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Home My WebLink AboutSCIMITAR #2 BLK 3 LT 11,Scimitar' Block 3 Lot 11 #0§1-132-67 Municipality of Anchorage .:?,..'.,~:?.. Development Services Department :~,.~ Building Safety DMsicn On-Site Water and Wastewater Program. 4700 Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 Page 1 of 3 www, cLanchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW090139 PID Number: 501-132-67 Mike Peratrovich Wastewater System: [] New [] Upgrade 20050 Tulwar Chuotak. AK 99567 ABSORPTION FIELD LEGAL DESCRIPTION s~'"'~' I o~o*e 7.5 3 11 Scimitar #2 576 n. I 1.5 0 n. 44144 ~,. Well: [] New [] Upgrade G,,~,~ 5.0 F,. """""""'2 ID~bm~e~l~'11.7 EXISTING PEIVATE n. n 564 ~ 3034 PVC *,.FLINTSTONE CONST. 8113/09~ ! G~I n. n. TAN K SEPARATION DISTANCES [] septic [] Holding n S.T.E.P. [] Other: T~To Septic Absorption Lift Holding >ubric./Pfivat e Mam,~lect ur ~' Tank Field Station Tank Sewer Une ANCHORAGE TANK 1000 G. w,, 115' 128' 200+ STEEL 2 s..,~w.,., 100+ 100+ ~ / LIFT STATION u,~ 10+ 11'//~ ~" '~'"~"~'"' c..~. D,.. 100 + 50+ ~.~ ~.,.. ~ E~. ~,..o.~ ~ Existing Field Abandoned In Place. Exlst'g tank abandoned per BENCH MARK Code. SHED DOOR "'~r~_.~ ~tc) I g 100.0 n. Engineer's Stamp ..speot,ons pe.orme SVC, L CDates:l" 2~ 8/13/2000 ~?'~ ¢" ................. . %, ~ '".~% Development Services Department Approval ,. _v.... ... ConditionalApproval Date: '~ ~.'"' 49TH '~ '\~ ' ......... ...,.: ~f¥~ ~Steven R. Ponnonei.~)~ I CO IFC I T1 I T2 I C2 I F~ [ F1 I ['4 I M2 '\ I 59,0 I I 19.2 FLO~ SPU~ER (rs) & co 7.4 I I I I 13.7 i 3o.8 I I I ~ 7.5'TD/ / / / / ~]~i~'":"'~V' ' ' x' ' / ' ' - ' 4 .6 I 15,5 I I I I 50.5 I I 1~.2 WELLS NOT HOUSE PERFORM OBERT 1.1 MEASL,I~ED FR OF AND )lNG ARE 2 IS NOT IN SE NOTES: RECORD DRA~NG PLAN o NEW 1000 GAL 1.7, TANK DCO EXISTING EX,ST,NC TANK/ ABANDONED PER CODE EXISTING FIEL[ IN FAILURE- ABANDONED .~- BUILT SURVEY. SURVEY TULWAR DRIVE NSON ON CLEANOUTS ERS. TIC SYSTEMS ,I~PROXlMATE. PANNONE ENG SVC, LLC P.O. I~OX 100217 ANCHORAGE, AK g9510 PHONE (gO7) 272-8218 FAX (907) 272-8211 Scimitar #2. BIk 3, Lt 11 Mike Peratrovich 20050 Tulwar Drive Chuglak, AK 99567 CE 8149 s/~ 81o9 1"=50' P,I.D. NO NO. SWxxxxxx Sheet 1 of 2 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALI?Y Of ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS. 2. ALL WORK SHALL BE IN ACCORDANCE WITH THE AI-EACHED SPECIFICATIONS. 3. SCOPE OF WORK: 3-BEDROOM HOUSE UPGRADE, NEW lO00g SEPTIC TANK, ABANDON EXISTING TANK PER CODE, CONNECT TO EXISTING FIELD, INSTALL UPGRADE FIELD. 4. GROUNDWATER IS NOT EXPECTED TO BE ENCOUNTERED DURING EXCAVATION, AS EVIDENCED BY THE SOIL TEST HOLE INFORMATION ABOVE 15 FI'. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 11 FEET BELOW EXISTING GRADE, NOTIFY THE ENGINEER IMMEDIATELY. 5. EXISTING TANK SHALL BE ABANDONED IN ACCORDANCE WITH THE CODE BY PUMPING, CRUSHING, AND FILLING WITH COMPACTED CLEAN EARTH MATERIAL. UPGRADE SECTION SEPTIC: ~ ~ PROFILE DESIGN PARAMETERS ABBREVIATIONS LEGEND RESERVE SEPTIC SYSTEM CU COPPER --W WATER LINE/ NO. BEDROOM: .3 (450 gpd) DIP DUCTILE IRON PIPE WELL RADIUS TANK SIZE: 1,000 gollon TH TEST HOLE PERC. RATE: < 1 mln/in. FC FOUNDATION CLEAN OUT -- SS EXIST'G SEPTIC SOIL RATING: 1.O gpd/SF T# TANK CLEAN OUT NO. AREA RQD: 450 SF C# CLEAN OUT NO. SS NEW SEPTIC SYS. TYPE: 5'-WIDE, 1.5'ED, RF=0.78 M# MONITOR TUBE NO. MIN LENGTH: 70 LF R.I. RIGID INSULATION O CHAINLINK FENCE USE: 2EA 44LFx5'WlDE, l.5'ED,7.5'TD DCO DOUBLE CLEAN OUT TOTAL AREA: 564 SF DV DIVERTER VALVE FS FLOW SPLI'I-rER P.O. BOX 100217 ANCHORAGE, AK 99510 RECORD DRAWING PHONE (907) 272-8218 FAX (907) 272-8211 Scole .." · NTS Scimitar #2, BIk 3, Lt 11 ~_~.____~.._______.~~tevenR. pann0ne ~ ;;5-093-2: Mike Perotrovichrl~,~,'-'. CE 8149 '~ ~ERMIT NO. 20050 Tulwar Drive DESIGN NOTES/CALCS Chugiak, AK 99567 'qk;;'~,~,~kt,:~,'Ct,'v~.