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HomeMy WebLinkAboutDEER PARK #1 BLK 1 LT 1Deer Park #1 Block 1 Lot 1 #051-042-52 Q.pine Drilling & Enterpri.,es Well Log Permit Number: #SW 111325 Date of Issue: 114841' Parcel Identification Number: 104252000 Date Started: 12-10-11 Date Completed: 12-10-11 Is well located at approved permit location? x Yes ❑ No Legal Description: Deer Park #1 Block 1 Lot 1 Property Owner Name & Address: Frank Erwin 1843 Parkside Drive Anchorage. Alaska 99501 Borehole Data: Soil Type, Thickness & Water Strata Depth (ft)Method From To of Drilling x air rotary ❑ cable tool Casing type: steel Stick-up 0 2 Wall Thiclmess:.25 inches silt gravelly silt 2 28 28 46 Diameter!k inches Depth: 101 feet Liner Type: _ Diameter: inches De feet sandy gravel 46 51 Casing stickup above ground: 2 feet Static water level (from ground level): 35feet gravelly silt 51 55 sandy silt 55 71 Pumping level: 100 feet after gravelly silt 71 89 2 hours pumping 20 gpm Recovery Rate: 20 gpm silty gravelly sand 89 96 Method of Testing: air li silty water sand & gravel 96 101 Well Intake Opening Type: x Open End ❑ Open Hole ❑ Screened Start — feet Stopped — feet ❑ Perforations Start — feet Stopped — feet Grout Type: bentonite granules Volume: 2 Start 0 feet Sto ed ? feet Pump: Intake Depth _ feet Pump size — hp Brand Name — Well Disinfected Upon Completion? a Yes ❑ No Method of Disinfection: chlorine tablets Comments: +Il III Dri11er. Alpine Drilling & Enterprises PO Box 1104 6 Anchorage A 99511 OM :Rlpine Drilling FAX NO. :907 345 0202 Jan.05 2012 08:21PN P1 Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Mara Begich Anchorage, AK 99507 s e e r r Mayor aww,muW.org/onsite (907)343-7904 PUMP Installation Log Well Drilling Permit Number: SW 111325 Date of Issue: 12.10.11 Parcel Identification Number:104252000 Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. gal Description er Park M Block t Property Owner Name & Address: Frank En%4n Remax Properties Suite 100 1i0 W 38Th Anchorage, Alaska 88503 mp Installation Date: 12.10.11 mp Intake Depth Below Top of Well Casing: 92 feet [Pump mp Manufacturer's Name: Goulds mp Model: 112 7 _qpm Size 112 hp Pitiless Adapter Burial Depth: 10 feet Pitiless Adapter Manufacturer's Name: Martinson 8.10 Pitless Adapter Installer: 'mow Pump & Well Service I.I.C. Well Disinfected Upon Completion? Yes ❑ No Method of Disinfection: Chlorine Tablets Comments: Pump Installer Name: John NomeneB e - Po � Iroo�R'L ��•y� .� � sit: i/ Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Mtjnicipality of Anchorage Community Development Department On -Site Water and Wastewater Program 4700 Elmore St. -P.O. Box 196650 Anchorage, AK 99519-6650 - http:flwww.niuni.orglonsite • (907) 343-7904 Well Decommissioning Log Legal flddrese: !�� Xon %Block / Subdivision ,Ae cz7m�lj Lot - T R Section Lot on site Water & Wastewater Program certified contractor performing theweif decommissioning: blame: / Company: � Well demnmissioningdate �`� ' /� Method ordeoommissionsrg: AMC 15.55.0601-1 a. ❑ b. ❑ C. J Location: Use the spoce below to provide a drawing of the property shoving the following items; MGM arrow Decommissioned welt, • Other water wells on the property, • Two sapanate swing4le dislances for each well shown an the drawing, Note: The swing -tie distarMzs shall be measured from sitter permanent sftotures or the property corners. 