HomeMy WebLinkAboutSUNDI LAKE BLK 2 LT 15Aundi Lake
Block 2
Lot 15A
#011-131-47
Municipality of Anchorage Page 1 of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: Gw00052 PID Number: 011-131-17
Nam ¢:
Wastewater System: 2 New ❑ Upgrade
Diamond Masonry
Address:
8351 Berry Patch Dr. Anch., AK
ABSORPTION FIELD
Phone:
727-2222
No. of Bedrooms:
F011r (4)
b1 Deep Trench ❑Shallow Trench Deed D Mound D Other
LEGAL DESCRIPTION
soil Rating: .8
Total Depth fr1n2 (iginalgrnde:
GPD/Sq. Ft.
Lot: Block: Sotatg n:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
8'
1 5 2 Sundl LdK2
4' Ft
Ft.
Township: —F."ge:Gravel
Township:
Range:
Section:
Fill added above original grade:
1 '
length:
51,
Ft.
Ft.
WELL: [XNew ❑ Upgrade
Gravel width: r
3
Number of lines:
1
Distance between lines:
N/A
Ft
FL
Classification (Private, A,B,C):
Total Depth:
Cased To:
Total absorption area:
Pipe material:
Private
190 Ft.
190 Ft.
816 So: Ft.
ASTM D3034 PVC
Driller:
Drilling
Dateprilled
4/22/00
Static Water Level:
69
Installer.
Red Do Masonry4/15/00
Date installed: -
Alpine
Ft
Yield:5.0
Pump Set at: -
I
Casing 2He0bI Above Ground:
TANK
GPM
I Ft,
Ft.
SEPARATION
DISTANCES
M Septic D Holding D S.T_E.P.
To
. Septic
Absor tion
Lfn
Holding
ublic/Pnva,e
Manufacturer.
Capacity in gallons:
From
Tank
Field
station
Tank
Sewer Lines
Anchorage Tank
1 250
>1QO'
>1��'
N/A
N/A
>25
Material:
Steel
Number of Compartments:
Two
WelF
Surface
>100'
>100'
N/A
N/A
N/A
LIFT STATION - N/A
Water
Lot
> 5 '
> 1 0 '
N/A
N/A
N/A
Size in gallons:
Manufacturer.
L_ ine
'
>5'
>10 '
N/ A
N/A
N/A
"Pump on" level at:
"Pump ofY'level at
High water alar at:
Foundation
Curtain
None
oted
n LO
Pump MakeBModel
Electrical Inspections perforetl by: -
Drain
BENCH MARK
Remarks: 2" Insulation over
Septic Tank.
LO a6onandD�Onp"°°' Garage Slab
Assumed Elevation:
100.0 Ft
- -
ENC�INEEf�t.�';SEAL
U,
r
Inspections performed by: MEA Dates: 1st -4/1 5/00 c«°
�^
2nd 4/15/00
Department of Health and Human Services approval
y.
Reviewed and approved by: ot&&t Date: ' /-`o_Q/-N,
9 �
t
M2 oI3 (Rev. 9/91) MOA 25
Municipality of Anchorage Page 2 of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 -Anchorage, AK 99519-6650 - 343-4744
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number SW00052 PID No. 011-131-17
EIGHTIETH AVENUE
8
S _89'59'00" E 285.00'
A
B
Sl
13.91113.9
9g
1123.8
C4
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d
C5
60.0
78.2
N
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51.3
68.9
Alternate
4
o
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S2
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edroom M1
ome
C5
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PLAN AS -BUILT
SCALE 1" = 50'1.c1�.4�4�
�y�Jy P,�layµp•.y` t yl t_. ;4•E$5 }�
Municipality of Anchorage Page 3 of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744
On -Site Wastewater Disposal System or Well Inspection Report
PID No. 011-131-17
1' 6' 2' 8' 213'213'
LO
v 98.7 H z U
85.3
79.0
41'
PROFILE AS -BUILT
1"=10,
93.25
v4��{ssi tt,1 --
Drainfield Rock
85.3
79.0
41'
PROFILE AS -BUILT
1"=10,
93.25
v4��{ssi tt,1 --
ROM DIAMOND MASONRY INC FAX NO. : 907 522 6562 Jul. 08 2000 09:09AN P1
® Municipality of Anchorage
Department of Health and Human Services
825 V Street
P.O- Box 196650 Anchorage, Alaska 99519-665o
Rick Mystrom - - http://w .ei.anchorage-akxs
Mayor
Permit Num bert #SW,000052-Date�f.Issue. 4--10-00 _ParcelIdentification Nnmbm- 011-131-17
Date Started: 4 -JI -00 Date Completed: 4-22-00 Is well located at approved permit location? ® Yes ❑ No
Legal Descriptio Sundi Lake Blk 2 It 15
Property Owner • ame & Address: Diamond Masonary
B35.1.8ery Patch_ Ddve.
