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HomeMy WebLinkAboutSKY RANCH ESTATES #2 BLK 1 LT 35 ky Ranch Estates #2 Block 1 Lot 3 #015-302-22 MUNICIPALITY OF ANCHORAGE On-Site Water&Wastewater Program 1 PO Box 196650 4700 Elmore Road ^ . Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 n ) http://www.muni.org/onsite .� . _� Duparttu�'nt 4hNOAAGE On-Site Wastewater Disposal System Permit Permit Number: OSP171208 Effective Date: 8/16/2017 Work Type: SepticTank Upgrade Expiration Date: 8/16/2018 Tax Code Number: 01530222000 Site Legal Address: SKY RANCH ESTATES #2 BLK 1 LT 3 G:2737 Site Mailing Address: 5045 WHISPERING SPRUCE DR, Anchorage Owner: LYONS JOHN J JR 50% & Lot Size in Sq Ft: 18279 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field E Septic Tank ❑ 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 Received By: /7/h1Date: VlabtedeA COMOQC 8 10 0261'1Issued By: Date: MUNICIPALITY OF ANCHORAGE Community Development Department " 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. 015-302-22 Property owner(s) CARA SHONSEY Day phone Mailing address 5045 WHISPERING SPRUCE Site address SAME Legal description (Sub'd., Block & Lot) SKY RANCH EST #2, BLK 1, LOT 3 Legal description (Township, Range & Section) Lot Size 18279 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) EK (w/wo ADU) Septic Tank U Upgrade X Duplex (D) n Holding Tank ❑ Renewal ❑ Multiple Dwellings n 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: oZ1 h Waiver Fees: Date of Payment: Q"1I2-1(1 b l Date of Payment: Receipt Number: amilo Receipt Number: Permit No. 05P I-I ( Waiver No. Permit App__-. :....c 1 July 31, 2017 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New Septic Tank Legal: SKY RANCH ESTATES #2 BLK 1 LT 3 To Whom it may concern: This is a request for a septic tank permit on the above referenced lot, the owner wants to expand their deck and need to move the existing 1000 gallon tank. The lot has a Alaska Department Environmental Conservation(ADEC)waiver to the class A well of 103 feet. This new tank will be moved approximately 10 feet further to the northwest, see site plan. A new waiver will be requested from the ADEC. This replacement system ‘N.ill not impact any of the neighboring properties due to the lot layout Please call me if you have any questions. Sincerely4A_ Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 t. f , r ' S' T12N,R3W,SECTION 22.LOT 45 -EAST KLATT RD- -., PROPERTY LINE . \ 10'UTILITY EASEMENT �. r,./1_ —,— --_ \ IT -) •1 / L /. �' t-r EXIST • - �\ .// CO r F J // co �r 1000 // C4'7 GALLON �Q SKY RANCH ES}ATES#2 Lr SEPTIC TANK >�0 BLOCK 1�OT 2 -u-` / EXISTING L / / IEXISTING' SEPTIC TANK '�y / HOXE 0-crv,,.n., Ir n 0 / P4'4' 4 PC -.\ r / tr? \ r PROPERTY LINE �� \\ r \ r \ \ 1 \ 1 r SKY RANCH ESTATES=- SKY RAN STATES#2 1 -WHISPERING SPRUCE DRIVE- I BLOCK 1.LOTS CK 1,LOT4 1 - I - - - 1 11 1 1 200 1 I EXISTING I 1CLASS A WELL Ii 1 ` ` PWSID 212916 1 / 1 \ / ----y 1 \ / 1 \ - / - — - 1 1 1 \ / 1 \ / \ \\ / // \ / \ • SKY RANCH ESTATES#2 \ • \ BLOCK 2.LOT 2 `. .1: • \\ ` �Q/ / \ 071--____ SKY RANCH ESTATES K2 \\ Z�/ BLOCK 9.LOT 9 \ • s \\ # • ,, \ - — — — J J / \ / Septic Design Prepared for _000010111 JOHN LYONS & CARA SHONSEY .•4.*`\� Or L.+'4, SKY RANCH ESTATES #2, BLOCK 1, LOT 3 :: 49TH �� ♦�I Anchorage, Alaska )„."214, i • Michael N. Anderson, P.E. DATE: 6/20/2017 °O. ':MICHAEL N. ANDERSON•/ 4601 NATRONA AVE �tNo. E 9 69 \i ANCHORAGE, ALASKA 99516 DRAWN: DJR 1��' 7 z,� p (907) 727-8864/FAX: (907) 345-1391 SCALE: 1"=50' 4.4. ` ��� •� THE STATE °1ALASKA GOVERNOR BILL NVALKER August 16, 2017 Michael Anderson, P.E. 4661 Natrona Ave. Anchorage, AK 99516 Department of Environmental Conservation DIVISION OF ENVIRONMENTAL HEALTH Drinking Water Program Re: Sky Ranch Estates #2 PWS - Sky Ranch Estates #2 Block 1 Lot 3 Source -Septic Separation Distance Waiver Dear Michael Anderson: 555 Cordova Street Anchorage, Alaska 99501 Main: 907.269.3076 Fax: 907.269.7650 thomas.brannanColaska.gov File: Sky Ranch Estates #2 PWSID: 212916 Class: Community Source: Groundwater On August 15, 2017, this office received your submittal requesting reauthorization of a reduction of the State's minimum separation distance requirements between a Public Water System (PWS) drinking water source and a potential source of contamination. This letter approves the requested reduction in the