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HomeMy WebLinkAboutEAGLE PARK BLK 2 LT 6Engle Park Block 2 Lot 6 #050-782-30 Municipality of Anchorage Development Services Department :ftp js' Building Safety Division ' On -Site Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage. AK 99507 Page I of 4 www.ci.anchorage.ak.us (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM ANDIOR WELL INSPECTION REPORT Permit Number. SW080231 PID Number: 050.782.30 Nams RON PERKINS Wastewater System: []New © Upgrade Aeaase 9727 WREN LANE EAGLE RIVER. AK 99577 ABSORPTION FIELD Ph"i. NunW d aspto"na 696-2170 4 0 oasp Tr«xh 0 Sn"ba' Trarcn 08W p Mou.p ❑ 0p.« sd Rating T" Dean nom Ong" Pape LEGAL DESCRIPTION 0.8 (;PDS? 11 FI. 13 a L" S"noobn pm ftOM °ngree. Depth w Dnre" O' b rxa." dwh n«isam P" 2 6 EAGLE PARK 6.5 Ft. 4.5 Ft Toensho, Renee se"on fe apaep ao"a onpn" papa Grad Length 43+42,eTOTAL$j 1.1-1.4 Ft, Ft. ❑ New ❑ Upgrade Grnei ran Hamner d treat z owan(A blwee , Ines 13 Well: 3 Ft. Ft Crssd,c",)n (Prn"e. A e. C) T"" Degh Casep W Td" eb"p1Cn eros 783 P" M"sn" ASTM D3034I1`810 EXISTING PRIVATE F4 Ft= nrl"rr Data ^"acro Ft DEAN CONSTRUCTION 10-31.2008 wa punpse, " c " Me.Gpuq TANK GPM FI. FI SEPARATION DISTANCES ❑ septic o Ing ❑ .T. P. ❑ Other. To I Septic Absorption Lit Holding ubix•1Pnvate'd paC ly From Tank Field Station Tank Sever Line c" LAW.*Hunner d ComP«wwaxs wan -110' 103' 25'+ LIFT STATION sutenwaier 100'+ 100'+ LNLM -.30' 34' 'Pump an'r."" Pump Mph eel«aWm" Fonml'o,..7' 143' ^ Pune Maes Ele"noi Mspxtvn P«Iprnsu by Calan Oran NONE KNOWN ' ReAe" BENCH MARK .- LtxM*n ane Dasaplun BOTTOM OF SIDING AT POINT"B* 100 Ft. S&S Engineering Engineer's Stamp Inspections performed by: 15861 S:81rchwood LD. Rd. Dates: 1" 10-31-2008 g�too!,lz@k Chuglak, Alaska 99567 10-31-2008 r jF. QF �.t►v� 2ne Development Services Department Approval v�j•f y����p;, p*� �'t Conditional Approval Date: �•d�i'p, Via.. •...... ....aww.•.a i � �� a5or ti Ehai4 ��j 1437-1 i •'� by: � Date: �� _2 0 -0q0 -0q op`•-w�J� «% Reviewed and approved o4ft) Q t�� � 9 (Rev PERMIT N0. SWO80231 PAGE 2 OF 4 Municipality of Anchorage DEVELOPMENT SERVICES DEPTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone (907) 343-7904 • www.ci.anchorage.ak.us ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 6 BLOCK 2 EAGLE PARK S/D P.I.D. NO. 050-782-30 • EXISTING 1250 GALLON C (INTEGRITY VERIFIEDA10-31-2008) STI 3 Z FC 8� W I EXISTING IBL2 DELI & 4 HOUSE v1''il M `I A B �I T M dl 71 v I I I DBL4 W ppl DBL5 y I j ``^� e� LOT 5 oGs 3�� z I W I I oo I I IANEW TRENCHES ' I GO --- - --- .'.: 02 MTI MT2`•, C04 CO3MT 1' - 40' ATH MT4 I I ENGINEER STAMP ............ mww • ���� (.119 I I •A .1 .�NN. ••M �i 5 L---- -------- GS ------ ................. .=. •n ——. ! lw� Awe e A. A. ihaShu 10' UTILITY EASEMENT �� J .�� PERMIT No. SW080231 PACE 3 OF 4 Municipality of Anchorage DEVELOPMENT SERVICES DEPTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone! elephone (907) 343-7904 • www.b.anchorage.ak.us ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 6 BLOCK 2, EAGLE PARK S/D P.I.D. No. 050-782-30 -- — I -�----------------------------- ---------- RAVEN DRIVE iy o EVISTI.O TRENCH I CO _ - �.}.. ns ANO 1250 auON ONCREtE SERIIC IANM (IN1CORITY VERIFIED 10-01-200!) it CS: U LOT 4A TIN i '[MODUA Y DELI • Rl2 I of oI 'I 1 I LSl I oRL. pp l DOLS ni I o a Qo1 LOT 5 zI � I � I INEW TRENCHES IT 4B N I o N . Cat M .N . I I I a i I ' 60, I K I I 9� �N_;rljl_kF,�2EiTAStP.. _ . ------ `---- --------"------- ------ ' y.• �. iIUTT CASEMENT i 10' UTILITY EASEMENT �•.••..• I�� •'TNls�k y ti ------ -------------- ---------, r LOT 7 C ••� Ir, LOT p'* J •'•' •� •0, PP •• .LD..rt•A. A. iSofa'. p L{. I I % •. Na 1497•! t �a C�`` R�OFESN��"o` PERMIT No. SWO80231 PAGE 4 OF Municipality of Anchorage DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET P.D. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone+ (907) 343-7904 • www.ci.anchorage.ak.us ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 6, BLOCK 2, EAGLE PARK S/D P.I.O. No. 050-782-30 C01=100.3' CO3=100.4' C04=100.1' FINAL GRADE VCO CO3=92.8' SR C04=92.8' M71=88.2' MT3=88.0' 1\172=88.3' — MT4 = 88.2' 62.0 — 5 Ak — 51610s1a7s NO RATER FOUND 82.0' B.O.H. 01490 A B C 51720 FCO — 23.5 4.5 ST1 — 24.5 10.0 — DV — 27.0 14.0 OBL1 — 26.0 14.0 DBL2 — 24.0 14.5 N. T. S. DBL3 — 28.5 14.0 EYfii,'^fFi'$ TANIP .y �E L ..M.YN • rA dw "x VCO46 << . �. •uo� .n•a. N.,a`. a }L.r ' A +. .