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Home My WebLink AboutSAND LAKE #2 BLK 4 LT 4Sand Lake #2 Block 4 Lot 4 #011-135-49 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 'I of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201459 PID Number: 011-135-49 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 9 Upgrade Name KYALE SWENSON ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ound Site Address 8033 SAND LAKE ROAD *ANCHORAGE, AK ❑ other Phone Number of Bedrooms Soil Rating Total depth original grade 907-360-7015 3 GPDISF Ft. LEGAL DESCRIPTION Depth to pipe invert from original gradFt, Gravel depth beneath pipe Ft. Subdivision Block Lot SAND LAKE #2; BLOCK 4, LOT 4 Fill added above original gr Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total orption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well 100'+ TANK ❑E Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER TANK Capacity 1250 Gal. Surface Water 1100'+ Material Number of compartments Lot Line 5'+ NA HDPE 2 Foundation 101+ LIFT STATION Manufacturer Capacity Remarks OLD TANK DECOMMISSIONED PER UPC Gal. Electrical installed by PER CONTRACTOR Alarm location Installer PIPE MATERIAL House to tank D3034 Tankto D3034 HOMEOWNER INSTALL Drainfield 03034/exisnHG CO/MTD3034 Inspector TIM ECKLUND AND GEG BENCH MARK (Assumed elevation) 99.96 ft Inspection f 5l 10/30/2_020 - Location and description 3r' _ 4'h _ TOP OF MH ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Slamp Conditional Approval: Date fl �F-• " '��% 4�� 000��. t /� •.�TO g TH. /(. ..... � ...: .. .Jleff ey A. Ga. n��s•' /J 0 �• �cE=7953-/ Septic System Approve Date 1(z3-Zd e`0� �o s Note: this approval does not include well permit requirements. Aeccea4��O�000�� krRCv VU/UL/ IDf PERMIT NUMBER: PARCEL ID NUMBER: OSP201459 RECORD DRAWING 011-135-49 MH1 39.3 39.3 STI 413 43.2 DBLi 45.1 45.1 DBL2 47.1 47.0 C01 51 J 86.5 SWING TIES DERIVED FROM AS -BUILT SURVEY Jg O� I I\ I I \ I SAND LAKE #2; BLOCK 4, LOT SAND LAKE #2; BLOCK 4, LOT 3 / NEW 1000 GALLON HDPE GREER TANK u 2I �; w•- .�:_� ENGINEERING- SALES, CONSULTINGw B PREPARED FOR: HE PAGE NUMBER: KAYLE SWENSON EXISTING 3 0 BEDROOM M I W. «,ul.: HE LEGAL DESCRIPTION: DBL1&2 DRAWN BY: 7- •DRIVEWAY < D.J.G. I WATER LINE PROFESSIONALLY LOCATED AND TAKEN FROM DATE: AS -BUILT SURVEY C) 1 111 7/2 02 0 I < I I / r i I ( SAND LAKE #2; BLOCK 4, LOT 5, 6, 47 AND 48 -A S IIS IJ , Lt �; w•- .�:_� ENGINEERING- SALES, CONSULTINGw 3701 F—WOORFMD.SLATE 101•ANC-HORAGE.AK99307• PHONE (807) 337tl179• FAX(907)33a-"0a VvEBSRE: wlw.Omas.<A9i+elfnp com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: KAYLE SWENSON 907-360-7015 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: SAND LAKE #2; BLOCK 4, LOT 4 D.J.G. TYPE OF WORK: DATE: �,_SEPTIC TANK RECORD DRAWINGS 1 111 7/2 02 0 I SAND LAKE #2; BLOCK 4, LOT 51 1 I SAND LAKE #2; BLOCK 4, LOT 50 l r— APPROXIMATE LOCATION OF EXISTING ' DRAINFIELD PER CLEANOUT AND SUMP LOCATIONS: EXACT SEPERATION DISTANCE FROM WATER LINE IS UNKNOWN; SURVEYOR DID NOT ADD WATER LINE PAST THE SHED. MT AT WEST END OF TRENCH WAS NOT INSTALLED (APPROVED BY MOA DURING INSTALL), I \I / /SAND LAKE #2; BLOCK 4, LOT 49 loo,IL \ L tW� N SCALE: I" = 40' d • .s OGJ«'�/ CE-7953 LICENSE4�p VR�OS0s4 V. #AECC884 / PERMIT NUMBER: PARCEL ID NUMBER: OSP201459 RECORD DRAWING 011-135-49 70P OF MANHOLE = 99.98 TOP OF TANK AT INTLEf - 93.71 INVERT OF SUNG AT INLET = 93.04 MH NEW 1000 GALLON H.D.P.E. SEPTIC TANK FINAL GRADE = 99.8-99.9 TOP OF TANK AT OUTLET= 93.70 INVERT OF BUNG AT OUTLET = 92.88 I , t ENGINEERING t SALES;; CONSULTING 3701 E. TUDOR ROAD. SUTE 101 ' ANCHORAGE, A1( 09507- PHONE (907) 777-0179 • FAX ]] W248 • NEBSITE: wxw.pamana09hasMg eam PREPARED FOR: PHONE NUMBER: PAGE NUMBER: KYALE SWENSON 907-360-7015 3 OF 3 LEGAL DESCRIPTION: DRAWN BY: SAND LAKE #2; BLOCK 4, LOT 4 D.J.G. TYPE OF WORK: DATE: � SEPTIC TANK PROFILE 11/16/2020 • •* LICENSE44 4 1k'A fl ��54��'�� #AECC88d 0 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PDBox 1o8aoo 47o0Elmore Road Anchorage, Alaska y9s1e-68nV pnomo: 07) Fax: (907) 343-7997 Ntp:VV�mwv.muni.arg/onsKe Permit Number: OSP201459 Work Type: SepdoTmnkDpgrade Tax Code Number: 01113549000 Site Legal Address: SAND LAKE #28LK 4 L 4 G:2224 Site Mailing Address: 8O33SAND LAKE RD, Anchorage Owner: 5VVENSENKYALE Design Engineer: GARNEG8ENGINEERING GROUP LTD This permit isfor the construction of: Effective Date Expiration Date Lot Size in Sq Ft: 10/27/2O20 1027C2O21 El Disposal Field 9 Septic Tank 0 Holding Tank El Privy F1 Private Well 0 Water Storage All construction shall beinaccordance with: 1 The attached approved design. 