~ Sheet MUNICIPALITY OF ANCHORAGE Development Services Deparlment 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 Date Issued: Aug 05, 2009 Expiration Date: Aug 05, 2010 Permit Number: SW090139 Legal Description: SCIMITAR #2 BLK 3 LT 11 Design Engineer: 0062 PANNONE ENGINEERING SERVI( Owner Name: MICHAEL PERATROVICH Owner Address: 20050 TULWAR DR CHUGIAK, AK 99567-0000 Parcel ID: 051-132-67 Site Address: 020050 TULWAR DR Lot Size: 55870 SQ. FT. Total Bedrooms: 0 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15,55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify 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. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 051.132-67 Property owner(s) Michael Peratrovlch Mailing address20050 Tulwar Drive, Site address 20050 Tulwar Drive Legal description (Sub'd., Block & Lot) Scimitar No. 2, BIk 3 Lt 11 Legal description (Township, Range & Section) Lot Size 55,870 Sq. Ft. .Day phone 727-3998 Zip Code 99567 .Zip Code 99567 Number of Bedrooms 3 THIS APPLICATION IS FOR (~;;~ all that apply): Absorption Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage [] THIS APPUCATION IS AN: Initial [] Upgrade [] Renewal [] I certify that the above information is correct. I further certify that this application is being made for a Single Famlly Dwelling and is in accordance with applicable Municipal Codes. Pannone Engineering Services, LLC ~.-.--"'~~-~ (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: Receipt Number: (Rev. 11/05) Waiver Fees: Date of Payment: Receipt Number: Pannone Engineering Services LLC Steven R. Pannone, P.E., Principal Licensed & Registered in Alaska and Florida E-malE ~ve~panen~ak.com August 3, 2009 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road P. O. Box 196650 Anchorage, Alaska 99519 Re: Scimitar S/D No. 2, Block 3, Lot 11 Septic System Upgrade Permit Request - RUSI! Ladies and Gentlemen: I am writing to request that a permit to construct an upgrade septic system be issued for this property. The proposed systems will serve an existing three-bedroom house. The lot is currently developed and is served by a private water system located on the west side of the lot. The proposed upgrade is to install a new 1,000 gallon septic tank and a new drain-field. A recent septic system adequacy test determined the existing field is in failure. The original septic tank was installed in 197S and is most likely corroded to the point of failure. A diverter valve will be installed between the 1975 field and the proposed upgrade field. This house is under contract to be sold. I request a RUSH review and issuance of the permit. Soils Investigation: A soils exploration was completed on July 28, 2009. The soils encountered were poorly graded sands to sandy gravel. The strata the new drain field will be installed is Sand. Though it percolates at a rate less than one minute per inch, the sand content is sufficient to waive the requirement for a sand layer. Bedrock and ground water were not encountered in the test pit. Ground water was not observed after the water monitoring period. Based on the soil investigation and the water monitoring performed to date, I believe the best system would be a conventional septic system using an application rate of 1.0 gpd/sf. Trench Deslgn: a. Percolation Rate: b. Application Rate: c. Numberof Bedrooms: d. Design Flow: e. Min. Absorption Area: f. Total depth: <1 rain/inch 1 gpd/sf 3 450 gallons per day 450 sf 6.5 feet Mailing: P.O. Box 102954, Anchorage, AK 99510-2954 Physical: 11301 Olive Lane, Anchorage, AK 99515 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 g. Effective Depth: 1.5 feet h. Width: 5 feet i. Reduction Factor: 0.78 j. Minimum Length: 71feet k. Design Length: 90 feet I. Effective Absorption Area: 576sf m. Septic Tank Size: 1000g steel Septic tank Surface Water: There is no surface water within 200 feet of the proposed installation. 4. Topography: The average topography In the area of the proposed septic system is approximately one percent to the southwest. 5. Future Development: The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, ee"~' CE 81149 ,~ Steven R. Pannone, P. E. Principal 8/4/o9 Attachments: Mailing: P.O. Box 102954, Anchorage, AK 99510-2954 Physical: 11301 Olive Lane, Anchorage, Al( 99515 ~-.~ I / \ /// · '~.~ ] { ~.~ '--'--.