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SCIMITAR #2 BLK 2 LT 25
Scimitar #2 Block 2 Lot 25 #051-132-43 Municipality of Anchorage Development Services Department.t. ' Building Safety Division s On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page ' Of'? www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: 5wos-o la I PID Number: Name: Q �� I/_1 � Zet1 er Wastewater System: El New ❑ Upgrade Ad r607 6 ZAz4 a S�% 635ABSORPTION LD ulwa,, c.� Phone: / [� 8_ / / ^ D Number of Bedrooms: lLJ1XJ VX 7oC/ ❑Deep Trench El Shallow Trench 0Bd Mound [I Other: LEGAL DESCRIPTION Soil Rating: Total Dept ro i I grade: GPD/Ftp Ft. Block: ^ Lot: /^ Subdivision: , J SLS Depth to pipe bottom fro original grade: Gravel de Ih beneath pipe: / Y %FL Fl. Township: Range: Section: Fill added a ve original grade: Gravel Length: Fl. Well: New Upgrade ❑ ❑ Gravel width: \ Number o nes: Distance between lines: FI. Fl. Classification (Private'A, B. �): Total Depth: �/ Cas Total a sorp'on area: pe Material: / /'It/12 e t. Fl. Driller. Dal ed: Static Water Level: Installer: _ Date Installed: Ft. Yield: Pump Set at: hl Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES 5rSeptic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding ublic/PrivatO Manufacturer: P f Capacity: From Tank Field Station Tank Sewer Line /"eni e ISS 1000 Gal. Well J 0 r '07 Material HDC Number of Compartments l Surface Water 100-f, LIFT STATION Lot Line Size: Manufacturer: , Foundation "Pump on' level at: 'Pump oft' a : High water alarm at: o(J in. Curtain Drain O�/ ^ Pump Make el Electrical Inspections performed by: Remarks: �x;s'fi �oS U� eW BENCH MARK / �%r5Aed + Location and Description: R. (� /1ons A6Ar►G%ne �l s ��;/1 x��i4j- L - IJ t }��L>? _,Assumed Elevation: 1i177� X00 Ft. El�gil3e�{. jamp 3' . (e \ S & S ENGINEERING Inspections by: Eagle River Loop Road, No. 80fes: 5'a � ' 05 performed 1St age Iver, as Eagle 2nd ,- ...... .1... . Development Services Department Approval , 0 ? ROBERT ccovt<�h, f �. Reviewed and approved by: Date: (Rev. 12/00) PERMIT NO. SW0501 21 PAGE 2 OF 3 MunicipaUty of Anchoranp DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,D. Box 196650 0 Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR L INSPECTION REPORT LEGAL LOT 25, BLOCK 2, SCIMITAR #2 P.I.D. NO. 051-132-43 EXISTING TRENCH OUTBUILDING WITHOUT FOUNDAT ON lillimpla op-law-m-001WA 100' WELL RADIUS X NEW 1000 GALLON HDPE SEPTIC TANK - - - - - - - - - - - - - - - - - - - - - - - - 33' SECTION LINE EASEMENT --- ----------- -------------- _Z 15' UTILITY EASEMENT ------------- lZ_ ----------------- SCALE: I" = 40' Vu POBERT C, COWAN cr PERMIT \,,,O, SW0501 21 PAGE 3 OF 3 Municipa�ltv of Anchorar�p DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P 0, Box 196650 GAnchorage, Alaska 99519-6650 0 Tete hone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR ULL INSPECTION REPORT LEGAL LOT 25, BLOCK 2, SCIMITAR #2 ST1 ST2 NEW 96. 05-/ 1000 GALLON POLYETHYLENE SEPTIC TANK P.I.L. N0. 051-132-43 100.7 5 N. T. S. 13" 0111111111111 P.I.L. N0. 051-132-43 100.7 5 N. T. S. MUNICIPALITY OFANCHORAGE 6pI Isom Development Services Department `� On -Site Water d 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: May 16, 2005 Expiration Date: May 16, 2006 Permit Number: SWO50121 Parcel ID: 051-132-43 Legal Description:cI AR #2 BLK-2 LT25' Design Engineer: 0003 S & S Engineering Site Address: 019607 TULWAR CIR Owner Name: SEELY & BRADLEY KATZENBERG Lot Size: 46679 SO. FT. Owner Address: 19607 TULWAR CIRCLE Total Bedrooms: 3 Permit Bedrooms: 3 CHUGIAK . AK 99567-6359 This permit is for the construction of: Q Disposal Field E 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. S IT tI�s Y°SHi CALCEO MID SR 00 T4 -EO'' W41 If tKt 141V /NJrf4a OF /goo jA lloN f ke 17yJk 0 A 'POO C741ION AIPPr TavL WAS rNj of ljrd. A40 T.,6e wAt pA,_c8 jy 7-44L. / Received By: Z Date: r/6/a. Issued By: l -I- Date: �/6k— 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.ci.anchorage.sk.us (907) 343-7904 ON-SITE SEWERMIELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING I Parcel I.D. © S-/ — 13 D —h13 Permit Number SW Property owner(s) Kee 