Aadfor�495a2
Borehole Data: ."Depth 00..
Soil Type, Thielatess & Water Strata from To
stick-up 0 2
Method -of DrillingN air tetary ❑ cable tool
Casing type:, steel
Wall Thieknessi .025 inches
Silt 2
20
_
Diameter: 6 inches XJepth:'19i) feet . .
sandy silt 20
185
Liner Type:
water sand&_gravel IR5
1,90
Diameter: inches Depth: feet
Casing stickup above ground: 2 feet
:Static watexievel (from ground level): 699 feet
Pumpingtevei::190 feet after
..2 hours purring 5fi+-gpm
Recovery Rate:.-M+...gpm
Method of.Trsting_Airlift
Well Intake'Operning -Type:
® Open End" [D'Open dole
❑ Screened ' -Start feet Stopped feet
RECEIVED
-I] perforations -Start -feet Stopped feet
Grout Type: bentonite # 8 Volume: 1 bis'
JUL 10 2000
Depth: Start 0 feet Stopped = feet
Pump: Intake Depth _ feet
Municipe. +-�jjchorage
Dept. Heaith • iuman Services
Pump size hp. BrandNaine .
Well Disimfeeted-UponCompletion? Yes -❑:No..
Method of-Disinfeetion: clarine tablets
Comments:
Well Driller: Alpine Drilling & Ente{prises
"PO Box. 110496
:Attelhorage., A1C -99511
Attention: The win driller shalT (provide a well log to the property owner within 30 days of completion and the property
msrnar nr +hn ,xrReceived Time""Ju �•�' 8:IOAM"'P''"+nf TI6'olYh;Q'k{timnnC»iiinrc •vitkin An Aave of nmm�lvfinn
ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Permit Number: SW000052
Legal Description: SUNDI LAKE BLK 2 LT 15
Date Issued: Apr 10, 2000
Expiration Date: Apr 10, 2001
Parcel ID: 011-131-17
Design Engineer: 0014 Anderson Engineering Site Address: 004813 SUNDI DR
Owner Name: Diamond Masonry Lot Size: 36850 SQ. FT.
Owner Address: 8351 Berry Patch Dr. Total Bedrooms: 4 Permit Bedrooms: 4
Anchorage , AK 99502 -
This permit is for the construction of:
M Disposal Field 0 Septic Tank Holding Tank [—] Privy Private Well Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date: LI -1U UQ
�' Date: 4 —40
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On -Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Permit Number: SW000052
Legal Description: SUNDI LAKE BLK 2 LT 15
Date Issued: Apr 10, 2000
Expiration Date: Apr 10, 2001
Parcel ID: 011-131-17
Design Engineer: 0014 Anderson Engineering Site Address: 004813 SUNDI DR
Owner Name: Diamond Masonry Lot Size: 36850 SQ. FT.
Owner Address: 8351 Berry Patch Dr. Total Bedrooms: 4 Permit Bedrooms: 4
Anchorage , AK 99502 -
This permit is for the construction of:
M Disposal Field 0 Septic Tank Holding Tank [—] Privy Private Well Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date: LI -1U UQ
�' Date: 4 —40
DT ERS'ON ENGINEER1NGz
� � �P;O80X 240773 i �
-s', i ��ANCfiOF2AGE, ASC 99524 :' ,t
April 1, 2000
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street -
Anchorage, AK 99502-0650
Subject: Lot 15, Block 2, Sundi Lake Subdivision
Septic System Tank Replacement Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 15, Block 2,'Sundi Lake Subdivision intends to construct a four:
bedroom home on the lot. We are hereby requesting a permit to construct a well and
septic system on the lot to serve the new home. The attached Site Plan and backup
documentation shows the location and configuration of the new well and septic system.
