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Home My WebLink AboutT15N R1W SEC 4 SE4NE4NW4 E530'S200'LESS E300' & DEER PARK # 1 TR A1Onsite File ............ Municipality of Anchorage -- — _ -On=Site Water and-Wastewater Program (907)-3437904__ - - -Page 1 of 1-- ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP171238 PID Number: 051-042-99 Dwelling: ❑■ Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑■ Upgrade Name: Robyn Elkins ABSORPTION FIELD ❑■ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address P.O. Box 672128, Chugiak, AK 99567 ❑ Other Phone Number of Bedrooms Soil Rating JTotal depth from original grade 907-244-0784 3 0.6 GPD/SF 7.31 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 1.31 Ft.6 Gravel depth beneath pipe Ft. Subdivision Block Lot Deer Park #1 Tr Al & Fill added above original grade Gravel length Township Range Section65 T15NR1 WSee 4 SE4NE4NW4,E530',S200',Less: Gravel width Beds: Number of Lines Distance between finest 3 Ft. Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 780 Ft z 1 13.6 Ft. Well 130' 153' NA NA 145' TANK ❑p Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Aneh Tank (Existing) Capacity 11000 Gal. Surface water 100'+ 100'+ NA NA Material Number of compartments Lot Line 52' 29' NA NA Steel 2 NA Foundation 10' 43' NA NA LIFT STATION Manufacturer Capacity Curtain Drain I NA 1 >50' 1 NA NA NA Gal. Remarks Drainfield replacement only. Pump on level =in. off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank Exist Tank to drainfield D3034 Installer Flintstone Enterprises, LLC Drainfield D3034 CO/MT Inspector Tyler Perron, AK Rim Engineering BENCH MARK (Assumed elevation) 100 ft Inspeection is` 9/27/17 9/27/17 Location and description 2nd ction 3b 4th Top of foundation COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engine Stamp ' '' q ✓e Conditional Approval: Date ��P� jos �:' •9 9TH ;. l........00 �� s'� • Mary Shreves Atold,QM, Date �'��t]�'• CE 9351 ul`FA�`_gPrq•rrcC�,.O�aF�a�� ' Ilh I Inspection Report_9-1-12.doc I �G%V N79•55 , TRIC X _ — _ — 2 01 � I EXISTING SEPTIC TRENC 6'ED 65' DEEP TR NCH OR w LO r LO 29' 0 U) �22 C0 C01x \6'W A 64'± TH 2 30, . DWE LING .......... ASPHALT DRI :: CONNECTED T EXISTING PERF SWING TIES: MT1 56.3 45.5 C01 55.4 44.7 MT2 76.8 64.7 CO2 75.9 64.0 DV 45.0 37.4 } C EXISTING -H (SEPTIC TANK & d" SEWERLINE) N DISCONNECTED FROM EXISTING SL FROM TANK; INSTALLED SL TO DV UNSU Conventional Single Family Residential °-FA44 i.'®®o SEPTIC SYSTEM AS BUILT ' 22449 DEER PARK DRIVE CHUGIAK MOA PARCEL 051-042-99 m `r� �TH ;� °. D�6�CRIPitoN > > �.— PARCEL No. 1 & 2, BOOK 2230 PAGE 693 �.(�.��............ "' •" ' ' ANCHORAGE RECORDING DISTRICT, ANCHORAGE, ALASKA. ®� Mar L. Shreves ®®®�JJ'•,CE 9351 'ORO FESSVP`'r®®� Scale: 1" = 30' SPO: 17-00469 �� % ALASKA RIM ENGINEERING. INC. ° 8/16/ 17 �MPp T° 9/27/17 SHEET 1 OF2 3/4' to 3' perforated 4' PVC sewer rock— cleanout ock— cleanout installed — oh end of perf pipe per sac monitor tube installed ndapon n�c g peartt pipe at each end of trench O �0 `d0 0 o 00 0 33''00 000 0X 0 0 0 �b o �0 0 \ O0 00 �0 0 0 \\ 2' 0<:=, X O O\\\ 0 0 0 0 0 0 0\\\ /// /// /// /// 00 c6 n 65' diverter valve perforated PVC 111� drainf connectedtom hole orientation e�sttng rnintlald (holes down) perf pipe SECTION X -X inlet DEEP TRENCH t line from septic tank PLAN VIEW 6' effective depth 79.82' TRENCH SECTION �— ram able cap ground surface sewer rock �— coupling MONITOR TUBE DETAIL 4' s• PVC orated a in in sewer rock ®®® OFA U�� Conventional Single Family Residential _��P�•'"" `A's��i�i SEPTIC SYSTEM AS BUILT SITE ADDRESS 22449 DEER PARK DR; MOA PARCEL 051-042-99 �.................',....... —LEGAL a DESCRIPTION vn'.� Mary . Shreves T A _ ® s CE 9351 *;1j,&PRO fESS\13\APS' Alaska Rion T15N R1W SEC 4 SE4 NE4 NW4 E530' S200' LESS E300' & DEER PARK #1 Tr Al DesignCompleted Inc 8/16 17 p Date 9/27/17 No Scale N _ MUNICIPALITY OF ANCHORAGE On-Site Water&Wastewater Program :' PO Box 196650 4700 Elmore Road Anchorage,Alaska 99519-6650 Phone: (907)343-7904 Fax:(907)343-7997 . http:llwww.muni.orglonsite 111E111111111 . 