HomeMy WebLinkAboutSUNDI LAKE BLK 2 LT 8B5und. i Locke
Block 2
Lot 8B
#011-131-24
Municipality of Anchorage ..,,.~ A",
Development Services Department :.--. -.,
~-_- = -: .o
Sulldlng Satet7 Division :~!'!~ ~*
On-Site Water & Wastewater Program, 4700 South Bragaw St.
P.o. Box 1~6so A~c~o~ag., ~K 905~=S0 ~ ~
www.d.anchorage.ak.us (907) 343-7904 Pege 1 of 2
On-Site Waetewater Disposal System and/or Well Inspection Report
Permit Number:, N4~ ~ ~ ~) / 0 ~ ~ ~ PID Number:. ~) //' / ~/" ~2=/7~
Nome:
LYNN PICKLI I Wastewater System: 1:3 New Is Upgrade
Address:
61~4 SUND~ WAY ABSORPTION FIELD
(907) 245-1234 2 DDeep Trench nShallow Trench DBed rlMound IOt~er
LEGAL DESCRIPTION '~ ~ "~ ~'~ '~ "~ '~ ,~1
1.2 =,o/=~ .. **'13.15
8B 2 SUNDI LAKE 9.61 .. 3.5~'
- - - N,/A rL '35' -- 37'
WELL:n New [] Upgrade 5 +/- ~L 1
.~- ~ .L "248 .~0262so.~L D 5034/ F-810
r~ C & N CONSTRUCTION APPROXIMATELY 1999
SEPARATION DISTANCES
To ~eptJ¢ Abloq~tJon Uf[ Holding ~./p~ I~nuf~mn ~ C,~$mc~/ ra ~
Well 100'+ - -- 25'+
- - - LIFT STATION
Surf=ce
Wote~
Lot Une 2'+ - --
Foundation 10'+ ' ' ~""~ ' I
Curtain Drain N~N£ KNOW ' ' '
.e.~a~: BENCH MARK
I. *TRENCH LENGTH PER EXCAVATOR. TOP OF BOTTOM DECK STEP
2. **EXISTING SEPTIC TANK WAS INSPECTED AND
DETERMINED TO BE STRUCTURALLY SOUND. 100.00
,...No TR NCN. ,o o,oc, o,
2nd 9/8/2001 f~ ~..~r eU~.~A..
Department of Health and Human Services approval
R~v~ew~d end epp~v.d by:/%~/~_/'/Z/. /~.<-~ Do~.: 9--~ ?'~1 '"'"
~ f f
C.J.G.
~S~ ~TER & WASTE~TER ~
~ONSULTANT$. INO.
LYNN PICK~ 245-1254 ~ OF 1
SITE P~N AS-BUILT OF "8OOTLEGOED TRENCH FOR DOCUMENTATION
AS- BUILT I) RAWIN G
/ / \
\.4-
_~__~ ........
- -~--%---Z~~-- 7'--~ /
~1 11.1 16.9 ~3¢ ~ 3~ LON¢
...... -?7
......... ~-- --~ ~ ~o~
9/20/2001
~SI~ WATER & WASTE~TER
CONSULTA~S, INC. .., .? .......
LYNN PICKE~ 245-1234 2 OF 2
~ D~R~:
Lo~ ~.. BLOCK ~. SU.., ~E S/.~
~ or ~R~:
AS-BUILT DRAWINO OF "BOOTLEGGED" TRENCH FOR DOCUMENTATION
Mtmicipalit). of
Anchorage
P.O. Box 1!166,-50
Anchorage, Alaslm
Telephone: (907) :~43-8161
Fmx: (~)7)
E-maih ~VI'~ ct.m~choragc.alcus
Georfle P. IVuerch.
OITI('I! III: I'I.~XXIXG. I)I~VI{I.()I'MI~XT. AXIl I'I'IH.I(' W{)RI(t4
9/27/2001
Alaska Water 8: Wastewater Consultants Inc.
6901 Debarr Rd. Suite 2B Anchorage Ak. 99504
Subject:
Waiver Request for Sundi Lake Block 2 Lot 8B
Waiver Request #WR010083
Parcel ID #011-131-24
HAA# 010510 Permit#010398
Dear Engineer:
Your request for a waiver of the required 10 feet horizontal separation from the
on-site wastewater disposal system to property line has been approved. The approved
separation distance is 2.0 feet.
