HomeMy WebLinkAboutDEER PARK BLK 3 LT 5Deer Park
Block 3
Lot 5
#051-042-43
Municipality of Anchorage
On'i_..z Water Wastewater
and Program a (907)',._.-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit. Number: 0SP1211.87 PtD Number. 051-042-43
Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade
Name:
Reilly & Patricia Bryant
ABSORPTION FIELD
® Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
22227 Deer Park Drive, Chugiak, AK 99567
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
2
0.8 GPD/SF
8 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
2.82 Ft.
Gravel depth beneath pipe
5.18 Ft
Subdivision Block Lot
DEER PARK 3 5
Fill added above original grade
Varies 0.19 —1.56 Ft.
Gravel length
57 Ft
Township Range Section
Gravel width
2 Ft.
Beds: Number of Lines
Distance between lines
__ Ft
SEPARATION
DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
590 Ftz
1
-- Ft
Well
100+
100'+
--
NA
25'+
TANK ® Septic D S.T.E.P. 0 Holding [i Other
Manufacturer
Anchorage Tank 1
Capacity
1000 Gal.
Surface Water
100'+
100'+
--
NA
Material
Steel
Number of compartments
2
Lot Line
5'+
0.5'+
--
NA
NA
Foundation
5'+
10'+—
NA
LIFT STATION
Manufacturer
Capacity
Curtain DrainNA
*50'+
NA
NA
Gal.
Remarks *None known. New field 7'+ to existing
Pump on level at
In.
Pump off level at
in.
High water alarm at
in.
field & 0.5'+ to property line per waiver.
Pump make and model
Electrical Inspections performed by
Installer JRS
PIPE MATERIAL House to tank 3034 Tank to 3034
drainf[eld
Drainfield 3034 C01MT 3034
Inspector ARCTERRA
BENCH MARK (Assumed elevation) 100 ft
Inspection
dates: T" 10/4/12 zed 10/8/12
Location and description
3`d 10/8/12 4" 2/8/19
Finished Floor
-- —COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
E."�'"
Conditional Approval: Date
�`q�
r'�`S� oApr
�01�
9 TH
PF
14
-A KENNETH M. DUFFUS
Approved
7116
_.— .. Date 3 ly 1
� �sslOOH' ,�low
eer's Stam
..._I _...... . ...... ,r
A -D=58.9'
B -D=55,2'
A -E=63,4'
B -E=56.8'
B -F=28.5'
C -F=63,1'
B -G=28.5'
C -G=62.0'
B -H=46,9'
C -H=24,7'
AS -BUILT SYSTEM DETAILS/SITE PLAN Permit ❑SP121187
DEER PARK SUBDIVISI❑N LOT 5 BLK 3 PID# 051-042-43
117.2'
®WELL
iU-)
(6
Q�9 N N
H
CO
MT
34.16 94,31
W �
A
0 1000 -GAL
ti SEPTIC r\= TANK
OF Ar
SCALE, 1' = 30'
FINAL GRADE
N89'5020811W
(N89'57'55"W
4
F11.TM FABRIC VARIES
> 86.15 T
80.97
SEWER ROCK s.Ia
80,9 97 GRND
VATTR _L_
10/4/12 V/
.JEFF PST
— 57' 74.9 Bw
SCALEi NTS
Ar <W. �� , PREPARED FOR, 61: ER
REILLY & PATRICIA BRYANT oA+
®1+ 22227 DEER PARK DRIVEId
*49 *A EAGLE RIVER, AK 99577
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JO® No.: 12-148
aoEXISTING
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UW
2 -BR HOUSE
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22.0'
co
co
12.0'
40.0
A
DECK
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GARAGE
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ANEW
1000 -GAL
40.0'
D CO
SEPTIC TANK
C
B
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ORIG. FIELD
IV
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MT
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W �
A
0 1000 -GAL
ti SEPTIC r\= TANK
OF Ar
SCALE, 1' = 30'
FINAL GRADE
N89'5020811W
(N89'57'55"W
4
F11.TM FABRIC VARIES
> 86.15 T
80.97
SEWER ROCK s.Ia
80,9 97 GRND
VATTR _L_
10/4/12 V/
.JEFF PST
— 57' 74.9 Bw
SCALEi NTS
Ar <W. �� , PREPARED FOR, 61: ER
REILLY & PATRICIA BRYANT oA+
®1+ 22227 DEER PARK DRIVEId
*49 *A EAGLE RIVER, AK 99577
oj D ; 0 FIELD BOOKS
CE -7 B �4 ® BOUNDARr N A