1)( I)artmL•nt 4 hCM OR RV*. On-Site Wastewater Disposal System Permit Permit Number: OSP171238 Effective Date: 9/21/2017 Work Type: Septic Upgrade Expiration Date: 9/21/2018 Tax Code Number: 05104299000 Site Legal Address: T15N R1W SEC 4 SE4NE4NW4 E530'S2001ESS E300' & DEER PARK# 1 TR Al G:1558 Site Mailing Address: 22449 DEER PARK DR, Chugiak Owner: ELKINS WARREN B & Lot Size in Sq Ft: 45780 Design Engineer: ALASKA RIM ENGINEERING Total Bedrooms: 3 This permit is for the construction of: 0 Disposal Field ❑ Septic Tank 0 Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: he access agreement is to be approved by the Muni and recorded prior to Inspection Report approval. T . Received By: WE-I-Pt! r,..f ( tl"*;3t:6 Date: ?/ Z z/17 Issued By: 4i1��,- ..//vv Date: q4-0 7 • $ � s`` 'rUNDClPAL TV SF '� N 0-1O1' AGE t� ;fir" , Community Development Department ::_r Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On-Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051 -6147- Property 1 'b`{ 2.Property owner(s) LJrirr'en s-/A,,75 Day phone 2tk1{— 6178L-( Mailing address r0 Bv) 172 /25, CAuq i arc, AK 99547 Site address 2.2 9T 7 Deer 4 -k Drive cJ, CAgi;a/, A-K '79567 Legal description (Sub'd., Block & Lot) 715N RN) Sec 41 S E`/NE`I NW L/ E 53D Legal description (Township, Range & Section) 5200LESS F X40` f €E '4'1W 4.Tr- Al t Lot Size y5 78z' Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: {® all that apply) Absorption Field Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank ❑ Upgrade Holding Tank I=1 Renewal Duplex (D) ❑ ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 4 " `1 Waiver Fees: Date of Payment: 131i431r7. Date of Payment: Receipt Number: 2..15435 Receipt Number: Permit No. 05P1 -(�-3S2 Waiver No. Permit App_9-1-12.doc ALASKA RIM ENGINEERING,INC. ENGINEERS—PLANNERS—SURVEYORS 9131 E.Frontage Road • • D1 Palmer,Alaska 99645 Telephone(907) 745-0222 Fax(907)746-0222 Online at: www.alaskarim.com August 29, 2017 Municipality of Anchorage,D.S.D., On-Site Water and Wastewater Department 4700 Elmore Road,Anchorage,AK, 99519 Re: T15N R1W Section 4,SE4 NE4 NW4 E530' 5200' Less 300'& Deer Park#1 Tr Al, 22449 Deer Park Drive,Chugiak Septic Replacement Narrative AK Rim Engineering File No. 1700469 This narrative addresses the proposed septic system renewal for an existing 3-bedroom single-family dwelling on the above referenced lot. The subject property is served by a private well and an onsite septic system. An adequacy test performed by our firm on 7/14/17 showed the septic drainfield to be in a failed condition. The septic tank passed the adequacy test. The lot is 45,780 sf in size. A survey as-built was conducted by our firm, showing the existing drainfield as well as the onsite well(see attached). The property is owned by Robyn Elkins,907-244-0784. Ms. Elkins is in contact with MOA Land Use Plan Review regarding an Access Agreement. The design narrative is summarized as follows: GENERAL SITE PLAN AND SEPARATIONS: All surrounding properties are served by private wells. See the attached site plan showing proximity to surrounding properties wells. There are no surface waters within 100' of the proposed septic system. There are no wells within 100 feet of the proposed septic system. SOIL CONDITIONS: In 1993, when the original septic system was installed,two test holes were dug in the proximity of the existing drainfield. The test holes were logged in the field and percolation tests conducted by David Dayton, P.E. (see attached, Soil Logs). Both TH#1 and TH#2 were dug to 16 ft below ground surface, and no groundwater was encountered after 12 days. Based on the datum of 100ft at top of foundation,with the ground surface sloping slightly downward from the south to north,the elevations of the bottom of the test holes were recorded as TH#1 77ft and TH#2 74.3ft. Based upon the percolation test results and the soil rating listed on the MOA On-Site Sewer Permit,dated 10/21/93,we are proposing to apply a soil application rate of 0.6 gpd/ft2. DRAINFIELD DESIGN: The proposed drainfield will be the same as the existing