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HomeMy WebLinkAboutSUNDI LAKE BLK 2 LT 4undi Lake Block 2 Lot. 4 #011-131-30 Douglas T. Kenley 9806 E. Northstar Circle, Palmer, AK 99645 (907) 746-1073 August 5, 2013 Municipality of Anchorage On-site Water and Wastewater 4700 S. Bragaw Street Anchorage, Alaska Re: Kenneth Merritt, Owner Sundi Lake S/D, Block 2, Lot 4 8254 Sundi Drive, Anchorage, Alaska 011-11SI- 30 This letter is to confirm the owner's understanding regarding a well located on the above-described property. In approximately 1984, a 280' well was drilled on the site in anticipation of construction of a residence at a later date. When construction of the house began in 1986, the water from that well became muddy and was not useable, so a second well was drilled to a depth of 480' approximately 12-20 feet from the original well. Jim Ridgeway at Anchorage Pump removed the pump from the original well. During 2012, in preparation to sell the house, the owner attempted to locate the original well and assure that it had been abandoned properly. He contacted Jim Ridgeway who stated that he couldn't remember positively, but he believed he cut it off, as the M.O.A. required, about 10' below the surface, although he has no record and there is no record of abandonment on file. The owner next approached Stan Sears, the land surveyor who had surveyed the property. Mr. Sears had a very sophisticated GPS and thought he could pinpoint the original well from the survey plat. He used a metal detector, but could not get a reading. Fred Kenley and others also tried to locate the well with a metal detector and other devices, but none was successful. Mr. Merritt subsequently spoke with Jay Crewdson at M.O.A. who said he thought due diligence had been exercised in locating the well and that is all his department would expect. Page 2 If you have further questions, please contact me at 243-5372 or 746-1023; otherwise, Mr. Merritt will conclude that no further action is required. Sincerely, Douglas T. Kenley, .E. cc: Kenneth Merritt LOCATION OF WELL (Please complete either to, Ib or lo.) l,. Borough Subdivlalon 'Lor slack Ib. I/astn. Io. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS r Sleet Address and Arco of Wall L ... flon 2. WELL LOG I Material Type - Top Top Boil I c oorse WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysical Survtys 18. WATER WELL CONTRACTOR'S CERTIFICATION': IS. Water Temperature .0 ❑ F ❑ C - \ This well was drilled under my )uriadlotlon and I'll 110,11 Is Its, to Its bell of my knowl*dge and belief; - t Sommerville Well .Drilling Al 3788 1 Regisar.d Bubin*es Nome Contract License Number ; Andress: Al 99516 Signed : �I Prs77 � ti / F-44� ' AOfhcrlaad Repruentallve - Form 62-WWR (11/81) Copy Distribution: WHITE -Steel DOGS, PINK-Drilllq CANARY•Cuslamer Drilling Permit No. A.D.L. No. Section No. TownehlpNO Ranp E❑ MeridianP gp WQ b. OWNER OF WELL: Yen Merritt Address: 825¢ Sundi Dr. AROh. v A$ 995©2 cew - oa - 4. 'W }tMslifnatl. EL({p7C�_"D._4!bT$ OF ICUSUTLIfew/' . Bottom 9 g, W Cable fool - 011hatary ❑Driven QDug . ❑Auger 0d0/tad ❑Sdnd Qothar: 88 T.UsE:'P Dam"fle Q PubH# supply ❑ Industry ❑ Irrigation ❑ Recharge ❑ Commerical j Tea 59 s. CASINO ❑ ThreadThreadedW Welded drom.,01 in. roy7A it. Depth Weight lbs./ft. q' 3>, diem, in. tofI. Depth sflakup_fr. g. FINISH OF WELL: CO PBA Type: Diameter, - Blot/Mesh $420:La ath: Set between - ft. end ft. gaekfillinp gravel peak 10. STATIC WATER LEVEL! is it. ' Above or ()9 Below land $Urfa" Oat* E4u10meat read: Pu II . PUMPING LEVEL below land. $Urfa" and YIELD atter^ -her. .pvegp"— �9vP.nt.-.-. ...