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Home My WebLink AboutSAND LAKE #2 BLK 1 LT 9and Lake #2 Block 1 Lot 9 #011-132-40 Develoomznt Services Depi?ft-nent 9uild;nc Safety Division Or -Site Water ? Wcs=eweter Progr_n j 4'00 6ragew Streei Gat: 19bo5 Mark Begich Anchorage, .A;. 99519-6650 Mayor-0111I.mi.ini.rr:u'^n>i7 (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW_ Date of Issue: Parcel Identification Number: Legal Description Property Owner Name & Address: S Aj Ak6- #2 ScovJwC—WUC,"y W11 coy, Pump Installation Date: /3/ yol,/ Pump Intake Depth Below Top of Well Casing: 299 feet Pump Manufacturer's Name: n ev yadco, Pump Model: CV 12 S 1� Pump Size / hp Pitless Adapter Burial Depth: /Sfeet Pitless Adapter Manufacturer's Name: — Pitless Adapter Installer: — Well Disinfected Upon Completion? [Yes ❑ No Method of Disinfection:CAAWI�,R Comments: t Anchorage Pump & ,VVell :service Pump Installer Name: 330 l=ast 76th Avenue Anchorage, Alaska 99513 Phone: 907-243-0740 Fax: 907-243-0742 Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Municipality of Anchorage •'i '• e Development Services Department Building Safety Division .. .. On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 Page of www.cLanchorage.ak.us (907) 3417904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SW050258 PID Number. 011-13240 Na"'a. Dale Ratcliffe Wastewater System: [3New j] Upgrade Addc... 8125 Wilcox St, Anchorage ABSORPTION FIELD PMro: Number of Bello : 2 O Dap TrmOl❑ shallow Tm.ch 0 Bed ❑Mound ❑Dere. LEGAL DESCRIPTION sW ft*v: 0.8 Tow Dean hom odPw gram: GPD/Fe Was111.51so.1325 F,• Bock: Lob s"Iftbn: 1 9 Sand Lake#2 Depen W ppe lW1,xrl Amt o lml Pale: Cm depm be m9l pipe: w7.0/S 7.9 Ft. W6.21S 5.3 Ft TOwmhp: Hrye: aecwn: Fa amad above orlpAw Pada: Gnwl Lerq : woe / s o.5 Ft, 20+20=40 Ft. Well: New ❑ ❑ Upgrade Gnv81 a6rtlt: 2.5 Number of am: Dista—b81wam Yves : Ft, 2 see dWg F,, Llasalkaben (Pnee• A B, cF Tow D.Pp: Geed u: 7081 amarpben area: Pax Maur W: C Ft. FL 460 FT ASTM D3034 order: Dap orllod: spec Waw Lowl: Inslaw. Dau Yuuaed: FL Wilco Contractors Aug. 5, 2005 Ylekt. Pwry SMaL CO.y HMhl Ab a Grweq: TANK GPM FL FL SEPARATION DISTANCES ElSeptic ❑Holding ❑S.T.E.P. ❑Other. To Septic Absorption Lift Holding ubbUPrlvate iC1i1e6 pec'T. From Tank Field Station Tank Sewer Line Greer 1000 Gal wed 104• 100.2' NA NA 25+ Melerw: steel Number of Dorrparbrwnla: 2 sudece WSW 100+ 100+ NA NA LIFT STATION lulu» 10 2.5' NA NA NA Gat ww. Www. FaaMaum 30 29 NA NA 'Pune an' oval al: Yum» Otr level ac Ilan wear 81st"' at: ti, ti in. eanae a.e NA NA NA NA PY^ p Mak. s Moral filecucal Inspec ores pedormad by Re.wk& Old tank hauled off site. *Waiver for 2' to lot line. BENCH MARK 'Waiver from ADEC for 100 ft to Class C well. Lwlorl and DafOpU0r1: Southeast comer of wood porch off MTs off bottom. See profile. Waxen. back door. 100.00 FL En i mp elle 49TH �9- Inspections performed by: Cindy W. Ellis, P.E. Dates: 1't 8/1/05 *:' 2nd 8/3/05 Development Services Department Approval Ci Y W. Ellis ,•' Reviewed and approved by: AA .0.0,iQtiDate: gbaIjs=j •., CE.toS77 ; (an. coot I •'`' �ssiot+A1• Class C Well 135.00' Lot 12 well i — — _35lZrad1us o � a Existing 2 BR house FCO inside Lot 10 \ 135.00' X Sand Lake #2 Blk 1 Lot 9 Record Drawing of Septic Upgrade Dale Ratcliffe Parcel ID: 011-132-40 Permit No. SWO50258 Cindy W. Ellis, P.E. September 6, 2005 Scale 1 Inch - 20' Lot 8 i COt sum MT1 I � E \ TH I o 9Ci \ � V 0ST1:AFS CO ..,.I \ I\\ 1 X01 y� AS -BUILT �aly'( ooh \ ^h I Watkins Engineering, Inc P.O. Box 110443 Anchorage, Alaska 99511-0443 Phone: (907) 349-1851, Fax (907) 349-1934 49 TB ;ti y u� �• �.. CI10 W ELUS QE - 10577 ' A B STI 44.5 34.0 ST2 48.3 39.0 DCO 49.3 40.2 DV 50.8 42.0 FS j 46.7 41.0 COI 1 32.2 47.8 Class C Well 135.00' Lot 12 well i — — _35lZrad1us o � a Existing 2 BR house FCO inside Lot 10 \ 135.00' X Sand Lake #2 Blk 1 Lot 9 Record Drawing of Septic Upgrade Dale Ratcliffe Parcel ID: 011-132-40 Permit No. SWO50258 Cindy W. Ellis, P.E. September 6, 2005 Scale 1 Inch - 20' Lot 8 i COt sum MT1 I � E \ TH I o 9Ci \ � V 0ST1:AFS CO ..,.I \ I\\ 1 X01 y� AS -BUILT �aly'( ooh \ ^h I Watkins Engineering, Inc P.O. Box 110443 Anchorage, Alaska 99511-0443 Phone: (907) 349-1851, Fax (907) 349-1934 49 TB ;ti y u� �• �.. CI10 W ELUS QE - 10577 ' A B MTl 32.8 45.0 CO2 48.6 30.2 MT2 49.7 30.0 CO3 62.8 50.7 sump 35.6 49.7 Class C Well 135.00' Lot 12 well i — — _35lZrad1us o � a Existing 2 BR house FCO inside Lot 10 \ 135.00' X Sand Lake #2 Blk 1 Lot 9 Record Drawing of Septic Upgrade Dale Ratcliffe Parcel ID: 011-132-40 Permit No. SWO50258 Cindy W. Ellis, P.E. September 6, 2005 Scale 1 Inch - 20' Lot 8 i COt sum MT1 I � E \ TH I o 9Ci \ � V 0ST1:AFS CO ..,.I \ I\\ 1 X01 y� AS -BUILT �aly'( ooh \ ^h I Watkins Engineering, Inc P.O. Box 110443 Anchorage, Alaska 99511-0443 Phone: (907) 349-1851, Fax (907) 349-1934 49 TB ;ti y u� �• �.. CI10 W ELUS QE - 10577 ' FCO 16 Final Grade 96.58 1000 Callon Steel Septic Tank 89.38 Final Grade = 96.23 - 96.65 4"0 PIPE FILTER FABRIC Top of Pipe 89 41 MT I Hollom of Sewer Rock Trench 82.89 West Trench Invert of Pipe Note: Test Hole Relative Depth: 76.81 89.09 No Haler. Final Grade = 95.48 - 97.04 4"0 PIPE FILTER FABRIC Top of Pipe 88.99 DV to old drainfield Original Grade = 95.63 - 96.09 Bottom of hlTI 81.46 CO3 NOTE I Original Grade = 95.07 - 96.58 Bollom of Serer Rock Trench 83.33 Bollom of Invert of Pipe MT2 85.08 South Trench 886.1 Note: Test Hole Relative Depth: 77.33 No Baler SEPTIC SECT' AS -BUILT N.T.S. Sand Lake #2, Blk 1, Lot 9 ` ��,�F.E►G y ru Septic Upgrade Record Drawing Watkins Engineering, InC. `�AP'� s�f Parcel ID: 011-13240 p�`2 49 T t^ Permit No. SW050258'•,,/..� ""'•••. p . CI W. ELLIS f Cindy W. Ellis, P.E. P.O. Box 110443 OGO.:, E - lose September 6, 2005 Anchorage, Alaska 99511-0443 qt ... . ••........