2, All requirements specified inAnchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72)and Drinking Water Regulations (1OAAD8O) 1 The wastewater code requires inspections during the installation. The engineer shall notify theDeve|opmooi Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7)� 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall beeither: a Opened and Closed onthe same day, or b. Covered, sealed, and heated hoprevent freezing Special Provisions: 1. The water service line shall be professionally located pf ior to installation of the tank to confirm minimum 10 ft separation toseptic system. 2. The final as -built survey shall show the 15ftCEA easement along the west property line. Received Byw: Issued By: • ., Community Development Department Phone: 907-343-7904 Development Services Fax: 907- 343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan On -Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 011-135-49 Property owner(s) KYALE SWENSON Day phone Mailing address 8033 SAND LAKE ROAD *ANCHORAGE, AK Site address 8033 SAND LAKE ROAD "ANCHORAGE, AK Legal description (Sub'd, Block & Lot) SAND LAKE #2; BLOCK 4, LOT 4 Legal description (Township, Section & Range) Lot Size APPLICATION IS FOR: ( ® all that apply) Absorption Field ❑ Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Sq. Ft. Number of Bedrooms 3 APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: N/A TYPE OF DEWELLING: Single Family (SF) (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: - I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: #1613.75 COvib Waiver Fees: Date of Payment:( 0 `23 --LD Date of Payment: Receipt Number: QC( i� Receipt Number: Permit No. 05P001 g 59 Waiver No. (Rev. 01/11) Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201459, Rebecca Carroll, 10/27/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201459, Rebecca Carroll, 10/27/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201459, Rebecca Carroll, 10/27/20 0 Hlnos U 8 C) y tD Q U co co U � (- o cwn ui Ln z o 9 • ,((\pper�� 11n �;;yj f— OWN, VxQ x,0'9 L �o" ,00'092' H12i0N 1-= � 0 0 0VON 3XV7 GN VS o `�\`1�1 tai\�1ttt CD ro LL 00 C0 �J lrrr ��;• 0); It, � �LZ LLlw fl -0 LJ� ¢ ,T p LJ uj O¢O<O t�-OQ L1- _..t O Z 0 U GL I— wOC, CE, o: = ¢ O :MF z � 3 Z W O w O W F-- m cn W LU 7�}= Q m = �E z - ::I UJ Li Ov�ioQzz =a=�E5R4= r O N Q O Z N zCO N wZ 0rr ►W-�� >cn1 Q°5 U�¢ 47 m VJ n O O ¢ G Q' F— co � :D Q 0C10 .� L5 LIJ0 `oo � CJI 0 �)/ co r)z O Q Y rQ��1 �+J LO 0 < `�\`1�1 tai\�1ttt CD ro LL 00 C0 �J lrrr ��;• 0); It, � �LZ LLlw fl -0 LJ� ¢ ,T p LJ uj O¢O<O t�-OQ L1- _..t O Z 0 U GL I— wOC, CE, o: = ¢ O :MF z � 3 Z W O w O W F-- m cn W LU 7�}= Q m = �E z - ::I UJ Li Ov�ioQzz =a=�E5R4= MUNICIPALITY OF ANCHORAGE �� J ® 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 PNEW I to r1rcli, e,,r 3_.5 e, I ❑ UPGRADE MAI LING ADDRESS �. qc75jo LEGAL DESCRIPTION Z_ C � Jff: /, % J Vl LOCATION r. NO. OF BEDROOMS c C' GCJE % Uy DISTANCE TO: Well Absorptionea / O . Dwelling 3 O', PERM O. 24 O IL- z Manufacturer Material No. of co artments W c e r Liq. capacity in gallons IF HOMEMADE: Inside I��,,n99,�t IV.— t -t&. Liqui ept 6 y DISTANCE TO: Well Dwelling PERMIT NO. z 02 h Manufacturer Material Liquid capacity in gallons . w= DISTANOCTO: Well . O Founciati n , Nearest lot line PER O. Q J LL Z Wiz¢ No. of lines Length of each line �� S-� —In, Total len th of lines Trench width rr Distance between lines r lI I.- Top of tile to finish grade inches- Material beneath tileTotal _1_. effective absorption area 0 61 r �r inches I n Rin ��. w Length Width Depth PERMIT NO. U a F LU Type of crib Crib diameter Crib depth Total effective absorption area W w DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. J W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area (s) OTHER P 'PV e PIPE MATERIALS rr ?c /> VC to SOI L TEST RATING Ss INSTALLER J err& er a< < REMARKS dia. n I, 3o %aw S o• C C overtD e�jGer PeaVer p,a 35' 01�®®®®.O®�I gyp'(.,....... 49th Zp, '!r e�'e- 133 -E aUARGFESSgIO� APPRO D Q,� Q{/f71sAT Ij LEGAL 72-Q13 (Rev. 3/78) HPPLICHNT LOCHTION LEGAL �� -�� .... DEPHRTMENT,OF HEHLTLJHND E�\IRONMENTHL.