• 8 58.0 — 62.0 — 5 160.0 — 51610s1a7s 01490 51720 5172.0.5 162.0 — MT4 161.5 163.5 — Permit Number: SWO80231 It -3 I. OS' S Ir:30 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade a- 3:30 Date Issued: Oct 22, 2008 Expiration Date: Oct 22, 2009 Parcel ID: 050-782-30 Legal Description: EAGLE PARK BLK 2 LT 6 Design Engineer: 0003 S & S ENGINEERING Site Address: 009727 WREN LN Owner Name: RON PERKINS Lot Size: 43560 SO. FT. Total Bedrooms: 4 Permit Bedrooms: 4 Owner Address: 9727 WREN LN EAGLE RIVER. AK 99577 - This permit is for the construction of: Private Well E] Water Storage M,(Disposal Field ❑ Septic Tank Holding Tank ❑Privy ❑ All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By. Issued By: Date: i Date: Municipality of Anchorage Development Services Department ' Building Safety Division ; _ On -Site Water and Wastewater Program ' 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.org/onsite (907)343-7904 ON-SITE SEWER/WELL PERMITAPPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 6,5V - Property Mailing (phone /�-1 - 1170 Code x%95%% Site address :5a me- Zip Code /5cAn1e Legal description (Sub'd., Block & Lot) LOU, gIoGk a, _� 1P_ kir c </I) Legal description (Township, Range & Section) Lot Size ---q 3. 5 tao Sq. Ft. THIS APPLICATION IS FOR (Z all that apply): Absorption Field Septic Tank Holding Tank El Privy El Private Well 0 Water Storage ID Number of Bedrooms THIS APPLICATION IS AN: Initial El Upgrade 54 Renewal E] I certify that the above information is correct. I further certify that this application is being made for a Single Famlly7lDwelling and is in accordance with applicable Municipal Codes. 15Q6I IL Bkehwmd l[ft &A (Signature of property owner or authorized agent) Permit/Rush Fees: Waiver Fees: Date of Payment: /0/7r r Date of Payment: (Rev. 11105) 1V Receipt Number.Su 5 Receipt Number. S& I tG nonenr c. cownnl, r.E. CIVIL ENGINEEnS (907)694-2979 FAX (907) 694.1211 October 16, 2008 twxitimu mlv MMOVALS MUNICIPALITY OF ANCHORAGE Development Services Department SEwEnAwATEn P.O. Box 196650 M NWEWX>M Anchorage, AK 99519 REFERENCE: Lot 6; Block 2; Eagle Park S/D sEWEn mun IN,^J`ECTION It is requested that you issue a permit to install a septic system upgrade to serve the existing four bedroom'residence on the referenced property. ENCdM[TUNGSTOOICS amnEronTs A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation (10/6/2008) water was not found. After seven days of monitoring, no ground water was found. wru ettrrcnoN "LoWfEST We do not anticipate any adverse effects on neighboring wells, septic systems, CCservc areas or drainage patterns by the installation of the proposed septic system. The SGEPUN4 construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. MAD TXSrN Sincerely, WE1ES1 ?We? 0w. Robert C. Cowan, P.E. RCCnbjj K KOUNON ZEST Enclosure STmICTUFMA MECI4 Cµ INGrECT"c ONSITE WAGTEWATEn DSrOG.LLSMEM COSIGN 15681 S. Birchwood Lp.11d.—Chuglak AIL 99567 5 \ o I Q r, o `• F- 'gym - 0 w �Y, �``� F i REG t W >W S � - o - z N -o2 `Qo ■a Y g O Dy U U �n p -_ NOy 0 d z 04 w 5 \ o I 1'a'y to F- a 0 a f- W � N IrZ, W W WDO >o W E.y d d U 1 W z U U �n p -_ d a 04 w i-np, E"n Nd LT==V 0 ) t •s\r O to to Go rl 0 m CO a �o J� 00 V) (D 4� 5 \ C. s cw------ P - ^pNN aN Y 1 Nazi Ai --\ -— - — - — - — - — - — - — - — - — - Yd !W r' Zoe ,Q [_] WDO >o E.y HN(14 d U 1 W z O � PPIze 04 w i-np, LT==V ) t •s\r 2 04 = „� nu WL N:ld-3115 \ Oi ti �0 1N3W3SV3 Alllll(1 ,Ol a C. s cw------ P - ^pNN aN Y 1 Nazi Ai --\ -— - — - — - — - — - — - — - — - — - Yd !W r' ,Q [_] WDO >o E.y HN(14 d U ►-7 z L'iLLI 04 w i-np, LT==V ) t 04 = „� NJIS30 N:ld-3115 Municipality of Anchorage Development Services Department Building Safely Division • +..! On -Silo Water and Waslewaler Program 4700 South Bragaw St. P.O. Box 190050 Anchorage, AK 995190050 www.munl.ag7onsilo (907)010.7904 C Soils Log -y.�7Percolation Test L Pmlormed ror- _ // ` AzMj V, Dale Peltotmed: Legal lMsniplion: loTG;l t3LnA�, (JKdE _�L'K Township, Range, Section: 9nn- 9 COMMENTS —CaA 1(,S -ML (ak a -5+J WAS GROUND WATER . 1 ENCOl1NTEREp71l^� pa 4.TTG�T�^ r YES. AT %M tAT DEI`TN7 E Depthlo Water Ahar D Moniloring7 p E Date' Q� R04ERT C_ COWAN CE -)3801 R.H. Plnn Reading Data Cross Tlma Nel Thnn Uaplh to WAlnr Net Drop l 806 /Ax+►i!S liveACS rr 30 30 5% a" 3o ca s3. 