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DEER PARK BLK 1 LT 5
Deer Park Block 1 Lot 5 #051-042-34 Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP161324 PID Number: 051-042-34 Dwelling: ❑® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑® Upgrade Name: KEVIN KRUSHENSITY ABSORPTION FIELD A Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 1.2 GPD/SF 7.0 Ft, LEGAL DESCRIPTION Depth to pipe invert from original grade 2.0 Ft, Gravel depth beneath pipe 5.0 Ft. Subdivision Block Lot DEER PARK, BILK 1, LOT 5 Fill added above original grade 2.0 FL Gravel length 38 Ft. Township Range Section Gravel width 2.0 Ft, Beds: Number of Lines 0 Distance between lines 0 Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line 380 Ft' 1.0 0 Ft. Well kvdd 100'+ 100'+ 50'+ TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ other Manufacturer w l Capacity 12 V0 Gal. Surface Water I�dfT 100'+ 100'+ Material `r � Number of compartments 2 Lot Line 10` 1 10'+ 10'+% NA e r Foundation 4- 10'+ 5'+ LIFT STATION Manufacturer Capacity Curtain Drain t}vi UN UN ANCH TANK 1250 Gal. Remarks Pump on level at 30 Pump off level at 24 High water alarm at 36 in. in. in. Pump make and model PS20 Electrical Inspections performed by RISING SUN ELECTRIC PIPE MATERIAL House to tank 3034 rank to drainfieltl 3034 Installer MIKE ANDERSON, P.E. Drainfield3034 CO/MT Inspector MIKE ANDERSON, P.E. BENCH MARK (Assumed elevation) 102.4 ft Inspection1" 10-31-16 10-31-16 Location and description dates: 2„d 3r” 4th TOP OF WELL CASING COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL .�P meev2s _Iqp O: Conditional Approval: Date '4 MICHAEL N. AN'D[RS cr 0 C 94 9 Approve g��•, rf5 i�'• (l��i0 y, w Date aXf`s r s �a inspection Hepon_a-r-rz.bad JE Permit No. OSP161324 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: DEER PARK S/D , BLK 1, LOT 5 PID No.: 051-042-34 MARK All B C C01 6 _ TC01 35 EN \\\H#1 I MT 76 MT1 \ !� �/ \ u \ i�-�TCO TC01 --— — — — -rrn o \ i {{JJ EW 1250�GALLON STEP TANK {— bLD TANK COMMISSIONED PER UPC I/ F�tywo P,co»Mssan�d P<� A P T I I I \II 1 \ ENCH./GARAGE SLAB 1NG WELL � I / EXISTING WELL / SHED }? // EXISTING WELL U \ ASBUILT SCALE: 1"=50' �lLul - �oz vnvisr wsoc �� 01 LLuwe iea rnew< {3 t 49 H A s ,ew0,,vrKm —� / ..MICHAEL N. i1N D` Ii SONa ,l�i 0#��'•. r No -E 9469 �.. . E EN � I / EXISTING WELL / SHED }? // EXISTING WELL U \ ASBUILT SCALE: 1"=50' �lLul - �oz vnvisr wsoc �� 01 LLuwe iea rnew< {3 t 49 H A s ,ew0,,vrKm —� / ..MICHAEL N. i1N D` Ii SONa ,l�i 0#��'•. r No -E 9469 �.. . E 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: OSP161324 Tax Code Number: 05104234000 Work Type: Septic Renewal HPermit Effective Dates: October 27, 2016 to October 27, 2017 40 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Subdivision: DEER PARK Site Legal Address: DEER PARK BLK 1 LT 5 G:1558 Owner/Address: KRUSHENSKY KEVIN B PO BOX 672210 CHUGIAK AK 995672210 Site Mailing Address: 22116 DEER CIR, Chugiak Lot Size in Sq Ft: 40010 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 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: 0 27 /6- njeE Community Development Department Phone: 907-343-7904 Development Services Division Fax 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-042-34 Property owner(s) KEVIN KRUSHENSKY Mailing address P.O. BOX 672210 CHUGIAK AK Site address 22116 DEER CIR, CHUGIAK AK Legal description (Sub'd Day phone 4? W' o �l"( S— Block & Lot) DEER PARK S/D BLK 1, LOT 5 Legal description (Township, Range & Section) Lot Size 40010 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Initial ❑ Single Family (SF) ❑ Septic Tank Upgrade F-1Duplex (w/wo ADU) (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: 67F Distance:_ I certify that the above information is correct. I further certify that this is ' accordance with applicable Municipal Codes. 101 0C1 2 �j�,, aKND O �' (Signature of property owner or authorized agent) Permit/Rush Fees: SG q /-341 4/0 Waiver Fees: Date of Payment: / 7v /to Date of Payment: Receipt Number: Receipt Number: Permit No. QS 1U 1324 Waiver No. Permit App__-' :L_c; Oct 24. 2016 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage. Alaska 99519-6650 Fax 249-7847 Re: New Septic system Legal: Deer Park S/D, Blk 1, Lot 5 To Whom it may concern: This is a request for a septic permit on the above referenced lot, the old system has failed and needs replacing. A new, test hole was excavated in the backyard and found various types of course gravels, GP. No water was observed during the test hole excavation or after the 7 day monitoring period. The perc rate was 4 minutes per inch at 4 feet below grade. A deep trench has been designed with a STEP tank due to the basement outlet. The lot is in a small basin with zero slope in the area of the proposed upgrade, sec the drawing. No slopes or cut banks exist within 50 feet of the this site due the site being in the bottom of a small basin. This replacement system will not impact any of the neighboring properties due to the lot layout. Please call me if you have any questions. Sincerely Mike Anderson, 1) E. 4661 Natrona Ave. Anch. Ak 99516 DESIGN CRITERIA: I / MOUND OVER GRADE (TH#1) o / 3 BDRM X 150 = 450 GPD i ° ORG I 2' INSULATION SOILS = 450/1.2 = 375 GPD FILTER FABRIC 375 GA/10 = 38' 1.250 PIPE GP -2.0 0.25'0 HOLES 0 48' (1) TRENCH SEWER ROCK 7.0 DEEP 5.0' EFFECTIVE —7 0 2.0' WIDE 12_0 40' LONG 16 SEPTIC FIELD SECTION i i � r PROPOSED � SEPTIC DRAINAGE FIELD SEd > \ w EXISTING S(76 DRAINAGE FIELD Ah 4 _ PROPERTY LINE (� � S&TIa EXISTING 3 `E?Tl `\ BEDROOM - i EXISTING WELL �`� HOUSE 100' RADIUS i I r Septic Design Prepared for OF KEVIN KRUSHENSKY .