__ _ft. afar—bre. pumping—O.P.m. 12.GROUTING Well Grouted: ❑ Yes til No Material: 0N*af C*m*PI 00t"r: - Is.PUMPI Uf avallable) NP Length of Drop Pipe _ft. capacity —9 -P.M. m ' ❑ 8ubm. 0 del 0 Cselrifipal 0 Other r ° e_ 14. REMARKS: z . e 18. WATER WELL CONTRACTOR'S CERTIFICATION': IS. Water Temperature .0 ❑ F ❑ C - \ This well was drilled under my )uriadlotlon and I'll 110,11 Is Its, to Its bell of my knowl*dge and belief; - t Sommerville Well .Drilling Al 3788 1 Regisar.d Bubin*es Nome Contract License Number ; Andress: Al 99516 Signed : �I Prs77 � ti / F-44� ' AOfhcrlaad Repruentallve - Form 62-WWR (11/81) Copy Distribution: WHITE -Steel DOGS, PINK-Drilllq CANARY•Cuslamer MUNICIPALITY OF ANCHORAGE DES,.ITMENT OF HEALTH AND HUMAN SER',,ES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name PEp c, VLHE DISTANCES TO FROM SEPTIC TANK ABSORPTION FIELD WELL Address 120.5 E (� 1"E12N,�ilor.l�L 12� WELL f/ 8 C' Phone(s) -aG iv - D a3 Permit No. No. of Bedrooms 8 0 0 83 I /V LOT LINE ; 38 LEGAL DESCRIPTION Lot Block Subdivision SUNDI 4AKE FOUNDATION q Township, Range. Section 'f ^+ 6 C / -r l.� LLL AS-BUILT DIAGRAM (Show location of well, driveway, wafer bodies, etc.) septic system, properly lines, foundation, TANKS SEPTIC ❑ HOLDING Manufacturer G2i��ItE2 Capacity in gallons I /,;25 C) Material No. of Compartments TYPE OF SYSTEM [TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER .' Depth to pipe bottom from original grade 3 FT Total depth from original grade FT FIII added above original grade Gravel depth beneath pipe D FT � FT Gravel l¢nglh FT Gravel width Y r 3-6 FT Total absorption area Distance between lines SQ FT — FT Number of lines Soil rahn 9'/ �'7DSQ FT Pipe material C1%'4z E 02 - Installer SPF2NAK Date Install WELLS V L' ❑ PRIVATE ❑ OTHER fldentiivl Classification (A,B,C) Total Depth Cased to r R E S FT FT — Installer Date Installed: ni — SO REMARKS: Scale: ttrn (pOr - Inspections Performed by: 2/ % r �S Date: 6 .. Lt k� f certify that [his inspection was performed according to all I Municipal and State guidelines in elect on this date: 9 bb %�✓ 1.% �"'sw'�—�_ . r�/ �c3 Health Department Approval � r/L� �. Date. ENGINEERS SEAL l r est .r r+i 9 f L a 0 1225-K b �� �0 11)N= zbr t971 Sit Qa ie-u);t (316b) �����1 F:�,, 1L_ 1 11 ',,ir AE3 [F:�' �FNI C­� F -A C], F-�: 4% 4_3 IE: DEPARTMEN7 OF HEALTH AND ENVIRONMENT PROTECTION n� /L STREET, ANCHORAGE/ HK W501 ' ��4-4720 ^ 0_3 P1114 _ E-3 1. �� Novato �/m�����{�^4��� \ PERMIT NO: 860083/ ' « « DATE ISSUED: 04/03/86 (/ APPLICANT: REED C. ULMER ADDRESS: ` 1205 E. INTERNATIONAL AIRPORT RD. ANCHORAGE, AK 99502 CONTACT PHONE: 268~0623 LEGAL DESCRIF: SUBDIVISION: SUNDI LAKE iPT: 4 BLOW 2 SECTION: 104Q�/0 TOWNSHIP: 12N RANGE: 'W_ V«f/��(! LOT SIZE: 1,13A (SQ.FT. OR ACRES) MAX DEDR[}OMSN 4 Listed below are the options available to you in designing your septic system` Choose the option that best fits your site. -7- 10 Eli F`%J CT F-1 Not FRI 1.1 LmJ"1-1 FAT 0% X P41 DEPTH TO PIPE BOTTOM (FT.) 3.0 ** 4"0 4"0 GRAVEL DEPTH (FT") 5,0 0"5 3^5 TOTAL DEPTH (FT.) 8"0 4"5 7^5 GRAVEL WIDTH (FT.) 2"5 21.0 5"0 GRAVEL LENGTH (FT.) 56^0 40^0 61^0 GRAVEL VOLUME (CU"YDS.) 28"6 31^2 45.2 TANK SIZE (GALS) 1,250"0 ** 1,250.0 ** 1,250.0 ** SOIL RATING (SQ^FT./9R) 140 140 140 ' ** DEPTH TO PIPE BOTTOM < 3.5 FT" REQUIRES INSULATION ** DEPTH TO PIPE BOTTOM < 4^0 FT. MAY REQUIRE A LIFT STATION ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS L I certify that: v 1. I am familiar wbth the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. T will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3" I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or pub]ic sewerage system on this or any adjacent or nearby lot, 4. I understand that this permit is valid for a maximum of 4 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST DE OBTAINED; (2) A5-BUILTS WILL NOT B TRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK M CENSED ELECTRICIAN. SIGNED DATE: --------������ APPLICANT: REED C. �LMER \ IS TYPE OF :OIL ABSORPTION SYSTEM IS: TRENCH _ MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATINdG (SO FT.'BR'= 141 THE REr..UIRED _,IEE OF THE SOIL ABSORPTIONd SYSTEM IS: = 1_EE04147-'9-1= WTI CA ems °1=1% E=L_ E>E=F0-FVA== THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS, NO _;ET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIt'U-M DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION'd (IN FEET). '1=-e-®8_1 S _Ev E> -a �. F"I A.: TFs54 PC "T E_= :lL 12 T" CA 1. aFY@_L_ED 14" PERMIT