1't D r f a IeV ra i Zen betI3 Day phone P93— l�Q� Mailing address (1)1940-7 I N I �W/a/ l ilG /e Mailing address (2) Cti uA rAk4 Zip Code 9956 7 Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size Acr /Sq.Ft THIS APPLICATION IS FOR: Number of Bedrooms 3 rA Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade W THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 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. S & S ENGINEERING 17034 Eagl• River Loop Road No. 204 (Signature of property owner or authorized agent) Permit Fees: $ H 6 0. • - Waiver Fees: Date of Payment: S'7A /* S Date of Payment: (,5)�/ `T Receipt Number: ceipt Number: (Rev. 12/00) W.kTHAUIHOFM APPWV&S SEWER l WATER MPEcnm VIMOSPECIM AFLQMTEST S TE nAw m PERCOLATION TEST ONSff WASTEWATER COPOSALSYSMA CES" ROBERTC.COWAN, RE ROBERTA.SHAFEP,RE CML ENGINEERS (9M 6942979 FAX (9M 694-1211 May 9, 2005 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 25, Block 2, Scimitar Subdivision #2 It is requested that you issue a permit to replace the existing septic tank currently serving the existing three bedroom dwelling on the referenced property with a new 1000 gallon septic tank. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic tank. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, W2.� Robert C. Cowan, P.E. RCC/bjj Enclosure 17034 NORTH EAGLE RNER LOOP 9 SUITE 204 • EAGLE FVVER ALASKA 99577 I " = 40' DESIGN SITE—PLAN 0 ONA hi goo`1qp c°:< I � �um� b �• I I I x I I I zmi : & I I I Os c) m I I I oz C" I I o za I I I o _ `- •- I I I f I I I 0 IV r o >z CJS o c�r> I I I N I I 0 C- I I I O y m 0 I I IjVtA3Al8Gr-i A X I I I Orvv o n s~s C7 m Z m 3SnoH S I I I Omzl w°J°n Six3 9x- _ m l z I I - N n I 1 0 I m"F-z I y I r I ZJc>o Ln •'J I < I z l "mo I > a l n I >K 113M •ool J I > I z v— sniova I .�. to N JC' O Z" i = i vcoz sniova 1n3M •o0t N I I I oamo I I I =611 s i I I o=" I I I zc:m 0 I I I mom � I I I s�o I I I z 1 CN I I I r �� y i SLZL 1••.i1j�?, fn :O ass 59y'fk I V•7 r�i� �O e � ;..�..j ROSERTC.COWAN, P.E PIOSMA. SHAFER, P.E. CMLENGINEERS (9071694-2879 FAX (OM 694-1211 MOFM .A""S ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS lEVIEX{WATER REFERENCE: Lot 25, Block 2, Scimitar Subdivision N2 May 9, 2005 SEWEALWATER RZPEanCN GENERAL: 1. The scope of this project includes the replacement of the existing 1000 A�wWOM gallon septic tank with a new 1000 gallon septic tank to serve the existing three bedroom residence located on the referenced property. 2. Construction shall be in accordance with the approved site plan and design VIULVO CT" &FWNnW drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary 8"ft" underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be RWM+ responsible for final grading areas subsequently depressed from soil settling. W&TIM 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. PERCO{ATM res. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. mcmMom VwEcn" Construction shall include two 4" cleanouts for pumping access. oNSa WASTEWATER osposkennm CESIGN 17034 NOM EAGLE RNER LOOP - SUfTE 204- EAGLE RIVER ALASKA 98677 Page 2 Lot 23, Block 2, Selmitar Subdivision 02 May 9, 2003 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type ofPipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). Page 3 Lot 25, Block 2, Scimitar Subdivision 02 May 9, 2003 INSPECTIONS: Typically there will be a minimum of two (2) inspections required during the installation of the septic tank. These inspections will occur as follows: The first inspection must be conducted after the septic tank is set in place, but may not be backfilled until after this inspection. 2. The final inspection is to occur upon final grading of the property. The inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owners representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 87.5 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL_ SYSTEM AND/OR WELL INSPECTION REPORT '.� NAME '�---_-/�/--m-- PHONE / NEW l.sc✓N,S�T1`-%�`" ltji`: ❑ UPGRADE -_.G-�'!Gi'.,i�-' MAILING ADDRESS LEGAL_ DESCRIPTION a LOCATION .