Loading...
HomeMy WebLinkAboutDEER PARK BLK 3 LT 6Deer Park Lot b Block 3 #051-042-44 Municipality of Anchorage Page ' of 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 S OOO 1 7 Perrnit Number: PID Number: Name: /V•—/7 +car. I/k� Wastewater System: o New Upgrade ` (` Address: O aa3� � Dr, hu ;A 567 '33BSORPTION FIELD Pnone:6439-22-7 No. 01 Bedrooms: Deep Trench C] Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: � � GPD/Sq. . Ft. Total Depth from original Q{ ,ghde IGs Lot: / Block: Subdivision: 6 .3 !ke Pyr Depth to pipe bottom from origi al glade : 3` r` FL Gravel depth henealh Pipe FI. 7 ownship: Range: Section: Fill added above original qr d .SIFT. Gravel length: so`•+•go`=-7Q'7®`t41 Ft. WELL: ❑New O Upgrade Gravel width: .Srt. Num bet of lines: a Distance belween lines: fs Ft. Classificationl (Private. A,B.C�: ,,[. �:� T/ Pe! vete 'total Depth: '7a Ft. cased To: (a FL Total absorption area: a O 0 SD. Ft. Pipe material: s7�r o30� y Driller: Ma ti,, Date Drilled: l-�D-$I Static Water Level: Installer: Eueg i Dale Installed: ST r �© n us'an �� I Ft. ec Casing Heighabo+ Vleld:n�l TANK pv Ft. Ft.: SEPARATION DISTANCES XSeptic ❑ Holding ❑ S.T.E.P. To From Seplic Tank Absorpllon Field un Station Homing Tank Public/Private Sewer Lines Manufacturer. a red- QQ 5 �iUk C. Capacity in gallons: (/{q li /0 W211 ` 1 •r—� — rjt;(?Sl+ Material � Compartments:Number of Compartments: [, ©( Surface Water FM�I.t.+ I 0'f- M0 1 M'4 "—'i LIFT STATION Lot �'C r� ( Size in gallons: Man ter. Line l Foundation p) I 1 ` �� ( "Pump on" level at: "P 1" leve Fligh water alarm at Curtain1 Drain ,1 r1� ! I <A Wdl ' Pump Mak el Electrical Inspections performed by: Remarks: TN 0 z Doc. y T > , ze BENCH MARK CA rrg614/,.A D(C CU�.rbr2vc•rroNA �n ly S/4N/£/J Location and Description: T.71.- peri. ro 13Crr4/1 so, J a ll tat 8 E�1SYan/G S'k.f�T tc. 7/1-Nk PUJyt�4O Assumed Elevation: Fl cA4,r /Yrv4�(� r At�4h deo^,.... .... Sf tQ rgt S & S ENGINEERING 17034 Eagle River Loop Road, No. 204 6'Y -®©, ,••1" d Inspections performed by:Eapla River, Alaska 99577 Dates: 1st '_ G�,7✓.....:.. 2nd - �i -Gtr 1a T " ROBERT C. COWAN ! C aoe`'��'•,< F.`rcl � lS�po c�.aaot ;����,��' Department of Health and Human Services approval tQ /? .•• tk 0 Date: C7 Reviewed and approved by: :0Z too»�ac�g� 72-0131aev. 9/91) MOA 25 PERMIT NO. SIN0001 37 PAGE 2 OF 3 Municipaht of Anchora e DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.D. Box 196650 0 Anchorage, Alaska 99519-6650 O Telephone: 343-4744 ®N -SITE WASTEWATER DISPOSAL SYSTEM AND/®R WELL INSPECTION REPORT LEGAL LOT 6, BLOCK 3, DEER PARK S/D P.I.D. No. 051-042-44 NEW TRENCHES 5'x10' UTILITY EASEMENT TH#1��S� T� MT Pf O Sys F DV (DIVERTER VALVE) DBL1 & DBL2 ST2 ° NEW 1300 GALLON STI ° HDPE SEPTIC TANK BECK 5'x10' UTILITY EASEMENT LOT 'S LOT SCALE: 1" = 40 y LF!l, I1 ROBERT C. COWAN i �2 CE - 8801 r�t� a 2" INSULATION UNDER DRIVEWAY / FS (FLOW SPLITTER) NEW TRENCHES 5'x10' UTILITY EASEMENT TH#1��S� T� MT Pf O Sys F DV (DIVERTER VALVE) DBL1 & DBL2 ST2 ° NEW 1300 GALLON STI ° HDPE SEPTIC TANK BECK 5'x10' UTILITY EASEMENT LOT 'S LOT SCALE: 1" = 40 y LF!l, I1 ROBERT C. COWAN i �2 CE - 8801 r�t� a PERMIT NO. SW0001 37 PAGE 3 OF 3 Municipalitof Anchorage DEPARTMENT OF NEA I N AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 oAnchorage, Alaska 99519-6650 0 Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 6, BLOCK 3, DEER PARK S/D P.I.D. No. 051-042-44 ST1 S 101.4' FINAL GRADE -12" INSULATION A B FCO 3.5' 23.5' NEW ST1 14.5' 32.0' ST2 _T8 34.0 DBL1 20. s' 35.5' POLYETHYLENE 97.0' DBL2 21.5' 36.5 97.3' 1300 GALLON SEPTIC TANK Dv 24.5' 38.5' FS 56.5' 42.0' C01 42.0' 17.5' MT1 43.0' 19.5' CO2 58.5 33.0' MT2 58.5 33.5' FINAL GRADE CO3 56.0 46.5' C04 62.5' 46.0' C01=99.6' CO2=98.1' CO3=99.6' C04=99.1' C01=94.6' CO2=94.6' SR CO3=94.4' SR C04=94.4' N. T. S. MT1-88.2' _ p���� MT2-88.1' ` SS'ra�sP AIAA 1 ROBERT C. COWAN.� V� f NO WATER FOUND ��j+�3s�. CE -8801 , `c:% 82.1' B.O.H. 1 .................. <. e Municipality of Anchorage _ DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG PERCOLATION TEST PERFORMED FOR: �'' Lp ZI �" K I N DATE PERF( LEGAL DESCRIPTION: L07- G f3iK 3 PA,",K To% DEPTH __t /v5 7- Nd L -ry- (FEET) 1 L ti� Uti�rA.v(C$ 2 dn 3 �)G(j za 4- 6 6 7 ' • S fLT 5/1�✓� V, 8 ' 9 lo- ll 0 11 J 12 13 19 10W COMMENTS &M MEMO MEMO MMEM MEME ■EEO EEME MEMO MEMO MEN ■ E■EE ;tion: SITE PLAN WAS GROUND WATER 0 ENCOUNTERED? JIV S IF YES, AT WHAT L DEPTH? O P E Depth to Water After Monitoring? Date: S 4 Reading Date Gross Time Net Depth to Time Water Net Drop 2 SVA lK Ane-, 1 Ah 4,3" r o ,/ i. a 61, ,. all 5-71 9 PERCOLATION RATE 6 (minutes/inch) PERG HOLE DIAMETER 6 TEST RUN BETWEENy FT AND % FT S & S ENGINEERING // PERFORMED BY: iF , 12.'3' CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eagle Iver oop oa C, /1 ACCORDANCE GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Y'/a ?/Z/CTCe_ Date Issued: May 31, 2000 Expiration Date: May 31, 2001 Permit Number: SW000137 Parcel ID: 051-042-44 Legal Description: DEER PARK BLK 3 LT 6 Design Engineer: 0003 S & S Engineering Site Address: 022329 DEER PARK DR Owner Name: Gloria King Lot Size: 40000 SQ. FT. Owner Address: 22329 Deer Park Dr. Total Bedrooms: 3 Permit Bedrooms: 4 Chugiak , AK 99567-5330 This permit is for the construction of: ❑✓ Disposal Field ❑v Septic Tank Holding Tank ❑ Privy Private Well Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: G - Date:3 —31-0o IIEALTHALTHIORNY APPROVALS SEWER& WATER MAINIXTENSIONS SEWER & WATER INSPECTION ENGINEERINGSTUDIES ANORE.PORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAODESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER OISPOSALSYSTEM DESIGN S&S� alneenu May 2, 2000 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 6, Block 3, Deer Park S/D ROBERT C. COWAN, P.E. CIVIL ENGINEERS (907)694-2979 FAX(907)694-1211 It is requested that you issue a permit to install a septic system upgrade to serve the existing four bedroom dwelling on the referenced property. A test hole was excavated and a percolation test was performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation 4/25/00, no water was found. After seven days of ground water monitoring the monitoring tube was dry. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, X-1 Robert C. Cowan, P.E. RCC/bjj Enclosure 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 1" = 60DESIGN SITE -PLAN J roDW ol"iir N d aov_i' Ac['ro N Ln O %g 2? C) m20 O m m m�� fJJo L a 0)Cf) -P, d CO > '� oOmOD tTj L y �^�� Ir x o D " C II 3 (Z) m CA Z 3 c� OII c r*i r II m O W O O vmDi A 0 VI N z x Z x o � ��I�Q mCIO 1N3w35tl3� O \ \J m n _ \ q<T \ p O D C: 95�p36 v ►? I oaa g n CWAN\ls\X3 .