anchorage, Alaska, this 6TH day of A P M%L 19 Q3.__
Revisions
�CQ�0• OFQ C•gSg S
0* a
f'966,0648
•ea••uu•u•a•w..e'..
io
io a. .•
m Ernest A. Marth �o
0 : S. NO. 1314-S
00
P�a9`c� p••••...•••••�!P
1, AOFESSIONNL V d�
%%;\ +�
Owner STOG1< C.ON ST. Survey tiller A S - a UI LT
Job no. 81, -166 Book no. E3 - I Z Scale Io = 3o' ALASKA TECH
Anchorage,
Alaska 99601
Drawn try t, R Checked by E M City grid z2 24 TeL 276-8218
ii
MUNICIPALITY
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 011-134-08 Expiration Date: I I zozo
1. GENERAL INFORMATION
Complete legal description SAND LAKE #2 BLOCK 3, LOT 17
Location (site address) 8118 SEAVIEW STREET, ANCHORAGE, AK 99502
Current property owner(s) BENJAMIN & HOLLY MOROOKIAN Day phone
Mailing address
Real estate agent
PO BOX 240191, ANCHORAGE. AK 99524
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
❑
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
®
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ 2 COVI 0 Waiver Fee $
Date of Payment T / Date of Payment
Receipt Number 0 12— /Q3 Receipt Number
COSA # 0LC Wl 4Z7 Waiver #
Distance:
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Address 13030 SUES WAY, ANCHORAGE, AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE Date 8/10/2020
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to _.S OFA
these various and dynamic characteristics and are outside the control of the evaluator of the �y
well and septic system. Therefore, any estimate of how long a system will function satisfactory ��Q: • • .. �,� ���
for current or future occupants or guarantee that no unseen encroachments, deficiencies or JJ
discrepancies exist can be given by First Water Consulting & FWf.S _ * • � TH , , ,•;*
�. ..r
6. DSD SIGNATURE Curtis Huffman j
System #1 Approved for bedrooms %t" , ,CE 128991
�l F,pFOPQ/10/zOPOc���
System #2 Approved for bedrooms l� ROFESSI*
Disapproved
Conditional approval for bedrooms, with the following stipulations:
Original Certificate Date:
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 X Nitrate Advisory
Septic System Advisory Arsenic Advisory jam'
Well Flow Advisory Other
COSA Checklist
Legal Description: SAND LAKE #2 BLOCK 3, LOT 17 Parcel ID: 011-134-08
If more than 1 septic system on lot: COSA Checklist # of _ Structure served by this system _
A. WELL DATA — COMMUNITY CLASS C WELL
❑ Well log is filed with Onsite (or attached)
Date drilled
Total depth _ft
Cased to _ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) _in.
Date of flow test for COSA
Static water level at beginning of test _ft.
Comments
B. TANK DATA
Age of tank(s) 14 years
Tank type/material SEPTIC / STEEL
Well production at time of test _gpm
er stora tank volume_ gallons
ell sinfeced for coliform test? ❑ Yes ❑ No
5;
COlifor /bacteria is Negative
Nitr mg/L ® Nitrate less than MRL (ND)
Arsenic 40.1 ug/LE] Arsenic less than MRL (ND)
S LS Collected by NES
Measured operating fluid level in septic tank 49"
® Standpipes/foundation cleanout per record drawing
Date of pumping 8/5/2020
D. ABSORPTION FIELD DATA
Date of Sample 8/5/2020
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material
Comments:
Which system tested (date installed) 10/13/2006
Adequacy test date 8/5/2020
® ALL standpipes present per record drawing
Results N Pass For 3 bedrooms
Total measured depth from grade 17.3 ft (max)
Fluid depth prior to test 0 in
Measured depth to pipe invert from grade 7.8 ft (min)
Water added 450 gal
❑ N/A — pressurized field
New depth 7 in
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective APPROX. 9.5' INTO THE 10' ED
Elapsed time 360 min
® Code -required soil cover over field
Final fluid depth 0 in
❑ System presoaked
Absorption rate 450 gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) N
date of test)
Gallons introduced gallons
If yes, enter date
FWD'S
Comments/Deficiencies:
E. SEPARATION DISTANCES
F`rbm-?riyate Well on Lot to: (Please enter distances if less than required or if community well) NA CLASS C
Septic Tank/Lift Sfa-tion o Lot > 100'
Community Sewer Manhole/Cleanout > 100'
"-Z, Yes if No ft
ft
® Yes
if No
Neighboring Tank > 100' ® Yes if No``x-- ft
Private Sewer/Septic Line > 25'
® Yes
if No
Absorption Field on Lot > 100' ® Yes if No ft
Hbldi:a..a Tank > 100'
® Yes
if No
Neighboring Absorption Fields > 100'
Animal Contain em nt-_-'-;-O,'--
® Yes
if No
® Yes if No ft
Community Wells > 200' ❑ Yes if No *101 ft
Surface Water > 100'
® Yes
if No
Manure/Animal Excreta Storage
> 100----„-
Community Sewer Main > 75' ® Yes if No ft
® Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ® Yes if No ft Surface Water > 100'
Property Line > 5' ® Yes if No ft Wells on Adjacent Lots:
Absorption Field > 5' ® Yes if No ft Private Wells > 100'
® Yes if No
ft
ft
ft
ft
ft
® Yes if No ft
Water Main > 10' ® Yes if No ft Community Wells > 200' ❑ Yes if No *108 ft
Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
® Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
❑ Yes
if No
*2' ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells > 100' ® Yes if No ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200' ❑ Yes if No *101 ft
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
*WAIVERS - SEE MOA RECORD DOCS.