3� /l orf herd tV e_1l WRi �BCOm /+II}SionPr�. nC C G:1CommurdW Developmentllkvelopmem Servims1Building Saf Qfj Site Water and 81-088££ FonhSlWalf Decommisfoning form.deo PC] B60:20 Z6 61, JeW On -Site Water System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP111325 Tax Code Number: 05104252000 Work Type: Well Upgrade Permit Effective Dates: November 08, 2011 to November 07, 2012 Design Engineer: ANDERSON ENGINEERING Subdivision: I DEER PARK#1 Site Legal Address: DEER PARK #1 BILK 1 LT 1 G:1558 Owner/Address: JP MORGAN MORTGAGE ACQUISTION TRUST 2006-CW2 US BANK NATL ASSOC / TTE 400 NATIONAL WAY SIMI VALLEY CA 930656414 Site Mailing Address: 22437 OAK KNOLL DR, Chugiak This permit is for the construction of: N Disposal Field N Septic Tank N Holding Tank N Privy All construction must be in accordance with: Lot Size in Sq Ft: 40002 Total Bedrooms: 3 Y Private Well N Water Storage 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. ,5x(`,jf"9 welt * beGrGcorh�+iks�'ope� Received By: �L'7 � Issued By: Date- /i'9—Zo(/ Date: MUNICIPALITY OF ANCHORAGE Community Development Department; Phone: 907-343-7944 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-042-52 Property owner(s): Frank Irwin Day phone: 244-8051 Mailing address: 1843 Parkside Drive Anchorage, AK 99501 Site address: 22437 Oak Knoll Drive Chugiak, AK 99567 Legal description (Sub'd., Block & Lot): Deer Park No. 1, Block 1, Lot 1 Legal description (Township, Range & Section) Lot Size: 40,002 Sq. Ft. Number of Bedrooms: Three (3) THIS APPLICATION IS FOR: THIS APPLICATION IS AN: (®all that apply) Initial ❑ Absorption Field ❑ Septic Tank ❑ Upgrade X Holding Tank ❑ Renewal ❑ Privy ❑ Private Well X Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: 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. (Signature of property owner or authorized agent) Permit/Rush Fees: c"00 _ wP Date of Payment: )l Receipt Number: CTD CJl Permit No. 05y m �S Waiver Fees: Date of Payment: Receipt Number: Waiver No. C:\UserslAndEng\Desktop\Mike\Deer Park\Permit Application Frank.docC:\Users\AndEng\Desktop\Mike\Deer Park\Permit Application Frank.doc Lot 1, Block 1 DEER PARK N0. \ 40,002 S.F. �/ 11 1l i W — — — N l 4. 7 O Exiting Septic System � J N � N r ,o O CP — Existing 1,000 Gallon Septic Tanko o aoy Three Bedroom \ 1 1 Home 11` 1 Existing ®I Well NOTE: \ Decommission Existing 1 za' Well in Accordance with ` PrMunicipal Code. oposed I ® Well Existing \ \ \ ® Well SITE PLAN SCALE 1" = 40' 2 49th MICHAEL E. ANDERSON No. CE -4361 gg� M I I � � J � J I � / -I N N O � w \ _T Lot 1, Block 1 DEER PARK N0. \ 40,002 S.F. �/ 11 1l i W — — — N l 4. 7 O Exiting Septic System � J N � N r ,o O CP — Existing 1,000 Gallon Septic Tanko o aoy Three Bedroom \ 1 1 Home 11` 1 Existing ®I Well NOTE: \ Decommission Existing 1 za' Well in Accordance with ` PrMunicipal Code. oposed I ® Well Existing \ \ \ ® Well SITE PLAN SCALE 1" = 40' 2 49th MICHAEL E. ANDERSON No. CE -4361 gg� M MUNICIPALITY OF ANCHORAGE DEPARTONT 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 C 3PHONE ICOUJt �% ,eA/ li(/>•W ❑ UPGRADE MAILING ADDRESS LEGAL D LOCATION -- -. ',OF BEDROOMS afJC We yL, Absorpti area DISTANCE TD: Dwelling ` / Y+ PER - _Y 2 i Q wF Manufacturer Z Ma n / / No. of comparts y Liq. iygallons �/ IF HOMEMADE: Inside length Wi Liquid depth Z DISTANCE TO: Well Dwelling PERMIT NO. _? H Manufacturer Material Liquid capacity in gallons = DISTANCE TO: Well C 0 Foundati _ Nearest) tline Q PERMIT � ZNo as Le hyf a Total h IiryEs� Trench // Distance be e s f- �f�-• D inches H Top of til fish rpde _5" ery4l ben h tRe- ,p ^7 k Total effective absorption area- —Width .t /�, G inches W Length Depth PERMIT NO. Q F- wa Type of crib C lame er Crib depth Total effective absorption area uJ DISTANCE TO: Well _ Building foundation Nearest lot line Class _ Depth Driller Distance to lot line PERMIT NO. J X-r Building foundation DISTANCE TO: Sewer line Septic tank Absorption area(s) OTHER. PIPE MATERIALS SOI L TESTr�$A7'1N