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HomeMy WebLinkAboutDEER PARK BLK 2 LT 2ADeer Park Block 2 Lot 2A #051-042-49 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: OSP111280 PID Number: 051-042-49 Name: Gary Scheerhorn Wastewater System: ❑ New © Upgrade Address: P.O. Box 670518 Chugiak, AK 99567 ABSORPTION FIELD Phone: Number of Bedrooms' 3 ❑ Deep Trench 11 Shallow Trench ❑ Bed ❑ Mound ❑ Other: LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: GPDlFt� Ft. Back:2 Lot: 2A Subdivision: Deer Park Depth to pipe bottom from anginal grade: Gravel depth beneath pipe: FL Ft. Township: Range: -- Section: Fill added above original grade: Gravel Length: FL Ft. Well: El New ❑Upgrade Gravel width: Number of Inc.: Distance between lines: Ft FL Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material' Existing FL FL Fts Driller. Date Drilled : Static Water Level:Installer Date Installed Ft Stuart Gilbert 10110-11/2011 Yield: Pump Set at: Casing Height Above Ground TANK GPM Ft. Ft. SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T. E. P. ❑ Other: To Septic Absorption Lift Holding ublic/Private Manufacturer. I Capacity: From Tank Field Station Tank Sewer Line I Anchorage Tank 1,000 Gal. well >100' >100' N/A N/A >25' Material: Steel Number of Compartments: Two (2) Sunace Water >100' >100' NIA N/A LIFT STATION ace Manufacturer Lot Line >51 >10' NIA WA Gal. "Pump on° level at: 'Pump off' level at: High water alarm at Foundation >5' >10' N/A N/A in. in. in. Curtain Drain None Noted Pump Make & Modei Electrical Inspections pedormed by. Remarks: Existing Septic Tank Decommissioned in Accordance BENCH MARK Location and Description: with Municipal Code. Existing Absorption Trench Remains Bottom of Siding. in Service. Assumed Elevation' 100.0 Ft tqVita Inspections performed by: M. Anderson Dates: tat 10/10/2011 '��0 � 10/11/2011 ��.....«.,E 2nd ,� /�P.•o Development Services Department Approval Conditional Approval Date: w :�IYIICiIM IL ANMSON- ; CE=4381PTorr Reviewed and approved by: ' Date: / -! -1 �aR`S s'���� M G SUBDIVISION N 00'04'58"W 158.00' 1 1 ? N V N N O Z Z W N U m O x D Cn m O N / N � c / Li V / N A / ry ODCD V / - O m 3 / o V O N Q a m ;u m co fT1 o < 0 > m m N D 0m� Z7 z n' 0 ti m D J --- s�/ CC)coSCD m r C DGo r� \ m O Q comms o ()i 77\// (fl U)0 an d e \ (3) -0 r4 O oDCD cn � z �� m m 7 CO m � \ ®Ex p �Knvi z 1 n A ° m O on CW N CD 3 0 F%o �e `.Cnj gy.Lll M,.6 // Q O •, F .. _.• 3n12�� j ♦�� Iii' w.� ��•• / / N 0 C) Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT 4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number: OSP111280 15 U) 1,000 Gallon Septic Tank 99.9 N NM � UU Tank Only Replaced Under This Permit. Existing Tank Pumped, Crushed and Backfilled on Site. PROFILE AS -BUILT - No Scale Page 3 of 3 PID No. 051-042-49 _-);: IIy. 49th � u-�•+�-C.r..Gf1(.t.