trench,consisting of a deep trench type drainfield,6 ft ED x 65 ft in dimension. The total depth of the deep trench will be 9.5 ft below grade. See attached design drawing for the drainfield specifications. The replacement trench will be greater than 12f1 from the nearest edge of the existing trench,and at least l Oft from all lot lines. A diverter valve will be installed where the sewerline from the septic tank connects to the existing perf pipe. In this manner, the existing trench can be available for future use.The trench will run parallel to the lot contours. TOPOGRAPHY: The general topography of the lot is such that it slopes gradually down toward the west and north from the house location. There are no slopes greater than 25%for this property. Included are sheets printed from the MOA Map Gallery"Elevations Contours and Profiles"(see attached). Various profiles were created,measuring slopes throughout the property. No slopes greater than 25%were found in this analysis. Municipality of Anchorage Page 2 of 2 August 29,2017 SETBACKS: The attached design drawing shows there will not be any encroachments into the setbacks. REPLACEMENT DRAINFIELD SITE: The replacement drainfield site is located in the area designated in the original submittal for the septic system for this property. The replacement trench will be greater than 12f1 edge to edge from the existing trench. The proposed well and septic system will not adversely affect the surrounding properties. If you have any questions,please contact me at 907-745-0222 or at marys(valaskarim.com. Sincerely, ALASKA RIM ENGINEERING, INC. I ``NNN" 11IIlli � �� S��E OF A�4S �', Mary L. Shreves,P.E. i / .- Project Engineer • Mary . Shreves 1, Attachments: �i� ��.. CE 9351 •,. • SurveyAs Built,dated 7/10/17 I,I'1lii��FEs;��`�� • Site Plan Drawing: Neighboring Wells ,�, / /I • Site Plan Drawing: Septic Design • Septic Design Details • Test Hole Logs, David Dayton,P.E.,dated 10/6/1993 • MOA Map Gallery"Elevation Contours and Profiles"sheets(6 pgs) VERED DttR p A 5/80" REBAR ' ik'"2;139,(M) ��N84'15'47"W 105.44' �R) 105.78' 191�9 Air UTILITY POLE f1 120.-- ‘..." Tato. s 1 • w/GUY ANCHOR' r% flo... 0 `g �13EARR)N33.3V M) (TYP.) ` 551..E.2'CM "' - - - B 079.55'1a"E 233• 1.1..- -- r — � 7 .. ..... ..... / �' 15' ELEC �C EAS�MENj r FENCE " ..... \ 1 'CS ...... 4C. / RECOVERED t-.I (TYR) \ SHED1‘ o /$4Ck'/CNI(1/ ,{; 2" AL-CAP U.G. NO FND o<1Vj (TYP ) TELE. / O1 VV G/ /All NAT. `' W) �' .� 4" PLASTIC k # GAS WELL o . /0"/� / RISER (IYP.} C o 26.1• 64't ..::./ o_ 0 ?) 0 / CANTS.- lo.7, �: :; O/ "a I'? DWELLING o f ASPHALT DRIVEWAY PARCEL No. 1 , �Le. S3 —w w 45,780 S.F. / in u, �s i.e.,' o Q 4, CONCRETE PC) Po ///// WALKWAY DECK 0 P o (TMP ) cn Cl) O ci ® �x " ,-CONCRETE UNSUBDIVIDED Y -H -PAD (]Le a m S89'54'41"E 230.00'(R) 229.78'(C) 41 LEGEND: W (C)=CALCULATED DATA Q (M)=MEASURED DATA (R)=RECORD DATA PER PLAT UNSUBDIVIDED ohu=OVERHEAD UTILITIES U.G.=UNDERGROUND TELE--=TELECOMMUNICATION NAT.=NATURAL FND.=FOUNDATION (TYP.)=TYPICAL TRACT A-1 ALSO KNOWN AS PARCEL No. 2 PER BOOK 2230 PAGE 693 11. - 50" NOTES: 1. EXCEPTING FOR GROSS NEGUGENCE, THE LIABILITY FOR THIS SURVEY SHALL NOT EXCEED THE COST OF PREPARING THIS SURVEY. 2. THIS SURVEY REPRESENTS VISIBLE IMPROVEMENTS et CONDITIONS ON THE DATE OF SURVEY. 3. THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY & IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. 4. THIS SURVEY SUBSTANTIALLY COMPUES WITH ASPIS MORTGAGE STANDARDS. 5. TIES TO PARTIALLY MONUMENTED OR UNMONUMENTED PROPERTY LINES ARE ±1 FT. 6. THIS SURVEY PERFORMED FOR ROBYN ELKINS, IT SHOULD ONLY BE USED FOR A SINGLE PROPERTY TRANSACTION. REUSE OF THIS DRAWING FOR ANY PURPOSE NOT STATED ABOVE WITHOUT THE EXPRESS WRITTEN CONSENT OF ALASKA RIM ENGINEERING, INC. IS A VIOLATION OF FEDERAL COPYRIGHT LAW. EXCLUSION NOTE: IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE Or ANY EASEMENTS. COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. 0��AWIII� JG ALASKA RIM ENGINEERING, INC. •�� OF A d ill AS—BUILT 9131 E. FRONTAGE RD. �� .\ •••••••. '9 �j PALMER, ALASKA 99645 .