G. ENGINEER'S CERTIFICATION
I certify that l 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.
•�.oF
TH
�J .... ....�..�....
r Curtis Huffman
�� �F� •. CE 128991 �`9i
11/2928�cc��m
��� PROFEWO
SGS Ref.#
1203961001
Client Name
First Water Consulting Set -vices (FWCS)
Project Name/#
Sand Lake #2 Blk 3 Lt 17
Client Sample ID
Spigot
Matrix
Drinking Water
Sample Remarks:
Printed Date/Time
Collected Date/Time
Received Date/Time
Technical Director
08/18/2020 9:06
08/05/2020 12:50
08/05/2020 13:33
Stephen C. Ede
Allowable Prep Analvsis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic 40.1 r 5.00 ug/L EP200.8 B (<10) 08/10/20 08/12/20 DMM
Waters Department
Total Nitrate/Nitrite-N ND 0.200 mg/L SN121 450ONO3-F C (<10) 08/17/20 EWW
Microbiology Laboratory
E. Coli Negative I 100mL SM21 9223B A 08/05/20 A.L
Total Coliform Negative 1 100mL SM21 9223E A 08/05/20 AI
Page 2 of 5
Arsenic Advisory
Certificate of On -Site Systems Approval # OSC201427
Subdivision: Sand Lake #2, Block 3,Lot 17
A water sample revealed an arsenic concentration of 40.1 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.
Parcel 1. D. 011-134-08
O
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904 sa E t v
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Expiration Date: !� " S _ l
Complete legal description Sand Lake #2, Block 3, Lot 17
Location (site address) 8118 Seavlew St.
Current Property owner(s) Micah & Hayley MIeSSner Day phone
Mailing address 8118 Seavlew St.
Real Estate Agent
2. TYPE OF DWELLING:
El Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual
0
Individual Water Storage
❑
Holding Tank
❑
Community Class 'C' Well
El
Community
❑
Public Water System
U
Public Sewer
❑
Waiver/Variance request fora
Distance:
Received by:
Date:
COSA to be released to th&engineer, unless otherwise requested by the engineer.
/
COSA Fee $ 52f
Date of Payment
Receipt Number 53gC-3
COSA# 65CI41236
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
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
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone
6. DSD SIGNATURE
1/SISystem #1 Approved for -3 bedrooms
System #2 Approved for bedrooms
Disapproved
Phone (907) 272-8218
Date 5/21/2014
Conditional approval for bedrooms, with the following stipulations:
By: a4��/ it✓ J Original Certificate Date: l�
The rV nicip ty f A rage 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 X Nitrate Advisory
Septic System Advisory Arsenic Advisory <_
Well Flow Advisory Other
COSAbluesheat r c
If more than I septic system is on the lot:
COSA Checklist # 1 of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: Sand Lake #2, B3, L17 Parcel ID: 011-134-08
A. WELL DATA
Well type Public
Date completed _
Total depth ft.
Date of test
Static water level
Well production
If A, B, or C provide PWSID # C
Sanitary seal (Y/N)
Cased to ft.
FROM WELL LOG
ft.
g. p. m.
WATER SAMPLE RESULTS:
Coliform ��colonies/100 mL Nitrate I'J"�,` mg/L
Arsenic 3 fO. ug/L Date of sample: 5I,t'y/2014
a.c)
B. SEPTIC/HOLDING TANK DATA
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground) in.
AT INSPECTION
Collected by: PIES
ft.
