HomeMy WebLinkAboutDEER PARK BLK 1 LT 3Deer Park
Block 1
Lot 3
#051-042-36
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: OSP151050
Tax Code Number: 05104236000
Work Type: Septic Upgrade
Permit Effective Dates: April 01, 2015 to March 31, 2016
Design Engineer: PANNONE ENGINEERING SERVICE
Subdivision: DEER PARK
Site Legal Address: DEER PARK BILK 1 LT 3 G:1558
Owner/Address: FRASER ANDREW R
22111 DEER CIR CHUGIAKAK 995670000
Site Mailing Address: 22111 DEER CIR, Chugiak
This permit is for the construction of:
Lot Size in Sq Ft: 45211
Total Bedrooms: 4
Y 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 B
Issued By:
y: Date:
Date:
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division QD Fax: 907-343-7997
On-Site Water &Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 051-042-36
Property owner(s) Andrew Fraser
Mailing address 22111 Deer Circle,
Site address 22111 Deer Circle
AK 99567
Day phone
Legal description (Sub'd., Block & Lot) Deer Park, Block 1, Lot 3
Legal description (Township, Range & Section)
Lot Size 45,211 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
(® all that apply)
Initial ❑
Absorption Field
❑X
Septic Tank
❑X
-- Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
APPLICATION IS AN:
TYPE OF DWELLING:
Initial ❑
Single Family (SF) ❑X
(w/wo ADU)
Upgrade 0
Duplex (D) El
❑
Multiple Dwellings ❑
(SF and/or D)
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Dis tance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: Waiver Fees:
Date of Payment: -J fS Date of Payment:
Receipt Number: CL(i'1f'-';iL' Receipt Number:
Permit No. ot>e1�J l0 5b Waiver No.
Permit App_.:
Pannone Engineering Services «c
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steveCcDpaneneak.com
March 19, 2015
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Rd.
P. O. Box 196650
Anchorage, Alaska 99519
Subject: Deer Park, Block 1, Lot 3
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. An
upgrade drain field will be constructed. The existing 10008 septic tank will be decommissioned per code
and a 1250g S.T.E.P. tank will be installed. This lot and the surrounding lots are served by private wells.
There are no wells within 100' of this system.
Soils. P.E.S. performed one test hole in the vicinity of the drain field in February of 2015, and
groundwater was monitored for seven days. Ground water was observed at a depth of 10.5 feet below
the ground elevation in the test hole monitor tube after the seven day monitoring period. 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 at approximately 5%
downhill of the proposed drain field. There are no steep slopes within 50' downhill of the drain field and
the field will be located at the toe of the steep slope on the east side of the lot.
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
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
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
777
110.4
DEER CIR. DRAIN FIELD (E)
IN FAILURE SEPTIC AREA (E)
RE -USE AS RESERVE N
UPGRADE DRAIN FIELD
78LFx5'vvxl.TEGx4.5
�
�
SEPTIC TANK ()
DECOMMISSION PER CODE
INSTALL 1500glT[PTANK (P)
109.7~'
v
/
SEPTIC AREA ([)7/ ./,
.
NOTES: ENGSVC,LLC
^""S'^"^''"'` P.0.BOX 1O0217 ANCHORAGE, AK995i0
�
PHONE /9O7>272-8210 FAX (907)272-D211
DEER PARK, BLOCK 1, LOT J
ANDREW FRA3ER
22111 DEER CIRCLE
PLAN | CHUC|AK. /\K 99567
�'
051-042-36
CE 8 49 PERMIT NO.
Sheet
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 SPECIAL PROVISIONS.
2. SCOPE OF WORK: INSTALL NEW 15008 S.T.E.P. TANK AND SOIL ABSORPTION SYSTEM.
3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 10.5 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 10.5 FEET BELOW
EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY.
TH-1
MIN 0-5FILL
FILTER FABRIC
125" 0 PERF PIPE W/ 1.25" HOLES DRILLED 18" O.C.
-DRAIN ROCK S" ABOVE PIPE INV
OR/
DIP
-20
OL
o�r
3.0
z S
T#
~
1.5L
CLEAN OUT N0.
M#
MONITOR TUBE NO.
FILTER FABRIC
RIGID INSULATION
,
SSM
DOUBLE CLEAN OUT
6.0
MIN 0-5FILL
FILTER FABRIC
125" 0 PERF PIPE W/ 1.25" HOLES DRILLED 18" O.C.
-DRAIN ROCK S" ABOVE PIPE INV
150Dg S.T.E.P.
TANK (P)
DESIGN PARAMETERS
PRIMARY SEPTIC SYSTEM
NO. BEDROOM: 4 (600 gpd)
TANK SIZE: 1500 S.T.E.P.