State's minimum separation distance requirement from 200' to 120' between the drinking water well serving the Sky Ranch Estates #2 (SRE#2) PWS and multiple potential sources of contamination on SRE#2 Block 1 Lot 3 (SRE#2 Bl 1-3) as detailed below. Waiver Determination To facilitate the construction of a deck, SRE#2 B1 L3 is proposing to install a new 1,000 gallon septic tank directly north of their existing septic tank; the septic drainfield will not be modified as part of this project. At its nearest, the septic tank and drainfield serving SRE#2 B1 L3 is located at 120' and 125' from the SRE#2 PWS groundwater well, respectively. The following additional items were taken into consideration as part of this waiver approval: 1. The septic tank will now be located =10' further away from the subject well then was originally approved; 2. From August 2000 to July 2017, source water sampling results for combined nitrate -nitrite or nitrate concentration rose from 1.37 mg/1 to 3.95 mg/1. This suggests that the well is minimally influenced by septic system exfiltration, decomposition of organic matter in the soils, and/or erosion of natural deposits. Despite this, combined nitrate -nitrite and/or nitrate concentrations remain well below the 10 mg/l Maximum Contaminant Level; 3. From February 2000 to July 2017, Total Coliform Rule sampling for total coliform (TC) and e. cok (EC) found no TC nor EC positive events; 4. Surface topography and conditions between the subject well and encroachments are generally shallow away from the well and are developed with lawn, trees, and fencing; and 5. The well accesses a presumed confined/semi-confined aquifer. Based on an evaluation of the available information and in accordance with the State's Drinking Water Regulations, 18 AAC 80, a Separation Distance Waiver for the encroachments detailed herein is issued. Limitations and Appeal Process Any changes, constructed or natural, that affect the conditions to which this approval was granted will void this approval. This approval does not imply the granting of additional authorizations, nor obligate any federal, state, or local regulatory body to grant required authorizations. This is not an approval of omissions or oversights by this office or noncompliance with any applicable regulation. The Department's approval does not guarantee correctness of the functional design or waiver the owner's responsibility for continued compliance with State regulations. Michael Anderson, P.E. August 16, 2017 Any person who disagrees with this decision may request by mail, e-mail, or facsimile an informal review in accordance with 18 AAC 15.185 or an adjudicatory hearing in accordance with 18 AAC 15.195-15.340. Informal review requests must be delivered to Division Director within 15 days of receipt of this decision. Adjudicatory hearing requests must be delivered to the Commissioner within 30 days of this decision, otherwise, the right to appeal is waived. For more information, visit www.dec.state.ak.us/comridsh/ReviewGuidance.h . If you have any questions regarding this plan review please do not hesitate to contact me. Sincerely, T.xanlian, E.LT. gineering Associate I Cc.: Martin Carlson c/o Sky Ranch Estates Home Owners Association 11710 Pinto Circle Anchorage, AK 99516 170816_Sky Ranch Estates #2 -Sky Rauch Estates #2 B1 L3 Souse-Septic_212916_WtLdoa Municipality of Anchorage Page I of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 O Telephone: 343-4744 On -Site Was1�tA�e/�wc�a'�ttef�r'' Disposal System and/or Well Inspection Report Permit Number: �lU3L« PID Number: Name: Wastewater System: U New Upgrade Address: SO L I S s�E2 NG- �2uck'. ABSORPTION FIELD Phone: 5_C ILl /� y SIC 16 No. of B ooms'. t Deep Trench �Q Shallow Trench 13ed ❑Mound O Other LEGAL DESCRIPTION Soil Rating Q . Ft. GPD/S Total DepCth lromoriginalgrade Lot:Block: ^ V Subdivision: \Jr Depth to pipe before original grade: Gravel depth beneath P 7 _ I I _/G— FL Township: Range: Section: Fill added above original grade: Gravel length: QED= l�r%o1$z 12v Ft. WIDE IN=HSr Ft. v gt WELL: LX tS7�11 n ❑Upgrade Gravel width: IU `da l Y WIDBD(/+w ED) Ft. Number of lines: Lt Disconce belween lines: /vA, $ 56 r' t. Classiticalio (Pri/v�ate, A,R,C): f� ��rl Total Depth: Cased To'. Total absorption area: Pipe material. ALa AS7M PVL- Ft. Ft. S_ SQ. FL '3 �O(,I FL810 N Driller'. Dale