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HomeMy WebLinkAboutHANSEN SAND LAKE LT 7 E2Onsite File #012-153-12 Municipality of Anchorage On -Site Water & Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number OSP201247 012-153-12 PID Number: Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two single Family Project: ❑ New ® Upgrade Name: BARBARA CHAMBERS ABSORPTION FIELD Site Address: ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound 3557 W. 74TH AVENUE *ANCHORAGE, AK ❑ Other Phone: No. of Bedrooms; soil Rating: Total Depth from original grade: 907-764-6416 3 ate. Ft. Ft LEGAL DESCRIPTION Depth to pipe invert from original grade: Gravel depth beneath pipe: FIL Fl. Subdivision: Block: Lot: Fill added above original grade: Grave HANSEN SAND LAKE _ g`h 7 E2 owns Ip: anger - QC Ion: Ft. Gravel width: CJ _ Beds Number of lines: Distance between lines: SEPARATION DISTANCES Ft - Total absorption Number of Trenches: Dist. between Trenches: To Septic Absorption Lift Holding From Tank Field Station Tank Sewer Line SQ Ft Ft. Well N/A - N/A TANK Z Septic ❑ S.T.E.P. ❑Holding ❑Other Manufacturer. Capacity: Surface Water 100'+ CD GREER 1000 Gal. Lot Line 5+ Material: Number of compartments: X NSA HDPE 2 Foundation 101+ _ _ LIFT STATION Remarks: Manufacturer. capacity: OLD TANK WAS DECOMMISSIONED PER UPC. Gal. Alarm Location: Electrical Installed by: Installer PIPE MATERIAL NORTHERN EXCAVATION House to tank EXISTING Tank to drainfield EXISTING/D3034 Inspector GEG, Ltd. Drainfield EXISTING CO/MT EXISTING/D3034 Inspection Dates: 1st 7/17/20 2nd BENCH MARK (Assumed elevation) 3rd - 4th 97.92 F,, Location and Description: TOP OF MH LID ON-SITE WATER AND WASTEWATER SECTION APPROVAL ENGINEER'SSE�AL o Conditional Approval: Date: o S��O .Je Garriess, stem: Septic S 6�Q s ' lY CE —7 4 m� p Y � Approved:_fV r y�0 P'e Note: this approval does not include well permit requirements Date. r 5' 6gp LICENSE4QQp fes 0\1 #AECC864 �>O�pOdO Incnnrynn Po..n rf S_�.14 Anr PERMIT NUMBER: OSP201247 A I B I C MH1 19.8 1 18.2 1 16.4 ST1 24.2 22.4 20.4 DBL1 25.5 23.5 21.2 DBL2 25.6 23.5 21.0 CO - 21.5 16.4 HANSEN SAND LAKE; LOT 7C SERVED BY PUBLIC R] WATER AND SEWER �o N 1000 GALLON HDPE SEP TANK; WITH DOUBLE CLEANOUTS AFTER TANK EXISTING 31 BEDROOM HOUSE DRAINFIELD N� PARCEL ID NUMBER: 012-153-12 WELL LOCATIONS AND RADII ARE APPROXIMATE 0 u> - I IHANSEN SAND LAKE; LOT 6C I 3PROXIMATE LOCATION OF EXISITNIG KEYBOX PER AWWU CONNECT CARD - SERVED BY PUBLIC R] WATER AND SEWER WEST 74TH AVENUE HANSEN SAND SAND LAKE; LOT 141 HANSEN SAND] LAKE; LOT 15 VACANT V A F SERVED BY PUBLIC BARBARA CHAMBERS WATER AND SEWER 907-764-6416 N PROJECT/LEGAL DESCRIPTION: SCALE: DRAWN BY: V=40' P.N.B. TYPE OF WORK: g r ,,, RECORD DRAWING 4"'ARNESS EN"INEERIN" "ROUP9 -w td ENGINEERING,, SALES* CONSULTING 3701 E. TUDOR ROAD, SUITE 101 - ANCHORAGE, AK 99507 - PHONE (907) 337.6179' FAX (907) 338-3246' WEBSITE: www.gamessenjneedng.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: BARBARA CHAMBERS 907-764-6416 2 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: HANSEN SAND LAKE, LOT 7 E2 P.N.B. TYPE OF WORK: DATE: ,,, RECORD DRAWING 7/20/20 4t LICENSE #AECC884 Eff SIT I AN A. Gam ss: Q A .4 ..