PERC RATE: 2.7 MPI
SOIL RATING: 1.2 GPD/SF
AREA ROD: 500 SF
SYS. TYPE: WIDE TRENCH 1.5'ED
RF: 0.78
MIN LENGTH: 78 LF
USE:
78 LFx5'Wx1.5' E.D., 4.5' TD
TOTAL AREA: 500 SF
LEGEND
W WATER LINE/
WELL RADIUS
— SS — NEW SEPTIC
ABBREVIATIONS
CU
COPPER
DIP
ro-
M IN 0.5' FILL m
o�r
FC
z S
T#
~
C#
CLEAN OUT N0.
M#
MONITOR TUBE NO.
FILTER FABRIC
RIGID INSULATION
DCO
DOUBLE CLEAN OUT
DV
DIVERTER VALVE
FS
a
N
z
1.25" a PERF PIPE W/ z
Z
FG
FINISH GRADE
TS&V
1.25" HOLES DRILLED 18" O.C.
NIC
U
U
_
n
rDRAIN ROCK 6" ABOVE PIPE INV ..
150Dg S.T.E.P.
TANK (P)
DESIGN PARAMETERS
PRIMARY SEPTIC SYSTEM
NO. BEDROOM: 4 (600 gpd)
TANK SIZE: 1500 S.T.E.P.
PERC RATE: 2.7 MPI
SOIL RATING: 1.2 GPD/SF
AREA ROD: 500 SF
SYS. TYPE: WIDE TRENCH 1.5'ED
RF: 0.78
MIN LENGTH: 78 LF
USE:
78 LFx5'Wx1.5' E.D., 4.5' TD
TOTAL AREA: 500 SF
LEGEND
W WATER LINE/
WELL RADIUS
— SS — NEW SEPTIC
ABBREVIATIONS
CU
COPPER
DIP
DUCTILE IRON PIPE
TH
TEST HOLE
FC
FOUNDATION CLEAN OUT
T#
TANK CLEAN OUT NO.
C#
CLEAN OUT N0.
M#
MONITOR TUBE NO.
R.I..
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 AND VEGETATE --
NIC
NOT IN CONTRACT
NOTES: �����\\ Date
PANNONE ENG SVC LLC _ of a h
FOR CONSTRUCTION ' - ��,... Lqs� 1 3/27/2015
P.O. BOX 100217 ANCHORAGE, AK 99510 J'�. 1
PHONE (907) 272-8218 FAX (907) 272-8211 Scale
NTS
..... ... ... P.I.D. NO
DEER PARK, BLOCK 1, LOT 3 -042-36
ANDREW FRASER ) Steven R. onnone PERMIT NO.
22111 DEER CIRCLE ��+Ps•. GE 8149 ��� OSP151050
DESIGN DETAILS CHUGIAK, AK 99567 (�l��foassoNa=Sheet
___ `\\\\\���� 2 OF 3
1
2
3
4
5
6
7
9
10
11
12
13
14
15
16
17
18
19
TEST HOLE 1
OR/OL I ORGANICS/
ORGANIC SILTS
GM!
SM
BOH
GRAY SILTY
GRAVEL WITH
SILTY SAND
DATE PERFORMED: 2/20/15
SOILS LOG - PERCOLATION TEST
SLOPE
X
TH
WAS GROUND WATER
ENCOUNTERED? Y
IF YES, AT WHAT
DEPTH? -11.0'
DEPTH TO WATER AFTER
MONITORING? -10.5-
DATE: 319/15
w�
j / r Syl E PLAN
.�' TH-1aj
i
s
l \
l
413R
HOUSE
SLOPE
TH
X
READING DATE
CLOCK
NETTIME
WATERTIME
LEVEL
READING
NET DROP
1 2/20115
1:30
---
3.81
---
2
1:40
10 MIN
7.56
3.75
3
1:40
---
3.81
---
4
1:50
10 MIN
7.51
3.70
5
1:50
---
3.81
---
6
2:00
10 MIN
- 7.52
3.71
PEROLATION RATE 2.7 (min/inch) PERC HOLE DIAMETER 6 inches
TEST RUN BETWEEN 3 FT AND 4 FT
COMMENTS: Test hole excavated by JR'S SEPTIC PUMPING. Prec hole was presoaked.
Test run for at least one hour. Last 3 readings reported
PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST.
NOTES: - _����Date
lR CONSTRUCTION PP,o�. NONE EN SVGE,C, 99510 r OF' Q`:gsl3/27/2015
PHONE (907) 272-8218 FAX (907) 272-8211j oj�p 9+�' scale
r *: TH
.... .. I P.I.D. NO
DEER PARK, BLOCK 1, LOT 3051-042-36
ANDREW ERASER
"Steven'R. 'Pan no pe PERMIT NO.