APPLICAI'+T HAS THE RESPONSIBILITY TO INFORM THIS, DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RE_,IDENC:E_. THAT THE WELL WILL SERVE. _ _ 1 1-0 Y > 1 PA F-' E ED -F g 1=11 4 "_Ex 0'1 F_ EE FZ E=7 Eli 1_/ I Fs? E= loo BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION ANTIC:' APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. P11141PIU'I DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING PSN THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM H PRIVATE WELL TO A PRIVATE _,EWER LINE IS 25 FEET AND TO H COMMUNdITY SEWER LINE IS 76 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFU_ATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F`E_FZP11r -7-" E=l >oF' 1r F:1="_° DEDEAm EEI"1E_:EEF: a :I_= I CERTIFY THAT is I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS 'SET FORTH BY THE MUNICIPALITY i iF ANCHORAGE. I 14ILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDEN I REMODEL '' 1-0 INCLUDE MORE THAN 4 BEDROOMS. SIGhdE � __ --- --------------------SSSS APPLICANT KEN MnERRITT ///,� (� ISSUED B,T_ a%_7_ Q i 2b�a`1 1 ° 11_11 1 I ED 141 =-11_. I � a$„ ASA 1 DEPARTMENT WHEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 PERMIT NO. N_ A gg y' g' g� } y --9-� V=4E=7 t. 2049; APPLICANT KEN MERRITT 8317 LOAM BERRY 99502 `.N_-r{_c= L!SCATION SAND LAKE AREA LEGAL L4B2 SUNNI LAKE LOT SIZE 999999 SQUARE FEET TYPE OF :OIL ABSORPTION SYSTEM IS: TRENCH _ MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATINdG (SO FT.'BR'= 141 THE REr..UIRED _,IEE OF THE SOIL ABSORPTIONd SYSTEM IS: = 1_EE04147-'9-1= WTI CA ems °1=1% E=L_ E>E=F0-FVA== THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS, NO _;ET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIt'U-M DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION'd (IN FEET). '1=-e-®8_1 S _Ev E> -a �. F"I A.: TFs54 PC "T E_= :lL 12 T" CA 1. aFY@_L_ED 14" PERMIT APPLICAI'+T HAS THE RESPONSIBILITY TO INFORM THIS, DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RE_,IDENC:E_. THAT THE WELL WILL SERVE. _ _ 1 1-0 Y > 1 PA F-' E ED -F g 1=11 4 "_Ex 0'1 F_ EE FZ E=7 Eli 1_/ I Fs? E= loo BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION ANTIC:' APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. P11141PIU'I DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING PSN THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM H PRIVATE WELL TO A PRIVATE _,EWER LINE IS 25 FEET AND TO H COMMUNdITY SEWER LINE IS 76 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFU_ATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F`E_FZP11r -7-" E=l >oF' 1r F:1="_° DEDEAm EEI"1E_:EEF: a :I_= I CERTIFY THAT is I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS 'SET FORTH BY THE MUNICIPALITY i iF ANCHORAGE. I 14ILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDEN I REMODEL '' 1-0 INCLUDE MORE THAN 4 BEDROOMS. SIGhdE � __ --- --------------------SSSS APPLICANT KEN MnERRITT ///,� (� ISSUED B,T_ a%_7_ Q i 2b�a`1 ST; I EY BRUST A10 ASSOCIATE ENGIN ERS SURVEYORS PLANNERS Phone 3444E ') 1610 Dimond Drive, Anchorage, Alaska 99507 SOILS LOG — PERCOLATION TEST Er' SOILS LOG ❑ PERCOLATION TEST PERFORMED FOR: //1 j�'y / ie �'3"!// DATE PERFORMED: LEGAL DESCRIPTION: ./� Q� ���� -��/7 '✓ L `�"�L� DEPTH �� (1DF circ oww (FEET) 1 /f ui/f" oLS 2 3 �a avy re ! S4- �� .1 5 / 6gy b�!✓.r-no yri+ 7 8 9 10 12 J 13 WAS GROUNDWATER ENCOUNTERED? IF YES, AT WHAT 7s S' PCY DEPTH? 14 Date Gross Time 15 Depth to Net Water Drop PSI zt F` 1 iqp 16 t ,8 0. No.• 1�f Q•> " 4 COMMENTS ■Nl11AI NE �. ■■MEN ■■■ Omni ■■.I�11I�M�■■ NE1;r/Mi'iN Reading Date Gross Time Net Time Depth to Net Water Drop 1 PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT PERFORMED BY: CERTIFIED BY: ,-%�s/ DATE: 61-5 --/f 2� 72008 (6/79) STAILEY'BRUST A!,0 ASSOCIATES Phone 344-68lb U' SOILS LOG METERS,- `I ERS, SURVEYORS PLA ERS � ❑ PERCOLATIONS 1610 Dimond Drive, Anchorage, Alaska 99507 TEST ,(SOILS LOG — PERCOLATION TEST PERFORMED FOR:/jDATE PER/FIORMED: LEGAL DESCRIPTION: DEPTHSLOPE SITE PLAN . (FEET) >/,---v/I i T�re�✓n Si/7` ui/i v'�S � / 2 3 4 5 6 7 8 - 9 10 11 12, 6 13- 14- 15 31415 16 16 19 20 �e ✓13C / ^' 1' -/nom �n..