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DEER PARK BLK 3 LT 3
Deer Park Block 3 Lot 3 #051-042-41 Municipality of Anchorage Development Services Department Building Safety Division_ t On-Site Water & Wastewater Program, 4700 South Bragaw St. „ P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907) 343-7904 Page 1 of 3 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SWO30417 PID Number. 051-042-41 Name: JEFF AND CONNIE IRISH Wastewater System: ❑ New ■ Upgrade Address: P.O. BOX 670593 a CHUGIAK. AK 99567 ABSORPTION FIELD Phone: No. of Bedroom*: (907) 688-0533 3 Cl Deep Trench ■Shallow Trench Cl Bed OlAound OOthar LEGAL DESCRIPTION W Raang: 1.0 Told Dept, Iron orWml gree.: 8.0 MAX Ft Gpo/-a rt Block: Lot: Subdivision: Depth to pipe bottom hom wgwl giver. Gra.N depth bwralh pip. 4.0 3 3 DEER PARK 4.0 n. rL Township: Range: Section: — — — FE odded above W41 al Pod. Grovel Wngft 45 SEE DWG. n n Grow Wkeh: Nw /bar or *nee: aetaar. Ml...n one. WELL: ❑ New ❑ Upgrade 5 1 — n Ckeelnoaaan PrNoe, Ae.a : Told Cooed To: Tod abeaptk,n ono: Pepe motww. D 3034/ F-810 R ft 450 so. n. Drab. We D WW; su,tb Wmw level: evel0ow: EVERETT CAULKINS Dau, eetdled: 10/8-9/2003 FL "dd: "n"p sd A G*.kg height Above G,aw,d` TANK GP, R FI SEPARATION DISTANCES ■Septic ClHolding OS.T.U. Gather To Septic Abso tion ri.`�d Uft Station Holding Tank b/Prlvate sew« once NO1Mi1a`I"'w` ANCHORAGE TANK C--a, 1000 From Tank Well 090'+ 090'+ — — 25'+ ud«1or STEEL ekwnbw f awapon w 2 Surface water 100'+ 100'+ — — — LIFT STATION Lot Une 5'+ 10'+ — — — sue In 9W YaaNaaOnw oa k«d x eN ft NNIn "ter dam d: Foundation 5'+ 10'+ — — — ►uap Yob nec4kel brgatbrr pwfomod 1pr. Curtain Drain NONE KNOW BENCH MARK Remarks: *WAIVER GRANTED Loodlon and Deecnptkm EXISTING SEPTIC TANK COMPLETELY ABANDONED BOTTOM OF MANDOOR THRESHOLD NORTH EAST CORNER `need °evaba 100.00 rt ENWNEER'sb L 000aoo 4 Inspections performed by: AKWWC, INC. Dates: 1st 10/8/2003 *�'.... ::.s.0� 2nd 10/8/2003 / 3rd 10/9/2003 fr Carne s.: 0 Services Department A al ` 4Op°dP E 79.o�r`'��av Reviewed and approved byt Date: 10 -20-03 (Rev. tg/01) 1% 0: o�a� PERMITNUMBER: AS -BUILT DRAWING PARCEL ID NUMBER: SW0 SW030417 051-042-41 I i 0NAINA42 WLMM \ y NO VISIBLE WATER DURING SITE VISOS) I 1 I — — — — — — — — — — NEW DRNNFlELD �+THJI EXISTING DRAINFIELD TO BE USED AS A RESERVE SITE / MALTED FLOW DNERTER DBL2 N 1000 GALLON SEPTIC TANK AI ASID «TA�rr: PERMtTSWO NUMBER: AS -BUILT DRAWING PARCEL ID NUMBER: SWO30417 051-042-41 TH#1 TOP OF TANK A INLET - 96.77 INVERT OF BUNC- AT INLET - 98.19 T 1 - RELATIVE ELEVATION OF BOTTOM OF TEST HOLE - 81.31 (TEST HOLE DRY) GRADE - 99.15-99.65 r INSULATION NEW 1000 GALLON SEPTIC TANK TOP OF TANK AT OUTLET - 96.77 `INVERT OF BUNG AT OUTLET - 96.02 FINAL GRADE - 94.57-98.57 FABRIC INVERT OF PIPE . 91.37 (AVG.) BOTTOM OF TRENCH . 87.31 (AVO.) AI.ASIU `CATER & «VAST L«AI ER CONSULTANTS, INC. 570. F Tl M ROA6. SuiTF 101 • ANC.ORAGF. AK 99507 • ENDIVE (007)557.6179 • FAX (9077552-3)66 oaf "•' O ' Q o g yV F Jef a A. rness:' '•, -7953 •. c%07s'o�000 Q Pr ��4p0000� SCAMC.J.G. N.T.S. PREPARED FOR: PHONE NUMBER: JEFF AND CONNIE IRISH (907) 688-0533 PAGE NUMBER: 2 OF 3 LEGAL DESCRIPTION: DEER PARK SUBDIVISION; LOT 3, BLOCK 3, TYPE OF WORK: PROFILE AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE Sent 9�^,;t.1'. 2003 El0:32--VER, INC.; 9076960214; Oct-17.03 10:30;!i0.12?1 I". 2 2/2 .. •. �'-�--•ac+'• .t7r _ .�. �. ''tom'- L': yr 54 • .. .\ •.� j'♦.,J D..:.(t..; ti ;S`•!`t'•trJCT ♦ F'`}�i�a:, • ,t .. k 4a•. Y .pnl ri. .. s • .. •. - ' • •. •' _%•� %I f�• •• V� ♦^ rel • ~/ ,. .. r•• , ��,;� �.~ rj , Cv ♦ � .. i � .. _ t .1, Yea: �, .. s.: 'J: :.. :r• a .. .• - . T:.3•Ji•�.n:.v�M�. .. : .-AS -B1IIIS' { ... ; . eetrby"cert;v ttut i -"iW mlgad' the 46Qoi;}n(` '. • described Diopertr. { ' -• � _ ': Anchorage Recording ?+educt, ALnka ltmd Ult"tae. i ...:.`r..,'•. •a• : . _ ltnprovet:>eau sltnalsa tbsrepn,ue.�itaia tbelprvpee'1y �. �., tinea and do DOL ovKttp or'ejArvarh 00'the ty, �.• > •• .. : `;,, yytnl a.djarent thereto, last a» im �m ti m •; :.• arty lying ediseeal thereto enao.eh bre tho yr:mta.si' Qaosre ttm and that there ano zoadtva s. tranatnLnian. .: Lnes or other visible eatemlints on said propettjr.ezaept Dated at tia Ricer, Alaska •tl y; tTAtc%.r.:a__day�S.•_ ROBERT-Q-40ILN•SON .?!.cd . SCALL`. T.ezil'.ered Lind swvelor.No. dd0.I•�,. �' DOz,'e36. Eagle RiveZ;Alaike' l MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW030417 tC)1 (Z6 -1a -Z3 -tl�'w Date Issued: Oct 08, 2003 Expiration Date: Oct 07, 2004 Parcel ID: 051-042-41 Legal Description:! DEER PARK BLK 3 LT 31 Design Engineer: 0041 AK Water & Wastewater Consultant Site Address: 022143 DEER PARK DR Owner Name: Jeff & Connie Irish Lot Size: 40000 SO. FT. Owner Address: PO BOX 670593 Total Bedrooms: 3 Permit Bedrooms: 3 CHUGIAK , AK 99567-0593 This permit is for the construction of: ❑✓ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specked in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3_ The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: b ! 1tS 3 y(?/�W V2. Date: Municipality of Anchorage 6• � • Development Services Department Building Safety Division 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 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING C Parcel I.D. om--NA _?_L41 Permit Number 1 W030417 Property owner(s) JFFF AND CONNIE IRISH Day phone 688-0533 Mailing address (1) P.O. BOX 670593 * CHUGIAK, AK Mailing address (2) Zip Code 99567 Legal description (Lot, Block & Sub'd.) LOT 3 BLOCK 3: DEER PARK SUBDIVISION Legal description (Section, Township & Range) _! z4 2,Z 14 :�j 7-) Q S t- 20-c-1' D {, LotSize4?i, Uff) Acre Sq.Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR: Sewer Only 0 Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. ALASKA WATER do WASTEWATER CONSULTANTS, INC. SeQ}(c Permit Fees: '400• Waiver Fees � 100 0 Date of Payment: 7-d2 -03 Receipt Number: Date of Payment: %-d / • 03 Receipt Number: 4 2.v, i ALASKA WATER & WASTEWATER .s.—.— CONSULTANTS, INC. —'��"•�`� September 23, 2003 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Proposed Septic Upgrade for Lot 3, Block 3; Deer Park Subdivision To whom it may concern: The existing 3 bedroom house is served by a private well and a septic system. The septic system is in a state of failure and needs to be upgraded. A test hole was excavated on the property. The drainfield will be designed around the 30 foot radius of this test hole. We are proposing to replace the existing 1000 gallon septic tank with a new 1000 gallon septic tank. We are also proposing that a 5 -wide type drainfield be installed. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that an application rate of 1.0 gallons/day/ftZ should be used. 2. TRENCH DESIGN: a. Percolation Rate: 1.0 minutes/inch b. Proposed Application Rate: 1.0 gallons/day/ftZ c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 450 ftZ f. Total Depth: 8 feet (max.) g. Effective Depth: 4 It. Width: 5 feet i. Reduction Factor: 0.5 j. Minimum Length: 45 feet long k Effective absorption area = 4502 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507 Ph: (907) 337-6179' Far: (907) 338-3246' Website: akwwc.com 4. TOPOGRAPHY: The area around the proposed drainfield is a 2 to 5 percent slope running approximately south to north. In short, there are no slope concerns. 5. WELL WAIVER REQUEST: As can be seen on the attached site plan and design drawings, there is little to no area available to upgrade the septic system. Based upon this fact, we request you grant 90 foot separation distance waiver from the well to the proposed septic tank and drainfield. The following items are justification for the waiver. • The lot has a slight slope in the area away from the well. There is also a house between the existing well and the proposed septic tank. If the septic system was to overflow, it would not travel toward the well head. • The location of the septic system is in a very visible area so that if any effluent was to surface, it would be noticed and the problem corrected. The other path of contamination is subsurface migration wastewater should the tank begin to leak. As can be seen on the attached well logs, the well depths vary from 45 to 82 feet deep, with a layer of 10 to 15 foot clay and gravel lense that has served to inhibit the migration of untreated wastewater into the aquifer. Recent water sample results indicated nitrate levels to be 0.1 mg/L and coliform bacteria results to be non-detected. Based upon the aforementioned facts, it appears that there is minimal risk associated with the 90 foot separation distance waiver. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your eecicfonrn .E., M.S. NOTE: A site plan drawing, a design drawing, a soils logs, and a 7 page constriction specification letter which are all part of the design package for this septic system. 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507 Ph: (907) 337-6179 0 Fax: (907) 338-3246 0 Website: akwwc.com 3 DEER PARK S/D; LOT 3, BLOCK J, i I / `-SEPTIC AREA / \ DEER PARK S/D; DEER PARK S/D; LOT 1, BLOCK 1, EXISTING 3 SEDROO / DEER PARK S/D; / LOT 2. BLOCK 1, / / / / ----------' r I r LOT 4, BLOCK 3, 1 I 1 ------�------ I /I /I / I 1 -1 I \ 1 PROPOSED SEPTIC UPGRADE (SEE DESIGN, PACE 2 OF 2 SEPTIC SYSTEM DEER HORN S/D; LOT S*BLOCK 2. SERVED BY PUBUC WATER / r � /Y/ DEER PARK 5/D; j ( LOT 2, BLOCK J, / IAC `� I DEER HORN S/D; -!D LOT 6, BLOCK 2, DATE: ALASKA WATER & WASTEWATER CONSULTANTS. INC. JEFF & CONNIE IRISH DEER PARK SUBD PHONE NUMBER: 688-0533 LOT 3, BLOCK 3, TYPE OF WORK: SITE PLAN FOR SEPTIC SYSTEM UPGRADE I 1 1 1 1 I 1 I C.J.G. r LE: AJ[ i ..�. 1 " = 100' .. ......... . . ......... E NUMBER: $: 1 OF 2 %r, Jeffr A. Gern s� p v+vry � 7 \ I 1 -(NO VISIBLE WATER \ DURING SNE VISnS) _ WO (� If A 1 Y 1 I I \ 1 I \ � 1 �4\ ;f. -PROPOSED DRAINFlELD. EXCAVATE A TRENCH THAT 5 8 FEET DEEP MAXIMUM BY 5 FEET WIDE BY 45 FEET LONG. ADD 4 FEET OF CLEAN, WASHED SEWER DWVNROCK. .0 lit NOTE: THE CONTRACTOR SHALL HAVE THE 100 FEET 'ELL RADIUS ON THE ADJACENT LOT, THE 90 FEET WELL RADIUS ON THE SUBJECT PROPERTY, AND THE EAST & NORTH EASEMENTS FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. APPROXIMATE LOCATION OF ELECTRIC LINE TALL ROW DNERTER TALL DOUBLE CLEANOUTS LOCATION OF ELECTRIC LINE EXISTING 1000 GALLON SEPTIC TANK TO BE EXCAVATED OUT AND REMOVED OFF-SITE AND REPLACED WITH A NEW 1000 GALLON SEPTIC TANK INSTALL FOUNDATION CLEANOUT DATE C.J.G. ALASKA WATER & «TASTEWATER p, ' vA SCALE: CONSULTANTS. INC. �" = 40� �.... "• •"•.. T F TIMM ROADM . AK 00501 • PRORF (001fl31-0AO • FAX (0010-SP16 . $TF 101 • ANCHORAGF155 ➢MED FOR: PHONE NUMBER: PAGE NUMBER: JEFF & CONNIE IRISH 688-0533 2 OF 2 A. G Q e O�a '•, ness.: E 9 AL DESCRIPTION: DEER PARK SUBDIVISION; LOT 3, BLOCK 3, Q °^°d \FeI • f0391 • 00 a 101i E OF WORK:°T DESIGN OF PROPOSED SEPTIC SYSTEM UPGRADE o�dJ 4000 OF ALASKA «'ATLR & WASTENVATKR H y�00 CONSULTANTS. INC. a a SOIL LOG — PERCOLATION TEST �. ......... 0 LEGAL DESCRIPTION:. DEER PARK S/D; LOT 3, BLOCK 3OD10 of e . Go ness:. PERFORMED FOR: JEFF & CDNNIE IRISH DATE:- 688-0533(feet) P, ofessiol\ -- - TEST HOT_E_# 1 0400000 1 FILL SOIL CLASSIFICATI0N 2 ORGANICS R`=-0: GW =__= ORG \'� .'r -> ----- - *- — `` 7.e GP I III ML 3 Al J ���TH+ 1 1 4 GC I' ' OL �\',� -- SW MH / 5 I •• SP CH ". , r g I 'owblas SC i ,', GP—GM TO SP—SM .S I ;.� (DENSER 9— T-, =U W/DEPTH) _ II / SITE PLAN 10 1'=100' 11 • �j •'f `l 12 •' •Ii 13 • I 14 B.oa1. 15 16- 17- 18- 19 61718t9 PERCOLATION RATE 1.0 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 5.0 FT. AND 5.5 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES N NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: JODY MAUS COMMENTS: PERFORMED BY AKWWC, INC. I, JEFFREY A. CARNESS, CERTIFY THAT THIS S ERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 03 DEPTH TO GROUNDWATER DATE DRY 9/5/2003 DRY 9/9/2003 DRY 9/15/2003 8:00 — DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 9/6/2003 1 8:00 — 6' — 2 8:05 5 0' 6" 3 8:06 — 6• — 4 8:12 6 0" 6' _ 5 8:13 — 6' _ 6 8:19 6 0' 6" Municipality of Anchorage Mark Begich, Mayor Bttildin� Sttfcty Dig ision P.O. Ik)x 196650 • 4700 Bragaw Street Anchorage, Alaska 99519.6650 • (907) 343.8301 • Pta (907) 343.800 11 it Inffinny.man. 10/16/2003 Jeffrey A. Gayness, PE Alaska Water & Wastewater Consultants, Inc. 3701 E. Tudor Road, Suite 101 Anchorage, Alaska 99507 Subject: Waiver Request for Deer Park Subdivision Block 3 Lot 3 Waiver Request #WR030087 Parcel ID #051-042-41 Construction Permit Number SW030417 Dear Mr. Gamess: Your request for a waiver of the required 100 feet horizontal separation from the absorption field and septic tank to private well has been approved. The approved separation distance is 90.0 feet. This waiver approval applies to the existing absorption field and septic tank to private well separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, L/ GGi Daniel J. Roth Civil Engineer On -Site Water & Wastewater Program Municipality of Anchorage \\ Development Services Department • 1 Building Safety Division On -Site Water and Wastewater Program _ 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchoragc.ak.us (907)343-7904 Waiver Review NYorksheet WR#: 030087 PID#:051-042.41 HAM Permit#: Date Received:f9 30/03 Legal Description: Deer Park Block 3 Lot 3 Engineer: Alaska Water & Wastewater 3701 E. Tudor Road Ste 101 Applicant: Jeff & Connie Irish Waiver Requested: 90 foot separation distance from the Well to the Septic Tank and Drainfield Criteria: Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: ..asonese....................oneness.............. sesames ..... move .... *ones ... 1 Waiver is Granted: _ � Waiver is not Granted: List Conditions or Reasons for above: � F L- /j 17-/% C "F/9 Date:9 O By: P,6Al Name of Reviewer ................. .............. mesa .......... ............ .......... ago ....... .s Rec#: 42371 Amount: $1000.00 Dale Paid: 9/30/2003 W///✓ER REQNS7 FOR OEE12 PR-IP�SNBO%V%SIOv I$LD t -TO -r 3 wA1vFR 1QF_Quc:rr /vN/t49EIQ WR0300$7 WAIVER RF-gt &sr Fon ON -Lor t~/p-rF/? WFLL TU SFPnC rq"k i APP I48S0IPp7-IoN FIELD OF 90 FF_ET, j -S FPr/ c DAT -4 - THE SEPTic SYSTEM To BE coNSrTUCrFO WILL gF A c0.1v6N7-1owj wWW TAArk AuD u' I VE GRAIN F/R LD T/YAT &-#tL. 1JOTN IgA_ $ FEfr' 12EFP, rl{E son. r BSE s"Km Hf o9R6Ib /l I� gTJg-ieT Ou r Pam Y GXAv6p 6f2RvIL (crP) �O/A/b TOR SP JM /Nb DENfF�p t-IYN N r;E>l 06prH, rh r,n IS :i SILT co,✓TENT RPV rI/IS rYPF_ OP SOIL I f vSIeYAv,5j2u/47,,r- K!`\TX2F,47-i4o6 IFGr/c r/9 -Alk /°FFLNEENT, rKE by PERcO4I4?rr AT M/A, rrz//A,CJ{ AND TK$ SP/SM /,mnv&c7 /",c PLKS )"46 SkKiac>= S10P65' ARE GEN6RaLtr FL14T wlrN A SGI6, SLOPF_ DowvL. PIRP rD rHF_ Aiole-hi coAicL.KG6r pit: 1„ 19fM--cuar IF 6141A/C19 .4ccesf ro rHi^ 61eoKAvrul¢>:ACE hull,,. Nor M16logrE rowl4no THS t�,EtL. —WEL.L VAr.4- 19LL Tt/E IN14TF_ I? tWF LLS IN TI-t/J f9l?EA• /41eE f r 7-v b 4 F 6f T DEEP, COARSE 6RI4v51 P rtAIOf ARE F_AiloKar6Re0 t(Alra- .4 PUT/AICT CLAYLAY62 /$ RFd Ar f/ FEET 7-H E' 6612gv6L ? w/4rfR tf EivCOu.tTFsIQsO. TftP- f L„ CE LGS Ie.TKIS AlCrA l✓EQr! 7`ttL Oe ILL TKF F_R/QLY /jOIS /NfGuG/A'6 SKOTrSCT- 4.ELL ANO NO N/rR4rES ARC GEracMOc-E..4po NO g,#cr6/?14 PIPES Tk>= WATE:ASuPPI 16D r'0 7HFSE t..>:LL1 Bj' TAftf I9 C?u/FSA; ftPpC�gRf To BE coNF/NI-O r-WOAA, MVY 5uRF/4eC coair4m �NaTro,v Of R. D. E. G. S. 0. W. G. For S. C. R. 0. POI/ TS �-. LVATFR TRBLE 6-RACIEN7 fiSS k tit F CoNsEI?vr4j'Iv! �NOR�70ryTl3L S EPI+IP/4Tr0,� Co#VCLU.Tt0A/ G J2�-uT" w�4-�vF_i4 &RftO TO TAqL 14.1 1 W�T�R Ti4DLE 576 , i� w14TER — 8 To 7 .. 48 - 437- 4. 6. D PERM EI95ILITy (�B�l.2st�fe,3 0 �-. LVATFR TRBLE 6-RACIEN7 fiSS k tit F CoNsEI?vr4j'Iv! �NOR�70ryTl3L S EPI+IP/4Tr0,� Co#VCLU.Tt0A/ G J2�-uT" w�4-�vF_i4 &RftO TO TAqL 14.1 1 �\ MUNICIPALITY OF ANCHORAGE 'J DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street • Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME / f o/UJ T P ONEQ 9�/63� NEW ❑UPGRADE MAILING ADORES v ox . LEGAL DESC TION 3 s DQP a�G s ova' er,Bn, ... LOCATION NO. OF BEDROOMS DISTANCE TO: Well .4 A- Absorption ares f' pwelfinq,, r 7 PEHMI NO. O Y .J — I IJ %I O a6i~ Manulxturer Mater' No. of compartments Liq. p p it ggalions �� IF HOMEMADE: Inside length Width Liquid depth DOZ - DISTANCE T0: Well Dwelling PERMIT NO. O —Z < Manufacturer Material Liquid capacity in gallons W = DISTANCE TO: Well l C /' f, FountlatiY Ap� .j, — Nearer[ lot Ilg� f"-I(-PEHM ! NO. li�gl u.Z Zw No. of lines Length of ah Jjne/ Total lenj Vines Trench width /,, Distance De�yr!e lin s P s J L U inches 11 h Tan of rile to finish grade 2-3 M� .riY ben th rile O l ne Total of fect absor n area a Z Z t inches W Length Width Vepth PERMIT NO. D Q, H W Q. Type of crib Crib dia ter Crib depth Total effective absorption area w DISTANCE TO: Well Building foundation Nearest lot line CI,Tsc..1� Z .. Depth Driller Distance to lot line PERMIT NO. W V 3 DISTANCE TO: Building foundation Sewer line Septic tank Absorption areals) OTHER PIPE MATERIALS (! G 14 1 G SOIL TEST RATING INSTALLER ^ C/•• ' ` f J f IF REMARK OF AL %%I Ro64st A. Sh r • W 0 1. iwtaa� APPH E DATE LEGAL SQt S F..nnirDr.Ir //AINil..trlw P.b...rol S7)•0CIf1 COPY o'i1M<Mr.M. AI.•N "Sol ].O�S VLTCM W It M 0►0 1,0111.1 C~.r Mw Magnuson Drilling o.t.e.t. LK•1 r. 1.1n1y 1.01,0 r. Duna o1 wu n.... <wla. •IIMr 1., n..1 1<. A.o.L. w. I.. bnV1A WNIVItIw Lot 11KL U. fNCEI•. Mat lw b. TO Iftlp 4y. rw1,04. pf-I 1 1 vs w I{. OI•uK. AN 11fKtl.o•Ire. Awl 1.br<«uw. BIW ). OWNER Of 140.1.1 Paul Myers A4,01.00: Eagle River ftrwt M,0r.,, .N All. It MIT L«11I.. I G6TIMRTED . tALL LOC f•.1 Mlr A. VIIL WT", (t.wlgNl W/r.<. tbwtiw NU or ,,.._. C,o,01.pLt:r M•Url•1 TTw w bI I.. ft. �- a S. 0C.11. twl OM14/1 ❑trl.w 0OW1 . ay#v 1 0AW1.r ❑JaIN ❑bn,0 00tN.ft— Cr"Ve and Water t. us[; ®G.ro.tl, O•NIIO t.wlr ❑brntq ❑Irr ll.11w ❑RKM11. ❑Low.f<I.1 01..1 wll ❑OIM" NCjjCE LASINC: „y , G.. N56 ft. art► wy►t 17 b✓/t I., t• ft. O..t► 1. ti-IIN O1 WILL, CND T,rd, Open 4tcty— Sl.t/N•.M 311.: Uq P: Mt Il1Np,: f. STATIC WIN LCVCIt 1t. ❑Abrw ❑MIw I.N wr649 TIM of M...r. tz • 10. IWNIING LEVEL MI. I.M •.'r,. It. •Ito 01,. A'N�Iq 1.► ft..ft./ ►...0+00.1 nr ll. Lt LL MCA* CMILiTIW: 0 1. Aw1o..1 /lt ©Iitlos. 04ytar 1«M, •Mw 1nb Is, CLOUTINC: wll C,wt.,0: Oros ®~ M to, 411 ❑M«t C.r t ❑OIMft 1), pin0: (It INIt•MIM) MI 1/3 L0.1tN •1 Dra0 01M 46 It. t.wClty 10 Str.: L.]1Vb.1•I►1. 01"1"«1/iN1 ❑J.t ❑OtNr• • . H. ACMAAAS: Bail tested at 10 g.p:In. If, MTU WILL CONTRACTOR'S CERTIIICATION: this wll w, 1,111.4 Wo w J.11,4I10w •N IMI, r•wrt 1. ION t. tM M.t of .q ►1...1«p .N MILS: Magnuson.) i11�inM • Mro AA 5385 A ..... :P.O. Box 504 Eagle River AK /s/ William R. Magnuson 1,ar Jul 6, 1981 •,rlrolliN MII•N.1•t'N to. 02•1M COPY 01Stf'MII6NI MMIlt - ft.t• *GCS. /IMM . *11114!. CAWAt . Cv,tw, I PERMIT NO. I F=*nL_ I T•r CI= PJt-a0Hnfz:,HrE DEPARTMENT G^.HEALTH AND ENVIRONMENTAL '`'?TECTION 825 'L STREET, ANCHORAGE, AY,. 99,..1 264-4720 ID r-4 TE S E1-1EF ' FIEF! Pi I T < 010810 ) APPLICANT MYERS CONST PO BX 351 CHUGIAK 694-9633 LOCATION PETERS CREEK. LEGAL LT3 BLK3 DEER PARK S/D LOT SIZE 40000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BP.)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C�EF�TH= I!,- L_a"C3TH= ?F: GRF-ik: EL_ L�EF�TH= :;2 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AFJD THE BOTTOM OF THE EXCAVATION (IFJ FEET). THE TF?EtJCH FJ I [7TH I n> - THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IFJ FEET). FrEL�L� I RED SEF?TIC Ttat�F� S I E=- PERMIT PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING, THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE FJUMBEP, OF RESIDENCES THAT THE WELL WILL SERVE. --- TWC' C 2 7 I tJ�-F=*ECT I C•tJS nFiE FR_ EC?U I F?EO --- BACKFILLING OF ANY SYSTEM IJITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A IJELL AND ANY ON-SITE SEIJAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE I -JELL OR 150 TO 200 FEET FROM A PUBLIC I -JELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER, LINE IS 75 FEET. OTHER, REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F~ERM I T E: ;F=' I F= E:S D>ECEMEsEFR :3:1. 1. 1 I CERTIFY THAT 1: I AM FAMILIAR, WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I I -JILL INSTALL THE SYSTEM IFJ ACCORDANCE IJITH THE CODES. I UNDERSTAND THAT THE ON-SITE SEWER. SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED yO INCLUDE MORE THAN 3 BEDROOMS. SIGNET_ - I ISSUED . -----DATE-_ DATE -_R17: --- V4. 