� �'l O2 Gy i �� /c' NO. OF BEDROOMS- 3 Ux �C DISTANCETO: / �" Absorp,ioare. v _ PE 4 Manufacturey��e ",� / �n E� No. of compartments LU (JJ C N� Lir. a c. in Mons f �� IF HOMEMADE: Inside length Width Liquid depth 0Well J z DISTANCE TO: -- c / -�- Dwelling PERMIT NO. -, F- --.-____- --- Liquid capacity in gallons J-- ---"- Manufacturer ((( --" - Material --tom w u, DISTANCE TO: WlI it- e Q �LJU No. of lines Length of e ch m,,�/, Foundati. Nearest li� ne � Total14gth of Ii R TrenchJ�/i It PE`� -� IF F L Diswink Ijnes F, z ¢ I - [7 ! [-G- aJ inch_e5 ( ./twge � �ij- 8 F- Top of rile q firy(sh c�Gxle 1 ��ial ba ti� - '�� Total effe rive absorption area _ _S La,jh inches w Length Width ,�� Depth \, PERMIT NO. - af- Type Lu of crib - Crib et/9r diam//Mr� - Crib depth Total effective absorption area N DISTANCE TO: - Well Building foundation Nearest lot line � w Class DISTANCE TO: D pt �, k 7"l Building foundation Driller - - Sewer line Distance to lot line — Septic tank PERMIT NO, Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING / j Ae INSTALLER R EMAR KS Y. t ] J i w A. v� V APP, ROV DATE LEGAL r-ui.s 1nev-.vin1 TYPE OF SOIL HBSURPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS � I SOIL RHTING (SQ FT/BR)� 85 THE REQUIRED SIZE OF THE SOIL IS: �R II. -.-N ���IF .-,1 �W f 11 Avu ENE R.. ������ G; THE LENGTH DIMENSION IS THE LENGTH (IH FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DI�THNCE BETWEEN THE SURFHCE OF THE GROUND HND THE BOTTOM OF THE EXCHVHTION (IN FEET) THERE IS NO SET WIDTH FOR TRENCHES THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN TH£ OUTFHLL PIPE HND THE BOTTOM OF THE EXCHY8TION (IN FEET). ��TEE Go Up ::N- N_-'�..E E."! NEE TOO 0- 1 Q W Fos 141 WK Gr 1 �����C� �y 1" � . PERMIT HPPLICHNT HAS THE TO INFORM THIS DEPHRTMEN1- (_: 11"I CTIONS OF HNY WELLS RDJHCENT TO THIS PROPERTY HND THE NUMGER OF RESIDENCES THHT THE WELL WILL SERYE. ��� �11 - 11 ::�: JI: IF E:,� _�� BHCKFILLING OF HNY SYSTEM NITHOUT FINRL INSPECTIQN HND HPPROVHL BY THIS DEP9RTMENT WILL BE SUBJECT TO PROSECUTION MINIMUM DISTHNCE BETWEEN H NELL HND HNY ON~SITE SEWHGE DISPOSHL SYSTEM IS 100 FEET FOR H PRIVHTE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDlHG UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE: FROM H FIFO IVHTE WELL TO H PRIYHTE SEWER LINE IS 25 FEET 9N� TO H COMMUNITY SENER LINE IS 75 FEET. WELL LOGS HRE REQUIRED HND MUST BE RETURNED TO THE DEPHRTMENT WITHIN ]0 DHYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MY HPPLK SPECIFICHTIONS HND CONSTRUCTION DIHGRHMS ME, HVHILHBLE TO INSURE PROPER INSTHLLHTION. �:::n NEE KV ERE Ov! 010 ERE III Th :L, L :!E7H K. I CERTIFY THHT 1� I HM FHMILIHR WITH THE REQUIREMENTS FOR ON—SITE SEWERS HND W�LLS HS SET FORTH 8Y THE MUNICIPHLITY OF HNCHORR��. 2 I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH THE COf)ES ]I UNDERSTHND THHT THE ON~SITE TEM MHY REQUIRE ENLHRGEME".4T F THE RESIDENCE IS REMODELED TO INCLUDE MORE THHN ] BEDROOMS SIGNED� ' __~ "RFPLICHNT MYERS 411^~— 0 KSOILS LOG MUNICIPALITY OF ANCHORAGE ®. +, DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 " SOILS LOG - PERCOLATION TEST PERFORMED FOR: / - C C-. DATE PERFORMED: LEGAL DESCRIPTION: SLOPE SITE PLAN DEPTH LF E E&), Z j Y 4 e 1 2 l.' c 3 i 4 6 - �>'�`CJ ��� �v j r1+ V� 7 G� 8 ;r 9 10 12 13 14 15 16 17 18 19 20 COMME J Date Gross Time Net Time Depth to Water ' WAS GROUND WATER i^) / ; ENCOUNTERED? L P IF YES, AT WHAT DEPTH? E PERFORMED BY:—S, `i .5 �VCLrI /l 72-008 (6/79) L Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE _(minutes/inch) TEST RUN BETWEEN s FT AND FT CERTIFIED 8 DATE: Z�l= Municipality of nchoragsker'll MEMORANDUM DATE: February 11, 1982 TO: Laura Crow FROM: Sewer and Water Program SUBJECT: Request for Refund - Account ;#2460 Please make arrangements for the following refund. A private engineer did the inspections of the installation of on-site sewer rather than this office. Thank you. Account $ 2460 Receipt ## 161623 Amount $60.00 Permit # 811156 Lot 26 Block 2 Scimitar Subdivision Permit 4# 811155 Lot 25 Block 2 Scimitar Subdivision Myers Construction Post Office Box 351 Chugiak, Alaska 99567 Laura J. Ward Senior Office Assistant Sewer and Water Program attachments 91-010 (5/7£3) RETURN TO: DIvIsio;j of Geological and hysical Surveys (DGGSJ .3001 Porcupine Drive (Tel_ .,ne: 277-6615) -Anchorage, Alaska 99501 W A T E R W E L L R E C 0 R D Drilling Company Name LOCATION OF WELL Please complete either ]a, - lb, or lc. o Ia. Borough Subdivision Lot I Block 1 lb, Fraction S . ection No. Ji- t ar A— Ic. Distance and Direction from Road Intersections Street Address and Area of Well Location WELL LOG Feet Below Material Type u Id er s .