�Soa cn m ® 1 C \m s iN \�Tf m COs ^€ I c Z ti 1T \�F o < n� \�F` roon \/ 0 mo m ;I � Do rt oc ti z f- f o I C\p Z \ z m �3p= 955 L O Me Municipality of Anchorage - DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: &L -01r-14 LEGAL DESCRIPTION: L (!i If, DEPTH (FEET) 1 2 3 4- 5 'C 6 7 8- s10- � 97m 11- 12- 13 1 12 13 ell14 15 !� 16- 17 18o 19- 20- COMMENTS 920 COMMENTS 6vt-•A DATE PERFORMEDC P14-ILK- 0mr, Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ,V ENCOUNTERED? S IF YES, AT WHAT L DEPTH? O P E Depth to Water After n 2, Monitoring? Date: ROBERT C. COWAN .m ,e mmmmm® PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER - TEST RUN BETWEEN FT AND 6 FT PERFORMED BS & 5 ENGINEERING CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eag a Iver loop Roado. 5 �l Y / do ACCORDANCE LAdbtp/UNr&T%'M>aNP4,9EWSCIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER - TEST RUN BETWEEN FT AND 6 FT PERFORMED BS & 5 ENGINEERING CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eag a Iver loop Roado. 5 �l Y / do ACCORDANCE LAdbtp/UNr&T%'M>aNP4,9EWSCIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) Ing ROBERT C. COWAN, PE CIVIL ENGINEERS (907)694-2979 FAX (907) 694-1211 ON-SITE WASTEWATER DISPOSAL SYSTEM P novas"onlTv AP CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS SEWER 6 WATEn MNNEXTENSIONS REFERENCE: Lot 6, Block 3, Deer Park S/D May 2, 2000 SEWER&WATEn INSPECTION GENERAL: 1. The scope of this project includes the installation of a 1300 gallon ENGINEEPINGSmoIES polyethylene septic tank and ` new trenchsto serve the existing four bedroom ANDREPORTS residence located on the referencedro e p p riY• 2. Construction shall be in accordance with the approved site plan and design WELL NSPECTION drawings, Municipal permit with any special provisions or conditions, and all R FLOW TEST applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground SITEPI S utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. ROADDESIGN 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing SOIL TEST their own systems must also receive prior approval from the Municipal Health Department. PERCOLATION SEPTIC TANK INSTALLATION: TEST 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. ME HOANICAL6 INSPECTIONS 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. ONSITE WASTEWATEn DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Page 2 Lot 6, Block 3, Deer Park S/D May 2, 2000 All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page 3 Lot 6, Block 3, Deer Park SID May 2, 2000 MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Tyne of Pipe Perforated olid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: Page 4 Lot 6, Block 3, Deer Park SID May 2, 2000 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre - construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER Municipality of Anchorage J -- Development Services Department Building Safety Division ;41.6, 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 r �y FOR A SINGLE FAMILY DWELLING Parcel I.D. oJ I - �`1 Z COSA # 00i 0Z -M Expiration Date: —/-Q - 6 - O 1. GENERAL INFORMATION Complete legal description Lot 6; Block 3; Deer Parc Subd vision Location (site address) 22329 Deer Parc Dr. Chugiak AK 99567 Current Property owners) Fannie Mae Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Bob Brock 