Tank Type/Material Septic/Steel Date installed 10/13/2006
Tank size 11000 gal. Number of Compartments 2 Cleanouts (YIN) Y
Foundation cleanout (YIN) Y Depression over tank
/(}Y/N) / N High water alarm (Y/N) N
S q
Date of pumping O Y Pumper N+ /—/pI17 ?�UkLE S
C. ABSORPTION FIELD DATA
Date installed 10/13/2006 Soil rating (g.p.d./ftz or ftZ/bdrm) 0.6 GPD/BR System type Deep Trench
Length 39 ft. Width 2.5-6 ft. Gravel below pipe 10 ft.
Total depth 15.8 ft. Eff. absorption area L80 ftp Monitoring tube Y Depression over field N
Date of adequacy test 5/20/2014 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 454 gal. New depth 32 in.
Elapsed Time: 410 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
D. LIFT STATION
Date installed
"Pump on" level at in.
Datum
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer /septic service line
Animal containment areas
Size in gallons
"Pump off"level at in.
Cycles tested
Manhole/Access (Y/N) _
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+
Water main 10+ Water service line 10+
Wells on adjacent lots
ABSORPTION FIELD ON LOT TO:
Property line 1 * Building foundation 10+
Water Service line 10+ Surface water 100+
Curtain drain 50+ Wells on adjacent lots **100+
F. COMMENTS
*WR#060061, **Waived in1982 by DEC
Survey As -Built on File
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 Steven R. Pannone
Date 5/21/2014
COSA brown sheet 10-10-12.doc
Absorption field 5+
Surface water 100+
Water main 10+
Driveway, parking/vehicle storage 110+
in.
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 # 141230
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 3, Lot 17 of
Sand Lake 42 Subdivision. This inspection revealed an arsenic concentration
of 36.7 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.or /off nsite) or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
Municipality of Anchorage
• -� Development Services Department .-
Building Safety 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
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. Off —13 Y— 06 COSA# 09 0383
Expiration Date: / — .2 vZ — / O
1. GENERAL INFORMATION
Complete legal description t -of 1Z 13 lock 3 Setnol 4e. lee -Clb 3x Z
Location (site address) 906 16 SPAye ecu sk,
Current Property owner(s) &Xcyftroi � I-ar ; Dran e -r Day phone 2-rS—Sn!ZS:
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
8116: Sett ue e w Sif.0 /}n�' A4 99&-07_
Day phone
Ciro ked a Alco ko,
QUSIP_ Sarluu/+ eul l=Stak'n Day phone 13So-161661
Unless otherwise requested, COSA will be held by DSD for pickup. P i'eafe coe ll 1?o /i a 04 clot✓ e
2. NUMBER OF BEDROOMS: 3 iso - 1666 4siAen & A rj rer dr Fo,P u.
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class K_ Well
®
Community On-site
❑
Public Water System
❑
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 FYaFfoe Techn;ca/ SPwtce Phonei3SS-
Address /H C TO Echo eermyen Acafe, h'1(4,
Engineer's Printed Name _77700o cdovr F. /-rco�d Date 16 / ►6 /09
' :manmmm eeeee eeuee
5. DSD SIGNATURE )' �"' t , A:uc
a.m.• Cl-0<Cq
Approved for �_ bedrooms.•.IaN6/F
Disapproved. i ;t_, • -
Conditional approval for bedrooms, with the following stipulations:
iV
m.
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By:a Z4 Original Certificate Date:
(Rev 11105)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore 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: 1,0f 17� ti /ache 3, San d l a 4e, S/d Parcel ID:_ Q 11
A. WELL DATA
Well type Glass %C" If A. B, cr C provide PWSID Well Log (Y/N)
Date completed _ Sanitary seal (Y/N) _ Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform _Q_colonies/100 mL Nitrate 40.1 mg/L
Arsenic: 12.6 ug/Ldate of sample: 2/2S/09
B. SEPTICIHOLDING TANK DATA
Tank Type/Material SP.p b C. l S/4e
Tank size 1000 gal Number of Compartments
Other bacteria 19_colonies/100 mL '*'
Collected by: ?` la tlEy / w c4 S 4C
Date installed 1 0 / 13/ 2A04�r
Cleanouts (Y/N) `1
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YM) N.A.
Date of pumping (/27109 Pumper rSaraC1
C. ABSORPTION FIELD DATA
Date installed A0 f 13 /uG Soil rating (g.p.d./ft2 or fe/bdrm) m•6?�System type TCtaCA
�
Length 39 ft. Width ft. Gravel below pipe 10.fi ft.
Total depth 1 .0 ft. Eft. absorption area 760—ft= Monitoring tube 'r_ Depression over field N
Date of adequacy test 9 / 7-d /09 Results (Pass/Fail) Por/ For 7 bedrooms
SI 61. y
Fluid depth in absorption field before test Y in. Water addedlrLeL gal. New depth!" in.