•�P�� �000 DEER PARK, BLOCK 1, LOT 5 .; � •`. Chugiak, Alaska � H 49 ..............................................0 j •c,MICHAEL N. ANDERSON: n �'� '• Michael N. Anderson P.E. ' DATE: 10/14/2016 4601 NATRONA AVE DRAWN: DJR No. E 469 ' � � ##j 1 ANCHORAGE, ALASKA 99516 ?t /f!; •'� U ���e�e,`..��• SCALE: 1 "=200' (907) 727-8864 / FAX: (907) 345-1391 EXISTIN SEPTIC JENNIFERS LOT 2B PROPOSED SEPTIC , , , , , / i / / / MG LOT 3B I I I I PROPERTY LINE I 1 1 1 aKR O BLOCK-IT K i, -1.D 6 II ' NEW 1250 STEP TANK EXISTING TANK TO BE DECOMMISSIONED PER THE UPC f i W ----------- 0 % SLOPE DEER PARK BLOCK 1, LOT 5 WELL / / / / Septic Design Prepared for EXISTING WELL 100' RADIUS DEER PARK BLOCK 1, LOT 4 PROPERTY LINE L ----------- FOX HILL BLOCK 2, LOT 1 KEVIN KRUSHENSKY DEER PARK, BLOCK 1, LOT 5 Chugiak, Alaska Michael N. Anderson, P.E. DATE 10/14/2016 4601 NATRONA AVE DRAWN: DJR ANCHORAGE, ALASKA 99516 (907) 727-8864 / FAX: (907) 345-1391 SCALE: 1.1=50' ................ pi TH 49— .r, ............................ °. MICHAEL N. ANDERS01 P•'•.• t 969C No. / / PROPERTY LINE L ----------- FOX HILL BLOCK 2, LOT 1 KEVIN KRUSHENSKY DEER PARK, BLOCK 1, LOT 5 Chugiak, Alaska Michael N. Anderson, P.E. DATE 10/14/2016 4601 NATRONA AVE DRAWN: DJR ANCHORAGE, ALASKA 99516 (907) 727-8864 / FAX: (907) 345-1391 SCALE: 1.1=50' ................ pi TH 49— .r, ............................ °. MICHAEL N. ANDERS01 P•'•.• t 969C No. Municipality of Anchorage k) b ;C:Nw. ZENGIN ERSSEHL) s, Development Services Department IF YES, AT WHAT DEPTH? L Building Safety Division �.� On -Site Water and Wastewater Program 04 ® "'��Jj'�//✓✓�%%�T7���'•� t,1 4700 Elmore Road / /`•..7 .............. rb P.O. Box 196650 Anchorage, AK 99507 www. ci.anchoraoe-ak-it MICHAEL N. AND[RSCN .•�; 343-7904 OP %n'• CE - 9469 .' `P•,,'�i (907) Soils Log - Percolation Test i. Performed Fork tr ul K.hu b Nth 4 I Date Performed: Legal Description: Q {r.,. 4 1; ( li frf Y Township, Range, Section: _ Depth (Feet) 1= 2 - LI I 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- 00 -9. - 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20 - COMMENTS poo 9. (40/NMr WAS GROUND WATER ENCOUNTERED? k) b Gross Time s IF YES, AT WHAT DEPTH? L Depth to Water Aker P P Monitoring? / E — Date: Zr� rA.. t.. - b . Reading Date Gross Time Net Time Depth Water Net Drop /I/' lfiMit 'to• /./f Zr� it Z.q— ri 7�C_ PERCOLATION RATE Lf (minutesnnch) PERC HOLE DIAMETER TEST RUN BETWEEN —SFT AND SFT PERFORMED BY: M)V4, 1 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: / (J MUNICIPALITY OF ANCHORAGE DL .RTMENT OF HEALTH AND HUMAN SEF% ,ES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES C. Address TO SEPTIC ABSORPTION �a X O�UAG O JJ FROM TANK FIELD WELL 20 V 'heis) permit No No OI bedrooms WELL /OQ •4 `QD BgDOB S 1 3 LOT LINE �O r f �Q T f - LEGAL OF SCaiaflON LOI 111ocll $u •MOO 2 !_ FOUNDATION Township, Range. Section Ste'aV / ! AS -BUILT DIAGRAM (brio. location of well. septic system, property lines. tounaaeon. driveway, water bodies. etc) If TANKS /S714) F t 17-1 1 SEPTIC C1 HOLDING 1I Itine., .I TYPE OF SYSTEM G/pGipAD E IF ❑ TRENCH BED ❑ W. DRAIN ❑ OTHER Depen to pipe bottom Irom Total depth tion, original grace original grade 6 7 FT 6 . S FT Fill added aouve Original grade' Gravel deplh beneath pipe / fi FT ,s FT Greveuenu!" Q Gravel .0th so FT l8 FT Total absorplion area Dlsldnce between lines 6 811 SO FTI G 7 FT Number ul Imes I sun sung /s �.pe material SO FT D3p0 //G Dale Instar (� �/ BU WELLS.YlSTiiv PRIVATE ❑ OTHER (Identih (:I Iota. Depen Lased to FT Date Imianea. REMARKS: I i i s F ixtNCCRlrav Municipal anb� ees RNt Loop RCad No. 204 Eegi iClverF /�9esk`6 �9 Health Department Approval: 72-013 (3,85) o Im Scale:`.r '[NGItiE55EAL Inspections PeAormed by ♦�,( r Dale i/ fi) a. I • a% inspection was pedortned according to all I A. u.......>f'�; A . � Ids �- tY► iLlTaE �'t�� foo©�!; : I���_Irj■ier��■r,�, Y�I�a■9■� � . �■ � I©801161 Scale:`.r '[NGItiE55EAL Inspections PeAormed by ♦�,( r Dale i/ fi) a. I • a% inspection was pedortned according to all I A. u.......>f'�; A . � Ids �- tY► iLlTaE �'t�� �1 M U N I C I P A L I T Y O F A N C H O R A G E Department of Health u Human Services 825 L Street, Anchorage, Alaska 99501 343-4720 O N- S I T E S E W E R P E R M I T Permit Number: 880088 Upgrade Date Issued: 06/21/88 Engineer Designed sr Z•�YI�'h� srS E%. J f S 4-A Owner Name: ALASKA HOUSING FINANCE CORPORATION Day Phone: Owner Address: P.O. BOX 101020 694-2979 ANCHORAGE, A): 99510-1020 Parcel Id: 051-042,% ?J'1 1. Lot Legal: Subdivision%.DEER PARK 9$ SURD. Lot' 5 Block: 1 ' Section% 4 Township: 15N Range: 1W Lot Size 40010 (sq.ft. or acres) Max Bedrooms: This Permit: 3 Total Capacity: 3 SEPTIC TANK: Minimum total septic tank. capacity: 1,000 gallons. Each septic tank must have at least 2 compartments. Depth to top of septic tank(s) C 4.0 feet requires insulation over tank(s). INFORM D.H.H.S. PRIOR TO IST & 2ND INSPECTIONS BY ENGINEER, IF AFTER OFFICE HOURS CALL 343-4681 AND LEAVE A MESSAGE CONSTRUCT PER ENGINEERS ATTACHED APPROVED DESIGN THIS PERMIT EXPIRES 12/31/08 THIS PERMIT VALID FOR A SINGLE FAMILY RESIDENCE ONLY 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 back 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. I also understand that the capacity of the total system is 3 bedrooms and any enlargement will require an additional permit. Signed: DATE: Z.,1. Qf j (Owner) tA NANCE CO-PORATION Issued By:�`"�_ �L%?