I
P�, CE 8149 .'cQ, OSP 151050
22111 DEER CIRCLE it
SOILS LOG CHUGIAK, AK 99567 ����epoi�s'sioea��: Sheet
3 OF 3
MUNICIPALITY OF ANCHORAGE
DE")TMENT OF HEALTH AND HUMAN SER'~S
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 284-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name DISTANCES
L
Lbr I EC /b StSBr�blrxuov TO SEPTIC ABSORPTION
A0°'B5a FROM TANK FIELD WELL
Phone(s) /Cbr
py q(p permit No No. Of Bedrooms WELL
/15 �'! acres j4i4 Cy pbAAJf +
LEGAL Of SCRIP TION LOT LINE Ori 01.4 /O ri
Lot Blocs Subawrsr
I r k FOUNDATION �y rr S r
Township, Range. Section
r . r •J < r / AS -BUILT DIAGRAM (Snow location of well. sepac system. properly hues. lounoation,
TANKS $
C✓SEPTIC ❑ HOLDING
5i EL"L
1 2 -
TYPE OF SYSTEM
TYPE
❑'fRENCH ❑ BED
❑ W. DRAIN ❑ OTHER
()spin to pipe bottom from
Total depth from anginal grade
Original grace
FT
8
FT
fill 8aoea above original grade
Gravel aeplh beneath pipe
FT
j
FT
Gravel length
Gravel wrath
Z AD 6b
FT
Z -S'
FT
Total abaarplwn area
(Distance between Il es
p ADj�D
SO FT
N R
FT
Number of lines
sort rating
pipe malenal
/L(0
SOFT
ASTM Lb3o3
mstaner
Date lnstallea
I
vii aC-�> Gx•
/
WELLS�sri/vr,
CYPRIVATE
❑ OTHER (Identifv)
Lwwhrauun IA.B.CI
Told, Chrpm
Case" to
FT
FT
Installer
Date Instaneo.
IREMARKS:
If
"'fl v "'3"75 95 NGAE; 6 NG
Municipal and'91EI1•y��EuJUXellect on this date:
EAGLE RIVER, AK 9
Health Department Approval:
72-013 (185)
C
'1` i.i
SC81e: y e �Z'V \ ENGINEERS WW W Inspections PeAormetl by ., , r� �Oi\F�1��';
A4�Bj
r�P•
Date . •,.... tS F.
.
/ AVy;.
!sPttJIEO 9(l3%gb * ' i
Dill,
certily that this inspection was performed according to all ••»•�• •• k
r^ • A. 4Ae1er, a
ice•% Fla. 1447.! �•"e"
�4G,CS/�3G "t ria `••na.`• .a.
Dale. ' � �•11'��;ET'' Q,,,,'.e,•
MUNICIPALITY OF ANCHORAGE
•
y DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
•� ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264.4720
ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAMEPHONE
JNEW
x
Gs3
UPGRADE
MAILING ADD _SS
Sts/
w x
LEGAL DESCRIPYfON
13 / PPS AUC tS' D D�/� .% B?P
LOCATION
NO. OF BEDROOO
(P C Z—r
DISTANCE TO:
WellO.�.
Absorption argZ 4
Dwelting �S (,F
PEFj�I/ � J r
a l
Y
EQ
Manufacturer
cr 4 r
Ma
� �' �
No. of compar ents
W �
Liey ea�agity�gallons
; C/ 6
IF HOMEMADE:
Inside length
Width
Liquid depth
6 Y
DISTANCE TO:
Well
Dwelling
PERMIT NO.
—10Z
=2 F
Liquid capacity in gallons
Manufacturer
Material
O
W=
DISTANCE TO:
WelFoundatio�p
±
e 1
OD
Neares t of hne
f�
PE T
j r
W w o
Zw
No. of lines
Len th q{ each/finer
B LL2
Total le th ofEI n
Y-
TrCGSh y�At
Distance t �/� li
7
T-
_I
e7 CJ inches
Top of til Knish grade
tit teria 4 eathh Ide
Qinches
Total eff 'w ablooarea
ZO v
f
O
Z
-2 L,J✓4/L ew1-
Length Width
Depth
PERMIT NO.
W
c F
Wil
Type of crib Crib dia r
Crib depth
Total effective absorption area
H
DISTANCE TO: Well
Building foundation
Nearest lot line
J
CI .f Depth
Driller
Distance to lot line
PERMIT NO.