56.5'
Elapsed Time: 10 2, min. Final fluid depth 1t.5' in. Absorption rate >= YS'b g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date N..4.
D. LIFT STATION
Date installed N• A,. Size in gallons
'Pump on' level at _ in. 'Pump off" level at_ in.
Datum
E. SEPARATION DISTANCES
Cycles tested
Manhole/Access (YIN)
High water alarm level at in.
Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO: - We -ft @r on 1,ol° /rf — 0w16,^ce zyat&vce k too•
Septic tank lift station on lot 106,
Absorption field on lot I o t
Public sewer main
Sewer /septic service line
Animal containment areas
On adjacent lots -�> toa.
On adjacent lots -> to 0
Public sewer manholelcleanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 'i I' Property line fie' Absorption field S'
Water main > to' Water service line > to' Surface water --� t ouo
Wells on adjacent lots 10,q'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
n
Property line 2' rpt Building foundation 26 ' Water main > to'
Water Service line 7 to' Surface water > tom' Driveway,parking/vehicle storage? S'0-1
Curtain drain None S otn Wells on adjacent lots lcn r
F. COMMENTS VA Pot., v/ u✓e orrenic.. d ;I k—or
9E OfAer 13ack,-tek count- tr cootAu7 acct
G. ENGINEER'S CERTIFICATION As - rue7ier
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-rAtoG?vrt r /-rcPa#r
Date 10 / 1d12-009
COSA Fee $ At 90 c=`
Date of Payment 20O
2�
Receipt Number. _00-5-o /
(Rev. 11/05)
o ee ,^ S/a /tool �..� de.sr y wain >�j,✓
, ate�verj% anC�FIP tel DSQ
'tg '.
TW p)OPE F.
Waiver Fee $i—
Date of Payment
Receipt Number
SCS Rcf.N
1095225001
Client Name
Flattop Technical Srv.
Project Name/p
LI7,B3 Sand Lake #2
Client Sample ID
L17,B3 Sand Lake N2
Matrix
Drinking Water
PNVSID
216546
Sample Remarks:
Printed Date/time
Collccled Date/time
Received Date/time
Technical Director
10/14/2009 8:34
09/25/2009 13:45
09/25/2009 15:00
Stephen C. Ede
Allowable Prep Analysis
Parameter Results POL Units Mcthod Container ID Limits Date Dam [nit
Metals by ICP/M3
Arsenic 42.6 • 5.00 ug(L EP200.8 C (<10) 10/08/0910/13/09 NRB
Waters Department
Total Nitrate/Nitritc-N
Microbiology Laboratory
Colony Count
Total Coliform
Fecal Coliform
ND
0.100 mFIL
SM204500NO3-17
B
(<10)
10/03/09
LCE
16
cot/lOOmL
SM209222B
A
(<200)
0925/09
DLC
0
coV100mL
SM209222B
A
(<I)
0925/09
DLC
0
col/100mL
SM209222B
A
(<I)
0925/09
DLC
Municipality of Anchorage
' Development Services Department
% Building Safety 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 # 090383
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 3, Lot 17 of
Sand Lake #2 Subdivision. This inspection revealed an arsenic concentration
of 42.6 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.
Municipality of Anchorage
Development Services Department
Building Safety Division "f "
Onsite 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. 011 - 13 V - O& COSA # Dio 51 p
Expiration Date: .1 - � 3 - 0-
1. GENERAL INFORMATION
Complete legal description
1.01-
17 13/ac k 3,
S«/Ia 1.o Lee S 1D 10 -2-
h: /
ft E, Day phone
7_73 -77-L?
Location (site address)
Location
6116
Secrv,<<.0
Sf.
Current Property owner(s) 7-1r*• Ay E i¢;ge to P c o -rift Day phone HT M -103 2
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Ro.t3ox7s/113 Fuer64nk1 hoc 9977S -
Day phone
lce�rn
lee
/b��
Pr"citn
h: /
ft E, Day phone
7_73 -77-L?
❑
3601
CenkW&,mf
DrLc
RAcAae!7;
44c 99ro3
,
Unless otherwise requested, COSA will be held by DSD for pickup. Plcare ca 11 bce-2 Th'V ibr
2. NUMBER OF BEDROOMS: 3 & Z.7_7-722.3 a.4.4 ccrh U ��p•w.
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual Water Storage
❑
Community Class 6 Well
Public Water System
❑
Individual On-site 91
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 Onsite 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 If— fee ikcAArccf Phone 3Ys-- r3ss—
Address rYSSo 5c -ho l«^,ems /td,• AnchorT2e hcc Sys—Ie
Engineer's Printed Name IT. I'1Go2 Date Oc/vi.f- i7s is
Additional Comments • 14 11111E
WASTEWATER
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
ull
By: Original Certificate Date: / - Z - O a
)R". 11105)
i
5. DSD SIGNATURE
'�. `�- ......•
Approved for '7 bedrooms. ,•'•. �� �=' ; '
�fl
Disapproved.