The 100' protective radius for the well is also shown along with its proximity to septic
systems in the neighborhood.
The ground surface on the lot slopes from east to west at a shallow grade and from
south to north also at a shallow grade in the area of the new absorption trench. The
new trench will be constructed across the slope in accordance with the municipal
ordinance. Surface grading and mounding over and around the trench will be
accomplished to assure drainage is away from the finished surface.
Testholes placed on the lot indicated silty sand with some gravel from 1' below the
surface to the bottom of the hole. Soil material percolated at a rate between 12 and 15
minutes per inch. No groundwater was noted during the initial testhole placement and
none was found during the ensuing monitoring period. We are therefore proposing,
construction of a deep trench system with 8' of drainfield rock beneath the lateral. The
lateral will be placed at 3' below the surface with a total depth of the trench at 11'.
Some mounding may be required to provide a minimum of T of cover over the trench.
If the system is constructed in accordance with our design the following statements
apply
1. The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
3. The system, if constructed as designed, will have no, adverse impact on reserved
space, either surface or subsurface, on any lots located-in.the area.
W
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ti �qyF AREA MAP
oM
SCALE 1" = 100'
tl N
O
' 2
O
m j i
WEST 80TH AVENUE
XO8'L?p?.XDepthide
Absorption Trench
,250 Gal.
eptic Tar
k vv{{
AvM. Gn 1.3,�$(.A p
6 C' ii
.b sa 1
141, yj
r6.M20N
4_ I�4
f
Four `C
\ RPdron N
Proposed
Well /
Alternate Site
T
Existing
Absorpti
Crib
SITE PLAN
SCALE 1" = 50'
LOT 15, BLOCK 2, SUNDI LAKE
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Four Bedroom Home Deep Trench System
Pero. Rate: 12 Min./Inch 1,250 Gallon Septic Tank
Application Rate: .8 GPD/SF 8' Drainfield Rock
4 Bedrooms X 150 GPD / .8 GPD/SF = 750 SF of Absorption Area
750 SF/16 SF/ LF of Trench = 46.9 LF Trench Length
Therefore: Construct a Deep Absorption Trench System With One Lateral
50' in Length with 8' of Drainfield Rock Beneath the Distribution Pipe.
Distribution Pipe in Trench Placed at 3' Below the Original Ground
Surface. Total Depth to be 11' From Original Ground Surface. Mound Over
Trench to Provide a Minimum of 3' of Cover.
Natural
Backfill
2.5'
.5'
M
d 'lhe. '• L �l5
F• y�a.Z4 t� YK��} �S%
Geotextile
Fabric
4" PVC Holes Down
Drainfield Rock
q' TYPICAL DEEP TRENCH SECTION
,q (NO SCALE)
NOTE: ' Grade Area Over Trench to Drain Away.
Provide 3' Cover Over Trench and 4' Over Tank or Insulate.
Maintain 10' Separation From Lot Line.
Maintain 10' Separation From Water Service Line.
Maintain 100' Separation From All Wells
1
2
3
Perc.
Zone
E.a
13
14
15
16
OG/OL
Silty Sand
SM Was Groundwater
Encountered? No
If Yet, What Depth?
Some Depth to Water
Gravel After Monitoring None
Date: 3129100
18Bottom of
Hole
Pere. Rate: 12 Min./Inch Perc. Hole Diameter: 6"
21 Test Run Between 4 Ft. and 5 Ft.
Comments: Percolation Cavity Presoaked Prior to Testing.