-r�i ,�r�2r 6gdi-no r+�+ G'� �6/e s. Goa/� s //fie wacs�t✓ WAS GROUND WATER- S ENCOUNTERED? b L / O / IF YES. AT WHAT E 7s SF/�G� DEPTH? OF lk4'F'FZ�� • D...... NO. 986 Reading Date Gross Net Time Depth to -ENetTime Water PERCOLATION RATE (minutes/Inch) TEST RUN BETWEEN - FT AND FT PERFORMED BY: -Z�w,17— CERTIFIEDBY:rDATE:GfZ/ ./j0/ TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = _OIL RATING < Q FT/BR)=\ 140 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ED9.� t-.6 a=� "�` 1-6 = Y,� �_ 1� °�,°° E= I_ ° E_ �° �' H = �q- THE LENGTH DIMENSION IS THE LENGTH (IN FEET)OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR FIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE E'iCAVATION CIN FEET?. THERE I= NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL _ERRE. a..� Y 1-_B 8'-°9 -0 AEA =i �N T 1*- `— C I O BACKFILLING OF CEFAFTIEtf i�HEHLTH AND Et4IF�t1E?TRL�-�jTETIOP APPROVAL BY THIS `J 825 L' STREET, ANCHORAGE, AK. 99501 264-4720 PERMIT NO. < 830847 APPLICANT KENNETH G MERRITT 8317 LOGANBERRY 563-3120 LOCATION LEGAL . L4B2 _,UNDI LATE LOT _•IEE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = _OIL RATING < Q FT/BR)=\ 140 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ED9.� t-.6 a=� "�` 1-6 = Y,� �_ 1� °�,°° E= I_ ° E_ �° �' H = �q- THE LENGTH DIMENSION IS THE LENGTH (IN FEET)OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR FIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE E'iCAVATION CIN FEET?. THERE I= NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL _ERRE. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DI_POSAL SYSTEM I= 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND t'U T BE RETURNED TO THE DEPARTMENT WITHIN 20 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAM_, ARE AVAILABLE TO INSURE PROPER INSTALLATION. F='EiF= 1-11 1- E=1111' % Fd'E= Es En C2 EnBlEDEEF1 " AL_>EDME: I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELL'_ AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. I WILL INSTALL THE _SYSTEM IN ACCORDANCE WITH THE CODES. _. I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED: -------- tL U -_= �---------- APPLICANT KENNETH G MERRITT � ISSUED E'' - ------------- ----�fDATE---/21- V4. 0 EF f=1 BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DI_POSAL SYSTEM I= 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND t'U T BE RETURNED TO THE DEPARTMENT WITHIN 20 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAM_, ARE AVAILABLE TO INSURE PROPER INSTALLATION. F='EiF= 1-11 1- E=1111' % Fd'E= Es En C2 EnBlEDEEF1 " AL_>EDME: I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELL'_ AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. I WILL INSTALL THE _SYSTEM IN ACCORDANCE WITH THE CODES. _. I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED: -------- tL U -_= �---------- APPLICANT KENNETH G MERRITT � ISSUED E'' - ------------- ----�fDATE---/21- V4. 0 B IC DIPPER DRILLING� 7529 E. 6th Avenue • Anchorage, Alaska 99504 0 (907) 333-6435 September 23, 1983 Mr. Ken Merrit L -OT iii BIc 4t SaNDt t-..AycE 8317 Loganberry Street Anchorage, Alaska 99504 PTATEMENT OF ACCOUNT Drill and Case Well 277 Foot with 6 5/8 OD .250 Casing Install 6" Drive Shoe Perforate 1/8" by 1"' Slots --------.2341 to 242► 255+ to 268' Develop and clean well 2'' hours ----- Producing 15 GPM Gt WATER WELL LOG --------------- \QPM\ e`�°� 1 4 foot Top Soil \ SX, '( qP �0� 4 30 "--------------- Gravel e �r �' 30 38 "--------------- Sand 38 78 Silt & Sand --------------- CI V 78 80 " C1Q.7 80 110 "--------------- Fine Sand 110 118 "--------------- Silt & Sand 118 218 "--------------- Fine Sand -- Water 218 234 "--------------- Clap - Blue - 234 242 "--------------- Gravel - Water 234 253 "--------------- Sand - Water 253 270 "--------------- Gravel - Water * 270 277 "-------------- Clay - Well Footing As per verbal agreement twenty ($20.00) dollars per foot: 277 Ft 20 ' Total Price ----- $5, 0.00 Thank you for specifying BIG DIPPER DRILLING for your water well needs. Sinc