•'°:r,y,_ , y
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments • 14 11111E
WASTEWATER
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
ull
By: Original Certificate Date: / - Z - O a
)R". 11105)
Municipality of Anchorage
e-
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Boz 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lo f f 7 43 /a 43 Sand 1•0 ke S/G 0 2 Parcel ID: V1 1 - 13 y - 08
A. WELL DATA
well type C tort °C If A, B, or C provide PWSID # 216,sY6 Well Log (Y/N)
Dale completed _ Sanitary seal (Y/N) _ Wires properly protected (YIN)
Total depth ft. Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform O colonies/100 mL Nitrate <o r mg/L Other bacteria G colonies/100 mL
Arsenic: O• ~Z mg/l Date of sample: 9 / 27 Collected by. FYo fbi %iclr -r .c
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Sept+ c / Sk e/ Date installed to r3 / 2G0d-
Tank size 10040 gal. Number of Compartments Z_ Cleanouts (YM) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) N• A.
Date of pumping A1.4. (-New)- Pumper -�
C. ABSORPTION FIELD DATA
Date installed I i3 /06 Soil rating (g.p.d.e or ftZ/bdrm) 40.6 !!-i System type Trr�eS
Length 39 ft. Width 2.S' _6 ft. Gravel below pipe 140.6 ft.
Total depth t o ft. Eff. absorption area Zoo ft' Monitoring tube Y Depression over field N
Date of adequacy test N• A. Al ew) Results (Pass/Fail) P^re For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added V gal. New depth_ in.
Elapsed Time: a min. Final Fluid depth O in. Absorption rate >= 'YS -D g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N. If yes, give date P. A.
D. LIFT STATION N• A.
Date installed
`Pump on" level at _in.
Datum
E. SEPARATION DISTANCES
Size in gallons
"Pump off level at _in.
Cycles tested
Manhole/Access (YM)
High water alarm level at
Meets alarm & circuit requirements?
in.
SEPARATION DISTANCES FROM WELL ON LOTTO: — WOU L on ")L 16— Oa<fanee K ar.ecd /b teb,
Septic tankAift station on lot I o8
Absorption field on lot 1 Or
Public sewer main �-
Sewer /septic service line
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding lank —
Animal containment areas — Manure/animal excrete storage areas —
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 511 ' Propertyline 16 * Absorption field S'
Water main > to' Water service line > 10' Surface water > loc>
Wells on adjacent lots 106'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 2' Building foundation 26 ' Water main > ro'
Water Service line > 10 ' Surface water > tuo' Driveway, parking/vehicle storage > SV t
Curtain drain Menc seen Wells on adjacent lots lot '
F. COMMENTS
1,ok Ilne 4tw4rre/' lrl Nf of ^.�, c�vtvCCw.
G. ENGINEER'S CERTIFICATION F" • " = '
1 certify that I have determined through field inspections and TN
review of Municipal records that the above systems are in s•"......•••�����������`•�
conformance with MOA COSA guidelines in effect on this date.,��
�. 'THLCxNe r. A40ORE ;•
Engineer's Printed Name TheocPa�e F. "00 -e pr eI'.•
CE -3589
Date— Or -/64e— /7 Z00e,
COSA Fee $ .?O -"J�
Date of Payment /Dh gQ(F
Receipt Number 8 �%
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
N
SMVIEW SiMf
a$
mi
Ig I
Vt
15 1
HjjWGO
Iz p
�s
Municipality of Anchorage
Development Services Department
• Building Safety Division
_ On -Site Water and Wastewater Program
4700 South Bragaw St. ' • "'
P.O. Box 196650 Ancticrtge, AK 99519.6650
www.cl.anchorage.ek.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D.- 011- A HAA is
Expiration Date: 1-.;L - O 1
1. GENERAL INFORMATION
Complete legal description Lo -1?, 12,14 _5 SP.rND 1-.AVKE IA R
Location (site address or directions) 8 118 Se . vi -e -
Current Property owner(s), flaw 13e./-li 2LkWvf Dayphone AYR -R E;t-i U
Mailing address 8-013 S«K D' (_>,O
Lending agency
Day phone
Mailing address
Real Estate Agent ( a j
46J
4 b as u b
Day phoneN 31fS-?i r
Mailing Address
Unless otherwise requested, HAA m7lbe
held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
(�
Individual Water Storage
❑
Individual Holding tank
❑
Community Class C Well
J
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipolity, 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 cM[
engineer registered In the State or Alaska. Certificates of Health Authority Approval are required for the transfer Of
tiue (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. Certificales 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 6lunictpality, of Anchorage is not responsblc rnr 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 verity 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 verity that based on the information obtained from the
Municipality of Anchorage files end from my Investigation and Inspection, the on-site viater supply and/or
wastewater disposal system la(are) In compliance with all applicable Municipal and State codes, ordinances,
and regulations In effect at the time of Installation.
