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HomeMy WebLinkAboutDEER PARK BLK 3 LT 4Deer Park Estates Block 3 Lot 4 #051-042-42 On -Site Water and/or Wastewater 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: OSP141516 Tax Code Number: 05104242000 Work Type: SepticTank Upgrade Permit Effective Dates: December 05, 2014 to December 05, 2015 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: DEER PARK Site Legal Address: DEER PARK BILK 3 LT 4 G:1558 Owner/Address: LEPROWSE STACEY J PO BOX 672582 CHUGIAKAK 995672582 Site Mailing Address: 22207 DEER PARK DR, Chugiak This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank Lot Size in Sq Ft: 49904 Total Bedrooms: 3 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. Special PfNsfyIN&'fr4 enih4er shall verify that ani adequiely opetafiiig t1f Ir ld ! � fif16 a� 7 the new tank disch6rge3 Received Issued By MUNICIPALITY OF ANCHORAGE Community Development Department Development Services Division On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT Parcel I.D. 051-042-42 Phone: 907-343-7904 Fax: 907-343-7997 APPLICATIONUBM!T�A� DECO 1 2014 Property owner(s) Stacey Leprowse Day phone Mailing address P.O. Box 672582, Chugiak, AK 99567 Site address 22207 Deer Park Drive Legal description (Sub'd., Block & Lot) Deer Park, Block 3, Lot 4 Legal description (Township, Range & Section) Lot Size 49,904 Sq. Ft. Number of Bedrooms 3 Gretchen Stuller APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X Septic Tank Upgrade ❑X (w/wo ADU) Duplex (D) ElHolding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 4'2 Date of Payment: /all h(/ Receipt Number: 6 }l7(„ 416 Permit No. (1 S(/q/54p Permit App_:;. : ::...:c Waiver Fees: Date of Payment: Receipt Number: Waiver No. Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steveCa)oaneneak.com November 26, 2014 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, Alaska 99519 Subject: Deer Park Estates, Block 3, Lot 4 Septic Tank Upgrade Permit Request Ladies and Gentlemen: I am writing to request that a permit to install a new 1000 gallon Septic tank be issued for this lot. The proposed system will serve an existing 3 bedroom house. Currently the lot is developed. The existing septic system was designed and installed for three bedrooms. The existing tank is perforated with gravel being removed by the pumper, and evidence of solids passing through indicating that the baffle has failed. This lot is served by a private well that is over 100' from the septic system. The surrounding lots are also served by private wells that are over 100' from this system. 1. Upgrade Tank Design. a. See Sheet 1 of 1 of the plan set 2. Surface Water: There is no surface water within 100 feet of the proposed system. The proposed systems will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: This lot slopes from north to south in the area of the tank replacement. The proposed installation will be located in the central portion of the lot, next to the existing system. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 1/2 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 The proposed installation will not affect the fature development of the surrounding or existing lots. There are no wells within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Iii iif"iiMifl Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 1/2 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 \ WELL (E) 3 3 —SEPTIC AREA (E) yd/ W�W�W �M—M_M� . 1000g SEPTIC TANK (P) • o. INSTALL DCO AND DV CONNECT TO ADEQUATELY `O OPERATING FIELD ,a < F • ➢ 10008 SEPTIC TANK (E) �M �\ IS PERFORATED AND LEAKING HOUSE \Z - DECOMMISSION PER CODE (E) \ 'f4 ss I aF LOT 4 WELL (E) O� L M 15' DRAINAGE EASEMENT WELL (E) I \C�/ PRIMARY/ RESERVE DRAIN FIELDS (E) ENSURE ADEQUATELY OPERATING DRAIN FIELD IS CONNECTED TO NEW TANK DISCHARGE / 1 a SV \ WELL (E) NOTES: PANpNE ENG SVC LLC Date TANK REPLACE P.O. BOX 100217 ANCHORAGE, AK 99510�.• 449 11/26/14 PHONE (907) 272-8218 FAX (907) 272-8211 * X49 ni �y*�i� Scale SD ... .. .. .... ... P.I.D. NO DEER PARK, BLOCK 3, LOT 4 051-042-42 STACEY LEPROWSE , Steven R Pan none j PERMI-TN 0 22207 DEER PARK DRIVE �) ��•. CE 8149 �� OsPxxxxxx PLAN CHUGIAK, AK 99567 +1�11F�P........ _ Sheet MUNICIPALITY OF ANCHORAGE _.4 DEiTMENT OF HEALTH AND HUMAN SER'S Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES an�,Psr TO SEPTIC ABSORPTION W L Pnon1e(s) pe2 l Permit No. Nal of Bedrooms 61 [: 1408 LEGAL DESCRIPTION Lot A Block �. Subdivision_ Township, Range Section ,\_ ` /�1✓Lr`Y./�Yll�,{ ,`,7 ,/_ TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from Total depth from original grade original grade t r r 1 4 S FT —10 FT Fdl added above original grade ` 1 Gravel depth beneath pipe J C> 1 FT !j• Q FT Gravel length / Gravel width FT Z,S FT Total absorption area Distance between lines SOFT �j 1 ToJFT Number.of lines Soil rating Pipe material Q I G3 80 FT f� Installer ate Installed -e WELLS -PRIVATE ❑ OTHER (Identify) Classification (A,B,C) Total Depth Cased to Glc 1._ FT FT Installer Date Installed; REMARKS: FROM TANKS SEPTIC `l -1 ❑ HOLDING Manufacturer // ` 1 Capacdy in gallons Material LOT LINE No. of Compartments 1 of TYPE OF SYSTEM TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from Total depth from original grade original grade t r r 1 4 S FT —10 FT Fdl added above original grade ` 1 Gravel depth beneath pipe J C> 1 FT !j• Q FT Gravel length / Gravel width FT Z,S FT Total absorption area Distance between lines SOFT �j 1 ToJFT Number.of lines Soil rating Pipe material Q I G3 80 FT f� Installer ate Installed -e WELLS -PRIVATE ❑ OTHER (Identify) Classification (A,B,C) Total Depth Cased to Glc 1._ FT FT Installer Date Installed; REMARKS: FROM TANK FIELD EL WELL ` 1 12a1-16 4 LOT LINE V dl-% 1 of FOUNDATION AS -BUILT DIAGRAM iShow location of well, septic system, property lines, fcundat driveway, water bodies, etc.I 4 MEN ME �1 Scale: -Carol L I-� �1 Inspections Pert r ed by: Date: 7-15-87 jar, n 17034 Eagle River Loop Road No. 2CA, a'g� Ieagle iVOrr, a certify that this inspection was performed according to all a a Municipal and State guidelines in effect on this date: Health Department Approval:"' Date. _±_ \\ w yy Q4b440A � 4 A, 3hofm �r 14674A _ :; n GRAIN SIZE DISTRIBUTION TEST REPORT c c r CD a) in 7 Gi 04 ' r ")o . N 100 %0 rte, ;t 90 80 70 w 50 i_ �1 1- 50 .w L) LU 40 30 <0 10 0 U1 I 1.0 0.1 .01 200 100 10.0 .001 OPEhI I NG SIZE - mm +3H ;; GRAVEL 'r'. CLAY X SAND 'l. .SILT 4 0.0 51.7 38.9 4.4 USCS Flassi+ication " COLLOIDS LL PI I160 I�30 j110 Cc Cu a GP -GM NP NP 9.66 0.881 0.0822 0.98 117.5 MATERIAL DESCRIPTION TYPE OF TEST 4 SANDY GRAVEL WITH SILT ASTM D 422-63(72) Mechanical analysis. Project No.: 1099A Remarks: Project: S e4 S ENGINEERING .0 Location: LOT 4p ELK 3 DEER PARE: ESTATES. Date: 7-17-87 GRAIN SIZE DISTRIBUTION TEST REPORT RODNEY P. KINNEY ASSOCIATES Plate No. 1 Test No.: 4 GRAIN SIZE DISTRIBUTION TEST DATA Project Data Date: 7-17-87 Project No.: 1099A Project: S & S ENGINEERING Location of Sample: LOT 4,BLK 3 DEER PARK ESTATES Sample Description: SANDY GRAVEL WITH SILT USCS Class: GP -GM AASHTO Class: Liquid limit: NP Plastic index: NP Remarks line 1: Remarks line 2: Remarks line 3: Remarks line 4: Fig. No.: 1 Mechanical Analysis Data Fractional Components y + 3 in. = 0.0 % GRAVEL = 51.7 Y. SAND = 38.9 % FINES = 9.4 D60= 9.661 D30= 0.8810 D10= 0.08222 Cc = 0.9772 Cu = 117.4898 Initial Dry sample and tare= 2541.0 Tare = 324.3 Dry sample weight = 2216.7 Tare for cumulative weight retained= 324.3 Sieve Cumul. Wt. Percent retained finer 2 inches 324.3 100.0 1 inches 468.5 93.5 0.625 inches 915.0 73.4 .# 4 1470.0 48.3 # 10 1692.4 38.3 # 20 1889.5 29.4 # 40 2067.4 21.4 # 100 2245.9 13.3 # 200 2332.3 9.4 Fractional Components y + 3 in. = 0.0 % GRAVEL = 51.7 Y. SAND = 38.9 % FINES = 9.4 D60= 9.661 D30= 0.8810 D10= 0.08222 Cc = 0.9772 Cu = 117.4898 1 w- I�ZJG @FI'S SEAL) 2 o 'CV rAV �Municipality 3- F, 4 �,o of Anchorage1DEPARTMENT OF HEALTH & HUMAN SERVICES �t• •••• ••-d0•825 "L"Street, Anchorage, Alaska 99502-0650,„.r .. }• SOILS LOG -- PERCOLATION TEST *bo,n A. V:03 ••. un No. 1431-2 �Q f PERFORMED 8 PE3--%Jp- FOR: g DATE LEGAL DESCRIPTION: g3�IL-TOWtlShip, Range, Section: Tis 4 Q rApEPTw SLOPE SITE PLAN 1 w- 2 o 'CV 3- F, 4 �,o 5 C 6 �m b a- 8 v .� g b .b 4D r, 10 Q Pump 2 12- 13 13- 14- 141516171819 15- 16- 17- 18- 191 20 COMMENTS WAS GROUND WATER A I ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? P E Depth to Water After Monitoring? Dale: PERCOLATION RATE Skhl.'Z (minutes inch) PERC HOLE DIAMETER lL TEST RUN BETWEEN �—rT AND _.1—FT ; 8` S ENGINEERING PERFORMED B I CERTIFY THAT IS TET E WAS PERFORMED IN ACCORDANCE lgX&*LvuA#fl192MVWIPAL GU ELI FFECT ON THIS DATE. DATE: _ 72-008 (Rev. 4/85( �M =_Pmmw� Pump PERCOLATION RATE Skhl.'Z (minutes inch) PERC HOLE DIAMETER lL TEST RUN BETWEEN �—rT AND _.1—FT ; 8` S ENGINEERING PERFORMED B I CERTIFY THAT IS TET E WAS PERFORMED IN ACCORDANCE lgX&*LvuA#fl192MVWIPAL GU ELI FFECT ON THIS DATE. DATE: _ 72-008 (Rev. 4/85( I-1 t__a F1,1 a C::: x I -T- V L3 F= o!ni [.,l c 1-1 C3 r. n C-3 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 26q-4720 i=7f^•a—+ 1 f 0= ;.=aEt4Gl i F'E=-6zM 2 "T PERMIT NO: 870168 UPGRADE DATE IS: e. S €< S ENGINEERING 17034 E. R. LOOP 0204 EAGLE RIVER, AF, 99577 PHONE 0694-2979 SEWER PERMIT' APPLICATION***************** AF'PL•ICANT: SCOTT CORSAUT ADDRESS: PO BOX 671343 CHUG1Ak, 99567 CHUG I AK ALASF:A 99567 CONTACT PHONE: 685-3976 LEGAL DESCRIPTION: LOT 4 BLOCK 3 DEER PART, SPECIAL CONDITIONS OR INSTRUCTIONS: j hhel oi✓E JZviJ L4555 T!