_ `�- _ DATE: / ko S & S ENGINEERING 17034 E. R. LOOP #204 EAGLE RIVER, AK 99677 PHONE #694-2979 wt A. firiw HM. 1"74 SEWER PERMIT APPLICATIUN****++�++*+�*+* DAFE: 6\13\88 AF'1ILICAN t: Robert Peterson ADDRESS: S&S Engineering 17034 E>R> Loop Rd Eagle River At; 99J77 CONTACT PHONE: 688-4275 I.EHAL DESCRIPTION: L5 B1 Deer Part: SL -"C 4 ,T15N,RM LOI' SIZE: 40010 (SU FT UR ACRES) MAX. NUMIzER OF BEDRUUMS: 3 SOIL RATING: 150 SV. FT/BR SUIT_ 'IEST DEP1H: 13 FT HIGHEST WAFER TABLE DEPTH: 12 FT (HIS IS AN UPGRADE OF 3 BEDROOM TRENCH EFFECTIVE DEPTH 0 COVER DEPTH O TOTAL DEPFH O LENGTH 0 WIDITT 0 SO FT. O ------------------------------------- ltPpR9 o b' THE EXISTING SEPTIC i BED W. DRAINI IELU 0 J. J U 6.5 U 38 0 18 0 684 U SPECIAL CUNDITIONS OR 1NSTRUGTIUNS: Remove concrete cap on septic tants and re-establish the second CU. Remove inspec tion port and remove all sludge from tank. LEGAL G r 11PA DRAWN .) a S a DEc,2 CKD. SHT/,o Z IiEF2 c/Q wf �'f�aba.►d.M. �'P9i a \ PST. /00o rA C � S a Y• U NO A0 A ?E,e soce,e5e s ` (.•' � T f/ / •� TH! S �3,2E�9 . ____ter 1 W Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED LEGAL DESCRI SLOPE !"1 DATE PER Section: /I 7WAS GROUND WATER 9 10 •/O /�� ENCOUNTERED? 11 FX �D S,ATWHAT L O 12 D TH7 P . J/• / p pE 13 j //V177 p �/fa/e• Depth b WAlter 6 �3 O O Monitoring? G Bair. 14 15 16 17 18 19 zo COMMENTS 11deA A S.t'eAR f No. t++hj oa�tti Reading Date Gross Time Net Time Depth to Water Net Drop 'f L , o io PERCOLATION RATE TEST RUN BETWEEN v4 •(minutesrinch) PERC HOLE DIAMETER `� FT AND 6 FT 4r S & S ENGINEERING 294 PERFORMED BY:Eag a Riva- Alaska 99577« �' ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINE'S 72-008 (Rev. 4/651 CERTIFY THAT THIS TEESS;.WWAS PERFORMED IN ON THIS DATE. DATE: / o O j�+WJ (Rev. 3178) ` ' j MUNICIPALITY OF ANCHORAGE f 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 NAME PHONE EW /v - / ❑ UPGRADE MAILING ADDRESS LEGAL DESCRIPTION S [. LOCATION NO. OF BEDROOMS DISTANCE TO: Well Absorption area / Dwelling AV PERMIT NO. U y t 2 Manufacturer - Material No. of compartments h K. [ Z Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid+Lt 6 be DISTANCE TO: Well I Dwelling PERMIT NO. 0Z _? H Manufacturer Material Liquid capacity in gallons DISTANCE TO: Well Foundation Nearest lot b e� PERMIT NO. a, = CJ =No. of lines - Length c� �`"' Total len q�lirtq Trench wid Distance between lines W F Q i i J nches F- Top of tile to finish grade C Material beneath rile rj Total effectiya.glasea J L.� inches sio-0 77 length Width Depth PERMIT NO. W F it. W L Type of crib Crib diameter Crib depth ZA Total ellectiva absorption area DISTANCE TO: Well Building foundation Nearest lot line JClass Depth Distance to lot line PERMIT NO. J AMAIAir J/vA Lu DISTANCE TO: Building foundation Sewer line Septic tank Absorption steals) OTHER PIPE MATERIALS vc- SOIL TEST RATING oo INSTALLER T G REMARKS Tj >>117 �!Z i r i st...Robs" A. AP E DATE LEGAL � - u. ��✓=tau• i SRO 123X Q �� �r..,.iLE,RIVER. ALL S Ut £:T7 PH. G:; 2079 �1 j�+WJ (Rev. 3178) ` ' j M -W DRILLING, Inc. P.O. Box 10.378 • 10300 Old Seward Highway (907) 349.8535 ANCHORAGE, ALASKA 99511 DRILLING LOG Well Owner YURI CLARK Use of Well Tblrstf C Location (address of: Township, Range, Section, if known; or distance main Size of casing--6L--Depth of Hole---Al---feet Cased to—L2.1--feet Static water level 2 ft. (00M (below) land surface. Finish of well (check one) open end Screen ( ); Perforated ( , ). Describe screen or perforation 1Yrnn Well pumping test at 40 gallons per *how) (minute) for--J---hours with IEYE x1t. of drawdown from static level. Date of completion Sentrrber 26, 1983 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 0 TO 2 Casing; sticl= --!—To 3 -----L—TO---A- TO44 4 TO 16 16 TO 26 26 TO 41 TO TO TO TO TO TO TO Fill Organics Silty gavel S=dy gavel and vaster GTaterbearinp, rravel `r 973 3—CONTRACTOR MUNICIPALITY OF ANCHORAGE Department r P Health and Environmentay^�rotection 825 �. Street, Anchorage, AK. '_4501 264-4720 Permit # �� * * * HANDWRITTEN PERMIT WELL ANDIV ON-SITE SEWER PERMIT Applicant: 84CrAV/t"5oV& Mailing Address: P1/0J9'/ '4 3.S' Location: Phone Number: 6441IAr,fr_# Legal Description: Lrs &k / cAw d.. Lot Size: Type of Soil Absorption System Is: Trench: i" Drainfield: Seepage Bed: Holding Tank: 0'7Maximum Number of Bedrooms: 3 Soil Rating(sq.ft/br) /SO L The Required Size of DEPTH ?' LENGTH SO : the Soil Absorption System Is: J .GRAVEL DEPTH :3. WIDTH 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). * * REQUIRED SEPTIC(MM-U G') TANK SIZE GALLONS 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(2) INSPECTIONS ARE REQUIRED Backfilling of any system without final inspection -and approval by this departmen- will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fee 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 this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper.installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more tha 3 bedroom . Signed: Issued by: Applicant p./3/ /�3 Date: O SWP/024(1/81) n `V --SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION O PERCOLATION TEST 825 L Street, Anchorage, Alaska 99501 2644720 SOILS LOG - PERCOLATION TEST - .