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Home My WebLink AboutSAND LAKE #2 BLK 3 LT 18Sand Lake Block Lot 18 #011 - 134-07 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 ' ' 'q ILEGAL DESCRIPTION .... LOCATION DISTANCE TO: :) ~[. Absorption area Manufacturer Liq. ca DISTANCE TO: IF HOMEMADE: Well Well DISTANCE TO; No. of lines/ Length of each lin~ ¢ Top of tile to finish Dwelling / Inside length Width Dwelling Material Foundationo~, _~ ~..~// Nearest lot line Total length of line~,~./ Trench WLdth, 'i-/Z/-~Oinches MateriaJ beneath tile ~) t~) inches NO. OF BEDROOMS PE"MIT"O'~za/%/ No. of compartments Liquid depth PERMIT NQ. Liquid capacity in gallons PERMIT NO. Distance between line~..~. Length Type of crib Width Crib diameter Depth Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALS SOIL TEST RATINGG P-- INSTALLER REMARKS APPROVED DATE LEGAL L~k~ ~ z Blo~k -~ Lo~r Z~ 72-0~3 IRev. 31781 [,EPF.:;.?TP. EHT "'~" HEF!LTH f:IN?. "':'"'""~c,,::: ..., '"'~ ..................... '::;TF-?F'F'T F:LNCHOR!aC:iE., ;2.64 - ......... ':..::~ ~ 476:!. , t- ,... ":F.' SC TL F!E:SORI::'TI 3H S'./STEP! 'IS 'FP::'~::F MRY:II"!._H ,NL!HBEF.: OF E;E:E:,ROOHS; = ]: ::SOIL F-:.:P:TI'NG ,::Si::! FT,.'BF:: ..... ]::~.;F..: THE .REg!U ! RE:[::, 'F T Z'E ']F "FHE S:;O i L :P,B'S;CLF<F'T I ON S'-?STEI"! ~ S · 'T'HE.' LENGTH [:,I.r,'IENSTON I':.:-q 'THE LENGTH ,::IN F'EET) OF THE TRENCH OR [,F'FI]NF'TELL':, ",-~.E [:,EPTH OF F:I 'TRE]'.!::H (),k~: F'iT iS TF!E [:, I !S "F Fi .N C': E E:ETHEE:N 'i"HE: SLIRFf-]CE OF THE ............ ~' * 7~ ~'"'~ - ,! ..... .. . . '3~'r' i'./1": Flf-,![) *f'i-tE' E ']'~T'I"['¢'i OF TNE ~,:~, .f,, h.*- ~,~1'. ,:.!N FEET':,. 'THEF::E ~.::, i",iC! ,:.:-T WZO.rH F'OE: ''"' -'~ .... . ..... F "['HE [:~F-:FWEL [:,EPT.'"I ZS; THE H'rHIH.M DEP]'H 3F GRRVEL E~ETHEEN THE OLFFFRL. L FIi'.~.E:, T-'.4F E;OTTOH ........ r" THE EXC:F!VRTI C!P.,! ,:: :[ ?',l FEET). .::'E];?H Z T F!PF'L I C:RNT H,',::IS THE RESPONS; ! E: .T. L i 'T"./ T ] INFORM TH I 'S ." -';2F'RE'7' ',- El'. 'r [:,UR I NG 'TF!E: ? .......... - ~ - l: .... b . !iq'::;TFIi ! FFr'IcLi'-~ )ji'.,!'..BPECT]:C[,X,!":'5 F FIN'?' ,b~F:'t L'.'S k':'IE:,.J'F:ICEhiT TCI THI':'; .P!-:U,-'E:F-,:! . F!!'.,t[) THE i'*,!UHE:EF: OF !;::ESI[:,E!'.,P]:ES THF:Fi' TPiE WELL NT. LL SEF:',,,'E. E:FICKFI~_._!NG OF RN'./ ....... ':'./'gT.-':'M HZTHOUT FiNFIL .t:NSF'EC:TZE~N FIN[:, FIF'P~'"¢,/Iqi. ...... F",, ..... TH'rS [' EP.PR'T';,1E,%.'.' !.4 :[ LL. E~E :5 .. EL:HE ] T ']-Ci PRO.S..;E(]U]." :r. OhL HINIHUH Di'STFiNE:E E:ETWEEN R HELL RND R.N'¢ ON-'S;ZTE SEHRC:;E DISPOSRL. S'~'STEH IS !e,3 FEET FOR R F'RIVFYFE I.,.iGL.L OR iSE~ TO 20e~ FEET FROM R PUSLZC HELL C:,EPENDZNG UPON 'T'FiE T'¢F'E OF PUBLZC: P.IELL. MINiHUM DISTF!NCE FROM R F'RI',,,'FFFE HELL TO f~ F'RiVRTE SEHER LINE IS 25 FEE"F FIND 'TO FI COHMUNZT'./ SEHER LINE IS 75 FEET. OTHEF?. REg!LtIREhIENTS MF!"/ RPF'L"r'. SPEC!F'IC~T:EONS RNE) CONSTRUCTZO!q DIFIGRF!HS RRE R',,,'FiZLRBL. E TO ):N:StJRE PROF'ER ZNSTFIL. LFiTION. Z i:].'E~:T ! F"r' TFiF!T !: ! RH FF!H):L. ZFff;'. i.,,~I'T,'FI T!4. E REQUiREHENTS FOR ON-SITE SEHEF'.S RND HELLS RS SET F'ORTH B? THE ML!N! E:iPRL. I TY' OF RNC:HORF~GE. 2: I I.,]IL.L INSTF!LL THE S?STEM IN RCC:ORDRNE:E HiTH THE CODES. 