-v%% EEO MUNICIPALITY OFANCHORAGE On -Site Water & Wastewater Program P0Box 1n665 *70UElmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 On -Site Wastewater Disposal System Permit Permit Number: OSP201247 Work Type: SepUoTankUpQrade Tax Code Number: 01215312000 Site Legal Address: HANSENSAND LAKE LT 7E2 G:2126 Site Mailing Address: 3557VV74THAVE, Anchorage Owner: STBNERBARBARA K Design Engineer: GARNESSENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sol Ft Total Bedrooms: 7/15/2020 7/15/2021 35100 D Disposal Field M Septic Tank El Holding Tank El Privy M Private Well El Water Storage All construction shall bminaccordance with: 1 The attached approved design. 2 All requirements specified inAnchorage Municipal codChapters 1555 and15G5 andth State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) -. The wastewater ----r-`—`~'''~,~~~~''~~~'^'u^'~^'~~^~~~'. The engineer shall notify the Development Services Department per AMC 15.G5.Provide notification by calling (8O7)343-7QO4(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, nr b. Covered, sealed, and heated to prevent freezing Received Issued By:LQ Date: MUNICIPALITY OF ANCHORAGE 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. 012-153-12 Property owner(s) BARBARA CHAMBERS Day phone 907-764-6416 Mailing address 3557 W 74TH AVENUE 'ANCHORAGE, AK Site address 3557 W 74TH AVENUE `ANCHORAGE, AK Legal description (Sub'd, Block & Lot) HANSEN SAND LAKE; LOT 7E2 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 APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ 3 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. f GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees:_168.15 , COV I D. `) q Waiver Fees: Date of Payment: WN/20 Date of Payment: Receipt Number: 006506 Cr' Receipt Number: Permit No. O S P ZO 12 qj Waiver No. (Rev. 01111) Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201247, Rebecca Carroll, 07/15/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201247, Rebecca Carroll, 07/15/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201247, Rebecca Carroll, 07/15/20 MUNICIPALITY OF ANCHORAGE WATER CONNECTION Location Record 91t S-e)c) ACCT. NO. ME ADDRESS IA) 7 BLOCK ADDITION A( a 4. !LI.ZE CONN. N. DATE MADE NEW CONN. REPLACEMENT CONN. LOCATION: AL LEY 0 STREET TYPE OF MAIN IS OW SKETCH ON REVERSE SIDE CORPSTOP THAW PLATE PERMIT NO.p CURB STOP C To C KEARNY WIRE CONNECTOR W. CURB STOP C To I OTHER: CONN. CORP CONNECTOR INSP. 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LIZ a n, 14, CU ve x rc ave c ✓ s oo u f U , ee s 79LL a 9LVE o � o �LOZOL � F- U � o � � •ice Ova OtlO 66 N78 E, rb °s P �s 2 sF sC SQ SB !e Ove 616. sf ...- � 108 a'g m ZOL4 No.. o.., .. m _ 0 ., 4£9z4 epi 01 OR R6, 109 ss f+e0 J o� os s9 5i m £oo£zF-I o . - e[ S6 C V- U7 d m = v v H °. m 2 cCN4:ljj `4Y U m g c 2• c= U m m `m Z ', y h (Dm D. uci a'li idx�aa�rn�� y 3m 3za ..:!t r e' 1 t a z. _ w mU U_aiz�_U-o�w>Uf m>>- ¢¢UUUU �Uowc�x�aa¢vf»3Sz• -i U) 6/25/20201" = 20'BFBBOBBY F. BURNETTSW 2126AS-BUILTASB2020 ~/~ MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONIVIEN'rAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE [~-'NEW MAILING ADDRESS LEGAL DESCRIPTION LOCATION m~ NO. OF B~ROOMS W]l ~0~ ~ ~ Absorption ar?/ Dwelling ~ PERMLT NO. DISTANCE TO: Material No. of com~rtments ~ Manufacturer .~ ~C~O~ Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth o ~ ~ DISTANCE TO: We~l Dwelling PERMIT NO. O Z ~ Manufacturer ~ ~ Liquid capacity in gallons D Well Ii nes Distance ~lines No. of linesI Length o,~a~line Total Trench~i~, ~ ~ ~ ~ Top of the to finish grade ~ I ~ Material beneath tile , ' ~ Total ef~t~b~tion are~ ~ ~ ~ inches m .