3111 'C St. Anchorage, AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone Day phone 261-7676 TYPE OF WASTEWATER DISPOSAL: Individual On-site El Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I verify that my Investigation, based on procedures outlined In the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my Investigation and Inspection, the on-site water supply and/or wastewater disposal system Is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations In effect at the time of installation. Name of Firm S a s Engineering Phone 694-2979 Address 15861 S. Birchwood Loop Rd. Chugiak, AK 99567 Engineer's Printed Name Robert A. Shafer Date 4t zu NI 5. DS�NATURE Approved for bedrooms. Disapproved. k EjS5 Conditional approval for bedrooms, with the following stipulations: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other_ By: Original Certificate Date: / — 6 — Q si (R. IIMS) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water &Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description:Lerr� J �� � r �*�� Parcel ID: Or -1- 0 q2 -4J4 A. WELL DATA Well type RAV4% If A, B, or C provide PWSID # Date completed O /P� t Sanitary seal) -r Total depth _Ia_ft. Cased to Bio ft. FROM WE L LOG Date of test I v �' Static water level Well production �� g p m• WATER SAMPLE RESULTS: Coliform �colonies/100 mL Nitrate mg/L Arsenic: Olt) ug/L date of sample: 01 B. SEPTICIHOLDING TANK DATA Tank Type/Material('1 IL lint✓ Tank sizeL gal. Number of Compartments a Well Logol) `E -s Wires properly protected l�l I) � n Casing height (above ground) /64 in. AT INSPECTION to �5 3,$ g.p.m. Other bacteria 0 colonies/100 mL Collected by: S+ -4S t;A.Z00156eaA,- Date installed 8 'f o Cleanouts Foundation cleanout�l) c ? Depression over tank, (Yo# High water alarm (Y® 00 Date of pumping Pumper C. ABSORPTION FIELD DATA y� Date installed 00 Soil rating (g.p.d./ft2 r ft2/bdrm) 0 • a System type rJE�P ; IzE i r Length �` ft. Width a.5 ft. Gravel below pipe ft. i Total depth 1�4 ft. Ef . absorption area SNO ft2 Monitoring tube IC15 Depression over field Date of adequacy test �0 ResultPas ail) For J_ bedrooms '� n Fluid depth in absorption field before lest D in. It Water added & gal. New depth in. Elapsed Time: min. Final fluid depth It; in. too Absorption rate >= t'o t g.p.d. Any rejuvenation treatment (past 12 mo.) (Y& type) Ivo If yes, give date D. LIFT STATION t3l11- Date installed Size in gallons Manhole/Access (Y/N) 'Pump on" level at —in. 'Pump off" level at gh water alarm level at in. Datum Cycles tested Meets alarm 8 circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: f Septic tank/lift station on lot /,-6 Absorption field on lot /co 4 Public sewer main _ l)In r Sewer /septic service line o�rJ Animal containment areas '504 r On adjacent lots /dd -t r On adjacent lots /Cr7 4 Public sewer manholelclean'out ADIM �lJ/ Holding tank %j r Manurelanimal excrete storage areas /OC9 f SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r Building foundation CJ f Property line �J Absorption field $ Water main A) ii Water service line 104 Surface water r Wells on adjacent lots fCC SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: I Property line to ' - Building foundation !D *4 Water main ASA, f Water Service line /0 *- Surface water /00 t'f Driveway, parking/vehicle storage