3:: Z UNDER:~;'TRN[) 'FHRT THE ON-SITE SEHER S;h.'STEM MR? REQUIRE ENLF~RGEMENT IF' THE RES ZE:,ENCE ZS REHODELED TO iNC:LLIDE MORE 'r'HFml 3 BE[>ROOM'S. ' ~ E3 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: /D/P, LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15- 16- 17 18 19 20 SLOPE DATE PERFQRMED: [ + WAS GROUND WATER S ENCOUNTERED? O 5i1 IF YES, AT WHAT · E DEPTH? SITE PLAN COMMENTS PERFORMED BY: (.~YIQ~. 72-008 (6/79) Gross Net D,,ept h to Net Reading Date Time Time water Drop ~ q:2o I0 ~l~ O.q? O, OZ q: .~0 I0 ~,~ O, YZ O. 03 PERCOLATION RATE 5g (minutes/inch) TEST R.N.E-rWEEN FT *ND CERTIFIED BY: C, Reld, Municipality of Anchorage Oevolopment Servi¢os 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. 0il-i3~-0'~- COSA# ~'~(~.,/.~// ~ '~ ~'~ ~ ~:' r .... . Expiration Date: GENER~E!NFORMATIoN Complete legal description '~ &n~ L~ ~Z ~i~c~ ~ Lo{ [~ Current Property owner(s) Mailing address. '" Lending agency Day phone Day phone Mailing address Real Estate Agent ~o~0 no .Address Unless othen~,ise.requeste~, COSA will be held by DSD for pickup. Day phone NUMBER oF BEDROOMS: TYPE 'O~F WATER SUPPLY: Individual Well,' ~ Individual wa~er.storage Community Class ¢-... Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank Community On-site Public seWer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional ~civil engineer registered in the State of Alaska. Certificates of On-Site System's 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 theprofessional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER ¸5. As certified by my seal affixed hereto and as of the validation date shown belOW, I vedfy 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_ .~?~,c~,..,~ Address ~0.5 ~0. 15~ Ave. Engineer's Printed Name L.A~3 bedrooms. DSD SIGNATURE ~,~"" Approved for Disapproved.. Conditional approval for Phone bedrooms, with the following stipulations: By: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X ArsenicAdvisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: (Rev. 11/05) 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: .-~ L~~ ~ A. WELL DATA Date completed. -- Total depth ~ ft. ~oc~Z. 3 Lo't' i~ Parcel ID: C)lt- t~-{-O~ IfA, B, or C provide PWSID # --" Sanitary seal (Y/N).. -- Cased to ~ ft. Well Log (Y/N) "-- Wires properly protected (Y/N) -- casing height (above ground) '" in. FROM WELL LOG AT INSPECTION Date of test --- '--' Static water level --- ft. Well production "=- g.p.m. WATER SAMPLE RESULTS: 'Coliform .~.~b~coloniesll00 mL Nitrate JV'D mg/L Arsenic: q~,~' ug/L date of sample: B; SEPTIC/HOLDING TANK DATA Tank Type/Material ~{'~ I Tank size. [0,09"' '~' ..... gal... ~' *'~ · ;Number of.Compartments' ;~ Foundati~ ~l~a~ut"(Y/N)"?~' ,"'"'.Depression over tank (Y/N) ~ ~' ,~. ,, ..~ . ',~, Date of, pumping .~/~[Zt'IZoI~~'" Pumper C. ABS~P~ION FIELD DATA Date ins{ailed I ~ Soil r~ing (g.p.d./ff2 o ) ~ Length "3~..:.'.' fl. '..~,~ Width H~-~ [.c~ Total depth .i~~ ff. *~' ~ ' Eft. absorption area ~0 ff~ Monitoring tube. Date of adequacy test Results (Pass/Fail) t Fluid depth in absorption r~ld before test. ~ in. Water added [5~ gal. Elapsed Time: [~0 min. Final fluid depth ~ in. Any rejuvenation treatment (past 12 mo.) (WN & ~pe) ...~ g.p.m. Other bacteda/Ve~. 