on PRESIDENT Licensed Bonded • Insured • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Appro.u, Parcel I.D. 011-131-30 1. GENERAL INFORMATION Expiration Date: Complete legal description Sundi Lake, Block 2, Lot I Location (site address) 8254 Sundi Lake Drive Anchorage, AK Current Property owner(s) GHM Trust Day phone 229-1658 Mailing address P.O. Box 22120 Anchorage, AK 99522 Real Estate Agent 2. TYPE OF DWELLING: E Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Four Day phone JUL 2 5 2016 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ll Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request Received by: /t'U �I �'�,/ i /�U/ u� Date: % pU COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 60 *&! 40 '90'46 ('W Waiver Fee $ Date of Payment_—?,r--I'K Date of Payment Receipt Number c9T i0��{�� Receipt Number COSA# Waiver# 5. STA BY ENGINEER AseErll'Fied by my ' ;'a ereto and as of the validation date shown below, I verify that my investigation, bas on procedur in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site wat upply and/or wastewater disposal system is (are) safe, functional and adequate for the numberof be'*oms and type of structure indicated herein. I further verify that based on the information obtained from tlie'fu)unApality 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 Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE System #1 Approved for _q_ bedrooms System #2 Approved for bedrooms Disapproved of ditionaT approval for bedrooms, with the Phone 522-7773 .Date 12/1212015 By: hien /t Original Certificate Dater The Municipality of Anchorage Development Services Division (DSD) issues Certificates of Onsite 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 sheeLr :. c If more than 1 septic system is on the lot: COSA Checklist # _of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Sundi Lake, Block 2, Lot 4 F -MI V 4110 rl_A 0 Well type Private If A, B, or C provide PWSID # Date completed 11/27/86 Sanitary seal (Y/N) Y Total depth 478 ft. Cased to 478 ft. FROM WELL LOG Date of test 11/27/86 Static water level Well production WATER SAMPLE RESULTS: 127 10 ft. Coliform 0 colonies/100 mL Nitrate ND mg/L Arsenic 13.4 ug/L Date of sample: 6/24/16 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,250 gal. Number of Compartments 2 Parcel ID: 011-131-30 Well Log (Y/N) Y Wires properly protected (YIN) Y Casing height (above ground) >18 in. AT INSPECTION 8-26-14 94.3 ft. 4.4 g.p.m. Collected by: Anderson Engrg. Date installed 6/7/86 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Date of pumping 6/29/16 Pumper Alaska Sewer and Drain C. ABSORPTION FIELD DATA Date installed 6/7/86 Soil rating (g.p.d./fe or ft2/bdrm) 140 SF/BDRM Length 60 ft. Width 3-6 ft Total depth 8-9 ft. Eff. absorption area 600 ftz Monitoring tube. Date of adequacy test 8-26-14 Results (Pass/Fall) PASS N System type Deep Trench Gravel below pipe 5 ft. Y Depression over field N For 4 bedrooms Fluid depth itt absorptior) field before test 0 in. Water added 699 gal. Elapsed Time: 1,440 min. Final fluid depth 0 in. Absorption rate >= New depth 0 in. 600 g.p.d. Any rejuvenativrrtmatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons _ "Pump on" level at in. 'Pump off" level at Datum E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested Septic tankAift station on lot >100' Absorption field on lot >100' Public sewer main >75' Sewer /septic service line >25' Animal containment areas >50' Manhole/Access (Y/N) in. High water alarm level Meets alarm & circuit requirements? On adjacent lots On adjacent lots >100' >100' Public sewer manhole/cleanout >100' Holding tank >75' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation >51 Property line >5 Water main >10' Water service line >10' Wells on adjacent lots >100, ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10, Water Service line >10' Surfacewater >100' Curtain drain None Noted Wells on adjacent lots >100' Absorption field >51 Surface water >100, Water main >10, Driveway, parking/vehicle storage >10, 11 F. COMMENTS