~ Width Depth PERMIT NO. ~ ~ ' Type of crib ~ Crib depth TotaJ effective absorption area ~ Well ~ DISTANCE TO: ~ Class ~L) ~ Depth Driller ~~~ PERMIT NO. ~ ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorptio~ OTHER SOIL TEST RATI~.oNG ~ ~ REMARKS ~ C~; ~'r APPROVED DATE LEGAL k~ 72-013 (Rev. 3/78) PERMIT ND: DATE ISSUED: APPLICANT: ADDF~E~. CONTACT PHONE: ~U~,~ I C I PA~ I TY OF ¢~E:~4OR:A .BE DEPARTMENT OF HEALTH AND ENVIRONIdENTAL pROTECTION G25 L STREET, ANCHORAGE,.' AK 99501 ON--SI T'E 840666 08/06/84 'CARL'S EXCAVATING PO BOX 110383 ANCHORAGE .~ Al.-':: 99511 ..:,46-.~,._,68 LE(.~AL DESCRIP: SUBDIVISION: HANSEN SANDLAKE ADD. LOT: E1/2 BLOCK: ]~RAOT 7 SE[;TION: 2 TOWNSHIP: ~RN , RANGE: 4W LOT SIZE: 34684 (SQ.FT. OR ACRES) MAX BEDROOMS: 3 Listed IDelow ape the opti(Dns available to you in cl~E~,igning youP septic. system~ Choose the option that best £its you~ site. DEPTH TO PIPE BOTTOM (PT:) 4.0 4.0 GRAVEL DEPTH (FI".) 8.0 0,,5 3.'5 TOTAL .DEPTH (FT.) 12.0 4.5 7.5 GRAVEL WIDTH (FT.) .2.5 19.0 5.0 GRAVEL LENGTH (FT.) 29.0 36.0 49,,0 'GRAVEL VOLUME (CU. YDS. ) ~ ~ -~' TANK SIZE (GALS) 1.~000.0 *.~ .. 1,000.0 '~'~' 1~000,,0 '~* SOIL RATING (SQ. Fl'. /BR) 150 150 150 TANK MUST HAVE AT. LEAST TWO COMPARTMENTS I cePti{'~ ~.hat: 1. I am £amiliar' ~ith the Pequirements For' orr:site se~ePs and wells as set ~oPth by the Municipality oF Anch~Page (MOA) and the State o~ Alaska. 2. I ~il]. in~tall the system in accoPdance with all' MOA codes arid Pegulations, and in compl~.ance with the design cPite~ia ~)~' this per'mit. 3. I will adhePe to all MOA and State ~]~ Alaska PequiPements ~oi~ the set ba~k dista[~ces ~Pom any existing wel~, wastewa{ep ~isp~sal system oP public sewerage system on th~:s or any. adjac:ent oP neaPby lot,, 4,, I undepstand that this pePmit is valid ~oP a ma~im~m o~ 3 bedPoo~s and any er~laPgement wilt Pequire an additional 'pePmit. IF A LIFT STATION IS INS]'ALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OB'FAINED; (2) A~ WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT~ AND (3) THE ............... ........... MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST SOIL~ LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: ~' ~ ~'~,T '7 ~~. TE~ PERFORMED: SLOPE SITE PLAN 2 3 I S 5 10 11 12 13 14 15 16 17 18 19 2O WAS GROUND WATER S ENCOUNTERED? /~L~ OL E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Date Time Time Water Drop PERCOLATION RATE (~m utes/inch) FT AND ~ FT TEST RUN BETWEEN • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Parcel I.D. 012-153-12 Certificate of On -Site Systems Approval S rF T Y Expiration Date: t,)unp- 1. GENERAL INFORMATION: Complete legal description HANSEN SAND LAKE; LOT 7 E2 Location (site address) 3557 W. 74TH AVENUE *ANCHORAGE AK Current Property owner(s) BARBARA CHAMBERS Day phone 764-6416 Mailing address 3557 W. 74TH AVENUE *ANCHORAGE AK Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee Date of Payment 0 / C" V' L � Waiver Fee $ �u 'o Receipt Number k 'klo 7 R�` COSA #1\� 9 I Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness 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\t in accordance with the guidelines and regulations established by the Municipality of Anchorage and F -• 4 industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or J f t encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a varietyof variables, including but not limited to, soil conditions, j J ..... ... i, groundwater levels (that may fluctuate during the year), quality of construction (materials and j workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and ...... .. v are outside the control of GEG. Satisfactory test results do not guarantee future