AT f INSTALLER REMARKS (.vt4lvrcO o lC- L. L. f ! e� , OF Mee. e•as ry I• q ® C. g 8oba11 A. Shafer o' W �••q No. 1457.E W, AP RO D LEGAL - - -- - -- _-- & (�' % fDATEE x(11'0 SRSG1196XERINfa l A P (Rev. 3/ -M I__' ---"PR. 694-2979 (�� ted► rI trt ' rug by DOC Co. d6a SULLIVAN WATER WELLS P.O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759 OWNER OF LAND ADDRESS LEGAL DESCRIPTION DATE • Started Ended PERMIT NUMBER KIND OF FORMATION: DEPTH OF WELL STATIC LEVEL OF WATER FT DRAW DOWN FT. GALS. PER HR KIND OF CASING From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. "', From Ft. to Ft. From Ft. to Ft. 4 From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. toi Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft_ MISCL. INFORMATION: DRILLER'S NAME MUNICIPALITY OF ANCHORAGE Department Health and Environmentalotection 825 Street, Anchorage, AK. 501 264-4720 HANDWRITTEN PERMIT # # # Permit # WE L AND/* ON -CTT SE R PERMIT Applicant: '"Mailing Address: 7328 /%(pX Location: Phone Number: 6 i c,/ `a 9 7 Legal Description: Lot Size: Type of Soil Absorption System Is: Trench: �-' Drainfield: _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: _ Soil Rating (sq.ft/br) �3Y9 -f'&J The Required Size of the Soil Absorption System Is: DEPTH _L__ LENGTH 0' 2s P_ GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(Het-HINS) TANK SIZE _ I6Z16 GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * # * TWO(2) INSPECTIONS ARE REQUIRED # # # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. PERMIT EXPIRES DECEMBER 31, 1 9 3 3 # # # I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3 bedr ms. Signed: ���� Issued by: 9 Applicant Date: SWP/024 (1/81) O e, r ❑ SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION X PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR:1+E-�V r-- ' —,1/J LaY jI,,y FORMED::1 x/1—141—d- LEGAL DESCRIPTION: Z— / 6 I O� /'�{'L K -\^ R 11"%3 n�r1 SLOPE SITE PLAN 1 ` 2 0�C 3 4 5 ,. S/G TX s'11LJO�6,C,C F(- 6 ���.S '6" 7 0,( 8 3`���� d44 9 10 11 WAS GROUND WATER ENCOUNTERED? 12 IF YES, AT WHAT 13 �� DEPTP1i ..i. - 1G 14- 4 eading Date Gross Time Net Time Depth to Water Net Drop OC 9/3SA — LF �< _ 16- C (/ /D ! Z l No. No. 16,`,7-c 17 18 19 IUD S L O P E 20 I I PERCOLATION RATE v (minutes/inch) TEST RUN BETWEEN FT ND FT /`fJ COMMENTS PERFORMED 84s`isG96X RING CERTIFIED B . DATEI L) 4f �iiv'-, SKy $3577 PH_ Fif A_nry 72-008 (6/79) eading Date Gross Time Net Time Depth to Water Net Drop OC 9/3SA — LF �< _ C (/ /D ! Z l /0 20 I I PERCOLATION RATE v (minutes/inch) TEST RUN BETWEEN FT ND FT /`fJ COMMENTS PERFORMED 84s`isG96X RING CERTIFIED B . DATEI L) 4f �iiv'-, SKy $3577 PH_ Fif A_nry 72-008 (6/79) 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. 051-042-52 1. GENERAL INFORMATION COSA # OS6 ! a �rro9 Expiration Date: 0 — 10 - Complete legal description Lot 1, Block 1, Deer Park Subdivision No. 1 Location (site address) 22437 Oak Knoll Drive Chugiak, AK 99567 Current Property owner(s) Koloa LLC a ship creek Landing LLC Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 1843 Parkside Drive Anchorage, AK 99501 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Three (3) 3. TYPE OF WATER SUPPLY: Individual Well ✓❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑✓ 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 Anderson Engineenng Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Phone 522-7773 Date 1/14/2011 Ei Aa, a ANDOWN CE -4381 Conditional approval for bedrooms, with the following stipulations: /:USA C:neCKIISt A Arsenic Aavisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineers Report Nitrate Advisory Other By: Original Certificate Date: 67- [ %Z (Rev 