Drilled: Static Water Level: Ins Iter: Date installed- �CNLSoN �ft��SE� Yield. Pump Set al: Casing Height Above Ground. TANK GPM Ft. Ft. SEPARATION DISTANCESSeptic El Holding ❑S.T.E.P. To From Septic Tank Absorption Field Lin Statim Holding Tank Public/Private Sewer Lines Man acture V l— Capacity a� qss l/l` Well I la.l I�� F V/ /f Material Material: -t,_—'C� S TEE Number o Compartments: Surface LIFT STATION Wafer co4-1co,+ Lot�� r f Size in gallons: Man Irer Line I _ Foundation / f 3p / — — _ "Pump on' level at: "P off' leve High water alarm at: Curtain✓ Pump Ma otlel Elected®feat Inspections performed by: DrainQ 01 Remarks: OLD � is 1[—Cr � v BENCH MARK //11 _ ' )-((C r&,ijC- / I lF�1� / Imo. C Location and Description: _ _ OI- ('C1Nc, �C.A-6 it\3 (&N -r ICS (N_SL�/vi Wl7f'fA �UUR 7o HgFle Assumed Elevation: T 7. Tff/S S V,5��- 2 rD8 7- O/e su 17,416LIff A,'4�1 n �` / ) //� y� ^yam �j �/� ,�(°� e.,a.{p+� V /i l ��L I/ °£p�l[it�• J / �® /9°e°'P® •. f,r}i %--® S& 5 ENGINCERING '! 7034 Login, River Loop RoRC11114,204 Inspections performed byra4l2lvorrAtaa�ka4R577, Dates:lst 2nd /U I 2' Gv,Fr:.rl Ae. Do No. C �1p, � Department of Health and Human Services approval �' ��� -JO(-W ! st t (774- Date: 7S Reviewed and approved by: —' 72-013 (Rev. 9/91) MOA 25 f� d Permit No. Soli cla0?�da: Page of .2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report 72-019 A (Rev. 9/91) MOA 25 w I (FEETI Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES — w 0 )IJ Loc, 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST f1„ jli%SS•A 2- V PERFORMED FOR: IM IV/� ITKAG-AtV/k DATE PER RMEO LEGAL DESCRIPTION: 27. Township, Range, Section: i DEPTH SLOPE SITE PLAN I (FEETI — w 0 )IJ Loc, 2- 3 3 ° , 4 J J r 5 b 6 7 8 4134M _ i1, U, lh rP,N 1 I* 1 0 1(F�) p0.C- 1 2 SW 3 0 Y ° Y0 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water Aller Monitoring? ---- -.__ Date: s 0 O P E Reading Date Gross Time Net Depth to Net Time Water Drop — w 0 )IJ Loc, PERCOLATION RATE (mmuies/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND _ FT IL COMMENTS 1 1�7 t e)tl— (JIN '11I1'^Agl(J'j �r �� QC,(2Cli=rn/thR. SJIc.S C Y57 +4 Ei —14 HD -ti io Il�nri �� tzP7H• PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) 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 WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920347 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:NAKAGAWA HOWARD K OWNER ADDRESS:5045 WHISPERING SPRUCE DR ANCHORAGE, AK 99516 PARCEL ID:01530222 LEGAL DESCRIPTION: SKY RANCH ESTATES #2 BLK T 3 LOT SIZE: 18279 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1 L Lem 10-'a0-'t'Q 5134 (0- R) -9a DATE ISSUED:10/14/92 EXPIRATION DATE:10/14/93 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THE EXISTING LOG CRIB MUST BE PROPERLY ABANDONED. THE UP- GRADE SYSTEM MUST BE INSTALLED AS SHOWN ON THE APPROVED ENGINEER'S DESIGN DATED 7/13/92. RECEIVED BY: • Lti DATE: ISSUED BY: - l.5- 9 DATE %� it. 32 Uctobeh 7, 1992 F9CEE NIVEP,P NSP ��/, s HEALTH AUTHORITY Municipa ity oU Anchoaage, APPROVALS DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.U. Box 196650 SEWERS WATER Anchorage, ACaska 99519-6650 MAIN EXTENSIONS REFERENCE: Lot 3; Block 1; Sky Ranch E,5tate6 82 ROBERT SHAFER. P.E. ROGER SHAFER. P.E. CIVIL ENGINEERS (907) 6942979 FAX 694-1211 SEWER & WATER INSPECTION Request you ibaue a pejun.it .to upghade. .the septic system heAving the, nebeaeneed paopeA.ty. The pnopo6ed system witt be in6.tatted under. a Department oU ENGINEERING STUDIES Env.ih.onmentat Co"envation wa,iveA to a Cta66 'A' wateA sy6ten 6oun.ee. AND REPORTS weft. (SEE CORRESPONDENCE ATTACHED) We do not 4mesee, any negative .impacts on neighbmhing p4opekties by .the .i"tattation ob .the proposed system. WELL INSPECTION � p +� &FLOW TEST IU you have, any questions o%L nequ.i,%Le. addit ona.t, 2nUontnati.on {o%L your nev,iew, p2ea,se contact u6. S.ineehety, SITE PLANS 1 � Y TRjGER J. SHAFER, P.E. ROAD DESIGN S/gm SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 I?u ii WALTER J, HICKEL, GOVERNOR DEPT. QIP' EN Vill ItON NIEN TA [,CONSEUViATION ANCHORAGE DISTRICT OFFICE I (907) 349-7755 800 E, DIMOND BLVD,, SUITE 3-470 ANCHORAGE, ALASKA 9;3515 October 1, 1992 Roger J. Shafer, P.E. S. & S Engineering 17034 Eagle River Loop, Suite 204 Eagler River, AK 99577 SUBJECT: Sky Ranch Estates Class "A" Pubic Water System, PWS]D #212916 Dear Mr, Shafer: I have completed a review of this office's files concerning the monitoring status of the above -referenced Class "A" Public Water System and found the following: 1. The last Satisfactory Total Coliform Bacteria Sample results was submitted to this Department on Augusta, 1992, This 9LQJ�2 meet the provisions of 18 AAC 80.200(a) of the State Drinking Water R@qulatlon$. 