-,r a V e I U.S.G.S. Local No. Drilling Permit No. A.D.L. No. Township lRange STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES Meridian I N/S I E/W 3. OWNER OF WELL:1,,].,_ Address: f0 4. WELL DEPTH: (comoiet d) Surface Elevation Date of Completion ft. 5. ❑Cable toot [5�Rotary MDriven 11 Dug ❑ Auger FIJetted [] Bored ❑ Other:_ 6. USE: 2"Domestic MPublic Supply M Industry 11 irrigation M Recharge M Commercial M Test Well Other: 7. CASING: M Threaded EJWeldid in. to ft. Depth Weight lbs/ft. in. to ft. Depth 8. FINISH OF WELL. Type: Diameter: Slot/Mesh Size: Length: Set between ft. and ft. Fittings: 9, STATIC WATER LEVEL: ft. M Above Meelow --and surface Type of Measurement; 10. PUMPING LEVEL below land surface ft. after firs: pumping 9 -P.M. ft. after hrs. pumping g -P.m. 11. WELL HEAD COMPLETION: In Approved Pit [] Pitless Adapter inches above grade 12, GROUTING: Well Grouted: Yes M No Material: M Neat Cement ❑ Other: 13, PUMP: (if available) HP Length of Drop Pipe _ ft. capacity _ 9-P Type: M Submersible FIReciprocating [I Jet E]Other: 14. RE14ARKS: -5;5 15. WATER WELL CONTRACTOR'S CERTIFICATION: This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief: Registered Business Name Contract License Number Address: Nov , 14 _Lq� Signed: Date: Authorized Representative WHITE - SrAtp. nrr.-; PINK Driller. CA14ARY - Customer Y • 56 i 8 4 017 GEO au, Municipality of Anchorage �4llin 4'2y On-Site Water and Wastewater Program `�' (907) 343-7904APR 2 8 2'?17 z F Y a ti Certificate of On-Site Systems Appro�� <<4, ,,,i,,�A`' 051-132-43 GI 6 B L.g Parcel I.D. Expiration Date: ."- -2._' 17 1. GENERAL INFORMATION Complete legal description Scimitar #2 Block 2 Lot 25 Location (site address) 19607 Tulwar Circle Current Property owner(s) Fay, Colin & Danielle Day phone Mailing address 19607 Tulwar Cirlce Chugiak, AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well E Individual E Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: a,— A.... ii/i� Date: yy/-k_ COSA to be released to the engineer,unless otherwise requested by th- - . eer. COSA Fee $ 5a2(0' Waiver Fee $ Date of Payment 6-11, (1 Date of Payment Receipt Number Cga n 4 Receipt Number COSA# c 5 c( j I J 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 inform44,9...ht i om the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater dFsposal sysy �s(are) in compliance with all applicable Municipal and State codes, ordinances,and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulatioj rted results describe the performance of the system under the conditions encountered at the time of the test, and separation distance, ur • o readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground waW�JJ tht y fluctuate during the year,and the water usage of the family being served by the system.These conditions are outside the conlrc' he evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, or do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 4128/2017 •.1% OF ACQS,kAi e � *:49.m i4\ -.*fir, 6. DSD SIGNATURE % l /"" XSystem #1 Approved for ___ bedrooms --- ••.Steven 1:N arinorie: System #2 Approved for bedrooms 9 c°`' CE-8149, \ Disapproved � +9POFEVickxSS�0•��4 Conditional approval for bedrooms, with the following stipulations: I .\\( OF AiV , 4a�- -� _ c %` 0N-SITE � . � , NATER AND . 11-k MPROGc QJ' 'rti!T Crn\>"cVASTEWPTER a By: t.t,. (`- - Original Certificate Date: -.