® STAKING; N A
AWLQLr. SLS
®FESSIOK� DW6. FILE
AAD FILE FILE
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DATE: 2 11 19
cRnr NW1558
JO® No.: 12-148
FR AK 995777—
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On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number:
OSP121187
Tax Code Number:
05104243000
Work Type:
Septic Upgrade
Permit Effective Dates: July 19, 2012 to July 19, 2013
Design Engineer:
ARC TERRA CONSULTING INC
Subdivision:
DEER PARK
Site Legal Address: DEER PARK BLK 3 LT 5 G:1558
Owner/Address: BRYANT W REILLY & PATRICIA L
PO BOX 671830 CHUGIAK AK 995671830
Site Mailing Address: 22227 DEER PARK DR, Chugiak
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank N Privy
Lot Size in Sq Ft: 49837
Total Bedrooms: 2
N Private Well N Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued By
Municipality of Anchorage
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907)343-7904 • Fax (907)343-7997
htto://www.muni.org/Onsite
Development Services Division
On -Site Water and Wastewater Program
relent 41
n r,
F
N
-. epa7tznerit .
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSP121188 COSA#: Permit#:OSP121187
PID#: 051-042-43
Legal Description: Deer Park, Block 3, Lot 5
Engineer: ArcTerra
Applicant: Reilly & Patricia Bryant
Your request for a waiver of the required 10 feet horizontal separation from the absorption field
to the property line has been approved. The approved separation distance is 0.5 feet.
Your request for a waiver of the required 10 feet horizontal separation from .the absorption field
to another absorption field has been approved. The approved separation distance is 7.0 feet.
This waiver approval applies to the proposed absorption field only. Any future upgrade to the
on-site wastewater disposal system will require all separation distances be met or another
approval from this department.
® The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
❑ Notarized lettcr(s) of non -objection have been received from the owner(s) of the affected
adjacent property.
❑ Adjacent properties are not affected by this waiver.
.................... ...... ......................................... ........... I
Waiver is Granted: X Waiver isnot Granted:
Date: �(l� 7� Approved hw—
Name of Reviewer
• ......................................... ........... a ........ ...... ..... .....
Rec#: 055060D Amount: $200.00 Date Paid: 7/11112
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
Mayor Dan Sullivan
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. DSI—aW_—C
Property owners) &ILLY i Y.tsyc)ca &y,47vr Day phone
Mailing address Po By 071133o cHire7,44, AA:c i- 5Z 7
Site address 2222-7 oEE2 Afiex o1r1e1E CHoa,4'e X4,1'--Nr6'7
Legal description (Sub'd., Block & Lot) P1194 133 ZS
Legal description (Township, Range & Section)
Lot Size n X l Sq. Ft.
THIS APPLICATION IS FOR:
(® all that apply).
Absorption Field
Septic Tank
Holding Tank ❑
Privy
Privy ❑
Private Well ❑
Water Storage ❑
Number of Bedrooms 7—
THIS APPLICATION IS AN I .
Initial
❑
Upgrade
Renewal
❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
ACT L/AfE � A�SaYLP77d)✓ �/�Z�f
I certify that the above information is correct. I further certify that this application is being mane
for a Single Family Dwelling and is in accordance with applicable Municipal Codes.
property owner or authorized
Permit/Rush Fees: 4
Date of Payment:
Receipt Number:
Permit No.
Waiver Fees: (4 c206
Date of Payment: ILI&a
Receipt Number: zzo t
Waiver No.