2, The last inorge nic Chemical Contaminants Sample results were submitted to this Department on August 18, 1992. This LLQu meet the provisions of 18 AAC 60,200(x) of the State Drinking Water Regulations, 3. The last Radioactive Contaminants Sample results were submitted to the Department on July 27, 1988, This `Q_Q nat meet the provisions of 18 AAC 80.200(a), Stat3 Drinking Water Regulatlons, 4. The last Organic Chemical Contaminants/Volatile Organic Chernicais were submitted to this Department on August 20, 1992. This �LpgZ meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not Imply that the above -referenced Class 'A/D^ Public Water System is in compliance with other provisions of the State Drinking Regulations. If you have any questions on she above Information, please do not hesitate to contact this office at 349-7755. aSiinncerely, 7� % '` ref. w. Keven K. Kleweno District Engineer WALTER J. HICKEL, GOVERNOR DEPT. OF ENVIRONMENTAL FONSER"TION RECEIVED ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 OC I 5 19{2 pviunir;ipality of Anchorage October 1, 1992 dept. I lealth et 1-Iuman Sel'VICes Roger J. Shafer, P.E. S & S Engineering 12034 Eagle River Loop, Suite 204 Eagle River, AK 99577 Subject: Lot 3, Block 1, Sky Ranch Estates #2 Anchorage, AK, ADEC Project 9321 -WV -004, Review Dear Mr. Shafer: This letter is in response to your submittal, received in this office on July 24, 1992, and faxed on September 25, 1992, in which you requested that the Department waive the separation distance between a Class A Public Water System Source Well serving Sky Ranch Estates #2 and a wastewater disposal system located on Lot 3, Block 1, Sky Ranch Estates #2, from 200 feet to approximately 103 feet. I have completed my review of the submitted information, this office's file on Sky Ranch Estates, and other pertinent information. Based on the results of this review, I have the following comments. The monitoring data tends to indicate that the aquifer and source well are not being directly influenced by improperly treated wastewater from the wastewater disposal system in question, nor from the other systems that are located within the 200 foot protective radius of the existing Class A Public Water System Source Well. Thus, it appears that there is existing evidence in support of the requested waiver without all the information required in 18 P.AC 80.030 (b) being provided to this office. Therefore, in accordance with the provisions of 18 AAC. 80.030, the following separation distances have been granted: Between the existing Class A Public Water System Source Well and Septic tank from 200 feet to 103 feet. (If septic tank does not meet DFIHS standards, it will need to be located as far as possible from the source well.) Between the existing Class A Public Water System Source Well and Soil Absorption System from 200 feet to 127 feet. Roger Shafer 2 October 11 1992 This waiver will remain valid until the wastewater disposal system on Lot 3, Block 1, Sky Ranch Estates #2 falls again, requires upgrading, is modified, or the operator($)/owner(s) of the Publio Water System object to this waiver. At that time, either existing separation distances will need to be met or another waiver request will need to be submitted to this offioe. This approval does not imply granting of any additional authorizations, nor obligate any state, federal or local regulatory body to grant required authorizations, Thank you for your cooperation with this Department. it you have any questions, please do not hesitate to contact me. Sincerely, Keven K. Kieweno District Engineer KKK/of rr� July 23, 1992 ROBERT SHAFER. P E ROGER SHAFER. P.E. CIVIL ENGINEERS (907) 694 2979 FAX 694 1211 HEALTH AUTHORITY APPROVALS State of Alaska DEPARTMENT OF ENVIRONMENTAL CONSERVATION 3601 C Street Suite 322 Anchorage, Alaska 99503 SEWER & WATER MAIN EXTENSIONS REFERENCE: Lot 3; Block 1; Sky Ranch Estates, #2 Request you issue a waiver for the horizontal separation distance from