Performed By: Mike Anderson. I, Michael E Anderson Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 3/31/00
See Site Plan
20
1'
Reading
Date Gross
Time
Net
Time
Depth To
Water
Net
Drop
1
20 -Mar 1:30
Municipality of Anchorage`
°
Department of Health & Human Services
r
825 L Street, Anchorage, AK 99502-0650
c� iwi %r' s
SOILS LOG - PERCOLATION TEST
C 3 , xk�
Date
Performed: "t
�iamQoa Mason
Performed For: rX
c L Subdivision
Legal Description: Lot 15, lock 2 ndi @kQ
2:31
1
2
3
Perc.
Zone
E.a
13
14
15
16
OG/OL
Silty Sand
SM Was Groundwater
Encountered? No
If Yet, What Depth?
Some Depth to Water
Gravel After Monitoring None
Date: 3129100
18Bottom of
Hole
Pere. Rate: 12 Min./Inch Perc. Hole Diameter: 6"
21 Test Run Between 4 Ft. and 5 Ft.
Comments: Percolation Cavity Presoaked Prior to Testing.
Performed By: Mike Anderson. I, Michael E Anderson Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 3/31/00
See Site Plan
20
1'
Reading
Date Gross
Time
Net
Time
Depth To
Water
Net
Drop
1
20 -Mar 1:30
.75-
2
2:00
30
3.25"
2.5"
3
2:01
1 °
4
2:31
30
3.5"
2.5"
5
2:32
5"
6
3:02
30
3"
2.5"
Municipality of Anchorage Q
Department of Health &Human Services � d
825 L Street, Anchorage, AK 99502-0650
SOILS LOG - PERCOLATION TEST
v
Performed For: DiamQod Masonry Date Performed:
Legal Description: I of 15 Block' c odd I ake S bdivision
SLOPE SITE PLAN
1 OG/OL
2
3
TESTHOLE WO
4 Pere.
Zone
5
6
7 Silty Sand
u
SM Was Groundwater
9
Encountered? No
If Yet, What Depth?
10
Some Depth to Water
Gravel After Monitoring None
11
Date: , 3/29/00
121
See Site Plan
20
Hole
Pere. Rate: 12 Min./Inch Pere. Hole Diameter: 6
21 Test Run Between 4 Ft. and 5 Ft.
Comments: Percolation Cavity Presoaked Prior to Testing.
Performed By: Mike Anderson I, Michael E Anderson Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 3/31/00
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 15, BLOCK 2, SUNDI LAKE SUBDIVISION
GENERAL:
1. The scope of this project includes the procurement and placement of a
new 1,250 gallon septic tank. It also includes the construction of one
new 50' long x 3' wide x 8' effective depth absorption trench at the
location shown on the attached Site Plan. The total depth from original
ground of the trenches will be 11' below ground. Mounding over the
trench may be required to provide a minimum of 3' of protective cover.
A minimum of 100' separation must be maintained from the well on the
lot to all components of the new septic system and the reserve system.
2. Construction shall be in accordance with the approved site plan,
design drawings, Municipal Permit with any special provisions or
conditions, and all applicable State and Municipal Wastewater
Disposal Regulations.
3. The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of the septic system and verification of the
location of all lot lines.
4. Unless specifically agreed otherwise, the contractor shall be
responsible for final grading areas subsequently depressed from soil
settling. Property owner shall be responsible for revegetation of
affected areas unless specifically agreed otherwise.
5. Contractors installing wastewater disposal systems must be certified
by the Municipal Department of Health and Human Services for
system installations. Owners installing their own systems must receive
prior approval from D.H.H.S. before beginning system installation.
SEPTIC TANK INSTALLATION
The new 1,250 gallon septic tank must be procured from an approved
source and installed at the location shown on the plans.
2. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access.
3. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct
burial insulation.
A foundation cleanout shall be installed one to four feet from the
building foundation. Two cleanouts are required between the tank and
the drainfield.
Lot 15, Block 2, Sundi Lake Subdivision
April 1, 2000
Page 2 of 3
7. Final grading over the tank shall be such that a positive slope exists
away from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the
design. The bottom of the trench shall be within 2" of level.
2. Distribution piping must be placed level with perforations down atop a
level bed of drainfield rock. Rock should then be placed over the pipe
to provide a minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between the drainfield
rock and the natural soil backfill
4. Monitor tubes must be 4" in diameter and installed at the locations
shown on the design. The portion below ground must be perforated.