0 t7U" I C I PFIL. I TY OF RIVCHORROE ----- ;�. DEPARTMENT ^•HEALTH AND ENVIRONMENTAL - OTECTION ~ 825 'L STREET, ANCHORAGE, AK. 264-4720 O N -SITE SEWER P E R M I T PERMIT NO. C 810310 > APPLICANT MYERS CONST PO BX 351 CHUGIAK 694-9633 LOCATION PETERS CREEK LEGAL LT3 BLK3 DEER PARK SID LOT SIZE 40000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING CSO FT/BR>= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: L?EPTH= S LEfVOTH= eao [3F;ZnVEL 1?EPTHm � THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BET14ES�HE SU FACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION <I14 FEET>. f��p,� q/ THE TRENCH 14X[:> -r" THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). REQU I REC> SEPTIC TF:W"K S 12r E- 1 joiac3 OM�L_LOt,15 PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY 14ELL5 ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL 14ILL SERVE. --- TWOS C 2 } I tJSPECT I OIVS FIRE REQU I RE1> BACKFILLING OF A14Y SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SE14ER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PE RM I T EXPIRES DECEMBER =r:3_, 1 4 B I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE.' 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED:____ / 240 APPLICANT MYERS/C ONST ISSUED 4. 0 dd%l , PERFORMED SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 2644720 SOILS LOG - PERCOLATION TEST r LEGAL DESCRIPTION: /_ 3 d 3 SLOPE 1 (FELT) f / S'lL 7 C� S -/j ^t o Net Time Depth to Water Net Drop r_ 2 \ Or 3 .e . \e 4 Jilr 5 �•o 7 .�. - a u� y e 9 0 �• 10 v DATE PERFORMED: Z Ha rY/ J_//v WAS GROUND WATERS ENCOUNTERED? Co•S L 12 Iii f�% D P D� Dl+�- ✓ 6 IF VES, AT WHAT l� I E 13 f DEPTH? 14 15 .\i .•`g 16 _..•• a•.. 17 jc [poem A. Shahr. 19 u W, 1137-E 20 `A��tRCFCcgO�.: COMM SITE PLAN FJ Reading Date Gross Time Net Time Depth to Water Net Drop P-7 Jilr PERCOLATION RATE — (minutes/inch) TEST RUN BETWEEN FT AND FT PERFORMED BY: S & S EngiueniDQ CERTIFIED 72-008 (6/79) Cel Parcel I.D. 051-042-41 1. GENERAL INFORMATION Expiration Date: /CC -/ Chi - /5— Complete legal description Deer Park, Block 3, Lot 3 Location (site address) 22143 Deer Park Drive Chugiak, AK 99567 Current Property owner(s) Jenifer L. SWigart Day phone Mailing address Real Estate Agent 22143 Deer Park Drive Chugiak, AK 99567 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Three Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: COSA Fee $ 5,R a Date of Payment's 1/5 Receipt Number 0/9406 COSA # 050,1044 Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION ER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 7/7/2015 By: _ ! 'e7_e" J Original Certificate Date: 7-10 o -/s--The Mui'ii ' It c ge 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 clvil 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 Septic System Advisory Well Flow Advisory CASA Nue sheet r '- ..t c Nitrate Advisory Arsenic Advisory Other ���P"� ���®o 6. DSD SIGNATURE 00"'•�•V..' . '.0 System #1 Approved for ®.,::.V.......... bedrooms /e 8"' A - MICHR KNDERSON System #2 Approved for _ bedroomsCE-4381 Disapproved �Olt,RQaas Conditional approval for oe��so bedrooms, with the following stipulation. By: _ ! 'e7_e" J Original Certificate Date: 7-10 o -/s--The Mui'ii ' It c ge 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 clvil 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 Septic System Advisory Well Flow Advisory CASA Nue sheet r '- ..t c Nitrate Advisory Arsenic Advisory Other 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: Deer Park, Block 3, Lot 3 parcel ID: 051-042-41 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 7/6/1981 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 56 ft. Cased to 56 ft. Casing height (above ground) >18 in. FROM WELL LOG Date of test 7/6/81 Static water level Unknown ft. Well production WATER SAMPLE RESULTS 10 AT INSPECTION 6/22/15 25.5 ft. 8.6 g.p.m. Coliform 0 colonies/100 mL Nitrate ND mg/L Arsenic ND ug/L bate of sample: 6/11/15 Collected by: And. Engineering B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Data installed 10/8/2003 Tank size 1,000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) f V Date of pumping 7/7/15 Pumper JRs Pumping C. ABSORPTION FIELD DATA Date installed 10/9/2003 Soil rating (g.p.d./ft2 or ftZ/bdrm) 1.0 GPD/SF System type 5' Wide Length 45 ft. Width 5 IL Gravel below pipe 4 ft. Total depth 9*7 ft. Eff. absorption area 450 fe Monitoring tube Y Depression over field N Date of adeY uacy test 6/22/15 Results (Pass/Fail) PBSS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 523 gal New depth 0 in. Elapsed Time: 0 min. Final fluid depth 0 in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N Absorption rate >= g.p.d. If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' level at in. Datum Cycles tested E. SEPARATION DISTANCES - AWWU Water System WELL ON LOT TO: 90'* Manhole/Access(Y/N) High water alarm level at in. Meets alarm & circuit requirements? Septic tank/lift station on lot On adjacent lots >4n0' Absorption field on lot 901*On adjacent lots >100 Public sewer main >75' Public sewer manhole/cleanout >100' Sewer /septic service line >25 Holding tank >75 , Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5 Property line >5 Water main >10 Water service line >10 Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >10, Building foundation >10' Water Service line >10, Surface water >100, Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS *Waiver Issued. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. Date 7/7/2015 COSA brown sheet 10-10-12.doc Absorption field >5' Surface water >100' Water main N/A Driveway, parking/vehicle storage >10' it '.•+�„ MICHAEL E. ANDERSON r� j "�•. CE -4381 �,41111111pA�q�� Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL / FOR A SINGLE FAMILY DWELLING gam_ 75s Ute( Parcel I.D. 051-042-41 COSAH 09 D q,2!1 Expiration Date: %-- f ._ 1. GENERAL INFORMATION Complete legal description DEER PARK SUBDIVISION BLOCK 3 LOT 3 Location (site address) 22143 DEER PARK DRIVE CHUGIAK AK 99567 Current Property owner(s) BRUCE b DEBORAH HOLLEN Day phone Mailing address PO BOX 671454 CHUGIAK AK 99567 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system Is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services, LLC Phone 272-8218 Address P.O. Box 102954. Anchorage, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date 4/1512009 Engineers Comments: In conducting an adequacy test, l attempt to provide a thorough, conscientious engineering analysis or the system in accordance with hI0A DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the lest, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions arc outside the control of the evaluator of this system. All systems eventually fail anc satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there arc no hidden defects or encroachments. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized nor will it confer any legal right whatsoever. 