11M) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & 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 CHECKLIST Legal Description: Lot 1, Block 1, Deer Park Subdivision No. 1 Parcel ID: 051-042-52 A. WELL DATA Well type Private If A, B, or C provide PWSID # _ Well Log (Y/N) Y Date completed 12/10/11 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 101 ft. Cased to 101 ft. Casing height (above ground) >18 in. FROM WELL LOG AT INSPECTION Date of test 12/10/11 Static water level 35 Well production 20 g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate N/D mg/L Arsenic: N1D ug/l Date of sample: 12/27/2011 Collected by: A. Harala B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 1983 Tank size 1,000 gal. Number of Compartments Two Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping No Sludge Noted Pumper C. ABSORPTION FIELD DATA Date installed 1983 Soil rating (g.p.d./ft' or ft /bdrm) 349 SF/BDRM System type Deep Trench Length 88 ft. Width 2.5 ft. Gravel below pipe 6 ft. Total depth 9 ft. Eff. absorption area 1,056 ftz Monitoring tube Y Depression over field N Date of adequacy test 10/23/2011 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 500 gal. New depth .5 in. Elapsed Time: 30 min. Final fluid depth 0 in. Absorption rate >= 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Size in gallons "Pump off"level at _ in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Manhole/Access(Y/N) High water alarm level at Meets alarm & circuit requirements? in. Septic tank/lift station on lot >100' On adjacent lots >100' Absorption field on lot >100' On adjacent lots >100' Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line >25' Holding tank N/A Animal containment areas >50' Manure/animal excrete storage areas >100' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5' Absorption field >5' Water main >t0' Water service line >10' Surface water >100' Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: >10' Property line Building foundation >10' Water main >10' Water Service line >10' Surface water >100' Driveway, parking/vehicle storage >10' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS: All information pertaining to absorption trench dimensions taken from Municipal records. Sump at end of trench appears to extend only 5.3' into drainfield rock. =s—'-i'ir FtLt�Stls ,� _ ' �lrj • G. ENGINEER'S CERTIFICATION 96 F. 49Mf I certify that / have determined through field inspections and i... *. review of Municipal records that the above systems are in ���J' not wseff conformance with MOA COSA guidelines in effect on this date. , o ;,`t OL49L 67 N Engineer's Printed Name Michael E. Anderson, P.E. ��,c�f : "CE- fit Date 1114/2012 �I�,PROFESS' COSA Fee $ WD rW Date of Payment Receipt Number (Rev. 11105) Waiver Fee $ _ Date of Payment Receipt Number Shu-�ca— q l z'-/-' IV f Shu-�ca— q l z'-/-' IV rvi � _ � _ •y_..W e 11 l 1 Shu-�ca— � •� f,'r c -i 3,. -rig fj +�F .. s`'.-.,___=� q l f S` � •� f,'r c -i 3,. -rig fj +�F .. s`'.-.,___=� i 1 'l z -1 T..:..M1AS-BUILT Lhereby certify that I have surveyed the following described property: l'.f • f �.�/�+l (1 w1 / /'tel Anchorage Recording Precinct, Alaska, and that the improve- ments situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent there- to, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Eagle River, Alaska t this Ll -- day of 1974�-- ROBERT C. JOHNSONc= SCALE: Registered Land Surveyor No. 686 -LS 1" =:u 0' Box 456. Eagle River. Alaska f S` i 1 'l z -1 T..:..M1AS-BUILT Lhereby certify that I have surveyed the following described property: l'.f • f �.