5. Contractor shall verify the septic tank and drainfield are a minimum
100' away from any private water wells in the area, 150' from a Class
"C" Well or 200' from any community well.
6. Direct bury insulation must be placed over the distribution system if
less than 3' of backfill depth is available. Finish grade over the trench
must be mounded to prevent settlement or depressions.
7. Grade area surrounding the absorption trenches to drain away.
8. A minimum 2' of accepting soil is required below the drainfield rock for
a 5' wide trench. Contractor shall verify this condition prior to
placement of the rock. All pockets of unacceptable materials must be
removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a municipally approved septic
tank manufacturer.
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated
and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and
ASTM D2662 or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Fernco, or equal).
Lot 15, Block 2, Sundi Lake Subdivision
April 1, 2000
Page 3 of 3
5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil layer.
6. All drain rock shall be .5" to 2.5' in diameter with less than 3% passing
the #200 sieve.
INSPECTIONS:
Municipal Ordinance requires a minimum of two inspections. These
inspections must be conducted under the supervision of a professional
engineer registered in the State of Alaska. The first inspection must be
conducted after the excavation of trenches, beds or pits and before the
installation of any gravel. A septic tank may be set in place, but may not
be backfilled.
The second inspection must be conducted after the placement of the
geotextile fabric, gravel, distribution piping, standpipes, cleanouts and
insulation. No backfill should be in place at the time of inspection.
Contractor shall provide a copy of all field .survey layout and construction
notes for use in preparing the certified as -built of the completed system.
Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 011-131-17
1. GENERAL INFORMATION
Expiration Date:
Complete legal description SUNDI LAKE; BLOCK 2 LOT 15 16
Location (site address) 4813 SUNDI DRIVE *ANCHORAGE, AK 99502
Current Property owner(s) TOBY DRAKE Day phone CIO AGENT
Mailing address 4813 SUNDI DRIVE *ANCHORAGE, AK 99502
Real Estate Agent GORDON SLOAN Day phone 244-3382
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
❑
WaiverNariance request for:
Received by:
TYPE OF WASTEWATER DISPOSAL:
Individual
❑
Holding Tank
❑
Community
❑
Public Seaver
lid
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date: 6
COSA Fee $ J�Z�O-�� Waiver Fee $ _
Date of Payment ��gnn/ Date of Payment
Receipt Number Q� 8 6� Receipt Number
COSA # Q15C1�7 �300 Waiver #
10-
J. S A 6MENT 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 E. Tudor Road, Suite 101, Anchorage AK, 99507-1259
Engineer's Printed Name Jeffrey A. Garness Date
In conducting this evaluation, GEG provided an engineering evaluation of the welt 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 system/s on the
dates of the evaluation. Separation distances were measured to readily identifrabte features.
Hidden defects or encroachments may exist that were not identified during the evaluation. The
operational life of all wells and septic systems depend on 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 systems.
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. The content of this report is for the sole benefit of the
person/party who retained GEG. Reliance upon the information provided in this report by any other
person or party, including but not limited to subsequent property purchasers, is not authorized. In
short, GEG disavows any legal duty to anyone other than the person/party, who paid for this report.
6. DSD SIGNATURE
AZ System #1 Approved for bedrooms
0
The
upor
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
bedrooms, with the following
�kkkll,ttiiltttltf
�N�P�\-\� OF
ON-SITE
WATER AND
WASTEWATER o^
PROGRAM
Original Certificate Date: �o
)ertficates of On -Site Systems Approval (COSA) based only
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist L� Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 9-1-12.doo
If more than I 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 15
A. WELL DATA
Parcel I D: 011-131-17
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES
Date completed 4/22/00 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth 190 ft. Cased to 190 ft. Casing height (above ground) 18+ in,
FROM WELL LOG
Date of test 4/22/00
Static water level 69 ft.
Well production 50+ g.p.m
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml.
Arsenic: 16.4 ug./L.
B. SEPTICIHOLDING TANK DATA
Tank Type/Material
Tank size gal. Number of Compartments
Foundation cleanout (YM) _ Depression over tank (Y/N) _
AT INSPECTION
5/21/15
68 ft.