L C-
3
DISTANCE TO: Building foundation
S= Y1Y+ �L'
Septic tank
Absorption area(s)
••
OTHER r� �•
PIPE MATERIALS—
e� � io s'
o
talc
-
it
SOI LTEST RATIN t C
INSTALLE /n� ,'�
r•
REMARKXit(trr�t'f.R:
:
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+ 6S
t
gc2 /0i s a
L
,
L
,
l"'kti
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D
tv-
in R,
APP V DATE LEGAL
...3✓6tL � S & S Engineering'
11/13 (Rev. 3/78)
�IC.Ikof uDnA�' r-)
SCALE ,. �►
T
��0004M-• \
rca,
�+fSvs( � PST Sf-,'fY••TYN�
ON
�m
PERMIT NO:
DATE ISSUED:
APPLICANT:
ADDRESS:
CONTACT PHONE:
MUr-'I I [:: 7~AL_ I -1-Y c) 1= AI-'d(--1'*�J1�AGE
DEPARTMENT uF HEALTH AND ENVIRONMENTAL PROTECTION r
825 L STREET, ANCHORAGE, AK 99501 V
264-4720
C3P4— S I T E
860343
09/13/86
VIRGIAN f:OHFIELD
7. S&S ENGINEERING
SRB 196X, AK 99577
694-2979
LEGAL DESCRIP: SUBDIVISION: DEER PARE; LOT: 3 DLOCK: 1
SECTION: 4 'TOWNSHIP: 15N RANGE: 1W
LOT SIZE: 999999 WO.FT. OR ACRES)
MAX BEDROOMS: 3
Listed below are the options available to you in designing your septic
system. Choose the option that best fits your site.
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS
I certify that:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements for the set batt:
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 3 bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA DUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST DE OBTAINED; (2) AS-DUILTS
WILL NOT DE APPROVED.WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORE: MUST DE /DONE BY A LICENSED ELECTRICIAN.
SIGNED� - DATE:
-------------- ---------------
APPLICANT: V nGIAN K IFIELD ^ '/
ISSUED DYMIS%,� - DATE:
Z'FENCH
.SED
W _ DF-tA I"
DEPTH TO PIPE BOTTOM (FT.)
4.0
4.0
4.0
GRAVEL DEPTH (FT.)
4.0
0.5
3.5
TOTAL DEPTH (FT.)
8.0
4.5
7.5
GRAVEL WIDTH (FT.)
2.5
18.0
5.0
GRAVEL LENGTH (FT.)
53.0
35.0
46.0
GRAVEL VOLUME (CU.YDS.)
22.1
23.4
34.1
TANK SIZE (GALS)
1,000.0
1,000.0 **
1,000.0 +�*
SOIL RATING (SO.FT./DR)
140
140
140
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS
I certify that:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements for the set batt:
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 3 bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA DUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST DE OBTAINED; (2) AS-DUILTS
WILL NOT DE APPROVED.WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORE: MUST DE /DONE BY A LICENSED ELECTRICIAN.
SIGNED� - DATE:
-------------- ---------------
APPLICANT: V nGIAN K IFIELD ^ '/
ISSUED DYMIS%,� - DATE:
• MI_It�! I G IFIL I TY OF Rt�ICI�RFiGE
DEPARTMENT HEALTH AND ENVIRONMENTAL .40TECTION
t^ 825 'L' STREET, ANCHORAGE, AK. 99501
... 264-4720
IJELL Fit•IC� Ott I -r 5= E14ER PERM I T
PERMIT NO. ( 810595 )
APPLICANT MYERS CONST P0. BOX 351 694-9633
LOCATION PETERS CREEK,
LEGAL LOT 3 ELF; 1 DEEP, PARKjSUB LOT SIZE 43560 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRE14CH
MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 85
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEPTH= S LEFJGTH= 3.M GRnVEZL E>EF'TH= 4
THE LENGTH DIMEFISIO14 IS THE LENGTH (IFI FEET) OF THE TRENCH OR 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).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MIFJIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IFJ FEET).
REGLI I RE[} _EF}T I C TF=lt-IK I ZE= 1CliDi ; GnLLOt-IS
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
FJUMBER. OF RESIDENCES THAT THE 14ELL WILL SERVE.
--- TWO C 2 ] I N_'SFD E(.::T I OtJS; FIRE REG)U I REI? ---
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MIFJIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER, LIFJE IS 75 FEET.
I -JELL 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='ERM I T EXF� I REE C ECEME aFZ 311 -1 -=.;I
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IFJ ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS.
SIGNED
ISSUED
APPLIC FIT /MYERS Cf�rT
/---/ DATE�9_/
V4. 0
MUN I iC Ir1RL I TY OF= FiNC119F�RCiE
DEPARTMENT HEALTH AND ENVIRONMENTAL( �OTECTION
825 'L' STREET, ANCHORAGE, AK. 99501
264-4720
44EL-L Fit+Id OtJ-SITE SEWER PERM I T
PERMIT NO. < 810595 >
APPLICANT MYERS CONST P0. BOX 351 694-9633
LOCATION PETERS CREEK
LEGAL LOT 3 BLK 1 DEER PARK SUB LOT SIZE 43560 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH &
MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SO FT/BR)=
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEF�TH- B L_ETH
NC3m 9i6 C3FznvE:L_ OEF='TH=
THE LENGTH DIMENSION IS THE LENGTH <IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
F ZaMU I FZED> SEF�'T I C -rnNK 55=a- 104 0 0F=tLL-0N55
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
-- TWO < � > I NSF='ECT I ONS FIRE FRa:MU I REO ---
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE 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=>ERM I T E:XFD'I RES OECEMFDEFR 31.. 1 501
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS.
