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Home My WebLink AboutDEER PARK BLK 2 LT 5Deer Park Block 2 Lot 5 #051=w042-28 Inspection Report_1-1-11doc Municipality of Anchorage Community Development Department Page 1 of 3 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP141522 PID Number: 051-042-28 ❑ New ❑✓ Upgrade Name: Harold & Patricia DeMontfort ABSORPTION FIELD ❑ Deep Trench ❑✓ Shallow Trench El Bed El Mound Address 22346 Deer Park Drive ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 1 .2 GPD/SF 5.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 4.0 Ft Gravel depth beneath pipe 1.0 Ft Subdivision Block Lot Deer Park 2 5 Fill added above original grade 0 Ft. Gravel length 88 Ft. Township Range Section Gravel width 5Ft. Beds: Number of Lines N/A Distance between lines N/A Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line 505 Ftp 2 10.0 Ft. Well 113.8 131.8 NA N/A 25+ TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufactureracity Anchorage Tank Cap 1000Gal. Surface Water 100+ 100+ N/A N/A Material Steel Number of compartments 2 Lot Line 39.4 10.0 N/A N/A NA Foundation 9.2 16.3 N/A N/A LIFT STATION Manufacturer Capacity Gal. Curtain Drain 50+ 50+ N/A N/A Pump on level at Pump off level at High water alarm at Remarks in. in. in. Pump make and model Electrical Inspections performed by PIPE MATERIAL Housetotank 3034 drainfield Tank to 3034 Installer JR's Septic Pumping Drainfield 3034 CO/MT 3034 Inspector Pannone Engineering Services BENCHMARK (Assumed elevation) 100ft Inspection1" 12/11/14 12/12/14 Location and description dates: 3'°12/12/14 20 a'" Top of Deck Pile COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp 4.01 .`i t= ACgil Conditional Approval Date 1.4 •••• •��} �11 co %- f *'tevenone ,CE 81419 Approved✓• Date Inspection Report_1-1-11doc LOT SERVED BY AWWU WATER - - NO WELL fWELL (E) d �, SEPTIC AREA (E) -- _- SEPTIC AREA (Q 1000g SEPTIC TANK NM ABANDONED PER CODE _- DRAIN FIELD (E) IN FAILURE AWINU WATER LINE (E) RE -USE AS RESERVE W/ (FUTURE) ADDN / — __j W — w OF 40LF x 5'W x VED x 4'TD �� ARMA5 DRIVE . r SHED ' _ ,1 ,_.._ � ... \ W_ NN ED —H NEW 12308 SEPTIC TANK S�H-�/ 113.8 F WITH DCO D A WELL (E) "\ B T2 C7 HOUSE d P 2 SHED DOE C2 `�, �� T1 ...HOUSE �FS(n\ _ .2\ CP.IVEWAY \ C4, \ M4 - HT - \ 7 NEW DRAIN FIELD _y 10.0 (2EA) 44LF x 5A'N x I C'ED x 5.O'TD SEPTIC AREA (E) J NOTES. RECORD DRAWING PLAN 31 . \ LOT 5 \ W� W- ,3 0 E PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 DEER PARK, BLOCK 2, LOT 5 HAROLD & PATRICIA, DeMONTFORT 22346 DEER PARK DRIVE CHUGIAK, AK 99567 A B C DC1 22.2 24.1 - Tt 2s. i 22.1 - T2 33.1 17.9 - DC2 35.6 17.0 - C1 - 19.9 22.2 M1 - 19.4 23.0 C2 1 83.6 48.7 - M2 82.5 47.6 - C3 - 35.4 33.9 M3 - 33.3 32.8 C4 93.8 56.1 - W4 94.4 56.3 - NOTES. RECORD DRAWING PLAN 31 . \ LOT 5 \ W� W- ,3 0 E PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 DEER PARK, BLOCK 2, LOT 5 HAROLD & PATRICIA, DeMONTFORT 22346 DEER PARK DRIVE CHUGIAK, AK 99567 -��OF.Al-gsl� �CD{ *: 49TH * j� ...... ... j — -�� Steven R. annanej CE 8149 .•IDi Oil'--P�OFE55l--,,00' �' �� "0 12/22/14 Scale 1.,_50' WELL (E) PERMIT N0. OSP141522 Sheet 2 O 3 i t -��OF.Al-gsl� �CD{ *: 49TH * j� ...... ... j — -�� Steven R. annanej CE 8149 .•IDi Oil'--P�OFE55l--,,00' �' �� "0 12/22/14 Scale 1.,_50' P.I.D. NO 051-042-28 PERMIT N0. OSP141522 Sheet 2 O 3 SPECIAL PROVISIONS TO SPECIFICATIONS 1, ALL CONSTRUCTION WAS INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS AND ATTACHED PES SPECIAL PROVISIONS. 3. SCOPE OF WORK: ABANDONED EXISTING 1000g SEPTIC TANK PER CODE AND INSTALLED 1250g SEPTIC TANK. INSTALLED DCO AND FS. INSTALLED SOIL ABSORPTION SYSTEM. 4. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 11.0 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. AN APPARENT WATER TABLE WAS NOT OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 11.0 FEET BELOW EXISTING GRADE. FABRIC — 91.3 V ROCK 10��5.0—{ SECTION 49 91 NEW 12509 �O SEPTIC TANK DESIGN PARAMETERS PRIMARY/RESERVE SEPTIC SYSTEM N0. BEDROOM: 4 (60C gpd) TANK SIZE: 12508 (P) PERC RATE = 1 MPI SOIL RATING: 1.2 GPD/SF AREA ROD: 500 SF SYS. TYPE: WIDE TRENCH 1'ED RF 0.87 MIN LENGTH: 87 LF USED: (2EA) 44 LF X 5' WIDE, 1.0' E.D., 5.0' TD TOTAL AREA: 505 SF DRAIN ROCK PROFILE LEGEND W WATER LINE/ WELL RADIUS SS NEW SEPTIC 91.3 90.3 ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T� TANK CLEAN OUT NO. z CLEAN OUT NO, M;) MONITOR TUBE NO. RI _ RIGID INSULATION w DOUBLE CLEAN OUT w DIVERTER VALVE FS FLOW SPLITTER BFG BELOW FINISH GRADE OG ORIGINAL GRADE m 7FILTEft FABRIC m TOPSOIL & VEGETATE Qo wo 0 o a �- z w z z z jo m Z p tt a" o PERF PIPE e, p zw �w w -w z V '� z wow ap u o� z V DRAIN ROCK 6" z A nn B n n ri In ABOVE PIPE INV CC d 49 91 NEW 12509 �O SEPTIC TANK DESIGN PARAMETERS PRIMARY/RESERVE SEPTIC SYSTEM N0. BEDROOM: 4 (60C gpd) TANK SIZE: 12508 (P) PERC RATE = 1 MPI SOIL RATING: 1.2 GPD/SF AREA ROD: 500 SF SYS. TYPE: WIDE TRENCH 1'ED RF 0.87 MIN LENGTH: 87 LF USED: (2EA) 44 LF X 5' WIDE, 1.0' E.D., 5.0' TD TOTAL AREA: 505 SF DRAIN ROCK PROFILE LEGEND W WATER LINE/ WELL RADIUS SS NEW SEPTIC 91.3 90.3 ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T� TANK CLEAN OUT NO. C# CLEAN OUT NO, M;) MONITOR TUBE NO. RI _ RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER BFG BELOW FINISH GRADE OG ORIGINAL GRADE FG FINISH GRADE TS&V TOPSOIL & VEGETATE NOTESPANNONE ENG SVC, LLC OF ki Date RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 �E Al�gsll� 12/22/14 PHONE (907) 272-8218 FAX (907) 272-8211 ig�PA-771 Scale 49* (� NTS P.LD. NO DEER PARK, BLOCK 2; LOT 5 // 051-042-28 HAROLD & PATRICIA DeMONTFORT Steven .Pannone' j PERMIT No. 2234E DEER PARK DRIVE %+P�sr CE 8149 U`oX�/ OSP141522 DESIGN DETAILS CHUGIAK, AK 99567 (l1F�FD ROFESSIONP.0 Sheet 3 OF 3 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: OSP141522 Tax Code Number: 05104228000 Work Type: Septic Upgrade Permit Effective Dates: December 10, 2014 to December 10, 2015 .a/(tIN rZ./iz.�iv ��,�ltw Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: DEER PARK Site Legal Address: DEER PARK BILK 2 LT 5 G:1558 Owner/Address: DE MONTFORT HAROLD B & PATRICIA 122346 DEER PARK DR CHUGIAK AK 995675329 Site Mailing Address: 22346 DEER PARK DR, Chugiak Lot Size in Sq Ft: 48460 Total Bedrooms: 3 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage '31.3o n; ,o a:3d all_; �d 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 Issued By: Date: Date: i3 MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWERIWELL PERMIT APPLICATION Parcel I.D. 051-042-28 Property owner(s) Harold & Patricia DeMontfort Mailing address 22346 Deer Park Drive, Chugiak, AK 99567 Site address 22346 Deer Park Drive Legal description (Sub'd., Block & Lot) Deer Park, Block 2, Lot 5 Day phone Legal description (Township, Range & Section) Lot Size 48,460 So. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade ❑X Duplex F-1 (D) Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Permit/Rush Fees: 5� q Waiver Fees: Date of Payment: 1,Z --/ L/ Date of Payment: Receipt Number: O ,meq 2 3 G Receipt Number: Permit No. DS P /.r'Z2 Waiver No. Permit App_-.;- :- :_'_C. Pannone Engineering Services Lac Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve(@Panenaak.com December 09, 2014 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Rd. P. 0. Box 196650 Anchorage, Alaska 99519 Subject: Deer Park, Block 2, Lot 5 Septic