•• �,• Not to Scale Phone: (907) 349-1851, Fax: (907) 349-1934 MUNICIPALITY OFANCHORAGaE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jul 28, 2005 Expiration Date: Jul 28, 2006 Permit Number: SWO50258 Parcel ID: 011-132110 Legal Description: SAND LAKE #2 BLK 1 LT 9 Design Engineer: 0844 Watkins Engineering, Inc Site Address: 008125 WILCOX ST Owner Name: DALE RATCLIFFE Lot Size: 6750 SO. FT. Owner Address: 8125 WILCOX STREET Total Bedrooms: 2 Permit Bedrooms: 2 ANCHORAGE. AK 99502-4153 This permit is for the construction of: Disposal Field Q 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 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: Issued By. Date: 2 •S Municipality of Anchorage M. Ilt�c 1!Mi1i5(1 • Anchomgc, �Umlm Y.9i19-06R) • Telephone (907) 343-SM)1 • Par (!X)7) 343-82M 47M Bmgmr Street • Anchortige, Afaslui ! .M7 . W"c.nuuU.nrg )Magor Mark Begich Ilutlding Safety Division July 28, 2005 Cindy Ellis Watkins Engineering P.O. Box 110443 Anchorage, Alaska 99511 Subject: Waiver Request for Sand Lake #2 Block 1 Lot 9 Waiver Request WR#: 050056 Parcel ID # 011-13240 PERMIT #: SR'050258 Dear Cindy Ellis: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is a 2 foot horizontal separation from septic field to north and south property lot line. This waiver approval applies to the existing absorption field 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, roodall Civil Engineer On -Site Water & Wastewater Program Conununity, Security, Prosperity Municipality of Anchorage Development Services Department .r Building Safety Division On-site Water and Wastewater Program 4700 Bragaw Street P.O. Box 1%650 Anchorage, AK 99519.6650 www.ci.anchoragc.ak.us (907)343-7904 Waiver Review Worksheet WR#: 050056 PID#: 011-132-40 HA/Permit# PERMIT #: SWO50258 Date Received: July 28, 2005 Legal Description: Sand Lake #2 Block 1 Lot 9 Engineer. Cindy Ellis Watkins Engineering P.O. Boz 110443 Anchorage, Alaska 99511 Applicant: Dale Ratcliffe Waiver Requested: 2 foot horizontal separation from septic field to north and south property lot line. Criteria: Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: r .................................................... .... .i.i..... some ... a Waiver Is Granted: X List Conditions or Reasons for above: Waiver is not Granted: Date: 7128105 By: Joe Goodall Name of Reviewer ............................................ some..... so .... women ... .eee... Rec#: 71528 Amount: $1M Date Paid: 7128/2005 Municipality of Anchorage Development Services Department Building Safety Division / On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 011-132-40 Permit Number SW ZD Property owner(s) Dale Ratcliffe Day phone Mailing address (1) 8125 Wilcox St Mailing address (2) Anchorage. AK Zip Code 99502 Legal description (Lot, Block & Sub'd.) Sand Lake #2, Blk 1, Lot 9 Legal description (Section, Township & Range) Lot Size 6750 Acre Sq.Ft. Number of Bedrooms 2 THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade El THIS PROPERTY CONTAINS: Hot Tub 13 Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. G�zltt , E (Signature of propUrty owner or authorized agent) Permit Fees:gbc) oa f /-75--dz Waiver Fies: Date of Payment: -7/pq �DS— Date of Payment: Receipt Number iSa� Receipt Number. (Rev. 12/00) Watkins Engineering, Inc. P.0 Box 110443, Anchorage, AK 99511 (907)349-1851 cwellis®gci.net July 26, 2005 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 RE: Sand Lake #2, Bilk 1, Lot 9 Septic System Upgrade To Whom It May Concern: Attached please find the application and supporting documentation to upgrade the septic system for the referenced 2 bedroom house. The existing septic system was installed in 1983 and the drainfield will not pass an adequacy test. It is proposed to retain the drainfield for future use and install a new 1000 gallon steel septic tank. The proposed design is based upon a test hole dug on July 6, 2005. The hole was dug to 19.25 ft with no water encountered. After a 7 day monitoring period, no water was detected. The proposed drainfield will be installed in a silty sand layer between 7.7511 and 13.25 ft. A percolation test conducted between 7.5 ft and 8.0 ft resulted in a rate of 5.0 minutes per inch. An application rate of 0.8 gpd/f is used in the design. The soil log is attached. Proposed Soil Absorption System: 2 Bedrooms x 150 GPD/BR = System Type: Application rate: 300 GPD / 0.8 gpd/ft' _ Maximum Depth: Effective Depth: Proposed Length: Absorption Area: 300 GPD Deep trench . 0.8 gpd/ft' 375 ft' required 13.25 ft 5.5 ft 2x2011=40ft 440 ft' Sewer Upgrade permit Application for Sand Lake #2 Blk 1 Lot 9 Watkins Engineering, Inc.; July 26,2005; page 2 Due to limited space available on the lot, the septic system will be placed 100 ft from the Class C well located on Lot 9, Sand Lake #2 Block 1 and 130 ft from the Class C well on Lot 12, Sand Lake #2 Block 1. The waiver has been granted by the Alaska Department of Environmental Conservation. A copy is attached. A lot line waiver is requested for a distance of 2 ft from the north and south property lines. Due to the configuration of the adjacent properties' septic systems, I do not believe that this will have any adverse effect on their water and wastewater treatment needs. Thank you for consideration of this permit application. If you have any questions or need further information, please call me at 349-1851. Yours truly, Cindy ZtE I I Ois, P. E. President PROPOSED SEPTIC SYSTEM 11 l� 79 \—Sand�Lake #2, Block 1 I / Sand Lake #2, Block 2 / I e I �e 18 7 Septic / / Septic I / Area system 18/ well well location Septic / / \ ' 17 Area a 135.00'\� 1 T r7L Lot #9 �/_ I gel • ° L served by — well on lot 12 is 14 7-1 T Septic Area14 I s� Inactive well Class C Approximate I I I Well 12 'I I 13 Location 1 1 I I I \ I W. 82nd Ave. Sand lake #2 Blk 1 Lot 9 Proposed Septic Upgrade -Site Plan Dale Ratcliffe Parcel ID: 011-132-40 Cindy W. Ellis, P.E. July 14, 2005 Scale 1 inch = 60' Watkins Engineering, Inc. P.O. Box 110443 Anchorage, Alaska 99511-0443 Phone: (907) 349-1851, Fax: (907) 349-1934 OFAt .............qs; :.. 