- .• • r. •. •- i � tet: ■i1■■ Vl,■■1.1 ■■■■■ ■��!! ■■■■"■■■■! MEMO ■■■■n■■■■0 111M■ ■■■■umannNL% t�talr.�ta taltatallwtlts�llra�t�t�t�►� WAS GROUND WATER 110 ENCOUNTERED? 12 b1 1 IF YES, AT WHAT ': �✓ DEPTH? 13 ?X:`1rMrv"- zli3 14- Date lit 6.l� Depth to Water FAC 16 U, ` f = ' •� �9 % 7 l• Q �r 00 $ 0 16 •. b Ite!»A A. 3hahr W 9 � .O No. 1457-E 1 i 191 O 10 . Sb WAS GROUND WATER 110 ENCOUNTERED? 12 b1 1 IF YES, AT WHAT ': �✓ DEPTH? 13 ?X:`1rMrv"- zli3 14- Date lit 15- Depth to Water FAC 16 ` f = ' •� �9 % l• Q �r 17 16 Ite!»A A. 3hahr W No. 1457-E 1 i 191 20 11 Reading Date Gross Time Net Time Depth to Water Net Drop �r i r PERCOLATION RATE SELF RUN BETWEEN FT-4ND FT PERFORMED 72.008 (6/79) Municipality of Anchorage • • L On-Site Water and Wastewater Program 1 F` t _ (907) 343-7904 LaIi S F S E*v CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-042-34 Expiration Date: 11-( 1 aO l I 1. GENERAL INFORMATION Complete legal description Deer Park Block 1 Lot 5 Location (site address) 22116 Deer Cir Current Property owner(s) Parkison Day phone 865-6472 Mailing address Same Real Estate Agent Sabra Day phone 865-6472 4�6A � 8 9 /0 777 2. TYPE OF DWELLING: 1 �1 ti : . ® Single Family (w/wo ADU) ❑ Duplex a Nov zuld ❑ Multiple Dwellings (Single Family and/or Duplex) tb\ \ �h 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Received by: Date: // COSA to be released to the engineer,unless of ise requested by the engineer. COSA Fee $ 52to Date: Date of Payment . l 11 (31 I Date of Payment Receipt Number 03359D Receipt Number COSA# o 5C 1 590 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm NorthRim Engineering Phone 694-7028 Address PO Box 770724,Eagle River Engineer's Printed Name Steve Eng Date 11/9/2018 6. DSD SIGNATURE _ . System #1 Approved for 3 bedrooms. System #2 Approved for bedrooms. I4 • Disapproved. ///f �, Conditional approval for bedrooms, with the following stipulafiohs:, -.g ON-SITE WATER AND �t WASTEWATER o PROGRAM �; " SER\nC.c By: ,('c,>` CCOriter# Original Certificate Date: 1I o V 77/ (201& The Municipality of Anchorage Devlopment 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 9.1-12.doc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On Site Systems Approval Checklist Legal Description: 3E6:47 pAnc 8/ L 5 Parcel ID: 051 0142 31/ A. WELL DATA Well type P If A, B, or C provide PWSID# Well Log (Y/N) y Date completed /2C/5J Sanitary seal (Y/N) \/ Wires properly protected (Y/N) Total depth '/1 ft. Cased to z/O.Sft. Casing height(above ground) 2 in. FROM WELL LOG AT INSPECTION Date of test. -/Z e/e3 ///Z// Static water level 7 ft. / 7. 5 ft. Well production VO-f- g.p.m. 6 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 2 9 mg/Lg/ Arsenic A11 ug/L Date of sample: /(7Z7�0 Collected by: /1//2( "''1 B. SEPTIC/HOLDING TANK DATA / Tank Type/Material S7L e/' S 7fl L Date installed /0/3/// C Tank size /Z 5-0gal. Number of Compartments 2_ Cleanouts (Y/N) Foundation cleanout(Y/N) Depression over tank (YIN) Al High water alarm (YIN) Y Date of pumping / (P Pumper (Sa,,ti-Ary C. ABSORPTION FIELD DATA � eta Date installed /0/3(//‘ Soil rating (g.p.d./ft2 or ft2/bdrm) 1. 2 System type i r Length 3 8 ft. Width 3 ft. Gravel below pipe S ft. Total depth 7 ft. Eff. absorption area 3 d0 ft2 Monitoring tube >/ Depression over field A/ Date of adequacy test ///2//8 Results (Pass/Fail) / J For 3 bedrooms Fluid depth in absorption field before test 5 in. Water added Li/5 O gal. New depth / CJ in. Elapsed Time: 3 0 min. Final fluid depth 5 in. Absorption rate >_ 115r0 g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) viv K If yes, give date__ D. LIFT STATION Date installed /O73///‘ Size in gallons /Z S O Manhole/Access (Y/N) y "Pump on" level at 3 0 in. "Pump off" level at Oct in. High water alarm level at 3‘ in. Datum /g ot,ph Cycles tested 3 Meets alarm&circuit requirements? y E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot /0 f On adjacent lots /QO F Absorption field on lot /G0 -� On adjacent lots /0O "/— Public sewer main / 0 '�' Public sewer manhole/cleanout . /00 (4` Sewer/septic service line 2 5 '4- Holding tank /do (It" r Animal containment areas 3 Q 14- f Manure/animal excrete storage areas /7 t SEPTIC/HOLDING TANK ON LOT TO: Building foundation J "r- Property Property line /O `'f" Absorption field /C r÷ Water main / 1 -f' Water service line /0 t Surface water /00 Wells on adjacent lots /00 (1.- ABSORPTION fiABSORPTION FIELD ON LOT TO: Property line /0 /-1- Building foundation /0 't Water main / /1- Water Service line l4 ) "f Surface water /Or/ Driveway, parking/vehicle storage la 4- Curtain Curtain drain l/AJ k Wells on adjacent lots /00 if F. COMMENTS 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. 