System Upgrade Permit Request Ladies and Gentlemen: I am writing request a permit to construct an upgrade four (4) bedroom septic system on this property. Currently the lot is developed. The existing drain field is in failure and will be re -used as a reserve with an future addition to accommodate four bedrooms. An upgrade drain field will be constructed. The existing tank will be abandoned per code and a new 1250g septic tank will be installed. The surrounding lots are served by private wells that are over 100' from this system or public water. Soils. PES performed one test hole in the vicinity of the drain field in November of 2014, and groundwater was monitored for seven days. Ground water was not observed to a depth of 11.0 feet below the ground elevation in the test hole monitor tube. It is my opinion, based on the results of the soils tests and overall soils appearance; an application rate of 1.2 gallons/day/square feet should be used for a conventional wastewater system. 1. Soil Absorption System Design. a. See Sheet 2 of the design package. 2. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: The existing topography slopes generally from east to west on this lot and is quite flat at the upgrade location. There are no steep slopes within 50' of the drain field. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 4. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On -Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of the surrounding or existing lots. There are no surrounding wells within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 r % � LOT SERVED BY AWWU WATER NO WELL 1 WELL (E) SEPTIC AREA (E) SEPTIC AREA (E) - -. - 10CCg SEPTIC TANK (E) ABANDON PER CODE DRAIN FIELD (E) IN FAILURE AWWU (NATER LINE (E)/ -- RE -USE AS RESERVE W/ (FUTURE) ADDN W W — W OF 40LE x 5'W x 1'ED x 4'TD �- AR HAS DRIVE •� SHED _. _; \p� \ W/ ¢ SHED 12UOg SEPTIC TANK (P) 104 x <�� WITH DCO /d/ d \ TH-1 DRAIN FIELD (P)_ (2EA) 44LF x 5.0'W x 1.0'ED x�5.0'TD SEPTIC AREA (E) 3BR I FS (P) _ HOUSE (E) 1 C.0 31 LOT 5 Wim_ w 140.6 /-WELL (E) WELL (E) DRIVEWAY I NOTES: �� \\� Dote PANNONE ENG SVC, LLC oP A/ - FOR i CONSTRUCTION `� ..... li, 12/09/14 P.O. BOX 100217 ANCHORAGE, AK 99510 ,. 'LS PHONE (907) 272-8218 FAX (907) 272-8211 %oj�p �y�) scale ..... . .. .. ...... P.I.D. NO DEER PARK, BLOCK 2, LOT 5 / D51-042-28 � HAROLD & PATRICIA DeMON TFORD � Steven RPannone PERMIT N0. f 8149 Pc,.�� OSP1 x1522 o CE 22346 DEER PARK DRIVE _ PLAN CHUGIAK, AN 99567 ��i��FRO SS1oN�� SheetOF 3 \ ��` SPECIAL PROVISIONS TO SPECIFICATIONS 1, ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS AND ATTACHED PES SPECIAL PROVISIONS. 3. SCOPE OF WORK: ABANDON EXISTING 10008 SEPTIC TANK PER CODE AND INSTALL 1250g SEPTIC TANK, INSTALL DCO AND FS. INSTALL SOIL ABSORPTION SYSTEM. 4.. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 11.0 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 1 1.0 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. rFILTER FABRIC 4" 0 PERF PIPE ROCK 6" ABOVE PIPE INV TH-7 J SP/ I 1-5.0� DRA10.0 GW IN ROCK 6.0 -IID SECTION 1250g SEPTIC TANK (P) PROFILE DRAIN ROCK ABBREVIATIONS Cu COPPER DESIGN PARAMETERS LEGEND o� PRIMARY/RESERVE SEPTIC SYSTEM W WATER LINE/ TH TEST HOLE NO BEDROOM: 4 (600 apd) m m FILTER FABRIC w Q o T# TANK CLEAN OUT NO. PERC RATE = 1 MPI SS NEW SEPTIC C`7 CLEAN OUT NO. SOIL RATING: 1.2 GPD/SF Mfr MONITOR TUBE N0. AREA ROD: 500 SF R RIGID INSULATION �w DCO DOUBLE CLEAN OUT 4" 0 PERF PIPE �w w w FS FLOW SPLITTER USE: z o BFG BELOW FINISH GRADE o z 5.0' TD OG ORIGINAL GRADE TOTAL AREA: 505 SF FG FINISH GRADE rDRAIN ROCK 6" z J n In n n n Date ABOVE PIPE INV 1250g SEPTIC TANK (P) PROFILE DRAIN ROCK ABBREVIATIONS