149 TTH jam.......... Cl Y W. ELLIS - 10577 Test Hole DESIGN DETAILS 2 BR, 300 GPD 0.8 gpd/ft2 Requires 375 ft2 Deep Trench 5.5 ft effective 2 x 20 ft long Max 13.25 ft deep 0 0 0 Lot 10 U) X U C? 135.00' Lot 12 �S`ratlwusl Existing 2 BR house l FCO _tinsid I � o fy eller 130' I S Proposed Trenches Lot 8 I� I II `"pert I pipe 5.5 It sewer I I Existing rock I drainfielcl r to be Gil retained) II to l osed new trenctes (2) long, 5.5 R effect4 / Proposed new l 1000 gal steel I I �O& I _ septic tank \ I I E Exisbi g 11�000 gal TH I o steel septic�anlLto b�� removed and buried �� on site. 0 Install DCO, i Flow Splitter, 135.00' \eft to MLL\ CO& MT yr nfiu waiver reque «u n \ C-ltle-44"t \ \ J-1 \ / tLi LOT 9 AND LOT 12 WELL RADII TO BE STAKED BY A REGISTERED tank LAND SURVEYOR Sand Lake #2 Bik 1 Lot 9 Proposed Septic Upgrade -Site Plan Dale Ratcliffe Parcel ID: 011-132-40 Watkins Engineering, Inc PEAL 49 TTH Cindy W. Ellis, P.E. P.O. Box 110443 Gn •. uNy7 W. 77 July, 13, 2005 Anchorage, Alaska 99511-0443 4�0%•.. �� Scale 1 inch a 20' Phone: (907) 349-1851, Fax: (907) 349-1934 ��;,�,„,,`,, Municipality of Anchorage Development Services Department Building Safety Division yr On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Boz 196650 Anchorage, AK 995196650 www.munl.orglonsite (907) 343.7904 Performed For. Legal Description: Depth 1 idY W. Ellis CE - lose Soils Log - Percolation Test I -•`�,' I Dale Ratcliffe Date Performed: 7/06/2005 Sand Lake #2 Blk 1 Lot 9 Township, Range, Section: �O��ail�cs 1' .O 2- 2 11 WAS GROUND WATER Date Gross Time ENCOUNTERED? NO Net Drop 1-2 71705 3 IF YES, AT WHAT DEPTH? — L O Depth to Water After 7/7/05 P Monitoring? None E Date: 7/13/05 12:35-1:05 Reading Date Gross Time Net Time Depth to Water Net Drop 1-2 71705 11:35-12:04 29 6-0 6 34 7/7/05 12:05-12:34 29 6-0 6 5-6 717/05 12:35-1:05 30 6-0 6 LEA PERCOLATION RATE 5.0 (mwwlea5nen) rcn� rn U,..,.,",... TESTRUNBETWEEN 7.5 FT AND 8.0 FT COMMENTS Presoak rlortotest. PERFORMED BY: RodryTrairar/Cindy Ellis I {i CERTIFY ETHAT TE: TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELI S IN EFFECT ON THIS DATE. DATE:? /5'05 U �� Ll E (a IFFU L S U U i, FRANK N. MUf tKOWSKI, GOVERNOR 555 Cordova St. Anchorage, AK 99501 DEPT. OF ENVIRONNIENTAL CONSERVATION Phone: (907)265,-3076 Fax: (907) 269-7650 DIVISION OF ENVIRONMENTAL HEALTH Sarah Rveh(ad -o.statc.ak.us DRINKING WATER PROGRAM htW://www.state.ak.us/dec/deh/ July 21, 2005 Cindy Ellis, P.E. Watkins Engineering, Inc PO Box 110443 Anchorage, AK 99511 Files: Sand Lake #2 Lot 7,8,9& : 0, Bk 1 Sand Lake #2 Lot ' 2, Bk I Re: Waiver Approval Separation Distance Waiver to Sand Lake #2 Lot 7, 8,9 & 10, Block 1 Class C Public Water System and Sand Lake #2 Lot 12, Block I Class C Public Water System Dear Ms. Ellis: On July 20, 2005 this office received your submittal requesting a separation distance waiver frc m a proposed single family septic system to the two Class C public water systems mentioned above. The septic system will be installed on Lot 9, Sand lake #2, Block 1. Due to the small lot sizes in this area, there is insufficient room to meet the 150 -foot separation distance requirement between the procased septic system and these two Class C wells. Sand lake #2 Lot 7.8.9 & 10 This well is located on Lot 9 and serves lots 7, 8, 9 & 10 according to our files. It was approved for operation by this department as a Class C public water system on 10/10/83. A waiver of 100 feat to the proposed septic system also located on Lot 9 is requested. This well has a depth of 520 feel below ground surface (bgs). Two layers of clay are noted on the well log, one from 252 to 390 feet bF s and the second from 413 to 470 feet bgs. Recent nitrate and coliform samples detected neither oftte contaminants. The well seal is in good condition and the surface water flows away from the wt 11. From the Site Plan included in the submittal, it appears there are four septic systems (including the one on Lot 9) located within the 150 -foot separation distance radius but beyond a 100 -foot radius. Based on this information, the requested waiver to 100 feet Is approved for the proposed septic system as long as its construction and sizing meet minimum Municipality of Anchorage standards. Sand Lake #2 Lot 12, Block 1 This well is located on Lot 12 and serves Lots 11, 12 and 15 on Block 1 and Lots 13 and 14 on Block 2 according to our files. It was approved for operation by this department as a class C well on 6/19/84. A waiver of 130 feet to the proposed septic system is requested. The depth of this we I is unknown. Recent nitrate and coliform samples detected neither of the contaminants. The well seal is in good condition. From the Site Plan included in the submittal, it appears there is one other septic Sand take k2, Lot 7,8,9&10 talk 1 WaNcr Requcst system within the 150 -foot radius but beyond a 100 -foot radius. Based on this information, the requested waiver to 130 feet is approved for the proposed septic system as long as its construction and sizing meets minimum Municipality of Anchorage standards. The approval of these waivers is based in part on a newly constructed septic system that meets -:he minimum requirements of the Municipality of Anchorage. The waivers are therefore only appraved to the proposed septic system on Lot 9 and do not apply to any other septic systems located wit tin the required 150 -foot separation distance requirement. Please in the future, show the entire separation distance requirement radius around each well you are requesting a waiver for. Any person who disagrees with this decision may request an adjudicatory hearing in accordance with 18 AAC 15.195- 18 AAC 15.340 or an informal review by the Division Director in accordance with 18 AAC 15.185. Informal review requests must be delivered to the Division Director, 555 Cot dova St., Anchorage, Alaska 99501, within 15 days of the permit decision. Adjudicatory hearing requests must be delivered to the Commissioner of the Department of Environmental Conserva:ion, 410 Willoughby Avenue, Suite 303, Juneau, Alaska 99801, within 30 days of the permit decision. If a hearing is not requested within 30 days, the right to appeal is waived. If you have any questions regarding this plan review, please contact me at 269-3076 Thank you, Sarah Rygh, EIT Environmental Engineer Assistant �-v1J I11C`0//0/ MUNICIPALITY OF ANCHORAGE ® I DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE NEW PACIN C PWA�'Q �.'' (� a �Z `•Jr3, ❑ UPGRADE MAILING ADDRESS LEGAL DESCRIPTION E7 9 ruzct< l s Affi I&A7 �L LOCATION NO. OF BEDROOMS Z C,O . v _ Y DISTANCE TO: Well �0 — � Absorption area / Dwelling AI PERMIT NO. 4336 l a z Manufacturer Material No. of compartments �7 Liq. capacity in gallons • IF HOMEMADE: Inside length Width Liquid depth O6)C) z DISTANCE TO: Well Dwelling PERMIT NO. JO = z H Manufacturer Material Liquid capacity in gallons w= DISTANCE TO: Well NQ //V Foundation NOr 1AJ% Nearest lot line PERMIT NO. p e7%SCi LU LL z No. of lines Length of each Total length o lines Trench width Distance between I" t z cc _3line t 47 inches ¢ F Top of tile to finish grade Material beneath tile!