5. DSD S1PNATURE Approved for _,� bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: fl+ / - Original Certificate Date: 7 — z --0q (Rev 11X5) SGS SGS ReLM 1091356001 Client Name Pannone Eng. Srv. Printed Daterl'ime Project Namt/N Deer Park 11313 Collected Dalelrime Client Sample ID Ner Park 133,L3 Received Datefl'ime Matrix Drinking Water Technical Director Sample Remarks: 0413/2009 16:57 04/06/2009 15:26 04,'07/2009 11:30 Stephen C. Fade Allo%ahle Prep Analysis Pammew Results ppl. Units Method Container lD Limns Date Date Init Waters Department Total Nitrate/Nttntc-N ND 0.100 mg/l, SM204500NO3-F II (<10) 04/09/09 JD/. Microbiology Laboratory Colony Count 0 Total Coliform 0 Fecal Coliform 0 col/IOOmL S\12092220 col/IOOml. S\12092220 col/IOOmL S\720922211 A (<200) A (<I) A (<I) 04/07/09 KAR 04/07/09 KAR 04/07/09 KAR Municipality of Anchorage • Development Services Department .i E Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650�j Anchorage, AK 99519519-6650 www.muni.org/onsite (907)343-7904 0 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 0 -rI — O g 2— q I COSA# 0 R d 2 9 1. GENERAL INFORMATION Expiration Date: — ? "7 — 0 Complete legal description DEER PARK, BLOCK 3. LOT 3 Location (site address) 22143 DEER PARK DRIVE • CHUGIAK. AK 99567 Current Property owner(s) BRUCE & DEBORAH HOLLEN Day phone C/O AGENT Mailing address PO BOX 671454 • CHUGIAK. AK 99567 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well E Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of 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 samples. (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 engineers 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 riles 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineers Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines B Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benorit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE _Z Approved for 3 bedrooms. Disapproved. Phone 337-6179 Date k ZZ j 0 I Conditional approval for bedrooms, with the flowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory 9 `11A V Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other . , , . . . I . . OFgly'%,,. ONSITE ••' to WATER AND : R'= WASTEWATER Q� PROGRAM By: fit/ Original Certificate Date: 2 ly � C) JR.. t A5) Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water 8, Wastewater Program 4700 Bragaw Street P.O. Bax 196650 Anchorage, AK 99519-6650 www.munf.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: DEER PARK, BLOCK 3, LOT 3 Parcel ID: 0,5_1-0 1/.21/ A. WELL DATA Well type MOTE If A. B, or C provide PWSID# N/A Date completed 7/6/1981 Sanitary seal (Y/N) YES Total depth 56 ft. Cased to 56 ft. FROM WELL LOG Date of test 7/6/1981 Static water level UKN ft, Well production 10 —9 -P.M. WATER SAMPLE RESULTS: Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 24" in. AT INSPECTION 9/23/2008 24 ft. 8.5 g.p.m. Coliform 0 colonies/100 ml. Nitrate N—mg./L. Other bacteria 0 colonies/100 mi. 12/12/2008 Arsenic: NO ug./L. Date of sample: 9/22/2008 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material - STEEL/ SEPTIC Date installed 10/8-9/2003 Tank size 1000 gat. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 9/6/08 Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATA a Low EXISTING GRADE Date installed - 1018-912003 Soil rating .p.d.! r ft'/bdrm) 1_0 System type TRENCH Length 45 ft. Width 5 ft. Gravel below pipe 4.0 ft. Total depth •9.66 ft. Elf. absorption area 450 ft' Monitoring tube YES Depression over field NO Date of adequacy test "9/23/2008 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test DRY in, Water added 950 gal. New depth 111 in. Elapsed Time: 360 min. Final fluid depth DRY in. Absorption rate >= 450+d. 9 P• Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - **PRESOAKED WITH 1500 GALLONS ON 9/22/2008 D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" Level at in. "Pump oft" level High water alarm level at Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot •90 On adjacent lots 100'+ Absorption field on lot '90 On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parkinglvehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *WAIVER #WR030087 G. ENGINEER'S CERTIFICATION Nyl- Ur I certify that I have determined through held inspections and p e 49T y t� r. ............... . review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this „ •,,, ..... •.. f date. �g A. Gar ess: Engineer's Printed Name JEFFREY A. GARNESS OQOtiE { ARG .� � Aq 100, •.12 22 Date f--l��V� 44n.�.�'�of ess, r'0\ COSA Fee 4 L� 3 ° Waiver Fee $ Date of Payment I :X v Date of Payment Receipt Number 3 Receipt Number (Rev. 11/05) C-23-200'3 03:19 PRUDENTIAL VISTA PEAL EST 907 562 5435 I%. V�7` 04%0 MY % -`\ i ---r---------- P.02 n FUN 7 UMATMM A• -RAT MERV A{, ff"atT m A►.A,IT tateu�eY 51rRYF'1' T w.rNs Ae•A�T .... •r.,us r..aT M MAy[m1 TAMM Received 22 -Dec -teas O4:19pa 1 t Aga lot�J I� 1� /CL of W 6 _.e �ti / :7 w 3 Prepared by Robert E. Johns, Jr. & Assoc. e.0" i• 40'. --- ---- 12-22-08 ",IF= "M I bL,�rd'*A� I2-27-C8 k Lot3 Bltrl 3 pecr Pa -9c 1T'� • SET MM '� � CIMN"& :.: •.. ..: A PNMT NO R�A.D�fRnDO�R+�0��1at. 19vOR TO oMty r.we F OMMANTD APOW OMwNO Mo v14t1 WL eK um q+CCTW�4 ANO tA0 D[ nK �.o :tee iwei�w Mme•. f@7f0 4 R .�e0K. mKT•�l+T! pt MESMrC'�oM! rwr MllevT51T '�MQ IM11� �s •f7w o� No SCG �Gm R10D�MAOM ►IJ�T. I.�L PrfT.w P O MI i xm*LA• M oe..•IALT K L= FM CDIQTNUCIION OR roe C:'M•Uwe" M01000Y OR SDMK t•Q h fele IM NTIAL TIUwN•CTOM O•.T MO AMOM H1AwAL UAMM O&Y FDR ?W Cosi OF 1V[ SISI Wy u,w r m. eVM eIWM rMv*o YCIIOI MAT CmM 011nn N !GAIL Fro: - To -Relocation Dept. Pace 002 TOTAL P.02 L VqJ SGS Reta 1086571001 Client lame Garncss Engineering Group, Ltd. Project lame/p 22143 Deer Pk Tank Client Sample ID 22143 Deer Pk Tank Matrix Drinking Water PR'SID 0 Sample Remarks: Printed Date/time Collected Dste/fime Received Date/fime Technical Director 12/17/2008 11:05 12/12/2008 11:15 12/12/2008 12:10 Stephen C. Ede Allo%ahle Prep Analysis Parameter Results PQL Units Mcttad Container ID Limits Date Date [nil Microbiology Laboratory Colony Count 0 col/100mL SM -109222B Total Coliform 0 coU100mL SM20 92226 recal Coliform 0 colIl00mL SM20 9222D 12/12/08 DLC 12/12/08 DLC 12/12/08 DLC SGS ReLN 1085187001 Client Name Garncss Engineering Group, Ltd. Project Namr/B Dear Park L3,B3 Printed Datellime Client Sample ID Dcar Park 1-3,133 Collected Date/time M1latria Drinking Water Received Duelt(me Technical Director PWSID 0 Sample Remarks 10/022008 15:28 09222008 8:00 09222008 9:50 Stephen C. Ede Allowable Prep Analysis Paramettt Results PQL Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 Haters Department Total Nitratc/Nitritc-N ND 0.100 ug/L EP200.8 C (<I0) 09/30/08 10/01/08 NRB mg/L SM204500NO3-F B (<10) MicrobiolgU Laboratory Colony Count 120 wUl00mL SM20 92228 Total Coliform Negative col/100ml- SM1120 922213 Fecal Coliform Negative eoUl00mL SM209222B A (<200) A (<I) A (<Il 0925/08 JDZ 0922/08 DLC 0922/08 DLC 0922/08 DLC Municipality of Anchorage .° Development Services Department =� ° Building Safety Division 13�' Onsite Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 995195650 www.cl.