7,) Engineer's Printed Name S ( Date l `/(X /(/ /4 • COSA yellow sheet_2-6-15.doc Sanitary Pumpers / JOB 17545 Kahiltna dr Date Eagle River, AK 99577 11/10/18 907-688-4602 TRUCK sanitarypumpers@gmail.com sanitarypumpers.com Name/Address Ship To MADISON PARKINSON / 22116 DEER CIRCLE \,// CHUGIAK, AK 99567 Contact Phone Alt. Phone Alt. Contact Gallons Pumped 719-694-6626 Hoses Memo Customer Since/pumps Item Description Cost ! Total SEPTIC PUMP !PUMP SEPTIC 12-jJ - 215.001 215.00 other CLEAN/INSPECT LIFT STA ON 100.00! 100.00 Remove and clean pump basket and effluent filter. ylq..- Clean floats and other components, ensure system performance.-N Y\32 Float controls in compliance with Manfacturer/MOA settings. 0)2\ Ensure alarm system is functioning, audible and visual. Inspect manhole riser to tank connection for ground water intrusionOl2.~ N) (n.'te.l .tclil Inspect Manhole lid for functional, insulation and properly secured. We, -Qc v eq_ Ensure outlet weep hole is functional to protect from freezing. Off-- or2kS Two separate circuits for alarm and pump. C 11I ►3\i _ . Total $315.00 Directions Directions 2 Directions 3 ^C E • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 s CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-042-34 1. GENERAL INFORMATION Expiration Date: — Complete legal description DEER PARK S/D BLOCK 1, LOT 5 Location (site address) 22116 DEER CIR, CHUCIAK , AK Current Property owner(s) KEVIN KRUSHENSKY Day phone Mailing address 22116 DEER CIR, CHUCIAK , AK Real Estate Agent Day phone 2. TYPE OF DWELLING: 4, u1 \� ® Single Family (w/wc ADU) l 4.. ,.. ,.�. .-' ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 '\.i 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for:W/A Distan Received by: IWAAL Date: l t COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 42-1•uo0 Date of Payment ILVIglm(la Receipt Number 20-7101 COSA# OSGILP[5H] 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 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 MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE. Engineer's Printed Name MIKE N ANDERSON, PE Date 11/13/16 6. DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. tp bedrooms, with the following stipulations: ROGRAM By: fnM= Original Certificate Date: �b The Municipality of AnchorageDevelopmentServices 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 10-1042 Coc If more than 1 septic system is on the lot: COSA Checklist # _of _ Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: DEER PARK S/D BLOCK 1, LOT 5 Parcel ID: 051-042-34 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 9.26.83 Sanitary seal (Y/N) Y Total depth 41 ft. Cased to 40.5 ft. FROM WELL LOG Date of test 9-26-83 Static water level 7.0 ft. Well production 40+ g.p.m. WATER SAMPLE RESULTS: Well Log (Y/N) Wires properly protected (Y/N) Y Casing height (above ground)24 Coliform NEG colonies/100 mL Nitrate 2.7 mg/L AT INSPECTION 101212016 ft. Arsenic: ND ug/L Date of sample: 101702016 Collected by: Mike Anderson 21 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC I STEEr6 P Tank size 1250 gal..' Number of Compartments 2 Foundation cleanout (Y/N) Y`.S Depression over tank (Y/N) N Date of pumping NEW Pumper NEW C. ABSORPTION FIELD DATA — 1985 SYSTEM TESTED Date installed 1013112016 Cleanouts (Y/N) High water alarm (Y/N) Y Date installed 10/31/2016.' - Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 System type DEEP TRENCH Length 38 ft. r .,. Width 3 ft. Gravel below pipe 5.0 ft. Total depth 9 ftn Eff. absorption area 380+ ft Monitoring tube Y Depression over field N Date of adequacy test' NEW Results (Pass/Fail) NEW For 3 bedrooms Fluid depth in absorption field before test NEW in. Water added NEW gal. New depth NEW in. Elapsed Time: NEW min. Final fluid depth NEW in. Absorption rate >= NEW g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) UNKNOWN If yes, give date D. LIFT STATION Date installed 10/3112016 Size in gallons 1250 Manhole/Access (Y/N) Pump on" level at 30 in. "Pump off' level at 24 in. High water alarm level at 36 in. Datum TANK BOTTOM Cycles tested 3 Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 1004 Public sewer main 75'+ Sewer /septic service line 50'+ Animal containment areas 1004 SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 54 On adjacent lots 1001+ On adjacent lots 1001+ Public sewer manhole/cleanout 100'+ Holding tank 100'+ Manure/animal excrete storage areas 100'+ Absorption field 5'+ Water main 1004 Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO Property line 104 Building foundation 10'+ Water main Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+ (None Known) Wells on adjacent lots 100'+' F. COMMENTS G. ENGINEER'S CERTIFICATION 1 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. Engineers Printed Name MIKE N. ANDERSON, PF, Date 11/1212016 COSA canary sheet_2-6-15.doc . 