�' P••••• •• :r �� PH: (907)745-0222 : FAX: (907)746-0222 4.1 S.•• !�. • •..q / w•.ubPoim.. / EMAIL: akrimOalaskarim.com : WEB: www.alaskarim.com E:*/49 /" \# o s � S • . i W0: 1700469 FB: 17-06�z- PAGE: 1 of 1 GRID: NW1558 Y'."' a Engineers: Planners: Surveyors SCALE: 1 " = 50' FILE: 1700469AS �, Robert J. Farmer .,C //j '4/. 10615-S :i I HEREBY CERTIFY THAT A MORTGAGE INSPECTION WAS PERFORMED ,�"�eop•..,,,,,`.--*1. `4* UNDER MY DIRECTION ON THE FOLLOWING DESCRIBED PROPERTY: IBOOK 2230 PAGE 693 Ilo N 11s1��-_�,` ANCHORAGE RECORDING DISTRICT, ANCHORAGE, ALASKA. 7-(t)--1� SURVEYED ON THE 6th OF JULY, 2017. ©2017+ P N° A� RECOVERED 1) 5/8" REBAR — — ________— N8415 R `O 191.38 0 ��1' � 105.78' �S1g‘ p Ac w/GT1U ANCHOLE ORr�U f, r - - k5`, 1 41��'+ � G 31'(M) (TYP.) `J p.76 .. — — - k SIB U r 233 g4 E � 51,62:(0::. • . 110;79.5514' "� , TRIC EASE EST _..... — -7 .. i4- AI / l" J �0y1) f — FENCE�` \_ \ i ........ (�, i�.��2G' EXISTING SHED o l_ c-, j/ . SEPTIC TRENCH U.G. y (-NO FND bo f::•:-..:::-..::':-..:- 0) ‹Qt TELE. rn ...`. G// � MT r# NAT. " W ,_.,j.... Ar/5/42/ GAS WELL -Cr' Sce .. C'NT 2 •o �� o _ 229 / 00 • o I'? 1DWE LING b t ASPHALT DRIVEWAY - * Ilk • . * 1'•61' I ' .:...::.: . In el ertilf in /pi-��•��.. ,i:.'! ; h CONCRETE P ' ��o ,; DECK WALKWAY o l] 0 M 0 �'fr4 _ o '• �I_,/ UNSU . 1IVIDED MC 4Eicz ": s- C<4 0 _ 0E 1, O m 6'ED X 65' -''54'•1"E 230.00'(R) 229.78'(¢) DEEP TRENCH INSTALL DIVERTER (PROPOSED) VALVE al .,-------- UNSUBDIVIDED TRA T A-1 ALSO KNOWN AS PA CEL No. 2 PER BOOK 2230 PAGE 693 1. 50 MOA PARCEL 051-042-25 ,�`�Nytk�>LIIII�! NEIGHBOR/N JG ALASKA RIM ENGINEERING, INC. �`.• S• OF ACgS44,�� WELLS 9131 E. FRONTAGE RD. ! _ '� PALMER, ALASKA 99645 �.. �•� // ► PH: (907)745-0222 : FAX: (907)746-0222 I/ :73 ` EMAIL: akrimGalaskarim.com : WEB: www.alaskarim.com *i49TH •1'i` W0: 1700469 FB: 17-06 /nd.(4 .� E PAGE: 1 of 1 GRID: NW1558 Mar4Shreves `• Engineers: Planners: Surveyors SCALE: 1" = 50' FILE: 1 700469AS / - , CE 9351 ///rs ' ••. . ' 22449 DEER PARK DRIVE, CHUGIAK, MOA PARCEL 051-042-99 'I,riIllllttx\��N``t ANCHORAGE RECL No. 1 ORDING DISK TRICT, ANCHORAGE, ALASKA. � 0 1 _2017 N' .- , , ,,,,, , 151 EL __ _ A-4.,.... __ _ _ - __ _ _ - . ,i _ _ __ 0 . _ _ _ hJ -y oo FENCE _ _ � —0 — ( TYP . ) ) 1, EXISTING STI N G SEPTIC TRENCH U . G. , TELE. I r"x A ,, /1H2 ?�p. iP �� CANT 22 - kl DWELLING o / : W „,,... , o i -- in ipprittnrisrear. ��.•G.•'� 0 lei ) 0 `n22N.� a C MT o 74C O Az,. , "SC) TH 1 ~ �� + N 1" = 20' :CT A-1 ALSO KNOWN AS 'A'CEL No. 2 PER 1B4 K$ 2230 PAGE 6• - S89'54'41"E 230.00'(R) 229.78'(C) 6 ' ED X 65 ' DEEP TRENCH INSTALL DIVERTE ( PROPOSED ) VALVE ��`w,wixi iii,• SEPTIC JG ALASKA RIM ENGINEERING, INC. °-S,< .-•-••.. q p ii DESIGN 9131 E. FRONTAGE RD. ,`Q:. '•...•'i �,- // PALMER, ALASKA 99645 Cq,• • 9 .� PH: (907)745-0222 : FAX: (907)746-0222 • "‘,,Nem d°"` EMAIL: akrim®alaskarim.com : WEB: www.alaskarim.com J � :• ,,,,T H ¢ WO: 1700469 FB: 17-06 G� :, PAGE: 1 of 1 GRID: NW1558 / -, '.� Mary U Shreves t GL Engineers: Planners: Surveyors =i SCALE: 1 ” 20' FILE: 1700469AS /c-s>'.,� CE 9351 � . 'lIii, R0FESSN�`;��` PARCEL` 22449 DNoR EEPARK& 2D BOOK 2230 23 PA EHUGIAK, O 693A ARCEL 051-042-99 litxxANCHORAGE RECORDING DISTRICT, ANCHORAGE, ALASKA. 9 %� 12017 monitor tube installed at each end of trench perforated 4" PVC 1-foot max. 3/4" to 3" sewer rock midpgnit emsof{ paarit pipe cleanout installed at each end of pert pipe t• .w• 0• as►0 0 /�•op0Os:p0 � Xori. \\ 1\\• n"-• V_ _ _ - • �\ 2' ,/� 00 X o •• .y\\\ 1 //7 7 7//i*. �,.off,.0�, ,o.„,•0�.•••\\ -_. 65' In DEEP TRENCH perforated PVC PLAN VIEW h(holntatieessle ia doowns n hwn SECTION X—X Found surface // /X///NX//X0 1111111 remmp oveeble earthinsulation. insulation. if used cover 7 if used 3' aroundsurface geoteztile 47.,„:„;101,W AIIPIIIII. 11 -non-perforated PVC above N — •., •.a • •.a• •.a•N . •.a•.: i;i; ;iiia newer rock 19.5' _ .<_ _•.•▪ • ,.�.;.� 1111111 couP�Y 1:4;.;;;=•:"•-• `.: 0` • -0`0:. 0`.ti .c:erdock;:;:;: s' _ • • .•_ 3 4"TO 3" ••_ _ p .a•.