'colonies/100 mL Collected by: /'ar~ Date installed Cleanouts (Y/N) High water alarm (Y/N) System type Gravel below pipe Depression over field ,· For ~ bedrooms · ~ New depth.~,(o in. Absorption rate >= t{,50 g.p.d. If yes, give date - - D. LIFT STATION Date installed ,,,"' "Pump on" level at ~in. Datum / SEPARATION DISTANCES Size in gallons '. /Manhole/Access (Y/N) ' "Pump off" level at ~ High water alarm level at / in. Cycles tested / Meets alarm & arcu nts? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot '-' Absorption field on lot "'- · Public sewer main ~ ~, Sewer/septic service line '- Animal containment areas -'- On adjacent lots """ On adjacent lots - Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation -~ ~' Property line 5 ~ Absorption field Water main /V'. ,~ ~ water service line j'O'~- Surface water · Wells on adjacent lots [{30 ~-I- ~ SEPARATION' DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Co' .¥-. I' Water Service line. lO l' Curtain drain Building foundation Surface water Wells on adjacent lots Water main ~ ,~. Driveway. parking/vehicle storage I0 COMMENTS *' loc)' G. ENGINEER'S ~RTIF~ATION Engineer's Print~ Name _ , Date . ~ .-~ -.~ ...' N-~ COSA Fee $ , ~ ~ 'b Waiver Fee $ Date of Payment ~" ;Z, · "' ! (~ Date of Payment Receipt Number .... ~ ? ,~ ._~ C,,~ Receipt Number (Rev. 11/05) ~ ......... SGS SGS Ref.# I 103776001 Client Name Spurkland Engineering Printed Date/Time 08/09/2010 16:36 Project Name/# Sand Lake #2 B3,L18 Collected Date/Time 07/30/2010 9:50 Client Sample ID Sand Lake #2 B3,L18 Received Date/Time 07/30/2010 16:00 Matrix Drinking Water Technical Director Stephen C. Edt Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic 44.7 * 5.00 ug/L EP200.8 C (<10) 08/02/10 08/05/10 KDC Waters Department TotalNitrate/Nitrite-N ND 0.100 mg/L SM20 4500NO3-F B (<10) 08/02/10 AYC Microbiology Laboratory E. Coli Negative 1 100mL SM20 9223B A 07/30/10 DLC Total Coliform Negative 1 100mL SM20 9223B A 07/30/10 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 # 101178 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 18 of Sand Lake #2 Subdivision. This inspection revealed an arsenic concentration of 44.7 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On-Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. 02/28/02 15:57 FA~ 907 273 8440I'~.., PRUDENTIAL ¥ISTA REAL ES ~002 I~oo2 ~ ~J~l 02/P.$/,?.00% T'~ 14:44 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cLanchorage.ak, us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAHILY DWELLING Parcel I.D. 011-134-07 1. GENERAL INFORMATION Expiration Date: Complete legal description SAND LAKE SUBDIVISION #2; LOT 18, BLOCK 3, Location (site address or directions) 8100 SEAVIEW DRIVE * ANCHORAGE,. AK 99502 Current Property owner(s) Mailing address Lending agency DENNIS McDONNELL Day phone 245-4204 8100 SEAVIEW DRIVE * ANCHORAGEi AK 99502 Day phone Mailing address Real Estate Agent Mailing address LARRY SUITER w/ PRUDENTIAL VISTA Day phone 4241 '~" STREET * ANCHORAGE, AK 9950.:3 273-7766 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well [] Individual On-site '1~ Individual Water Storage [] Individual Holding tank [] Community Class "C" Well · Community On-site [] Public Water System [] 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 4 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, or pdor to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER ¢s certified by my seal affixed hereto and as of the validation date shown below, I vedfy 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 Anchorege 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC. Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Phone ,337-6179 Engineer's Comments: In conducting this evaluation, AWl/CC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulation& The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of afl wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. A WWC, Inc. can therefore nat provide any warranty orfuture estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other peraon or parfy ts nat authorized, nor will it confer any legal right whatsoeve~ 5. DSD SIGNATURE Approved for --~ bedrooms. Disapproved. Conditional approval for Attachments: HAA Checklist Septic System Advisory Well Flow Advisory bedrooms, with the flIowing st pu at ons' , (((fi,fi';',,. ~ -~,-. ~,LmTE ~: WATERANO ~ ; ~)~A,STEW)ZER ~ ' PROG~M Manitenance Agreements ,-9)j ~ ~ ] )~ ) ~))1, Supplemental Engineer's Reo~ Other (Rev. ~'01) Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Dlvisinn On-Site Water & Wsstewater Program 4700 Souffi Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ek.us (;07) 343-?;04 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: SAND LAKE S/D 1~2; LOT 18, BLOCK 3~ Parcel ID: A. WELL DATA 011-154-07 Well type ';' If A, B, or C provide PWSID# 21~4~ Well Log (Y/N) Date completed Sanita~/seal ~) ~ ft. Casing height (above ground) FROM WELL LOG AT INSPECTION ~ J g.p.m. g.p;m. Nitrate O0,~ mgJL. Other bacteria Date of sample: 2/27/2002 Collected by: Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform ~) colonies/100 mi. Arsenic: N/A mg./L. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Tenksize 1000 gal. Numbar of Compartments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping 6/18/2001 Pumper ,~l coicnies/100 mi. AWWC, INC. Date Installed 6/12/1982 Cleanoufe (Y/N) YES High water alarm (Y/N) N/A ROTO ROOTER C. ABSORPTION FIELD DATA Date installed s/12/19s2 Soil rating (g.p.dJff=or(~) 100 System type' ' Length 54 ft. Width 3.7-5.0 fl. Gravel below pipe Total depth 2o.5 .ff. Eft. absorption area 340 fi= Monitoring tuba YES Date of adequacy test 2/27/2002 Results (Pass/Fall) PASS Fluid depth in absorption field bafora test 0 in. Water added 478 gal. Elapsed Time: 20 min. Final fluid depth 20 in. TRENCH 5 It. Depression over field NO For 3 bedrooms New depth 31 in. 450+ g.p.d. Absorption rate >= NONE KNOWN If yes, give date Any rejuvenation treatment (past 12 mo.) (Y/N & type) D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump_.~_JJ~. High wa~r alarm level at ~ ~ Cycles tested Meets alarm & circuit requirements?. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main On adjacent lots Public sewer manhole/cieanout Holding lank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water sen, ice line 10'+ Wells on adjacent lots '100'+ Absorption field Surface water. 5'+ 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water sewice line 10'+ Curtain drain NONE KNOWN Building foundation. 