t< Curtain drain Al WF KluDu 1U Wells on adjacent lots _!AO F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 have determined t u review of Municipal records th t the conformance with MOA COSA gvidelins Engineer's Printed Name Date /, Wa ( b field inspections and above systems are in effect o� dat� COSA Fee $ L19 0 Date of Payment 6 Z9 U Receipt Number d 3 C Q4V (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number & Skala. I N►.t t SCS ReLN 1091270001 Client Name S & S Engineering Project Name/N Lot 6; Block 3; Deer Park Client Sample ID Lot 6; Block 3; Deer Park 1lalriv Drinking Water Printed Date/Time 04/13/2009 13:48 Collected Date/Time 04/01/2009 11:15 Received Date/Time 04/01/2009 12:55 Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results PQL Units Wthod Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 04/08109 04!09/09 NRB Waters Department Total Nitratc/Nitrite-N ND 0.100 mg/L SM20 4500NO3-F B (<10) 04/03/09 JD7. Microbiology Laboratory Colony Count 0 col/100mL SM209222B A (<200) 04/01/09 DLC TotalCohform 0 col/100mL SM209222B A (<I) 04/01/09 DLC FecalColifortn 0 col/100mL Sh1209222B A (<I) 04/01/09 DLC Municipality of Anchorage *'pf 84i • Development Services Department r Building Safety Division _ On -Site Water and Wastewater Program sE T Y 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. , 051-049--:44 HAA # 0 j Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 6; Block 3; Deer Park Subdivision Location (site address or directions) 22329 Deer Park Dr. Chugiak, AK 99567 Current Property owner(s) Gloria Treis Day phone 688-3127 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address same Day phone Kathi Olmstead Day phone 694-4200 16600 Centerfield Dr. #201 Eagle River, AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY:* TYPE OF WASTEWATER DISPOSAL: Individual Well [l Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Individual On-site a Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S & S Engineering Phone 694-2979 Address 17034 Eagle River Loop Ste. 204 Eagle River, AK 99577 Engineer's Printed Name Robert C. Cowan Date 6' />0 0 yC�`�� �............. tkt 'xi*•.f .. .MY .M�...i.?.t 6. DSD SIGNATURE r� ,� ROBERT C. COWAN �� CE - 8801 r �i ✓ 10 Approved for 3 bedrooms. .� VX, Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory WASTEWATER JJ��J0 '�'rNt SE��S`` \• Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: ( — 0 (Rov.01102) Municipality of Anchorage ' Development Services Department Building Safety Division W " On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lo T- h -'g i114*2_4< �/-r> Parcel ID:_�%Cjf'- d 2-' 'A. WELL DATA j i' Well type Z7e If A, B, or C provide PWSID # " Well Log (YM) T Date completed f I l81 Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth _ILft. / Cased to o ft. Casing height (above ground) l in. FROM WELL LOG AT INSPECTION Date of test S lo4- Static water level t�K ft. SS ft. Well production n g.p.m. �' g.p.m. WATER SAMPLE RESULTS: Coliform U colonies/100 ml. Nitrate d' mg.A. Other bacteria O colonies/100 ml. Arse ' Date of sample: 's 4 4 Collected by: 51SEC-7Z/NG- B. SEPTIC/HOLDING /TANK �DATA Tank Type/Material �% TIL ! i'}� �� Date installed /OC) Tank size 15120 gal. Number of Compartments 7i Cleanouts (Y/N) Foundation cleanout (Y/N) 4- Depression over tank (Y/N) l� High water alarm (Y/N) Date of pumping 4—Pumper m I e, C. ABSORPTION FIELD DATA Date installed z C) Soil rating (g.p.d./ft2 or ft2/bdrm) 0-1 g System type Q • 7��enNC'H Length '' IIft. Width Z s ft. Gravel below pipe ft. Total depth t.