� '� 0 • i _ • / • -_ • ,� affective depth \•. • 0�\ ,. =.a.sewer rock,=,a• 1'.4` I C� iggiiiiiiiiiigggggg �71••�,0 0��,O vol, ,4c�2°•� 0 p0:�Cbp�0..:#.;,'":.0: ▪ • 4" PVC perforated 0�7- b 's �-,, • 8' lntervaL • '• •so'/U sR0` �s. p_\moi ir,V;A in sewer rock o •.• _ • at6 .•o ��o '�+�- .............. 79.93' _ �o•w.� �_ cv • _ � •o ' TRENCH DETAIL undisturbed 0 + earth > 2,0 o: ..,,,,t9241) U' -..*:::47.H QZp TH1: 77' 8o•'. • ,,,,,,.. , TH2: 74.3' go,1 ,,..a ...., ,..,.... ..--...2 ,.,..„ TRENCH SECTION MONITOR TUBE DETAIL '''�,OF q 14 Conventional Single Family Residential '`� ll �P�E ......•.-s,/ SEPTIC SYSTEM DESIGN *:' TH .011\//141_11,,.• knnnREss 22449 DEER PARK DR; MOA PARCEL 051-042-99 /•' ,. / LEGAL ;1..1.. �„ DESCRIPTION .e.,13,,,. Mar.• . Shreves �` T15N R1W SEC 4 SE4 NE4 NW4 E530' 5200' LESS E300' /e 13,,,'•. CE 9351 •\,�`� & DEER PARK #1 Tr Al .�•... ...••. ��./iPROFESS1ON',.$' 11111\\\‘�J'/d"l/ 1 8/18/17 Completed Alaska Rim Engineering, Inc. Date nate No Scale T.�. 5 �`�� t.l �y ` �• ami '5'18 r r„ CJ Yl 5, f( Yf t s k m CJ � � f J'R3"!5 rXK G1 T.�. 5 �`�� t.l �y ` �• ami '5'18 r r„ CJ 5, f( Yf t s k m CJ � � f J'R3"!5 rXK G1 � r l� � _ z�v 5 2G' 22 37 28i.i2 I r � 549.91 T.�. 5 �`�� t.l �y ` �• ami '5'18 h r„ CJ f( Yf t s m � r l� � T.�. 5 �`�� t.l �y ` �• r„ CJ Qif t m l� � � l5G'R5'SS'_��DS>•f>' 6l -- �_ T.�. 5 �`�� t.l �y ` �• _ � � � } � Na°os•3s^w 149 9a` �� C�\� n' � D C6 h A R2 chi ,,EL� ASS•' nff�^-r xsxn 4" 1 i 4 Fy'�m tx r�Q I -02 �rlm rij �.^•Ill ��` oxo �3x=v �yo�.. � �" r f - S >w !'s _ I"- ��oat E � a'r f•+' I� �m h F�o�Sz o nl ns'—+.. kk� Qif t _ � � � } � Na°os•3s^w 149 9a` �� C�\� n' � D C6 h A R2 chi ,,EL� ASS•' nff�^-r xsxn 4" 1 i 4 Fy'�m tx r�Q I -02 �rlm rij �.^•Ill ��` oxo �3x=v �yo�.. � �" r f - S >w !'s _ I"- ��oat E � a'r f•+' I� �m h F�o�Sz o nl ns'—+.. kk� " Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-site Wastewater Disposal System and/or Well Inspection Report Perrriit Number: ~ ~ q~ ~)5/¢'/-~ PID Number: ¢~/~ Na~:Wastewater System: ~New ~ Upgrade Address~.~. ~o~ ~7 ~/~, ~1~ k~ ~2 ABSORPTION FIELD Phone: ~_ ~/ ~ IN°'°fBe~°ms: ~DeepTrench ~ Shallow Trench ~Bed ~Mound ~Other ~ Soil Rating: ~ Total Depth from original grade; Lot: alock: j Subdivision: ' Depth to pipe bosom from original grade: Gravel depth beneath pipe Township; ' ~ Range: .~ Sect[on: Fill added above original grade: Gravel length; WELL: ~ New ~ ~ Upgrade ~' .t. / Cla~sificaEon (Private. A.~.C): " Total Oep~h; Cased TO: Total a~sorption area: Pipe material: . Oriller: Date Drilled: Static Water Leveh Installer; Date instal[ed: Yield; ~ GPM ~ Pump Set at~ Ft. ] Casing Height Above Ground:~, Ft. TANK SEPARATION DISTANCES ~Septic Q Holding D S.T.E.P. From Tank Field Stslion Tank Sewe~ Lines ~ ~ ~ ~ ~ O~ Well ~0 ~ ~ Mater'ak 5~ Lot ~ Size in gall°ns: I Manufacturec ~/ Foundation I~ ~ / ~ "Pump on" I.~ve, at: I ?~p o~' leve~': ~ IHigh water alarm at: CuHainDrain ~ ~ / ~ Pump Mske & Model Electrical Inspections pedormed Remarks: BENCH MARK ENGINEER'~ SEAL Department of Health'and Hu~ah~-6rv,ces approval ~?..;. Permit NO.' ~-V,~ q ~'4:~-/~3 Page 'Z- of ~" Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box J96650 · Anchorage, Alaska 99519-6{~50 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: ..~ ~o, ~ ~=~' PID No.: c~5-'/~ ?/2_z.5,~ 72-013 A IRev 9/91] MOA 25 KIND OF FORMATI From From . i From__ From ' TM Ft. From ?'" 'Fi;'to:/:'" F~. Frbm ':' "Bf. io ' Fro From- Ft: From From Ft. ti). MIscL. INFORMATION: PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930443 DESIGN ENGINEER:DAVID R. DAYTON, OWNER NAME:ELKINS WARREN B & OWNER ADDRESS:P.O. BOX 672128 CHUGIAK, AK 99567 P.E. DATE ISSUED:10/21/93 EXPIRATION DATE:10/21/94 PARCEL ID:05104224 LEGAL DESCRIPTION: T15N R1W SEC 4 SE4NE4NW4 E530 'S200'LESS E300' LOT SIZE: 32232 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: DATE D,T : R. DAYTON, P.E., R.L.S. ]~-~t~ Chugiak, Alaska 99567 20210 Donalar [907) 696-2417 October 16, 1993 Legal Description: Remainder of South 200 ft. of East 530 ft. East 330 ft.) of SE¼, NE¼, NW¼, Sec. 4, T15N, R1W, S.M., Ak. ( less The proposed septic system is to serve a 3 bedroom home. The lot ~lopes from SE to NW at slopes ranging from 10% to 20%. The system will have no measurable impact on wells or wastewater syst6m on adjacent properties. There will be no adverse impact on reserved space or drainage. MUNICIPALITY OF ANCHORAGE ~:NVIP. ONMENTAL SERVICES DIVISION OCT 1 9 199~ RECEIVED N David R. Dayton P.E. 20210 Donalar St. Chuglak, Alaska 99567 David R. Dayton P.E. 20210 Dofialar St. Chugiak, Alaska 99567 PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 'T, ~1. '~1 LEGAL DESCRIPTION: 1 SLOPE SITE PLAN WAS GROUND WATER ~.