This waiver approval applies to the existing on-sitewastewaterdisposal system to
property line separation only. Any future upgrade to the on-site wastewater disposal
system will require all separation distances be met or another approval from this
department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
Je[frey W. Poet
Engineering Technician
On-Site Water & Wastewater Program
Mnnicipa!Ry of Anchorage
Development Services Department
Building Sd'e,~y Division
On-Sile Waler and Was{ewaler Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
,~vw.ci.ancho~ge.ak.us
(907) 343-7904
Waiver Review Worksheet
WRft: WR010083 PID~: 011-131-24 HAft: HA010510 Permit~:
Date Received: 9125/01
Legal Description: Sundl Lake Block ~ Lot 81~1
Engineer. Alaska Water & Wastewater Consultants Inc.. Jeffrey A (~a~9~a P.E.
6901 Debart Rd. Suite 2B Anchoraup, AK 99~
Applicant: Lynn Pickett
Waiver Requested: 2 feet from field to lot line
Criteria: Geolegy
A. Water Table
B. SOIl Soq3tion
C. Permeability
D. Water Table Gradient
E. Horizor~al Separation
Total:
Points:
Waiver Is Granted: (./ Waiver Is not Granted:
Ust Conditions or Reasons for above:
Rec~: 10555 Amount: $115.00 Date Paid: 912712001
MUNICIPALIT~ OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 Soufh Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7004
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Sep 27, 2001
Expiration Date: Sep 27, 2002
Permit Number: SW010398
Legal Description: SUNDI LAKE BLK 2 LT 8B
Design Engineer: 0041 AK Water & Wastewater Consultan'
Owner Name: Lynn Pickett
Owner Address: 8114 Sundi Way
ANCHORAGE, AK 99502-0000
Parcel ID: 011-131-24
Site Address: 008114 SUNDI DR
Lot Size: 17729 SQ. FT.
Total Bedrooms: 2 Permit Bedrooms: 2
This permit is for the construction of:
[] Disposal Field [] 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 noti~ DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 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: Date:
Dato:,2,. 7- O !
Municipality of Anchorage
Development Services Dep. artment
Budding Sal'ety Division
On-SRe Water and Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-79O4
ON-SITE SEWEPJWELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLI'NG
Parcel I.D.
al
Property owner(s)
Mailing address (1)
Mailing address (2)
Legal description (Lot, Block & Sub'd.) ~_
Legal description (Section, Township & Range)
Lot Size /"7 7¢,Q- '~ Acres~.
Permit Number SW O ! O :3 ~'
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool ·
Therapy Pool
Day phone
Zip Code
Number of Bedrooms
[] Well Only []
Water Storage []
[] Jacuzzi []
[] Water Softening Unit []
I cedify that the above information is correct. I fudher cedify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees: ,'~ jO__..t'~, o'~ Waiver Fees:
Date of Payment: ~7/~7_'7~/&[ Date of Payment:
Receipt Number: _/t~ ~.~7' ~ Receipt Number:
(Rev. 12/00)
ALAS KA WATER & %VAS TEWATER .~. "~'~ ~ ~..~!
CONSULTANTS. INC.
-, ~'" ~. ,~, , ""~ "~ "~ ' "'~ ,-'~'~'" "~ ,"~" ' ~ ~ ..... ri'~- ~; ....
ISOIL LOG - PERCO~TION TESTI ~.~ ~.~ .....
~'~;~ A. ~: .
~ D~CRI~ON: LOT 8 BLOCK 2 SUNDI SUBDMSION;
PERFORMED FOR: L~N PICK~ BA~:
~ ~] VEST HOLE ~l
3 ..... ORg
"" ~' ' SP ~RY RNE
4--~' '" GC OL
5--
~"..%', SM OH ./
/
7-- I DEPTH TO DATE
,,,4,o,
_~ DATE RE. lNG CLOCK NET TINE WATER LEVEL NET DROP
11
TIHE (HINGES) RE. lNG (INCHES)
12__ :'~:',~ 9/7/01 I 4:13 - 6- -
2 4:25 10 4
13~ 3 4:24 -- 6' _
4 4:34 10 4 1/2' I 1/2'
14~ 5 4:34 -- 6' _
'**~ ~'* 6 4:44 10 4 1/2" 1 1/2'
',~,~ 7 4:45 -- 6' _
~_,.::.:::~ s. ~ 4:5s ~0 ~ ~/2' ~ ~/2'
17~ ~ 80.85 I0 5:05 10 4 1/2' 1 1/2'
S.O~
11 5:06 - 6' -
18~ 12 5:16 10 4 1/2' 1 1/2'
19~ PERC~TION ~TE 6.7 (HIN./INCH) PERC. HOLE DIA. 6' (INCHES)
TEST ~ BET~EN 11.0 FT.
20
CO~ENTS: ~R~ ~OM 6'-11' IS <1 MiN/INCH.