��OTECTION 825 ' � STREET, HNCHORHGE/ HK��1 264~4720 - ��~�� SIE�RH BUILDERS X 67 99510 - ' SHND LHKE RD/8�ND �4B4 SH�D LHKE#2 LOT SIZE 8100 SQ T � MHXIM�M NUMBER OF BEDRO�MS � � MEN= SQIL RHTING (SQ FT/BR)� 85 THE REQUIRED SIZE OF THE SOIL �BSORPTION SYSTEM IS� THE LENGTH DIMENSIOH IS THE LENGTH (IN FEET) OF THE TRENCH OR DRSINFI�LD ^r�Uucr'�D��H� TRENCH �R PIT IS THE DISTHNCE BETWE..... N TH� SURFHCE OF THE EXCHVHTIO�� (IN FEET) THERE IS NO SET WIDTH FOR TRENCHE5 THE GRH;ELTDEPTH IS T�fE Ml�IM�M j4 1.,ir OF GR�V�L �ETWEEN THE OUTFHLL PIPE !Up, OF THE EXCHVHTION (IN FEET) �q7,�� v�� If� ' PERMITLHPPLICHNTpHHSITHE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE SN�c| ��S OF HNY WELLS HDJHCEMT TO THIS PROPERTY HND THE zu� �� THHT THE WELL WILL SERVE �--LL�� m q�� W-, g---�� r� ��b C� H�Y SYSTEM WITHOUT FIHHL INSPECTION HND HPPROVHL BY THIS ~~-~-~ V��MHTMENT NILL BE SUBJ�CT TO PROSECUTION MINIMUM DISTHNCE BETWEEN H NELL HND HNY ON^SITE SEWHGE DISPOSHL SYSTEM IS 100 FEET FOR H PRIYHTE WELL OR 150 TO 200 FEET FROM H PUBLIC NELL DEPENDING �FON THE TYPE OF PUBLIC WELL MINIMUM It 'L FROM H PRIVHTE WELL TO H PRIVHTE SEWE� LINE IS 25 FEET HND TO H COMMUNITY SEWER LIN� T IS 73 FEE WELL LOGS HRE REQUIRED HND T BE R�TURNED TO THE DEPHRTMENT WITHIN ]0 DHYS OF THE �ELL COMPLETION - OTHERREQ�IREMENTS MHY HPPLYSPECIFICHTIONS HND CONSTRUCTION DIHGRHMS SRE HVHILHBLE TO INSURE PROPER INSTHLLHTION I CERTIFY THHT 1� I HM FRMILIHR WITH THE R�QUIREMENTS FOR ON^SITE SEWERS HND WELL5 HS S FORTH BY THE MUNICIPHLITY OF HNCHORHGE ET 2� I WILL INSTHLL THE TH THE CODES ]�SIDUNDERSTHND THHT THE ON~SITE SENER'SYSTEM MHY REQUIREENLHRGEMENT IF THE � ..... F[E IS REMODELED TO INCLUDE MORE THHN ] �E�ROOMS SIQNE �~... ..... ..... _. ' ��L1�HNT SI�RRH BUILDER� PERMIT N(l HPPLICHNT LOCHTION LEGAL �� -�� .... DEPHRTMENT,OF HEHLTLJHND E�\IRONMENTHL.��OTECTION 825 ' � STREET, HNCHORHGE/ HK��1 264~4720 - ��~�� SIE�RH BUILDERS X 67 99510 - ' SHND LHKE RD/8�ND �4B4 SH�D LHKE#2 LOT SIZE 8100 SQ T � MHXIM�M NUMBER OF BEDRO�MS � � MEN= SQIL RHTING (SQ FT/BR)� 85 THE REQUIRED SIZE OF THE SOIL �BSORPTION SYSTEM IS� THE LENGTH DIMENSIOH IS THE LENGTH (IN FEET) OF THE TRENCH OR DRSINFI�LD ^r�Uucr'�D��H� TRENCH �R PIT IS THE DISTHNCE BETWE..... N TH� SURFHCE OF THE EXCHVHTIO�� (IN FEET) THERE IS NO SET WIDTH FOR TRENCHE5 THE GRH;ELTDEPTH IS T�fE Ml�IM�M j4 1.,ir OF GR�V�L �ETWEEN THE OUTFHLL PIPE !Up, OF THE EXCHVHTION (IN FEET) �q7,�� v�� If� ' PERMITLHPPLICHNTpHHSITHE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE SN�c| ��S OF HNY WELLS HDJHCEMT TO THIS PROPERTY HND THE zu� �� THHT THE WELL WILL SERVE �--LL�� m q�� W-, g---�� r� ��b C� H�Y SYSTEM WITHOUT FIHHL INSPECTION HND HPPROVHL BY THIS ~~-~-~ V��MHTMENT NILL BE SUBJ�CT TO PROSECUTION MINIMUM DISTHNCE BETWEEN H NELL HND HNY ON^SITE SEWHGE DISPOSHL SYSTEM IS 100 FEET FOR H PRIYHTE WELL OR 150 TO 200 FEET FROM H PUBLIC NELL DEPENDING �FON THE TYPE OF PUBLIC WELL MINIMUM It 'L FROM H PRIVHTE WELL TO H PRIVHTE SEWE� LINE IS 25 FEET HND TO H COMMUNITY SEWER LIN� T IS 73 FEE WELL LOGS HRE REQUIRED HND T BE R�TURNED TO THE DEPHRTMENT WITHIN ]0 DHYS OF THE �ELL COMPLETION - OTHERREQ�IREMENTS MHY HPPLYSPECIFICHTIONS HND CONSTRUCTION DIHGRHMS SRE HVHILHBLE TO INSURE PROPER INSTHLLHTION I CERTIFY THHT 1� I HM FRMILIHR WITH THE R�QUIREMENTS FOR ON^SITE SEWERS HND WELL5 HS S FORTH BY THE MUNICIPHLITY OF HNCHORHGE ET 2� I WILL INSTHLL THE TH THE CODES ]�SIDUNDERSTHND THHT THE ON~SITE SENER'SYSTEM MHY REQUIREENLHRGEMENT IF THE � ..... F[E IS REMODELED TO INCLUDE MORE THHN ] �E�ROOMS SIQNE �~... ..... ..... _. ' ��L1�HNT SI�RRH BUILDER� -� -� SOILS LOG MUNICIPALITY OF ANCHORAGE +.� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST ` QQp PERFORMED FOR: �� j�._� r to/� P..P-S DATE PERFORMED: �CJ 1%4AY 8Z LEGAL DESCRIPTION:_ SAND LA,,V SUFb. 0 R2 `,,,®T AC3 �/ �•� ( I SLOPE SITE PLAN DEPTH /2� TO P 5CO IL- JILT' 1 I. I GROWN $IL7 z 3- -4- 5 5 6 C w CgR.A.Ve s 7 weR>yAsimicr Ifs. 8 51E w rrH D L Pim llc> CtoP,LW>1.E:5 9 10 12 13 14 15 16 17 18 19 20 COMMENTS PERFORMED BY: 72-008 (6/79) ��w�••••••i s>L �.` •. 04 49 •`• r T S R, SMITH Y 2248-E r1111�i111��11R�111�r Reading Date Gross Time Net Time Depth to Water Net Drop N 0 r PERCOLATION RATE TEST RUN BETWEEN 41 v v' CERTIFIED BY: FT AND (minutes/inch) _— FT DA CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT Plans for the construction of.—SAW D L,49C S10 ` 2_ L013 41 4 U 5i .910e 6c- 14 1' 1nss � C7111 — CA 196) ---public water system located inRvn c 1A6(' jCz F / 1e ( Alaska, submitted in accordance with 18 AAC 80.100 by 101 O S CA to e e have been reviewed and are X approved. conditionally approve (see attached conditions). �� TITLE,1 VV 14 vJ-I`'tile(� a�tz I NPf't' DATE �J f" If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. APPROVED CHANGE ORDERS Change (contract order no. Approved by Date or descriptive reference) The "APPROVAL TO OPERATE" section must be completed before any water is made available to the public. APPROVAL TO OPERATE The construction of the k t 49 public water system was completed on �"- �� = (date). The system is hereby granted interim approval to operate for 90 days following the completion date. TITLE _ DATE As -built plans submitted during the interim approval period, or an inspection by the Department has confirmed the system was constructed according to the approved plans. The system is hereby granted fina approval to operate. rg0ft1pe1&j4j-1+( CL 9, Y TITLE DATE q.w 73 4��✓� z GARB -H01 GRr -TER ANCHORAGE AREA BOROL ,4 ' DE-rARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE.'DISPOSAL SYSTEM r - NAME ��Cr'ilh"� `�I_�f%/ _- MAILING '-+ , ADDRESS /'PHONE LOCATION `;%/f///'' LEGAL DESCRIPTION 47k % �;;1P_/5�tf�, cP_rc.l� l cis NUMBER OF COMPARTMENTS LIQUID INSIDE WIDTH DEPTH__ - )TH , LENGTH , DEPTH , BUILDING FOUNDATION , (WALLA _7c)—_._._ --- SQ. FT. /� ` TOTAL LENGTH__ —_. 