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Home My WebLink AboutSAND LAKE #2 BLK 3 LT 16NO INDICATION ♦ I. �vc�r�.cs MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of Qn-Site Systems Approval Parcel I.D. 011-134-09 Expiration Date: _ 1. GENERAL:INFORMATION Complete legal description Sand Lake #2, Block 3, Lot 16 Location (site address) 8124 Seaview St., Anchorage, AK Current property owner(s) Ronald & Sandra Harp Day. phone 907-223-4428 Mailing address 2910 Barbara St., Anchorage, AK 99517 Real estate agent Sandra Harp 2. TYPE OF DWELLING: Day phone. 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Private Well Water Storage Community Well Public Water System . Waiver request for. Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment Receipt Number COSA # Waiver Fee $ Date of Payment Receipt Number Waiver # ❑ . DISPOSAL: nd Lc ke Block Lot 16 #011 - 134-09 m MUNICIPALITY OF ANCHORAGE Development Services Department - Phone: 907-343-7904 On -Site Water & Wastewater Section - Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 011-134-09 Property owner(s) Sandra & Ronald Harp Day phone 907-223-4428 Mailing address 2910 Barbara St., Anchorage, AK 99517 Site address 8124 SeaVieW St Legal description (Sub'd., Block & Lot) Sand Lake #2, Block 3, Lot 16 Legal description (Township, Range & Section) Lot Size 6750 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) Ej (w/wo ADU) Septic Tank Q Upgrade F-1Duplex (D) ❑ Holding Tank ElRenewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: ++�5- 00 Date of Payment: l6 1q 9.011 Receipt Number: 0 < <.11 3,r a Permit No. ps1 4 ol l Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc W41M Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191476, Rebecca Carroll, 10/21/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191476, Rebecca Carroll, 10/21/19 Municipality of Anchorage Development Servtceb Department Building Safety Division On-Site Water and Wastewaler Program ,~700 South Bragaw St. P.O. Box i96650 ~,nchorage. AK 99519-6650 www.cl.anchorage.ak.us (907) 3,l:L7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. O I) - ) 3"') - o ,~ '1. GENERAL INFORMATION Complelelegaldescfiption Lot: 3.6; Block 3; Location (site address ordireclions) 83.2/, SeavJ. e~, Streeb, Expiration Date: Sandlake S/D, #.2 Anchorage, AK oct Current Property owner(s) John Allen Mailing address . P.O. Box 872214, Lendin'g agency- Dayphone 232-7075 Wasilla, AK 99687 Day phone Mailing address Real Eslate Agent Gallery Homes Attn: Debbie Moore Day phone 562-3638 Mailing Address ' Unless otherwise requested, HAA wEl be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Wa[er Slorage Community Class C. Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual, Holding lank Communfly On-site Public Sewer The Municipality of Anchorage Developmen{ Services Departmenl (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 Slate of Alaska. Certificates of Health Authority Approval are required for the Iransfer of lille (except belween 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 vnlid for 90 days from the date of issue for propedies served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Cedificates may be reissued for a period of up to one year with valid water samples.) Certific~{es are valid tot one year for propedies served by Class A or B wells er a public water syslem. The Municipality or 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 ot {h~ validalion da{e shown below, I verify Ihat my Inves~Igalioh, based on procedures outlined In tile Health Aulhorl{y Approval Guidelines for this application, shows that the on-sile water supply and/or wastewater disposal ~y~erfl Is(are) sate, functional and adequate [or Ihe