performance of the t,� � � ;';. �?:�r• system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of i1 fr o 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 y perform the evaluation. Reliance upon the information provided in this report by any other person or 1tiv ; eS' party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE �\s``Y System #1 Approved for 3 bedroomsIS� System #2 Approved for bedrooms ON-SITE Disapproved WATER AND Conditional approval for bedrooms, with the followirM4ipWAREV1'ATER Z PROGRAM By: �lNZ Original Certificate Date: 7/2 1,24U U The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: �/ COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc COSA Checklist Legal Description: HANSEN SAND LAKE; LOT 7 E2 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for CO Static water a21'at beginning of test ft. ments PUBLIC WATER B. TANK DATA Age of tank(s) NEW years Tank type/material-0.1HOPE Measured operating fluid level in septic tank NEW ❑Q Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Which system tested (date installed) 1984 01 ALL standpipes present per record drawing Total measured depth from grade 11.58 ft (max) Measured depth to pipe invert from grade 3.16+ ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 6.83 ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced n/a gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 012-153-12 Structure served by this system Well production at time of test gp Water storage tank volume gallons Well disinfected fo orm test? ❑ Yes 0 No ❑ Col" acteria is Negative .11�itrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station year Lift station material Comment Adequacy test date 6/26/20 Results [DPass For 3 bedrooms Fluid depth prior to test 0 in Water added 623 gal New depth 3 in Elapsed time 30 min Final fluid depth 0 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date n/a 119 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 > 100' Community Sewer Manhole/Cle > 100' rl Yes if No Neighboring Tank > 100' ❑ Yes if No Absorption Field on Lot > 100' ❑ Yes if No Neighboring Absorption Fields > 1 / Yes if No Comms ewer Main > 75' ❑ Yes if No ft ❑ Yes if No ft ft Priva er/Septic Line > 25' Yes if No ft Holding Tank > 100' ❑ Yes if No ft Animal Containment > 50' ❑ Yes if No ft ft ft Manure/Animal Excreta Storage > 100' Wells on Adjacent Lots: ft ❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Yes if No ft Surface Water > 100' Q✓ Yes if No ft Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200'✓0 Yes if No ft Water Service Line > 10' R 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' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' M Yes if No ft Wells on Adjacent Lots: Water Main > 10' S Yes if No ft Private Wells > 100' Q Yes if No ft Water Service Line > 10' Q Yes if No ft Community Wells > 200' S Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION o OF ��44 I certify that I have determined through field inspections and review S��Q of Municipal records that the above systems are in conformance with Cl) MOA COSA guidelines in effect on this date. g H `�. V .J ftP y Garne s, Q �O 9. E-79 COSA Checklist yellow sheet 40ea pr o f e s s'o000\ � #AECC884 Sonja Blewett From: Barb Chambers <pushingstonesuphill@gmail.com> Sent: Tuesday, July 28, 2020 2:21 PM To: Sonja Blewett Subject: Re: Follow up Hi Sonja, I have never had freezing issues with my septic system. In 20 years, I never had one issue with my septic system. Thank you very much. -Barb Chambers On Jul 28, 2020, at 2:13 PM, Sonja Blewett <Sonja @garnessengineering com> wrote: Hello, the MOA is needing a statement stating you have not had any freezing issues with your septic. You can just email statement to me. Thanks! Sincerely. Son - ja fflcu,,ett Corporate SecretarN'1/TreaSU1-C1- Garness Engineering Group, Ltd. 3 701 E. Tudor Road, Suite 101 Anchorage, Alaska 99507 Phone: (907) 337-6179 Fax: (907) 338-3246 Website: wvv-w.