-7-2---/ 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 sheeli If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Scimitar #2 Block 2 Lot 25 Parcel ID: 051-132-43 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (YIN) Y Date completed 11/14/1981 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y Total depth 80 ft. Cased to 80 ft. Casing height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 11/14/1981 4/17/2017 Static water level N/A ft. li,)(') ft. Well production 5.0 g.p.m. -D,--D g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 9.26 mglL Arsenic NDug/L Date of sample: 4/17/2017 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/HDPE Date installed 5/21/2005 Tank size 1000gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 4/17/2017Pumper Sanitary Pumpers C. ABSORPTION FIELD DATA Date installed 11/16/1981 Soil rating (g.p.d.Ift2 or ft2/bdrm) 85 SF/BDRM System type TRENCH Length 26 ft. Width 4 ft. Gravel below pipe 5 ft. Total depth 7 ft. Eff. absorption area 260 ft2 Monitoring tube Y Depression over field N Date of adequacy test 4/17/2017Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test C.) in. Water added 'q C' gal. New depth (i) in Elapsed Time: \'C min. Final fluid depth (� in. Absorption rate >= 't5C -i- g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date L) 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: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS -�1 - .•'. - �J 64-___ ______- . -.1......-...------_ p .. + . ,_eOti'1 . I ' r�- i G. ENGINEER'S CERTIFICATION ��F I certify that I have determined through field inspections and re651.- ••,A- review of Municipal records that the above systems are in *• 4 •AI& I\ •,*t♦, conformance with MOA COSA guidelines in effect on this date. -• •• i •_3•tr• ••• 0 Engineer's Printed Name Steven Pannone -- en *l�arinorie • Date 4/28/2017 it s. eE-8149 COSA canary sheet 2-6-15.doc • Municipality of Anchorage ri Development Services Department =` Building Safety Division : ,I , On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory' Certificate of On-Site Systems Approval # OSC 171157 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 25 of Scimitar #2 subdivision. This inspection revealed a nitrate concentration of 9.26 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/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. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. Nitrate Fact Sheet From Northern Testing Laboratories, inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. OSI - (12' HIP COSA a 09 0063 Expiration Date: to — rg' 1. GENERAL INFORMATION Complete legal description LOT 25; BLOCK 2; SCIMITAR #2 Location (site address) 19607 TULWAR CIRCLE, CHUGIAKAK. 99567 Current Property owner(S) JOSH d SHAWNA HEGNA Day phone 630-2123 Mailing address SAME Lending agency Day phone Mailing address Real Estate Agent OWEN STRONG W/PRUDENTIAL J.W. RE Day phone 351-4366 Mailing Address 16635 CENTER FIELD DR. #103, EAGLE RIVER AK. 99577 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well 2 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site I] Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S 8 S ENGINEERING Address 15861 S. BIRCHWOOD LOOP RD., CHUGIAK AK. 99567 Engineers Printed Name ROBERTA. SHAFER 5. DSD SIGNATURE ,_(_/ Approved for _- bedrooms. Disapproved. Phone 694-2979 Conditional approval for bedrooms, with the following stipulations: 5 Attachments: COSA Checklist X Arsenic Advisory . Septic System Advisory Well Flow Advisory Nitrate Advisory Maintenance Agreements Supplemental Engineer's Report Other By:� fit-- Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343.7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lol a5 i 'Bcoc/c o? , SO M 1171 #oZ Parcel ID: 0.5/— / 3 a 113 A. WELL DA Welltype P-IWITL- Date completed r Total depth W ft. If A, B, or C providdePWSJ6 IDs# _ Sanitary seats^��j( t) � Cased to eo ft. FROM WELL LOG Date of lest II Al Static water level /V1)4 ft. Well production S. Q g.p.m• WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate �mg/L 4' Arsenic: _�) ug/L date of sample: 3 ciq Well LogDN) Wires properly protecte(J J) Casing height (above ground) /6'4- in. AT INS E TION 3 3 �.S g.p.m. Other bacteria colonies/100 mL Collected by: �4 S €it7C�I>VEEI2IIUCm B. SEPTICIHOLDING TANK DATA Tank Type/Material gLPj1C_ DPC Date installed 15 2/ 05 Tank size /COO gal. Number of Compartments cZ CleanoutsT�N) Foundation cleanout ( J) C5 Depression