33 0 30 90 5S aye LLE 30 3O 0 Sv5%z 5%Z 3j 3%,r _.____-__._.._ n•--+v+oq vtrq; 11ME DIAMETER•• 7ESTRUIIBETWEEN _'d; FT AND (a FT PERFORMEDDY: f 4 S I �CERIIrY111A711IIS7CST AS AL GUIDELINES IN F.FrECT ON IIIts DATE. DATE: PERFORMCD IN ACCORDANCE WITI I ALLSTATE AND MUNICIP ROBERT C. COWAN, P.E. ROBERTA. SHAFER, PE. CIVIL ENG W EERS (907) 694-2979 FAX(907)694-1211 ON-SITE WASTEWATER DISPOSAL SYSTEM NEALTIIAVTIIONITY CONSTRUCTION PRACTICES APPROVA,S and MATERIAL SPECIFICATIONS SCHEgA WATER REFERENCE: Lot 6; Block 2; Eagle Park Subdivision MNNEXTENSIONS October 16, 2008 GENERAL: KSPECTION 1. The scope of this project includes the verification of the existing 1250 gallon concrete septic tank, replacement if necessary, and installation of two new trenches to serve the existing four bedroom residence located on the referenced property. ENC�I:CER:NG STIIDI[S ANORCMMS 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special WELL INSPECTION provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. A FLOW TEST 3. The contractor shall be responsible for obtaining any necessary underground utility locates. SITE PLAY 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. ROAD DESIGN 5. Contractors installing wastewater disposal systems must be certified by the Municipal Development Services Department or ADEC if required, for SOIL TEST system installations. Owners installing their own systems must also receive prior approval from the respective agency. TANK INSTALLATION: PERCOLATIONSEPTIC 1CS: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. All IIDPE STRLCTORAL& MECINNICAL septic tanks are required to have a 4" monitoring pipe installed next to the tank extending to the bottom P PECTICNS of the tank. ONSITE WASTEWATER OrSPOSALSYSTEM DCiION 15561 S. Birchwood Loop Road — Chuglak, Alaska 99567 Page 2 Lot 6: Blod 2. Eagle Parc Subdivision Ocbber 16.2W8 2. The septic tank shall be sufficiently bedded to prevent settling of shitting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. All HDPE septic tanks are required to be covered with a minimum of 2" direct burial insulation, and a maximum of 4 feet of cover. 5. A foundation cleanout shall be installed one to four feet from the building foundation. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCII/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the holes faced downward. The distribution piping is to be of PVC (ASTM D3034 or equal). All joints are to be solvent cemented. Gravel is then to be placed over the distribution Pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backlill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page 3 Lot 6; Bbd 2; Eagle Park SubdiyS October 16.2008 MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type ofPi Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mimfi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, whichever specifications apply. Page 0 Lot 6: BW 2. Eagle Park Subdivision October 16, 2008 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractor's activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owners representative and will inspect the work as stated above to document the contractor's activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER \f MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 1 ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME - PHONE ❑NE p MAILING 5RE .., LEGAL DESCRIPTION I- LOCAT11ON ^ .. , NO. OF BEI FMS Well Absorption area Dwelling PERMIT NO. DISTANCE TO: O 2 Manufacturer / Material No. of compartments W la.. Liq, ci inyallons .'Z CJ IF HOMEMADE: Insid ngth Width Liquid depth 6 5e DISTANCE TO: Well Dwelling PERMIT NO. JUZ _? FQ- Manufacturer Material Liquid capacity in gallons O DISTANCE TO: Well Foundation Os Nearest lot line Qr PERMIT NO. /jvW= LL Z No, of lines length of each line Total length of linFs Trench width Distance betweypn nes F 2 W 160 too Inches r! a� RH Top of tile to finish grader Material beneath tile Total affective absorption area p .1—inches o 0 Length Width Depth PERMIT NO. W Q F- Type of Crib diameter depth Total effective absorption area W 1 a(STANCE Well Buil ing found Nearest of line TO: J Class Depth Driller Distance to lot line PERMIT NO. J W DISTANCE T0: Building foundation Sewer line Septic tank Absorption areas)/ e OTHER MATERIALS PIPE MATERIALS _Il C-1 SOIL E T RATING v IJ yi INSTALLER REMARKS `t W � 1 0 3 0 r r APP