PERFORMED ~ ~ WATER · W~A~R I, JE~R~ ~ G~NESS, CE~ T~T THIS W~ P~FORMED
IN ACCORD~CE W~ A~ ~A~ ~D MUNICIP~ CUIDEUNES
09/14/01 15:19 FA/ 907 273 8440 PRUD£NTIAL VISTA REAL ES 1~002/002
. ..~/13/2001/ 17:19 ~J0~2767804 ~ ;' ~ JR PAGiE: 62
~ ~ ~.. MUN,C,,AL,TVOrANC,ORACE ~..
~ (([~. ~} ENVIRONMENTAL ENGINEERING DIVISION
~ ~ 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
~ ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
/MAILING ADDRESS O ~A . ~. __
NO. OF BESOMS
I DISTA"CE TO; [Well I Absorction?~ Dwelling ~ PERM~.OS ~ ~
~¢ L q. capac t~ Inside length W dth I Liquid depth
PERMIT NO.
DISTANCE TO: mdation Sewer line~ ~.~"~ Septic tan~/(~ O Absorpt on area(s)
OTHER
SO,'TESTRA:) ¢
REMARKS
DATE LEGAL
TE-IE LENGTH D:[I"IENE51 ON I S TEE L..ENEiTH ,:: I N E:EE:EE'f' ) CIE:: TE"IE: TRENCH OR DRR l i",!E:':!: E:E..D.
THEE; DEPTH OF:' I'q TE.~:ENCH OE~: E::':[T :[:~; THE f.':,ZS.:;'I'FINC:ES: E:IE'FI.,.IE:EN 'TI-lEE :SU[;?.F:'F!CE: OF: THE!;
CJf;~:CflJI"~E:, FIND THE: BCFI"TOPl OF' '1'1'"1[~: E::.::CF'¢,,,'E:i-rzoJ'.,!
TFIERE ):'.5 ?.,IO E;ET !.4:[[>TE..I FOR T,qtE:NCI.qE. EtiS.
THE GI'4'.FIVEE.. [:,E:E:'-FE.i :[~; THE hlINZI"IE.JH [>E:PTH OF G[;?.I::I%'[EL !:3ET!.,.!EEEN
FII'.~D THE E:CF'E'TOI'"I OF' THIT:'. E':::.:;C:I::I%'FITZOI'.~ (]:1",! FEE:ET>.
PERM I T I'qF'PL i CaNT HI:::IL:5 THE: F?.E:iSF'ON~i; :[ E: I L. :E 'T"¢ -re t t',IFE]F;:PI TH I S [:,E:E::'Fff;;:Tt','IEENT DUE;?. I N61 "rile
ZN'.::.;TI::II...L.RTIOI'.,I IN~'~;r:'E2:CTZON!ii; OF' I::'lN"r' I.,.IEI..t...~'; P~DJI::IE:Ii~:NT TO THI~; E:;'ROPEEF;:T'T' Fqlq[) '!'t'"I[;:
NUP1BER OF E;ir[E?'2]:DEi",IE:EtE; 'r'HE:iT THE HE:L.L !.,.I:[LL '_'.-.:EE;?.',/E
EE~FtC:I.(F:[LLII'.,IC~ OF l:.'.ll'.d~' S'-¢:STEH Ed]:'TT.IOE.JT FIHE, qL :E,I'.,I'.:~;E:'[i~OT:E,C~H F:INI) RPF'E~:Ok,'F:I[_ E:'¢
[::,[:::E:'FI[;'.THE[~]T klIl_.E_ E.rE:E.:; k;L.IE33'EC:T 'FO
i'"IINIP'ILIP! D:[STI::IIqECE BE:"I"klE:EN fq I,!E:LL. Fff',ID F:ll",l"r' Olq-.sLr. TtZ S;EI.,.!FIGE DISF:'Ot.E-;F!L :::':;'.,.'%TE.r,'t !:E;
:1.~() TO 2C~¢_4 FEET I=[?.CiPI Fl ,r::'LIErL.:[C I.,.IE:I...L DEF:'EI".![::,:[J'qG UF'OIq THEE T'¢PE
I...IEL. L LOG'?; F:ff~:E~ I::~:E[;!LIZ~:ED Fii",l[;:, i'ql...I:E-;T BEE F~:E"I~LIRtNE:D TO TI'I[:E DE:E:'F:If;:'TP'IE;NT
OE: THE kI[ELL COP'IF'LE;T:[ON.
CrTE..IEEE-:.' F~:E;I~:!U:[F.:E;P'IE:NT:E.:; f'lFl"r' I:::IPF'L"r'. :!i;F'E:C]:F:[C:FIT;[iPN'.~!; FIND CON:iS'E'F~:UCT:EEIN
FIVE::I .'E L ElBE~E: 'TO :[ i".IS:;t.IF~E E:'F?.OF:'[EI:~: ]: H:~Tf:II..LFIT ~ O[".1.