49TH j ........... \L 1 �� • MICHAEL N.. ANLER60N , r" °. CE 469 N00'04'58"W 354.27 / Ao1 _ 00 I A AN Nm I m (P m X J r J IN I c� Z D zo \ Oo r UA U1 QR�I/V G mM III 70.79 M \ \ < J \ q SEMFM \ \ my n FT]\ \ DMo L4 v \ \ N2 5CD m\ I \ �Rgl�qU,ILITY EAS— {, i \ c\ \M O N00'04'58°W 65.18 o /EST DEER CIR. ® � R —�F 4.9 v I msso- >��� 1111 49 TE /, CURVE CHART r aur 2941BobbvC rr Burnett GRAPHIC SCALE: 1 Inch = 40 Feet Ilk a j 2941 Carriage Drive NO DELTA RADIUS LENGTH 1 -�' �oAir Anchorage, Alaska 99507Af 1 34'22'39" 50.00 30.00 V�SSIo""' � (907) 350-5541 20. 0 20 40 80 0 Date Scale Legal Description I hereby certify that the property described hereon has been surveyed 10/27/2016 1" = 40' Lot 5 Block 1 by me, or at my direction, and that the improvements situated thereon Grid AS -BUILT are within the property lines and do not overlap or encroach on the property lying adjacent thereto unless otherwise shown. That no NW 1558 improvements on the property lying adjacent thereto encroach on the DEER PARK premiiLes in question and that there are no roadways, transmission BFB ASB -2016 Dby Field Hook SUBDIVISION linea or other easements on said property except as shown. BFB NJ -0AF1'7 e,C �5 7- 76) Z A� <�7 - 0�6 1?14 % , 4 _ �J Vic,. v (ING SERVIC ES 8221 DEL STREET ANCHORAGE, ALASKA 99502. '0 7- LS - 5773 OX PLOT Ectt;r'3r#s not QPPecring On record 1-vbdivi3imr Plot are not shown unle es ; r. of casement Is Provided by cliert. it is the respon3ibility of the owner or builder, prior to construction, to verify proposed building grade felctive 10 finish grade and uti litles connections, and 13 determine the existence of any n: nt^, or restrictions which do not appear on tine recorded subdivision plot. Elevations based a,, assumed datum unless otherwise indicated. CLIENT 4 �_Fx /�6e�F�'� 44� LEGAL .. DESCRIPTION LOT , -BLOCK DATE SCALE MUNICIPALITY OF ANCHORAGE Aak 41m� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services low 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 l.D. N 1. GENERAL INFORMATION Complete legal description HAA # V` (-:� S -1)fhlnR.O11 Lot 5; Bfock•l; Dee)L`Paak Subdivision Location (site address or directions) 22116 DP h Pahb C.ihcto Property owner bf.ichaeC Baock Day phone 688-4047 (h) Mailing address P.O. Box 671932 CHugiak AK 99567 265-8465 (w) Lending agency Mailing address. 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 r XXX Day phone 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 XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72.025(R..1/91) Fwr MOA n, 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 invest!qation 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 17034 Eagle River Address - Engineer's signature 6. DHHS SIGNATURE A_ Approved for 7/�a bedrooms. Disapproved. Conditional approval for Additional Comments • Phone 4rz9 '052 >79 Date nA A.•s!.%hA No. 1457•E bedrooms, with the following stipulations: Date I/— /;z. —? :I. The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an Independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(n«.1/91) eKk MOAY21 ® Municipality of Anchorage AL Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: (.arm Pa.,,r- O g / — \ 'D�h "Pates Parcel I.D. 7/ A. Well Data ?R Weli type -%y kTJL_ If A, B, or C, attach ADEC letter. ADEC water system number Log present1�/N) �4 Date completed c{ -2 L -8 S Driller Total depth -11 t I Cased to Ax.5 Casing height Sanitary seal 69N) J Wires properly protected ON) FROM WELL LOG AT INSPECTION Date of test Z(, - $'S 3-18-9Z of Static water level h Well flow 40.D g.p.m. 7.2 X.P.M. rT 1 4O. - c Pump levellLi r__ tT<j c`yo C SEPARATION DISTANCES FROM WELL TO: c } ti C 0 n Septic/holding tank on lot \ oo ; On adjacent lots 1 Absorption field on lot \ tea\ 1 �} rp ; On adjacent lots \ oa �1 Public sewer main s Public sewer manhole/cleanout Sewer service line 2S \� Petroleum tank ZS WATER SAMPLE RESULTS: Coliform 0 Nitrate 0.1 Other bacteria Date of sample: 10 -29 -q3 Collected by: c x 5 ENGINEERING Road Mo. 204— 17034 Eagle Kiver [cop Eagle River, Alaska 99577 B. SEPTIC/HOLDING TANK DATA Date Installed °I - 1 O 9 Tank size \ o0 o Compartments Cleanouts ON)�Foundation cleanout &N) I/Depression (YIA High water alarm (Y/I9 ra Alarm tested (YM) lA' Date of pumping 2-210 - d'� -Pumper'�� "� £SSPno L. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: y Well(s) on lot \ o� On adjacent lots \ oo Foundation S To property line \� Absorption field �!�� Water main/service line \ 0..Ar Surface water/drainage \oo \k' 72-02e(ss3)•Fmt CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size In gallons Manhole/Access Vent (YIN) High water alarm level Meets MOA electrical codes SEPARA 'Pump on' level FROM LIFT STATION TO: tested off Level at on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date Installed -1 �\—e`S Soil rating (GPD/F?) n� �� System type 5C-,0 Length 1 Width `b� Gravel thickness d. S ' Total depth Total absorption area L84 `f Cleanout present (9/N) Depression over field (Y60 .1 Date of adequacy test ResultsJIJA�ail) PntS for 3 Bedrooms Water level in absorption field before test 5 After test S Peroxide tre tment (9gast 12 months) (YO f, . te^10aAJIf yes. sive date I'47/�G<S iJ�7� PX�PP P /C4(/ 'r�'c SEPARATION DISTANCE FROM ABSORPTION FIELD TO: / // f3 / / Well on lot 1 oc> On adjacent lots 10=> Property line t 10 To building foundation Vo 1.i,' To existing or abandoned system on lot 7-5- On SOn adjacent lots 3D r Cutbank is L, Water main/service line In �y Surface water o o 1 Driveway, parking/vehicle storage area ?