- A j 7S ' F 6 -PJ196r-4 �wl mac. NE�-� To 8t✓ V -11--106b To A- c DW n1 /oo , Adri. 1 7Wl-krO 7ZJ 16od Qi E Ott -7- 77 -7 0 .+'`.y�►'�11tLA 1P p ri�-+s ~• % i.. .... ti No. 14574 'IlSO _•I•N 111 .\y�Y�/ SEC 4 1715N,R1W LOT SIZE: 49904 (SO FT OR ACRES) MAX. NUMBER OF BEDROOMS: 3 SOIL. RATING: 150 SO FT/BR SOIL TEST DEPTH: 1"S F'I NO WATER PRESENT IN "FEST HOLE. THIS IS AN UPGRADE OF 3 BEDROOM TO THE EXISTING SEPTIC SYSTEM -------------------------------------------------------------------------------- TRENCH BED W. DRAINFIELD EFFECT'IVF DEPTH S 0 3.5 COVER DEPTH 4 4 TOTAL DEPTH 9 0 7.5 -..ENGT H 45 0 49 WIDTH 2.5 0 5 SU FT. ------------------------------------------------------------------------------- 450 0 450 SPECIAL CONDITIONS OR INSTRUCTIONS: j hhel oi✓E JZviJ L4555 T!- A j 7S ' F 6 -PJ196r-4 �wl mac. NE�-� To 8t✓ V -11--106b To A- c DW n1 /oo , Adri. 1 7Wl-krO 7ZJ 16od Qi E Ott -7- 77 -7 0 .+'`.y�►'�11tLA 1P p ri�-+s ~• % i.. .... ti No. 14574 'IlSO _•I•N 111 .\y�Y�/ 0 Y U J Z W 2 J O 4 3� °3 MUNICIPALITY Of ANCHORAGE ENVIRONMENTAL SERVICES DIVISION JUL 10 1987 ECEIVED � 1 r 1M P • ��„; +oc� 4th` t ' 0 Y U J Z W 2 J O 4 3� °3 MUNICIPALITY Of ANCHORAGE ENVIRONMENTAL SERVICES DIVISION JUL 10 1987 ECEIVED � 1 r 1M P ro"'' 4 Municipality of Anchorage DEPARTMENT OF HEALTH & WWl N4ffWVjM9:HGRAGE 825 "L" Street, Anchorage, SmikeW502AIDWACES DIVISION SOILS LOG — PERCOLATION TEST / J U L 101987 PERFORMED FOR: �C�OT� C �.- l��_�T_�_�C In�LD[)E PERFI D LEGAL DESCRIPTION: L_ A -b YCyTownship, Range, Section:'rIC� t�Nq p��tL SLOPE r—TTf1 r"'Z—T •e • b� 2- 3- 4- 5 3 4 5 "\O 6 �a s 7 8=� �t o 9' 10 �r 11 12 r b ,Q. 13- 14 3 14 ✓� ` 15- 16- 17- 18- 19 516171a19 20 COMMENTS U? ,4/ ,-�1Cm1A-r 5I L--7 tis'dcfP 4y't- WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Waler her Monitoring? I SITEPLAN PERCOLATION RATE (minuteslinch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT PERFORMED BY: 17n34 CERTIFY THAT THIS ST WAS PERFORMED IN ACCORDANCE F17 pt�q Risyeer Alaska 99577 W STATE AND MUNICIPAL GUIDEL EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) r MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street -Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT VMIC LCIaHL is & S Engin-••=_.. 1 ' ` F_ /2 S ,O 1.� -7 PHONE NEW c1 -IG 3 3 ❑ UPGRADE MAILING ADDRESS zu LEGAL DESCRIPTION - LOCATION NO. OF BEDROOMS v Y DISTANCE T0: Well / -E- Absor do area P ��. Dwelling �— PER 41� NQG, I.- 2 W !a- H Manufacturer -� F f Mate 'aP /. � ( L { (� No. of compartments 7 P Liq, ca ac't i lions � IF HOMEMADE: Inside length Width Liquid depth Y 0 y O DISTANCE TO: Well Dwelling PERMIT NO. Manufacturer Material Liquid capacity in gallons w= � U DISTANCE TO: Well /Z O / Foundation / �� Nearest lot line / PER W 't 2 w No. of lines / Length of ey.h.line 41.1- i U Total IenQth of lin Trenr4width r, Distance be ween lines ~ H Top of tile I o finish grade _- Material b� th file `� �) inches �. Total effecti absorQtio area � W Length 9 Width Depth f inches ' J. PERMIT NO. W a Type of crib Crib di a ete Crib depth Total effective absorption area V) DISTANCE TO: Well Building foundation Nearest lot line J Lu ClassDepth Driller Distance to lot line PERMIT NO. W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER ` (; PIPE MATERIALS w� SOIL TEST RATING INSTALLER % REMARKS (/ 1 C;0 Je l:fl r• :.. .......:. r^ • Robert A. Shafe r ^J Jf �> No. 1457-E '••: /4,D VMIC LCIaHL is & S Engin-••=_.. I ' A(TVRN TO: Ol,blon Of Geological aM ^Yslcal SYr.eys (OC.S1 /''� 0! ALASKAAMMrpe, Absb 55501 ' . ` -• 3001 Porcupine Drive (TalDEPARTMENT OF MNATURAL*, ,nee 7774615) ( 1 STATE RESOURCES V A T II V f l L R f C O R O Drills Copan her t'3L-s'UCZLs Lri 11 1R�; M Y V.S.C.S. local o. ' Orlll leg ►.Cell No. r N Of KtLPluse to.ol.a alther b, Ib, er le. A.O.I. wo. • ro.24 rAr.: S.bd I,I*lee Cdr Par K. let blocY 3 10. Inctlen / Section we. town+h 1p w7s 14np. [Jv Mr10bn It. Olstenco aM Direction )roe Road Inters.ttlonl Strut Address and Area of Wall toeatlen 7. CAER OF KLLs I:nUl %; rr It Addre++, 'iPtlo Iciver, a.. • i 2. WELL LOG /eat Salon urges A& serial Type Top /att. \. WELL OATH, (ceplel*d) 45 tt. far feu Cle.etlon to Oat* of Coppletlon 7-b�Gl Io I I Cot a. ❑Ce\le tool .QRotary ❑orl,en ❑0ug ❑Auger ❑Jetted 0S.,44 ❑Other: , Au OLn er 6. GSC: ©Dont Ic ❑P.011c S.pply ❑ Ind.stry ❑ lulfitlon ❑Ibch rge ❑ omertlal ❑Test Wall ❑othert 7. CASINCt Threaded E14.14.4 G A. to 45 ft. Guth weight 17 IbJft. �I.. to ft. Depth S. Timm Or KLL, Typern :,,l n• Olarar, 41. Slot/hesh Silt*: Lengths Set O.twen ft. *M ft. fillingu 9. STATIC WATER t(Y(LI ft. ❑Aoo.. ❑alor IaM S.rqu Type of Muearernt: 10. •fUNPINC LEVEL ►ala., land surface ft, after hrs. peoing lC S.p.A. ft. after hrt. sr ping S.p.A. It. KLL MGD CORPL(7104, ❑ In APOM.ed fit -i❑/ltldt$ Adlotor L,cMs *Dove grade 12. MUTING: Vail Crested: ❑ yes;❑i wo Materiel: ❑Nut Curet ❑Other: U. WNh (It.wllable) 14P1/� lanyth of Crop 11" 7r It. capacity Tn 2•0. Trpe, %L2Subrn Dl* ❑R.t 1prootLp Jet ❑Other 1%. 