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-042-41 HAA# 0 3 06- 3 0 1. GENERAL INFORMATION Expiration Date: /— a O —04 Complete legal description DEER PARK SUBDIVISION- LOT 3 BLOCK 3 Location (site address or directions) 22143 DEER PARK DRIVE 0 CHUGIAK AK 99567 0 Individual On-site Current Property owner(s) JEFF AND CONNIE IRISH Day phone 688-0533 Community Class Well ❑ Mailing address Lending agency Mailing address Real Estate Agent Mailing address P.O. BOX 670593 • CHUGIAK AK 99567 Day phone AUDREY MASON w/ REMAX PROPERTIES Day phone 16600 CENTERFIELD DRIVE • EAGLE RIVER, AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 694-4200 3. : TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water samples. (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. 11 Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, or prior to closing /or the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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 Finn ALASKA WATER do WASTEWATER CONSULTANTS, INC. Address 3701 E TUDOR ROAD SUITE 101 • ANCHORAGE. AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AKW WC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKW WC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will It confer any legal right whatsoever. 5. DSD SIGNATURE _J�_ Approved for _3 bedrooms. Phone 337-6179 Date j0116/03 Disapproved. Conditional approval for bedrooms, with the flowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other QPM,•-- -., ..0.�� o �RAND �.•�' , w`ASTE�iV A PROGRAM By: ��(/. / Original Certificate Date: I 0 —1?- 0 - D3 (R".12!01) Municipality of Anchorage Development Services Department Building Safety Division Onsite 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: DEER PARK S/D: LOT 3, BLOCK 3 Parcel ID: 051-042-41 A. WELL DATA Well type PRIVATE If A. B, or C provide PWSID# N/A Date completed 7/6/1981 Sanitary seal (Y/N) YES Total depth 56 ft. Date of test Casedto 56 ft. FROM WELL LOG 7/6/1981 Static water level UNKOWN ft Well production 10 g.p;m, WATER SAMPLE RESULTS: Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 8/26/2003 24 ft. B-0 — g -p.m - Coliform 0 colonies/100 ml. Nitrate D.1 mg./L. Arsenic: N A mg./L. Date of sample: 9/9/2003 B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Tank size 1000 gal. Number of Compartments E Foundation cleanout (Y/N) YES Depression over tank (YIN) NO Date of pumping NEW Pumper C. ABSORPTION FIELD DATABErow� nwu_ caanl Other bacteria 0 colonies/100 ml. Collected by: AKWWC, INC. Date installed 10/8-9/2003 Cleanouts (Y/N) YES High water alarm (YIN) - N/A Date Installed 10/6-9/2003 Soil rating .p.d./f r ft'/bdrm) 1_0 System type TRENCH Length 45 ft. Width 5 ft. Gravel below pipe 4.0 ft. Total depth•7.26-9.26 ft. Eff. absorption area 450 @' Monitoring tube YES Depression over field NO Dale of adequacy lest NEVI Results (Pass/Fail) - For 3 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 "Pump on" level at _in. Datu E. SEPARATION DISTANCES Size in gallons High water alarm level at in• Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOTTO: Septic tank/lift station on lot "90'+ Absorption field on lot '90'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *WANER GRANTED G. ENGINEER'S CERTIFICATION o r 1 certify that I have determined through field inspections and e , • • ,,.�*, review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. . , • • • . ....... ff A. ss: Engineer's PrinteNa a JEFFREY A. GARNESS QQ P C 7953 I �qp Date f D3 4�D"\Q':ofes%1000\, HAA Fee $ -? 1% J - Date of Payment t v • 17.o?) Receipt Number_ (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE ' DEPARTMENT OF HEALTH ti HUMAN SERVICES ., Division of Environmental Services On -Site Services Section Q� P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. ti Q_41 — Q14,a_ Ll GENERAL INFORMATION Complete legal description HAAk 1D15C74 Location (site address or directions) / ¢.:S T�ot.T,L F4> j?.k Property owner -T ztCaNAti P_tSN z+�sw► Day phone W" oS~33 Mailing address PD 80bL (070 S�"� Lending agency _- L'1H-cL� t P�Qg)7%Day phone Mailing address Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rwr.1/91) front MOA621 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 FirmDavid R. Dayton P.E. --2021tTDonaiarS .Phone —Vi 371a AP/i Address ChAak, Alaska 99567. Engineer's signature 6. DHHS SIGNATURE Approved for 2Z.ne2(-T) bedrooms. Disapproved. Conditional approval for Additional Comments Un Date - 45 Oji Y:.✓;s +� ryi �� t... r ... ......., . David G cjyl xj NO. 22205-1 ;•�µ;r �aN.u.••.•^1. er bedrooms, with the following stipulations: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an Independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate Is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-0s5(n•v1A1) B. MOA 021 y, Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: / J" 4� %i.1- A -Z-1 Parcel I.D. -_ n.r/-6e/2- (// A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y e 1 !F" Date completed - -7141' 121 Driller Total depth Cased to Z5,L Casing height Sanitary seal (Y/N) u � 5 - Wiresro erl y p p y protected (Y/N) _ y¢. FROM WELL LOG Date of test Static water level Well flow oN Pump level SEPARATION DISTANCES FROM WELL TO: AT INSPECTION MU"llc.OP'.m ^F Ar�^I+0vAoE /—iA=CNATNT/.LSER`•1%�_SDIVISION 177 FEB 2 2 1993 g.p.m. _'i. S DECEIVED Septic/hokW g -tank on lot - /p ; On adjacent lots - /a0 Jo Absorption field on lot - BOG ; On adjacent lots --/00.4- Public sewer main _�e ��3 Public sewer manhole/cleanout oN 46r_ Sewer service line /O f Petroleum tank i(loA 5 arks_� WATER SAMPLE RESULTS: Coliform 0 Nitrate <00, /0 Other bacteria/ O Date of sample: a /0? /9 3 Collected by: ��-„ �.--- B. SEPTIC/HOLDING TANK DATA Date installed S P/ - Tank size / a O o Compartments Z Cieanouts (Y/N) Y Foundation cleanout (Y/N) Depression (Y/N)- High water alarm (Y/N)—Alarm tested (^Y/N) Date of pumping �[z rA7z, � Pumper rN�u i SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: ` Well(s) on lot I Dd On adjacent lots foo f Foundation 7 To property tine f0 'I' Absorption field S Water main/service line /ot Surface water/drainage 1610 -+- 72.026 (Rev. 7M) Fr nl CONTINUED ON BACK PAGE C. LIFT STATION / iL Date Installed �l ��I Manufacturer: Size In gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) 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,- ":nz�5, Soil rating S AC System type T� .- . j t.:Z�r.r 4 r Total de i Length 3� Width Gravel thickness depth ' ' ZSG Cleanouts resent Y/N Total absorption area P ( ) Date of adequacy test/-2�'i 3 Depression over field (Y/N) On*ss tor / Peroxide treatment (pas( 12 months) (Y/N) N If yes, give date Results (pass/fail) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /Do On adjacent lots /0021 Property line 20t To building foundation of 0 To existing or abandoned system on lot �Na On adjacent lots Ma Arm Cutbank Nvvwtr= Water main/service line �O t Surface water /OO t Driveway, parking/vehicle storage area �n t Curtain drain E. ENGINEER'S CERTIFICATION bedrooms I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this Inspection. Date of Payment -2','4 2 -L? Date of Payment Receipt Numberc::IP4 41 SS Receipt Number 72-026(R". 