:1: E:IEE;..'T:['F'¢ TEHRT
:1_: :[ I:~r4 FRfq:[L]:FIFr I.,.IZTt-I TEqE F..'E~::!UZF.:.'EP'IENT':.q; FOE.;: ON-.-.:5;U'E'E: E;E!,.IEEERE; FINE::, HE:L:[...2:; Fd5 '.;:;E:"!'
FOf~'.-E'E.I E~q.' THE f'IE_IN].'E::[F'E:fl...ZT~¢ OF I::~Ii'4C:HOE;.'.REi[E.
2: :[ 14:[L.L. :[H:-STF:IL.I... THE :5'./:STEEZI¥1 :[l'..I FIC:COr~%,RI'..IC:E I...!:[TH TEqE.'
:¢: Z UNDEE.~:'.:_:;Trqi'..!D -I-HF!T THEE: OI'.,t.-..!5:[-E'E :E;EI.,.IEEE;?. ::5'.,.':E;TE3,'I I'"11:::1'¢ F;:[E-:f;!LI]:F:rE E::P.II...I:::IIE'.GEZi'qE, EF.IT :[F THE:
RE2.";~(DENCE :[:5 Iq:E:FIO[>Ek. ED TO
iFORMED~FOR
MuNIcIPAl- ITY~OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
SOILS LOG - PERCOLATION TEST
DATE PERFORMED:
PE SITE PL:AN
PERCOLATION
TEST
WAS GROUND WATER
ENCOUNTERED7
','
.
Gross · ' Net Oepth to -' ,: Ne~
' Readilig. '. Date ,Time Time ~ Water . : Drol~
PERCOLATION'AATI--' ~ (minutes/inchl
BETWEEN -- ~ .~T AND
!
!
~' :¢~ormed For
~i, egal Description: Lot. aa Block
~'~;'~s Form Reports Soils Log
- Soil Tes~ Must Be Logged To 4'
'
'}=¢~. e t Soil Characteristics
:"
'.~' L'.;~I -~ , ~ ~
f ]A,T. Ek~ ANCHORAG[ AREA BOR[ jH. (
DEI'~r~ThENT. OF ENV~RONMFqTAL O~.'ALIT¥ Case
· 3330 "C" Street
~NCHORAGE, ALASKA 99503
~' Dated Performed ~o~
~ Subdivision ~u~
Percolation Test
Below Proposed Seepage System
Ground
~¢ ?es,
Water Encountered?
At What Depth?
Date
Gross Time
, i I t
~et'co] a ~lion Rate _M1 nu,.e
Net. Time
Fi-~)~.,osed Installation: Seepage Pit Drain FieldX ,
Del)th of Inlet._. ~'~' Depth ~6' Bottom o~-~-~'-Pit 6r Trenc~-~.
CO?,IME~tT'~: ~Z~ ~'
.. _, _~....y ~_~ ~. ~ ~ ~
T~st Performed BYrd'-Date Certified B~:
W S&S Coo
WATER SYSTEMS & SERVI[CE
Rt. 1, Box 1517 renal, Alaska 99611
Dear Sir;
The following is a well loQ locato(J or~ l,ot Block
i~ th~ ~'ec~'~d-zn~ District. '~h~ ~,,rr,- at the time
water well was requested $~_.;~ .~f0~_
/ to ~0 feet ~t~ ~t~$ ~ /~
Submersible pump ~wasn't inst~] ]~,~ a:~ roquested
Screen ~wasn'~ installed as requo?~ c-r:t ,~nO/or nece:-*sary
Well yield~wasn't tes%ed by pu~ w[n~f, bailing at
~4'e Bave been pleased to serve your water needs and if you
bare any furhber quesqions, problem::, or commenhs Dl~ase
don't hesitate to ca]] or write.
,,lncerely,
i<ENNP]Tf{ D. ~YFJtl ~
OwDer
kd/dd
gpm
M~i~IICIPALITY OF ANCH~ORAGE
F i~ i 7 I~uc
RECEIVED
•
Municipality of Anchorage
On-Site Water and Wastewater Program
(907) 343-7904 SA ETY
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 011-131-46 Expiration Date: I (-1 7-17
7
1. GENERAL INFORMATION
Complete legal description SUNDI LAKE BLOCK 2, LOTS 8A&8B
Location (site address) 8114 SUNDI DRIVE, ANCHORAGE,AK 99502
Current Property owner(s) ZACHARY R.TOMCO Day phone
Mailing address 8114 SUNDI DRIVE,ANCHORAGE,AK 99502
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
TYPE OF WASTEWATER DISPOSAL:
4. TYPE OF WATER SUPPLY: Individual
Individual Well ® Holding Tank ❑
Individual Water Storage ❑ Community ❑
Community Class Well ❑ Public Sewer ❑
Public Water System ❑
WaiverNariance request for: Distance:
Received by: Date: erg 7 / 7
COSA to be released to the engineer, - otherwise requested by the engineer.