10'+ Surface water 100'+ Wells on adjacent lots '100'+ Water main N/A .Driveway, parking/vehicle storage 25'+ F. COMMENTS · 100' BLANKETS WAIVERS GRANTED TO CLASS "C" WE'LLR ON LOT 8, BM( .3 & LOT 22, BM( 3. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and revfew of Municfpal records that the above systems ere/n conformance with MOA HAA guidelines in effect on this date. JEFFREY A. GARNCSS Engineers Printe(J Name Date ~/I/OZ.. Waiver Fee $ Date of Payment Receipt Number. .~o~ · /- - ~- "7 - .toc~ ---- l-- %.. ---/---\----:-...-~----'m>. /~,, __.\J "" _~-:,. x i -' ,~ ./ ~,. ,.~ ..--- ~ ~-v~ , ~ ~-, - ALAS~ WATER A~ WASTEWATER CONSULTAmS, ~C. ~-- : ~'i i ~"~:";'~ PAT AND PAU~ WlTHERELL (gO7) 248-5445 ,o,,,,,, I. ".~.~. I '='°°' I~°~ 02/28/02 19:57 FAX 907 273 8440 PRUDENTIAL VISTA REAL ES [~002 ................................................ ~oo; 02/~'$/2Q0~ TEU '14:44 [TX/RX rio 1~3u) 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 ~N/~fPALITy OF ANc ~ ENTAL $~RVm- ~ ~8 DIVi~ioN OCT 09 1997 R CEIvED 1. GENERAL INFORMATION Location (site address or directions) / ./ Property owner Mailing address Lending agency Mailing address / I / / / Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: Day phone Day phone TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 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 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 ,~]~'/-/-/ ~,,q"z'),~J/,,,2,d/"~ Phone Address /TL~L~ YET.~/)4::~/? C1'7'~/c ~/~772/~C /~ Engineer's signature / Date ! DHHS SIGNATURE ' ~ APproVed for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations; Additional Comments By: The Municipality of A~chorage 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 enginee[ registered in the State of Aleska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of 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, I/91) Back MOA~e21 Municipality of Anchorage ~IRONM~AL SERVICES ~1~ DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Se~ices Division . . ,0C~ 825 L Street, Room 502. Anchorage, Alaska 99501 Health Authority Approval Checklist Legal Description: ,~0~ ~,/~E~2 /-07c/~, B/~,-~ Parcel I.D.: ~// /,~ 07'000 A. WELL DATA If A, B, or C, attach ADEC letter. ADEC water system number Casing height (above ground) Wires properly protected (Y/N) Well type Log present,N) (r.~/./ ~ F//'/~ Date completed Total depth 4/~-' Cased to 4~' Sanitary seal (Y/N) AT INSPECTION FROM WELL LOG Date of test Static water level Nitrate /V/O/D~t~c'/~d Other bacteria / 0 /0~ /'~/ 7' Collected by: Well production WATER SAMPLE RESULTS: Coliform ~ Date of sample: B. SEPTIC/HOLDING TANK DATA High water alarm (Y/N) ~,//~/,~_ Tanksize /OC)O Number of Compartments ? Cleanouts(Y/N) ~ · Depression over field (Y/N) . . __ For Immediately after ~,/~ gal. water added (in.): Absorption rate = ~ ~'~ g.p.d. If yes, give date /~/'/~ System type ~ Total depth /~'o Z Date installed Foundation cleanout (Y/N) ~ Depression (Y/N) Date of Pumping /~ ~t'~ ?~--Pumper C. ABSORPTION FIELD DATA Date installed ~ Soil rating (g.p.d,/fF o~ Length 3~ ~ Width /-/'/-/"~ ~ Gravel thickness below pipe Effective absorption area ,~ .~'_,~ Monitoring Tube present (Y/N) Y Date of adequacy test ~//~//?~7 Results (Pass/Fail) Fluid depth in absorption field before test (in.); Fluid depth 0 (ins) Minutes later: /.