1\. R[AARKS: LAil tc•:tod ;,t 10 ' IS. WT(R WILL CONTRACTOR'S ctATIf(CATION, This .nil r+ erllled under py J.rlsdlctton end this report It Ir" to the best of My iia ladle and belles, 1:CII'IS11Lo22 [71111r.J• AA 53^S •gees, +Hne)e .r on 11.11 Addr.ssi.sl. llox c.01 rn.ie vivor. ,:v. G^.5'77 auto, July L. ]. Jt?1 YIIW1 led Repl.tln lel Ye Fore 02•VWR CopyOlstrib.tlon, WHIT( • State OCC$• PINK � Driller. CA14AAY . Custorr I - t•7 �� r,1 I �� I :~� L I T'r O � A r-.1 G F-{ � >rf iG E DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE, AK. 9?501 264-4720 1 -TELL nr-4C� iL r-a—SS I TE E44EFR FIEF= M I T PERMIT NO. C 810685 ) APPLICANT MYERS CONST. INC PO BOX 351 CHUGIAK, AK 694-9633 LOCATION DEAR, PARK DRIVE LEGAL , LOT 4 BLk% 3 DEER PARK ESTATEAS LOT SIZE 49904 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (50 FT/BR>= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C?EF=>TH= SO 1-ar40-r = = ^ C3FZnVaL_ OEF=�TH= THE LENGTH DIMENSION IS THE LENGTH (IFJ 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 (IFJ FEET). THERE IS NO SET WIDTH FOR, TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BET14EEF4 THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IFJ FEET). F�--, E -=c u I Fz E: E> =-Ef„T I G Tnr-iu< , I E= 1iDoet imRLLLLrr-15~ PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DUPING THE INSTALLATION INSPECTIONS OF ANY 4JELLS ADJACENT TO THIS PROPERTY AND THE FJUMBEP, OF RESIDENCES THAT THE WELL WILL SERVE. --- T1.4r < ^ > I "ti7-F='ErT I KDr45~ AFZE RE0U I REE? --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTAFJCE BETWEEN A I -JELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR, 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTAFJCE FROM A PRIVATE WELL TO A PRIVATE SEWER. LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. 14ELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT 14ITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F�ERtrt I T EXF=lI RE's L'tiEr`EMe-EFZ ?Zr 1n-4 1 I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND I -JELLS 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 LS RE?1ODELED TO INCLUDE MORE THAN 3 BEDROOMS. /�✓ v--------- APPL IC it T MYERS 0 T. INC ISSUED BY - ---- ------------ --_DATE_ __ V4. 0 PERFORMED FOR: LEGAL DESCRIPTION:_ D CPTH O ( 74 1 2 3 4 5 6 7 8 10 11 12 13 14 15 16 17 18- 19. 20• SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 0 PERCOLATION 825 L. Street, Anchorage, Alaska 89501 2644720 TEST SOILS LOG - PERCOLATION TEST r S M) 605 -e (- 1'3 SW "`e-� ) G� SLOPE WAS GROUND WATER ENCOUNTERED? IF AT WHAT DEPTH '^ DEPTH? DATE PERFORMED: I SITE PLAN Reading Date Gross Time Net Time Depth to Water Net Drop J PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS PERFORME 72.008 (6/79) CERTIFIED BY: 6 9 7 •( ') Municipality of Anchorage �� On-Site Water and Wastewater Program "' mid I i (907) 343-7904 E AUG T• -� Certificate of On-Site Systems Approval Parcel I.D. 051-042-42 Expiration Date: ) Z- 7 _r 1. GENERAL INFORMATION Complete legal description Deer Park Block 3 Lot 4 Location (site address) 22207 Deer Park Drive Current Property owner(s) Stacey LeprOWSe Day phone Mailing address PO Box 672582 Chugiak, AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: E Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual Ix Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: 1 �1'l A �' ►t.' Received b . i .t ���4 _ 1 Date: VEM COSA to be released to the engineer,unless otherwise requested by t ngineer. COSA Fee $ .526 Waiver Fee $ Date of Payment 'I31/i1- Date of Payment Receipt Number U �a-�-d- Receipt Number COSA# dJ(�( iW 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. In conducting an adequacy test, I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 8/30/2017 .�cOF�\qrll 6. DSD SIGNATURE e .... "" t r System #1 Approved for bedrooms "- • •.•Steven '. 'ann ne System #2 Approved for bedrooms �� �, CE—B149 AP' Disapproved (‘1D S � "` Conditional approval for bedrooms, with the following stipulations: r)\l' �Oppid 03- vi Sd dMSl (11‘\° L1S"NC ; ' 1``��a,`� ',, �INV 30 ,..� By: Original Certificate Date: L r1"-- 1 7 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory. Well Flow Advisory Other .