-/ / '~. ,,~/ ~ ~ ~. /%/ I ~o~os~.,,', ~- ~;'%. / ........... ,, ~ /gx// _~_~ I ~,,,... ~ .~// ~ ~EXlS~INaV / t ~ , ~ .-'-~.~ /J / WELL /l //' / ~.~ ;~)--~_%z~ ~ ~ ~2.5 .. / { ,,~ ~ ~~ ~;;~&. //' /,, -. .~ ./..- I ,,/ ~ I ~j I ~ / // %. /~' / '.~ ~ DRIVE /// SEPTIC ~---~ ~./¢ / 'a ~ ~' A~~ x ., ~ / t,/ ~ X~. X r / I '~ W~-~ k / %~._ ./,'~ ~OT[S= ~0~ ~g ~C, ~ ISSUED FOR CONSTRUCTION PHON[ (907) 272-8218 FAK (907) 272-8211 ~49~ ~ '"%~ Sca~ Scimitar ~2, BIk ~, Lt 11 -- ~32-6; Mike Peratrovich ~ CE 8149 .~ P[RMIT NO. 20050 Tulwor Drive ~ ~m'. . .~ PLAN Chugiak, AK gg567 ti " ...... · Sheet f. ~ ..... ~.... ///// /. --... /~/ ./* ~'"'" -~ ~ PROPOSED UPGRADE / // / ~t U 2 EA45LFX5'W1,5ED~ / / 'NOTE TH,S,S'NOT^N^S-BU'LTSUR' Y. ';, I / HOUSE LOCAT')N BASED ON SURLY ~ .' ./ / PERFORMED E ' ROBERT JOHNSON ON ~ / / / 4-21-81. ~1 .S AND SEPTIC CLEANOUTS ~ ~ ~ ~ ~ I MEASURED FE~M HOUSE CORNERS, ~ ./ / / /~ CONTRACTOR LOCATIONS OF ~LLS AND SEPTIC SYSTEMS · / .'1 ~ SHALL HAVE ON SURROUN[ JNG LOTS ARE APPROXIMATE. ~ / / / / ~ LOT LINES ~LL 2 IS NCT IN USE ~ ~/ / ~ ~ND WELL · / ~ ~ ~ i ~ RADIUS ~ ~ ~'~ ~ J STAKED BY ' ~ ~./ ~ ~ ~ ~ ~ REGISTERED ' _ ~ ~ ~ ~ x ~ SURV~OR ~j~' ~" '.__ ~ FLO~ - ~ ~1~,~ ) ~EPTIC TANK /// //~ 3s~~A ~1 / ' ~ / EXISTING HOUSE 134.~~ a t ~ ABANDON EXISTING/ J L ~ ~ ~ TANK PER CODE // ~ / ~ ~ ~ ~ ~/ EXISTING FIELD P.O. BOX 100217 ANCHORAGE, AK 99510 ~ .... ISSUED FOR CONSTRUCTION PHONE (907) 272-8218 FAX (907) 272-8211 ~';:_, ~;L~]J/ Sc?j:... Scimitar ~2, BIk 5, Lt 11 Mike Peratrovich 'i~ ~[eve~,~nn~e~ PERMIT NO. 20050 Tulwar Drive ~t~.. PLAN Chugiok, AK 99567 I~~j~ Sheet SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALll~F OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS. 2. ALL WORK SHALL BE IN ACCORDANCE WITH THE All'ACHED SPECIFICATIONS. 5. SCOPE OF WORK: .1-BEDROOM HOUSE UPGRADE, NEW I0009 SEPTIC TANK, ABANDON EXISTING TANK PER CODE, CONNECT TO EXISTING FIELD. INSTALL UPGRADE FIELD. 4. GROUNDWATER IS NOT EXPECTED TO BE ENCOUNTERED DURING EXCAVATION, AS EVIDENCED BY THE SOIL TEST HOLE INFORMATION ABOVE 15 Fi. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 11 FEET BELOW EXISTING GRADE, NOTIFY THE ENGINEER IMMEDIATELY. $. EXISTING TANK SHALL BE ABANDONED IN ACCORDANCE WITH THE CODE BY PUMPING, CRUSHING, AND FILLING WITH COMPACTED CLEAN EARTH MATERIAL. UPGRADE SECTION PROFILE DESIGN PARAMETERS ABBREVIATIONS LEGEND RESERVE SEPTIC SYSTEM CU COPPER --W' WATER LINE/ NO. BEDROOM: ,3 (450 gpd) DIP DUCTILE IRON PIPE WELL RADIUS TANK SIZE: 1,000 gallon TH TEST HOLE PERC. RATE: < 1 m~n/in. FC FOUNDATION CLEAN OUT -- SS I EXIST"C SEPTIC SOIL RATING: 1.O gpd/SF T# TANK CLEAN OUT NO. AREA RQD: 450 SF C# CLEAN OUT NO. SS NEW SEPTIC SYS. l~PE: 5"-WIDE, 1.5'ED, RF=0.78 M# MONITOR TUBE NO. MIN LENGTH: 70 Lr R.I. RIGID INSULATION ~ CHAINLINK FENCE USE: 2EA 45LFxS'WIDE,l.5'ED,7.5'TD DCO DOUBLE CLEAN OUT TOTAL AREA: 576 SF DV DIVERTER VALVE FS FLOW SPLll-FER NOTES: PANNONF ] IO 8VC, LI£ P.O. 80X 100217 ANCHORAOE, AK 99510 ~-~.~- ..... ISSUED FOR CONSTRUCTION PHONE (907) 272-8218 FAX (907) 272-8211 ~,~c~...~314 , . Sca~e NTS ~ ..c-~.tK~--(~.....~.'.' 7.~- ' I~ ~.,.~. NO Mike Peratrovich ~f~,-¢,.~'. CE 8149 "/~-,~ ~ERIC~T NO. 20050 Tulwar Drive ~ ~... . ..~,~ sw,~,~,~ DESIGN Chuglak, AK 99567 SOILS LOG - PERCOLATION TEST TEST HOLE 1 , __o. TOPSO,. SLOPE ! \~ '~"~'////// / 12 ~.~'1'/'~I I 4 -- COBBLES ~IEST ~ ~ ~/ ~ TH ~ j I ~D ~ORLY WAS GROUND WATER SLOPE 14 ~ SP~M G~ED SlL~ ENCOU~ERED? ~ 15 IF YES, AT.AT TH 1 DEPTH? -' DEPTH TO WATER A~ER MONITORING? DRY - DATE: 8-3~ PERO~TION ~TE < 1 (minAnch) PERC HOLE DIAM~ER 6 ~ TEST RUN B~EEN 5 ~ ~D 6 ~ COMMENTS: Test hole excavatcd by ~intstonc Excavation. Test tlole was presoaked ~forc ~rc test. PERFORMED BY: Stevcn R. Pan.one, P.E. l CE~I~ THAT THIS T~ST WAS PERFORMED IN ACCORDANC~ WITH ALL STATB AND MUNICIPAL GUIDLINES IN EFFB~ ON THB DATE OF THIS T~ST. P.0. BOX 100217 ANCHORAGE, AK 99510 ~ - ....... '.~: ! Scimitor ~2, BIk 3. kt 11 ~ ~ '.L~. UO Mike Perotrovich ,/~%~no~e~ PERMIT NO. [, ~". ." ~ J SWxxxxxx 20050 Tulwar Drive ~,~.....