� Total effective absorption area 4-1 r inches _ _ / r w Length Width Depth - PERMIT NO.� (7 a H wa Type of crib Crib diameter Crib depth Total effective absorption area to DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. ..i W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS V SOIL TEST RATING 7 Ae 20 INSTALLER I ca . REMARKS G ladL c E:6 C QF_ 12— N P rJ _RTE0 P`PE W1T14 Z ,r s F _ ._da v rL 6HALL DROP 00 t,€7_ •rO LE Et - P C ,WPROVED DATE LEGAL Q a T G1< E io�z �-v1J I11C`0//0/ P1 U N 1 0 z F='t=l_ L_ I —IF CH F= F=l N 1: H't F-_ F=R Ca a DEPARTMENT i HEALTH AND ENVIRONMENTAL =iTECTION•d L` STREET: ANCHORAGE: AK 99501 264-4720 PERMIT NO. 8301. ;, APPLIO:ANdT PACIFIC RIM C.'ON ST. -140' W. 47TH. #'u 5G.2-5_3<9 LOCATION LEGAL LOT 9 10 BLK i SAN DLAKE #2 LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS _ _ SOIL RATING <:_Q FT,/BR?= 176 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM I S : THE LENGTH DIMENSION I THE LENGTH (IN FEET) OF THE TRENCH OR DRA I NdF I ELD. THE DEPTH i �F A TRENCH OR PIT IS THE DISTANCE BETWEENd THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION(IN FEET:. THERE IS NO i _.ET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINdIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATIONd (INd FEET;. = U I R'FEER _.E=F1' —r 1 a7—: _rn"K _ 3 =�=_ -1 C-1 0t �1_9_._a-1ra PERMIT APPLICANT HAS THE RESPONdSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION iNd INSPECTIONS OF ANY WELL_, AD_7'AO:ENaT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES DEN CES THAT 'THE WELL WILL SERVE. —_ -r-W _m ■-_ a Ira° F -F='®_: -r 2 Csr _• r=l F-�EE F2 EE CA '_s I F_FEce --- BACKFILLING OF ANY SYSTEM WITHOUT UT FINdAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO i PROSECUTION. MINIMUM DISTAN CE BETWEEN A WELL AND ANY ON—SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL i sR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINdE I- 25 FEET AND TO A COMMUNITY _EWER LINE IS 7:5 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATIOiNd. I CERTIFY THAT 1: I ANT FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE SEWERS AND WELLS AS SET FORTH BY THE t'UUNdICIPALITY OF ANCHORAGE. : I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. . I UNDERSTAND DERSTAN D THAT THE ON#—SITE _EWER SYSTEM STEM MAY REQUIRE RE ENdLARGEMENdT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN =. BEDROOMS. S I GNdED :— --- — --- -------------------- ---- APPLI1_ANJ' "'ACIFIC RINT CONST. ISSUED E'T -----DATE _'�`3�g�___ _ V4. 0 r1'� SOILS LOG MUNICIPALITY OF ANCHORAGE p DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION it PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: 6,11 C' 1 req Ay- ,,L.DATTE PERFORMED: J3?q-40 LEGAL DESCRIPTION: ✓,-OC Z.?�� f� 7/OG� �c�l / �"4� E SLOPE SITE PLAN 1 2 3 �-- 4 5 6 7 8 9 .z 10 P• 12 13 i 14 15 r ' 16 17 18 19 20 COMMENTS Pen, S, /f Art c) S�'d tjy4o-s WAS GROUND WATERA ►O ENCOUNTERED? /V L O IF YES, AT WHAT E l y DEPTH? T�lAai :w% Reading Date Gross Time Net Time Depth 40, Water Net Drop Q _$Z6 Hm • 015- Z. r •8' o O•l /3 _ a o / �s o o r o O•/ PERCOLATION RATE oC • v (minutes/inch) �J � TEST RUN BETWEEN `• FT AND [rsL_ FT PERFORMED BY: /� . IG,c/� CERTIFIED BY: 72-008 (6/79) DATE:"S'--��""o j well COMMUNITY WELL Lots 9 & 10, Block 1, Sand Lake Subdivision, #2 Sherwood Builders 345-3816 50' 100' radius from well -all septic systems outside radius 10' easement for waterline Well has Pitless adaptor at a minimum depth of 10 feet. An approved watertight sanitary seal is installed. The top of the well casing extends a minimum of 12" above ground with drainage sloped away from the well -for a minimum of 101. fvlain supply line is 1 1/2" Type K copper tubing. Individual service lines are 3/411. Each service line has a "key box". System is buried a minimum of 10' deep with "thaw" provisions. Each house has "Well X Troll' model 202 pressure tank capable of 11.5 gallons of drawdown per tank. Tank capacity is 20 gallons. Power source and controls are located in the house on lot 9. M. tv a to z 09 i tv ro rp�y W hi w N Oo w w ya r I u iJ 7 .-� Co J •.1 -J •N� � 1•�3 ® O to i,�'7 H � •1�'3 1•�� H H 9 ® 0 13 H H y• H *a] t-'• i io :i.� :L,; kms• f.: T-1 a il�y rl `:r7 :v) ', ri iCs r.f ;r1 •fp �. y.. (, t(J 1 J M. tv a to z 09 i tv ro rp�y W hi w N Oo w w ya r I u 7 .-� Co J •.1 -J •N� � 1•�3 ® O to i,�'7 H � •1�'3 1•�� H H 9 13 H H y• H *a] t-'• i io �o a n 0, :v) ', ri iCs r.f ;r1 ;y r,7 .,y 3 M. tv a to z 09 i tv ro rp�y W hi w N Oo w w ya r I u •ti�3 •N� � 1•�3 ® O to Ll J t-'• i io �o a n 0, M. tv a to z 09 i tv ro rp�y W hi w N Oo w w ya r I u 111111111 1111''111 911 111 ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION . PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT Plans for the construction of I�- S �D �-V �S' 6%y p . L t4 )C F W cC_ 451[ ` I' .3 Z I �" Z� n 0 1"14,S,c rC� t public water system located in t_ F1 d 1--u g::c Alaska, submitted in accordance with 18 AAC 80.100 by -51 U E, 0- d Rhave been reviewed and are W approved. ❑ conditionally approved (see attached conditions). J ji BY TITLE - — ATE If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. APPROVED CHANGE ORDERS Change (contract order no, Approved by Date or descriptive reference) The "APPROVAL. TO OPERATE" section must be completed before any water is made available to the public. APPROVAL TO OPERATE The construction of the T- water system was completed on �� - "- 3 (date) granted interim approval to operate for 90 days following the cpmpletion date. public The The system is hereby BY TITLE - D_. ATE As -built plans submitted during the interim approval period, or an inspection by the Department has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to operate. BY V TITLE DATE x 1 t ' r • -'� Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 011-132-40 1. GENERAL INFORMATION Complete legal description Sand Lake #2 Block 1 Lot 9 Expiration Date: 1 O_Nj Q q , ),02D Location (site address) 8125 Wilcox Street, Anchorage AK Current Property owner(s) Heidi B Mailing address Real Estate Agent 8125 Wilcox Street, Anchorage, AK 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class _ Well ❑ Public Water System ❑ WaiverNariance request for: Received by: Day phone Day phone 2 TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ I a o 5 �0� I - `1� Waiver Fee $ Date of Payment 0-2_''-20 Date of Payment Receipt Number (✓r) Receipt Number COSA # O S C d2 O. N 59 Waiver # istance: 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 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 8/4� ." T 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 ,.r OU AZ, encroachments, deficiencies or discrepancies exist. rj,�y t , Kc,) DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the fVl[winuo mutations: OF 4- nkt_gITE nr� f yg WAT,ER AND ` Z.10 WAST[�N`A► r -r% 5 PROD M By: (r`�rl 960un J Original Certificate Date: � �] .O� C7 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 K Nitrate Advisory Septic System Advisory Arsenic Advisory is Well Flow Advisory Other COSA blue sheet i0-1D-12.Ccc COSA Checklist Legal Description: Sand Lake #2 Block 1 Lot 9 Parcel ID: 011-132-40 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system 1 A. WELL DATA U Well log is filed with Onsite (or attached) Date drilled -d&3 Total depth SzD ft Cased to �ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) /8 in. Date of flow test for COSA AIA Static water level at beginning of test Ni¢ ft. u n Comments1rZ✓/ou5%r CIQ5S t✓ B. TANK DATA Age of tank(s) 8/5/05 years Tank type/material Septic/Steel Measured operating fluid level in septic tank 49" ® Standpipes/foundation cleanout per record drawing Date of pumping 10/8/19 D. ABSORPTION FIELD DATA Which system tested (date installed) 8/5/05 ® ALL standpipes present per record drawing Total measured depth from grade 12 ft (max) Measured depth to pipe invert from grade 8.6 ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective ® Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons COSA Checklist yellow sheet Well production at time of test IVA qpm Water storage tank volume MA gallons Well disinfected for coliform test? ❑ Yes ®No ® Coliform bacteria is Negative Nitrate mg/L ® Nitrate less than MRL (ND) Arsenic 20.7 ug/L ❑ Arsenic less than MRL (ND) Collected by Arcterra Consulting Date of Sample 8/6/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 8/6/20 Results Z✓ Pass For 2 bedrooms Fluid depth prior to test 0 in Water added 300 gal Newdepth 12 in Elapsed time 30 min Final fluid depth 0 in Absorption rate 300+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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' ® Yes if No Community Sewer Manhole/Cleanout > 100' If absorption field is under driveway comment below Property Line > 10' ® Yes if No ft [0 Yes if No _ ft Neighboring Tank > 100' ® Yes if No _ ft Private Sewer/Septic Line > 25' 2] Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No _ ft: " Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ft ®Yes ifNo_ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft 0 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' ® Yes if No _ ft Property Line > 5' ® Yes if No _ ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No _ ft Private Wells > 100' Yes if No _ ft Water Main > 10' ® Yes if No _ ft Community Wells > 200' 0 Yes if No * ft Water Service Line > 10' ® 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' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No 2.5* ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No _ ft Water Service Line > 10' ® Yes if No _ ft Community Wells > 200' ® Yes if No ft Surface Water > 100' ® Yes if No _ ft F. ENGINEER'S COMMENTS *WR#050056. **: Well on lot previously class "C" well but changes in regulations have removed classifications ***: Additional ADEC Wavers on file dated 7/21/05 G. ENGINEER'S CERTIFICATION I 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. COSA Checklist yellow sheet MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904 On‐Site Water and Wastewater Section Fax: 343‐7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Arsenic Advisory Certificate of On‐Site Systems Approval # OSC201459 Subdivision: Sand Lake #2, Block: 1, Lot: 9 A water sample taken prior to the water treatment system revealed an arsenic concentration of 20.7 micrograms per liter (ug/L). Additional water samples taken after the water treatment system revealed an arsenic concentration of non‐detect. 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 On -Site Water and Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 011-13240 Expiration Date: c2 -,,29— 1(7 1. GENERAL INFORMATION Complete legal description SAND LAKE #2 BLOCK 1, LOT 9 Location (site address) 8125 WILCOX STREET, ANCHORAGE AK 99502 Current Property owner(s) KEITH D. GUERRY Day phone Mailing address Real Estate Agent 8125 WILCOX STREET, ANCHORAGE, AK 99502 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 2 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ® Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: /d COSA to be released to the engineer, unless oth it requested by the engineer. COSA Fee $ Date of Payment Receipt Number COSA# Waiver Fee $ 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 ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 11/21/16 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 tet; OF A r� encroachments, deficiencies or discrepancies exist. c�V 4 s1 * 4 C, T}I 6. DSD SIGNATURE System #1 Approved for c2_bedrooms. # °�, x xsere t"'. ° ru System #2 Approved for bedrooms. ° 0 ss Nh Disapproved. Conditional approval for bedrooms, with the following stipulations: r�titi(iu:,. =o WASTEWATER 0E PROGRAM j By: �� L� r (— —(/ Original Certificate Date:' C� 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Cosa mue sheet 10.10.12.Em 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: SAND LAKE #2 BLOCK 1 LOT 9 Parcel ID: 011.132.40 A. WELL DATA Well type C If A, B, or C provide PWSID # _ Well Log (YIN) Y Date completed 1983 Sanitary seal (YIN) Y Wires properly protected (YIN) Y Total depth 520 ft. Cased to 520 ft. Casing height (above ground) 18 in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate ND mg/L Arsenic: 20.4 ug/L Date of sample: 11117116 Collected by: ARCTERRA B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 81512005 Tank size 1000 gal. Number of Compartments 2 : ''Cleanouts (YIN) Y Foundation cleanout (YIN) Y (INSIDE) Depression over tank (YIN) N High water alarm (YIN) N Date of pumping 11116116 Pumper ONE STOP + C. ABSORPTION FIELD DATA Date installed 81512005 Soil rating d / or ft2/bdrm) 0.8 System type DEEP TRENCH Length 40 ft. Width 2.5 ft. Gravel below pipe 6.215.3 ft. Total depth 12 ft. (Measured 11/16/16) Eff. absorption area 460 ft Monitoring tube Y Depression over field N Date of adequacy test 11.17.16 Results (Pass/Fail) PASS 'For 2 bedrooms Fluid depth in absorption field before test 010 in. Water added 360 gal. New depth 011 in. Elapsed Time: 10 min. Final fluid depth 010 in. Absorption rate >= 300 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at in. Pump off' level at Datum Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 104' * Absorption field on lot 100.2' Public sewer main 75'+ Sewer /septic service line 25'+ Animal containment areas 504 SEPTIC/HOLDING TANK ON LOT TO: in. Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout 100'+ Holding tank Manure/animal excrete storage areas 100'+ Building foundation 54 Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 1304 ABSORPTION FIELD ON LOT TO: Property line 2.5' * Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 1004 Driveway, parking/vehicle storage 10'+ Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 130'+ * F. COMMENTS Vacant system pre-soaked per code prior to test. * ADEC waivers to 100'& 130'& MOA waiver to lot line G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in'conformance _ with MOA COSA guidelines in effect on this date. i OF A� Engineer's Printed Name KENNETH M. DUFFUS Date 1112112016 do TH / COSA canary sheet_2-6-15.doc KENNETH M D w� p n «� in. Municipality of Anchorage o ;< Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Arsenic Advisory Certificate of On -Site Systems Approval 9 OSC161570 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 9 of Sand Lake 42' Subdivision. This inspection revealed an arsenic concentration of 20.4 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.or onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Municipality of Anchorage \ Development Services Department Building Safety Division OnStte water and Wastewater Program 4700 South Bragaw St. +• �.. P -O- Box 196650 Anchorage. AK 99519.6650 www.munl.orglonsile (907) 343.7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 011-13250 HAA 1. GENERAL INFORMATION Expiration Date: ��l►a/�p�r� Complete legal descriptionSand lake #2. Blk 1. Lot 9 Location (site address or directions) Current Property owners) Dale Ratcliffe Day phone Mailing address 8125 Wilcox St., Anchorage AIC 99502 Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. Day phone Day phone 2. NUMBER OF BEDROOMS: 2 3. TYPE OF WATER SUPPLY: Individual Well TYPE OF WASTEWATER DISPOSAL: Individual Water Storage ❑ ❑ individual On-site Class C Well l] Individual Holding tank 13Community Water System . E3Public Community On-slte 13Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of No (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSO also Issues HAAs upon request to homeowners. 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. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates aro valid for one year for properties served by Class A or B wells or 0 public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validatirov dlate shoi es for this epF motion, below. I verity that shows bthat the based on procedures outlined in the Health Authority ADP on-site water supply andfor wastewater disposal system is(are) safe, functional and adequate for the number o e of structure indicated herein' a gation verit based fy the the on-site water siupply adfor bedrooms and to a flies and from my al and State codes, ordinances, wastewater of disposal system N(are) in compliance with all applicable Munidp wastewater disposal ays and regulations In effect at the time of installation. phone 349-1851 Name of Firm Watkins Engineering. Inc. Address P.O. Box 110443. Anchorage. AK 89511 0443 Engineers Pointed Name Cindy W. Ellis 5. DSD SIGNATURE Approved for ,._4Q— bedrooms. Disapproved.' Conditional approval for oato 98'05 bedrooms, with the following stipulations: Attachments: Maintenance Agreements HAA Checklist supplemental Engineer's Report Septic System Advisory Other Well Flow Advisory — P ""I O- • IN ow.oaw2r Original Certificate Date:44214C� Municipality of Anchorage Development Services Department BUIUM Safety MWm O"lla astewa Program 4700 South eragaw SL P.O. Box 196650 Anchorage, AK 69519.6850 wNw.muml.orglonsaa (90i 343.7604 HEALTH AUTHORITY APPROVAL CHECKLIST L49W Description: Sand (ake 1% B& 1 Lot 9 Parcel ID: 011-13x-40 A. WELL DATA WON type.E-- If A. B. Or C wovlds PWSID 11 Well Log (YIN) Y Data Completed 1W &Wtary seal (YIN) Y Wws property Pomaded (YM) Y Total depth l ! _R. Cased b 520 R' Gsk6 fbkA>t (above ground) 19• kn, FROM WELL LOO AT INSPECTION Date of test Static water Ievei ft. n. Watt production g.p.m. 9.p.m. WATER SAMPLE RESULTS: CoUfarn C (p•L2.OS Cdonles/1W ml. Nitrate X0.1 mqA. Other badade 0 oolonies/100 ml. Am&&- NA m6.A• Date of temple: cram Coaeded by: Watkka Enak eerkn Ing B. SEPTICIHOLDtNG TANK DATA Tank TypalMaterlat steel Data knttatied 11&W Tank ttzs 1000 gal. Number of Compertrrwrts 2Y Cbanouts (YM) Fomdallm deanout (Y/N) Y_ Depression over tank (YIN) N High water alarm (Y/N) NA Data of pumpkq NA - new Pumper C. ABSORPTION FIELD DATA Data Installed 816/05 Soa reting (".dla' or ftslbdrm) 0„_8 System type deep trench Ianptif 40 It. Width 25 A. Gravel blow pipe 6.215.3 a, Toth depth 182 It. Eff. absorption area 480 R=Y Monitoring tubs.__ Depression over sell N Date of adequsq less NA- new Results (Pass/Pall) For,_, bedrooms Fkld depth in absorption held before lest _, in. Water added_ gal. Now depth_. In. Elapsed Time: _ min. Fkral Auld depth _, in. Absorption rats -" Any r0tvarration treatment (past 12 mo.) (YIN S type) It yes. give date D. LIFT STATION Data knataded JNA Size In pkffl 'Pump on- level „min. 