SIGNED
ISSUED
V4. 0
C
PERFORMED
LEGAL DESCRIF
DEPTH
(GL EIn-
2-
3-
4-
7z3 4 • Or
CCC
5-
6-
4 6 !1
8 `
9-
10-
11 1011 L /
12
13-
14-
15-
16-
17-
18-
19-
20-
COMMENTS
314151617181920
COMMENTS
n
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
H r -/ac
G3
ORFAl-pl C
Gp - 128 �le<
SLOPE
D
Section:
Net Depth to Net
Time I Water I Drop
PERCOLATION RATE )minutesnnch) PERC HOLE DIAMETER- —
TEST RUN BETWEEN FT AND '� FT
41�r Ar n �a�, .ate. r_ ns r
PERFORMED BY:—SSC p& pRAS ENGINEERING I �/ v CERTIFY THAT TH TEST WAS PERFORMED IN
ACCORDANCE WITATMA) MUNICIPAL GUIDELINES ECT ON THIS DATE. DATE ep
7x-008Rev. 4 85) EAGLE RIVER, AK 99577
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DD f�
95�X6DEPTH?
�f
Depth to Wafer After
B
Monitoring?
Date:
Reading I Date
Gross
Time
Net Depth to Net
Time I Water I Drop
PERCOLATION RATE )minutesnnch) PERC HOLE DIAMETER- —
TEST RUN BETWEEN FT AND '� FT
41�r Ar n �a�, .ate. r_ ns r
PERFORMED BY:—SSC p& pRAS ENGINEERING I �/ v CERTIFY THAT TH TEST WAS PERFORMED IN
ACCORDANCE WITATMA) MUNICIPAL GUIDELINES ECT ON THIS DATE. DATE ep
7x-008Rev. 4 85) EAGLE RIVER, AK 99577
(; V5-. SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION
TEST
825 L Street, Anchorage, Alaska 99501 264.4720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: ' — ]C`JI / DATE PERFORMED:
LEGAL DESCRIPTION: �7 �v _ I sf"�"� ""' �• /
SLOPE SITE PLAN
1
2
3
_4
5
6
7
�8
9
10
11
12
13
14
15
16
17
18
19
(, k 4- -I-,-
�Oc"Jw
66L.x) (`507c),,LNJ
CK ('107,
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
20-1 �DOOOwSTSPO
JrRN�?`;ry
PERCOLATION RATE (minutes/inch)
1 TEST RUN BETWEEN A FT AND FT
/��
COMMENTS V�4�� av n- 'S— L ' G� AA n ��'��r. 4iPinsa
PERFORMED
72-008 (6/79)
CERTIFIED
ALASKA
a RETURN TD: Division of Geological and G/`�1slce1 Surveys (OGGSi ' 1 STATE OF
3001 Porcupine Drive (Tale; a: 277'6615) DEPARTMENT OF NATURAL RESOURCES OURC[S
Anchorage, Alaska 99501
WATER WELL RECORD
Drilling Company Naw r' - r ^^ `..tn s a..-
nrerrnu�nr cent 1
please cowlets either la. Ib, or Ie.
U.S.G.S. Local Ib.
Drilling Permit No.
A.D.L. No.
Ia. borough
;Inch
Subd lv i s ion
Uet r nr�.
Lot
3
Block
1
lb. Fraction
/ / /
Section No.
TownshIP
N/s
Range
E/W
Meridian
Ic. Oistance and Direction from Road Intersections
Street Address and Are, of Well Location
7. OWER OF WELL('uc l P'y er A
Address: 'e Uvey.
2. WELL LOG Feet Belau
' Sur/ace
material Type —TOP bttom
6. WELL DEPTH: (completed)
5o ft.
Surface ElevationDate
�^
of
Completion
- -" 1
. 1UVCl c 3ti
S. ❑Cable tool X❑Rotary ❑Drloen ❑Dug
❑Auger ❑ Jet led ❑Bored ❑Other:
L ILL
r&vel ano water J U
6. USE: )❑Daws; is ❑:vent 5Dpv1y ❑ Industry
❑ Irrigation ❑ Recharge ❑ Coerrrcial
❑Test Wall ❑other:
7. CASING: [3 Threaded y,❑Wal dad
L In. to S7 ft. Depth We I g h t - r lbs/ft.
In, to ft. Depth
8. FINISH OF WELL:
TI z -n ;!ole Olaemtar: r u
Slot/Mesh Size: Length:
Set between ft. and ft.