~ SOILS LOG Chugiak, AK 99567 ~~:c~ ..... ~'~ 5beet NAME GRE/"--? ANCHORAGE AREA BOI Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM (~)~A~/ MAILING ADDRESS 7 LI /~//~:~ ~: /~,~':~-',',/ ~' > >'C/PHONE LOCATION SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER ~_~e~ MATERIAL NUMBER OF COMPARTMENTS ~ '- INSIDE WIDTH LIQUID DEPTH_ LIQUID CAPACITY I~-g-~) GALLONS. SEEPAGE t~lih 'T~re~ '- NUMBER OF PITS I DIAMETER~::~-'~OR WIDTH LENGTH BUILDING FOUNDATION ~¢ NEAREST LOT LINE ~ / TOTAL EFFECTIVE ~ ABSORPTION AREA {WALL AREA) ' SQ. FT. ADDITIONAL ABSORPTION WELL: 'L),, ~- TYPE CONSTRUCTION BUILDING NEAREST NEAREST FOUNDATION- LOT LINE SEWER LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK SYSTEM DISTANCES: INSTALLED BY: PIPE MATERIAL: LOT SLOPE, REMARKS: Form No. EO-031 DIAGRAM OF SYSTEM GrEaTer ANCHORAGE ArEA BorOUGh DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. INSTALLATION LOCATION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH BOIL TEST RESULTS NOTE~ THIS PEEMIT IS NOT VALID WITHOUT SOIL COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIFtEMENT$ FOUNDATION TO SEPTIC TANK FOUNDATION tO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PiT WALL-- SEPTIC TANK .. SEEPAGE PIT DRAIN Field . DRAIN FIELD BEEPAGE P'T SEPTIC TANK, , SEEPAGE PIT TO RIVER. LAKE, STREAM. , DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WiTH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. DIAGI~AM OF $¥BTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DATE ~ ~ / APPLICANT'S SIGNATURE O~rE Russell Oyster 694 2774 Soils Et Foundations GEOTECHNICAL 8 DEVELOPMENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Earl Ellis 688-2280 Land Development performed for: SOXL LOG Name:. ~%,'~ ~--~a~ Mailing Address: ~otl Charactertstic~ If yes, what depth Drain Field Comments: Performed by: Legal Description: ~ ~\ D e.~p_t h (feet). 1 3 6 7 ~ -- lO~ ll Ground Water Encountered: Yes ~ No Proposed Znsta. llation: Seepage Pit · erlifie rilling by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 9956? · TELEPHONE 688-2759 OWNER OF LAND , ., . i,-/-_.~...~, t ..... ~ DEPTH OF WELL STATIC LEVEL OF WATER FT. LEGAL DESCRI~ION DATE - Started Ended ~:'/"~ '~ GALS. PER HR ''"' PE~IT NUMBER KIND OF CASING KIND OF FORMATION: From ~)'- Ft. to :'~ From , , Ft. to r From '!" Ft. to ~ From From :r From From From ,: From From -,,'- '.;Ft. to'"?.? '.: Ft. /3,'~',)>~4;:,. ; ~.'~/:'/:~7~..t From ! From'C'l, e.':' Ft. to-oC' 75, Ft. c .,/ :i' ~' A/;~5?,~;-;/:C /<~ From Ft. :~' "':J & From Ft. to_. FI. · ' From Ft. to Fl "From Ft. to Ft ' F~om__FL ~o Ft Ft. to Ft. _Ft. to Ft. From Ft. to FI. From From Ft. to Ft From_ From Ft. to Ft. From From Ft. to__FI From From FI. to Ft. From Ft. to Ft Ft. to F JAN 1 1 1994 F~ *~, Mu~,c.pal!!~, al Anchorage Ft. to Ft. Ft. to Ft MISCL. INFORMATION: DRILLER'S NAME PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920400 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:NELSON DAVID E & OWNER ADDRESS:PO BOX 671923 CHUGIAK, AK 99567 PARCEL ID:05113267 LEGAL DESCRIPTION: SCIMITAR #2 BLK 3 LT 11 DATE ISSUED:12/01/92 EXPIRATION DATE:12/01/93 LOT SIZE: 55870 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM 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 (iSAAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: NOTICE: UNCONSOLIDATED AQUIFERS IN THIS AREA MAY NOT BE USED AS A POTABLE WATER SOURCE. THE WELL CASING MUST BE DRIVIN INTO BEDROCK TO PREVENT MIGRATION OF CONTAMINATED WATER. IT MAY BE NECESSARY TO GROUT THE .~ CASING · DATE: DATE: Aurora Properties Full Service Real Estate Professionals Sharon Dunckle Associate (907) 685-4939 Peters Creek Business Center E O. Box 671923 Chugiak, AK 99567 (907) 688-...~.~ SPECIAL POWER OF ATTOILNEY STARE O1~ ALASKA THIRD JUDICIAL DISTILICT KNOW ALL MEN BY 'I'IIESE PRESENTS, that, I/we '~o io moo . Io, q. ~ Ne_.l. son have made, ¢omtltuled, and appointed, mid by these presents, do make, " constitute and appohtt ,' . C / }).._O ~2 _F'P,,[ c. ~' my/our tam and lawful attorney for indus and tn my/our name, phtce and stead, mid for my/our use and benefit to do any and every act m~d exe~x:is¢ any and every p~er flint Fwe misht or could do if ~rsonally present, or exercise tim)ugh ~y off,er ~non flint he sh~ d~m p~r or advisable, Msofar as such action is or may ~ela~ to ~eal p~rw l~a~d In the City of ..... ~ 3 O q/~ ~ , Sram or ...