�arnessen�ineerin�.com <image001.jpg><image002.png><image0O3.jpg> MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # 012 153 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 000 HAA# GENERAL INFORMATION Completelegal description Tract 7 E 1/2 : ;~ansen Sand Lake Subdivision Location (site address or directions) Property owner Mailing address Dean 3557 W. 74th Avenue Anchoraqer AK & Laura Barlow Dayphone 3557 W. 74th Avenue Anchorage, AK 248-3433 Lending agency Mailing address Day phone Agent Address Wendy Stevens/Dynamic Properties Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: XX If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. ×X 72-025 (Rev. 1/91) Front MOA 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein, lfurtherverifythatbased 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~l..~(~,¢~)st !s inspection. Name of Firm Wa~*ac~t~_~/~on$~'~n~_ __~.__ Phone Address /64)0t] ¢~, Irr I~o~¢,/~u~ ~ Engineer's signature ~..~ ~¢,~,~/i.~ '(/ ~ ...'~,-- Date Wastewater Consultants, ifl¢. Shall be PAID or pdor to, closing for the Engineerin9 Services Provided, DHHS SIGNATURE ~ Approved forT/¢'¢~ ~c E.. bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~25(Rev. 1/91) Beck MOAt!21 RECEIVED MAY 20 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES MuNIC:IPALr[Y Environmental Services Division F. HVit~ON~ENTAL SEP-VI~N 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Health Authority Approval Checklist Z ~ ~:-- .,~'/~,E,5.~/?~t.~/~,~Jd-~.Parcel I.D.: ~'~ If A, B, or C, attach ADEC letter. ADEC water system n er.~~ Date completed ~ Cased to C~ height (above ground) t / Wires properly protected (Y/N) ,/~/~/// g.p.m. Date of test Static water level Well production WATER SAMPLE Coliform Date of Sa~O~ AT INSPECTION Nitrate Collected by: Other bacteria g.p.m. B. SEPTIC/HOLDING TANK DATA Date installed ~/~'/~y Tank size/~) Foundation cleanou[~/N) ?/~;~_ ~ Depression (Y/(~ Date of Pumping Number of Compartments c~ Cleanout~N) ~/' .~. High water alarm (Y/N) "~,/.~ Pumper, C. ABSORPTION FIELD DATA Date installed ~/o~,/~/-"~ Length ~.~ / Width Effective absorption area /-7/o~(~ Date of adequacy test ~-'- ~ Soil rating (g.p.d./ft2 or fF/bdrm) ! Gravel thickness below pipe Monitoring Tube present ~1) Result (Pa~ai,) System type ~ ~ °<~/ Total depth /c~ / . Depression over field For ~.~ Fluid depth in absorption field before test (in.); ~ Immediately after/~(~0 gal. water added (in.): Fluid depth /~4.~ (ins) Minutes later: Z2/c~. Absorption'rate = ~5~ q.p.d. Peroxide treatment (past 12 months) (WN) ~ ~ If yes, give date ~/~ bedrooms 72-026 (Rev. 3/96)* Date installed ~ ~ ,, Manhole/Access (Y/N) ~on" leve~CFatz--~ ~.~ump off level at* SEPARA'rlON DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot O~ ~ bu ;l~:l:iie°~iire Imdai°~ I °t ~ Public sewer manhole/cleanou"'"~'-'~ On adjacent I°ts ~'-'-~ Sewer/seine Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: / / Foundation~-'-- f/,? Property line .~ -/-' Absorption field ! Water main/service line /O -/- Surfacewater/drainage IOO-/- Wells on adjacent lots r~Or)G SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: ! / Property line /¢.