COSA Fee $ 2-(,o Waiver Fee $
Date of Payment '7I to Iii Date of Payment
Receipt Number OJ��S� Receipt Number
COSA# -1I 1 34N Waiver#
_ — _ a
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 ARCTERRA CONSULTING,INC. Phone 868-3791
Address 20441 PTARMIGAN BLVD.,EAGLE RIVER,AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 7/27/2017
THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED
WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineer's Comments: This investigation was completed in compliance with
ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested.
The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use,
local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the
system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the
control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function
satisfactory for current or future occupants or can ArcTerra guarantee that no unseen ��-\
encroachments,deficiencies or discrepancies exist. OF 4I�
*A\
9t#
6. DSD SIGNATURE ` 4 • TFI
System #1 Approved for bedrooms.
KENNETH M. D
System #2 Approved for bedrooms. 4 1r% . s
Disapproved. ,�Eo`"' 0.
Conditional approval for bedrooms, with the following stipulations:
•
a' c
V- ° -e - � S �D PA`S Cgd
U�n
` J ON-SITE
E -
WATER AND
WASTEWATER
r,,EcIAR/ 'its
{ !ALJ U, ,
y: Original Certificate Date: (7-( 7
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
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, LOTS 8A &8B Parcel ID 011.131.46
A. WELL DATA - 'PER MOA RECORD DOCS
Well type PRVT If A, B. or C provide PWSID # Well Log (YIN) Y_
Date completed 10/1979 Sanitary seal (Y/N)Y Wires properly protected (Y/N) Y
Total depth 112 ft. Cased to 40+ ft. Casing height (above ground) 18+ in.
FROM WELL LOG AT INSPECTION
Date of test 219/1982 7125/2017
Static water level -• ft. 89 ft.
Well production 9 g.p.m. 4,2+ g.p.m.
WATER SAMPLE RESULTS:
Coliform iVE(r colonies/100 mL Nitrate 2.17 mg/L
Arsenic. .. ND ug/L Date of sample: 7125/2017 Collected by: ARCTERRA
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 110/25/1979
Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) Y
Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (YIN) N
Date of pumping 5"-B '/7 Pumper A + $eyt/tCe_S
C. ABSORPTION FIELD DATA — TESTED 1999 TRENCH WITH SAME COMMENTS 1 CONDITIONS AS 2013 COSA
Date installed 1012519& 1999 Soil rating (g.p.d./ft2 or ft2/bdrm) 101 11.2 System type TRENCH
Length 33135.37 ft. Width 4/3 ft. Gravel below pipe 5/3.54 ft.
Total depth 12.75 ft. (Measured 7/25/17)Eff. absorption area 3301250 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 7125/17 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in Water added 450 gal. New depth 7 in.
Elapsed Time: _30 min. Final fluid depth 0 in. Absorption rate >= 450 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 Manhole/Access(Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100'+ _ On adjacent lots 100'+ _.
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
Sewer/septic service line 25'+ Holding tank 100'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+ _
ABSORPTION FIELD ON LOT TO: -- 1979 TRENCH / 1999 EXT.
Property line 10'+!2'+(WR010083) Building foundation 10'+ Water main 10'+
Water Service line 10'+ Surface water 100'+ Driveway,parking/vehicle storage 10'+
Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 100'+
F. COMMENTS
Septic tank appears to be operating appropriately based on visual observations of levels and pumping.
G. ENGINEER'S CERTIFICATION
1 certify that 1 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. OF A
Engineer's Printed Name KENNETH M.DUFFUS r ��
Date 7/27/2017 _ * ,9TH v
COSA canary sheet_2-6-15.doc + nF:Nn e
of
Aar ,
.FES ' .�
`_tet
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.d.anchorage.ak, us
(~07)
Parcel I.D.
1. GENERAL INFORMATION
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAHILY DWELLING
Expiration Date: ~ ~. --.~-- 7- ~ I
Complete legal description ' SUNDI LAKE SUBDMSION; LOT 8B, BLOCK 2,
Location(slteaddrassordirsctlons) 8114 SUNDI WAY * ANCHORACE~ AK 99502
Current Property owner(s) LYNN PlCk~ ~
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
Day phone 245-1254
Day phone
KIMBERLYJEF~ER~ w/ PRUDENTIAL ~STA Dayphone
4241 "B" STREET * ANCHORAGE, AK 99505
727-1051
Un/ess otherwfse requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: - ~
3. TYPE OF WATER SUPPLY:
Individual Well ~
Individual Water Storage
Community Class Well J~]
Public Water System
TYPE OF WASTL=WATER DISPOSAL:
Individual On-site
Individual Holding tank
Community On-site
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil
engineer registered in the State of AJaska. CorlJficates of Health Authority Approval are required for the transfer
of title (except between spouses) for propoffdes served by a single family on-site wastewater disposal and/or
water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority
Approval ara valid for 90 days from the date of Issue for properties sen/ed by a private or Class C well and may
be reissued with new water sample results less than 30 days old. (CertJficetes may be reissued for a period of
up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B
wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions In the
professional engineer's work.