over tank (Y®L�0 Hi h water alarm (Ye) Date of pumping 3oL1 Pumper EE t 7/'�9Pz:k-S C. ABSORPTION FI LD DATA _ Date installed Soil rating (g.p.d./ft, ft2/bd ) �S System type Length � ft. Width �{ ft. Gravel below pipe s , ft. Total depth ft. Eff. a sorption area c2(!nf? Monitoribe t Depression over field _ao Pa Date of adequacy test 3 Results s / ail) M For J bedrooms r� Fluid depth in absorption field before test Q in. Water added 5/6 gal. New depth ti in. Elapsed Time: 0 min. Final Fluid depth n t/� in. 1 `` Absorption rate >= � g.p•d. 1D Any rejuvenation treatment (past 12 mo.) (Y/ type) M C1 If yes, give date :( D. LIFT STATION 018 Date installed Size in gallons _ "Pump on' level at _ in. "Pump of ' Datum Cycles tested _ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 1 Septic tank lift station on lot Wo 1 Absorption field on lot 00 4 Public sewer main N f% Sewer /septic service line nQ 6; '4 Animal containment areas 6 1 (Y/N) in. High water alarm level at in. Meets alarm 8 circuit requirements? On adjacent lots /GYM -It- On On adjacent lots /CO r Public sewer manhole/cleanout Holding tank k7 /A i Manure/animal excrete storage areas /G10 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation + Property line /O -0/- Absorption field S t� r Water main Il) Water service line Surface water /LYS Wells on.adjacent lots /oc 1 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r r Property line /0 Building foundation Water main On r Water Service line /0 r Surface water /00 rt Driveway, parking/vehicle storage r, Curtain drain KWC. KAYaIL3V Wells on adjacent lots 100 f F. COMMENTS �( Frna� Q_rdT?IGTr<p 8�1 PvN1P Q. PLOmpixxx'�hre-) #P# -Tr- &nT �uy/jQ'Af%ii (i 'ares ork r V� -4114.1 411 uS GIN ac-e-UZ G. ENGINEER'S CERTIFICATION ='E ,r 44r ry w.nj7 e.e"a on�" {� Q• I certify that I have determined f h field inspections and <., �., ,.. '• q`. review of Municipal records th t th above syste s are in ''k -_+ ? % conformance with MOA COSA oidel' s in ff, t n is d e. Engineer's Printed Name OF "'"'"""°? �. 1tsr-e Date COSA Fee $ Waiver Fee $ Date of Payment O Date of Payment Receipt Number. 01/ 59�%C Receipt Number (Rev. 11/05) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 90063 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 25 of Scimitar #2 subdivision. This inspection revealed a nitrate concentration of 7.66 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/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. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. qq wqiE�Al SGS RcEN Client Name Project Name/N Client Sample ID Matrix Sample Remarks: 1090802001 S & S Engineering L25,B2,Scimitar N2 L25,B2,Scimitar N2 Drinking Nater Printed Date/Time Collected Date/time Received Date/1'ime Technical Director 03/13/2009 8:45 03103/2009 13:15 03/03/2009 16:10 Stephen C. fade Allowable Prcp Analysis Parameter Results PpL Units Merhod Container ID Limits Date Date but Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 03/09/09 03/11/09 NRB Waters Department Total Nitratc/Nitrite-N 7.66 0.100 Microbiology Laboratory Colony Count 0 Total Colironn 0 Fecal Coliform 0 mg/L S%t204500NO3-F 13 (<IO) col/IOOml. SM209222B col/IOOmL SM209222B col/IOOmL SM209222B A (200) A (<I) A (<I) 01/06/09 JD7_ 03/03/09 IIKG 03/03109 IIKG 03/03/09 IIKG r- O m n � z r m Z� -n r �c m 0 h � N a �o �m { N P 0 0 z r 0 11 I' 0 z 0 P -- b Ob N� t•I 0 4 v r n z O0 I�IXn 0 x I y aFo�: V�^ l0Ch 2 r �olblb° zo e oQL - o00 a tA4h3 Cb 'hTh C4 i N �` \ c a� ,no�'e4 v N Z rn S N Parcel I.D. 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.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 051-132-43 1. GENERAL INFORMATION HAA # D5O��I(� Expiration Date: �Jr Complete legal description Lot 25; Block 2; Scimitar Subdivision #2 Location (site address or directions) 19607 Tulwar Cir. Chugiak, AK 99567 Current Propertyowner(s) Ceeli b Bradley Katzenberp Dayphone 688-4200 Mailing address same Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ®K Individual On-site El Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of 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 title (except between spouses) for properties 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 are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority 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 s F S EnpinPPrinp Phonehg4_?o70 Address -17034 N Eagle River Loop Ste 204 Eaple River, AK 99577 Engineer's Printed Name RD664r C. C'eWAA1 Date 6 4c /o,T" 5. DSD SIGNATURE __AZ Approved for .3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following Additional Comments G OF y ! ROBERT C. COWAN a-8801 r<< •;, tt+f Inti• .. ,;�; 4 stip ��Y OF .,.....