1� EST LOT LINE k�, OF LINES<= TRENCH WIDTH�.3 �� IN. TOTAL EFFECTIVE RIAL BENEATH TILE IN. ABOVE TILE / [ION. �'� / SAMPLE %r:i�i WATER NEAREST OTHER M CESSPOOL SOURCES_ - SYSTEM DATE 7 APPROVED G.A.A; . GAAB-hD-22 n/ GREATF" '.NCHORAGE AREA, ")ROUGH Case No. Cf Sf5_� /A0 HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT /041 MAILING ADDRESS A112 A/ PHONE NO. 2l� y�Jtl RESIDENCE ADDRESS z LOCATION OF INSTALLATION LEGAL DESCRIPTION- APPLICATION ESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK _X, SEEPAGE PIT , DRAIN FIELD , OTHER TO SERVE THE FOLLOWING FACILITY m GZ v12� 'Lc <�L/�E'�Giu✓ FINANCED THROUGH 4CZZ TO E INSTALLED PERCOLATION TEST RESULTS! �� ANTICIPATED DATE OF COMPLETION I -ZIP BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS 't( f� ✓v � � PERMIT TO INSTALL A 419! V ✓� AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED SEPTIC TANK SIZE 1 -TYPE � 9 TYPE•��'� '��, �� e DIAGRAM OF SYSTEM j°L�� DISTANCES l l u� Li LZ L kL�� alvlvf HEALTH AUTHORITY OR LICENSED DESIGNER I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code, ATEL%l APPLICANTS SIGNATURE �1 ?SSP ap0110R4pE4p�q GREATER ANCHORAGE AREA BOROUGH * O IIIIIn/\\/'eoc HEALTH DEPARTMENT 9 c 327 EAGLE STREET • P. O. BOX 968 z ANCHORAGE. ALASKA 99501 s ;y PHONE 278.2517 r January 18, 1971 Dir. Tom Swanson 8041 Sand Lake Road Anchorage, Alaska 99502 SUBJECT: Application and Permit for Sewage Disposal System, 8041 Sand Lake Road Dear Mr. Swanson: September 14, 1970, you obtained a permit from this Department for the installation of a sewage disposal system. As of this date, the permit is still outstanding. Please advise this Department is you have installed, or still intend to install, a sewer system on the subject property and wish your permit kept pending in our files. Sincexely, y Ly n S. Coad Sanitarian rn Cry CGCI�-�AIR �1i�C��LASKA�l9==%F" �T'€ �G� ..� a=• �- 2C: v Municipality ®f Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I. D.011-135-49 1. GENERAL INFORMATION: Complete legal description Sand Lake #2; Block 4, Lot 4 Location (site address) 8033 Sand Lake Road "Anchorage, AK Current Property owner(s) Mailing address Real Estate Agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Expiration Date: 2 - _:Z_7� ZOZf Day phone Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ® Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ H 12.90 co vin Waiver Fee $ Date of Payment 1 I I `� I o� �� U Date of Payment Receipt Number 14 `E 7 C Receipt Number COSA # OS G 7 D 16 y O 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: Gamess Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: In conducting this evaluation, GEG provided an engineering evaluation.of the.well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the systems on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation_ Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for E bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the foll0 -�2 .�, f.. i V(� cD / CE 1 7053 V. JV k1 #AECC884 i sti'tr�� p Jam, J -- i��,f1 NT VV_ 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 Nitrate Advisory Septic System Advisory Arsenic Advisory_ Well Flow Advisory Other Legal Description: 'COSA Chddklf�t SAND LAKE #2; BLOCK 4, LOT 4 Parcel ID: 011-135-49 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system SERVED BY WELL ON SAND LAKE #2; BLOCK 4, LOT 49 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is fun ing correctly ❑ Wires are pro y protected Casing hei (above ground) in. Date flow test for COSA water level at beginning of test ft. Comments B. TANK DATA Age of tank(s) NEW years Tank type/material Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping NIA D. ABSORPTION FIELD DATA Which system tested (date installed) 9/2/82 ❑ ALL standpipes present per record drawing Total measured depth from grade .10 _ ft(max) Measured depth to pipe invert from grade 7.3 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 2.91 Well production at time of test N/A gprn Water storage tank volume NIA gallons Well disinfected for coliform test? [IYes F1No MR Coliform bacteria is Negative Nitrate ND mg/L ❑ Nitrate less than MRL (ND) Arsenic 