Fittings:
9. STATIC WATER LEVEL: ft.
❑ Above ❑Below land surface
Type of Measurement:
10. PUMPING LEVEL below land surface
it. after hrs. pumping 9•P.m•
ft. after hrs. pumping 9•P•m•
11. WELL MEAD COMPLETION: ❑ In Approved Pit
;',❑Pl tins Adapter Inches above grade
12. GROUTING: Well Grouted: C] Yes 'ONo
material: Cheat Cement ❑other:
13. PUMP: (If available) HP �/ i
Length of Drop Pipe 40 ft. capacity 1 9•p•
Type: '❑Submersibla ❑Reclprocs ting
❑Jet 13 Other:
Ik. REMARKS:
..11.1 te:.ted tit 10 G.z •Ie..
15, WATER WELL CONTRACTOR'S CERTIFICATION:
This well eras drilled under my urlsdtction and this report Is true to the best of my knledge and belief:
I'l11�I1 ow
Registered .,.nese k1. Contract License Number
Address:
Signed:
Author;zed Representative • �.
Form 02 -WR Copy Distribution: WHITE - state DGGS. PINK - griller, CAILARY - Customer
Municipality of Anchorage ..
• '-`1 Development Services Department':
Building Safety Division ..
On -Site Water& Wastewater Program
4700 Bragaw Street n
P.O. Box 196650 1
Anchorage, AK 99519-6650 (r,
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING rr,G �i .-/
Parcel I.D. 651 — 09 S ' � Vh COSA# Q 1 y l
1. GENERAL INFORMATION Expiration Date: 2-/0-0
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
DEER PARK, LOT 3. BLOCK 1
22111 DEER CIRCLE • CHLIGIAK, AK 99567
MARY KELLER Day phone
PO BOX 770788 ' EAGLE RIVER, AK 99577
Day phone
688-9241
KATHI OLMSTEAD w/REMAX PROPERTIES Day phone 694-4200
16600 CENTERFIELD DRIVE • EAGLE RIVER, AK 99577
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
0
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal afrNed 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. 1 further ve* that based on the
information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Finn GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 . ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LID. attempted to provide a thorough,
conscientious engineering analysis of Bre system in accordance with ADEC and MOA
DSD Guidelines 6 Regulations. The reported results described fire performance of the
system under the conditions encountered attire time of Me fes; and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee brat
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system writ continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sofa benefit of the owner/isted above. Any reliance upon or use of this report by any
other person or pally is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for 3 bedrooms.
Disapproved.
Phone 337-6179
Date Q 8 08
Conditional approval for bedrooms, with the tllowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
y
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Reort
Other
m�
.....r.........
ONSITE =
WATER AND
WASTEWATER
PROGRAM
i„••....••-�w
By: v`' ' Original Certificate Date: 0 — OE
f
Municipality of Anchorage
Development Services Department
• �, Building Safety Division
On -Site Water 8 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
CHECKLIST
Legal Description: DEER PARK, LOT 3, BLOCK 1 Parcel ID: 05'1 ' O q 2 - 3&
A. WELL DATA
Well type PRNATE If A, B, or C provide PWSID# N/A
Date completed 7/1981 Sanitary seal (Y/N) YES
Total depth 50 ft. Cased to 50 ft.
FROM WELL LOG
Date of test 7/1981
Static water level UKN ft.
Well Log (Y/N) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 18 in.
AT INSPECTION
8/12/2008
30 ft,!
Well production 10 g.p.m. 6.0 g.p.m.
WATER SAMPLE RESULTS:
Coliform +D colonies/100 ml. Nitrate NO mg./L. Other bacteria *_colonies/100 mi.
Arsenic: 0.65 ug./L. Date of sample: 7/31/2008 Collected by: GEG Ltd.
"8/7/.2008
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 7/3/1981
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) ""YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Daae of pumping 8/18/2008 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA QELQW EXISTING GRAM
Date installed 7-3-81/9-13-8 Soil rating (g.p.d.lft'o /bd 140 System type DEEP TRENCH
Length 22/22 ft, Width 2.5/2.5 ft. Gravel below pipe 5/5 ft.
Total depth •9.33 ft. Eft. absorption area 220/220 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test "8/13/2008 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before lest DRY in. Water added 500 gal. New depth 18 in.