�/�+l (1 w1 / /'tel Anchorage Recording Precinct, Alaska, and that the improve- ments situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent there- to, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Eagle River, Alaska t this Ll -- day of 1974�-- ROBERT C. JOHNSONc= SCALE: Registered Land Surveyor No. 686 -LS 1" =:u 0' Box 456. Eagle River. Alaska SGS SGS Ret# 1116076001 Client Name Anderson Engineering Project Name/# Water Samples Client Sample ID Deer PK 41, LI, BI Matrix Drinking Water Printed Datell'ime 01/09/2012 15:20 Collected Date/I'ime 12/27/2011 14:45 Received Date/Time 12/27/2011 16:21 Technical Director Stephen C. Ede Sample Remarks: 4500NO3-F - Nitrate/Nitrite - MS recovery is outside of QC criteria. Refer to the LCS for accuracy information. Allowable Prep Analysis Parameter Results LOQ Units Method Container I Limits Date Date [nit Metals by ICP/MS Arsenic ND 5.00 ug/l. EP200,8 C (<10) 12/28/11 01/04/12 SCI. Waters Department Total Nitrate/Nttrite-N ND 0.100 mg/L SM20 4500NO3-F B (<10) 12/28/11 CMA Microbiology Laboratory F. Coli Negative 1 100ml- SM209223B A 12/27/11 DSH Total Coliform Negative I IOOmL SM209223B A 12/27/11 DSH MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 05-1 -0112 —,6-z- 1. J6 -Z 1. GENERAL INFORMATION HAA # 1�Qq 1-1 Complete legal description 201 . 1 n A , Location (site address or directions) zZ- `/3 -,7 v Property owner Day phone Mailing address Lending agency — Mailing address— Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well Day phone Day phone Public water 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 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 Q -bo 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 u.isposal 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 _Phone Address C. Sa Z- 2 Engineer'ssignatura %i.�����i% �- Date �/-zcj-r`/ 6. DHHS SIGNATOR Approved for 3 bedrooms. Disapproved. Conditiona approval for OF 10 y MICHAEL R. SKIBO ; e �6i CE 8617 bedrooms, with the following stipulations: Additional Comments W r4i tt c -K * U\1 1� 14 o f s- L7 >2- F& -1l Z-0 N Vit_ A i -E 111 z`3 F i d 6— FP —t 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 order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Rev.1/91) Back MOA#21 Y 0 Municipality of Anchorage Department of Health and Human Services aman HEALTH AUTHORITY APPROVAL CHECKLIST /� z Legal Description: Loft, NacX I Veer 10G1'� AW f Parcel I.D. G S/ -O yZ - S Z A. Well Data Well type /o Pi ild� If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) x25 Date completed l0 - Driller Sal/rurs`r Alafer 1,-IWI's Total depth FD Cased to A5 Casing height /' Z Sanitary seal (YM) Date of test Static water level Well flow Pump levell Q FROM WELL LOG /0- 5-- J'3 41% < Wires properly protected (Y/N) lLe 5 / Z g.p.m. AT INSPECTION z. Z S �/of SfafP� 7D SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot f �' ; On adjacent lots -�`lGCI Absorption field on lot ± !GO ; On adjacent lots �lGY1 Public sewer main Public sewer manhole/cleanout f /'/3' Sewer service line f 25 Petroleum tank lVc-Ile- Ayo44ea WATER SAMPLE RESULTS: Coliform 0�/0o ra/ Nitrate 0•/7,V:2 A Other bacteria Date of sample: y - /- qi Collected by: 44 AV�7 B. SEPTIC/HOLDING TANK DATA Date installed ;t %o' 3 Tank size OaU Compartments Z Cleanouts (Y/N)YcFoundation cleanout (Y/N) u� e S Depression (Y/N)� High water alarm. (Y/N) <Uo Alarm tested (Y/N) Date of pumping Pumper S SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on tat u➢S=� '� On adjacent lots Foundation S To property line t/O Absorption field 6 Water main/service line f ZS Surface water/drainage -;ks See G✓c</J«/ 72-026 pm)- Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pump off" Level at High water alarm level Cycles tested Meets MOA electrical codes (YM) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed _/9Z_3 Soil rating (GPD/Ft) l'% V 5 System type Length 3/ `✓z r Width 30 Gravel thickness (�5 Total depth / z Total absorption area 5E Cleanout present (Y/N) v — Depression over field (Y/N) Wo Date of adequacy test `/- l �`/ Results (passlfail) -`'S for 3 Bedrooms Water level in absorption field before testrr �l Z After test yz Peroxide treatment (past 12 months) (Y/N) Z/W/ 1&51zvf2 If yes, give date A-// SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot +/G'O f, On adjacent lots f /C%C) Property line To building foundation t /9 To existing or abandoned system on lot On adjacent lots 7/!,D Cutbank w/f! Water main/service line Surface water -//(f Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I certify that f have checked, verified, or conformed to all MOA and HAA guidelines in Signaturect�/��u Engineer's Name Date 9 HAA Fee $ _ Date of Payment Receipt Number, 72-026 (3W)' Bads Waiver Fee $ Date of Payment Receipt Number 4 9 49 {-Z5- MICHAEL R. S00 CE 8617 this inspection. Municipality of Anchorage x)) Department.of Health and Human Services 825 " L' Street Tom Fink, Mayor p,O, Box 196650 Anchorage, Alaska 99519-6650 343-47441 May 17, 1994 Micha.2l R. Skibo, P.E. Alaska Rim Engineering PO Box 2749 Palmer, Alaska 99645 a Subject: Waiver Request for Lot 1 Block 1 Deer Park Subdivision #1 Waiver Request #WR940015, PID #051-042-52, HA940207 Dear Mr. Skibo: Your request for waiver(s) of the required 100 foot horizontal separation of a septic system to a private well has been approved. The approved separation distance(s) are a private well to the septic tank on property of 85 feet. This waiver approval applies to the existing septic well separation only. Any future upgrade to either require all separation distances be met or another from this department. Si cerely, % J mes Cross C'vil Engineer On-site Services JC/ljm system to will approval NICIPALITY OF ANCHORAO t of Health and Human Services -site Services Section Waiver Review Worksheet wR# j ��nqi��� 1� PID# 051-042-52 HA# [�Z�J Permit # Date Received: �Pril 13, 1994 Legal Description: Lot 1 Block 1 Deer Park #1 Engineer: Michael R. Skibo, P.E., Alaska Rim Engineering PO Box 2749, Palmer, Alaska 99645 Applicant: Michael and Paula Williams Waiver Requested: Private well to septic tank of 85 feet Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation 2. Special Conditions: 3. Other: TOTAL: Points: -z 4o fV— 3 Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: Wltt� E(" cIEJ 75 No fees accompanied this request. LM Rec #: Amount: $ Date Paid: 'j -Ives WK 9 oo/ LID ➢- 192 L--o c.K d E ER RAA- K * i 19by Joni s 1&f- I N,Q-t L '! L NN 1, NVO 0 U IS T'. WA I W U�L 033 D-70ry K 1 StI E Cr— b.r !ney In c- K w&j-. 400kFT-� s &x--n e-Aj w o C- r6vK 5 9 o1, o Fri ' 5 Vy�fi�C w t.FV &r— 4--�- f-"uGA/ uIt O AE (c6 In 90 ro cam' 8 o i i «LOIo s I N c9fN f oa W A-r� r" IS S, TIF Is ew Fot 51 L - ,m© �g-r11 I L- i P foil S i L4Y Z,�ro W L E CSN Pz A -e' La -V- 2- O t°ls�c Ibex EJ Z 40 i M- EC POI &YV R-�G Ul Wild EK G i ,l bs{ o �I�gil�eeni�tg Phone (907) 7450222 Fax (907) 7460222 RECEIVED APR 131994 P.O. Box 2749 Palmer, Alaska 99645 Municipality of Anchorage April 12, 1994 Dept. Health & Human Services Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Attn: John Smith, Section Supervisor Re: Lot 1, Block 1, Deer Park Addition No. 1; Waiver Request Dear Mr. Smith: The following is a request for a waiver of the septic/well separation distance. The municipality of Anchorage DHHS records indicate a separation distance of +85 feet. This was verified by field measurements on April 1,-1994. The Municipality of Anchorage's Handwritten Permit for