~ Peroxide treatment (past 12 months) (Y/N) bedrooms 72-026 (Rev. 3/96)* D,-.J=[FT STATION --~. Date ins~ Manhole/Access (Y/N) High water alarm level at* Cycles tested Size in gallons *Datum "Pump off" I~Vel at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: -- Septic/holding tank on lot ~ ' /v'/~ On adjacent lots ~E)~, / /~ Absorption field on lot 15ublic sewer main On adjacent lots Public sewer manhole/cleanout Sewer/septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~ Property line _~2.' Absorption field · ~ot~,'~9 ,c~,~c/ Water main/service line ~78 Surface water/drainage /04) ' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~,' ~ (~ ' Building foundation .~ .5'~ Water main/service line Surface water I~/O//~i'D~2 ~OU,Od ~1'~ /~' Driveway, parking/vehicle storage area / Cudarn drain ~ Wells on adjacent lots /~ / ENGINEER'S CERTIFICATION ~ Co~C~ ~[~ ~a~ ~-~//~ I ce~ify that I have determined thru field inspections ~ in conformance with MOA H~ guidelines in effect on' this date. Signature ~/2~J~ Engineer's Name / / HAA Fee $ Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ and ~- 5/"/° are Date of Payment .Receipt Number CT&E Environmental Sewices Inc. Drinking Water Analysis Report for Total Coliform Bacteria ~oo w, Anchorage, AK 99818-1805 MUST BE ~ PUBLIC WATER SYSTEM LD. # P~VAT~ WATER SYSTEM Mootb SA M~LE TYPE: Yea r 0 Treated Water O Repeat Sample (for routine sample ~ Uatreated Water ~th lab ~f. no. ~ _ ) ~Special P~rpoae Time Collected SABLE LOCATION Collec~d By gax: (9071 561-5301 TO 1t~ COMPLETI/D BY LABORATORY Satisfacto~ Unsatisfa~o~ Sample over 30 hours old r~sul~ may be unreliable S~pJe too long in transit; s~ple not be over 48 hours old at examination to indicate reIiabl= result, PIeasesend new sample via special deJivem mail, Aaalyttcal Me/bed: ~embrane Filler * Number ofcolonles/IO0 ml, L__ab Ref. No. Result* Analyst 97.6077 ~ ~ Sent to A.D.E.C, Ancl~ FbI~I Jun [] Fazed Client ~otjfied of unsatisfactory results: Fazed BACTERIOLOGICAL WATER ANALYSIS REcoRD MMO.MuG Reault. Total Coliform Membrane Filter: Direet Cnunt __ , --' -- Verification: L'ra _ Co~onie~'100 mi -- .Ga Fec. I Coliform Confirmation __ Fine! Membrane Filter Reslllts Collform/i 00 Time ~ _ hr~ TOTAL P. 01 CT&E Environmental Services Inc. CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By 975466001 S K L H Consultants Sand Lake No. 2 L18,B3 Sand Lake No. 2 L18,B3 Drinldng Water Client PO# Printed Date/Time 09/17/97 19:21 Collected Date/Time 09/12/97 12:07 Received Date/Time 09/12/97 12:30 Technical Director: Stephen C. Ede PWSID 216546 Released By~ ~ Sample Remarks: Allowable Prep Analysis :Parameter Results PQL Units Method Limits Date Date [nit Nitrate-N 0.100 U 0.100 mg/L SM18 4500-NO3F 10 max 09/13/97 JRJ Total Colfform 1 OB, NO COL[/ 100 ML SM18 9222B 09/12/97 TMW 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ~ ~ LI ~ ~)"~ HAA# ~---~ %'--'"~ ~ ~,~ IC'~'~-E-~ ~''') 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Ad dress Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: Individual well Community well X Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 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 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. NameofFirm _/-~'¢~-/P/~ ~/~'¢h'///~.