• . • • COSA blue sheet c • .. If more than 1 septic system is on the lot: COSA Checklist# I of I Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Deer Park Block 3 Lot 4 Parcel ID 051-042-42 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (YIN) Y Date completed 7/6/1981 Sanitary seal (YIN) Y Wires properly protected (YIN) Y Total depth 45 ft Cased to 45 ft Casing height (above ground) 30 in. FROM WELL LOG AT INSPECTION Date of test 7/6/1981 8/16/2017 Static water level 12 ft. 23 ft. Well production 10 g.p m. 7.7 g.p.m. WATER SAMPLE RESULTS. Coliform NEG colonies/100 mL Nitrate ND mg/L Arsenic ND ug/L Date of sample: 8/16/2017 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 3/22/2016 Tank size 1 000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) N/A Date of pumping 8/16/2017 Pumper JR's Pumping C. ABSORPTION FIELD DATA Date installed 7/18/1987 Soil rating (g.p.d./ftz or ft2/bdrm) 150 SF/BORN System type TRENCH Length 45 ft. Width 2.5 ft. Gravel below pipe 5 ft. Total depth 9-10 ft. Eff. absorption area 450 ft2 Monitoring tube Y Depression over field N Date of adequacy test 8/16/2017 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 13 in. Water added 460 gal New depth 25 in. Elapsed Time: 360 min. Final fluid depth 12 in. Absorption rate >= 450+ g.p.d. N Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off level at in. High water alarm level at in. Datum _ Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer/septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION ,.1+�3.OF A ��t I certify that I have determined through field inspections and _I-To..•• _) '�•y�� review of Municipal records that the above systems are in S*; • ! I k1 *�A conformance with MOA COSA guidelines in effect on this date. ' ••• • • • • • •���ii0•• 0 Engineer's Printed Name Steven Pannone -"• even `.•Pannorie:* e Date 8/30/2017 00:-.. CE-8149 0% COSA canary sheet_2-6-15 doc a , 44 . ' N'Ai A t y, -N „ . \: .• ,. p 0.Lr� .: i a _ t, Iv f IT ` if4. V, oaf � ., t t \Ns a :c h - ) —77 ---- I A/osa a� f .' ..?d-�G> ASBUILT SEWARD S ASSOCIATES LAND SURVEYING 694-0829 SCALE: I I HEREBY CERTIFY THAT I HAVE SURVEYED THE 6��� ( FOLLOWING DESCRIBED PROPERTY: — tea �� q 0 , / r 41%� , € 4t I � . '� '.t'fl/� ,--67 7-/=-t`"=� DATE: s" 4� AND THAT NO FNCROAG`HMENTS EXIST EXCEPT AS / /e5��' -- 1 = r - . •'`. !��4 INDICATED. IT IS THE RESPONSIBILITY OF THE ;*(..1:'•.:. �.' PV %r OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: =• .ease ,:. .. 14 EASEMENTS, COVENANTS, OR RESTRICTIONS �y��`s—S� ;,r , WHICH DO NOT APPEAR ON THE RECORDS) SUBDI- _ o;;,,,n M•;;. sewArd • 0 VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' 1 � •. LS—;EX' -+ 45 ANY DATA HEREON BE USED FOR CONSTRUCTION ,��- 9 �t -4 ". "7,4-4- .1, Yy,OF FENCE LINES, OR FOR ESTABLISHING BOUND- �, ':iic.c�r,�`'�� DRAWN ARY LINES. zr"�f 1,,m �,...- Municipality of Anchorage • Development ServicesDepartment 81 If Building Safety Divisiontj 176-11, On -Site Water and Wastewater Program 5 A F E T 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us , Z (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.' "uZ HAA Expiration Date: 3 O b- 1. GENERAL INFORMATION Complete legal description La �- S%.d�cc•� 3, o �.Q .� .���o.y�fio� Location (site address or directions) .�2.za�I%•r��,,C1J,e G°.y�Gi.�,e, �¢,�, Current Property Day phone �8B—.Za oG Mailing address Lending agency Mailing address Real Estate Agent Mailing Address •r?D, 8c X l070� 4/ L�s1u�ia,C , �,�� 9¢J'G 7 Day phone Day phone Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY:* TYPE OF WASTEWATER DISPOSAL: Individual Well Q� Individual On-site [El Individual Water Storage ❑ 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 Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority 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 Phone( Q0.;5144— .10,v -Y Address %9�c �: ,Pcoir� tJ per, Fygt�uG .4,! Engineer's Printed Name JOriWG�/.r /`.'/!s �JcGy Date ,....: 5. DSD SIGNATURE T.In CE airs Approved for 3_ bedrooms. fOle, 10..... Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: _ Original Certificate Date: JA ' 30-03 (Rev. oiroz) Muinicipahty, of ,Anchorage Development Services Department ��- Building Safety) Division ` ;On=Site Water & Wastewater Program g"' "' GSI ! ti ''4700;South�Bragaw St. ' a +P.O.' Box 196650 An� AK. AK' 9951 M650 I I , r�www.ci.anchorage.ak.us i I li ' . • 3 i E (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST:`' s II� : Legal Description: ,C'er `.�`o:eAll .7" Ie.. Parcel ID: a A. WELL DATA I �T1d�J'Lc' Well type ; If A, {B, ,or C providelPWSID # Well (Log (Ylli Y I Date lcom IetedB/ l ; I; Sanitary seal) /N ;_ Wires properly I ( ) N P � i . S rY (Y ) P. P , Y{ protected Y/N y `I ! r' { z.'