~ ENCOUNTERED? IF YES, AT WHAT DEPTH? pO E 5- 6- 7 8 9 10 11 13- 14- 15- 16- 17- 18- 19- '20 - Gross Net Depth to Net Reading Date Drop i ~/~//~.~ Time Time Water I Io~~- II ~ ~ 7" - 8Y~' lY~" PERCOLATION RATE ~/~ (minutes~nch) PERC HOLE DIAMETER TEST RUN BETWEEN ~' FT AND ~ FT COMMENTS ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THiS DATE. DATE; 72-008 (Rev. 4/85} PERFORMED FOR: LEGAL D ESC R I PTI O N: -~/~.~.¢:; Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, A aska 99502-0650 SOILS LOG -- PERCOLATION TEST ~ ~ Township, Range, Section: 2 ~ 4 10- 11 13- 14- 15- 16- 17- 18- 19- was GROUND WATER ENCOUNTERED? L IF YES. AT WHAT O DEPTH? P SLOPE SITE PLAN Oepthto Water After / Moflitoriflg? /~' ~',-" E Gross Net Depth to Net Reading i ~)~.t~c] ~ Time Time Water Drop PERCOLATION RATE ~) ' ~"~(minutes/inch) PERC HOLE DIAMETER ~'~ TEST RUN BETWEEN ~ FT AND ~ FT COMMENTS PERFORMED BY: ~ ~-- ~/~t.~.~,,..3 ~'~ ~ I . ERTIFY THAT THIS TeST WAS PERFORMED IN ACCORDANCE W,TH ALL STATE AND MUN,CIPAL GU,DEUNeS ,N EFFECT ON TH'S DATE-DATe: .//~4/~ 72-008 (Rev. 4/85) •11c- Municipality of Anchorage °� On-Site Water and Wastewater Program `, (907) 343-7904 Certificate of On-Site Systems Approval {t Parcel 1.11051-042-99 Expiration Date: 1 —Ig —1 1. GENERAL INFORMATION Complete legal description Deer Park#1 TrA1 &T15N R1W Sec 4 SE4NE4NW4 E530'S200' Less E300' Location (site address) 22449 Deer Park Drive, Chugiak Current Property owner(s) Robyn Elkins Day phone 244-0784 Mailing address PO Box 672128, Chugiak, AK 99567 Real Estate Agent Renae Werner Day phone 365-9105 2. TYPE OF DWELLING: El 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: ( Date: D 41/47____ COSA to be released to a engineer,unless otherwise requested by the engineer. COSA Fee $ 210156 Waiver Fee $ Date of Payment I C}lig CI" Date of Payment Receipt Number ' �JaSti'CI Receipt Number COSH# O ?C FM 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 AK Rim Engineering, Inc. Phone 745-0222 Address 9131 E. Frontage Rd, Palmer, AK 99645 Engineer's Printed Name Mary L. Shreves Date 10/11/17 NN..\\‘ I l 1 I >lOF AL r -77 • ' 6. DSD SIGNATURE p #'4gTH I1 •''� i y r • System #1 Approved for 3 bedrooms s.//// (1:‘,4 r • r ^ X ,f 9Mary . Shreves System #2 Approved for bedrooms j;''•,•• CE 9351 Disapproved IF ��,PROFE5c.10‘s Conditional approval for bedrooms, with the following stipulations:' �-�� OF,q �ti0 �V ON-SITE CO •: : WATER r WASTEWATEAND R =. o tint �r. PROGRAM u3 SE Original Certificate Date: / fZSr r 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 COS,blue sheet .c '• . c 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 T15N R1W Sec 4 SE4NE4NW4 E530 ' S200' less E300 ' Legal Description Deer Park #1 Tr Al Parcel ID: 051-042-99 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 11/93 Sanitary seal (YIN) Y Wires properly protected (YIN) Y Total depth 142 ft. Cased to 141.2 fit. Casing height(above ground) 17 in. FROM WELL LOG AT INSPECTION Date of test 11/93 7/14/17 Static water level 103 ft 100 .4 ft. Well production 20 g.p.m. 6 •2 g.p.m. WATER SAMPLE RESULTS: Coliform A colonies/100 mL Nitrate 0 • 938 mg/L Arsenic ND ug/L Date of sample: 7/5/17 Collected by: Brandon Jones B. SEPTIC/HOLDING TANK DATA Tank Type/Material Steel Date installed 11/93 Tank size 1000 gal. Number of Compartments 2 Cleanouts(Y/N) Y Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N Date of pumping 4/12/17 Pumper Sanitary Pumpers C. ABSORPTION FIELD DATA (NEW - Replacement) Date installed 9/27/17 Soil rating (g.p.d./ft2 or ft2/bdrm) 0 .6 gpd/s f System type Deep Trench Length 65 ft. Width 3 ft. Gravel below pipe 6 ft. Total depth 10. 