Name of Firm { o a e" 212UrV U
Address 203 lt�i lib /—t^ lw
Engineer's Printed Namet o b� c K Sa
5. DSD SIGNATURE
fV� Approved for 3 bedrooms.
3
1�_C Phone x-74-39!!0
Date q/17/p/.
Z1�
1-411
• vc;:•' ( NGINEER'S
u '44S t
its i STAMP
•,�'r'�,'� T�t:b�l S�ur4fa�d
r�
Disapproved.
Conditional approval for' bedrooms, with the following stipulations:
•. e
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By - W_- Original Certificate Date: I o - — O 1
C
vu.. IV")
Municipality of Anchorage
Development Services Department rra
&Aft Safety Division
On -Site Water 6 Wastewater Program t • a r
4700 South Brepaw St.
P.O. Box I MW AnchoraM AK 99519.850
www.d.anchorsge.ak.us
(907) 343.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:— -- L e If l7. IRK 3 5,jx . o! . 14 Z' Parcel ID -
..Oil - 13 4 - 06
A. WELL DATA
1.
wen type 6eIf A, B. or C provide PWSID * A -14s l- Well Log (Y/N)
Date Completed Sartitary seal (Y/N). W1res pity prod (YM)
Total depth fL Cased to fL
FROM WELL LOG 1�
Date of test
Static water level ft.
Casing height (above ground) In.
AT INSPECTION
ft.
Well production Q -0-M.
9 -P.M.
WATER SAMPLE RESULTS:
COIUemn _�colortiesf100 mil. NitrateN1�mg n. Other bacteria —hj0colonies/100 mit.
Data of sample: 1 IV A Collected
by:
B. SEPTICIHOLDING TANK DATA
TankType/Materiel nLa!:
Date installed 2
Tank size _ 1040 gal. Number of Compartmerrh g Cleanouts (YM)
Foundation dearwut 6M) Demon over tank (YM) High water alarm (YIN) tq
Date of pumpkV !i7 o L per _ �¢ �d �-o
C. ABSORPTION FIELD DATA
Date Installed y 2 Sol rating (g.p.dJfe or teurm) l &Jr System type _[ .L[ 6t G 4
Lenges ft. Wki>n — fl Gravel below Pipe 7_ ft.
Total depth J --y— ft. Eff. absorption area J Oh fe Monitoring gibe Depression over field N
Date of adequacy test 9 o Results (Pass/Fal) �_ For_-:!;, bedrooms
Fluid depth ki abewpWn field before testA in. Water added pal. New depthM in.
ElapTime: '� IZ kr-
sod Final fluid depth ,l� in. Absorption rete >■t� _
x/50 9•P.d.
Any rejuvenation treatment (past 12 mo.) (YIN a type) _� If yes. give date t1,11
D. LIFT STATION
Date Installed Size In gad=
'Pump on' level at _ in. 'Purrp orf at _ In.
Datum C tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO: /
Septic tents station on lot I -
Absorption field on
Public sewer main
ManhoidAccess (YIN)
High water alar level at in.
Moab alarm b drwH requirements?
On a0oant lots
Public sewer menholddeanout '
Sewer/septic service fine Z /—I,' Holdlnp tank
SEPARATION DISTANCES FROM SEPTICAIOLDING TANK ON LOT TO:
Building foundation ��� Property line —.1p if Absorption field g
Water main %bo of Water service line 5 D Surface water 11D
Wells on adjacent lots 112-
SEPARATION
12
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line _ 4 &&drop loundatlon .99 Water mein 100+
Water Service Una , 50 Surface water N to Driveway. parUpMdhide s(aaye O
Curtain drain _ N I T) Wells on adjacent lots 1 I R
F. COMMENTS
G. ENGINEER'S CERTIFICATION
•=.,':.' �'."'••.;,'• S <3
�
1 codify Chet I have detenr*W through Reid kwactIons and
�" •: - «/� :! ! ' = r
review ofMunicoal records that the above systems are In
r•+• :"• • . ••.•..
conformance wRh MOA HAA ptrketlnes In efied on MIs date.