.,,,,i Total depth s :ft, Cased to y� ft, i Casing height ((above (ground) .3o in. . • II .� l� ',�, I .�I I �I1 1,. � � �.l:ll�I � I� � . FROM WELL LOG j I; AT INSPECTIONS ! a� � ll� 'f �1,f "IVi I IIS � t ii i!! � I!{I �I 'i'j I� • ! Date of test ✓��;�. �, i9'�!!' ; ;; 1. I z Static water level i�,C, l iii ft ft. IK,, Well production P. m., g.p.m. WATER SAMPLE RESULTS C j a • ,it • 10�� �•' I� ,�•' Coliform' colonies/100 ml Nitrate l �� •� m /LB Other bacteria %2 colonies/100 ml. I;il 'iy/A3 9:'�/� jlll I� " Arsenic: mg./I. Date of sample., Collected by.., it I I II'le"I', F -� tl B. SEPTICIHOLDING TANK DATA i �i' I�' RI� ' I �` II I I I 41,� i 1 I II, :I • E��iG` S�E�'L f, hJ ,. 1, I ' lI I Tank Type/Material S . / i I' `Date installed ; it IIS 2n%8 / ��: i - i,� ,>" 'II, y ;II Iti Tank size Bova 'gal, , Number of Compartments Cleanoutsl(Y/N) ' lly'ii, I� � �i ►.j ji II' .I'f i j',i ;,. �, t I;I li 11 �,I.I' Foun ationlcleanout (YIN) Depression over tank (Y/N) ;High water alarm (Y/N) �l�J �� I� I �.1• k� �'� �� I I"li�.� Date of pumping' Pumpelrl £6 .�tiiy,�i.i1GS . IiI I E I� Is ABSORPTjQN FI LD DATA' . I Date In'stal160) .� a Soil rating' � (g.p:d./ftt or ft�/bdrm) • �� �� ; System, IZ,Is,..-1-4.... i i iii Length': IYIF �o ft. °p t Width i I Z� y' ft. ! Gravel Ibe(ow pipe _ r' ft. r ,�I• Ili ,./ ' 3 t�� 2 1 Total depth': b� or ,ion area I ft I Monitorin tube � D ... d h' ft. Eff. a s t e session over field ' P P 9 P I I I l�For bedrooms Date of adequacy test � ���-� �'� 'Results (Pass/Fail) ��� °' � ; I j I `� 3 I f I' �' '� " ' ' y7z' l l l� 00-�y-i Fluid depth in absorption field before test y 1n 61 { Water added , gal. New depth7� in. 'i I I 2 �,t�s fI� 111. t•�;; i _ Elapsed Time: 3 B min. ' Final fluid depth II'1B in. Absorption rate >= I? �6' g.p.d. I, � � I I ,IIt 'Ii r � •I'� �� t: ,I'I li I Any rejuvenation treatment pas '2'm (Y/N&type) If yes, (give date !1 r E �1•'I I11�_ .1 f '� �11 'I i, I i 11, � i -F F i� it 'J • � 1 S I 1 I' T 1 , 1 I D. LIFT STATION Date installed Size in gallons "Pump on" level at —in. "Pump off' level at 02t1,R9 Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanklift station on lot /6O�Fi Absorption field on lot /2e' Public sewer maim 11 i14 Sewer /septic service line .elrti� Manhole/Access (YIN) er alarm level at in. Meets alarm & circuit requirements? On adjacent lots ie0 On adjacent lots /oo *. /- Public sewer manhole/cleanout—..� Holding tank . SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation /O e;4 Property line-roYl--, Absorption field 3 r Water main Al% Water service line Surface water /,a C, Wells on adjacent lots /6a _irX SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: .1c a -/ Property line r '�i�i� Building foundation Za'/- Water main Water Service line X Surface water /40-041'rl Driveway, parkinglvehicle storage A64. Curtain drain T Wells on adjacent lots eCO ice` '.d6srvctGo e.t9 /9B/ � G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and 0JT�K review of Municipal records that the above systems are in AP_1. conformance with MOA HAA guidelines in effect on this date.• ENI.EY•. Engineer's Printed Name CE 8176± Date ('/. l0 .0s HAA Fee $� Date of Payment ' U Receipt Number (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number ASBUILT HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: � ���"•n/�,r�- fad GorS; �.E :.� AND THAT NO ENCROA&HMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY 1 EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. SEWARD & ASSOCIATES LAND SURVEYING 694-0829 SCALE •"'F a DATES A GRID r ..'.. •� , T H 5)1 FB �, Dueno mt k 'rwa d ii i1 • LS -691? DRAWNIN 12-22-03; 6:13PM; ;907 5615301 -577/ • IP'l�tii�il7� • H SOS— .200 W. Potter Drive Anchorage, AK 99518-1605 Drinking Water: Analysis Report for Total Coliform Bacteria Tel: (907) 562-2343 READ INSTRUCTIONS ON -REVERSE SIDE BEFORE COLLECTING SAMPLE Fax: (907 561-5301 BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY 1VIUST Analysis shows this Water SAMPLE to be: O PUBLIC WATER SYSTEM I.D. # Satisfactory p --'PRIVATE WATER SYSTEM ci Unsatisfactory. ' O Send Results O Send Invoice O Sample over 30 hour: old,,results may be unreliable rSample too long in transit; sample should Water Sys 3n not be over3tfJhours old at examination to indicate reliable results. Please send ere sumotr new sample via special delivery mail. aims �. ^� -66.�•� Date Received � - . � m n try . , �2 Time Received �•.�' , Send Ruu►ts O Se,ldinvoice Analysis Began . rr GC v b•O G. `p • ua nerve coorf-Y Name t./C L��Z-i ar WS ,rte jO�CiO 6[se' swe zy City !8 �3 SAMPLE DATE: Month Day ' Year ' SAMPLE TYPE: O Routine p- Repeat Sample (for routine sample- with amplewith lab ref. no.