3N1( Bxk MOA 21 David R. Dayton P.E. r �` . { > ; ! u 20210 Donalar 5t.'r : ""' "`, •, c 567 fe t i:. .::'g".;•+'T Signature .. Engineer's Name /C 4r+.✓ •. .... F Date c72T z 3 4A I.+M.WtN.... r ; ca. rt. HAA Fee $ Oi Waiver Fee: $ Date of Payment -2','4 2 -L? Date of Payment Receipt Numberc::IP4 41 SS Receipt Number 72-026(R". 3N1( Bxk MOA 21 D. R. DAYTON, P.E., R.L.S. UM-A N Chugiak, Alaska 99567 (9071.EE 20210 Donalar 696-2417 February 18, 1992 WELL FLOW TEST Legal Description: Lot 3, Block 3, Deer Park Subdivision Date of Test: February 11, 1993 Depth of Well: 56 ft. (per well log) Casing Depth: 56 ft. (per well log) Static Water Level:17.7 ft, measured Requirements: 3 bedroom - 450 gallons per day Test: The well was.pumped at varying rates until the water drawdown was stabilized. Water levels, volumes pumped and time intervals were recorded. Results: A total of 457 gallons were pumped in 136 minutes. The well production at stabilized drawdown was 3.46 gallons per minute. Conclusion: The well is currently functioning adequately for a3 bedroom home. Cord R. to/. NO. 212", • MUNICIPALITY OF ANCHORAGE p DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL �J g� _ C),Qb OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date _z/ -3o — P7 1. GENERAL INFORMATION (a) Legal Description (include lot. block, subdivision, section, township, range) L31� 3 __N'a CA ;>. , Location (address or (b) Applicant Name - �G . h.t � M FE Telephone: Home Business S/O ( 10 l 7,.6 Applicant Address -32oi /°�� �+�t7 F( n.. f (c) Applicant is (check one): Lending Institution d ; Owner/builder 2�Buyer[3: Other ❑ (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: S 8 S ENGINEERING Ij034E3g1e Rhrw-Lv p -Road No 204 Fsele River, Afaske 99577 2. TYPE OF RESIDENCE Sin gle-Familyl�_Multi-Family❑ Other t Number of Bedrooms 3. WATER SUPPLY IndividualWellk Community ❑ Public ❑ f� Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite & Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 411,84) /1—. ben 0 szo-Z[ Z Io z 06ed ll�om s iaaul6ua leuo!ssalad a41 ul suolss!wo io siaia iol olq!suodsai lou s! a6eio4ouy to Apledlo!unyrl e41'panssi si aleo!1!vaO a aiolaq elep Wieue jo suolloadsul ionpuoo lou op d3H0 io saaAoldw3 -sluawannbai alels pue lejapal u!eUao Alslles of Japio u! suo!lni!isu! 6ulpual naUi pue sawo4 io siasel101nd of Asavnoo a se S!141 saop d3HO 841 'e�lsely io aleiS 8U1 ul paiais!6ai iaau!6ua leuolssalad luapuadapu! ue Ag enoge S 4dei6eied u! uanl6 suo!leluasaidai ayl uodn Alalos paseq sateoll!vaO lenaddy Aluoylny WleaH sanss! (d3H0) uo!loalad leluawua!nu3 pue U1leaH io ivawvedaO a6eioyouy io Al!ledlounyl ay1 NounvO rig•' vii '•k.?.',",::. ;.;" Lir ��iri'7,s?t7 t 0 lenaddy leuolllpuO3 to swial leuO!ilpuoO panaddesi0 Panaddy Aq swoapaq Tj/?� SOI Panaddy r, C�IJ ltlAOtlddtl d3H0 '9 a1e0 ssaipptl boL -ON P9all dool a9Ai*d 91663 VV01I euo4dalal wJ!A io aweN -uo!loadsu! SIM io alep 041 uO loath ul suolieln6ai pue'saoueu!pio'sapoo aleIS pue ledioiunyi Ile 4l!m souepdwoo ui st walsAs lesods!p jalemalsem jo/pue Alddns lalem el!s-uo a41 'uo4oadsui pue uo!le6llsanu! Aw wail pue salt' a6ejo4ouy io At!ledio!unVq a41 wwl pouleigo uoliewjOlu! 0y1 uo paseq le41 Aluan ja4vn1 I-u!aiay paleo!pui einioniis io edA1 pue swoapaq to iagwnu a4l iol alenbape pue leuo!louni'ales si walsAs lesodslp jalemalsem io/pue Alddns ialem ales-uo aql leyl smogs lenaddy Al!ioUiny 41leaH sl4l to uope6!leanul Aw 1e41 AluaA I'molaq umoys alep uonep!len a4110 se pue olaiay paxgle leas Aw Aq pa!l!vao sy NOI1tlWIIOANl ONtl tlltl0'HOHtl3S 311A'S1S31'SN01103dSNI ONIOIAOHd MIA JNI833NVDN3 'S MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCHORAGE HEALTH AUTHORITY APPROVAL (HAA) ENVIRO\A4ENTALSERyICES DIVISION CHECKLIST- FEBRUARY 1984 2644720 (� MAY 15 1987 Legal Descrip o A. WELL DAPAECEIVED YAzkViLc Shi 3 Well Classification _S. F If A. B, C, D.E.C. Approved (Y/N) Well Log Present ZON) Date Completed - r7 - to -e / Yield L.PM -r- Total Depth ST�' Cased to 510, Depth of Grouting 1— Static — Static Water Level Pump Set At L_).k Casing Height Above Ground 15" Sanitary Seal on Casing (!7N) Electrical Wiring in Conduit(�/N) Depression Around Wellhead (Y64 Separation Distances from Well: To Septic/Holding Tank on Lot /cx-, '1 ; On Adjoining Lots loc> To Nearest Edge of Absorption Field on Lot //o ;On Adjoining Lots /on'I To Nearest Public Sewer Line WDA To Nearest Public Sewer Cleanout/Manhole �/A To Nearest Sewer Service Line on Lot LS r -F Water Sample Collected by �S cN��/�'- rA/ V ;Date _ ,S1/2�gr� Water Sample Test Results AT 11, PAc-i�R,f Comments t cow B. SEPTIC/HOLDING TANK DATA Date Installed 2-5-S? Size /000 No. o1 Compartments L Standpipes6N) Air -tight Caps&T N) Foundation Cleanout (AN) Depression over Tank (YA6P Date Last Pumped—_S-/3-814 'K Pumping/Maintenance Contract on File (Y/N) NJA ; for N A Holding Tank High -Water Alarm (Y/N) ___fl- Temporary Holding Tank Permit (Y/N) �r Separation Distances from Septic/Holding Tank: To Water -Supply Well _ / oo'-/ To Property Line /Drf To Water Main/Service Line Course i To Building Foundation To Disposal Field $ To Stream, Pond. Lake, or Major Drainage Comments 4` /_�Y -JZ'S Yo. Pn vu. :# _5P CS a -p2-Z Page 1 of 2 72-026(11,84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �S �• Type of System Design Date Installed /� "5" 8 f Length of Field 3 L r Width of Field 3� Depth of Field - Gravel Bed Thickness Square Feet of Absorption Area L5S Standpipes Present/N) Depression over Field (Y/(? Results of Last Adequacy Test Date of Last Adequacy Test A''yz 8 S671,,rf GFLCy %02 S �� Separation Distance from Absorption Field: To Water -Supply Well f� U To Property Line /rca'/ To Building Foundation `y t r To Existing or Abandoned System on Lot ; On Adjoining Lots 31b To Water Main/Service Line lt>* 4 To Cutbank (if present) �� A To Stream/Pond/Lake/or Major Drainage Course �A To Driveway, Parking Area, or Vehicle Storage Area x S Comments t` Sa"*� Fr« 1ALMD 04F4_^2 JL�—�✓ y/ D. LIFT STATION Date Installed Size in Gallons Dimensions Manhole/Access (Y/N) "Pump On" Level at Il "Pump Off" Level at High Water Alarm Level at / `( Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments •• Check Permitted Bedroom Rating Against HAA Request as I certify that I have checked, verified, or conformed to allMOA and HAA guidelines in effect on the date of this inspection. Signel18SIN0INNEEMNO Date •S /S� -,-) Com 17+034 Eagle River Loop Road No - 2 WOA No. R �agYa ve , tit31ts9937T— .; t 41- • �`i t: Receipt No. 1oo�oos'6 s'� `• ..� Date of Payment Amount: $ i it+4vA st Slaw l; Page 2of2 72-026 (11,54) APPLI"—*11 FILLS OUT UPPER 1-I/ NLY .T Prpp„rfyown�r O % l��r, ;I ,cY♦j:. .y. �I M„rling Add,eSS ;Das �•I�e .:cr- C:z PI•one `', --- �' t��+—ftrc.. ,.'pit t'I,cou. Buyer V Address u -- I / r•I ---—...... — i _ Lenemy brslhutwn f^ T.__1 � • t/'y YIG't. _._.._ -....!u Coca 95':5-o-3 . L�r'n3S is %•�. r1 I . I _ f Pnone Adereas �t.