Engineers Printed Nana go v rkl mo$
a�i7�oj
(j
Date
_ �..'•••.....•; \ .r
HAA Fee $ Sob U—
Date
—
Date of Payment i0
Receipt Number
(Rev. 12100)
.Waiver Fee S
Data of Payment
Receipt Number
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.# dli _ 1 w -CA
1. GENERAL INFORMATION
•• -Lam • •
Complete legal description LoT 1-1 RLk 3 SANtD LAKE '�Z
Location (site address or directions) Si
ANCHORAGE
it/
Property owner JACK WOLF Day phone
Mailing address 49 CAPISTRANO p12 DARTMovTN N.S. CANADA
Lending agency NorweC N01 - fry e -may Day phone 276- Yzso
Mailing address '2S-,6'0 Del)ctli Sr�.� SurFC /YU�� A -ACA, 4k 99So3
AgentR� DAVE W IR'TH Day phone 2-17 -0/08
Address 2600 Cr�caro�a Std All r-4 kGc 9qS03
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #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 FLATTOP TECO SVCS Phone 34S- 13SE
Address 114530 ECtlo ST 4fkC f}k 99s 16
Engineer's signature �� Date /993
0, � s" .. .
4.
t•
. as � ,.,• "� �"_
Ai b.
�..a.................
e FAi'.�.Pb221tE F. MOORE o
6. DHHSsSrIGNATURE "'4D� y
I// Approved for bedrooms.
Disapproved.
Conditional approval for
M
Additional Comments
bedrooms, with the following stipulations:
47IC
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 courtesyto purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025(Rev.1/91) Back MOAa21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lb -r 17, BLV 3 SAND LAKE 42 Parcel I.D.
A. Well Data
Well type CLAss C „ If A, B, or C, attach ADEC letter. ADEC water system number 2 1 /o 5q6
Log present (Y/N) Date completed
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump levell
Cased to
FROM WELL LOG
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
WATER SAMPLE RESULTS:
Driller
Casing height
Wires properly protected (Y/N)
AT INSPECTION
; On adjacent lots
On adjacent lots
blic sewer manhole/cleanout
Petroleum tank
Coliform 0
CO( / (a 0 int
m
Other bacteria
n al e r ovk-l(
Date of sample:
9112193
oz
FlArfor -rscN
Svcs
K�
r�+ I
�
M Y
Z r
O
M.
m
y
P
roti
c�
N o
®
<_
m
O
z
Coliform 0
CO( / (a 0 int
Nitrate G o, ! T/ Q
Other bacteria
n al e r ovk-l(
Date of sample:
9112193
Collected by:
FlArfor -rscN
Svcs
B. SEPTIC/HOLDING TANK DATA
Date installed 14/82 Tank size loon GAL Compartments
Cleanouts (Y/N) y Foundation cleanout (Y/N) y Depression (Y/N)
High water alarm (Y/N) N . A , Alarm tested (Y/N) N,A
Date of pumping 8/2-0/9? Pumper Tceycarr
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot N - • On adjacent lots I I I ' y -
To property line Ing Absorption field 5 r
Surface water/drainage > too,
V_ D6C cA�orver An loo' on :0/2
72-026 (3/93)' Front
Foundation `fz
Water main/service line ^ 65 r
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed Manufacturer
Size in gallons Manhole/Access (Y/N)
Vent (Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on
D. ABSORPTION FIELD DATA
Date installed 14(82-
Length
4(8zLength 421
"Pump off" Level at
Cycles tested
On adjacent lots Surface water
$oil rating (GPD/Ft2) 0.9 r_pp/r✓f2 Systemtype TREN04
Width 3 Gravel thickness 15w,
4 Total depth
14'
Total absorption area 533 Ff' Cleanout present (Y/N) Y Depression over field (Y/N) _g
Date of adequacy test 8 JIzl 93 Results (pass/fail) Pass for 3 Bedrooms
Water level in absorption field before test > r r z" 1341cv 6:4d. I.e-er Aftertest 1 /H•5" 6et� w !ge&,,A c lewd
Peroxide treatment (past 12 months) (Y/N) NoNE KNowa If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot N -A. On adjacent lots 112 )� Property line `i
To building foundation
On adjacent lots 12'
Surface water > too'
Curtain drain NONC 05SERVF—D
E. ENGINEER'S CERTIFICATION
To existing or abandoned system on lot
Cutbank N ,A . Water main/service line l5
Driveway, parking/vehicle storage area -75'
-k DI -C u/ct,ve-v, /v t0a, Cin ��lC
1 certify that have checked, verified, or conformed to all MOA and HAA guidelines ine to of this inspection.
t�_ i
Signature y'PV@RPq gP°PP•Peq Pggq Pgga.•if�
EngineePs Name Ttieo 6(& re66R1�
CE 3;189 °
Date
HAA Fee $. 0 00 ° 4
Date of Payment L— P? — 7 3
Receipt Number A. S -b
72-026 (3/93)' Back
Waiver Fee $
Date of Payment
Receipt Number
WALTER J. HICKEL, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99515
August 19, 1993
Mr. Ted Moore
Flattop Technical Services
14530 Echo St.
Anchorage, AK 99516
(907) 349-7755
SUBJECT: Lot 17, Block 3; Sand Lake #2
8118 Seaview St.
Class C Public Water System ID no. 216546, ADEC Project no. 9421 -DW -
228 -033.