number of bedrooms and type of struclure Indicated herein. I i'urther Verify {hat based on the InformaUon oblalned from {he Munlclpali[y of Anchorage files and from my Investigation and Inspection. the on-site wa[er supply and/or wastewater disposal system Is(are) In compliance {Nilh all applicable Municipal and State codes, ordinances, and regulations tn effect at Ihe time o1' installation. NameofFirmS&S EngineerinK Phone69&-2979 Address 17034 N. EaRle River Looo, Ste. 20&, Ea~le River, AK 99577 Engineer's Prinled Name Robert C. Cowan~ P.E. Dale/Y-.J.A'-02 DSD SIGNATURE ~ Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements SUpplemental Engineer's Report Other Original Cedil'icate Date: z./_/~-0 ~ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. 8ox 196650 Anchorage, AK 99519-6650 www.cl.anchorage,ak, ue (9O7) 343-79O4 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Descdption: LO ;- /~ ~4.~c,< .,~ 5',q~,,~r~e~2 ParcollD: C) II - I 3'¥-oq A. WELL DATA ' ' If A, B, or C provide PWSID # ~ Date completed __ Sanitary seal (Y/N) Total depth __ff. Cased to ft. ~.........~g height (above ground) in. FROM WELL LOG ~ AT INSPECTION Date test Static water level ~ fl, ff. W~ ~fl~'''''''''''~ g.p.m, g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Nitrate I .o mg./l. Other bacteria O colonies/100 mi. A~enic:~..~' .~- - .'.,, - Date of sample: e. SEPTIC/HOLDING TANK DATA ~gte River, ~ta=4ta 99572 TankType/Material $~"°~"c / .,<Tf..,~ t_ Dateinstelled ~/17/ Tanksize /~OO gal. NumbarofCompmtments Foundation cleanout~/N) ~-~ Depression over tank (Y/~ Date of pumping ~//.3/0 3. Pumper /~o,{r/w. 4.v O C. ABSORPTION FIELD DATA Oateinstalled r°/l?/~"i' Soilraflng (g.p.d./l~or~-'~ ~n~ ~ I ~. Total de~ 30 ff. Eft. a~n FluM dep~ in a~o~on ~ld ~m t~t ~ in, ~r edd~ ~ 70 gal. Eam~ ~: 6 0 ~n. Final flu~ de~ ~ mjuvenaa~ ~a~nt (~st 12 ~.) Dt.,4. P Gravel below pipe / O Depression over field For '-~ bedrooms · New depth~ ~' ~ O g,p.d. If yes, give date -- D. LIFT STATION Date installed Size in gallons 'Pump on' level a~ Datum / Cycles tested Manhel;,JAc~s (Y/~I) High water alarm level at Meets alam~ & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROMqNELL ON LOT '[:O: Se~c ten,itt staUon on lot / u o 4- ~.~,,,, ~ .,/ On adjacent lots Absorption field on lot /oo '4- (. ~,,~,~.,c ,) On adjacent lots /OO Public sewer main Id lA Public sewer manhole/cleanout Sewer/sep'dc service line ~ ~- ~' [6..~m,,,,~ ;4,#~ding tank ~/'~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: /oo -+ Building foundaUon ~ ~ ~ Property line ;3 0 / Absorption field f Water main ! o + Water se~ line / o 4- Surface water, Wells on adjacent lots I 0 o '+' in. /0o ~ SEPARATION DISTANCE FROM ABSC[RPTION FIELD ON LOT TO: , ,~ t...'~,~ ~' ) / Pmpertyline ~ ('P~'~ 4,~t. Buildtngfoundation ,.~-0 /+- Watermain /0 4- Water Service line /O ..P Surface water / O 0 'f- DrNeway, pattdng/vehlcie ~orage Curtalndraln pi o~/~ ~<,~ou~ Wells on adjacent lote I OD ~ F. COMMENTS G. ENGINEER'S CERTIFICATION /"~'.'?" /~'"'.?".""~ .,.,.. I certify that l have determinecl thmugh flelcl mspec#ons and ,.. ;, t~ ~ ~,~ ~...~, : ~ mwew of Municipal records that the above systems are tn ~~.,.~,. conformance with MOA HAA guidelines in effect on this date. ~..~.~-/, .f.~..?.-~.-.-.-.-.-.-.-~-_ .~ - . ,mi. ~./~ '~ HAA Fee $. Date of Payment Receipt Number (Rev. ~2/0~) Waiver Fee $ Date of Payment Receipt Number B t IURVtY. OH'~ (;ERTIFICATION 4)14 THIS pLS.T. LEOEND O LO'I: CORNERS Fou~,lP , FOUNpATION DI~AINAeE ARROWS NOTE3 ~ 4. Tltl INPO~INATiON O#TNI$ PLAT IaL Iron THE ~11 OF LI#§INI ISITITUTIBHI (' ~ 5- 8UI LT" ...... LOT ID, 15LOC, K, ~ ,SAIdD LAKE 5LIISDN'ISIOt4 1,4o BESSE, Epps O~ POTTS 22?.0 E. 88th. AVE. ANCHORAGE~ ALASKA 99507