• %3 w, `a` = • WATER AND WASTEWATER • PROGRAM Note: The well for this property meets existing State and Municipal Codes. There are nitrates present. It Is suggested that periodic testing be performed to insure the wells continued suitability. Current nitrate concentration is 7.17 mgA. EPA maximum concentration is 10.0 mg/l. Tiore information on nitrates is available from the On -Site Services Program, at 343-7904. Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: (Rw 0/03) Municipality of Anchorage Development Services Department ,•. =•: Building Safety Division = On -Site Water & Wastewater Program ' • ` ` 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99518-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST' Legal Description: Lar .25 j BW, 2 � Scl*n lmg-t- Z Parcel ID: OS 1- 1'3Z- L/3 A. WELL DATA Well ty'at V*Tr Date completed- -- 114-81 Total depth -eeft. If A, B, or C provide PWSID # Sanitary seal &) J65 Cased to _8—OLft. Well LogLVN) Wires properly protected t9q) %11575 Casing height (above ground) 18`rin. FROM WELL LOG AT INSPECTION Date of test 11-1 l'a 1 Static water level N ft. _101 it• Well production S 9 -P.M. �' S 9.P -m. WATER SAMPLE RESULTS: Coliform O colonies/100 ml. Nitrate mg./I. Other bacteria D colonies/100 ml. Arsenic: — mg./I. Date of sample:' "%S Collected by: a�J G lR7l rIl1G� B. SEPTIC/HOLDING TANK DATA Tank Type/Material -TIL 1 1 qDPir Date installed -547-1.&C, Tank size (MO gal. Number of Compartments 2 Cleanouts (tel 1) yEg Foundation cleanout&N) _J�!5 Depression over tank (Y/8) K10 High water alarm (YI® uO Date of pumping 19EA&2 T -10c P K- Pumper 14 C. ABSORPTION FIELD DATA CW s' Date installed ( Ile b or ( Soil rating (g.p.d. ftZ/bdr System type / AZ*"C + � Length a6 ft. Width Ji ft. Gravel below pipe* 5I ft. Total depth ft. Eff, absorption areacG D ftZ Monitoring tube -JX4 Depression over field A-10 Date of adequacy test 6VI:q109 Result as Fail) 0*'&15 For 3 bedrooms u Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: )O- min. Final fluid depth in. Absorption rate >= qckl g.p.d. Any rejuvenation treatment (past 12 mo.) (YQ,B type) A,'10 If yes, give date D. LIFT STATION Dale installed Size in gallons "Pump on' level at _ in. .131 JeuaFet Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1001% Absorption field on lot Ido (4 - High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots !o0 r t— On adjacent lots IDC 1 �- Public sewer main J.] YY Public sewer manhole/cleanout 0 Ile - Sewer /septic service line ' 11— Holding tank I1..) Ise SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 1 o f tit Property line -Lb I4— Absorption field/ - E - Water main 10 Ar- I- Water service line /d f Surface water /DO 14 - Wells 4 -Wells on adjacent lots I DO SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Id I - Building foundation IO 14 -- Water Service line Ib I t Surface water 100 /f— Curtain drain tVOwC71E ILMUA- Wells on adjacent lots 100 1-r F. COMMENTS 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 HAA guidelines in effect on this date. Engineer's Printed Name 9084,0-,— C. CO r+/d ,J Date roo /b AS - HAA Fee $ 9 30. s o Date of Payment Receipt Number _ �gRy�,-Ji im „ (Rev. 12/01) Water main Driveway, parking/vehicle storage /d I Waiver Fee $ Dale of Payment Receipt Number -P -� ROBERT C COWAN �i,'•� CE -81301 IVA%. 