a Class "A" water system well and a proposed septic system to serve the SEWER &WATER referenced property at 1031. INSPECTION The existing septic system serving the referenced property consists of a 1000 gallon steel septic tank and a log type seepage pit permitted and installed in 1974. At present the property owner periodically ENGINEERING STUDIES experiences "backing -up" from the septic system. Liquid levels within AND REPORTS the seepage pit were inspected and are indicative of a septic system in a state of failure. On July 2, 1992, a soils test was performed on the property for purposes of designing an upgrade. Please see the design attached. With the issuance of the requested waiver, we will apply to WELL INSPECTION the Municpalicy of Anchorage, Department of Health and Human Services a FLOW TEST for a permit to upgrade the septic system. For the following reasons we feel the requested waiver should be granted: SITE PLANS 1. From inspection of the ADEC files we found some confusion as to which well log belonged to the subject well. We contacted the developer of the subdivision (George Wilmoth) for ROAD DESIGN clarification and he provided us with a well log dated October 2, 1973 by Penn Jersey Drilling Company. Mr. Wilmoth felt fairly certain this is the log for the subject well (attached). From inspection of this log we see the well was SOIL TEST drilled through a clay layer between 35' and 871. There are other clay and gravel layers below this depth. (Inspection of the other well logs on file for this water system also reveals clay layers of varying content.) We feel the stratification PERCOLATION of these clayey soil layers will hinder and possibly alleviate TEST the migration of septic effluent toward and into the aquifer. 2. Also in viewing the well log for the subject well we find that water was not encountered until a depth of 120' to 1451. STRUCTURAL& However, the static water level was measured at 881. This is MECHANICAL indicative of a confined aquifer also suggesting the existence INSPECTIONS of confining clay layers which would alleviate the migration of effluent into the aquifer. ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 Page Two Lot 3; Block 1; Sky Ranch Estates, #2 July 23, 1992 3. With a static water level of 88' and a total well depth of 1451, even with a 100% water level drawdown during well use, only a relatively small hydraulic gradient is created by use of the well. In fact, with a confining clay layer present, the hydraulic gradient felt by the septic effluent would be non-existent. Therefor, septic effluent would not be "drawn" toward the well. 4. From topographical maps (see contour lines on sheet 1 0£ 3, The Design) we see the topography for the area is sloped away from the well toward the proposed septic upgrade. Typically, subsurface flows are in the same direction as indicated by the topography. Therefor, effluent from the proposed septic system would tend to travel away from the subject well. 5. As can be seen from the soils log performed for the septic upgrade; below the SW receiving soils is a silty ML layer of soil. As septic effluent migrates downward toward the aquifer, these silty soils will have a purifying effect on the effluent preventing contamination of the well. 6. On file for the subject well are inorganic water sampling results for. May 1986 and August 1989. Inspection of the nitrate results show very little change for that time period. (in fact, nitrate levels appear to have decreased.) The results were also very low at less than 1.0 mg/1. Since septic tank effluent is very high in nitrates and nitrates travel through soils often unaltered, it appears that after several years of septic system use in the area (including the existing septic system on the property), the well is still not affected by septic effluent. For the above mentioned reasons, we feel the requested waivers may be granted. If you have any questions or require additional information for your review, please contact us. Sincerely, ROGER J. SHAFER, P.E. RJS/tv Attachments cc: Howard Nakagawa - Owner ,fit a :; '� �1.—._---• 19 O 0 J LU Ld N O J Jay N77d 31/S Og = „/ to , � ez , ° \\(( (Y) g �\— )\) ) (\# a ' ^ \ 3 o /9}" " t , \\( \ \ qke \ V\ \\( gE = w 4 Municipality of Anchorage DEPARTMENT OF HEALTH r£ HUMAN SERVIi 825 "L" Street, Anchorage, Alaska 99502-065 SOILS LOG, -- (PERCOLATION TES' PERFORMED FOR: MF"•.