Cu COPPER DESIGN PARAMETERS LEGEND DIP DUCTILE IRON PIPE PRIMARY/RESERVE SEPTIC SYSTEM W WATER LINE/ TH TEST HOLE NO BEDROOM: 4 (600 apd) WELL RADIUS FC FOUNDATION CLEAN OUT TANK SIZE: 12509 (P) T# TANK CLEAN OUT NO. PERC RATE = 1 MPI SS NEW SEPTIC C`7 CLEAN OUT NO. SOIL RATING: 1.2 GPD/SF Mfr MONITOR TUBE N0. AREA ROD: 500 SF R RIGID INSULATION SYS. TYPE: WIDE TRENCH VED DCO DOUBLE CLEAN OUT RF 0.87 MIN LENGTH: 87 LF DV DIVERTED VALVE FS FLOW SPLITTER USE: BFG BELOW FINISH GRADE (2EA) 44 LF X 5' WIDE, 1.0' E.D., 5.0' TD OG ORIGINAL GRADE TOTAL AREA: 505 SF FG FINISH GRADE TS&V TOPSOIL & VEGETATE NOTES: PANNONE ENG SVC LLC --oF A klk Cg19, Date FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 _ . .. . P � f ig,' -V 1 9TH *l� ......*, .. .., ....... ��— -/ z/oe/1a Scale NTS P.I.D. NO 051-042-28 DEER PARK, BLOCK 2, LOT 5 HAROLD & PATRICIA DeMONTFORD "Steven "R. Pan'none'j PERMIT NO. 22346 DEER PARK DRIVE CE 8149 c . OSP141522 DESIGN DETAILS CHUGIAK, AK 99567FR�OESSIONPV�' Sheet 2 OF 3 SOILS LOG - PERCOLATION TEST SLOPE X TH - SITE PLAN —Nr-- —W—� SHED TH - I WAS GROUND WATER ENCOUNTERED? N IF YES, AT WHAT DEPTH? -DRY DEPTH TO WATER AFTER MONITORING? -DRY'- DATE: 12/03/2014 i SLOPE TH x ARMAS A, 3613 HOUSE (E) READING TEST HOLE 1 NET TIME OR ORGANICS 1 11/25/14 9:00 -- 2 -- 2 3 5.45 8.17 4 3 9:06 -- 2.17 POORLY 5 GP/ GRADED 8.17 SP SANDY 8 -- GRAVEL 7 6 9:18:03 8 8.17 6.00 9 10 GM SILTY GRAVEL HARD DIGGING 11 BOH 12 13 14 15 16 17 18 19 20 DATE PERFORMED: 11/25/2014 SOILS LOG - PERCOLATION TEST SLOPE X TH - SITE PLAN —Nr-- —W—� SHED TH - I WAS GROUND WATER ENCOUNTERED? N IF YES, AT WHAT DEPTH? -DRY DEPTH TO WATER AFTER MONITORING? -DRY'- DATE: 12/03/2014 i SLOPE TH x ARMAS A, 3613 HOUSE (E) READING DATE CLOCK NET TIME WATERTIME LEVEL READING NETDROP 1 11/25/14 9:00 -- 2.17 -- 2 9:05:27 5.45 8.17 6.00 3 9:06 -- 2.17 -- 4 9:11:42 5.70 8.17 6.00 5 9:12 -- 2.17 -- 6 9:18:03 6.05 8.17 6.00 PEROLATION RATE 1.0 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 5 FT AND 6 FT COMMENTS: Test hole excavated by JR's SEPTIC PUMPING HOME SERVICES PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDL7IIN�E+S IN ENG ON THE DATE OF THIS TEST. NOTES: PAMONE LiS`I lG SVC LLC d�Qf p �� Date FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 C .• "''qs<<�12/09/14 PHONE (907) 272-8218 FAX (907) 272-8211 ig�P �y +` Scole NTS ..... .. ... P.LD. NO DEER PARK, BLOCK 2, LOT 5 7M-042-28 HAROLD & PATRICIA DeMONTFORD Steven R Pannone / PERMIT NO. 22346 DEER PARK DRIVE ��P�•. CE 8149 osPl41522 SOILS LOG CHUGIAK, AK 99567 p �I Sheet 3 r G—� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION I\, 825 L Street • Anchorage, Alaska 99501 Telephone 264-4720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME C Tf u C t0 n -NG PHONE %aC% 633 NEW t ❑ UPGRADE l_ akA7AI LING A LEGAL DESCRIPTION •Q2l- 1-5 d .Ir, rpar- LOCATION 'e'o r Pa r- V r. Pe-lel-3 G NO. OF BEDROOMS 3 D WellO T DISTANCE TO: Absorption areas r Dwelling 14 . PERMIT NO. (� y N Y ;:z Manufacturer G o �Qr Materiay J T No. of compartments n~ Liq. c PO ty in311ons IF HOMEMADE: Inside length � Width ^� Liquid depth G y J02 DISTANCE T Well weui PERMIT NO. CIZ4 CI H Manufa rer al Liquid capacity in gallons O m= DISTANCE TO: Well Foundation Nearest lot ne r r PERMIT NO. , �O�Cf 2 W No. of b� Length of et).n Total length of lines d Trench width tr Distance bet .n lines 2 t] Top of rile to sh grade 3 Material beneath life la inches Total effect a absorption area W Length Width Depth PERMIT NO. d ~ W S Type of crib Crib diameter Crib depth Total effective absorption area W �' DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot line PERMIT NO. Q1(O Ay CQJ O W 3 DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER I PIPE MATERIALS 3o3-i. per• . SOIL TEST RATING Ss t i INSTALLER REMARKS .i& I I APPKOV.jisD DATE LEGAL 04,kx - le L5 6 P0--'LjU 72-013 iRK. 3/78) MU"I r=` I F `FJ IL I T'- QF FIC-4ICNJC+F''f�lGE /jC? J . ps DEPARTMENT"' HEALTH AND ENVIRONMENTAL' 'QTECTIOM 11 325 STREET, ANCHORAGE, AY,. 