-• . O Special Purpose SAMPLE LOCATION O Treated Water O' ' Untreated Water Time Collected Collected By Please Print Analytical Method: PE LNlcmbrane Filter O ' MMO-MUG - - - 9 ml. -y Result* 1038002 • - Analyst en to A. E.C. Anch Fbk3 Jun Faxed Date: Time: .,Client: notified of unsatisfactory results:. Pboo*ned Spoke with. Faeri Date: Time: BACTERIOLOGICAL WATER ANALYSIS RECORD' E. MMO-MUG Result: Total Coliform Coli..--,:-.-- fjb �. _ _ Colonies/100 ml hlembraneFilter: Direct Count MTC -Too liunwour%Count Verification: LTB S BGB ll%�4 COLIFIRM OB-OthnBaderrs Fecal Coliform Confirmation . -e, - - I Coliform/100 ml Final Membrane Filter Results _ C7Ct�S ri � �/ ��.;;,�_ Date %,� % - Time / �i ' C'q hrs Reported }3yo --41— Comments: Ln eq N N \ 200 West Potter Drive, Anchorage, AK 99518-1605 t (907) 562-2343 119071551-5301.www.sgscnv"rOnmental.com —77 CT&E Environmental Services Inc. Membor or the SGS Group (Socleli Genitals do survelilance) . 1 ,1 , 12-15-03 05:41PM FROM-CT&E ESI, SGS ENV SERVICES t I SGS Ref,# 1037823001 Client Name Douglas Kenley P.E. Block Project ample Lot 4, Block 3, Deer Park Deer Park Client Sample ID Drinking Water Matrix PWS1D 0 Sample Remarks: Results PQL Parameter Waters Department 0.100 0.100 U Nitrate -N Microbiology Laboratory 13 OB, W/Fecal Coli Total Coliform 9075615301 T-963 P.02/03 F-644 All Dates/ Times are Alaska Standard Time Printed Date/Time 12/15/2003 14:50 Collected DatelTime 12/09/2003 10 15 0812003 16:30 Received Date/Time Steppe .Ede Technical Dlrec�tor/ Release" Allowable Prep Analysis !nit Units Method Container 1D Limits Date ate mg/L EPA 300.0 B (<=10) col,100mL SM18 9222B A (<-1) 12/09/03 JIB 12/09/03 DKC � � ff • `1 4 •�l'W .. tj ,^ .oi•anr // . , • ti 4.1 •1 N 17 TQ it I -11A .Li'l V lk c ' e0''At o !l w �� � I AI c ,� � Vii• �_ • 1 , ' �_ ����„ k� �'� rl�ira�..• ,' >. .eras •.x.N Nn fA N I. 1 l t 1 . s it•'Jvl 1 . ` p/iJ. ILI lot. a w ' W `- �� e • 4 S i, C Ln c �, s1Lv • � �6, / .agsv� 7 �� I iia > ,+ b Sao ' p Area Z � ,erg- . • — . �, �z- —'-- — — �� : 1 ', ���K'°^' _ �� (w70 Y Val . s �1 MUNICIPALITY OF ANCHORAGE n DEPARTMeNT OF HEALTH AND ENVIRONMENTAL I-nOTECTION DIVISION OF ENVIRONMENTAL HEALTH O J�.� 0 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL- OF PPROVALOF ON-SITE SEWER AND WATER FACILITY ; 264-4720 • M, Application Date 1. GENERAL INFORMATION k. (a) Legal Description (include lot, block, subdivision, section, township, range) r L� 4 5L'K, 3 Location (address or directions) i :(b) Applicant Name-U*'�"-+�1� r' Telephone: Home-���'�`(,b Business Applicant Address (o% 1345 - Y= lae== G_, 99,156-7 (c) • , Applicant is (check one): Lending Institution[3 ; Owner/builderx. Buyer ❑ ;Other O •(explain), _. (d) ` Lending Institution V5A Telephone Address (e) -Real Estate Company and Agent �/=i �+✓?�t_ Kf . .: u Address = to c,�C 7? ZF3)� �f ✓E¢_ o ✓ 995 77 '' Telephone 9�� �ZOD :, -T— • F, `._. z tiS t (f) -ta»Fthe HAA to the following address y1 i ! 1 t 'J 1 � '•r, ' r '' t ' `'���`�r4� � � t f J :fr' •CRI17LY ' '••� y•i, )!. rc. l� if ' 17034 Facie River Loop Road No. 404 �S s Eagle River, Alaska 99577 ^.�' • , , r ' , t 0- • . : a. 2 +TYPE OF RESIDENCE Single -Family Multi Family [IOther " NUmt)efof Bedrooms t ,1 ,• r y l 1 l' f � '•'. 3 ' WATER SUPPLY 4 v` Individual Well • Indiw � •'- Community � �-: blit Pu O Note If community well system,must have writterib"on irmation rom he State Department of Environ mental Co6iervation attesting to the legality and status.:;' e r , 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. " 'i Page 1 of 2 72.025 411184) 5. ENGINEERING FIRM PROVIDIP ""IINSPECTIONS, TESTS, FILE SEARCH, D 0- A AND INFORMATION _ As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Heafth- 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 S & S ENGINEERING Telephone 170M Eagle River LOOP KbadNa. 204 Address Date % zY T MUNICIPALITY Of A&MfALITY OF ANCHORAGE (MO..r' ENVIRONMENTAL SEkVMW"PTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1904 J U L 2 0 1987 264-4720 Legal Description: RECEIVED Q5*1aay 1t4'V.= A. WELL DATA Well Classification ��r If A, B, C, D.E.C. Approved (Y/N) tJ� Well Log Presentd�VN) 1 Date Completed - 81 Yield4l=i Total Depth A95� Cased to 405 Depth of Grouting Static Water Level t2 1 Pump Set At 1 �=- M Casing Height Above Ground 7y Sanitary Seal on Casing ('V1) Electrical Wiring in Conduit (9>/N) Separation Distances from Well: Depression Around Wellhead (Y/M To Septic/tom-Tank on Lot t I-C2;t r ; On Adjoining Lots t 14 - To Nearest Edge of Absorption Field on Lot L?