� 1 Curtain drain `} /Y E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, loaned to all MOA and HAA guidelines in effect on the date of this inspection. • � �x' p _ Signature I ERING Engineers Narr�� s 17033E a River Loop a o. f Mubod Date laska 99S77 No. I�J7•E HAA Fee $ 300 •6 D Date of Payment r'� Receipt Number c26 7 (7 75 72-026 (3193)' Back Waiver Date of Payment Receipt Number MUNICIPALITY ANCHORAGE O DEPARTMENT OF HEALTH 6 HUMAN SERVICES �t 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 Parcell.D.# 0S1-01-121-18 HAA# a1Aq���11 GENERAL INFORMATION Complete legal description Lot 5: Block 1: Deer Park Subdivision Location (site address or directions) 22116 Deer Park Circle Property owner Michael and Lorian Brock Day phone 265-3465 wk b88 -4U4/ hm Mailing address P.O. Box 671932, Chugiak, Alaska 99567 Lending agency CITY MnaMAGE Day phone Mailing address Eagle River, Alaska Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 V 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC . attesting to the legality and status of system. 72-025(Rw. 1121) Front MOA 621 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I 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 Phone 5 & 5 ENGINEERING Address 17n31 FagleRiver Lanp Rnarl No IJ04 Eagle River, Alaska 99577 Engineer's signature 6. DHHS SIGNATURE Approved for 6 EE 3)bedrooms. Disapproved. Conditional approval for Additional Comments Date bedrooms, with the following stipulations: CS a c r t Date 7 7"/ a 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 engineers work. 72-025(P.AAq S. k swn m Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: -L�'r S 01AL\ T SP PA44-5ki Parcel I.D. pS-1-- Oy/A -35L A. WELL DATA Well type Pk\Jfef(� If A, B, or C, attach ADEC letter. ADEC water system number A, Log present &N) V Datecompleted Driller Total depth q �� Cased to q ° SI Casing height Sanitary seat (JIN) U Wires properly protected (9/N) U Date of test Static water level Well flow FROM WELL LOG I ,40. t7 g.p.m. Pump level SEPARATION DISTANCES FROM WELL TO:. AT INSPECTION 1" r7n 1't�1 n N '1.2Xrn o g.p.m� J rn N Septic/holding tank on lot \ �� t ; On adjacent lots \ bol r< - Absorption field on lot lop, ; On adjacent lots no \k Public sewer main �I Public sewer manhole/cleanout ala Sewer service line 'LS I Petroleum tank WATER SAMPLE RESULTS: Coliform O I1 c a r . Nitrate tip • Other bacteria AD Af,: Date of sample: Collected by: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date installed 5 � 10 ' 03 Tank size t DO o f„✓� Compartments v CleanoutsLoYf*) 4 Foundation cleanout Depression WO J High water alarm (Y/N) i, 1"'h 'Alarm tested (Y/N) - A Date of pumping 3 18 -`I 1� Pumper Ste_ GEiSrd o�- , SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Welt(s)onlot le; '0' t+ On adjacent lots tco 1.1 Foundation sl 11r1 Topropertyline to Absorption field ?� Watermain/service line 1 Surface water/drainage \ o° tx 72.026 (Rev. 7/91) Frmt CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons %ent(Y/N) —"Pump on" level at Manufacturer Manhole/Access(Y/N) off" level at High water alarm level Cycles tested Meets MOA electrical codes (Y/ -SEPARATIO ANCE FROM LIFT STATION TO: on lot On adjacent lots ' Surface water D. ABSORPTION FIELD DATA Date installed Soil rating �SD�I Ew System type P��D Length ��� Width t `h Gravel thickness 0.5-1 Total depth L•S t Total absorption area Cleanouts present&N) - y Depression over field (Yo + Date of adequacy test Resultss)�/faih PASS for L?) bedrooms Peroxide treatment (past 12 months) (Y1? rjojf, W -.*Jo W41 If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I ! L) t On adjacent lots IC0 1 f I Property line l o t t - To building foundation Po 1 To existing or abandoned system on lot 25 14 - On adjacent lots 201 f Cutbank (p Water main/service line Surface water f oo I r Driveway, parking/vehicle storage area Z� t Curtain drain E. ENGINEER'S CERTIFICATION rc:r I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines In effect on the date of this inspection. OF 4t,4 Dtt S i S ENGINEERING,••'•M••�•'••.rsr I Signature 17034 Eaale River loop Road No. 204 k f� t9 too Eagle River, Alaska 99577 s9L •«r««v,«p u• Engineer's Name Date '� iO' `�y o". 11:0: •q J. 'HAFER E �� `v .• No 8 15 ✓ I�_ RnccectON •e. HAA Fee $ Waiver Fee: $ Date of Payment 2,0 rDate of Payment Receipt Number 7 Receipt Number 72-026 )Rev. 9/91) Beck MOA 21 n n MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH d HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date Ju.ty 2, 1988 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 5; Block 1; DeeA Park Eatat a Location (address or directions) (b) Property Owner Mailing Address AHFC (c) Lending Institution _ Mailing Address Telephone: Home Telephone Business (d) Real Estate Company and Agent REMAX OF EAGLE RIVER - Bob WomboGt Address 16600 Centm6ietd D21ve, Suite 201, Eaqte RLveR, A.taaka 99577 Telephone 694-4200 (e) Mail the HAA to the following address: or, Check here IN. if hold for pick up. List contact person and day phone number below. M&I,J;f7.,,, r- 2. TYPE OF RESIDENCE Single -Family Rk Number of Bedrooms 3. WATER SUPPLY Individual Well Q 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 IS" 8161 F Ont r,. 