~L~.~ . _, descri~ as: /07--// d/odd P/# T A o 7q-/?o,, any interest fl~e~ein and/or buildh~g(s) thereon, Includh~g, but not lhnlted to, tim ~ver to contact for Ibc purchase or sale of, to purclmsa or 8~, to convey ~d ~nant tifl~ flm~eto, m take or give ~ssesslon flmr~ff and of evidence of title fl~ercto, ~ leto the stone for m~y term or pur~sc, ~ mortgage, um~sfer h~ mint, or oflmnvise e.cumber or hyl~flm~le tim s~ne, to s~ure payment of a negot~ble or nonq~g(,t~ble note or performmmo of any obligation or nfltecment, ho~e~ ratifying and confln~fing whatsoever my/our said attorney shall or may do ~ virtue hereof in the pmnlses, and Fwe agree m~d rep~sent to those dealing wiflx my/our said attonmy flint tiffs l~v~r of At.racy m~ ~ voluntarily ~k~ alone ~ rev<a- tion given the smn~ general dNu~bufion as ~1, originfl ~er of ~m~. (Y,~,p,,i,e , ,~x ?¢5~7 .... ~ ST^T, or ^x asKA } Tills IS 'ID CERTIFY flint on tiffs ,\' d~y of ~'-~0 ~l_~ ~)~ , 19 q~, bolo~ me tim nnde~igned, a No~ rani'6 in mid for tim State of'~as~, d~y conunissioned mid kmmn to me to be the pm'son(s) who signed tim foregoing, and acknowledged to me that tm/flmy sig.ed mid sealed the sran¢ freely and voluntarily for the uses and puqvoses flmrein m~ntioned. WITNESS my hmxd aud official seal the day mid year in t~s Certificate first above written. ~.9- 0 5 ~ 7 0 1 ~o~ ~biie in-~n~r My Con~ion Expos: O~ .'~ t X~q~ REQUESTED BY STATE OF. ALASKA NOTARY PUBLIC BONNIE J. I(ING INVOICE MO0 i:LL DRILLING ~;7043 Terry Place Anchorage, Alaska 99502 Phone: 344-6139 or 337-2406 INVOICE NO. DATE ' ' .' YOUR P. O. NUMBER .WELL LOG DEPTH CASIN DEPTH CASIN FORMATION IN FT. DEPTH CASIN FORMATION IN FT. -- _ L1 ~ 101 -- -- - --102-- , · __ __202__ _____~-~.--.. -- -- 203 __2. : 103__~-- !~ ' 3 t 104 /204 4 : 105 ; . 205 5 106 206 ~6 ' " ~ 107 , , ..~ ' 207 7 ~ 108 r' . ~, 208 8- .', . 109 ~ : .. 209 -- -- . ~10 9 . 110 ; ' ' 1' 211 --~0 ~ '111 ~ ! '' 212 11 112 ' '- 213 ~12 _- '. na 13 114 214 --14 , 115 215 --15 ,i ' ' 216 116 217 --'16' 117 -' 218 _17_ ~ 118 219 _18 119 220 __19. 120r 221 __20 121 - ' 222 __21 122 ', 22 123 223 -- 224 __23 124 225 24 125 25 126 226 -- 227 26 127 228 527 128 229 .__28 '129 230 29 130 --30 '131 231 '~31 "! 232 32 ;, 132 233 __ 133 33 ~ 134 234 235 ---34 ' 135 236 __35 136 237 __36 137 238 __37 ; 138 239 36 139 ' '' "'' /' /' 240 39 140 241 --40 ' 141 242 --41 142 243 ~42 143 244 ~43 ' : 144 245 --44 145 ~45 , .. 246 ~46 : ~ 146 24~ 1~? ~ 248 ~47 '148 249 --48 149 ~49 ' 150 250 '251 ~50 151 ~ 252 --51 : :. ~ 152 "' 253 --52 153 ~ 254 --53 '154-- · 255 --54 , i ' " 155 '256 --55 : '156 257 ~56 157 ' 258 ~57 ~ 158 '259 58 ~ 159 . ' 260 --59 ; 160 ' 261 --60 i - '161 --61 ' 162 ~ 262 ' 263 --62 163 ' 264 63 ;./ 164 --64 '165 265 · '266 --65 166 66 ~ '26Y __ 167 67 ; ' 168 268 ~68 ~, 269 169 ~69 ' 170 270 -- '271 ~70 ' ,,, 171 272 71 : 172 --72 { ' 173 / 273 ~73 ~ 174 : 274 74 = '175 ~ '275 ~ ~ 276 75 r ~ 176 277 --76 177 278 --77 [ 178 ! '279 --78 i 179 t 280 79 r "180 ' 281 80 ! 181 ' '282 81 "182 82 186 i 288 83 ~ 284 84 i 184 i , "18§ j 285 --85 I 186 } 286 --86 ~ 187 ~ 287 --87 ~ '188 ¥,;. .288 --88 ; '189 ~ 289 ~89 '190 !,, '290 ~90 '191 ~ 291 __91 '192 i . 292 29~ 92 J 198 I 294 --98 ~ { 'lg4 'l ", 295 --94 ' { 195 i -' 296 --96 ; --197 ~97-- I --198-- ~ ~- 298 ~98 -- - --199-- +, _ --299 --99 -- ~7. --200 300 --100'~. PLEASE PAY FROM THIS INVOICE per foot AMOUNT E:,EF'FIB:2"f'IEN'T' , Z¢:It..'TH FINI.::, E[",I",'l ]: F::ONHEN"I'FIL 2.~i~el E. ' I~Ul~:~l:J[~: RI"., RNCHOF;~:RGE., FIF: ROBERT R ~ ~E ~ER E;6:t. 3: [)ONNR [)1;7. LOCRT ]: ON Tt...ILI.,] R[~: LEGRL I_.:l.:t. 13:3: E i"': Z f'1Z "['FIR E;I..IE:E:, LO'T ~; ~ ZE ...... :, r .. H [ N [ HUH [) ]:2;I'RNCE F'ROH NE:LI... TO IqN'~' E;EF'T ]~C 'ff:~NK,.."F'FICKR(:~E F:'LFIN't' Oi~: FO ~ L RE~2;ORF'T :t: ON ,RIENbLL FIN[::' '::'~:~R FT FOR R F'JE~L~E: NELL. [4EL. L LOGE; ~I.JS"i~ DEE F:EYI"URNEI::' TO '1"HE: [':,FF'F~'THE:N'" bJ:[TH:[N ::~:E~ B, FI'¢E; OF THE 1.4EL~L CO~'IF'LET ]: ON. E F'EC :[ F' ]: E:l~'" [ ONE; F:IN[::' : NE;TF IJCT ]'. ON [::' :[ FtGRF:IHE; FIRE F~',,,'f::l ~ LFIBLE ~ NE;TRLLRT ~ ON. ]: C:EFW):F'¢ THR'I" ~ RH F'FIH:I:L..]:I:~I~: N[TH THE: RE3::~Lt[BEHENTE; F'E~R ON-E;:[TE z,E.I.,IE.k.