~ -/' Building foundation /~ '¢' Water main/service line Surface water Curtain drain / _/._ Driveway, parking/vehicle storage area Z/.,',~ / Wells on adjacent lots /,~/~ ¢~- /¢'/')~Ec)/'~ F. ENGINEr:R'S CERTIFICATION/./ · I ceRify that/~ d~t~r~2th, , field inspections and review of Municipal r~fh~tf~~ms are in conforma~o w/t¢/~ ~ g, do/inos in effoct on this date. Signature ~ ~~% ' HAA Fee $_ ¢~/M~' Date of Payment //'~2 / ~?' Receipt Number /~'~ 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number Aa'Row Pump & Well Service, LLC .,' ~1~¥©l]~" P.O, BOX 110496 Anchorage, AK 99511 Offic.: (907) 346-9355. Office (907) 346-0202 5 Cellular: 244-3541 · Fex 333.8976 INVOICE DATE ~TE S.~IPPE0- OUR ri NO. T-- / 8- ? ~' o~ T~RM~ F.O~, SALESPERSON LABOR HOURS ~TE AMOUNT TOTAL MATERIAL ~¢R¢ORDEREDL¢~f~ BY] ,DATE CO~R TOTAL-~BOR Thank You SIGNATURE 1 Heml3y Acknowledge th,e Satisfactory Complatlo~, of ~e Above Des~r;bed Work,) TERMS: ADDOUN'f8 PAYABLE AT 10TH O[~ MONTH FQI-LOWING PURCHASE, SERVICE CHARGE AT RATE OF 1,{i% PER MONTH WILL BE CHARGED ON OVERDUE ADCOUNT~. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date ¢¢d/'~)f'7.,(~c~ ~, / ¢8'7 GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) (b) (c) Leaal Description (include lot, block, subdivision, section, township, range). Location (address or directions) _ -- ,.,.,.~..~_, Property Owner .~ rbA¢~ ~.! ~'~2r~q Telephone: Home C~3 '0{~?(t~ Business Mailing Address ~"~q ~. q'/-[ ,,L.~ ~ Lending Institution ,~.~~ /~¢ ~O~ ~l~t ~ Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the followina address: or: Check here ~hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family ~ Number of Bedrooms WATER SUPPLY Individual Well [] Community [] Public ~ Note: If corem unity well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. SEWAGE DI~SAL 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 fRev 8/861 Front 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 water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inst~ection. , ,, ,, ~ Name of Firm ~,~ ~*'~,-} I t'1.~7'. ~-D ,.--~0 ~--,/,0--'~ ,,~)~,~--, .Telephope~ ~t-~~) Address _ ~ ~~ P~ ~/~) ~ ~) ~' ~ ~0~ DHHS APPROVAL Approved for Approved bedrooms by >~'/~ ¢ "~'~/-~ate Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority ApprovaJ certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 fRev 8/86) Back & associates, inc. Consulting Engineers 4790 Business Park Blvd. · Bldg. D · Suite One ° Anchorage, Alaska 99503 · (907) 561-6151 February 19, 1987 Municipality of Anchorage Department of Health and Environmental Protection 825 "L" Street Anchorage, Alaska 99501 Attention: Mr. Dan Roth SUBJECT: El/2, TRACT 7, HANSON-SAND LAKE ADDITION Dear Dan: Corwin & Associates, Inc. performed an adequacy test on the septic system of the above referenced lot. At the time of testing, we were instructed by the homeowner to test for 2 bedrooms. The mortgage company has since asked us if the system could be approved for 3 bedrooms. We have reviewed our records and believe that the system is adequate for a 3-bedroom house. The original design and installation was for 3 bedrooms. During our adequacy test procedure, we added sufficient water (600 gallons) to test for a 3-bedroom system. The system absorbed at approximately the same rate as the water was introduced. Therefore, we request that the number of bedrooms be changed to 3 and ~he system be approved. Very truly yours, CORWIN & ASSOCIATES, INC. Laura Ogar Environmental Engineer LO/d MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL.iLl. OF ON-SITE SEWER AND WATER FACILITY ° ~)~)~/ 264-4720 1. GENERAL INFORMATION (a) Leg,al Description (include lot, block, s,ubdivisio,n,,s,ection, township, range) Location (address or directions) (bi Applicant Name % "~J (q.L"~f-.