99z�)d1 254-47201 J �- I-JEL-L- nr4E> Qta—E I TE SEL•1EF' P�EF�t•1 I T PERMIT NO. { 810844 ) APPLICANT MYER.S CONSTRUCTION, INC P. O. BOX 351, CHUGIAK, AK 694-9633 LOCATION DEEP PARK DP.., PETERS CREEK LEGAL L5 82 DEEP PARK ESTATES 5/1) LOT SIZE 49337 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/PR.)= 85 THE P.EDUIP.ED SIZE OF THE SOIL ABSORPTION SYSTEM IS: CEP'TH= � L_Et-JGTH= �� GRFIti:'EL_ C•EPTH= 1 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OP. DP.AINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THE TFt EtJl_ H IJ I CATH I S Z5. 4=+GC=+ FEET_ THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). RE:CnU I REC• SEPT I C -rnNK " I 2:E= 1i=iiDQ GFlLLQtJ_- PERMIT APPLICANT HAS THE PESPONSISILITV TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE 14ELL WILL SERVE. --- 'r <^ ? I tJE P ECT I QtJS nFRE REGILJ I Fr* EC* --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT !•JILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR. A PRIVATE WELL OP.. 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC !-JELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS AF:E REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER. RE!UIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. P'EF= t'1 I T Er�F' I F'E� L�ECEt1EEF: = 1J 15�:= 1 I CERTIFY THAT 1: I AM FAMILIAR. WITH THE REQUIREMENTS FOR ON-SITE SEWEPS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY P.EOUIF.E ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED :-aL&O-_L9 _-9 ______ 3e__7 - APPLICANT MYEKS vONSTRUCTION INC. ISSUED ----------DATE1c?_az CCC u 4'4. 0 • s PERFORMED FOR: LEGAL DESCRIPTION: DEPTq (FE&41 fes, e�\ k SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 2644720 SOILS LOG - PERCOLATION TEST 2 ! �/ 3- 4- 5- 6- 7 4 7 8 - O 'O 1 / 9 10 th* , SLOPE DATE PERFORMED: r 1, WAS GROUND WATER PJ 11 �ENCDLINTERED7 12 �- IF VES, AT WHAT DEPTH? 13- 14 3 14 Date %�pjJ�j/lra� Net Time Depth to Water Net Drop 15 16 wtisQF .'�t��tir 17 �. aye. � r •ti � ? q 18 �C�'• Ns. 1457 Reading Date Gross Time Net Time Depth to Water Net Drop 1 of •., : . �ttf• �'ACFESS � PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT PERFORMED BY: iiwA.' Fl& 1 Tirtcr CERTIFIED 72.008 (6/79) Tf A 0 o t -Is-.z7 4 RFTNNK TO Ol vl, inn .rr G,e..ingiml An( bn Ya real 5•rr ve Ya IOGGSi TIMI P,rr•.-' f•• ..., 77T-An1K) • Y A- L R Y[ I L R E C 0 R 0 c.•Iling Cpl•na,,y h— , Magnuson Lril linF. IJ'AT 04 O1—. T LI Pleat/ tl.jl •. el!h r W. Ib• Or IC. 1 STATi )i ALASKA II OFPA-- (NT OF NATURAL 05011NIES .I.S.G.S. Luc.l Ib. _ . JGllllrg Err.l( 4o. - A 0.1. No. . la IV.rnugn finch $uhJ•Yi,•n� T -a1, Nlu.'L Deer FT} e rl IU. ifxtlOn $..tion No. T,—.,nip lung.• / / / N/$ f,I M.rldlnn ' Ir Di,tance And •r rlien rrnn• ,tre,t Add,.-,, and Are. of Y.I I Loc.' ion T. "•MfR Or WELL: I•ir,raul Myer -- Pryers Const, Ea; -1C River, Ake 7 WELL LOG Feet R.1•w Snrfece ".far;..[ Tvpe Top F &.ttnrn 4. YFLL DEPT": kru- led) Surf.ue Elevation 60 ft. OCoant,op of 1_i'J'��i } 1 S. oc4hle tml "0 ReterY ❑Orlven 110.9 ❑Auger ❑J.tted ❑kved ❑Diner. N. tISE: Dnturst is ^0I Public Supply 0 Iod.stfY Ftrr lqa tun 13Recharq. ❑Cuernereial E]Ta,t Well 00lhar: 7. CASING: 0 Threaded XBiAnlded �6 1., To �rLf I. Depth Weight —.IV bs/ft. . to ft. Depth 8. FINISH Of WELL: Type: Open hole Oletar; 611 Slot/Mesh SIT.: Length: Set b.t"een ft. and ft. rlltingr I I 9. STATIC WIN tEVIL: ft. 0 Ate,ve 138,1. land Surface Type of MN wrnnlrnt: 10. PUMPING, LEVEL Wo. 14M Surface ft. after hr S. oulnofng g.p.M. fl. after hr,. pw in9 9.0.0. 