38.4 ug/L ❑ Arsenic less than MRL (ND) Collected by GEG Date of Sample 10113/20 C. LIFT STATION ❑ Required maintenance co Age of lift station yea Lift station material Adequacy test date 10113120 Results M Pass For 3 bedrooms Fluid depth prior to testQ _ in Water added *606 gal New depth 9 in Elapsed time 120 min no Code -required soil cover over field Final fluid depth 0 in 450+ ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NO date of test) If yes, enter date NIA NIA Gallons introduced gallons Comments/Deficiencies: 'THE FIRST 204 GALLONS CAUSED A RISE OF 4 INCHES COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 1001 El Yes if No ft Community Sewer Manhole/Cleanout > 100' r7 Yeses ft Neighboring Tank > 100' El Yes if No ft Private Sewer/Se 25' ❑ Yes if No ft Absorption Field on Lot 100, n yes if No ft, Ing Tank > 100' El Yes if No ft Neighboring Absorption Fields > 100, es if No ft ft a I Animal Containment > 501 F� Yes if No ft Co > w r Co ewer Main > 75, ❑yes Co C3 if if No _ 7 ft ft Manure/Animal Excreta Storage > 100' Q Yes if No ft From Septic/Holding Tank -on Lot to: (Please enter distances if less thah'required)' Building Foundations > 10' ID Yes if No _ ft Surface Water> 100' 0Yes ifNo-ft Property Line > 5' 0.1 Yes if No ft Wells on Adjacent Lots: Wells on Adjacent Lots: Absorption Field > 51 0 Yes ifNo_ft if No Private Wells > 100' Yes if No ft Water Main > 10' M Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 101 R1 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, M Yes if No ft If absorption field is under driveway comment below Property Line > 10' FV1 Yes if No **** ft Wells on Adjacent Lots: Water Main > 10' M Yes if No ft Private Wells > 100' Yes if No ft Water Service Line >10' M Yes if No ft Community Wells > 200' El Yes if No *** ft Surface Water ?i 100' 0 Yes if No It F. ENGINEER'S COMMENTS *SEE RECORD DRAWING AND AS -BUILT SURVEY FOR WATER LINE LOCATION "EXACT SEPERATION DISTANCE IS UNKNOWN ***100' WAIVER TO CLASS C WELL ON LOT 49 - ADEC# 8221 -FA -18 ****EXACT DISTANCE BETWEEN EXISTING DRAINFIELD AND LOT LINE IN UNKNOWN - ASSUMED 10' PER IR IN MOA RECORDS O� 1i,1-1.!-- G. ENGINEER'S CERTIFICATION ', �p 4::: P:;N �.,�,q`4p� certify that /have determined through Feld inspections and review V7 of Municipal records.that the above systems are in conformance with TPHI�J MOA COSA guidelines in effect on -this date. .............. / ...... �.. , .................... Jef A. Garnless.-' % CQ -7-953 COSA Checklist yellow sheet rofess'100 #AECC884 11* -mo mm �: lC,=l CA 3. C= r1l a CO ;;a > Comm 2r ;:R �3 T. ::, i!� m 0 m Z: C,o 4 ---1 -< C) m > 00 Lo r Z c7 C) ZLn zom P cn m " N m > a):V C)0 K �� c:S > = m CM -0 4� C-) U) ma- m0 0 (n j!� P r� M > M > k: ;u z -0 0 m Q n ;o Z: C) r- =rOZ--4 m > 0 —MK z m U) m =zoo > M mmvi M rri 0 (A CA p SAND LAKE ROAD p 0 o Ci 15' ELECTRIC EASEMENT ul GI m PD m z n 'Sid 16.0'± m rn > x C31 rn* 6a ;_, 0 mu C> cn C) x no 1 2. 0, m Z n m m m SOUTH 60.00' cn 0 0 r" IL" rn o0 ul GI m PD z n 4. is m v 0 C) C> cn C) m m Z n m SOUTH 60.00' cn 0 0 r" IL" www.muni.org/onsite Arsenic Advisory Certificate of On -Site Systems Approval # OSC201640 Subdivision: Sand Lake #2 B4 L4 A water sample revealed an arsenic concentration of 38.4 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. Ma�lmg Address P :O Box 196650 *Anchorage, Alaska 99519 6650 *www mum org Parcel 1. D. 011-135-49 s, Municipality of Anchorage "P On -Site Water and Wastewater Program (907)343-7904 < sa Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: Complete legal description Sand Lake #2, Block 4, Lot 4 Location (site address) 8033 Sand Lake Rd. Current Property owner(s) Mailing address Real Estate Agent Theodis & Kristina Talbert Day phone PO Box 240553 Anchorage, AK 99524 2. TYPE OF DWELLING: 0 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 i] Individual Water Storage ❑ Holding Tank ❑ Community Class 'O' Well i] Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ GJ Date of Payment 9 13jli Receipt Number C -,q COSA # ot0L iq I 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for System #2 Approved for Disapproved Conditional approval for 2 bedrooms bedrooms Date 8/25/2014 bedrooms, with the following stipulations: By: f Original Certificate Date: ®` The nici ally, of An 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 COSA blue sheet f If more than 1 septic system is on the lot: COSA Checklist # + of 1 Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Sand Lake #2, Block 4, Lot 4 A. WELL -DATA Well type Class 'C' Date completed Total depth ft. Date of test Static water level Well production If A, B, or C provide PWSID # 216075 Sanitary seal (Y/N) Cased to ft. FROM WELL LOG ft. ieB!