1 ft. Eff. absorption area 780 ft2 Monitoring tube Y Depression over field N Date of adequacy test 1\41-e...0 Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed Size in gallons _ Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm &circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 130 ' On adjacent lots >100' Absorption field on lot_ 153 ' On adjacent lots > Public sewer main >100 ' Public sewer manhole/cleanout >100 ' Sewer/septic service line 145 ' Holding tank >100 Animal containment areas >100 Manure/animal excrete storage a areas ' SEPTIC/HOLDING TANK ON LOT TO: 15 ' (old field) Building foundation 10Property line >10 ' Absorption field40 ' (new field) Water main >100 ' Water service line 76 Surface water >1 00 Wells on adjacent lots >100 ' ABSORPTION FIELD ON LOT TO: 29 ' (new field) 43 ' (new) >100 ' Property line Building foundation Water main 93 ' (old) Water Service line lc) (new) Surface water >100' Driveway, parking/vehicle storage 93' (old) 105' (new) Curtain drain >50' _ Wells on adjacent lots > F. COMMENTS Septic drainfield replaced 9/27/17; septic tank left in place. G. ENGINEER'S CERTIFICATION "`vN. �� ``", t'1'l, ! certify that l have determined through field inspections and �Qc �F•A(gsl��/ review of Municipal records that the above systems are in .• •••./- / conformance with MOA COSA guidelines in effect on this date. = C?%• �� •.'9 ��j nn,,,, *;[ 9TH IV l �� :7k Engineer's Printed Name h� L , ��t re vt J Date C t l Mary Shreves CE 9351 COSA canary sheet_2-6-15.doc P NI( 5/8" RECOVERED DV 5/8" REBAR �_ g`R'2A 1.39'tM0 �N8415'47"W 105.44'(R) 105.78' �� +`V AJ UTILITY POLE �� \-' rc�n.- S.F F . w/GUY ANCHOR-- : iN /731'�M� (TYP ) - - - i : ��'. N79 ��f — ,G', `' C `C EASEMENT 1 / ��' J 15' FENCE�" 1 ._, ( •) S i il:-:-:-:-:-:-:-.• i �\ f`_ RECOVERED �'- SHEDfit o �' 4_4''� 2" AL-CAP U.G. rNO FND `. k'Q%/ (TYP.) 4" PLASTIC TELE. , ,G� RISER (TYP.) / NAT. la, ` GAS G � } 64' WELL ..:.:: `:. /01'/ ® o z, f h 26.3 N/ CANT CANT—_ 1ar,� 0 1 �i rn/: °0 I'? DWELLING b , ASPHALT DRIVEWAY PARCEL No. 1 5. ::;.;::;.:<.:::::. --rW W 45,780 S.F. ,,,:. Q In in © i} G -, CONCRETE P RN. DECK WALKWAY o U� o m >> ,p-Zo (TYP.) cn �.� CONCRETE UNSUBDIVIDED PAD p•., m S89'54'41"E 230.00'(R) 229,78'(C) (24 W LEGEND: W (C)=CALCULATED DATA Q (M)=MEASURED DATA (R)=RECORD DATA PER PLAT UNSUBDIVIDED ohu=OVERHEAD UTIUTIES U.G.=UNDERGROUND RECERT NOTE: TELE=TELECOMMUNICATION ADDED 5 ADDITIONAL NAT.=NATURAL 4" PLASTIC PIPES NO EFFORT FND.=FOUNDATION MADE TO DETERMINE IF ANY (TYP.)=TYPICAL OTHER CHANGES WERE MADE. 10-11-17 ‘dogl'\7' - --- TRACT A-1 ALSO KNOWN AS PARCEL No. 2 PER BOOK 2230 PAGE 693 1" 50. s NOTES: 1. EXCEPTING FOR GROSS NEGLIGENCE, THE LIABILITY FOR THIS SURVEY SHALL NOT EXCEED THE COST OF PREPARING THIS SURVEY. 2. THIS SURVEY REPRESENTS VISIBLE IMPROVEMENTS & CONDITIONS ON THE DATE OF SURVEY. 3. THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY & IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. 4. THIS SURVEY SUBSTANTIALLY COMPLIES WITH ASPLS MORTGAGE STANDARDS. 5. TIES TO PARTIALLY MONUMENTED OR UNMONUMENTED PROPERTY LINES ARE ±1 FT. 6. 11-115 SURVEY PERFORMED FOR ROBYN ELKINS, IT SHOULD ONLY BE USED FOR A SINGLE PROPERTY TRANSACTION. REUSE OF THIS DRAWING FOR ANY PURPOSE NOT STATED ABOVE WITHOUT THE EXPRESS WRITTEN CONSENT OF ALASKA RIM ENGINEERING, INC. IS A VIOLATION OF FEDERAL COPYRIGHT LAW. EXCLUSION NOTE: IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. %NOWA%%%I.a JG ALASKA RIM ENGINEERING, INC. 44 AS-BUILT 9131 E. FRONTAGE RD. �rQ�F:•��....,.9/4, PALMER, ALASKA 99645 �o ' ;•• •. ,�� _ PH: (907)745-0222 : FAX: (907)746-0222 mb ;%•4 TH %\ '•.: �y4 5"\---_,, EMAIL: akrimOalaskarim.com : WEB: www.alaskarim.com S • ' — A RWO: 1700469 FB: 17-06 0 • PAGE: 1 of 1 GRID: NW1558 �'••o' H Engineers: Planners: Surveyors SCALE: l '' = 50' FILE: 1700469AS 1 r. Robert J. Farmer . $` . - • 3j vi.".. 10615-S I HEREBY CERTIFY THAT A MORTGAGE INSPECTION WAS PERFORMED ,•'rih-qt.pp,..... ... DINT,' ~•'`` PARCEL No.UNDER MY D1R &T2 DIRECON TION 2230 PAGEHE N693 G DESCRIBED PROPERTY: i1111SSI\Nt��. ,,; , - SURVEYED RORECORDING DISTRIC1T, AONCHORAGE, ALASKA. 