11. YELL MEAD COMPLETION: In Approved Pit �. Pi IIHs AJ. pt of Inches abuve 9..J. MUNICIP r 17. GROUTING: Yell Grouted: 0 res 0 NO Material: ❑ Neat Ceaurnt ❑ Other: „1 L. 17. PUMP: 111 at/. Gable) HP Length of Drop Pipe 45 ft. capacity 9-0• T,o.: XQ Subner,lble ❑Reciprocating ❑ Jet ❑Other. _ 14REMARK.. Dail tested at 20 611.1 IS, YATfP WELL C0't!P?f.•^P'S CC^'Ir I'�d'InV. This •.ell .., .,-lied end t,;, raw,rt 1S true to the belt of nv Nnw I.dge and belief: M.1 LT.Drilling ____ AIj�iE` T- ,— egnlered Ti.r'•ne„ V.m• tr,,l Numnar Y.O. Fox 504 EaCle River, Ake vUgr •rFl Yon c,rnlal•re (farm O7"wN Luov 0i.trinul4,n: YHITC - StAle DG,,S, PINK - Dr -11e,. CAIIARY - Cu,tcaer Parcel I.D. 051-042-28 Municipality of Anchorage ° a tf as^,tC:a On -Site Water and Wastewater Program <?Q #a a (907) 343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Location (site address) Expiration Date: — Deer Park, Block 2, Lot 5 22346 Deer Park Drive Current Property owner(s) Harold & Patricia DeMontfort Day phone Mailing address Real Estate Agent 22346 Deer Park Drive, Chugiak, AK 99567 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Fx1 Individual 17-71 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance requert for: , Distance: Received by: _�� Date: g 2D l 5 COSA to be released to the g' eer, unless otherwise requested by the engineer. - COSA Fee $ '2(08'60 Date of Payment Receipt Number 6}[firtJt COSA# o-5 CJ Waiver Fee $ Date of Payment Receipt Number 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 sLpply and/or wastewater disposal system !slate) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe 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 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 are outside the control oftheevaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 12/22/2014 By: 4Z'e�Original Certificate'Date: The ni pa i chorage Development Services Division (DSD) issues Certificates of On -Site. Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. _ 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet : ., . f k: TH f 6. DSD SIGNATURE �..... . � System #1 Approved for bedrooms tf tSeven 2.'i�annone CE System #2 Approved for bedrooms -8149 tf¢¢ DisapprovedONOFES9 Conditional approval for bedrooms, with the following stipulations: OF q ^kt SITE `j =� WATER AND o WASTE F By: 4Z'e�Original Certificate'Date: The ni pa i chorage Development Services Division (DSD) issues Certificates of On -Site. Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. _ 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet : ., . If more than 1 septic system is on the lot: COSA Checklist # 1 of + Structure served by this system + Certificate of On -Site Systems Approval Checklist Legal Description: Deer Park, Block 2, Lot 5 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 11/13/1981 Sanitary seal (Y/N) Y Total depth 60 ft. Cased to 60 ft. FROM WELL LOG Date of test 11/13/81 Static water level Well production 20 WATER SAMPLE RESULTS: ft. Coliform Neg colonies/100 mL Nitrate 2'58 mg/L Arsenic ND ug/L Date of sample: 11/6/2014 B. SEPTICIHOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping New Pumper C. ABSORPTION FIELD DATA Parcel ID: 051-042-28 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 18 in. AT INSPECTION 11/6/2014 34 ft. 6.4+ g.p.m. Collected by: PES Date installed 12/11/2014 Cleanouts (Y/N) Y High water alarm (YIN) N Date installed 1 2/1 212 01 4 Soil rating (g.p.d./ftz or ft2/bdrm) 1.1 System type Wide Trench Length 88 ft. Width 5.0 ft. Gravel below pipe 1.0 ft. Total depth 5.0 ft. Eff. absorption area 505 fe Monitoring tube Y Depression over field N Date of adequacy test New Results (Pass/Fail) Pass For 4— bedrooms Fluid depth in absorption field before test 0 in. Water added 0 gal. New depth 0 in. Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= New g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed _ "Pump on" level at Datum Size in gallons _ in. "Pump off' level at E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested Septic tank/lift station on lot 113.$;. Absorption field on lot 131.8 Public sewer main 100+ Sewer /septic service line 25+ Animal containment areas 50+ Manhole/Access (Y/N) _ in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 9'2 Property line 39'4 Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10'0 Building foundation 16.3 Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION t certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 12/22/2014 COSA brown sheet 10-10-12.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 110+ ral c �41 D C u X13 n c� s rZI,rn �� SeSs.;...� o W n✓ O Co V v o Cl) F vo c� F5 N 0 ac- mz m CZJ—y � 'aO p V I j fP � p co Pi N Lo c of s= 0+ :c7 Z r M maN 6ea' m z n CO p O N y tC z N < I pa ° I =. 1p J f \ m r » Ir I m 0 n N a N > S C � ®NBCA \ I d \ p L \ I �'x f 7 S✓ F y O m ti MUNICIPALITY ANCHORAGE O DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. It r8l-10 � _ HAA # u AS OZIIc'1 S 1. GENERAL INFORMATION Lot 5; 82ock 2; Deert Park r Complete legal description Location (site address or directions) 22346 Deer Partk Dni.ve Property owner HoAotd B b Patricia I. DeMontOlt Day phone 688-2917 Mailing address HC 80 Boz 5179 Chu4,iak AP.a6ka 99561 Lending agency N.B.A. Day phone Mailing add Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 XX Day phone 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 XX 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. noxs(n«.+ro+) Fro t MOA921 S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm . . . . 4 ,,SENC-4µ=fRMG Phone Address 17034 Eagle River Loop Road No. 204 a la River, Alaska 99.�qj Engineers signature 6. D HS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments _Date 'SOF at°aaa )THrF N1M..�1O�. C� I�i/.•�t .. M.�M �J )GER J. SHAPER . wyf No. 8215 aAV pROFESStON-�►o'� bedrooms, with the following stipulations: 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. nos 0+«.1/91) 8. wog m e Municipality of Anchorage Ak Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST IN Legal Description: L'•F S 7- arcel I.D. A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number � J/'' Log present O/N) 4t Date completed \\ - 13 -a \ Driller M ac��10S0 1 Total depth lno� Casedto lvo% Casingheight \'L%\a- Sanitary seal O)N) V Wires property protected &N) Date of test Static water level Well flow Pump level FROM WELL LOG 1 7-0.0 9.p -m. J \4 - SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot %k Absorption field on lot AT INSPECTION -�) -Zlot -92 014- — On K - On adjacent lots ; On adjacent lots Public sewer main A- Public sewer manhole/cleanout 111A_ Sewer service line 2S 14-- r Petroleum tank 2S Or N W m m > cli l l N V Q L.0 ._ WATER SAMPLE RESULTS: Coliform 'O''ti� Nitrate qs y �� • Other bacteria Date of sample: �' ZO Collected by: S 8 S ENGINEERING 17034 Eagle River Loop Road No. 404 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date Installed Cleanouts &N) High water alarm (Ya Tank size 1000 6 'wL- Compartments - +2 Foundation Foundation cleanout ON) —Depression (Y& ^J Alarm tested (Y/N) Date of pumping T'_" -Co_ Pumper (CESS foo L SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot too 14- On adjacent lots 100 Foundation } To property line in, Absorption field S1 Water main/service line 1 41 - Surface water/drainage 1 C> 72026 (Rev. 7/9f) Front CONTINUED ON BACK PAGE C. LIFT STATION , Date Installed Manufacturer Size In gallons Manhole/Access (Y/N) Vent(Y/N) High water alarm level Meets MOA electrical t :SEPARA ISTA� ell on lot "Pump on" level at " FROM LIFT STATION TO: On adjacent lots ip f" level at Cycles tested Surface water D. ABSORPTION FIELD DATA --.Date installed a ' Z o -8 Soil rating SS �f3c System type _DY -a+. l F) F t -b Length 45' Width S I Gravel thickness I ) Total depth 4 Total absorption area 21 S Cleanouts present&N) Depression over field (Yct Date of adequacy test 3 - 2e4 -ct 7 - Results Results as fail) P1xsS for _ -VA 7-c bedrooms Peroxide treatment (past 12 months) (Ya If yes, give date '1�A SEPARATION DISTANCE FROM ABSORPTION FIELD TO: I , Well on lot too t Y Onadjacentlots- Nov t ~ Propertyline to I A` To building foundation 2c t To existing or abandoned system on lot 'I I,,, On adjacent lots 30 1 L- Cutbank J(pr Watermain/service line to %t' Surface water % o o t r Driveway, parking/vehicle storage area 4D I + Curtain drain E. ENGINEER'S CERTIFICATION :C', t 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect onokPFdate of this Inspection. •. e�OF At -*4%%- I S & S ENGINEERING Signature 17034 Eaole River Loop Road No 204 Eagle River, Alaska 99577 Engineer's Name Date "7,�--2-4= iy HAA Fee $ _lT� Waiver Fee: $ Date of Payment Z Date of Payment Receipt Number Z S3 /33 Receipt Number 72-M )Rev. 3/91) Suk MOA 21 M ?n,!„ ^HAFEn r.o. 215 I S. LEGAL DESCRIPTION - D...e RECEIVED, / INSPECTION APPOINTMENTS Estates TIME, TIME - TIM DATE - DATE DATE ❑ One ❑ Four ❑ Other /— - INSPECTOR INSPECTOR INSPECTOR - MUNICIPALITY OF ANCHORAGE `\ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 1 825 L Street • Anchorage, Alaska 99501 \ ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 depth (attach log if available.) REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts cei page 1. Incomplete requests will not be processed. Please allow ten 110) days for processing. 1. PROPERTY OWNER FPRUNE Myers_Ogns u _ ;o1L, Tn MAILING ADDRESS 9�px SirChnai�k- 51j-_ - — PHONE PHOPEN7V RESIDENT litdifler om above) N/A 2. BUYER Harold B. & Patricia I. deMontfort - MAILINGADDRESS 517 Price Street, Anchorage, AK 3. LENDING INSTITUTION - PHONE MAILING ADDRESS C Street at 32nd, Anchorage, AK 4. REALTOR/AGENT PHONE Jim Montague, Totem Realty, Inc. 694-9494 MAILING ADDRESS PO Box 911, Eagle River, AK 99577 S. LEGAL DESCRIPTION - W V.' Lot 5, Block 2, Deer Park Estates STREET LOCATION p, t1 NIIN Deer Park Drive (✓JrC.+J•er 6. TYPE OF RESIDENCE NUMBER OF BEDRUOMS ❑ One ❑ Four ❑ Other 6d SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY Ja Three ❑ Six 7. WATER SUPPLY )CI 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.) S. SEWAGE DISPOSAL SYSTEM EI INDIVIDUAL/ON-SITE',' 1981 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLICUTILITY , NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. �/i•//O(Rw. 6/79) W V.' / p, t1 C� 0A'Y.Yf^I{' (✓JrC.+J•er THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLEFAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMITNUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED�� 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED �y G Y "1 INSTALLER SOILS RATING ❑Septic Tank or ❑ Holding Tank Size: Om0 If Tank is homemade give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELLTO: SepticlHoiding Tank Absorption AreaSewer Lina Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS 11; APPROVED FOR _ BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED 42 DATE /J By 72010 (Rev. 6/79)