= Parcel ID: 011-135-49 Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate A) D mg/L Arsenic Xv (o ug/L Date of sample: 8/22/2014 Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel ft. 9 - p.m - PES Date installed 9/2/1982 Tank size 1,000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N/I) N High water alarm (Y/NC) N Date of pumping a < Pumper i4t. 06 -%(4 PeA_J 0Q C. ABSORPTION FIELD DATA Date installed 9/2/1982 Soil rating (g.p.d./ftz or ftZ/bdrm) 85 SF/BR System type Shallow Trench Length 45 ft. Width 6 ft. Gravel below pipe 4 ft. Total depth 9,9 ft. Eff. absorption area 1 1080 fe Monitoring tube Y Depression over field N Date of adequacy test 8/22/2014 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 466 gal. New depth 0 in. Elapsed Time: 100 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons _ in. "Pump off' level at Cycles tested _ in Manhole/Access (YIN) High water alarm level at Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer /septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line **Unknown Surface water 100+ Wells on adjacent lots *100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10 Surface water 100+ Driveway, parking/vehicle storage 110+ Curtain drain 50+ Wells on adjacent lots *100+ F. COMMENTS *ADEC waived to 100' 6/1/1982. Letter on File **Location of water line from lot 49 unknown. 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 8/25/2014 COSA brown sheet 10-10-12.doc in. Municipality of Anchorage $ ��o w Community Development Department Development Services Division s 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 # 141466 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 4, Lot 4 of Sand Lake #2 Subdivision. This inspection revealed an arsenic concentration of 36.6 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.or /og 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 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. COSA # 5C 11 6� - � I. GENERAL INFORMATION Expiration Date: _/ 0 Complete legal description Sand Lake #i Block 4 Lot Location (site address) 8043 Sand Lake Road Anchorage AK Current Property owner(s) Kevin Hand Day phone Mailing address 3600 North Point Drive Anchorage AK gg502 Lending agency Homestate Mtg/Chris Chisholm Day phone 334-8g26 Mailing address 38os Centerpoint Dr. Ste :Loo, Anchorage AK ggSo� Real Estate Agent Day phone Mailing Address Unless ptherwi§e'-rgquested, COSA will be held by DSD for pickup. 2., NUMBER O.F BEDROOMS: 3. TYPE OF WAFER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Iridividual Water.. e g Stora ❑ Individual Holding Tank ❑ Community. Class A Well ® Community On-site El Water System El Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services, LLC Phone 272-8218 Address P.O. Box soo217, Anchorage AK ggz;so Engineer's Printed Name Steven R. Pannone P.E. Date 6/a1 Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water .�� F levels that may fluctuate during the year, and the water usage of the family being served by the system. • These conditions are outside the control of the evaluator of this system. All systems eventually fail and �P ...........'•,S/r �# satisfactory test results do not guarantee future performance of the system, nor do they guarantee that • ��• i • 91t there are no hidden defects or encroachments. PES can therefore not provide any warranty for future %..... .. ... ': performance nor give any estimate of how long the system will continue to meet the operational ...... �..� requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed �� ' 0 ♦� :Steven R. •Pannone Ti s above. Any reliance upon or use of this report by any other person or party is not authorized nor will it �1 J No. CE 8149 � confer any legal right whatsoever. �♦�% 5. DSD SIGNATURE �� ... �:• L� Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: y . will "A n114v ; • -- V PROGRAM Jj��%JJ1T S) jl�Z1`� Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory ' Other By. Certificate Original y rt ficate tate:_ 7S (Rev. 11/0 y / Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite' (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Sand Lake #2 Block 4 Lot 4 Parcel ID: -013.