05-06-05 03:31PM FROM-CUE ESI. SCS ENV SERVICES Asw SGS RdJ 1052287001 COaatName S dr: S Fnginecring Project NosdM Lot 25. Block 2.Scimitar p2 Cheat Samek ID Lot 25. Block 2.Scimitar A2 Match Drinking Water Somplc Remarks: 9075615301 T-618 P.02/04 F-741 All DatcaMmes are Als4m Stsmiard Time Printed DatdTIme 05/0412005 16:00 Collected Date/time 042912005 15:35 Retched Date/Time 0412912005 16:42 Teehakal Director Stephen C. Ede Allowable Prep Amlysis parameter Rawls PQL Uaim Method ConctinerID Limits Date Date lalt Maters Departaemt Nitrate -N 7.17 0.100 1licrobiology Laboratory Total Coliform 0 mg/1. EPA 300.0 8 ("10) 04/19/05 WAV{ coVlOOmL SM209222B A (o -l) 04129/05 TU R! CD CD L 71 N T O r O m Z p m 2 r m O ZO 0 Gl �' a Ih .P b 0 z m 0 1� I' 3 r w r Q R l� rn m T A � 3 4g� o C1��E V � •° 0 4" o ,i- o,2 j m Cb DJ 0�0 O m fT 1; N (b L^ sp Cblb m I "Z o N �y e d 0 'C I„ t x r �� • i AN r N f\ � m ? NI • yp�v W A � b w r Q R l� rn m T A � 3 4g� o C1��E V � •° 0 4" o ,i- o,2 j m Cb DJ 0�0 O m fT 1; N (b L^ sp Cblb m I "Z o APPLK _4T FILLS OUT UPPER HAI ONLY Time Prop,!rty Owner _ .. �. �G�; ,//I/ v �f v" 6— / o�'�J Phone ((-2) Z Mailing Address 'o��%i�/ ip Code Date l Buyer Date �^ Address Zip Code Lending Institution //����/�)%��r (� Phone Address f!�G` R% J /', %)i�J�� A7 /�-.Zip Code Inspector Really Co. & Agent / � Phone Address �(� /�Jy ��i��'���t/� // Y�`�l0/J���� ..�-CL" Zip/Cotle �1t' --. % _ Legal Description Street Location Type of Residence Field Notes: ( q L $ <Single Family ❑ Multiple Family No. of Bedrooms � `ru cQ ( ❑ Other SVS LX Water Supply 19Jndividual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community - For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility ( ) CONDITIONAL APPROVAL.' Sewer Disposal Individual Year Individual Installed: �� 2 DATE>-- / —U ❑ Public Utility When Connected to Public Utility: BY: ❑ Holding Tank Soils RR NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Well To Absorption Area Time Time Time Time Dale Date Date Date �^ Inspector Inspector Inspector Inspector Field Notes: ( q L MUNICIP ALI hEPL OF H`i`•LTI I t: � `ru cQ ( V RNVIROV)1ENTAL PROTECTION SVS LX (7j) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL.' �� 2 DATE>-- / —U BY: Soils RR Date Sewer Installed Well To Absorption Area Well Log Received 51 Well to Tank Septic Tank Size 72023131821 -t So 5. LEGAL DESCRIPTION L RECEIVED - e INSPECTION APPOINTMENTS Subdivision STREET LOCATION TIME TIME TIME 6. TYPE OF RESIDENCE' DATE DATE DATES ,. INSPECTOR INSPECTOR INSPECTOR 7. WATER SUPPLY MUNICIPALITY OF ANCHORAGE E:3 INDIVIDUAL* DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ❑ COMMUNITY 825 L Street - Anchorage, Alaska 99501 • ❑ PUBLIC UTILITY ENVIRONMENTAL SANITATION DIVISION 8. SEWAGE DISPOSAL SYSTEM Telephone 264.4720 E2 INDIVIDUAL/ON-SITE** REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplato requests will not be processed, Please allow ten Il 0) days for processing. 1. PROPERTY OWNER PHONE Myers Construction, Inc. 694-qh�� MAI LI NGADDRESS PO Box 351 Chu_giak, AK 99567 _ PROPERTY RESIDENT (If different from above) -. _ PHONE NHN Tulwar Drive, Chugiak, AK None 2. BUYER �s� PHONE John S., & Karla K. Erp MAI LING ADDRESS - General Delivery, Chuqiak, AK 99567 3, LENDING INSTITUTION First Pp -doral Savings and Loan PHONE 274-6561; MAILING ADDRESS 813 W. Northern Lights Blvd. 4. REALTOR/AGENT - - PHONE Commonwealth Totem Realty, Inc. Jim Montague 694_.S 694--9494 MAILING ADDRESS _ PO Box 911, Eagle River, AK 99577 5. LEGAL DESCRIPTION Lot 25, Block 2, Scimitar Subdivision STREET LOCATION NHN Tulwar Drive 6. TYPE OF RESIDENCE' NUMBER OF BEDROOMS® 0 SINGLE FAMILY ❑ One ❑ Four ❑ Other__ ❑ Two ❑ Five ❑ MULTIPLE FAMILY 1Z Three ❑ Six 7. WATER SUPPLY E:3 INDIVIDUAL* ' ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM w' E2 INDIVIDUAL/ON-SITE** 1981 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ 'TWO ❑ FOUR ❑ SIX 2.. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified__ PERMIT NUMBER DEPTH OF WELL DATE DRILLED - - - LOG RECEIVED \ , 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER - ❑Septicr,Taank or El Holding Tank Size: _1 F d If Tank is homemade 0 give dimensions: SOILS RATING - TYPE OF TANK MANUFACTURER - - TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELLTO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot line 5. COMMENTS APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE 3 p BY