%O V'% (c) Ave, Telephone: Home o, 3 Business Applicant is (check one): Lending Institution []; Owner/builder ;E~Buyer []; Other [] (explain); (d) Lending Institution ,~c'~'~ ~¢~L~(~ ~_ Telephone t ~ Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RES~,~;E Single-Family ~ Multi-Family [] Other Number of Bedrooms /~' WATER SUPPLY Individual Well [] Community [] Public ~ Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. 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 I of 2 72-025 (~1~84) ENGINEERING FIRMPROVIDI, .INSPECTIONS, TESTS, FILE SEARCH, r.. A 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 water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of struclure 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 ir~spection. , NameofFirm (,.,~. ¢'(,3i~i.~ ~:x-~,~r;~_.7,J~-~ ~/~'~, Tele. p_hone ~ ' ~....~,,. % /N~. C:~;2S; ,,- -.: Engineer's Seal (.. ,% ,,~ , . ..-¢ Approved for ~' bedrooms by Approved '/~ Disapproved Terms of Conditional Approval ,~' '~~Date Conditional 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 (11/84) ;. '~UNt~PALI'IY O~ ANa,IORAGE ENviRONMENTAL SERVICES DIVISION FEB ! 1987 RECEIVED MUNICIPALITY OF ANCHORAGE (MOL/ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: J~0,Aq~Y~ ~:LA/t/~ ~.'~ Fa Trot A. WELL DATA Well Classification Well Log Present (Y/N) Tota~,,?t h Cased to Static WAte.~Level ___ Casing Height Above Ground ____ Electrical Wiring in C~¢ro d~ Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sampte Test Results Gomments eon ~bd % If A, B, C, D.E.C. Approved (Y/N) Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots -~'~'"'""~, ~n g Lots __ To Nearest Public'"Se.~ To Nearest Sewer ;S;rs~ieCe Line'"o~.....~ B. SEPTIC/HOLDING TANK DATA Date Installed 8-8 ..fC~ Standpipes (Y/N) L.(~.~ Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~J A Separation Distances from Septic/Holding Tank: To Water-Supply Well ~-l~r- - To Property Line ~;20 I +_ To Water Main/Service Line c-j~ i Course /~ ' S ze //aOO/~. NO. of Compartments c~. Air-tight Caps (Y/N) ~--~-~ Foundation Cleanout (Y/N) HO Date Last Pumped IJ 'for -- Temporary Holding Tank Permit (Y/N) qOg~O~'(~ ~ i,To Building Foundation 5' To Disposal Field ~'~ To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 8-~ -_(~ (t Width of Field ¢'~ ''~ id-o¢ Type of System Design Length of Field Depth of Field Square Feet of Absorption Area Depression over Field (Y/N) /~(~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line r-lei t To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storag. e Area Comments . Gravel Bed Thickness (~ Standpipes Present (Y/N) ~'.~, .~.~'~ Date of Last Adequacy Test II F:::4C'~3~'ULC'(_~, I C~:)'~ To Property Line /-'/0 ~ To Existing or Abandoned System on ; On Adjoining Lots /~'/~t · To Cutbank (if present) f~J'~ LIFT STATION ~3~te Installed Dimensions ~ ~ Tested for ~...,~,/'"'"/ Pumping Cycles during Adequacy Test. MeJMOA ** Check Cr~itted Bedr~oom Rating Against HAA Request ** I certify t h,~t/f'/)C~c,e .¢hecJ/-ecJ¢, verified, or conformed to all ~OA ~d HAA guidelines in effect on the date of this inspection. Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) Engineer's Seal