�/"/K'-:��!'��jV�P�� LEGAL DESCRIPTION: L-� '/2� -/1L'y 1�/�ro�l[_r-1-Township, Range, Section: �� � SLOPE SITE PLAN ISE FJfI 1 ./^ 2 ^rte ETL�cit✓1 15 16 19 20 COMMENTS WAS GRO' -ND WA -t ENCOUNTERED? IF YES, AT WHAT DEPTH? S L O P E Depth to Water At �J 2- Monitoring, T Dale: - Reading Date Gross Time 3 �o Net Drop 4 .i 5 6 ---- 7 IZ'�Q"O 8 / 9 ML 10- 0 12 B" rj 14 I ��Ol7 12 12 — / 50- 13 V '• I � " Z� 13 �i 15 16 19 20 COMMENTS WAS GRO' -ND WA -t ENCOUNTERED? IF YES, AT WHAT DEPTH? S L O P E Depth to Water At �J 2- Monitoring, T Dale: - Reading Date Gross Time Net Time Depth to Water Net Drop ---- IZ'�Q"O 12 C7 C;) 12 B" rj 14 I ��Ol7 VI 1Z g 50- Gi V '• I � " Z� 13 �i — � 12•GZ ., H la. A� a � �t� �•O^ h /1� �M � aN PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND ___i FT �i I�>✓�, 2 Y o �t M r33 vv P�(i /off on PERFORMED BY: S % S ENGINEERING 1 -*?—A/ CERTIFY THAT T IS TEST W PERFORMED IN 17034 Eagle River Loop Road NO (� ` '� ACCORDANCE WITH g�1�j��i NT's x/$511 UI DELI FIi M EFFEGT ON TI11S DATE. DATE: 72-008 (Rev. 4/85)"� GREA "R ANCHORAGE AREA BOR' "GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL. SYSTEM NAME /100rl 00I_S�C�0 . _ MAILING ADDRESSS���%I A & �/OZ `I PHONE l �'y --5e)/-7/ �l LOCATION 8/k:L// k(,{ (AI�I"R /''14/J LEGAL DESCRIPTION %fir 3L --sj SEPTIC TANK: DISTANCE NUMBER OF FROM WELL ("OnVW MANUFACTURER:! o1A: C -%tJ- MATERIAL /-4 S��]��-� COMPARTMENTS INSIDE LENGTH_ INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY /000 GALLONS. SEEPAGE PIT: NUMBER OF PITS DIAMETER OR WIDTH-T,' LENGTH3±' DEPTH /y LINING MATERIAL (fir CRIB SIZE: DIAMETER SX(5 DEPTH 7 DISTANCE FROM: WELL C�E)i1(iizl� C1, / TOTAL EFFECTIVE `� BUILDING FOUNDATION�U 1, NEAREST LOT LINED ABSORPTION AREA (WALL AREA) Z96SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE (1101216V1 CONSTRUCTION BUILDING FOUNDATION CESSPOOL APPROVED_ NEAREST LOT LINE OTHER SOURCES DISAPPROVED DISTANCES:�S S_600 3 INSTALLED BY: 6101 1129 C% LkjL1 PIPE MATERIAL: LOT SLOPE: REMARKS: Form No. EQ -031 NEAREST SEWER LINE REMAR DEPTH SEPTIC TANK_ DIAGRAM OF SYSTEM DISTANCE FROM: SEEPAGE SYSTEM _ ` 10.nIL 3 t`ieri o-cx,;n l.tvld2.n Coll DATE CIA&4�� /7L APPROVED G.A.A.B. Dov Ra' GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330''C"STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT //' ' `/��F 't 7 NAME OF APPLICANT / '"per w MAILING ADDRESS 17� INSTALLATION LOCATION LEGAL DESCRIPTION �a INSTALLATION OF: SEPTIC TANK SEEPAGE PIT L-- DRAIN FIELD PERMIT NO 7'/ – JC PHONE OTHER TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH G TO BE INSTALLED BY / 41 SOIL TEST RESULTS ?� 7�r %%%7 �n �3 NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION, SEPTIC TANK SIZE TYPE MINIMUM DISTANCES, REQUIREMENTS C ` FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT O DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL y � ' 6 AREA SIZE 2' XZ( ( 4%CO (/� TYP� % DIAGRAAMMO OF SYSTEM SEPTIC TANK , SEEPAGE PIT zc� DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANKSEEPLAT PIS_ DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD SEPTIC TANK, U� SEEPAGE PIT Z� DRAIN FIELD-' 6/ , TO RIVER, LAKE. STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G.A.A.B. OR LICENSED DESIGNER 1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH O INANCE NO. 28-60 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. /I BATES — ;74 APPLICANT'S SIGNATURE J FORM NO. EQ -016 GREATER ANCHORAGE AREA QOROUG k �'. Department of Environmental Qua .ty 3330 "C" Street Anchorage, Alaska 99503 SOILS LOG - PEROLATIION TEST Performed forT� Legal Description:— A, eMckl This form reports: Soils og_ Perco ation Depth Feet --- 2- 3- 4 5 - e _ dM - -� 7 _ Q-+ g _ �3 S/ope 14 .- (61 Ra ?4 Was ground water encountered? If yes, at what depth? R VLD IIJL = » 199 ANI P2rfbGMg. `T �.... v Reading Date Gross Time Net Time Depth to Water Net Drop Percolation rateminute. Proposed installation: Seepage Pit Drain Field Depth of Inlet _ Depth to-Uottoiii of pit or trend C01.111ENTS: ._. _�9� s_-�i�l�il�/�i.y4`'--�L.�t -.-f'ey leo___ or_c. A4.5r _ Tir-6/Q_ � ow_ ec�pa re --- .__ _*� ter- nate: *� Performed fiy:_---�„�_pU�F� .---Certified [3y aY'� CASL } ,, AT ANPHORAVY A3AFKA 99$07. Porrovued Qr ,M ot Rock This }_ :.i ?Rt?i (IL u� �. ,......a...