Dear Mr. Moore:
The Department has reviewed the information received in this office August 18, 1993,
regarding the above public water system which included water samples analyses for total
coliform bacteria and inorganics for nitrate. Since this drinking water system has been
previously approved by this Department, verification that the water supply has been
recently tested will be required to maintain compliance with State Drinking Water
Regulations. Results from the recent water samples submitted were satisfactory for both
total coliform bacteria and inorganics for nitrate, and satisfy this concern. Therefore, for
the concerns of this Department, this system is in compliance with State of Alaska
Drinking Water Regulations (18 AAC 80). Attached is an "Approval of On -Site
Residential Water and Sewer Systems" certificate verifying this systems status as an
approved water system that is in compliance with 18 AAC 80.
Thank you for your cooperation with the Department. If there are any further questions
concerning this matter please do not hesitate to call.
Sincerely,
Ae�
Michael Lu, E.I.T.
Environmental Engineering Assistant II
ML/pf
Attachments
OF T"F STATE OF ALASKA
,. DEPARTMENT OF ENVIRONMENTAL CONSERVATION
r
APPROVAL OF ON-SITE RESIDENTIAL WATER AND SEWER SYSTEMS
S -ji
PROPERTY DESCRIPTION
Block & Subdivision or U.S. Survey
Lot 17, Block 3 (8118 Seaview St.)
Sand Lake Subdivision #2
PWSID no. 216546
Certificate Issued for Application No.:
9421 -DW -228-033
This approval does not constitute a guarantee of any kind, explicit or implied, as to the performance
of the water supply and wastewater disposal systems.
WATER SUPPLY
A recent water sample was tested and found to meet Department of Environmental Conservation drink-
ing water standards for total coliform bacteria.
Name/ TWEEEnvironmental Date
v}�}�/'_ ng. Asst. II 1 8/19/93
WASTEWATER DISPOSAL
The domestic wastew'Xpr system was:
❑ inspected by the Depart t of Environmental Conservation and found to be in compliance with
applicable requirements of AC 72;
❑ inspected by a Professional Engin who certifie at the system complies with applicable re-
quirements of 18 AAC 72;
❑ installed by a Certified Installer w ertifie%that
tem complies with applicable requirements
of 18 AAC 72; or
❑ tested by a Profes nal Engineer who certperformance of thesystem is satisfactory
and that the tem complies with the minimum separ 'on distances specified in 18 AAC 72.
This approval is valid for a F-1single family Elmulti-family unit�vwth a total of bedrooms.
180404 (Rev. 8)85) DISTRIBUTION: WHITE—BANK/LENDING INSTITUTION; CANARY—APPLICANT; PINK—DEPARTMENT
Piaiis-f or
'I -ho
.construe
vraca systed
gia ted -inte �ri
Time
Time. -
%Time
-
-
Dale
Date
Date
Inspector
Inspector
Inspector
Comments_
Conditional Approval
1
/
!/ � f,�„'�—
W.
.4 ,
)_AJ
Date Sewer Installed
Permit No.
Septic Tank Size
Holding Tank Size
Soils Rating
Well To Absorption Area
Well Log Received
Well to Tank
APPLICANT FILLS OUT LOWER HALF ONLY
Property Owner \ e -b- k–
12:2 Z'=
Phone
Mailing Address &$c/v
C ro- r16�vv4�/ Z2��
Buyer Z
F
Address
Lending Institution
Phone
Address -7T A c%
�9 Cr
Realty Co. & Agent
Q94
7 JJ 3 /7 J�/
Address
Legal Description L 7
3 S v,v
Street LocationL) Q kJ
TypeResidence
Single Family
❑ Multiple Family
No. of Bedrooms
❑ Other
Water Supply
Individual
ATTACH WELL LOG. A well log is required for all wells drilled since June
Community
1975. For wells drilled prior to that date, give well depth (attach log if
❑ Public Utility
available.
Sewage Disposal
C? Individual
Year Individual Installed:
❑ Public Utility
When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.