OV DATE LEGAL n / / 72-013 (ReN(--!f'/78) r'1 C PA Vrtet/ �OkSE/�P/J z meg: 5 0\.?,,. GRE'"R ANCHORAGE AREA BOf'"'4'GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM C-xw Ne¢dlGf MAILING ADDRESS SftHCI14GIAK LEGAL DESCRIPTION CM7 PHONE Z746tC (` for (G kt-2 NAME LOCATION J I OW QecK SEPTIC TANK: DISTANCE// NUMBER OF FROM WELL MANUFACTURER 0"-44"E -MATERIAL 6"OtErC COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH I IQUID CAPACITY-AW—GALLONS. SEEPAGE PIT: II 22�X 19rX 2�ox I NUMBER OF PITS)1. DIAMETER 19—OR WIDTH_, LENGTH—, DEPTH LINING MATERIAL •},C& CRIB SIZE: DIAMETER JLDEPTH I01 DISTANCE FROM: WELL �01' 1 TOTAL EFFECTIVE 00 BUILDING FOUNDATION I7 NEAREST LOT LINE 7 ABSORPTION AREA (WALL AREA) �SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE IN;Ur't3 CONSTRUCTION SrgNOARD DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION LOT LINE , SEWER LINE , TANK , SYSTEM. CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED REMA DISTANCES: INSTALLED BY: '\ kkaLl I. Ste+ `3 PIPE MATERIAL: G*e't zee LOT SLOPE: Le ft REMARKS Form No. EQ -031 711�l-lg - 0Lb DIAGRAM OF SYSTEM T 6MMC tool ��auic DATEAPPROVED n - .A.A.B. MUNI I C I F~1L I TY OF FiMCHC'-"dFiGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL Pr%iTECTI ON * e 825 'L' STREET, ANCHORAGE, AK. 99501 d��adnu�s d 264-4720 Ot,i—SITE SEWER PERM I T PERMIT NO. C 790381 ) APPLICANT MICHAEL D. PENISTEN PO BOX 825 EAGLE RIVER 694 9965 LOCATION CORNER WREN LN & RAVEN DR LEGAL L6 62 EAGLE PARK. S/D LOT SIZE 43000 SQUARE FEET TYPE OF SOIL ASSORSTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BP,)= 225 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH= 12 LEt�IGTH= 7� GRREL_ I?EPTH= 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 CIN FEET). THERE I5 NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). Rj=—G IU I REO SEPTIC TRMFC S I ZE= 1250 GFiLLOtJS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DUPING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- TWO C 2 ] I INSPECT I OMS RRE RE(n U I REQ BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTA14CE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELLa OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERM I T EXP I RES DE0EME3ER 31., 1S?S 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 THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE 'RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4ZPEDROOMS. ' SIGNED ISSUED BY cit 0_ _ t -,cd DOI Tf`G�.IT MTI"4GC1 A PFS CTF�I V3. 2 MlJt.l I ri FAL' T TY QF= F=t r.4' ;HCoF�=.��- �Er.r. DEPARTmEN f OF HEALTH AND ENV I RONt1EFJTAL . PROTECTION I' /�3-„T._LI{(I.�_Jo 'ICI .•GI.�1% E25' I'L' STREET; ANCHORAGE, K�45501' 1 }litil� , -1264-472L, I TE1-= 1-4 II FEFct•l I T PERMIT N0. :APPLICANT J71+ChQ2/ (7, _(°P i)1g4P O USG 3'a 5 LOCATION ��tCJjC�2��1 LEGAL [� (oma Q Q�yl Ct, l � v i ��1� L0T 'SIZE �-,3 00IoSQUARE FEET ' TYPE OF SOIL ASSORSTIOtJ SYSTEM IS: JAL -I aAj MAXIMUM NUMBER OF BEDROOMS = SOIL RAT ING• (SP FT/BF,')=' I THE REQUIRED SIZE OF'THE,'SOIL ABSORPTION SYSTEM IS: GEF•TH= /�, L ErJuTH= .;75 sif<:A'•.•'EL- GEFTH= THE LENGTH DIMEN510N IS THE LENGTH (IN•FEET) OF THE'TP.ENCH OR DP,AINFIELD., THE DEPTH OF A TREFJCH,'OR PIT IS THE DISTANCE BETWEEFJ THE SURFACE OF THE' GROUND AND THE BOTTOM,OF THE EXCAVATION <111 FEET). I THERE IS NO SET 14IDTH,FOR TRENCHES. THE GRAVEL DEPTH IS'THE MINIMUPI DEPTH OF GRAVEL' BETWEEN THE'OUTFALL'PIPE AND THE BOTTOM OF TNE,FXCAVATIONI(IN FEET). r;• REC�L� I I�EG =.EF•T I �� TA[Jt� _. I ?E_ PERMIT APPLICANT HAS THE RESPONSIBILITY TO 114FORt•J THIS DEPARTME19T,DURING THE I14STALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS'PROPERTY'AND THE NUMBER OF RESIDENCES THATITHE (JELL WILL SERVE. 1 --- TL•JL� C 2 ] ' I tJ=.FEGT I Cit t=. t=JFE ' f2EC!L1fFZEG --- BACKFILLING OF ANY SYSTEM ,WITHOUT,,FINAL I11SPECTIOtt AND 'APPROVAL 'BY THIS DEPARTMENT WILL - BE SUBJECT TO PROSECUTION.' I MINIMUM DISTANCE BETWEEN 'A WELL AND'ANY Ott -SITE SEWAGE'DISPOSAL'SYSTEM'IS 100 FEET FOR A PRIVATE 'l4ELL: OR I I 150 TO 200 FEET FROM A'PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS ARE REQUIRED'AND MUST BE RETURNED TO THE DEPARTMENT WITKIN 30 DAYS OF THE WELL COMPLETIOry , I ,' OTHER REQUIREMENTS MAY 'APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION., F'EFZ:rl I T ES{F I RE•= GE�.Et•1E-EFz z3 I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOP, ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUFJICIPALITY ,OF ANCHORAGE. , ' ; ' ,' 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.I 3: I UNDERSTAND THAT THE'ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED 'TO ,INCLJJDE MORE THAN E BEDROOMS. SIGNED p�ntI 7—�1 ISSUED B4' - �/ DAT / % .J VT. 4v l9 7 xt u O -Q GREATER ANCHORAGE AREA BOROUGH ��w w l• 3 DEPARTMENT OF ENVIRONMENTAL QUALITY i 3510 ••C•• STREET ANCHORAGE, ALASKA 99505 TELEPHONE 274.4581 t'� V SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT NAME OF APPLICANT INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED PERMIT NO. MAILING ADDRESS (4X6 Ct '41( Sb� PHONE OTHER FINANCED THROUGH TO BE INSTALLED BY fit' SOIL TEST RESULTS 'y NOTEE , THIS PERMIT IS NOT VALID WITHOUT SOIL TST COMPLETION DATE ANTICIPATED t FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE 115m TYPE MINIMUM DISTANCES, REQUIREMENTS 1-/ SEEPAGE AREA SIZE FOUNDATION TO SEPTIC TANK ✓ FOUNDATION TO SEEPAGE PIT 201 DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL /�' 2-0 r SEPTIC TANK SEEPAGE PIT DRAIN FIELD TO NEAREST LOT LINE. , //FT -TA WELL TO SEPTIC TANK /VV SEEPAGE PIT / DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD //1 SEPTIC TANK, V� SEEPAGE PIT _L - DRAIN FIELD TO RIVER. LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION S FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUG EGULATIONS REGARDING INSTALLATION. cu G.A.A.B. OR LICENSED DESIGNER 1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER DESCR;j3�27 ED YST M IS IN ACCORDANCE WITH SAID CODE. DATEAPPLICANT'6 BIGNATU n.eo-eta TYPE DIAGRAM OF SYSTEM AREA BOROUGH ORDINANCE NO. 28.48 AND THAT THE ABOVE � MAW MINE r� 0 & E E/vGINEERING & DEVELOPMENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 333-5240 Russell Oyster Earl alis 694-2774.' 333-5240 Civil Engineering Surveying Soils Er Foundations Land Development SOIL LOG Performed Performed for: Name: CkMz' Q V�aw Tel. No. toil - 7/1 n Mailing Address: Legal Description: moo: 1��. Depth (feet) 0 1 2 3 4 5 6 7 8 9 10 11 Z%a 4'4�< Soil Characteristics Gen- ZZ -'S SA i< acAvi'l-, 12 Ground Water Encountered: Yes No ✓ If yes, what depth Proposed Installation: Seepage Pit ✓ Drain Field Comments: PPON xcr''a' -, 7-U' \a ?i Jai .C7S�JGG- Gc's(A ��vjmc n or -1 I;fn% Performed by: � . J' .s Date: MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-782-30 1. GENERAL INFORMATION Expiration Date: 3 — Z Q' 2_�OZ,2_ Complete legal description EAGLE PARK BLK 2 LT 6 Location (site address) 9727 Wren Ln Current property owner(s) MCGRAW ROBERT J & ANDREA L Day phone 907.267.9647 Mailing address Real estate agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Q Private Septic Fx-1 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 550 Waiver Fee $ Date of Payment 42 Date of Payment Receipt Number_ 02-9 Receipt Number COSA # O 5 C 2 (1 7.2,(o Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm NorthRim Eng. Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 12/18/21 6. DSD SIGNATURE irjw '`P� jW s * : 49 =, . System #1 Approved for � bedrooms f • ��••;�.�• .... System #2 Approved for bedrooms f Stew Eng Disapproved Conditional approval for bedrooms, with the following stipulations: Y� OFf Ar1(6_, Original Certificate Date:_] The Municipality of Anchorage Development Services Division (DSD) issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet 10 WATER A In mr G WAST(=v'ATEReG oz= �. Original Certificate Date:_] The Municipality of Anchorage Development Services Division (DSD) issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: EAGLE PARK BLK 2 LT 6 If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1974 Total depth 75* ft Cased to 40+* ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 12/16/21 Static water level at beginning of test 69 ft. Comments *MOA file B. TANK DATA Age of tank(s) 47 years Tank type/material Cncrt Measured operating fluid level in septic tank 50 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 5/24/21 D. ABSORPTION FIELD DATA 10/31/08 Which system tested (date installed) same ❑ ALL standpipes present per record drawing Total measured depth from grade 12 ft (max) Measured depth to pipe invert from grade 7.5 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 050-782-30 of Structure served by this system Well production at time of test 6+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 