-�...,..... o:; T� eC,. In• b)YI 12 1 1/F_ro 4 - is - SO+1 vo Yl�j and ___-_ Location Sxetrr'r, TI r Arformed r;. Data Certified By �.._� nate. Parcel I.D. 015-302-22 Municipality of Anchorage On -Site Water and Wastewater Program' (907)343-7904 sArg,r Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: / D _. 3 %' l Complete legal description Sky Ranch Estates #2 Blk1 Lt3 Location (site address) 5045 Whispering Spruce Dr., Anchorage Ak. 99516 Current Property owner(s) Joel & Jacqueline Cusick Day phone Mailing address 5045 Whispering Spruce Dr., Anchorage Ak. 99516 Real Estate Agent 2. TYPE OF DWELLING: Il Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class A Well Public Water System WaiverNadance request for: Received by: � E COSA to be released- the eti4 neer. unless o Day phone TYPE OF WASTEWATER DISPOSAL: ❑ Individual 0 ❑ Holding Tank ❑ I] Community ❑ ❑ Public Sewer ❑ requested by the engineer. Date: — i,,� COSA Fee $ gg0,a2 Waiver Fee $ Date of Payment a i /a ll a Date of Payment Receipt Number_ /� Q1/550 Receipt Number COSA# _ !J 610�'V 7 Waiver# S. 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 Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Date 1241 Z0 Conditional approval for bedrooms, with the following stipulations: By: IV, 0,� Original Certificate Date: f ". The pa Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheetf _, 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 Legal Description: Sky Ranch Estates #2 Blkl Lt3 Parcel ID: 015-302-22 A. WELL DATA Well type Public Date completed Total depth ft. If A, B, or C provide PWS ID # A Sanitary seal (Y/N)_ Cased to ft. FROM WELL LOG Date of test Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: B. SEPTIC/HOLDING TANK DATA Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION Collected by: ft. g.p.m. Tank Type/Material Steel Date installed 10/20/92 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) Y High water alarm (Y/N) NA Date of pumping 10/19/12 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 10/21/92 Soil rating (g.p.d./ft2 or ft2lbdrm) 0.8 Sf/bd System type Bed/Trench Length bed/19'trench/45' ft. Width bed/20 Trench/5 ft. Gravel below pipe 0.5 ft. Total depth 5.5 ft. Eff. absorption area 585 ft2 Monitoring tube Y Depression over field N Date of adequacy test 10/31/12 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 8/0* in. Water added 477 gal. New depth 8/0* in. Elapsed Time: 90 min. Final fluid depth 8/0* in. Absorption rate , 450+ * g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons in. "Pump off' level at E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas Cycles tested Manhole/Access (YIN) in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 03 ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain + Wells on adjacent lots 127 ** Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 10+ iii F. COMMENTS Bed portion of this system is inundated with fluid. The trench portion is able to absorb 450+ a day. This system is 75% used. ** A separation waiver was issued in October of 1992. G. ENGINEER'S CERTIFICATION l certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R Pannone Date / Zl 17J COSA brown sheet 10-10-12.doc D 130.00' SW 59'44"E � 1 10' UTIL ESMT , ..WINGI� zawc asnacT — — — ' — — — — — — — — — — — — RtlYIT saNun aereux soa ■Iluoew s[reArx 1F/R MLNp S,.A« LU 0 e- N 0 C. .s rn 0 2 22.7 2 N a 42.0' M ^ 0 o EXISTING N HOUSE N 4 T8.0' 0 3 -e.-. N 24.0' v, ^ 4 L-73,39,' p Rc CVj �/1/y/S 26p 00.. 1 a� C`4 �J RAN^ SO0, UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. LOT SURVEY SURVEY TYPE SYMBOLS . ASPHALT FOUNDA11011 AS-BUILT ❑ IWAL SIRUMM AS-BUaT • SET REBAR DRAINAGE 0 FOUND REBAR 0 a WOOD FENCE CONCRETE ❑ PIoT PUN ... AS-BUILT ... LOT S RWY ... TOPmAPRY 00 ASSUMED ELEV. .X—X—K- METAL FENCE ® WOOD DECK AS- LT ... NO SET RECERTFlCA ON AS-BLIT ... NO WRNFR NOTE: PLOT PLANS & LOT SURVEYS IT I$ THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE FENCES. WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE SHOWN. ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY. SNOW PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. MAY ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. Prepared by SURVEY CERTIFICAl10N .++++ice*��' OF 4 Robert E. Johns, Jr. & Assoc. �• PLOT PLAN �E...... • Surveyors ++p, /_ r •• I N.. ,wary e,n I A °epesr ••••1•r `1 � � aw aI sa.n a,a a.aw n. nrt I Professional Land 1700 Brink Drive, ft w AM yb . Mt�lNlwtl a a nw Nr rrn•+ -J Wl .. ANCHORAGE. ALASKA 99504 Y. MwA Atli Va+aMblM of TY - _ >/ •. ♦` Scale: Rec. Lot S.F. Rec. Plat Flle Na. ih, - 1" - 301 FOUNDATION AS-BUILT .