Dimensional information for septic system taken from Municipal Records. Absorption Trench remains dry. No well flow or adequacy test performed as previous test was less than 2 years ago. The trench section under the driveway is insulated in accordance with G. ENGINEER'S CERTIFICATION Municipal Code. I certlfy 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 Michael E. Anderson, P.E. Date 7/25/2016 COSA brown sheet 10-10-12.doc ' �e 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 # OSC161311 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 4 of Sundi Lake Subdivision. This inspection revealed an arsenic concentration of 13.4 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 /onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. ENDICOTT ST._ iS 00'0600° E 3 00'06'13' E I 2 3 SETTFTWSiN I. t LOT 4 o67440VPLAT g, Ln gym- OT SA www OFF rn V) n @ -wFSN .? zsz •• PDFOU4DATOM v O r1 EXISTING ® d`'' in TWO-STORY '- WOOD FRAME HOUSE i. ,9x LLr ; 5 (oTT toLOT.4 tYY FPAH u a 5$ 23.Y•. EPK,`QOAC416B7T DETAIL PH+E RPTFW y t O AY I / N / yµgg77 T7 -0S SLRVEY IS FOR THE UM OF ORA WAY8�*I7C TANG � � r- �5LwV Rea THAI OLE I TLrrIONS SPECIFICALLY BS+iiC fT5 XEASISAEAND PLA7re � / cP O• NMTURM 40MR NO :ES SHOLLD-AW DATA a"ED FOR POSITIONCJ67PIX RY g OOA7 _ BOL A ocATIN6 BOLPDARY 2 IS LEM t) RECORD WORMALIOIV )OPISIBw7Y d.= TFE ExION MOR �AG DRIVEWAY O RJOCK RESTRICTrc- E. VOT APPEAR ON 7I:E. OF W PARC LOT P1LEVIV BLOCK 0*4I CMACWM • RcOOVERED $/S'RE3AR PECOVE W 51 Sl87N1610N ENL40AUC6 74E �IVMPROVLAT AND 70 PROPGiifY LPE A&"N110MOk ® WELL I T14E Ik7PRCIEL !✓?g 0lTAH. BJ.ARCB♦BJA o SEPTIC VENT PIPE THIS PARGa ME T ALL '. �VHVANfSAND ZONINCs.. AND Z r N n fIFY THAT I HAVE AS-MXT SURVEY 40; PLAT. I DECLARE w•,��tl �'♦ O.F1\t LOOT 4 BLOCK '�t/y� SYIENTS APD VIS- -va�Ts Ha,vE a 1 V111M1 LAKE Sl�till$�1 34M TO THEoex ,ppj ROMMIONAL NUM 1) /� PD BMW=. t NNt4y�1i S� 7 1 A s STANLEY ........... ESEARS !/ 7A87-3 9107n4 +�' [ / o enm�a .e+w.w o.wre). x• en ��1, v.1 ILUABAB� SEAR :• N� / 1E0s RAM AT RR r aPem ANfJi1RA9E, AK 1®YHPALLA s95oH aaa s,.,� ndw HIIIDmuw 9n5na IWA _ �— - Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 vAm.muni.org/onsite (907)343-7904 -CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 011-131-30 1. GENERAL INFORMATION !`.....plete legal dVesc.�. C__ Sundi Lake S/D, Block 2, Lot 4 vvniNicw icyai uca�.n Nunn Location (site address) 8254 Sundi Drive, Anchorage, AK snFtr, 635_76` q I I41 11 COSA# hSG IqIq b Expiration Date: Current Property owner(s) Kenneth G. Merritt and Paula G. Merritt Day phone 243-6255/H 227-3131/C Mailing address 6254 Sundi Drive, Anchorage, AK Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ✓❑ Individual On-site ✓❑ Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Douglas T. Kenley, P.E. 8176 Address 9806 E. Northstar Cirde, Palmer, AK 99645 Engineer's Printed Name 5. DSD SIGNATURE Douglas T. Kenley Approved for Disapproved. Conditional approval for bedrooms. Phone (907) 746-1073 Date /I dB % (� bedrooms, with the following stipulations: Aiac�ri�r� COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: iz �;, a—C­ Original Certificate Date: ' d t, r, (Rev. 11105) ff more than 7 septic system is on the lot: COSA Checklist # Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: A. WELL DATA Sundi Lake S/D, Block 2, Lot 4 Well type Private If A, B, or C provide PWSID # Date completed 11-27-86 Sanitary seal (Y/N) Y Total depth 478 ft. Cased to 478 ft. FROM WELL LOG Date of test 11-27-86 Static waterlevel 127 ft. 10 9•p•m- Parcel ID: 011-131-30 Well Log (Y/N) Y Wires properly protected (YM) Y Casing height (above ground) 20-1./4. in AT INSPECTION 8-26-14 94.3 e. 4.4 WATER SAMPLE RESULTS: Coliform Negative colonies/100 mL Nitrate 0.291 mg/L Arsenic 18.6 ug/L Date of sample: 9-1 & 12-14 Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material "Septic/Steel Tank size *1250 gal. Number of Compartments *2 Cleanouts (Y/N) _ Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) Date of pumping 9-5-14 Pumper A+ Home Services, Inc. g.p.m. F. Kenley Date installed *6-7-86 C. ABSORPTION FIELD DATA Y N/A Date •installed *6'7-86 Soil rating (g.p.d./ftz or felbdrm) *140 System type *Trench Length *60 ft. Width *3-6 ft. Gravel below pipe *5 ft. Total depth 8'9 ft Eff. absorption area *600 it —Monitoring tube Y Depression over field N_ Date of adequacy test 8-26-14 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 699 gal. New depth 0 in. Elapsed Time: 180 min. Final fluid depth 0 in. Absorption rate >= 600 g p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) N if yes, give date --" D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump ofr I a Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ft. Absorption field on lot 100+ft. Public sewer main NIA Sewer /septic service line 25+ft. Animal containment areas 50+ft. SEPTIC/HOLDING TANK ON LOT TO Manhole/Access (Y/N) _ iqh water alarm level at Meets alarm & circuit requirements? On adjacent lots 100+ft. On adjacent lots 100+ft. Public sewer manhole/cleanout _ NIA Holding tank NIA Manure/animal excrete storage areas 100+ft. in. Building foundation 5+ft• Property line 10+ft• Absorption field 5+ft• Water main N/A Water service line 10+ft Surface water 100+ft. Wells on adjacent lots 100+ft. ABSORPTION FIELD ON LOT TO: Property line 10+ft• Building foundation 10+ft• Water main N/A Water Service line 10+ft• Surface water 100+ft. Driveway, rki .s" coff "e"' y pa ngJvehide storage Curtain drain Nolle Known Wells on adjacent lots 100+1 F. COMMENTS *From M.O.A.Records. 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. Engineers Printed Name Douglas T. Kenley, P.E. Date rl I I ib 11`{ COSA brown sheeL10.10.12.doc Municipality of Anchorage , Community Development Department Development Services Division s„E„ 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 4 141490 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 4 of Sundi Lake Subdivision. This inspection revealed an arsenic concentration of 18.6 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. ENDICOTT sr. (S 00'06'00" E 120.00') _ S 00ro6'13" E 119.92' NOTES I. ALL RECORD INFORMATION IS BASED ON SUNDI LAKE E SAND LAKE SUBDIVISION NO. I, PLAT NO. P-II2, ACCORDING TO WARRANTY DEED BK. 100, PG. 149, ANCHORAGE RECORDING n/n0 DISTRICT, UNLESS OTHERWISE ar/nni Ina NOTED. 2. NO MONUMENTS SET THIS SURVEY. LOT 4 _ PER PER PLAT NO, 2 PLAT NO. ,LIt 67-140 O 73-215 `x- - eo rn m h w co '.. ou M M w w w ctt Li4 _ ` 000 rnoo •.� - O 00 o o mrocO10 I IJ mrnrn •i 00 00 co ��Z EXISTING SHED Nw in `;�•�� cis (NO FDL10ATIOM -� rte\\ EXISTING wEu TWO—STORY WOOD FRAME HOUSE DECK 39 2 iv LOT 4 13.7• FP.01-L N o 5? 3A 4 23_2' ENCROACHMENT DETAIL DECK -/ V/ C.O. PIPE . a, ID? 1 N.T.S. CONCRETE q �NORTH PE o- 1 WALKWAY EXCLUSION s �J �, ;,;,AY 5 TANK THIS SURVEY IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY SEPTIC ID O- / TO SHOW ANY CONFLICTS BETWEEN Co. PIPE 'O- / EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR POSITIONING ,L9'Sp0 ADDITIONAL STRUCTURES, BUILDING 5 ry8� lE6END FENCES, OR LOCATING BOUNDARY �5 LINES. RECORD INFORMATION IT IS THE RESPONSIBILITY OF THE O BLOCK NUMBER OWNER TO DETERMINE THE EXISTENCE A.C. DRIVEWAY OF ABUTTING LOT OF ANY EASEMENT OR RESTRICTION NO. 7, BLOCK I. ALD52 PARK • RECOVERED 5/8' REBAR WHICH DOES NOT APPEAR ON THE SLBDIVISION, ENCROACHES THE 0 WELL RECORDED SUBDIVISION PLAT AND TO PROPERTY LINE AS SHOWN HEREON. VERIFY THAT THE IMPROVEMENTS (SEE DETAIL ENLARGEMENT) D SEPTIC VENT PIPE SITUATED ON THIS PARCEL MEET ALL SUBDIVISION COVENANTS AND ZONING ORDINANCES. orl SURVEYORS CERTIFICATE NO. ILS10N DE,SCRIPYIXNS DATE I HEREBY CERTIFY THAT I HAVE ��'Qr,`\� AS-BUILTeSURVEY�( A RBESURD ON THIS PLAT. I DECLARE YED THE PROPERTY DE=SC-�° °°°°4. k LOT 4, BLOCK L THAT IMPROVEMENTS AND VIS- gyp ° ° ° ° • 0 , IBLE ENCROACHMENTS HAVE 'fie �, SUNDI LAKE SUBDIVISION BEEN ESTABLISHED TO THE �* 49— ° °°` * / (SEE NOTE 1 ) BEST OF MY PROFESSIONAL lo°; ' ° ° ° ° °' ° ° ° ° ° ° ° ° ° ° ° ° °� ANCHORAGE, ALASKA KNOWLEDGE AND BELIEF. I C� . c 4LCS,aa1�} eO a 9CNG SIRVtY DAIS •I ° °STANCE E. SEARS o o jo 1' - 50' 9/07/14 ° ° ° ° ° / GLoaou