� �Eff. absorption area 64& f?Monitoring tube _� Depression over field ^) a•- %� Date of adequacy test Results (Pass/Fail) / �i-5 S For 4 bedrooms Fluid depth in absorption field before test 10 in. Water added -&&gal. New depth in. Elapsed Time: 60 min. Final fluid depth in. Absorption rate >= ov g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date — I J� i:';D.1 LIFT STATION Date installedAll A 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 SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank' AiiiFstation on lot -1.00 1-4 _ : _ , On adjacent lots Absorption field on lot 1 dd 14- On adjacent lots 14- Public s'e'wer main ti/ Public sewer manhole/cleanout Se/septic service line 7i� -t' Holding tank /V SEPARATION DISTANCES FROM SEPTIC/H@t-MG TANK ON LOT TO: ' Building foundation �4- Property line �� Absorption field Water main "J A Water service line ! t Surface water /00 r -F - Wells on adjacent lots /00 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ' /0 4 Building foundation t- Water main ,J � Water Service line 0' Surface water /db + Driveway; parking/vehicle storage Curtain drii%i/aN� k�DwA) Wells on adjacent lots OD fi 'i an � F. COMMENTS(:t� t16 ENGINEER'S CERTIFICATION s •'.,:`% tdi, �I i I certify that I have determined through field inspections and review of Municipal records that the above systems are in Fee.. ••• �»-., P -A ROBERT.C" COWAN w�fh I conformance MOA HAA guidelines in effect on this date. II, cE - 8601 Engineer's Printed Name Rb -64x,— CD wA'� 'fit e,•o :••��' c F�..........••�'r Date E i &J/ ii 7o, ,Q Waiver Fee $ Date of Pa I S 0 o + Payment IH�DAA Fee ate of Payment) ym . Receipt Number' O .� 3 Receipt Number' (Rev. 12/01) SGS Ret.# 1042242001 Client Name S & S Engineering Project Name/M Lot 6, Block 3, Deer Park SID Client Sample [D Lot 6, Block 3, Deer Park S/D Matrix Drinking Water All Dates/Times are Alaska Standard Time Printed Date/time 05/07/2004 16:42 Collected Date/Time 05/04/2004 14:30 Received Date/Time 05/04/2004 15:35 Technical Director Steph C. Ede Released B�'�`' Sample Remarks: EP300 - Nitrate for CB recovers outside control limits; sample concentration is below PQL. is Parameter Results PQL Units Method Container ID Allowable An te Date Limits Date Date ]ysnit Waters Department Nitrate -N 0.100 U 0.100 Microbiology Laboratory Total Coliform 0 mg/L EPA 300.0 B (<=10) 05/05/04 JMP coUl00mL SM189222B A (<=1) 05/04/04 DKC Sent By: RE/MAX OF EAGLE RIVER, INC.; 9076960214; t CF( /� r/0 Jun -10-04 13:59; Page 2/2 ASBUILT I HEREBY CERTIFY -THAT I HAVE SURVEYED THE SEWARD &ASSOCIATES LAND SURVEYING 694-0 SCALEt FOLLOWING DESCRIBED PROPERTY: ���S�d dr+�►r►�� � •�� OF A C %%* AND THAT NO ENCROACHME6TS EXIST EXCEPT AS DATE: • • .. , ti INDICATED. IT IS THE RESPONSIBILITY OF THE�'�P'••.. • • T • S�b4 OWNER TO DETERMINE THE EXISTENCE OF ANY TH 4 EASEMENTS, COVENANTS OR RESTRICTIONS GRID: WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD F8' Duan♦ Mer �.v.rQ„' • ' d ANY DATA HEREON BE USED FOR CONSTRUCTION /az•.o� �.•'•, 1S-6913 •.= ,�w`s OF FENCE LINES, OR FOR ESTABLISHING BOUND- - o ARY LINES. DRAWN'`�v.