'Punta 0fr WM st �I In. Datlxn Cycles lasted E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Sepik tw*m station on iot 1 �� AbsppAion Raid on lot 100.2• Public sewer main 100+ Sewer Iso* service line ManhdelAocess (YIN) HO water alarm level at kn. 1Aseb atom 6 dram rep:ro�? On atlacent kft 1Do*(vetious wahera) On 000011t ilio 100• (vari "M"ivs') pub0c sewer manho1eldesnout1. — - Holding tank SEPARATION DISTANCES FROM SEPTICMOLDINO TANK ON LOT TO: Bulldtn0 foundation 90 PmPertY I'"e 10 AWfPWn Reid 5 100+ water service line �++Surface water 100+ Water mein Wets on ad)eceM Iob 130+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: prooarty 1" 2.6• Buldkq foundation 29 WSW mail 100+ so water Service arb to• Surface water 100+ Driveway, pogwngNotide store06 curtain drain NA Watts on adjacent bb 1301* F. COMMENTS .FCO Msbs. At*C waMr for 100 R eom Coss C,." on b1 fi.1d0 b was on b112. Let Iwed G. ENGINEER'S CERTIFICATION I oaroy Mat I hove determined Uuough RaM Brspecdors and review OfMunldpol rsoords Mat Me above sYstems era h oordorrmwe wIM MOA HAA Qnddennes in eAeef on Mb dole. Engineers printed Name Cindy W Enls Date t3/121O5 HAA Feet Date of Payment — Receipt Nnsnber (iev. 12/01) Waiver Fee $ Daft of Portent Receipt NuntW 49TH' flow. 10 W. Ellis CE.tesn so• �•a i3sao' • e -a s ; ' yriP w I f�NC 2.42 JC :f I 'Ci._ \C4ri /,35.00 4-10 JO' ' UNDER N0 CIRCUMSTANCES SHOULD AN AS -BUILT BE U= FOR CO+SMCI1OL OR FOR trAWs HIND eoUNOARr OR nNCE UNE--, UNE SURVEYOR TARES RCSURUNWJTY FOR INC IMDAL TRANSACTION OILY AND ASSUMES FINANCIAL 1.1"UN ONLY FOR THE COST or THE SURVEY USTm OSTANCrS PREVAIL OVER SCALPIC. RtWOOUCMW MAY CAUSC ERRORS N SCALL SURVEY TYPE SYMBOLS 13 LAT SURVEY [3AS-lidl.T ... NO CORNptS SET e SET REBAR AP--+ DRASUCE L'•'-" d ASPHALT ® PEGORnFICAIIOH AS -Butt... NO CORNERS SET MCC_ omcprm rCUNO BARELE 13 PLOT PAN ... AS -/ULT ... LOT SURVEY ... TCPOCRAPNY 0DP D M—_M—trf � UNR FUHa ® PLOT PLANS A LOT SURVM NOTE: IT rs THC RCSPCN339UTY V THE BUILDER OR OWNCR. PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CONSTRUCTION. TO VERIFY PROPOSED BUILDING CRADC RELATIVE TTHC O FINISHED DUDE AND CONNECTIONS AND TO DETERMINE SOWN. MCES. MUSSEPTIC CLEANOUSS. SIDEWALKS. DRIVEWAYS, AS AC COVENANTS OR OF PEAR NOT ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY. SNOW WICHOO AP�E ACCOPom UAY PREVKNT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. SURVEY CERTSICAITION Prepored by LOT SU REY A=-OR`T 'ON PLAIN L'.L Q" •Y REcuTMwLTION ASlT AS-WO : Gi Robert E. Johns Jr. & Assoc. hereby th"� ,, CdA Professlonc! Und Surveyors Property Or*" And MaMd hereee. «. the hnprewnante «wh I }} SatHc •- O•� en R.E.J. thoroon are wlthln ths,ERT Property On" «d .e Ret o...rtoo er enerpoeh an E ::5. JR. �I } e eS' .N .dr•d e � A C C D.H. e..: - - "'°2224 e.0. Lrya D«oryuac edge«t pmoerty. except as Indlooted hereon. -0. .11-$ .{.;S �•r� o�� oivinsHNo H.i•�''J�� •e2 er.. na LOT.9 BLOCK IMentw on the Peoorded plot. *22 SAND LAKE SUBDIVISION ADD.12 L pre net .hewn Parson. MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES �y i Division of Environmental Services - On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # LU -1 Cbn - LAC) HAA # . 6AQcL9Uf) 14 -1,Q 1. GENERAL INFORMATION Complete legal description Lot 9; Btoek 1; Sand Lake #2; Location (site address or directions) 8125 Wltcox Property owner BiLi.an A)Lend Day phone g"�' 124 Mailing address 8125 Wilcox D4i.ve Anchatage, Ak. 99502 Lending agency Day phone Mailing address Agent Unless otherwise requested, AA will be held for pickup. 2. NUMBER OF BEDROOMS: 2 V 3. TYPE OF WATER SUPPLY: Individual well Community well XX Public water Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX 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. 72-025 (Rev. 1/91) Front MOA #21 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. I furtherverify 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 inspection. Name of Firm Phone 17034 Eagle River Loop Road No. 204 Address ca rver, as a Engineer's signature 6. D S SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for /1% A&G, Additional Comments Date 3_2 . r n H Ai; era N0. bedrooms, with the following stipulations: Date 3 Z, 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 DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto 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. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: � tL.K ��-+� Parcel I.D. j 2 A. WELL DATA Well type Log present(Y/N). Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to FROM WELL LOG Driller Casing height Wires properly protected (Y/N) < - ZZ n AT INSPECTION I®iq m n .a Z T M O ? M M ® ® rr, co Z y S g.p.m. g.p.m. 11=7o N 0 < �r rA O O M z SEPARATION DISTANCES FROM WELL TO: JC�- Septic/holding tank on lot j ; On adjacent lots Absorption field on lot 1 ; On adjacent lots Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Nitrate Public sewer manhole/cleanout eum tank Collected by: Other bacteria Date installed ;5— "e5:22 Tank size \ Compartments CleanoutsVN) Foundation cleanout(2N) High water alarm (Y/N) Date of pumping ---;5 - 2-,q ?-- •Z. Depression (Yog) tf Alarm tested (Y/N) Pumper SEPARATION DIySTANCES FROM SEPTIC/HOLDING TANK TO: t - J Wei I(s) on lot `� On adjacent lots c -i Foundation + To property line l� (� Absorption field r®t Water main/service line Surface water/drainage j L I 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off' level at Cycles tested Surface water . Date installed �72 /-�O' V� Soil rating �_l (-� System type IA Length Width Gravel thickness Total depth —� Total absorption area 2 Cleanouts presentOgN) y Depression over field (Y/6 Date of adequacy test Results �/fail) �S for 3 bedrooms Peroxide treatment (past 12 months) (Y/N) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: gyp. 12�_WrTE!P ��i On adjacent lots �� Property line vts Well on lot To building foundation o To existing or abandoned system on lot I A- Cutbank �� Water main/service line_ N a r� I� On adjacent lots I A - Surface water ,��t Driveway, parking/vehicle storage area — Curtain drain OVJ6 I(_�l�N E. ENGINEER'S CERTIFICATION I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in eefffeckpgat�,daatte�of, this inspection. AV S & S ENGINEERING �9'9,`p 77034 Eagle River Loop Read Ne 90¢ �� ;0. r gyps ¢ � Signature Eagle River, Alaska 99577 oa¢aeae 006 Q� 9040 NU X1 Engineer's Name C W -¢&q v o¢ son a w� a R. 0 :�; J ahIAF'l:fi Date pQ No. 2t' y no ` ",�� 07to d¢a C0 ¢¢Sa ��•��E,�3' HAA Fee $ 7D� Waiver Fee: $ Date of Payment 4— / Date of Payment Receipt Number ✓ 3 Cog /D/if Receipt Number KI 17034 Eagle River Loop Road ROBERT A. SHAFER it Eagle River, Alaska 99577 CIVIL ENGINEER A *# WELL FLOW TEST DATA SHEET ## 694-2979 PROJECT: —ILJ ��Y��h�IQ DATE OF TEST: LOCATION OFWELLL(Legal Description):—Lc;�r i7L1L ✓/SyJ� �/ � Z WELLDEPTH: 7 / FT. /CASING: SZd� FT. SCREEN: DATE DRILLING COMPLETED: `' — !J/ ori/ DRILLER: STATIC WATER LEVEL (Top of Casing): ��1 FT. DATE: CLOCK TIME ELAPSED TIME SINCE PUMPING STARTED/ STOPPED, MIN. DEPTH TO WATER, FT. DRAWDOWN! PUMPING RECOVERY RATE, GPM REMARKS z- 0 (SWI) 0 0 Start F1.