6.87 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by NRimEng Date of Sample 12/16/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 12/16/21 Results ❑✓ Pass For 4 bedrooms Fluid depth prior to test 3 in Water added 600 gal New depth 6 in Elapsed time 30 min Final fluid depth 3 in Absorption rate 600 gpd Any rejuvenation treatment (past 12 months) no If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No 5+ Community Sewer Manhole/Cleanout > 100' R Yes if No ft M" Yes if No ft Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25' M Yes if No ft Absorption Field on Lot > 100' Q Yes if No ft Holding Tank > 100' R Yes if No ft Neighboring Absorption Fields > 100' Water Main > 10' if No Animal Containment > 50' R Yes if No ft R Yes if No ft Water Service Line > 10' Q Yes if No ft Manure/Animal Excreta Storage > 100' comment below Community Sewer Main > 75' S Yes if No ft [D Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No 5+ ft Surface Water> 100' Q Yes if No ft Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' Absorption Field > 5' Yes Yes if No ft Private Wells > 100' Q Yes if No ft Water Main > 10' if No Yes , if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' Q Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' 21 Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' Yes i I f No ft Water Service Line :10' Yes if No ft Community Wells > 200' Yes if No ft Surface Water> 100' Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION / 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. COSA Checklist yellow sheet OF --1%4 Steve Eng Aar CE -62 www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC 211726 Subdivision: Eagle Park B 2 lot6 A water sample revealed a nitrate concentration of 6.87 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. �� Mailing Address P .O Box 196650` Anchorage, Alaska 99519 6650 *www muni org � From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred'to as "blue baby" disease. - The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical' methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. '�Madmg Address P O Box 196650 *,Anchorage, Alaska 99519,6650 *www muni org Zvi Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. -5p COSA #__ Oq Qpp� 1. GENERAL INFORMATION Expiration Date: _ J-/--�2 O - D Complete legal description Lot 6; Siodc 2; Eagle Perk Subdivision Location (site address) 9727 wren Lane Eagle River, AK 99577 Current Property owner(S) Ron Perkins Day phone 696-2170 Mailing address Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ✓❑ Individual On-site ❑ Individual Water Storage El Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my Investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this applicafion, 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 invesfigation 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 S a S Engineering Phone 694-2979 Address 15861 S. Eagle River Loop Rd. Chuglak, AK 99567 Engineer's Printed Name Robert A. Shafer 5. DSD SIGNATURE Approved for bedrooms. Disapproved. �Z r Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory _ Other By: �v`' ( Original Certificate Date: (A" lift) Municipality of Anchorage Development Services Department Building Safety Division " ✓' On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SIT rE� SY TEMS APPROVAL CHECKLIST Legal Description: �� �. Cr`tC�Cf PIS tZ/A. Parcel ID: OS -0 —79.2-30 A. WELL /� '� Well type lVf� h,I If A. B, or C provide PWSID # = Well Log ()o / ue Date completed "q 7`( Sanitary sealelJ) _�6 Wires properly protected,10N) Total depth I Lsft. Cased to y L'i'ft. Casing height (above ground) 164 in - FROM WELL LOG AT INSPECTI N Date of lest 12 x Static water level v ft. �� ft. Well production g.p.m. S•S g.p.m. WATER SAMPLE RESULTS: Coliform _colonies/100 mL Nitrate 7.0S m /L Arsenic: 0ug/L date of sample: IZ b B. SEPTIC/HOLDING TANK DATA Other bacteria O colonies/100 mL Collected by: �a g E�G/rt'V5c/'Jtl Tank Type/Material g£ —11c_ Al mY:1'm- Date installed Tank size 60 gal. Number of Compartments _f _ Cleanoutsd:NN) h Foundation cleanout J J) 4' Depression over tank (Y( II� A High water alarm Date of pumping Pumper cJ 2 S C. ABSORPTION FIELD DATA Date installed O 3/ 4 Soil rating (g.p.d./ftp or fe1bdrm) D• System type DFEY H Length �O 3s 41 t. Width J ft. Gravel below pipe "1.5 h r Total depthL7("IZ ft. E . absorption area V5 ftZ Monitoring tube VE6 Depression over field / Date of adequacy test of 'S ye7rlls (Pass/Fail) — For —4—bedrooms Fluid depth in absorption field before test = in. Water added gal. New depth= in. Elapsed Time: min. Final fluid depth = in. Absorption rate >= Ig.