=, RND NEL. Lz, RS SE'I"FOF:TH B'¢ THE HLIN.EL.~FHL):I OF: FINCHCt~'RGIE FINE:' f4I'I"H THE IL::O[::,E. ~ ..... .. 2' Parcel I.D. o?-132-67 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 /4% COSA Expiration Date: Jeremy & Laurelyn Miner 20050 Tulwar Dr. Chugiak, AK 99567 GENERAL INFORMATION Complete legal description Scimitar #2 BIk 3 Lt Location (site address) :zooso Tulwar Dr. Chuqiak, AK 99";67 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Day phone 688-o878 TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class __ Public Water System Day phone Day phone TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] Individual Holding Tank E~ Well [] Community On-site [] Public Sewer [--1 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 1o2954, Anchorage, AK 9951o Engineer's Printed Name Steven R. Pannone, P.E. Date Engineers Comments: [n conducting an adequacy test, ! attempt to provide a thorough, conscientious engineering ana]ys/.s of the system in accordance with MOA DSD Guidelines & 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 of the evaluator 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. 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 SIGNATURE ~/'/ Approved for ~_~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory ~<' Nitrate Advisory (Rev. 11/0 Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bregaw Street P.O. Box 196650 AnChorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: scimitar #2 blk Parcel ID: A. WELL DATA Well type private Date completed 81~.l~.qq:~ Total depth 60o ft. 'If A. B, or C Provide PWSID # ~ Sanitary seal (Y/N) Y Cased to ax~ ft. FROM WELL LOG Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) a] AT INSPECTION in. Date of test 8/,.,/:iqq'~ 8h. ol20o9 Static water level unknown ft. .ax g.p.m. ff. Well production o.~; g.p.m. WATER SAMPLE RESULTS: Coliform o colonies/100 mL Nitrate ND mg/L Other bacteria e colonies/100 mL Arsenic: ~.~,~ ug/I Date of sample: ?1261,,o~.o Collected by: SRP B. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size ~.0oe gal. Foundation cleanout (Y/N) Y_ Date of pumping 7'/! (~/l 0 C. ABSORPTION FIELD DATA Date installed 8h.2120o_q SEPTIC/STEEL Date installed 8/~.2/2oo9 Number of Compartments Z Cleanouts (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) NIA Pumper ~ ~1~ ~/-~tO c~£1~.'C_.0_ ~ Soil rating (g.p.d./ft2 or ~/bdrm) =.o System type 5.WIDE TRENCH Length ~IM~ ft. Width ~i ft. Gravel below pipe ~..5 ft. Total depth ~_5 ft. Eft. absorption area 56zr ft= Monitoring tube Y Depression over field N Date of adequacy test 81q12ooq Results (Pass/Fail) NEW For 3 bedrooms Fluid depth in absorption field before test -~- in. water added~r,:~' ~ al. New depth ~ in. Elapsed Time: "----min. Final fluid depth'~:~---~n. Absorption rate >-- /-'/,.~) ~ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) tf yes, give date LIFT STATION Date installed "Pump on" level .at Datum in. E. SEPARATION DISTANCES Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot ~.~.5.~ On adjacent lots ~.oe+ Absorption field on lot =~,8.~ On adjacent lots ~.oo+ Public sewer main NIA Public sewer manhole/cleanout NIA Sewer/septic service line *,o,~ Holding tank *,oo+ Animal containment areas ',oo+ Manure/animal excrete storage areas =oo+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO~ Building foundation 8' Property line ~o+ /~ Absorption field ~.o+ Water main N/A . Water service line ~ Surface water ~.oe+ Wells on adjacent lots .,oo+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~.~' Building foundation ~.2' Water main NIA Water Service line N/A Surface water ~.oo+ Driveway, parking/vehicle storage :~i+ Curtain drain NONE'KNOWN Wells on adjacent lots ~oo+ F. COMMENTS 7/261~o Checked Septic MTs - Dry 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 Steven R. Parmone~ P.E. Date 7hlol'o=.o COSA Fee $ Date of Payment Receipt Number. ~) ~ o[ .