2017 GENERAL INFORMATION' Complete,legal descriptiOnl ~oeation (site address or diroctions] MUN CIPALITY, OF ANCHORAGE ~r~EPARTMENT OF HEALTH &;HUMAN SERVICES ' I J I ' ; I J On~S~te Se~lces Section P.O.- Box196650 Anchorage;,Alaska 99519~6650 . '':_ :C~'~YiFic~TE0~hEAL~'HAUTH~RI~ ..... .:; ..... '.'~ ' ~PP'ROVA~'~R AsINGLE FAMILY DWELLING : :;:prbp,erty owner ~)t~!:~lC ~/&~'~ Lending agency " Day phone ig address' ;Ag'ent Day phOne Un!ess otherwise requested, HAA will be held. for pickup. )F BEDROOMS: .. TYPE OF WATER SUPPLY: Individual Well Community"~eii' ' Public water NOTE: If community well system provide w~ritten confirmation from State ADEC'attest- ing to {he Ibgality'and~tatus O~:~ystern. · ' WASTEWATER DISPOSAL: Individual on-site - Holding tank~ ' ' Commun t~/~n-site sta{~i;Pr~)~idt~m, rmatl°nd ,:: OTE:' -' If commumty wastewater system; e. ~ritten confi a~esting to the le I ' 5. STATEMENT OF INSPECTION BY ENGINEER As certified by myseal 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 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 s, ystem is in compliance with,all Municipal and State codes, ordinances, and regulati0n~§ in effect on the d~te of this i~spection. Name of Firm David R, Dayton P.E. 20210 Donalar St. Address Chugl~k~ Alaska 99567~ Engineer's signature : Phone DHHS SIGNATURE APproved for _'? bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments ? Date The:~l'~'nicipality of Anchorage Department of Health and~uman ServiCes (DHHs) iSSues Health Authority ' Approval Certificates based only upon the representations gigen In:paragraPh 5 ab0ve by an independent , : profesSional engineer registered in the state of Alaska; The DHHS does this as a courtesy to purcheeem of homes andtheirlendinginstitutionsinordertoSatisfYrCerta nfedera and state requirements Emp oyeesofDHHSdOnot Con,dUct inspections or analYze.data befor~ a,certificate,:is issued. The Municipality of Anchorage. s not responsible for errors or OmiSSions in the ProfeSSional engineer's Work, , -, :' 72-O25(Bav. t/~J1) Back MOAlY21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type ~D£tO'3'T~- Log present (WN) Total depth Sanitary seal (WN) _If A, B, or C, attach ADEC letter. ADEC water system number 'V' Date completed /g~/¢ ,.~ Driller /5/'z-- Cased to /~--/'2__ Casing height Wires properly protected (Y/N) AT INSPECTION Date of test Static water level Well flow Pump level1 FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /~' ' Absorption field on lot /~$~' Public sewer main /~/.~r- Sewer service line --,- ~- -~ .g.p.m. g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate ~, 7~¢,/ Other bacteria Collected by: ~/~'¢~ B. SEPTIC/HOLDING TANK DATA Date installed / Cleanouts (Y/N) High water alarm (Y/N) Tank size Foundation cleanout (Y/N) Date of pumping ,~-~.-O ~y'~'Z-~-~-~'~_-- Pumper / o~ Compartments Y Depression (Y/N) /t/' Alarm tested (Y/N) ~//,¢' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Surface water/drainage On adjacent lots Absorption field Foundation /4.) Water main/service line CONTINUED ON BACK PAGE 72-026 (3/93)* Front . 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) "Pump off" Level at .Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length ~,'~-- I Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) //,/~z~J~ ~ Soil rating (GPD/Ft2) (-)' Width '~-~ ~/~ ~ Gravel thickness ¢ ~D Cleanout present (Y/N) '~/ /'~/~c~) ~-¥'~ Results (pass/fail) System type /-~ Total depth Depression over field (Y/N) for Bedrooms After test If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain On adjacent lots / o ¢* ~- Property line Z-~'/~' To existing or abandoned system on lot Cutbank ,'~/.//~ Water main/service line /~o/- Driveway, parking/vehicle storage area Z ~-/~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. David R. Dayton P,E. 20210 Donnlar St. ~:i~ugiak, Alaska 99567 Signature ,~ ~---~ Engineer's Name HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number