` „•, .,. • Date carve a: " 11/26/12 Ora. b r REJ Checked by^AK J I V I , ,.... d N.� ' R013ERT NS,J Q o Date Drawn: 11/27112 Grid: 2737 WD 12-520 FINAL STRUCTURE AS-BUILT•�, of •`•. • 1 — S ` 4 Legal Description: of ,. �;' ���,°`•......,... •" °a;•+ Lot 3 BLOCK 1 .arv. m nr Na me mn a u. , PY esaional �0.+ s °` o SKY RANCH ESTATES #2 _�--43 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 s HAAtI 1. GENERAL INFORMATION Complete legal description Lot 3; Bloch 1; Skynanch E4.tate6 42 Location (site address or directions) 5045 Whi.Spe&inq Sp/Luce Anchonagp. Property owner Howard Nakagawa Day phone 34 914 Mailing address P.U. Box 111889 Anchona.ge, AK 99511 Lending agency Mailing Day phone Agent Na.ta2i-e Thavehh/Budig C-21 Pati. is Non-th Day phone 345-1444 Address 1120 HuUUman Anchacage, AK 99515 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 v 3. TYPE OF WATER SUPPLY: Individual well Community well XXX 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 XXX 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 (Ray. 1/91) Front MOA 024 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S Eagle Address Engineer's signature 6. D/7H SIGNATURE Approved for T3)bedrooms. Disapproved. Conditional approval for Additional Comments aoa Phone 6 �/�'2 !I7�/ Date / �/ bedrooms, with the following stipulations: Date /i— 3W _r�3 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. 7M5 (floe. 1M) Back MOA k21 Municipality of Anchorage Department of Health & Human Services M1+ HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: loZ 3 SKy IZAr'Cyf 42 t�2 Parcel I.D. A. WELL DATA Well type CLAR's /+ If(@ Log present(Y/N) Total depth Sanitary seal(Y/N) Date of test Static water level Well flow Pump level �i ADEC �2o5d 1 or C, attach ADEC letter. ADEC water system number 113AIn-WV- 6011 __ Date completed /N%4 Driller Cased to—Casingheight— Wires properly protected (Y/N) vU FROM WELL LOG AT I till) — g.p.m. MUNICIPAII I UP Hie Ho At l: .,i,,.vannFNTAL SERVICES DIVISION 110 V 1 0 1993 SEPARATION DISTANCES FROM WELL TO: r� Septic/holding tank on lot 02 ; On adjacent lots V" 4 r Absorption field on lot^/ �02� On adjacent lots � A Public sewer main /VA Public sewer manhole/cleanout Sewer service line AJIA Petroleum tank 6rdF_ WATER SAMPLE RESULTS: IVSD ColiformII 11 II II Nitrate �` 7/ °4 �/�- c Other bacteria � Date of sample: �(K 193 Collected by: Jt S P_WINER"Vru6- B. SEPTIC/HOLDING TANK DATA Date installed 16b,I 6,/ Tank size 1006 6ft(Compartments Cleanouts (DN) Foundation cleanout ON) � Depression (Y/© High water alarm (Y/a Alarm tested (Y/6) �J/A Date of pumping Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot N 1 On adjacent lots �a Foundation o property line Absorption field Water main/service line 10 Surface water/drainage 72026(Rev. 7191) Front ADE( WfNuEr- ZSSueo /oil 172. CONTINUED ON BACK PAGE fo�� P[Zo5 E�.7 93a.( - WV - 00L( LIFT STATION Date i led Size in gallons Vent(Y/N) Nf Manufacturer High water alarm level Meets MOA electrical codes (Y at Manhole/ SEPARATION DISTANCE FROM LIFT STATION TO: On adjacent lots "Pump off" level at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed /O// �Z1" Soil ratingy St System type BEE w/S y Length 5'WIPF-711 lWidth t8/Aa5 t3E0 Gravel thickness Total depth 'Y's Total absorption area Scg� St- Cleanouts present O/N) Depression over field (Y/6) Date of adequacy test NIA - NEw SYS• Results (pass/fail) NIA for J bedrooms Peroxide treatment (past 12 months) (Y/6) If yes, give date h!/A SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot &1A On adjacent lots Property line I r < 7 To building foundation 3s 1* To existing or abandoned system on lot On adjacent lots aQ Cutbank N/A Water main/service line Y() /_ Surface water N/ADriveway, parking/vehicle storage area ?6 Curtain drain /-EPEC IwRivEA =SUE -0. 10 1 f yL E. ENGINEER'S CERTIFICATION f}jrC }P&7i c? X73? l—wV_coy 1 certi !nd HAA guidelines in effect on the date of this inspection. Signature S & S ENGINEERING 17034 Eag arver p Engineer's NameEagle River, Alask 77 Date tv HAA Fee $ �Waiver Fee: $ Date of Payment " 9 - LS Date of Payment Receipt Number C, <25 �) Receipt Number 72-026 (Rev. 3/91) Back MOA 21