-��1 : On Adjoining Lots To Nearest Public Sewer Line A To Nearest Public Sewer ) Cleanout/Manhole c �� To Nearest Sewer Service Line on Lot -- Water Sample Collected by ! s��aal� -►^; Date 6- 15. Water Sample Test Results Comments�i�:!��lilttt�Ii��►f/tilrflt•�Jl�f�.'/�.i�i�.�Y�' r d 8. SEPTIC/VJN;0I= TANK DATA Date Installed 1'x`81 Size I C:N242' No. of Compartments Z Standpipes&/ l) Air -tight Caps JqN) Foundation Cleanoute N) Depression over Tank (Ye Date Last Pumped Pumping/Maintenance Contract on File (Y/N) for "— Holding Tank High -Water Alarm (YIN) _ Temporary Holding Tank Permit (Y/N) N d Separation Distances from SepticLNeidiM Tank: I To Water -Supply Well \ (<�)I To Building Foundation 15 k To Property Line I c.-> It. To Disposal Field `5 I To Water Main/Service Line I c> To Stream, Pond, Lake, or Major Drainage Course rJ /Q Comments 5f � C� J? cpL, �Jt�P I r`Yz 61 -oZZ Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ��a4� 115P-� Type of System Design r Date Installed Length of Field �s r ( 1 Width of Field 2'S Depth of Field - c r Gravel Bed Thickness Square Feet of Absorption Area A Sb $ Standpipes Present ON) Depression over Field (Y/I? Date of Last Adequacy Test Results of Last Adequacy Test N P Separation Distance from Absorption Field: I To Water -Supply Well To Property Line I o f -f - r To Building Foundation �� To Existing or Abandoned System on Lot �& ; On Adjoining Lots 3'� I"(" To Water Main/Service Line ) I'}' To Cutgank (if present) a To Stream/Pond/Lake/or Major Drainage Course A To Driveway, Parking Area, or Vehicle Storage Area 5�-10' Comments �A-: .! <t57 C9-A6Ur- A1 -- fol A -- f . I rJ5;17 MGel-1,epr,�, GkVG,� is moa- JFGt�A,� P�-�nE>A D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level al High Water Alarm Level at Vent (Y/N) Tested for Electrical Codes (Y/N) Comments Check Permitted Bedroom Rating Against HAA Request •' Pumping Cycles during Adequacy Test. Meets MOA certify that I have checked, verified, or conformed to all M PA and HAA guidelines in effect on the date of this inspection. Sig" S ENGINEERING Date 8 e7 17034 Eagio River Loop Road No. 204 Co MOA No. f+'7 --on 3 Receipt No. _U U -Ove Z_ Date of Payment ,,�-7 Amount: $ .51J Page 2 of 2 72-026 (11/84) •' '_ 4 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343 FEDERAL TAX ID # 92-0040440 � T�PONYTORES ANALYS 15 REPORT Bz'SA:':PLE Ci tent Pu; VEc:3AL Feq u: kcri; urcrr No. Iu:3s Cl lent Smol ID: LT4 BLU DEEP. PARI; Cl len: Account T bate Report er!nteo: JUIN I+, br Sa^plePec't :JUN 1587Pei; asecly LC' W ' Ordered bt i REPORTS ADDRESS #2 REPORTS ADB -ESS #1 1 S & S ENGINEERING 11034 EAULE RIVER. LOOP P.D. , #204 EAGLE PIVE'st, A!a' 99571 Special ROU7'IRESANPLECOLLECTED 6/8/871238 HRS BY SGS ENDS. Instruct: J Chemlab Ref #:6175 Lab Smpl ID: 1 Matrix: Water Ai laraoIe Para meter Tested Result/Units Method Lunits •------------------------------------------------------------------------------ NITRATE-N 0.16 ca/1 II, Sa ..ple ANALYS IS COMPLETED: P,emarks: ROUTINE SA.M,PLE: — — — LAbORATOk'f SUPERVISOR: Si'e"Pfl tt C. EDE C 1 Tests Performed ► See Special Instruct I cnsAooie ((D= None Detected *4 See Sample Pe!13rks Above NA= Not Analyzed LT=Less Tnan. G1=6reawTnan r NEW CONSTRUCTI9*,,, '"", 5. LE p� ih 1Voer D., t` RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME II A C` DATE DATE 1� - ^ C p INSPECTOR INSPECTOB ��ow gas. 1 MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH& ENVIRONMENTAL PROTECTIOeLtTI_V� DEFT.IRONMEN H T L rJA..O & / 825LStreet -Anehompe.Ab *a 99501 TECTION ENVIRONMENTAL SANITATION DIVISION SEP ] 0 1981 Telephone 264-4720 RR E CFF ���� REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER`PAD1tI lE D DIRECTIONS: Complete all parts on page 1. Incomplete requests; will not be Proeem". Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE MA t NG ADDRESS 21111 99567 OPERTY RESIDENT If diHaront ram above)PHONE Z BUYER PHONE Scott Corsaut MAI LING ADDRESS PO Box #10-1277, Anchorage, AK 99511 & LENDING INSTITUTION PHONE Alaska U.S. A Federal Credit Union 276;1;- MAILING ADDRESS D@Barr Road Anchorage, AK 4. REALTORIAGENT PHONE Jim Montague, Totem Realty, Inc., Ea 694-94 4 MAILING ADDRESS P.O. Box 9110 Eagle River, AK 99577 5. LE p� ih 1Voer Park Estates STREET LOCATION NEIN Deer Park Drive, Chugiak, AK (Peters Creek) B. TYPE OF RESIDENCE NUMIER OF BEDR ❑ One ❑ Four ❑ Other Qj -SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY - IN INDIVIDUAL' ' ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) S. SEWAGE DISPOSAL SYSTEM 15d INDIVIDUAL/ON-SITE'" 81 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED / 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS ❑ APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE i � �� � Is Y — � o�_ .1-4 1 72-010 (Rev. 6/79) ..