~-- 7 c{ (Rev. 11/05) Waiver Fee $ Date of payment Receipt Number .............. SGS Ref.# 1103645001 Client Name Pannone Eng. Srv. Printed Date/Time 07/29/2010 8:56 Project Name/# Scimitar #2 B3-L11 Collected Date/Time 07/26/2010 14:45 Client Sample ID Scimitar #2 B3~L11 Received Date/Time 07/26/2010 16:55 Matrix Drinking Water Technical Director Stephen Co Ede PWSID 0 Sample Remarks: 4500NO3 - Nitrate & Nitrite - MS recovery is outside QC criteria. Refer to the LCS for accuracy. Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic 5.45 5.00 ug/L EP200.8 C (<10) 07/27/10 07/28/10 KDC Waters Department TotaINitrate/Nitrite-N ND 0.100 mg/L SM20 4500NO3-F B (<10) 07/27/10 LCE Microbiology Laboratory E. Coli Total Coliform Negative 1 100mL SM20 9223B A 07/26/10 DLC Negative I 100mL SM20 9223B A 07/26/10 DLC Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street Anchorage, AK 99519-6650 www.muni.org/onsite CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 1. GENERAL INFORMATION Complete legal description Scimitar #2 BIk ~ Lt~ Location (site address) 2oo~;oTulwar Dr, Chugial<. AK ¢1q~;67 Current Property owner(s). Mike Pemtrovi(;h Mailing address 2oo~o Tulwar Dr. Chugial~, AK nqq67 Lending agency Mailing address COSA # O 2.-7...%. Expiration Date: / I - ( c~. O Day phone 688.~46 Dayphone Real Estate Agent Mailing Address Un/ess otherwise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: ~ Dayphone 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class, Public Water System Well 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 a~n~....~tate cedes, ordinances, a. nd regulations in effect at the time of installation. ; ~Name of Firm pannone Engineering Services. LLC Phone Address P,O. Box a.o:~e~5/.. Anchorage~ AK qq~;:t° Engineer's Printed Name Steven R. Pannone, P,E, Date 8hTIoq Engineers Comments: In conducting an adequacy test, I attempt to provide s thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. 'l'be reported results describe the performance of thc system under thc conditions encountered at the time of thc test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on thc local soil condition, ground water levels that may lluctuatc during thc )'car, and thc water usagu of thc family being se~ed by thc system. These conditions arc outside thc conlrol of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of thc system, nor do they guarantee that there arc no hiddcn defects or encroachments. P'ES can therefore not provide any warranty for future performance nor give any estimate of how long Ibc system will continue Io meet thc operational t'cquirements of the MOA DSD. 'Ibc content of this report is for thc sole benefit of the owner listed above. Any rclianca 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 t ,~ Approved for --~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & 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 APPROVAb CHECKLIST Legal Description: ~cimiter #a blk '~ It a:~ Parcel ID:_~;oz.~2.67 A. WELL DATA Well type Drivate Date completed 8/zlzclg~ Total depth. 600 ft. Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform .9 colonies/f00mL Arsenic: ND ug/I B, SEPTIC/HOLDING TANK DATA IfA, B, orC provide PWSID # Sanitary seal (Y/N) y Cased to FROM WELL LOG onknowfl ft. Well Log (Y/N) ,y Wires properly protected (Y/N) y Casing height (above ground) ~ AT INSPECTION 81zo12oOet ft. g.p.m. Nitrate ND mg/L Date of sample: Other bacteria ~ colonies/100 mL Collected by:, ~;RP Tank Type/Material ~ Tank siZe .. ~.ooo gal. Foundation cleanout (Y/N) Y Date of pumping C, ABSORPTION FIELD DATA Date installed Number of Compartments Depression over tank (Y/N) Pumper NEW Cleanouts (Y/N) .y High water alarm (y/N) .N/A Date Installed 8/z~,l~o9 Soil rating (g.p.d./ft~ or ~/bdrm) ;~,o System type ~ Length ..~L~4 ft. Width ,~ ft. Gravel below pipe .