6.47 —
9 -p.m -
Nitrate ND mg./L. Collected by: GFG. Ltd_
Date of sample: 5/21 /15
Date of pumping
C. ABSORPTION FIELD DATA
Date installed
Length I ft,
Total depth ft. Eff.
Date of adequacy test
PUBLIC SEWER
Date installed,
Cleanouts (YIN)
High water alarm
Soil rating (g.p.d./ft2or ft2/bdr _ System type
Width ft Gravel b 1
e e ow pipe ft.
ft Monitoring tube Depression over field
Results (Pass/Fail) For bedrooms
Fluid depth in abso on field before test _ in. Water added _ gal. New depth _in.
ElapsedZ7
e: _ min. Final fluid depth _ in. Absorption rate >_
g.p.d.
y rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN
"Pump on" level at n. "Pump ofP level High water alarm level at
Cycles tested Meets alar & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot N/A
Absorption field on lot N/A
Public sewer main 75'+
Sewer /septic service line 25'+
Animal containment areas 50'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/deenout 100'+
Holding tank 75'+
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line Absorption
Water main Water service line Surface
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD
Property line
Water service line
F. COMMENTS
G. ENGINEER'S
Water main
Surface water Driveway, parking/vehicle storage
Wells on adjacent lots
1 codify 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 PrintedZ2e—?-Z4r
JEFFREY A. GARNESS
Date
(Rev. 11105)
— •.J�t�rness�
CE 795 m�
Lot 14
0
M
W. 80th Avenue
N89°30'21 "W 129.69
10' T & E Easement
0
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Lot 15A
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EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON. FB 155 pg 11 BE
8414U
Lot 15B
SCALE: 1 "= 40'
i
NO CORNERS SET THIS DATE
I hereby certify that I have performed a Mortgagee's inspection
of the following described property: LOT 15A. BLOCK 2.
SUNDI LAKE SUBDIVISION
Anchorage Recording District, Alaska, and that the
improvements situated thereon are within the property lines
and do not overlap or encroach on the property lying
adjacent thereto, that no improvements on the property lying
adjacent thereto encroach on the premises in question and
that there are no roadways, transmission lines or other
visible easements on said property except as indicated
hereon.
Dated at Anchorage, Alaska
this 20th day of MAY ,2015.
FRED WALATKA & ASSOCIATES
(907-248-16M)Engineers and Surveyors
Municipality of Anchorage
P4 < L
Community Development Department
.4Y
Development Services 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 # 151300
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 15A
of Sundi Lake Subdivision. This inspection revealed an arsenic
concentration of 16.4 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.org/onsite) or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
Municipality of Anchorage
Department of Health and Human Services
p Division of Environmental Services
On -Site Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-4744
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FORA SINGLE FAMILY DWELLING
Parcel I.D. 011-131-17
HAA#'deCi ���'
Expiration Date:
1. GENERAL INFORMATION
Complete legal description
Lot 15, Block
2 Sundi Lake Subdivision
Location (site address or directions)
West 80th
Avenue & Sundi Drive
Current Property owner(s) Diamond Masonry
Day phone 727-2222
Mailing address 8351
Berry Patch Drive
Anchorage, AK 99502
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DHHS for pickup.
HAA picked up by:
2. NUMBER OF BEDROOMS:
Four (4 )
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
)FA
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Department of Health and Human Services (DHHS) 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) on properties served by a single family on-site
wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners.
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
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.
2-025 ( Rev. 01'001'
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 Health Authority Approval Guidelines for the Health Authority Approval
application show 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 applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation.
Name of Firm Anderson Engineer
Phone 522-7773
Address P.O.
Box 240773
Anchorage
AK 99524
_
Engineer 'sPrinted Name
Michael E.
Anderson,
P.E. Date
7/8/00
6. DHHS SIGNATURE
b-'� Approved for _*__ bedrooms.
Disapproved.
Conditional approval for
ENGINEER's
STAMP
bedrooms, with the following stip latidns.