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION tJ I► I Date installed Size in gallons *Pump on" level at _ in. •Pump off I t� Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot r Absorption field on lot Public sewer main I Sewer /septic service line o2s i / Animal containment areas SD 1 High water alarm level at Meets alarm ti circuit requirements? r' On adjacent lots / I On adjacent lots Public sewer manhole/cleanout I ) Holding tank A2117 r Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation s t Property line S7 Absorption field Water main AR Water service line Surface water /OD 7 Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: I / Property line to -t Building foundation /D "r' Water main fi r / / Water Service line /4 t Surface water /C & -I- Driveway. parking/vehicle storage /Q Curtain drain / X(X Wells on adjacent lots /GO / F. COMMENTS G. ENGINEER'S CERTIFICATION 13 OCC -UQ . 1 certify that I have determined through held inspections and r .•' + 1' review of Municipal records a above syst ms are in v ' conformance with MOA COSA gui /hes in K e this e.li.......�«. ' �. Engineer's Printed Name I •••^•rS / q v 1 A. Shufa' Date / (3 O9 + �.,• 1u78 COSA Fee Date of Payment Receipt Number (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage • Development Services Department Building Safety Division On -Site water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 090007 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 6 of Eagle Park subdivision. This inspection revealed a nitrate concentration of 7.05 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. SCS Ree# 1086761001 Client Name S R S Engineering Project Name/N Lot 6 Block 2 Eagle Park SD Client Sample iD Lot 6 Block 2 Eagle Park SD %Iatric Drinking Nater P%%Sll) 0 Sample Remarks: Paramctcr Results Metals by ICP/M3 Arsenic ND Waters Department Total Nitrate/Nitrite-N 7.05 Microbiology Laboratory Colony Count 0 Total Coliromt 0 Fecal Coliform 0 Printed Date/Time Collected Dale?ime Received Dale/Time Technical Director 01/05/2009 13:26 12/19/2008 11:30 12/19/2008 13:45 Stephen C. Ede Allowable Prep Analysis POL Units M1010d Conminer ID Limits Date Date Init 5.00 ug/L EP200.8 C (<10) 12/22/08 12/25/08 NRB 0.100 mg/L S%1204500NO3-F B (<10) 12/29/08 3D7 col/IOOmi. SM20922211 col/IOOml. SM2092228 col/IOOmI. SM20922211 A (<200) A (<I) A (<I) 12/19/08 DLC 12/19/08 DLC 12/19/08 DLC k ASBUILT SCALE' , I HEREBY CERTIFY THAT I HAVE SURVEYEU THE yd FOLLOWING FOLLOWING DESCRIBED PROPERTY: DATE ".G&'li�.s�rCf2i" Lo�' ` AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE TH' EXISTENCE OF ANY GRID: ws� EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' ANY DATA HEREON BE USEC FOR CON;;TRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN ARY LINES. far�c 694 - OF Al �I D... Med a ---d Jr itis'•, l5 -e Sao �'� � p't:skx•a� �at�� W, IL s ^ 050 — X82— 3Q [ MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES JUL 1$1988 DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL�I OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date June 28, 1988 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 6• Btock 2• Ea to Pan.k Subdlv.iSion Location (address or directions) (b) Property.Owner Mike Pencnbten Telephone: Home 694-9965 Business Mailing Address P 0 Box 710825 Eagle R.iveA, Ataska 99577 (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent RE/MAX OF EAGLE RIVER - ViAg nia Koh6ietd Address ' • 16600 Centea6ietd Drti.v2 St to 201 Eaqte Riven, Ala6ka 99577 Telephone 694-4200 (e) Mail the HAA to the followina address: or. Check here L�, if hold for pick up. List contact person and day phone number below. S S S ENGINEERING1694-2979 17034 Ea to R,ive4. Loop Road Suite 204 Eacite RiveA,.AtaAa 9957Z oadeAed 6y Vi,%ginila Koh6letd 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms 4 , 3. WATER SUPPLY Individual Wel= Community ❑ Public ❑ Note: it community well system, must havewritten 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 IFI" 81861 Front 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 i� Ect . W81NEERING Name of Firm 77n4A •gle Rlver Loon Road ka -2da Telephone Address Eagle Rlwro Alaska 99577 Date 6. DHHS APPROVAL Approved for _\/ bedrooms by 1 Date 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 professionaf 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•075 (Rw 81861 Buk MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTMNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PRO13EMH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 ,iUL 111988 2CA4744 RECEIVED Legal Deipt' Z A. WELL DATA Well Classification `� lY A.4` If A, B, C, D.E C. Approved (Y/N) Well Log Present (YaP_ Date Completed NM=� Yield 4M &Aft^ 4— Total Depth 04-• Cased toI Depth of Grouting ' - J� Static Water Level 7 toPump Set At u Y Casing Height Above Ground S-0 Sanitary Seal on Casings I) t — Electrical Wiring in Conduit CV J) Depression Around Wellhead (Y44p Separation Distances from Well: 1 Oct l� ; On Adjoining Lots OaI'F- To SeptiWHo+ding-Tank on Lot 1 9 f t To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots -I,- To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole t To Nearest Sewer Service Line on Lot Water Sample Collected by �7`+S S �V—tlr�lr�t/ • Date Water Sample'' Test Results O�s' Comments wC'A, 5_� =IXK� '01U .s� B. SEPTIC/HOLDING TANK DATA Date Installed 6'ZU '�4 Size V�� No. of Compartments StandpipestON) — Air -tight CapsQ43N) y Foundation Cleanout (Y4M f-3 Depression over Tank (Y/ 1t Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (YIN) fa Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holdi to Tank: To Water -Supply Well t t To Building Foundation o To Property Line I -( To Disposal Field To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course I 'lir- Comments Page 1 of 2 72-0M IPM 8'$61 From C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata SS6 %ey t l Type of System Design Date Installed ^ 1 Length of Field �� r Width of Field Depth of Field ` t ' I Gravel Bed Thickness �D Square Feet of Absorption Area '9- Standpipes Present45 1) - 'I/ Depression over Field (Y� Date of Last Adequacy Test ^ g- e5G Results of, Last Adequacy Test Separation Distance from Absorption Field: d t f . . To Water -Supply Well � 00 I To Property Line (o' To Building Foundation O ' To Existing or Abandoned System on Lot r 1-4-11 ; On Adjoining Lots • ol-�' To Water Main/Service Line O t -i To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course -- Co 14 - To Driveway, Parking Area, or Vehicle Storage Area 1 O Comments D. LIFT STATION Size in "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments' — Dimensions Manhole/Access (Y/N) — "Pump Off" Level at Vent Pu ` t •' Check Permitted Bedroom Rating Against HAA Request •• during Adequacy Test. Meets MOA I certify that I have checked, verified, orconiormed to all OA and HAA guidelines in effect on the date of this inspection. Sigyii5 ENGINEERING Date Coa7034 Eegte River Loop 04 ,p_�i�t TW, A1*4 99577 MOA No. l—Cjn Receipt No. ?� % y4,P �•ti�¢9 Date of Payment a Amount: Q �' • ������ eel �* • i 8961 T, inr Page 2 of 2 NOI$IAIO S301Ab3S N11`13WNOAINV3 30V80H:)NV 10 A lJYdOINnW 72.026 (P" 8'881 Back (1 n HEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE. ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID M 92-0040440 ANALISIS REPORT RI SAMPLE for Work Order 8 7570 Date Report Printed: JUL 6 88 8 15:08 Client Sample ID:L6. 62, EAGLE PE PWSID :UA Collected JUN 30 88 4 13:00 his. Received JUN 30 88 4 17:00 his. Preserved with :4 DEG. C Analysis Completed :JUL 1 88 Laboratory Superri�o�r STEPHEN C. EDE Released By : G. Client Name : S 6 S ENGINEERING Client Acct : SNSENGP P.O.B NONE REC D Req 8 Ordered Ry : R.J.S. Send Reports to: 1)S 4 S ENGINEERING 2) .................................................................................................................................... Special Instruct: Chemlab Ref 8: 1610 Lab Smpl ID: 1 Matrix: Water Parameter Tested Result/Unita Method --------------------------------------____----___----- NITRATE-N 3.1 mg/1 EPA 353.2 Sample ROUTINE SAMPLE. Remarks: SAMPLE COLLECTED BI R.J.S. Allowable Limits 10 .............................................................................................................. 1 Tests Performed See Special Instructions Above UA -Unavailable ND- None Detected " See Sample Remarks Above NA. Not Analyzed LT -Less Than, GT -Greater Than