�,S; n y� Really Co. 6 A --nl _— _— �—_-___ '_- 0 .-:_I i 1_ ��: !L._. z,P Coo., 7 I •_�. �i S 'r� 3���.�. �•Z Pnone Address--� S Yui �i ryf /•/” I .y Legal Deecnptlon % •:'� `ro�. '1 ''--- f.^ _ Lu Coac-' 9 j SQ i I /�'�s / / L -tom ✓GL+r- fl•_w (� if::�a..cs � :'�� c•.5 C're_,r � 1---��1.1L_ Slreel LDCallan �`•'N rr �`�-Y! ��E.,r l/ �, TY�Dee• of Pesiepnce VAL-� __,- ,------_ .r Single Family r ! I r, Multiple Family No of Uedrow" -- _— J.. :3 other - 1 Water Supply *--- •---__—._... ___'_-_ 1 f-- Indw.dwl 't I - ------ JUL Ci Community — r I i 1 AT TACIT VVI LL LOC. A w,fl n+g r; raVwrrd for all wuhs onuud since ral 1975. i PoDhC Unhly i • For welly Willed pu.•, lu Ina! Idr, o,r•, well iloplh (uflnct, avdllaDlr) - Se-ef �i P.c uYear Ind:vNuaf Inst.fied ., J ham_ J O J i� uDnC utility 1 f. P I_-HNoldmg rank I wt.l:n Comrctrd fu Put'lic Ut nlp _----- NOTE' Yt,[ INSPCCTIO(j FEL MUST ACCOLIPANy EACH SILO)L 7 L•CT UTII {K OCCSSIF;G C.11l DC IN171ATCD--�— MUNICIPALITY O`ltt ANCHORAGE DEPARTMENT OF HEALTH 8 ENVIRONMENTAL PROTECTION Environmental Sanitation Division 825 L Street a Anchofi gc,JF Iaska 99541 a Telephone 264.4720 I � CERTIFICAT OF IIJSPECTIO V ON-SITE SEWER AND WATER FACILITY r ,.�.—a:y-Co„i�F',y• �7c:,�•�•s.i Crsy�lf ..---- iMj.:mj AdbeSs 2. Legal Descophon 20r- 3 l J. Type of Dweumg i X Single Family 1 I Mu:np'e Fainly L: Ofhe, ` 'CONDITIONS OF APPROVAI I I' I 4 Smragu Ursp e.at--- s Vj'e' Su;" -_---_--' V loewiyr:,t 'k LWnWuul I f WDbc UIilIIY :) P"Llic --_(1 Holding Tank - --- -Ci Cornmumly (shared! APP40VAL FOH -- { is CUNDIfIGI l ---- 7 : U15API'Hl1V%,L IH:S APPROVAL NOT VALID t X•Af PHOYED "ItIOIIT DEPARTMENT SFAL �... -. - ^�,.,�.�s^.sir,sw...•..e•Y,e�w•..».�,vr..r,-n...•�m+ ' - APPLIC NT FILLS OUT UPPER HAL~ONLY Property Owner �—a r f, C 0 h. Q o r\ i e v e 5 .1 Le v �v � Phone Mailing Address �oZ s I/t16 S lir 4 a ^ 1� ir. ✓eH v. r ZIP Code G 66-3�.2 q Buyer VtrSrn.� - A. 12"r,e.t \1 Address y Ht ss n ess Ry k- �1 v1, Zip Code 9S S Inspector Lending Institution LbrNaS 4 /Veft/CtL)m Phone Address �y ,r,JkS�ne SS Ne- Zip Code %9SU ,[ 'r63—�T Really Co. d Agent// We M Ke We Phone Address 11 15""" O %' a CAK Zip Code Legal Description L 3 8 3 tee r 1 Street Location ENVIRON'41,1TAL PROTECTION Type of Residence %j Single Family ❑ Multiple Family No.'ol Bedrdomg_3._ ❑ Other Water Supply RECEIVED ( I APPROVED BEDROOMS ( I DISAPPROVED Individual ❑ Community '&NCITIONS OF APPROVAIr ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. ❑ Public Utility �. • , �J''j/ For wells drilled prior to that date, give well depth (attach log If available). Sewer Disposal t, ��h 9t A V Individual ❑ Public Utility Year Individual Installed: - nsu� nn .v. r r / ).Q/ ❑ Holding Tank When Connected to Public Utility: �f NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REOUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time ^ 7/� Time EC /u V Date Date Date , i � -j/ Date Inspector Inspector Inspector Inspector Field ries: r .M.v MUNICIPALITY OF ANCHORAGE '—a"Z `1ee "T DEPT. OF H5A! TFI t. r 1 ENVIRON'41,1TAL PROTECTION MAK 3 1 !?8? Oo�Ir RECEIVED ( I APPROVED BEDROOMS ( I DISAPPROVED '&NCITIONS OF APPROVAIr ( ) CONDITIONAL APPROVAL' DATE �. • , �J''j/ bLW1Jr� BY: t, ��h 9t A X. �f �r Soils RatingDate Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size rlon ivai APPLI('NT FILLS OUT UPPER HAL ONLY Time P,7,,ty dwner r Larry E. Jr., & Teresa A. Compton Phone Mailing Address Deer Park Drive zip Code 99567 688-3929 Buyer James O. , and Kim Blomoness Address 1410 Garden Street Anchorage AK zip Code 99504 1 0 Lending Institution Alaska School Employees Federal Credit Union Phone Address 3500 Edie Street Anchorage, AK Zip Code 0 272-9446 Realty Co. & Agent Commonwealth Totem Realty, Inc (Jim Montague) Phone Address zip Code 99577 rqA—Qdqd 10 Legal Description Lot 3, Block 3, Deer Park Estates Street Location NHW Deer Park Drive Peters Creek Inspector Type of Residence Q Single Family 3 ' Field Notes:/ CA(- V► L ! i C.tb VLSI [J Multiple Family No. of Bedrooms COT. C` 11:,' 1V-1 • ❑ Other Water Supply R Individual ATTACH WELL LOG. A well log Is required for all wells drilled since June 1915. ❑ Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility 1 ) DISAPPROVED Sewer Disposal ( ) CONDITIONAL APPROVAL' R Individual Year Individual Installed: �Q$1 ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank BY: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time 1 0 Date Date Date Date Inspector Inspector Inspector Inspector Field Notes:/ CA(- V► L ! i C.tb VLSI COT. C` 11:,' 1V-1 • CK Ll C•c:,' ErJVln;rc,a:;A.l.oE'n:.+ AU3 2 G 1982 RECEIVED ( APPROVED BEDROOMS 'CONDITIONS OF APPROVAL 1 ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE G �• �� r Y BY: Soils Rating Date Sewer Installed Well To Absorption Area (p Weil Log Received M r1� 65 -v I Well to Tank e> 0 r Septic Tank Size 19 :-. . NEW CONSTRUCTION r 5. LEGAL DESCRIPTION GATE RECEIVED INSPECTION APPOINTMENTS. Estates. TIME TIME TIME DATE DATE DATE 0 SINGLE FAMILY ❑ One ❑ Four ❑ Other INSPECTOR INSPECTOR INSPECTOR 7. WATER SUPPLY Pyn ' ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY MUNICIPALITY OF ANCHORAGE MUNICIPALITY Or ANCHORAG: DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF \ 825 L Street • Anchorage, Alaska 99501 FVVIRCNMEN1AL i'. ,:, _'CTIOi I • 1 ENVIRONMENTAL SANITATION DIVISION SEP 21981 Telephone 2644720 L:3 INDIVIDUAL/ON-SITE" REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWERffE(CI il-VE D DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. PHONE Myers Construction, Inc. 694-2980 MAILING ADDRESS Eagle River Loop Road Eagle River AK 99577 PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE Larry E.Jr., & Teresa A. Compton, 333-4465 MAILING ADDRESS 5343 Sillary Circle, Anchorage, AN 99504 3. LENDING INSTITUTION PHONE First Federal Savings & Loan 274-6565 MAILING ADDRESS 4. REALTOR/AGENT PHONE Jim Montague/ Totem Realty 694-9494 MAILING ADDRESS P. O. Box 911, Eagle River, AK 99577 5. LEGAL DESCRIPTION Lot 3, Block 3, Deer Park Estates. STREET LOCATION NHN Deer Park Drive 6. TYPE OF RESIDENCE NUMBER OF,BEUHOOMS 0 SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY ® Three ❑ Six 7. WATER SUPPLY n INDIVIDUAL' ' ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM L:3 INDIVIDUAL/ON-SITE" 1981 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLICUTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72010(Ray. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLICUTILITY Connection Verified PERMITNUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAUON-SITE ❑PUBLICUTILITY Connection Verified PERMIT NUMBER DATEINSTALLED S �� INSTALLER ❑Septic Tank or ❑ Holding Tank Size: rnoo If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELLTO: Septic/Holding Tank % Absorption Area Sewer Line Nearest Lot Lina Absorption Area to nearest Lot Line - 5. COMMENTS M APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY L—t", i) Ivy 72010 (Rev. 6/79)