Note: Alaska Water and Wastewator Consultants, Inc. shall be paid $2310.00 a~ or pdor
to dosing for the engineeEng services prevfded.
4. STATEMENT OF INSPECTION BY ENGINEER
As ce~fied by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures ouffined in the Health Au~hotfty Appreval Guidelines for this apptication,
shows that the on-site water supply and/or wastewater disposal system is(are) safe. fun~'onal and adequate
for the number of bedrooms and type of structure indicated herein. I further veery that based on the
information obtained fiom the Munidpali~y of Ancl~orege files and from my investigation and Inspec~on, the
on-site water supply and/or wastewater df=posa! system I.~(are) in compliance with all applicable Municipal
end State codes, ordinances, bnd regulations in effecf at the time of lnstallaEon.
NameofFirm ALASKA WATER & WA~'t~.WATER CONSULTANTS, INC. Phone 337-6179
Address r 6901 DEBARR ROAD. SUITE 2B * ANCHORAGE. AK 99504
Engineers Printed Name JE~t<EY A. CARNESS, P.E. :
Date
Engineer's Comments:
In c~nducting this evelua~bn, AWWC, In~ attempted to provide e O~m~ugh,
consclenEous engineering analysis of the sy~em In ecco~ance w~h ADEC and MOA
DSD Guidelines & ReguleEoe~. The reported msuite descdb~l the pan, finance of the
system under the conditions encountered at the Ume of the tes~ and separation
distances measured to readily identifiable toatures. The operational life of all walls and
sepUc systems depend on the Iocal soEs condi~on, gmundwater levels that may
fluctuate dudng the ~ar, and the water usage of the fatuity being served by the system.
These ¢~lditions em ou~lde the contn31 of the eveluator of the aystem. ~a§~acfory test
results do not guarantee future performance of the system, nor do they guarantee that
them ara no hidden defec~ or encroachments. A WWC, Inc. can ~emtora n¢~ provide
any wan"andy or futura es~mate of how I~g the system w~ con§hue to meet the
operational mquimmanfe of the ADEC or MOA DSD. The co,tent of this report Is for
the sale benefit of the ownor #sted above. Any ralianse upon or use of thfe report by any
other person or party I~ not authorized, nor wf#1t confer any legal dght whatsoever.
DSD SIGNATURE
~ Approved for
Disapproved.
bea,ooms.
Conditional approval for __
'
~: ON-SITE :
~: WATER AND
bedrooms, with the fllowing sflpulafions~ : WASTEWATER
' r ' ~ t PROGRAM
....
:-'. <0~ ' ,,~¥,~
Attachments:
HAA Checldist
Septic System Advlsory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
Odginal Certificate Date:
Municipality of Anchorage
Development Services Department
Bulkling ~;'.~ ~
On-S~ Water & Wastewater Program
4700 South 8ragaw St.
P.O. Box 196650 Anch~, AK g9519-6650
www. cl.anchomge.ak.u~
A. WEM. DATA
We~ type f,~VA~
Oate completed ~0/1979
Toteldepth 112 ft.
HEALTH AUTHORITY APPROVAL CHECKLIST
SUNDI LAKEi LOT 8B, BLOCK 2 Pal~el
IfA, B, ~C provide PWSlI:~ N/A
Casedto 40'+ It.
FROM WFlt LOG
2/9/1982
UNK It.
g.p.m.
Date of test
Static water level
WeB producl/ofl 9
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi.
Date of ~ample: 9/14/01
SEPTIC/HOLDING TANK DATA
Nllmte 0.757 mg./L.
Tank Ty~flal S'TEEL
Tank alze lOOO gal. Number of Compe~mente
Foundation cteanout (Y/N) YES
r , p.m ng ./lO/Ol
wen Log (Y/N)
Wires pmpe~/protec~d (Y/N)
Casing beight (above ground)
AT INSPECTION
./,o/2ool
89 .It.
4.2 g.p.m.
20 In.
2
Depresalon over tenk (y/N) NO
Pumper.
Other becterla I colonies/IiX) mi.
AWWC, INC.