Elapsed Time: 440 min. Final fluid depth 1 in. Absorption rate >= 450+ g,p,d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date -
"PER SOAKED WITH 900 GALLONS ON 8/12/08
***CLEANOUT SHOWN ON THE 1986 INSPECTION REPORT IN THE EXISTING TRENCH WAS
NOT FOUND. DOUBLE CLEANOUTS WHERE INSTALLED AFTER THE TANK
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN
"Pump on" level at in. "Pump off' level at . High water alarm level at
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO
Septic tankAift station on lot 100'+ On adjacent lots "82'
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main NSA Public sewer manhole/cleanout N/A
Sewer /septic service line 25'+ Holding tank N/A
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage "0'
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS **AREA IS ALL GRAVEL WITH THE STAND PIPES STICKING
*SEE WAIVER #WR14 UP,SO IT IS ASSUMED THAT R IS NOT A PARKING AREA
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and p e !
review of Municipal records that the above systems are in 0"""'
conformance with MOA COSA guidelines in effect on this 0
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date 102)109
COSA Fee S Li 3C) 1�o Waiver Fee $
Date of Payment j o 112 A //I'ow Date of Payment
Receipt Number. �� g' 1 "t' Receipt Number
(Rev. 11105)
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AS-BUILT
1 hereby certify that 1 have surveyed the following described
property: L cT
K
4 1
Anchorage Recording Precinct, Alaska, and that the improve.
ments situated thereon are within the Property lines and do not
overlap or encroach on the property lying adjacent thereto, that
no improvements on property Iving adjacent thereto encroach
on the premises in question and that there are no roadways,
transmission lines or other visible easements on said property
except as indicated hereon.
Dated at Eagle River, Alaska
this -E-1 r day of `s no
ROBERT C. JOHNSON 7J
SCALE: Registered Land Survevor No 1 W -LS
Box 77-0456, Eagle River, Alaska 99577
Phone (907) 695-2543
08/27/2008 12:27 9073449821
Jr's Septic Pumping dbo
P.O Box 773415
Ea&, Rhrar, Ak
99577.3415
Invoice to:
Mary Keller
JRS SEPTIC
Flintstone Enterprises
DESCRIPTION
1. Install two new clean outs from tank to field
2. Replaced clean out that was broke on tank
3. Extended monitoring tube 3 feet
4. Camera leach field line recommend line jetting
PAGE 01
Date :8/27/08
Phone: 907.694.6454
Fax 907-3449821
Invoice: 8043
Job Lowton:
22111 Deer Cirde dtugiak, Ak
NMajiline Address:
Po box 770788
Eagle, River Ak 99577
TOTAL AMOUNT DUE. Mom
Please Make check Payable to Fllntstone Enterprises
AN amunts mer 30 days wIN be subjM
To Interest"aN CoNecWn M's
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
1. GENERAL INFORMATION
(a) ' Legal Descjrption (include
Location (address or irections)
(b) Applicant Nam
Applicant Address -416
(c) Applicant is (check one): Lending
(d) Lending Institution,0
Address
(e) Real Estate Compar
Address/
Telephone
Mle
subdivision,
Home
Application Date 6
Business
❑ ; Owner/builder; Buyer ❑ ; Other ❑ (explain);
[towing address
2. TYPE OF RESIDENCE
Single -Family Multi -Family ❑ Other
Number of Bedrooms 3
3. WATER SUPPLY
Individual Well Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2
72.025 (11-M(
S. ENGINEERING FIRM PROVIDING SPECTIONS, TESTS, FILE SEARCH, DA1. ND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown�pelow, I verity that my investigation of this Health
Authority Approval 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. l 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 In compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm 9 JL e ENGIN Telephone 69'i� �Z 971
Addre
Date
DHEP APPROVAL
Approved
Approved for ;%142 bedrooms by r
Approved C9_ Disapproved Conditional _
Terms of Conditional Approval
CAUTION
AL
bwt 4. URW
N^ 1401
Date/4
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an Independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
Institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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 engineers work.
Page 2 of 2
77-025 (11/84)
n
MUNICIPALITY OF ANCHORAGE (MOA)
•
W814"Am m OF ANCTL M AUTHORITY APPROVAL (HAA)
DEPT, OF HEALTH d CHECKLIST - FEBRUARY 1984
ENVIRONMENTAL PROTECTION 264-4720
A. WELL DATA
4SEP 151986
RECEIVED
Legal Description: L-97 3 &1<
Well Classification S-% If A, B. C, D.E.C. Approved (Y/N)
Well Log Present &N) Date Completed �7 -
(� �8/ Yield Cr
Total Depth �� Cased to Say Depth of Grouting
Static Water Level /11" Pump Set At u , k-