~.,~; Total depth ~ ft. Eft, absorption area ,~6~. ~ Monitoring tube Y Depression over field N Date of adequacy test 8/el~oe9 Results (Pass/Fail) NEW For 3 bedrooms Fluid depth in absorption field before test. in. Elapsed Time: rain. Final fluid depth Any rejuvenation treatment (past 12 mo.) (Y/N & type) Water added ,, . gal. : Newdepth in. Absorption rate >= If yes, give date in. g.p.d. D. LIFT STATION Date installed "Pump on" level at Datum /Size In gallons y~.."~ m p off', eve, at " ' C,]'cles tested in. Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot ~.~ Absorption field on lot Public sewer main Sewer/septic service line Animal containment areas ;too. On adjacent lots ;toO+ On adjacent lots 3oo+ Public sewer manhole/cleanout H/A Holding tank 3oo+ Manure/animal excrete storage areas 300+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 8' Property line ;to+ ~p_,,~bsorption field Water main Nl^ Water service line ~ [O1~ Sudace water Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ;t~.~' Building foundation 3~' Water Service line N~ t(::)31'' ~urface water Curtain drain ~ Wells on adjacent lots Water main Nl^ Driveway, parking/vehicle storage F. COMMENTS House has 600 Gal of' water storage 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 Steven R. panngne~ P.E. Date 8hSl=ooq._ Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 _Water Well Advisory Certificate of On-Site Systems Approval (COSA) # 090272 During a recent COSA on-site inspection and test of the potable water supply well on Block 3, Lot 11 of Scimitar #2 subdivision, the well's productivity was determined to be 0.5 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3-bedroom residence is 0.31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. SGS Ref.# Client Name Project Name/# Client Sampte ID Matrix 1093702001 Pannone Eng. Sty. 20050 Tulwar Scimitar//2 Drinking Water Sample Remarks: Printed Date/Time Collecled Date/Time Received Date/Time Technical Director 08/07/2009 8:50 07'28/2009 15:10 07/29/2009 9:50 Stephen C. Ede Total Nitrate/Nilrile. N Hi~robioloc~ Z.a.bora to~,r Cok,ny Count 0 Tolal Coliform 0 Fecal Colt fom~ i 0 ug/L EP200.8 C (<10) 0~/04/09 0~/06~9 NEB ND 0.100 mg/L SM20 4500NO3-F B 07~1~9 LCE col/I OOmL $M20 9222B A (<200) col/lOOmL SM20 9222B A (<1) col/lOOmL ~M20 9222B A (<1) 07~9~9 DLC 07~9~9 DLC 07~9~9 DLC ..,r0 I NO1°45'OO"E 59.23 \ / \ DATE RECEIVED " INSPECTION APPOINTMENTS TIME TIME DATE " DAT~ DATE MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHO~GE DEPARTMENT OF HEALTH& ENVIRONMENTAL PRO~CT~T. OF HEALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL P~:OTECTION ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REOUEST FOR APPROVAL OF INDIVIDUAL WATER AND S~ ~A~S DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1, PROPERTY O~ER PHONE MA~LING ADDRESS PROPERTY RESIDENT (If different f~o~ able) PHONE 2. BUYER MAILING ADDRESS 3, LENDING INSTITUTION ~ PHONE MAILING ADDRESS 4. ~AL~O~/AGE~T / / 5, LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE SINGLE FAMILY .Fl MULTIPLE FAMILY 7. WATER SUPPLY NUMBER OF~BEDROOMS Fl One ~ Four [] Two [~] Five Fl Three [] Six [] Other INDIVIDUAL* COMMUNITY [] PUBLIC UTI LITY 8. SEWAGE DISPOSAL SYSTEM *ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY /~'-~'~'~.YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Bob Richraeier P.O. Box lo9 Chugia k, Alaska 99567 Dear Mr. Richmeier, DAVID A, S LEN KAMP MECHANICAL ENGINEER 694-9055 April 23, 1981 ROBERT A. SHAFER CIVIL ENGINEER 694-2979 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION / PR 2, '7 1981 RECE/¥FD Reference: Lot ll, Block 3; Scimitar Subdivision A sewer system adequacy test was performed on the reference property per your request. The sbsorbtion trench w~,s tested by a continious flow of approximately 611 gallonsof water, over a period of 24 hours, with no measurable increase in the.~ater level, in the sUmo, st the end of the~.trench. ~ It can be concluded from this test, that the absorbtion trench is currently functioning adequately for the ~ bedroom residence located on the property. If we may be of further service, please do not hesitate to call us. Go. B~nner Reat~v ATT~TION: Harvey Weldbon }'~nicipality of Anchorage Department of Health and Environmental Protection SRB 196X EAGLE RIVER, ALASKA