a well and on-site sewer of October 6, 1983 shows that there is an 85 foot well to tank waiver. Also, the Municipality of Anchorage On -Site Sewer Disposal System and/or Well Inspection Report indicates an OK for a waiver. The satisfactory test results of December 23, 1983 and of April 4, 1994 for total coliform bacteria shows that the well is not being contaminated due to the less than minimum required separation distance. Enclosed for your review is data for this parcel and the parcels to the north and east. I request the deletion of the waiver fee because the intent to grant the waiver was already there. After this waiver is officially granted, a Certificate of Health Authority application will be submitted. If you have any questions, or wish to discuss this matter further, please feel free to contact me. Sincerely, � A .-� OF r 'IN Michael R. Skibo, P.E. w'�Po o 9T H* / 4— MRs/lmj .! .. ................. �� Encl: Asbuilt �/ Well Log MICHAE1,11,0130 Well Flow Test, CE 8617 +1 DHHSRecords Adequacy hi`'�Poe�iociaoiV� Do Engineers • Planners • Surveyors Time APPLIONT FILLS UPPER HAI Time wner )OUT /O/NLY -1�E�-C �: �;J��P �)l 1 �1�Ou S2 Geu zrUl Phone Mailing Address �/, e�l pk/ 4%oj �r� � r/?Y- A14- Zip Code C'y� Buyer �. Date Address Zip Code Date tt�� Lending Institution `1/ .� Phone Address Zip Code Realty Co. & Agent .tGx U ..�tiP✓ Phone Inspector Inspector Address Zip Code Inspector Legal Description / / / .�J/� / _PY Gr -K �"S ej alfj i�g,k Street Location (-k7jl I i S Field Notes: Type of Residence ENViROivlh=N1AL PEOTLCTIOIV Single Family ❑ Multiple Family No. of Bedrooms_ ❑ Other `' RECEIVE® Water Supply (� ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED Jy Individual ( ) CONDITIONAL APPROVAL' 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 Soils Rating Date Sewer Installed Well To Absorption Areaf `J Sewer Disposal 3.9 , t �/_ 13 Individual 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 Time Time Time `` c>, cl_ Date Date Date Date tt�� Inspector Inspector Inspector Inspector (-k7jl I i S Field Notes: IIGI DEP?. OF ENViROivlh=N1AL PEOTLCTIOIV 6 c C)- `' RECEIVE® (� ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE 2 - Z BY: Soils Rating Date Sewer Installed Well To Absorption Areaf `J Well Log Received 3.9 , t �/_ 13 Well to Tank ; S Septic Tank Size O O O 72-02{(3,92) Time APPLICONT FILLS OUT UPPER HA `ONLY Time bOA Orouse Phone Date Date 69/��s`/ Maih,ng Address '4 0k / � 4/n a � Fe /(-i (/{7^ Zip Code 9 Inspector - // Buyer /i/i[61Ce� Inspector -. Address Zip Code Lending Institutiono��C4 Vill e� _�r Q�--�G -p.� _ _ ✓ Phone Address - DEPT OF. HFl.LTI l Z< -NTAL Zip Code - - Realty Co. & Agent 6 , C) ��"�� 'zs- 'l �t/eY DEC 2 l 196 7 O - C �" A /Phonnee Address - Zip Code Legal Description Y. ) APPROVED BEDROOMS a ( ).DISAPPROVED Street Location - - // )) e2t' Type of Residence DATE. -12-2 W -1c .7 - - - - --irZ Single Family -Multiple - Soils Rating 40 Family No. of Bedrooms_ 3 9 ❑ Other Well to Tank ss Septic Tank Size O O O - Water Supply _ - Individual - 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 - - Sewer Disposal Individual 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 Time Time Time ^1 Date Date Date -. - - Date sa—as-S3� 5 Inspector - Inspector - Inspector -. Inspector Vill Field Notes: d DEPT OF. HFl.LTI l Z< -NTAL �.7 • - EWJRONM PROTECTION 6 , C) DEC 2 l 196 7 O - C �" A U->q�1 RECEIVED 2- Y. ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ).DISAPPROVED - - -( } CONDITIONAL APPROVAL' DATE. -12-2 W -1c .7 - BY: Soils Rating Date Sewer Installed Well To Absorption Area c°i C7 Well Log Received 3 9 -I "-'B3 Well to Tank ss Septic Tank Size O O O - 72423 (NW) S 4 S.