Date Installed 10/25/1979
cm.x~s (y~r~ ~gs
High water alarm (Y/N) N/A
NORTHLAND
C. ABsoRPTIoN REID DATA * 35' EXTENSION PERFORMED APPROXIMATELY 5/99o UNDOCUMENTED
DateinMalled 10/25/1979 & 1999 Sollrallng(g.p.d./lt~or~/Ixln~)101 & 1.2 6ystemtype DEEP TRENCH
Length 33' ,& 35'-37' Wklth 4' & 3' Grawl below pipe 5' & 3.54'
Totaldepth 13.1 lt. Eff, abeoq~narea ** It' Monltodngtube YES
Date ofadequacy test 8/10/2001 Results(Pass/Fall) PASS ***
Fluid depth In abeorpllon field before lest 8 In. Water added 600 gal.
Elapsed Time: 11 min. Final fiuld depth 13.5 In. Absorption rate >=.
Any reJuvenallon trealment (pest 12 mo.) (Y/N & type) NONE KNOWN If yes, give date
e* 330 + (250 +/-) - 680 eec TESTED 1999 TRENCH ONLY.
Depresalon over fiald NO
Now depth 27.5 II1.
450 Il.P.d.
D. UFT STATION
Date Instefled Size In gallons ~
"Pump on' level at In. 'Pump . High water alarm level et In.
~ Cycles tested Meets alarm & drcult requlmmente?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
8epfio tenk/lilt stetlon on Int 100'+
Abeoq~on field on lot. 100'+
Public sewer main N/A
Sewer/sepUc aendce llne 25'+
On adjacent lots. 100'+
On adjacent lots 100'+
Public ~ewer manhote/cteanout
Holding ~nk N/A
SEPARATION DISTANCES FROM 8EPTIC/HOLDING TANK ON LOT TO:
Bulldlng foundation 5'+ Property line 5'+ Abeoq~lon field. 5%
Water maln N/A Water aervlce line. 25'+ Surhlce water. 100'+
Wells on adjacent lots 100'+
* 15' EXTENSION PERFORMED APPROXIMATELY 8/99, UNDOCUMENTED
Property line
Water service llne 25'+
Curte]n draln
F, COMMENT8
8EPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Bulidlng foundation 10'+ Water main N/A
Surface water 100'+ Driveway, patldng/vehlde storage 5'+
NONE KNOWN Weliaonadjacentlote. 100'+
~NNVER REQUESTED
G. ENGINEERS CERTIFICATION
I mrS~ thet I have determined through field ir~oe~lons and
mvtew of Munldpal reco~ls ~at e~e ebove ayafema ara in
conformance ~ MOA HAA guidelines in effect on this date.
Date
JEFFREY A. GARNESS
HAAFee$ or,
Oate ot Puymant
Receipt Number
wa er ee$ ·
Receipt Number
MUNICIPALITY OF ANCHORAGE~
DEPARTMENT OF HEALTH AND ENVIRONM~NTAL PROTEGTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1 · General Information Application Date ~t"%/~l t~t--TL
(a)
Legal Description (include lot, block, subdivision, section, township,
Location (address or directions)
(b) Applicants Name_~o0~ ~OM/~
Applicants Address... ~//4 SU~D! O~IV~
(c) Applicant is (check~on~) Lending Institution
Buyer ~--~ ; Other~--~ (explain);
(d) Lending Institution
Ad~ss
range)
Telephone - Homef¢~. c~/T Business.~/- /Z2£
..,.I [; O' er/builderl '--T;
Telephone
(e) Rea~__Estate Co. & Agent O#,~lo~oN f~E.4LTtl
Telephone ~&~- 0~,~
(f) Mail the ~ to the follo~ng ~dress:
2. Type of Residence
Single-Family~
Number of Bedrooms
3. Water Supply
Individual Well~.
Multi-Family~
Other (describe)
Community~--~ Public~
Note: If community ~mll system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
Sewage Disposal
Onsite~ Public V-~ Community~-~ Holding Tank~-~
i~.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] ~%,~
5. En~ineerin~ 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 wsstewater disposal system is safe, fu~ctional and adequate for
the number of bedrooms and type of structure indicated herein.. I further verify that,
based on the information obtained from the M~nlcipality of Anchorage files and from my
investigation and inspection, the om-site water supply cod/or wsstewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect ou the date of this inspection.
ame Firm 7 zi/dl,
DREP Approval
Approved for --~ bedrooms
Approved~_._ Disapproved __
Terms of Conditional Approval
(ENGINEER SEAL)
!
Coaditiona.~'
Telephone
(Michel i. A~erWn
~*% 4381 · E
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTE AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPrESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN T~i~ 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 REQULRE-
MENTS. EMPLOYEES OF DEEP 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.
(DEEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7-19-84
Well Classification $t~&l~
Well Log P~esent _~N)
Total Depth //~' Cased to
Static Water Level
Casing Height Above Ground
Elect~ical Wiring in Conduit ~N)
Seps~ation Distances f~c~ Well:
To Septic/Holding Tank on Lot
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
MUNICIPALITY OF ANCHORAGE (M~A)ENVIROI'~MENIAL PROTECTION
HEALT AUT ORZTY APPROVAL ( aa) NOV '!
CHECKLIST - FEBRUARY 1984
Legal D e s c rip t i0 n .~ Ezf~E~ ~z~D~/r £
If A, B, c~ C, D.E.Co Approved(Y/N)
Date Completed /~./? ~ Yield
Depth of Ghzouting
Pump Set At
Sanitary Seal on Casing ~N)
Depression Around Wellhead (Y~
; On Adjoining Lots /~-~
To Nearest Edge of AbsoFption Field on LOt /~'~ % ; On Adjoining Lots ~'~
To Nearest Public Sewer Line ~/~////~F~-~; TO Nearest Public Sewer
Cleanout/Manhole A/~/~/~w ~ To Nearest Sewer Service Line on LOt
Water Sample Collected By g~A~A- I%C~ADD~ ; Date /(/~//~
Water Sample Test Results o~ ~ f;~lcto~
B. SEPTIC~ DATA
Date Installed /~,/£~/?~ Size ./,~d ~WFF~' No. of Cc~t~artments
Stan~i~s ~) Ai~-tight ~ps ~)' Foun~tion Cleanout
~ession o~ Ta~ (Y~ ~te ~st P~d
P~ing~intenan~ ~n~a~ ~ File (Y~) ; for
Holding Ta~ High-Wate= ~a~ (Y~) W~ ~ Holdi~ Tank ~t (Y~)
~p~ation Distan~s ~ ~ptic~olding Ta~:
To Wate=-Supply ~11 /DC' ~ To ~ilding F~ndation
To ~o~rty Li~ ~' To Dis~sal Field ~7'
To ~ter ~i~=vi~ Li~ 40' To S~e~, ~nd, ~e, ~ ~jor ~aina~
Coarse
Comments
[Page 1 of 2]
Receipt 9
Date Paid:
Amount: ~.~.
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date .Installed
Width of Field
Square Feet of Absorption A~ea
Depression over Field
Results of Last Adequacy Test
/ol Type of System Design
LGngth of Field .fl'
Depth of Field
Gravel Bed Thickness
~O Standpipes iMzesent ~/N)
of Ade cy Test
Separation Distance from Absorption Field:
To k~ter-Supply Well /~'0'~ To P~operty Lime
To Building Foundation ~' To Existing or Abandoned System cn
Lot ~0N~ ; On Adjoining Lots /dP'
To Water Main/Be~vice Line ~' To Cutbank(if present)
To Stream/Pond/Lake./or Major D~ainage CoArse ~, ~
To D~iveway, Parking Area, or Vehicle Storage Area
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Ievel at
High Water Alarm Level at
Tested for
Elect=ical Codes(Y/N)
Dimensiens
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles du~ing Adequacy Test.
Meets MOA
Coranents
** Check Permitted BedrocraRatingAgainstHAARequest **
certify that I have checked, verified, o~ conformed to all MOA HAA Guidelines in effect
on the date of this inspection.
s gned P/AJ J C ate
Company ~//~f£~ -~ .,J&.,,~4~..Ti-.-//.J6, ~c. MOA No.
KB1/d5/s
[Page 2 of 2]
2-15-84
Time~ ~ . ~" Time ~.~
Date Date Date
Inspector Inspector Inspector
Comments ~'~ ,,~¢ [~jd~ ~)(~ ~/~3~ Conditional Approval
Bate Sewer Installe~
~ ~ ~9 ~ Holding Tank Size
Soils Rating Well To Absorption Area Well Log Received
Well to Tank
APPLICANT FILLS OUT LOWER HALF ONL~
.,o,e.~ Owner j~ /~ / .,one
Address
Lending Institution
. . one
Address ~
Legal D~s~ription
Typ~f Residence
~SinCe Family ~ _
~ Multiple Femily No. of Bedrooms
~ Other
Wate~upply
~ Individual . - A~ACH WELL LOG. A well log is required for all wells drilled since June
~ Community 1975. For wells drilled prior to that date, give Well depth (attach log if
D Public Utilit~ available.)
Sew~ Disposal
~ Individual Year I~d~vidual Installed: _
~ Public Utility When Connected to Public Utility:
~ Holdin~ Tank
NOTE: THE INSPECTION FEE MUST AccOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.