�JL �.M ICHAEL E. ANDERSON No. CE -4381 f `_� On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP111280 Tax Code Number: 05104249000 Work Type: Septic Upgrade Permit Effective Dates: October 06, 2011 to October 05, 2012 Design Engineer: ANDERSON ENGINEERING Subdivision: DEER PARK Site Legal Address: DEER PARK BLK 2 LT 2A G:1558 Owner/Address: SCHEERHOORN GARY L PO BOX 670518 CHUGIAK AK 995670518 Site Mailing Address: 22240 DEER PARK DR, Chugiak Lot Size in Sq Ft: Total Bedrooms: This permit is for the construction of: 41233 3 N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: /C) --CL"' /I Date: a �� a SIF11 \ 0 Community Development Department Phone: 907-343-7904 Development Services Division I Qbf Fax: 907-343-7997 On -Site Water & Wastewater Program Mayor pan Sufffvan ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 05*1 -041. -- 'f9 Property owner(s) 6�Atq Sc#466'2_li-> OO/Zne Day phone Mailing addrE Site address Z -7-Z40 b e7Z PA4LA4- b2 .iJ0 (�4-OC AA-, Legal description (Sub'd., Block & Lot) (LL'j2. f�1�1°a-- 3L.A(I'L Z 1t.,�;7- Legal description (Township, Range & Section) Lot Size ZSj Sq. Ft. Number of Bedrooms _% _j*%A6_'t THIS APPLICATION IS FOR: (® all that apply) Absorption Field ❑ Septic Tank F. Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION IS AN: Initial ❑ Upgrade '1 Renewal ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees p , Date of Payment:c1 Receipt Number: Permit No. Waiver Fees: Date of Payment: Receipt Number: Waiver No. GABuilding\On Site\Forms\Client Forms\Permit App_010411.doc (Rev. 1/11) ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) October 3, 2011 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 2A, Block 2, Deer Park Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The septic tank on Lot 2A, Block 2, Deer Park Subdivision has failed and must be replaced. We are proposing to replace the tank with a new 1,000 -gallon steel septic tank to serve the three-bedroom home on the lot. We are therefore requesting a permit be issued for the construction of a new septic tank to serve the home. The attached Site Plan and backup documentation identify the location and configuration of the existing septic system and the location of the new tank. Also identified on the plans is the existing well on the lot. The existing tank on the lot will be properly disposed in accordance with Municipal Code. The drainage patterns on the property will be maintained after construction. The ground surface on the lot slopes to the southwest at a 3% grade in the area of the new tank. The tank will be placed near the same location as the existing tank at nearly the same elevation. It will then be tied in to the existing service line. The tank will be constructed parallel with the contours of the land as much as possible in conformance with Municipal requirements. If the tank is constructed in accordance with our design the following statements apply: 1. The tank, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The tank, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. Lot 2A, Block 2, Deer Park October 3, 2011 Page 2 of 2 3. The tank, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The tank, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, W"�J'za"(-� Michael E. Anderson, P.E. Attachments ••�P7E' �F.... mF ••••49th• •�� �.... ..... ...... .� ..7- ■ MICHAEL E. ANDERSON c� •.• NO. CE -4381 i �S ••����F ••� ................ ♦�'ht. f/Y0FESS\ NP�•• - DE�R / 1419„W 117.48' ! I \ ,00'99L M„SS.170.00 N �� / I I !