�
Casing Height Above Ground LB. Sanitary Seal on Casing B!N) _
Electrical Wiring in Conduit CY)N) Depression Around Wellhead (Y&
Separation Distances from Well:
To Septic/Holding Tank on Lot /rte 2' ; On Adjoining Lots W�
To Nearest Edge of Absorption Field on Lot JIG' On Adjoining Lots
To Nearest Public Sewer Line 11/4 To Nearest Public Sewer
i�
Cleanout/Manhole To Nearest Sewer Service Line on Lot ZS
Water Sample Collected by S •/ 5 ailojrlodgkj Ll& ;Date 3'/g
Water Sample Test Results sA5p&jj=-Yy
Comments Wcr+,c- ylr� ids! SHoyy ± WaLL. 22ADa Gd1� lu
&X VSs or' biM
B. SEPTIC/HOLDING TANK DATA
Date Installed 7-3-8/ Size /a)= No. of Compartments
Standpipes ®'N)
Depression over Tank (Y.&
Air -tight Caps &N)
L
— Foundation Cleanout P/N)
Date Last Pumped 8 -LD .5, y
Pumping/Maintenance Contract on File (Y/N) Nle' ; for --
Holding Tank High -Water Alarm (Y/N) Nl$ Temporary Holding Tank Permit (Y/N) A60
Separation Distances from Septic/Holding Tank:
To Water -Supply Well /10' To Building Foundation
To Property Line SS r To Disposal Field
To Water Main/Service Line 46014'
Course N/A_
Comments
Page 1 of 2
72-026111/841
To Stream, Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata r�iy0 � Type of System Design 712&h_K ">'
Date Installed Length of Field - y L &.I
Width of Fields Depth of Field sr
Gravel Bed Thickness Sr
Square Feet o1 Absorption Area L/Zo 96— Standpipes Present (*N)
Depression over Field (Y64 Date of Last Adequacy Test g'L/ -,6&"
Results of Last Adequacy Test SAn:SPAUzX-V V
Separation Distance from Absorption Field:
To Water -Supply Well 115,-, To Property Line
To Building Foundation Bir To Existing or Abandoned System on
Lot 101 ; On Adjoining Lots �6rf
To Water Main/Service Line /O� ( To Cutbank (if present)f/k
To Stream/Pond/Lake/or Major Drainage Course liM
To Driveway, Parking Area, or Vehicle Storage Area
Comments up&, Mk S AfallCO o 4-&0Z o -y aellaf, r geyory.24r
r �.
mS5 bd/ -//o )4 �Yo,. A A01 Joe lr_ene7 w Elttr.
D. LIFT STATION
Date Installed Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On" Level at "Pump Off" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N) _
Comments
Check Permitted Bedroom Rating Against HAA Request "
Vent(Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Ice f triI have checked, verified, or conformed to all MOA and H A guidelines in effect on the date of this inspection.
Sig`S�NGINEERING Date B
YOJL
ConMtVLE_RMS1, AK99"5T7— MOA No. ......•...Z
LI 4% 1
OU t — Cx�a"1 +�%1%v
Receipt No.
At
Date of Payment
Amount:$ (�C.cb
Page 2 of 2
72-026 (11,84)
, 14EW_ CONSTRUCTION '"1 .-1
_
DA �.RECEIVEO
' INSPECTION APPOINTMENTS
5. TYPE OF RESIDENCE
NUMBER OF BEDROOMS
NME..
TIME
TIME
❑ Two ❑ Five
❑ MULTIPLE FAMILY
.l<I
DATE
DATE
DA
e
In -✓
❑ COMMUNITY
r
INSPECTOR
INSPEC O
INSPECTOR
MUNICIPALITY OF ANCHORAGE
DEPT. Of HE -.;LTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOWIRONMENTAL K.OTECTION
825 L Street - Anchorage, Alaska 59501
•
SEP 10 1981
-
ENVIRONMENTAL SANITATION DIVISION
Telephone 264.4720
RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be Processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER
PHONE
M-
298D—
DDRESS
MAILING Ac
P.O. Box 351, Chugiak, AK 99567
PROPERTY RESIDENT (If different from above)
PHONE
2. BUYER
PHONE
Lorraine A. Michaud
349-7063
MAILING ADDRESS
SR Box 1745 D Anchorage, AK 99507
3. LENDING INSTITUTION
PHONE
First Federal Savings & Loan
274-6565
MAILING ADDRESS
.1 Northern Lights Blvd., Anchorage, AK
4. REALTOR/AGENT
PHONE
"Ontague,-Totem Realty, Inc.
694-9494
MAILING ADDRESS
Box 911, Eagle River, AK 99577
S. LEGAL DESCRIPTION1. Deer Park
`
Estates . - XAW
STREET T ON
NHN Deer Circle
5. TYPE OF RESIDENCE
NUMBER OF BEDROOMS
❑ One ❑ Four ❑ Other
Cj SINGLE FAMILY
❑ Two ❑ Five
❑ MULTIPLE FAMILY
�t C Three ❑ Six
7. WATER SUPPLY
(� 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
® INDIVIDUAL/ON-SITE"
1981 YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
0101Ry 61791 �_ ter✓ /
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
❑ PUBLIC UTILITY
Connection Verified-
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOGRECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON-SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATEINSTALLED
INSTALLER
❑SepticTankor ❑Holding Tank
Size: If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL TO:
Septic/Holding Tank
Absorption Arw
Savver Lina
Newralt Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
L'7 APPROVED FOR —3 BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE
t o ^a a —12l c
BY
1
72010 (Rev. 6/79)