Po=wNwr 2087-5 ° ; SERVlCEf /NC. ,�' Digital Surveying and Mapping Canauganfe MAWN9W' CLEd®ntl LLUMBAB S. SEARS PROFESSIONAL �a�Aw 2603ANC�BLLUEBERARK RD.fA w�M®e•Da DAIe DDAvrta r�D 9oop DA7F; PAGEJ E PARA N5321TT 9/16/14 N/A \� 99503 4 SUNDI DRIVE 907-569-2000 VOICE CHORAGE, AK Fla Gwo 907-569-2002 FAX 02 514505 SW 2224 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 9/ Z'3_/ C_6 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) aT 4 ,SKQ, Sum®I AV_ _C�51t_ 12 a /aN Location (address or directions) , 68.215y sot4b, n - (b) Applicant Name Vaig " ale'ITT- Telephone: Home Business Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/builderld Buyer ❑ ; Other ❑ (explain); (d) Lending Institution �� E; ^r Dt w4&" Telephone Address (e) Real Estate Company and Agent N. Address Telephone (f) Mail the HAA to the following address: pp�� 2. TYPE OF RESIDENCE Single -Family Multi -Family El Other Number of Bedrooms %' 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite) Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025(11/84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 shows that the on-site watersupply 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 i s�1 pectic 6j y Name of Firm " A —" Telephone 9- `� Address a6D 3 L� !9 +, 6 Date i _y9 22`5-,Eingineer Seal 2v (9L `r S. •9� 6. DHEP APPROVAL �✓ Approved for f---- bedrooms by Approvedy Disapprove Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72-025 (11184) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal A. WELL DATA MUNICIPALITY OF ANCHORAG@ DEPT. OF. HEALTH& ENVIRO 'N IMENT )AL P,FOTcCTION AUG 6 G 5 9986 Well Classification F= 5� If A, B, C, D.E.C. Approved (Y/N) ,VIA Well Log Present (Y/N) y Date Completed 4A'AA16 Yield J* Total Depth 4277 _Cased to Depth of Grouting�On Oo Static Water Level (� % Pump Set At ®W Casing Height Above Ground a-� Sanitary Seal on Casing (Y/N) yy Electrical Wiring in Conduit (Y/N) y Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot l i On Adjoining Lots 7/lf� To Nearest Edge of Absorption Field on Lot On Adjoining Lots > lG�d To Nearest Public Sewer Line nON-9 To Nearest Public Sewer NONE To Nearest Sewer Service Line on Lot CleanouVManhole Water Sample Collected by Date Water Sample Test Results Comments B. SEPTIC/HOHM"TANK DATA Date Installed 86 Size lal!50 No. of Compartments 7%4: (O Standpipes (Y/N) >�.___-- Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Date ped N/A NM L✓ Depression over Tank (Y/N) r, I � Last Pum Pumping/Maintenance Contract on File (Y/N) —hA; ; for N�iQe- ��q Holding Tank High -Water Alarm (Y/N)� Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank To Water -Supply Well I P3 To Building Foundation To Property Line S 5r To Disposal Field — To Stream, Pond, Lake, or Major Drainage To Water Main/Service Line Course Comments Pagel of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 1,4-o Type of System Design T&MwCE4 Date Installed *1 U W W 1986 Length of Field O Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area/�/�nr90 Standpipes Present(Y/N) Depression over Field (Y/N) / Date of Last Adequacy Test N�ii ° IJU Results of Last Adequacy Test N Let Separation Distance from Absorption Field: To Water -Supply Well / �✓a To Property Line 7 C _ To Building FoundationNO � / 3 ! To Existing or Abandoned System on 'y Lot O" On Adjoining Lots 7 /U -Z) To Water Main/Service Line > O To Cutbank (if present) �Oly4 To Stream/Pond/Lake/or Major Drainage Course N O To Driveway, Parking Area, or Vehicle Storage Area 011k Comments 0 ZQ4,INF/_A1 b _( h1D*AE2 Z)P_1t/�F ��g0(��•� tON 1 N $TA f6L,L J> D. LIFT STATION tJ O NE Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access(Y/N) — "Pump Off' Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or c nformed to all MOAand HAA guidelines in effect on the date of this inspection. SignedDate �/( d74 CompanyT_��� MOA No. Receipt No. 141)n I - 00c):a Date of Payment SC g5-SS� Amount: $c�Q� DEPT. 0i HE/,LTH ENVIP,ONMioNTkL PROP-CrION Page 2 of 2 AUG 1 Fj 1986 ]2-026(11,84) RECEIVED ngineer's Seal �+ n ' iu°�t�>s. 159/1