� \ 1'-WIY33NlM'3 NOA/30NY N o i s i n i a e n s V Y Y � Ld 2� W, ;,� - 00.u ' '¢W�� w �: T O L Z :Qui / / / �o w / i I I I I � w � I of � x I \ OLO / / (n N o d q _ PO (.0 Q ( \ 00 M I I I O Z � c / / c _ Q/ I / F Q / C .a Q N i Q m ° J % H x a w ¢ � o C w m W N V ° 0 W U w O O �a=a (p F'C ON p C O O (� W 2 H 3 x ^ y 0 V w W e° Z~U N V U c p ":z Y O �aarn° 00 En w U a Z N Z J H OZ Q I t J ,00'99L M„SS.170.00 N �� / I I !� \ 1'-WIY33NlM'3 NOA/30NY N o i s i n i a e n s V Y Y a� C «. - >O~ 0 0 �c0= 0'- a a� 0 cn w V)um� w J 0um� WN �— (14 OM M M 0) co G � Ld 2� W, ;,� - 00.u ' '¢W�� w �: ♦U�': 0\ O L Z :Qui / a� C «. - >O~ 0 0 �c0= 0'- a a� 0 cn w V)um� w J 0um� WN �— (14 OM M M 0) co G / / / / i I I I I //%% I MUNICIPALITY OF ANCHORAGE • 1r'�'� DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION �� l ENVIRONMENTAL ENGINEERING DIVISION 825 LStreet -Anchorage, Alaska 99501 Telephone 264-4720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME �eNS77�, y NE � EW O UPGRADE MAILING ADDR LEGAL DESCRIPTION T // ' / LOCATIONfil' NO.OF BEDROOM /! C /� DISTANCE TO: try eV �{/7J Absorn ' r rev Dwelling PERMIT NO. O Y F-2 Manufacturer /' Mater' ee-- No. of compartments Z �` r -P-w to Liq. p it in_gaO llons IF HOMEMADE: Inside length Width Liquid depth d Y J02 DISTANCE TO: Well Dwelling PERMIT NO. _? F Manufacturer Material Liquid capacity in gallons O w= DISTANCE TO: W I "' 17 //L Foundation re Neastlotline �s$- 'f PERMIT NO. �Iw W No. of lines Length of a h live Distance be n f, Ce•O inches /7 _ _.,,� Top of file fo i sh grade terial be each file Q¢ H Total eflectiv absorption area p +_F L.4 %7 t� .p inches Length Width Depth PERMIT NO. W 4/- Type of crib Crib teter Crib depth Total effective absorption area W L X71 DISTANCE TO: Well Buitding� ticOF St lot line 1. J Class D Det _ Dnlleow •.• _S L�ti.. plot line PERMIT NO. i DISTANCE TO: Building foundation Sev;* finl� Absorption area(s) I OTHER / e ••• •{, PIPE MATERIALS `t`„ °� ho! �I Dive a .� _ '+ it y SOIL TEST RATIN � XV 30 D /3 Yl 2e INSTALL E C REMAR I t lcJ rv' % 46 ll i v t•3 / o cQl✓d WQ SIN 41 Zee APP VE DATE LEGAL 1%/ �S 6 S Er-C:roFrin 724(31Rev. 3/781 h1I—Ir-J I I= I RFtL I T`r' ID F=* ter -J I_ HCIF:Fi13E DEPARTMENT e'" HEALTH AND ENJVIROtJPIENTAL'OTECTION 825 STREET, ANCHORAGE, AK. gS_epi 264-4720 F-1ELL Fat -.ICS Clr-.1 I TE SE44EF: F}ERM I T PERMIT NO. C 810845 APPLICANT MYER.S CONSTRUCTION, INC P. 0. BOX 351, CHUGIAK, AK 654-9633 LOCATION DEER PARK, DR., PETERS CREEK LEGAL L2 62 DEER PARK ESTATES S/D LOT SIZE 41184 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINJFIELD MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING CSO FT/6R)= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C•EF TH= r' LErJGTH= 2:!5 GRn%-'EFL r_ -EF' -r"= 1 THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR. DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET). THE TFRErJ(--H W I C•TH I'= !Z;. 100Cy FEET_ THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). RE0U I RECD =F3T I C TFir-JF< �1=== 1c+I3CEF GF=fLLnr-JS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DUPING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE IJELL WILL SERVE. --- TWCI C 2 ] I rq�7,PECT I Qr4 FIRE F_EiGFU I RECD --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT IJILL 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 IJELL TO A PRIVATE SEWER. LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'ERrl I T E:xF• I REQ C•ECEr1BER 1S•+S1 I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND I -JELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODE_. _- I UNDERSTAND THAT THE ON-SITE SEWER. SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MOPE THAN 3 BEDROOMS. S I GNJED : L c— -_L_ _-- �l ----- APPLICANT MY E 'S COFJSTRUCTION, INC. ISSUED ________ V4. 