~ Z~,~,;¢,.~,'~- Phone Address ~ ~/~~r~ ~,/, .~.~ Engineer s signature ~~~2~ Date DHHS SIGNATURE /~ Approved for ~ __ Disapproved.' COnditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DH HS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev, 1/91 ) Back MOA ¢Y21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAl CHECKLIST Legal Description: ,'~--J'-?~,~-~'~ ,'~/-~/', .¢~;','/,'('~//,~.'//,~ Parcel I.D. A. WELL DATA Well type Log present ~)'N) Total depth /.~Z./.,~ / Sanitary seal ~N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed _ ¢/'/~,~//~ Z Driller Cased to --~/~'~ / Casing height ///"~ Wires properly protected~/N) Date of test ' Static water level FROM WELL LOG AT INSPECTION " 1/.~ Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /~).'~ Absorption field on lot /~-~'z~ / ; On adjacent lots /~ ;5" ; On adjacent lots //.~" Public sewer main Sewer service line WATER SAMPLE. RESULTSi co iform · Date of sample: // SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) / P~blic sewer manhole/cleanout /~A,~- Petroleum tank /'~,~,~' Nitrate Collected by: Other bacteria / -,~ Tank size / Foundation cleanout (Y/N) / Compartments ~ Depression (Y/N) High water alarm (Y/N) Date of pumping Well(s) on lot . ./I//~ On adjacent lots ! To property line ~..,.~- Absorption field .--~- ./ Surface water/drainage Alarm tested (Y/N) P'umper ~ Foundation Water main/service line 72-026 (Rev. 7/91) Front 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 "PumP'0ff" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~'/Z//~-~ Length y,,~, Z / Width Total absorption area Depression over field (Y/N) ..,¢¢ Results (pass/fail) yd~ Peroxide treatment (past 12 months) (Y/N) Soil rating Gravel thickness Cleanouts present (Y/N) Date of adequacy test for Total dePth If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water · Curtain drain On adjacent lots //3_~" Property line To existing or abandoned system on lot Cutbank ,,A/~,~,... Water main/service line Driveway, parking/vehicle storage area ~-~,/' E. ENGINEER'S CERTIFICATION bedrooms Signature Engineer's Name Date HAAFee$ l~ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 WALTER J. HICKEL, GOVERNOR (907) 563-6775 December 27, 1991 FOR: Harding Lawson Associates PWSID # 216546 My review of the records on file in this office reveals that Lots 13-18, Block 3, Sand Lake #2 Subdivision, Class "C" Public Water System, is in compliance with the provisions of 18 AAC 80.200, State of Alaska Drinking Water Regulations. Sincerely, Byron Roys Environmental Engineer BR/~ RECEIVED ,lAN 1 4 1992 Munic~pah~y ot Anchorage Dept. Health & Human Services Date Date Date inspector inspector ~ Conditional Approval 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 /~. Phone Mailing AddressZtT ! Dr' Buyer Address Phone Lending InstiJuJion Address ~-~, Realty Co. & Agent ~eg,.~t? (~e~J~r ~O,:~.~- ~ ' ~ , - .... Phone Street Location ~C~/I ¢0 Type~f Residence . ~ Single Family Q Multiple Family No. of Bedrooms Q Other Water Supply - ' ~ Individual A~ACH 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 Utilit~ : available.) Sewage Disposal ~ 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,