-135-49 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 Well Log (Y/N) Sanitary seal (Y/N) Cased to ft. FROM WELL LOG WATER SAMPLE RESULTS: Coliform &2�colonies/100 mL Arsenic: `2- ug/I B. SEPTIC/HOLDING TANK DATA ft. g.p.m. Nitrate U- mg/L Date of sample: 6 20 2o11 Wires properly protected (Y/N) Casing height (above ground) in. AT IAIC0Cf%T1nK1 ft. Collected by: Laura Pannone Tank Type/Material Greer Steel Date installed 9/2/1982 Tank size l000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N/A Date of pumping _2124 2oi1 Pumper _Northland Pumping C. ABSORPTION FIELD DATA Date installed 9/2]1982 Length 45 ft. Total depth zo ft. Soil rating (g.p.d./ft2 or ft2/bdrm) pi Width 6 ft. System type Wide Trench Gravel below pipe 4 ft. Eff. absorption area S&o ft2 Monitoring tube Y Depression over field N Date of adequacy test 6/2o/Zoi1 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test o in. Water'added45o+ gal. New deptho in. Elapsed Time: o min. Final fluid depth ft in. Absorption rate >= 45o+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date STATION Date in7olevel "Pump a in. Datum E. SEPARATION DISTANCES Size in gallons Manhole/Access (Y/N) "Pump off" level at in. High water alarm level at Cycles tested Meets alarm & SEPARATION DISTANCES FROM WELL O T TO: Septic tankAift station on lot Absorption field on lot Public sewer main Sewer /sep)L-fervice line containment areas On adjacent lots On agent lots Public sewer Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation io+ Property line so+ Absorption field io+ Water main NIA Water service line *Unknown Surface water soo+ Wells on adjacent lots **soo+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line s+ Building foundation io+ Water main N/A Water Service line *Unknown Surface water 3.00+ i Driveway, parking/vehicle storage io+ Curtain drain None Known Wells on adjacent lots **zoo F. COMMENTS *Location of water line from lot 4,9 unknown **ADEC waived to loo' 6/1/82. Letter on file. G. ENGINEER'S CERTIFICATION •.•�p�� ••OF" �� S��1 1 certify that 1 have determined through field inspections and .,•• 4 g TH •.: �� review of Municipal records that the above systems are in ,,,,,,, t,,,,,� conformance with MOA COSA guidelines in effect on this date. 1i C Steven R. Ponno Engineer's Printed Name Steven R. Pannone, P.E. � No. CE 8149 y J' Date��''••..............•••. �h.ssa_� COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number in. Municipality of Anchorage aGG w Community Development Department Development Services Division s 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 # 111221 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 4, Lot 4 of Sand Lake 92 Subdivision. This inspection revealed an arsenic concentration of 36.2 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. -4tf Municipality of Anchorage Development Services Department Building Safety Division On -Site Water 8 Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 9951M650 www.cl.anchorage.ek.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING e Parcell.D. 011-135-49 HAA# Q1a3Q7 1. GENERAL INFORMATION Expiration Date: _ 9 — ;? t: — 0 / Complete legal description SAND LAKE i12: LOT 4, BLOCK 4 Location (site address or directions) 8033 SAND LAKE ROAD Current Property owner(s) DONALD K. HAYES Day phone 243-1720 Mailing address Lending agency Mailing address Real Estate Agent Mailing address 8033 SAND LAKE ROAD Day phone BUCK PRASUCKI w/DYNAMIC PROPERTIES Day phone 261-7600 3111 "C" ST. ANCHORAGE AK. 99503 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 in 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 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $800.00 at, or prior to closing for the engineering seMces provided 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined In the Health AuthorftyApproval Guidelines for this application, shows that the on-site water supply andlor wastewater disposal system Islara) safe, functional and adequate for the number of bedrooms and" of structure Indicated herein. I further verify.that based on the Information obtained from the Municipality of Anchorage files and from my Imrestigation and Inspection, the on-site water supply and/or wastewater disposal system Isiere) In compliance with all applicable Municipal and Stale codes, ordinances, and regulations in effect at the time of Installation. Name of Finn ALASKA WATER k WASTEWATER CONSULTANTS, ; INC. Phone ` 337-6179 Address 6901 DEBARR ROAD, SUITE 2B.* ANCHORAGE, AK 99504. Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date ZY o7 Engineer's Comments: In conducting this evaluation, AWWC, Ina attempted to provide a thorough, ; conscientious engineering analysis of the system In accordance with ADEC and MOA, _ .. DSD Guidelines d Regulations. The reported results described the performance of the . system under the conditions encountered at Ne time of the test, and separation distances measured to readily Identifiable features. The operatlrnal He of all wells and , septic systems depend on the local soils condition, groundwaterlevels that may fluctuate during the year, and the water usage of time family being served by the system. These conditions are outside the control of the evafuator of the system. Satisfactory test . results do not guarantee future performance of the system, nor do theyguarantse that there are no hidden defects or encroachments. AWWC, Ina can therefore not provide any warranty or future estimate of how long the system will continue to meet the opera flonal requirements of the ADEC or MCA DSD. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing more than twice the current minimum allowable by Federal and SYIOFrgr�c,,, jS ON -SIT c= ., •`�; ,WATER AND ons :WASTEWATER : PROGRAM State standards.of 50 ppb. For further information contact ADEC or the municipal Health Department. Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineers Reort Other By: � Original Certificate Date: %Z (o — O J QUV. iwom Municipality of Anchorage ' Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 South Bragaw SL P.O. Box 198050 Anchorage, AK 99519.8850 www.d.anchorage.akus (907)943.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: SAND LAKE M2; LOT 4 BLOCK 4 Parcel ID: 011-135-49 A. WELL DATA Wen type PUBLIC it A, B, or C provide PWSID# C Data completed Sanitary seat Cased to ft. FROM WELL LOG Date of test Static water level 9— p.m- WATER SAMPLE RESULTS: Well Log properly protected (Y/N) Casing height (above ground) in. AT ft. g.p.m. Coliform 0 colonies/100 ml. Nitrate 0.5 m9A- Other bacteria 0 colonies/100 mi. Date of sample: 6/13/01 Collected by: AWWC. INC. e. SEPTICMOLDING TANK DATA Tank Type/Material GREEK/STEEL Date installed 9/2/82 Tank size 1000 gal, Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping fi/ 13/01 Pumper NORTHLAND C. ABSORPTION FIELD DATA Date installed 9/2/82 Soil rating (g.p.dAlo /bdrn 85 System type WIDE DF Length 45 ft. Width 5+ ft. Gravel below pipe 4 fL Total depth 10 ft. Eft, absorption area 450+ fe Monitoring tube YES Depression over field NO Date of adequacy test 6/13/01 Results (Pass/Fan) PASS For 3 bedrooms Fluid depth in absorption field before test 0 In. Water added 603 gal. New depth 16.5 in. Elapsed Time: 8 min. Final fluid depth E in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) NONE KNOWN N yes, give date — 0. UFT STATION Date installed 'Pump on' level at _In. E. SEPARATION DISTANCES Size in gallons High water alar level at in. Cycles tested Meets alar & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot Absorption field on lot Public sewer main service line On adjacent lots Public sewer manhole/deanout Holding tank SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5'+ Property One 5'+ Absorption field 5'+ Water main - N/A Water service One 'UNKNOWN Surface water 100'+ Wells on adjacent lots *0100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 108+ Building foundation !V+ Water main N/A Water service line 'UNKNOWN Surface water 1001+ Driveway, parkingivehide storage 50'+ Curtain drain NONE KNOWN Wells on adjacent lots *1001+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through held inspections and review of Munidpal records that the above systems are in " ' ...""' conformance with MOA HAA guidelines in effect on dris date. �j f e A. Garness.• EngineerSPrin Nam JEFFREY A. GARNESS •Poa .• C 7953 Q+00 Date ty a� •......... HAA Fee $ -SQQ . °D Date of Payment lei alto Receipt Number [9 rxcl I (Rev. i?JW) Waiver Fee $ Date of Payment Receipt Number Zd WtM:60 7002 02 'Unr L£t094LL00 : 'ON ktld innateid s3%vr mu told 8481-Z9Z(Zo6) elv"05 sy 2 .aeuq"W 454uuog d££:£O tO-IZ-unC _Sand Loke Rovd .'1.' 0 VI) 1t�iM gyp' r N ppI� N 29 8 v Zd WtM:60 7002 02 'Unr L£t094LL00 : 'ON ktld innateid s3%vr mu told 8481-Z9Z(Zo6) elv"05 sy 2 .aeuq"W 454uuog d££:£O tO-IZ-unC Time APPLIC .NT FILLS OUT UPPER HAL ONLY --Y 4 Phone Property owner � _ �� Time L/ 2 � Zip Code Mailing Address 1� .6�. p Buyer �j <-7 xv� �/ > f- /. �.— Address / U�' 7, (/"' �� / Zip Code 3 � / '� ` ` Lending Institution Phone 7`� � z5U /- �� j � 7 0 h is J' Address / lJ. 1 j� /��-/ Zip Code - Phone Realty Co. & Agent Inspector Inspector Inspector Zip Code Address Legal Description/— �/ S �`� � /"-� 7-1/ Z Street Location - Type of Residence X 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 1975. depth (attach log if available). 'CONDITIONS OF APPROVAL For wells drilled prior to that date, give well Community - - ❑ Public Utility ( ) CONDITIONAL APPROVAL` Sewer Disposal >> c_ ��Z((❑``.�` Year Individual Installed: Individual OPublic Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector MUNICIPALITY OF ANCHORAGE Field Notes: FcrT C' -'] ENVIE...!!. :I.=F-.: .V L ,- 'J 10K RECEIVED 'CONDITIONS OF APPROVAL (�) APPROVED BEDROOMS ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL` io DATE BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size 72023 (3182)