0 ' SOILS LOG MUNICIPALITY OF ANCHORAGE r\ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 0 PERCOLATIONTEST 925 L. Street. Anchorage, Alaska 99501 2644720 SOILS ,L.O-�T G�- PERCOLATION TEST PERFORMED FOR: /�sS/{wDATTE PERFORMED: LEGAL DESCRIPTION: Z .pp �V s P 2 V �J Q eY' DaII `--' S —r 1- 2- 3- 4- 5. .3•45 6- 7 8 9 10 11 12 13 14 15 16 17 18 19 20 s,L 7 .SeN. y uryaNL c c"I E7 9 rave OF , ,.....R7AN h SITE PLAN WAS GROUND WATERe 5 ENCOUNTERED? -6 0 IF YES, AT WHAT / E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop orr PERCOLATION RATE / V (minutes/inchl TEST RUN BETWEEN FT AND FT PERFORMED BY: S A S Fntrins nrinw CERTIFIED 72-006 (6/79) DATE ; 17106 „1 0,10...5 Df"" �'•(Yf OF 44111m, PCSOUPf FT ' ,,,-_ Magnuson Drilling •I •''� '•" --- — Yf�llnnl C,. nt.n, _.----—`----- �- '— Orr. resp .... mil •1'� �--'-- IOCAa f,VDi-F.li ..�.___-.._w_ •-,..,.� ___ �.��_:.._., r.., _._- .. ,r .r IYY Anch iDeir Park i-2 ..-1 I•d. t I 4PN(P n( „r, I. Paul Myers ."Eagle River, Ake I wrti. LD4 Nnleri rl qne _. nd_ersvel_— _and-fater— feel D.L.. 4 NLL JkTh, •-nmll••M) 1 :nr r+Ye FMvatlnn Oete of Carmol el ion tr.• 1 _•_ + rvrt l.un 62 ft. _—_____- 1 _1 5 to -'i )+ 11m.rY �O'wo,, []Coq _-L-4Q C❑T'--'IIC.bl. ❑Jet ❑Bared ❑Otter: .--a Y:. .rt•r hrs. Pw Iinq g,p•N, t_1 Auprr led J R.Iwot er inch•♦ agave grade- 6 6. Ulf - �t17ame,t .c n1 P,.n14 T,.aalY u''77l ndu,trY _ 1.�'�ur 1ts,'�,�il Cement 0Other: 0CINrr•orc 1.1 l •e l' I.1x.wm •`�lt7CN�1FNWL 1 jell qth,17 i2. CASPIc: Lj lhr.aded j'111e IAid - 62_ft. Drath Weight 17 1bS/ft. ft. 0eatn B. FINIS", PF Will T Ype:��Ole Diene ter: fie SIaVN.,n Si/e: Length: Solt het, .11 ft. and ft. ,1 t ll l lnpt: y, STATIC lATIP t(Y11: !''�� �A!ove l_-/•/, IwnA sur (•r• _—_____- 1 tr.e t: —_—_�--1_- of M•ewr.r+rn ' 10, PV.r IYG IEYfL h.l,w land .,rf Al. ift,r __hr,. pero 1n9 q•P N. I ` .--a Y:. .rt•r hrs. Pw Iinq g,p•N, __ 11 N1.: •f Aa f�nh ET 10N' � In Ap,mn .d Pit _ j J R.Iwot er inch•♦ agave grade- ''Mllf 12. GPOJTING. Yrll Grouted: 1-1 Yes L3 No 1.�'�ur 1ts,'�,�il Cement 0Other: """T 7rJi-L l •e l' I.1x.wm •`�lt7CN�1FNWL 1 U. Punr: (it a+wllanlel NP 1 Length y,i 1`1-- IP;-- 4'� et. ea PaCl[Y 9•P -..-u_4-1R7 Type k; %uornersi0ln ❑PeC iOfncat inq I IE rlf MrlMeT: -- j -- I Bail tested at 10 g.p.m. ----- This •.ell .na rr il.. u.ur , vl:. .. r. .nl t'I a retort it rr., to In• U•,• 0 -1 k--lepge "d bel let: Magnuson Drilling AA 5385_—_T_-_____ ---v.rl -- t uL^n •1: t _ _... rn., _ .. ,..,• Vem,n. ne.;�,-th:r..q-'Lr, P.O. Boz 504 Eagle River, Ake Andre,,, Sept. 20, 1986 _ t r e . •u. .rn. Y•�1:. • ',twl• Df.r.'., Vt•1 •. - 'r 1:•" I l'tANY - CN,loe•ef farm 02-�Fu(r .,r o. r . LEGAL DESCRIPTION L :RECEIVED Lot 2, Block 2, Deer Park INSPECTION APPOINTMENTS STREET LOCATION - TIME TIME TIME NUMBER OF BEDROOMS DATE DATE DATE ❑ Two ❑ Five ❑ MULTIPLE FAMILY EJ Three ❑ Six 1 — INSPECTOR INSPECTOR INSPECTOR _ MUNICIPALITY OF ANCHORAGE depth (attach log if available.) ' DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 • 1981 YEAR ONSITE SYSTEM WAS INSTALLED. ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DI RECTIONS: Complete all parts at page 1. Incomplete requests will not be processed. Please allow ten 00) days for processing. 1, PROPERTY OWNER PHONE Myers Construction, Inc. 688-4521 MAILING ADDRESS - PO Box 351, Chugiak, AK 99567 PROPERTY RESIDENT lit ddfercnI from above) PHONE N/A N/A 2. BUYER PHONE Gary Scheerhoorn 694-2942 MAILING ADDRESS - SR 1B Box 1538, Eagle River, AK 99577 3. LENDING INSTITUTION PHONE First Federal Savings & Loan 274-6565 MAILING ADDRESS 813 W. Northern Lights Blvd. Anchorage, AK 4. REALTOR/AGENT PHONE Jim Montague, Totem Realty, INc. 694-9494 MAILING ADDRESS PO Box 911, Eagle River, AK 99577 . LEGAL DESCRIPTION Lot 2, Block 2, Deer Park Estates, Subidivision� STREET LOCATION - NIIN Deer Park Drive 8. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ One -ED Four ❑ Other f� SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY EJ Three ❑ Six 7. WATER SUPPLY - M1 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 ® INDIVIDUAL/ON-SITE" 1981 YEAR ONSITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY I' NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 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 PERMIT NUMBER DEPTH OF WELL DATE GRILLED . LOG RECEIVED Y 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLICUTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER ❑SepticTankor ❑Holding Tank Size: /P If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line b. COMMENTS ❑ APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY 72010 (Rev. 6/79) MUNICIPALITY OF ANCHORAGE t Development Services Department �, Phone: 907-343-7904 On -Site Water & Wastewater Section - Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-042-49 1. GENERAL INFORMATION Expiration Date:' Complete legal description DEER PARK BLK 2 LT 2A Location (site address) 22240 Deer Park Dr Current property owner(s) SCHEERHOORN GARY Day phone 854-7020 Mailing address Real estate agent Day phone 2. TYPE OF DWELLING: Fx_1 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ —6 50 Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number COSA # 0SC-?,2 11'30 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm NorthRim Eng. Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 4/30/22 s *�49Ili� 6. DSD SIGNATUREAf f System #1 Approved for bedrooms ♦♦ CE- System #2 Approved for. bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: lllll(((frrrr OP f ON,sITE T' W IAND m WAS ROOD AIU o By: Original Certificate Date: The Municipality of Anchorage Development Ser%lces Division (DSD) issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: DEER PARK BLK 2 LT 2A If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 9120/81 Total depth 62 ft Cased to 62 ft Al Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 4/21/22 Static water level at beginning of test 39 ft. Comments B. TANK DATA Age of tank(s) 11 years Tank type/materia.! sPtcstl Measured operating.fluid level in septic tank 50 ❑-Standpipes/foundation cleanout per record drawing Date of pumping 5/5/22 D. ABSORPTION FIELD DATA 8/27/81 Parcel ID: 051-042-49 of Structure served by this system Well production at time of test 6+ gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ N ❑ Coliform bacteria is Negative Nitrate 1.18 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by NRim Eng. Date of Sample 4/21/22 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: -- - -___ __ . - - - Which -system -tested same--- (date installed)--- 4/21/22 Adequacy test date HE ALL standpipes present per record drawing - Results --�]✓ Pass For 3 - bedrooms - Total measured depth from grade 6 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 3 ft (min) Water added 450 gal ❑ N/A — pressurized field New depth 4 in ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Elapsed time 30 min Final fluid depth 0 in Absorption rate 450 gpd Any rejuvenation treatment (past 12 months) no If yes, enter date E. SEPARATION DISTANCES From Private Well onLot to: (Please enter distances if less than required cnifcommunity well) Septic Tank/Lift Station onLot �>1OO Yes ifNoft, Community Sewer Manhole/Cleanout >�1OO' |fabsorption field iounder driveway comment below RYes ifNo# Yes MV Yes ifNoft Neighboring Tank >1O0' Yes ifNoA Yes Private Sewer/Septic Line >25'Yes ifNoM Absorption Field onLot >�100` Yes ifNo8 Yes Holding Tank >1OO' Yes ifNmft Neighboring Absorption Fields > 100' Yes Animal Containment ��50" Yen ifNn# F,1Yoe i[NoO ��anuroA\nirna|Excreta Storage > 10U' Communib/Sewmr�Woin��75' ��Yee ifNnM — Yen ifNoft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations >�1O' Yes ifNVM Surface Water 1OO' Yes |fNwM Property Line >5' Yeo ifNo# Wells unAdjacent Lots: Absorption Field >5' Yeo ifNo8 Private Wells >1OO' Yeo ifNoft Water Main >1O' Yen i[Nnft Community Wells >2O0' Yes i[Nm____ft Water Service Line >�10' Yes i[N0ft (fseptic tank isunder driveway comment below From Absorption Field on Lot to: (Please enter distances ifless than required) Building Foundation >1O' Yes ifNoft, |fabsorption field iounder driveway comment below Property Line 1O' Yes ifNoft Wells unAdjacent Lots: Water Main >10' Yes i[Noft Private Wells >1U0' Yen ifNoft Water Service Line >�1O` Yes ifNoD Community Wells >2OO' Ye* ifNoft Surface VVa<er>10O' Yes ifNVft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION OF /certify that / have determined through field inspections and review myMunicipal records that the above systems are /nconformance withAr M�COSAq��eo�e�ot�����. �Steve Eng A�J;rCE-6256 R COSChecklist yellow sheet 0 1101 sinOWT13 OLLaS .j.5 ££z, VZ 10-1 X IRL 4 ' —1NVO ,C'9x,9'Z \ x030 ,9'£Zx,ZL 03HS ,l'Zlx,L'Zl 3snOHN3380 \ L`11 x ZZL 3u0£,60.98 N ,00'9L'�gl 3w8Z LZ.�B S 1N3W3SV3 J.LnLLn ,OLx,S VC I M NNII-NIVHO —+:- MEMO IWO �,�aeoppO4�, 0 0 .r. / CI I M aQ: C9 O > 70- 7— Opo.: D z Y •' Qe°�O z o Op04,�s R Q pt O N CL 0 v ° o m c o m y Qc c o m m >` U) o `mmLm ° �o LO m a <,-t 3� 0 m ?� m t0 to m C m> C Z ° N mr m Q t�D �7 � � ° �- m '�' C •O w-"cr ° 0-0 p Q N N m N B 0 m CL t�� a1ooa })0 @®0 m0Om° 00 MEOLo- m 0vCto p 3N y m `t ° aoiaoamoo 0 cc m m° ®� U 0 omym s�- a _ 0> P H- = C rt- E 0 c CUr- O m 0 N 0 c 0 gg L J A 0 O: O U V D a € ° L �j 0 in E; .� � m Q CU m>'°o`o>c a QM Mm : N 0 0 _ o °a o o`�c.a ° -t- c X1 .0mNgc_oa cc J O C ° °D 3Q0aX 0 m C 0 m`Q �_ °a(DQ c >wLvo� mo— 0 'O no 0 C,d 0 0 }� t: O 'L0y° c� O h N Oi 0.C -'=N 0 � t mo LEC0 rC NO p. 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