•oli 1 5 S 1� 10 15 20 25 1-10 30 1 2 35 40 45 (: 4 50 ?� 55 60(1 hour) 90 1�g 3a� 120 (7_ hours) 150 160 (3 hours) 210 240 (4 hours) 1"2�j RECOVERY t 0 0 5 10 _ 15 20 25 30 Comments: /335 �l 1 �P• %i 1" l • ele. '- --a " - _ ..o s. w nv VVO�Ya.Oa{� Subsequent Variations Can Occur. DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 FOR: S & S Engineering March 4, 1992 PWSID 217314 WALTER J. NICKEL, GOVERNOR 349-7755 My review of the records on file in this office reveals that the Class "C" Public Water System Survey, Lots 7, 8, 9, and 10, Block 1, Sand Lake #2 is in compliance with the provisions of 18 AAC 80, State of Alaska Drinking Water Regulations. Sincerely, 4ev., �L' ��" Keven K. Kleweno Environmental Engineer Associate MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES M}i 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D.#..0\� -1 JQ )-In HAA# k�2&- L�� 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Go7 Tiz,J E4 See- /o Location (address`or directions} (b) Property. owner Ilab Telephone: (home) Business Mailing Address QCy$ irf CjCl (c) Lending Institution- Telephone Mailing Address (d) Real Estate Company and Agent ,iMf3T.r/ /?iPAze71_FS 4:r2 %OGLE/ Address Telephone7/7 (e) Mail the HAA to the following address: (or check hereXif hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family,K Number of bedrooms 7- 3. 3. WATER SUPPLY Individual Well ❑ CommunityX Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site( 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. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site 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 inspection. Name of Firm /lECS Telephone Address ��y b'j3� 14AI6 Date Z79-sss3 5So 3 OF A4 S�: 4 T �� • E,Vi s:Staa 1a. • CE -2251 �i lk 4q'p essio*\ '0- 6. DHHS APPROVAL /J 7 Approved for 2 bedrooms by/2".Z__ &Y -nate Approved )< Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto 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. 72-025 (Rev. 7/88) Back Page 2 of 2 cN` aE MUNICIPALITY OF ANCHORAGE (MOA) M\eP ` n ' �` Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 M�t ENJ "rJ;J ;` 34_) 343-4744 hs Legal Description: A. WELL DATA` Well Classification &*R If A, B, C, D.E.C. Approved(ON) Log Present(Y/N) Total D -Cased to Static Water Casing Height Above Electrical Wiring in Conduit Date Completed SEPARATION DISTANCES FROM To Septic/Holding Tank on Lot Depth of Grouting To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) On Adjoining Lots ; On Adjoining Lots To Nearest P41ic Sewer Cleanout/Manhole NIM -A B. SEPTIC/HOLDING TANK DATA Date Installed 3"3G'" Size 16r" No. of Compartments ; Date Standpipes &N) Air -tight Caps(ON) Foundation Cleanout (Y/O Depression over Tank (Y/O Date Last Pumped 7`94? /SAf�Gf Pumping/Maintenance Contact on File (Y/N) A11A ; for '4 i4 Holding Tank High, -Water Alarm (Y/N) /`I Temporary Holding Tank Permit (Y/N) SEPARATION D.187,ANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well -`_ /0 To Building Foundation 3G To Property Line S To Disposal Field To Water.,Main/Servfce:.line /G To Stream, Pondke or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /74 Type of System Design %—R4AJe* Date Installed '-3o-yj Length of Field 3'P Width of Field Depth of Field Square Feet of Absortion Area Y6)_RDepression over Field (Y6)- Results esults of Last Adequacy Test Ab6_Q0A-7-9' 5-3 L - Gravel Bed Thickness SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well /05 To Building Foundation Lot f1 To Water Main/Service Line /o _ Statndpipes Presentt{ /N) Date of Last Adequacy Test 87 OF To Property Line /3 To Existing or Abandoned System on On Adjoining Lots o To Cutback (if present) A17A To Stream, Pond, Lake, or Major Drainage Course /dro a To Driveway, Parking Area, or Vehicle Storage Area /o -f Comments D. LIFT STATION stalled Zaze in Gallon "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect o�L,,gp,te of this inspection. o OF A ' h-- d 44k Signedt--E �. �.......Iq �•D• Company �EG% �„rry04 go Date //-44V �.•.: !�7 el s S 1 k MOA No. UZ ; ...... .. ....A 1lI ROY C. REID, CE -225i 0 ��5'O�'U �� fit\ Receipt No. ,i Receipt No. .,�► Date of Payment ��'ls- Waiver Fee: $ Amount: $ U Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 L� DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 1334 ANCHORAGE, ALASKA 99503 STEVE COWPER, GOVERNOR l 563-6775 DATE: 10-11-88 PWSID: Class C Well To Whom It May Concern: According to the records on file in this office, the Lot 10, Block 1, Sand Lake #Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, ��m'�� Michael P. Lewis, PE p®� �® A gyp,- Environmental Engineer MPL: pkk �•°.,••.o, 09$+ f �•••• •••o •• too . - •O ••• •t°° 404R.* ne rr,• - Y C. REID, JR. ®,�• • CE - 2251'' F • I Time APPLIC 'NT FILLS OUT UPPER HAI " ONLY Time Property Owner �' Time Phone Mailing Address f �.�L_ Zip �,._"- Zip Code Date Buyer 0 Date Address Zip Code Lending Institution�,�, ��f �;yz�;�`�;/� Inspector Phone Address - Zip Code 27�_ Realty Co. & Agenti C �/ r" p. c`..;1_ _ /��!>^'� �. �,�- Phone Address DEPT. N,ANCHO,4gGE OF :-i,Lif I Zip Code Legal Description /� � �i / L � C — Lr� PROTECI-ION Street Location >��C/LAX I Type of Residence Q--Srngle Family (,2)APPROVED BEDROOMS `CONDITIONS OF APPROVAL ( ) DISAPPROVED ❑ Multiple Family No. of Bedrooms ( ) CONDITION APP OVAL' ❑ Other 3 Water Supply ❑ Individual �( C �- ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ULl ommunity `_ Well To Absorption Area dog' For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Z f� l Well to Tank Sewer Dimes osal f r^ 1f I>.J�ndividual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time i Time Time Date / Date Date Date Inspector Inspector Inspector Inspector Field Notes: C �/ r" p. MUNICIPALITY OF G P- l DEPT. N,ANCHO,4gGE OF :-i,Lif I ENVIRO, ;. 71=N7AL PROTECI-ION E C V E (,2)APPROVED BEDROOMS `CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITION APP OVAL' 3 DATE BY:j Soils Rating Date Sewer Installed Well To Absorption Area dog' Well Log Received Septic Tank Size 00 Z) Z f� l Well to Tank 72023(3/@)