Additional Comments
Attachments:
HAA Checklist Maintenance Agreements _
Septic System Advisory Supplemental Engineer's Report _
Well Flow Advisory / Other
By: Original Certificate Date:
Expiration Date
-5;)25 Rev. 0i OU
Reissue Date:
�` Municipality of Anchorage
• Department of Health and Human Services
Division of Environmental Services
On -Site Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci. anchorage. ak.us
(907)343-4744
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 15, Block 2, Sundi Lake Subdivision
A. WELL DATA
Well type Private If A, B, or C provide PWSID #
Datecompleted 4/22/00 Sanitary seal Yes
Total depth 190 ft Cased to 190 ft
FROM WELL LOG
Date of test 4/22/00
Static water level 69 ft
Well production 50 9 -p.m
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml Nitrate • 5 mg/I
Dateofsample: 6/20/00 Collected by: MEA
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Steel
Iie.tCEIVE It
JUL 10 2000
MUNICIPALITY OF ANCHORAGE
^'nNIMENTALSERVICES 01VI"
Parcel I.D.:
011-131-T7
Well Loa Yes
Wires properly protected Yes
Casing height (above ground) 24 in.
AT INSPECTION
ft
g.p.m
Other bacteria 0 colonies/100 ml
Date installed 4/15/00 Tank size 1 , 250 gal Number of Compartments 2
Cleanouts Y Foundation cleanout Y Depression over tank N High water alarm N
Date of pumping New Construction Pumper N/A
C. ABSORPTION FIELD DATA
Date installed 4/15/00 Soil rating (g.p.d./ft2 orft2/bdrm) • 8 System type Deep Trench
Length 51 ft Width 3 ft Gravel below pipe 8 ft
Total depth 12 ft Effective absorption area 816 ft' Monitoring tube Y Depression over field N
Date of adequacy test New const. Results (Pass/Fail) For bedrooms
Fluid depth in absorption field before test in Water added gal. New depth in.
Elapsed Time: min Final fluid depth in Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
72-026 (Rev. 01/00)'
D. LIFT STATION - N/A
Date installed Size in gallons
"Pump on" level at in "Pump off' level at in
Datum Cycles tested
E. SEPARATION DI;iTANCES
Manhole/Access
High water alarm level at _ in
Meets alarm & circuit requirements
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot > 10 0' On adjacent lots >100'
Absorption field on lot > 10 0, On adjacent lots >100'
Public sewer main N/A Public sewer manhole/cleanout
Sewer /septic service line >25' Holding tank N/A
N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line >5' Absorption field _ >5'
Water main N/A Water service line > 1 0' Surface water >100,
Drainage > 1 00' Wells on adjacent lots >1001
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10, Building foundation >10' Water main N/A—
Water
A_Water Service line > 10 Surface water >1001 Driveway, parking/vehicle storage > 1 o
Curtain drain None Wells on adjacent lots >100'
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
a 1d
V+F 've tiNGIN 'S
review of Municipal records that the above systems are in
a
conformance with MOA HAA guidelines in effect on this date.rt
A�v1P
Engineer's Printed Name Michael E. Anderson. P.E.
Date 7/8/00
n<,4 ._:
HAA Fee $ am • c>,0
Date of Payment %�/ )� Co
Receipt Number (7/ 53)
72-026 (Rev. 01/00)'
Waiver Fee $
Date of Payment
Receipt Number
CT&E Environmental Services Inc.
CT&E Ref.#
1003183001
Client Name
Anderson Engineering
Project Name/#
Lot 15 Blk 2 Sundi Lake
Client Sample ID
Lot 15 Blk 2 Sundi Lake
Matrix
Drinking Water
Ordered By
PWSID
0
Sample Remarks
Client PO#
Printed Date/time
06/26/2000 12:05
Collected Date/Time
06/20/2000 10:15
Received Date/Time
06/20/2000 11:00
Technical Dire for Stephen C. Ede
Allowable Prep Analysis
Parameter Results PDL Units Method Limits Date Date Init
Waters. Department
Nitrate -N 0.500 U 0.500 mg/L EPA 300.0
Microbiology Laboratory
Total Coliform 0 col/100mL SM18 92228
10 max 06/20/00 SCL
06/20/00 KAP