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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 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 Telephone ENGINEERINU Address nnu�kl• Rlv� Len„ Re•d u �nw Date Rlvr, Alaska 6f5e- z177p fN f f f f,... f f Yf�,• lowl A. IMk 6. DHHS APPROVAL � ) Approved for Aeez. — edrooms by �,'2Date 9, Zjp� Approved — Disapproved Conditional Terms of Conditional Approval CAUTION 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. Page 2 of 2 72.015 )p" 8'86) Balk r.. n `S( Of PN ovv-iA 'rtCIPALITY OF ANCHORAGE (MOA) /��0 y2 —6-6MJN\Gtp A�S,TV HEALTH AUTHORITY APPROVAL (HAA) v� CHECKLIST -FEBRUARY 1984 ENv%tow ` . 5 �gga 264-4744 A. WELL DATA Legal Description: LS ,6 Mel-,Qnex Z Well Classification If A, B. C. D.E.C. Approve (Y/ ) Well Log Presen(Y/ ) Date Completed ��— �B7 Yield �- Z )9L0 Total Depth d� / Cased to -'/0.5 Depth of Grouting u 11C Static Water Level Pump Set At tA tr Casing Height Above Ground 3o Sanitary Seal on Casing(Y N) — Electrical Wiring in Condui (Y N) Depression Around Wellhead (Y49 Separation Distances from Well r r To Septic/Hoid v Tank on Lot '/ ; On Adjoining Lots /Ua F r To Nearest Edge of Absorption Field on Lot ZOD f ; On Adjoining Lots /Oo To Nearest Public Sewer Line To Nearest Public Sewer / Cleanout/Manhole Nle To Nearest Sewer Service Line on Lot 1S f Water Sample Collected by ; Date Water Sample Test Results J F/ T/Sfr9ET��Y c 121ftor�u 6 A T y /k--'/ rir�r Tf Comments IV B. SEPTIC/HOLDING TANK DATA Date Installed �� 3 Size Z�0 No. of Compartments 2 Standpipes (Y/ ) Air -tight Caps (Y N) Foundation Cleanout Y/ ) Depression over Tank ( N) Date Last Pumped Pumping/Maintenance Contract on File (Y/N) —;for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/H Tank: To Water -Supply Well lO c) r� To Building Foundation To Property Line ZO To Disposal Field Z To Water Main/Service Line �O To Stream, Pond, Lake, or Major Drainage r. Course N O AJ Comments Page i bf 2 72-M FFI v 8'861 ROM C.' ABSORPTION FIELD DATA 1ta/117144' Soils Rating in Absorption Strata / K Type of System Design Be c Date Installed % Length of Field Width of Field 4E Depth of Field' " ,1 Gravel Bed Thickness S' Square Feet of Absorption Area T Standpipes PresentY J) Depression over Field (YCN) Date of Last Adequacy Test N e lti% Results of Last Adequacy Test /✓ "' u� r� Separation Distance from Absorption Field: / - r To Water -Supply Well 'lOt, f To Property Line r To Building Foundation To Existing or Abandoned System on Lot S f ; On Adjoining Lots /O 7/' / To Water Main/Service Line l0 f To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course ti t9 "JF To Driveway, Parking Area, or Vehicle Storage Area G Commens /S/N�7:•oi, u- D. LIFTSTATION `.v. Date Installed Dimensions Size in Gallons 1 Maphole/Access (Y/N) "Pump On" Level at "P mp Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments " Check Permitted Bedroom Rating Against HAA Request •• Icertilythatlhave checked, verified, orconformed toall MgAa3d HAA guidelines in effect on the date of this inspection. SignedS & 5 ENGINEERING Date l 17034 Enle River LOOP KO§a F40 204 COMPUVI*PAw AI•s4.4917 IMOA No. Receipt No. Date of Payment % od Amount: $ Z:2 0 QS• t J12 Page 2 of 2 72.878 IRw 8'861 Pxk APPLIL..NT FILLS OUT UPPER HALr ONLY PropeCy Owner' /'L i9! /vim?�s Phone Time 35,E MallinO Address 7 54 ZIP Code �f Date Buyer Date Address Zip Code Lending Institution Inspector Phone Inspector Address r Zip Code Realty Co. Agent ,/0, Phone Address '/ ?_— . Zip Code Legal Description ;• / Ci C / q /-C%� �/ �/ V• Street Location •.� Type of Residence F}ASlfig a Family ❑ Multiple Family No. of Bedrooms 17, ❑ Other Water Sup ly "-4,C6 dnridual ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log If available). ❑ Public Utility Sewer Disposal � E C E I V E D dividual Year Individual Installed: O Public Utility When Connected to Public Utility: ❑ Holding Tank I NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. —11 _. 1•Gir r i 1 Time T me Time Time Date Date Date Date Inspector Inspector Inspector Inspector I Field Notes: LQXS)•a v -,C -V-' MUNICIPALITY OF ANCHORAGE L -,to L co^ DEPT. OF HFI.:TII P, G� 5,0." "-4,C6 La, Y] .0-C4tNVIRON,J,_NTAL PROTECTION 1— (f•ti•o7C' o a+oaJ N 0 V 2 9 1.»3 �•• 0 C C)t��- � E C E I V E D ( ;L4 APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DAT& I T. -S _ . Solis Rating Date Sewer Installed Well To P Well Log Received Septic Tank Size C p c:7 OC2 - ( V 3 Well to Tank s r]ml ryen l�/g3 December 5, 1983 Clark Construction 13001 Back Road Anchorage, AK 99515 Subject: Lot 5, Block 1, Deer Park Estates Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: VykA well log submitted to this office for our files and review. ° The top of the well casing should be sealed so that it is ��_water tight. ° The water facilities were not turned on at the time of the scheduled inspection. ' Please call this office for another appointment. 1-42�0 Please notify this Department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, CdQ,villi6 �1J ✓n r� Actiny Sewer & Water Program Manager CW�3