G:1BuildinglOn SiteTorms\Glient FormsTermit App_010411.doc (Rev. 1/11)
July 3, 2012
ARC 1 ERRA
CONSULTING INC
212 E. 51"Ave, Anchorage, AK. 99503
Office (907) 868-3791, Fax (907) 868-3793
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Upgrade Sewer Permit with Waivers – Deer Park Block 3, Lot 5
It has been determined that the absorption field of the subject property is
saturated. Subsequently, the owner has requested we proceed forward to obtain
a septic permit to upgrade the failed leachfield on the subject lot. Due to well
location and topography restraints on subject and adjacent lot—the proposed
leachfield will need to be placed within 0.5' to lot line and within approximately
7' to the existing leachfield. We therefore request these appropriate waivers.
The general slope of this lot is from north to south at a grade of approximately 0-
3% over the septic area. A cutback of 25%+ exists in the south, portion: of the Jot.
On June 25, 2012 a testhole was performed to investigate soils and groundwater..
The results of this test are attached for -your review. The proposed :upgrade will
serve the existing 2 -bedroom house. We propose to install one 57' long deep
trench. Groundwater was not encountered at excavation or at monitoring.
The property and adjacent lots are served by private water. There is no surface
water within 100' of the proposed system and there are no known curtain drains
within 50'. We do not expect there to be any adverse effect on adjacent lots by the
development of this system. If you have any questions, please contact me at 868-
3792/FAX 868-3793.
Respectfully submitted,
ArcTerra Consulting, Inc.
Kenneth M. Duffus, P. .
Attachments: On -Site Sewer Application
Wastewater Absorption System Details/ Site Plan
Soils Log/ Percolation Test
WELL & WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PLAN
DEER PARK BLOCK 3, LOT 5
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25
FLAG PROPERTY LINES, SURFACE WATER - SCQIeI 1'= lOO'
WELL RADII & EASEMENTS
a PRIOR TO CONSTRUCTION DESIGN DETAILS - - - PAGE 1 OF 2
v
3 BDRM X 150 GPD = 450 GPD
ra 450 GPD/ 0.8 GPD PER SQ. FT. (12 MIN/IN.)= 563 SO. FT
N (563 / 2 X 5' ED = 57' LONG TRENCH
USE 1 TRENCH - 57' (L) X 2' (W) X 5' (D)
Total depth of system is 8' MAX from original grade.
3
NO PUBLIC WELLS WITHIN 200. OF Total depth of gravel below distribution pipe is 5.0'
i PROPOSED
m NO PRIVATEYSWELLS WITHIN 200. OF NOTES;
PROPOSED SYSTEM EXCEPT AS NOTED. 1, INSTALL 1000 GAL & INSULATE TANK IF <4' COVER.
NO SEPTIC SYSTE14S WITHIN m PROPOSED WELL EXCEPT AS NOTEDF 2. INSULATE TRENCH WITH 2' HD BURIAL & 21+ OF FILL.
3. -CONTRACTOR WILL ENSURE MAXIMUM 2% SLOPE INTO SEPTIC TANK.
a 4. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT
m WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC...
0
AW .AL qs 1 PREPARED FOR: CTE
REILLY & PATRICIA BRYANT
0
PO BOX 671830
m / *
:AH
* / CHUGIAK, AK 99567
m
y a� r
a
t` I KENNETH M. D S : / FIELD BOOKS COMPUTED: ;
/ <
" '.. CE-7116 Tya OOUNDARY:BOUNDARY °ftANN' BMW
W , 7�3�/�.. s'�I sTacNc, STAKING aaaem KMD n°i
N !
1 ` FTisslovp 1W Assu2r. REJ DATE: 7/3/12 `' ••••�_. y1
DxG. rTtt•:: cRm:NW1558VLING
9p�F Cp
AAD FILEFILE J08 xo.: 12-147 R/`e R, AH. 9957 -0b l
Gi
WASTEWATER DISP❑SAL SYSTEM DETAILS
DEER PARK BLOCK 3, LOT 5
34.0
..2 -BR
w a H❑USF�!
J .... ro
22,0
103,6 is..
O
l()
GARAGE
N
O
� L
N I
39.5'' -MT MT CO_
C❑ FLAT
Jv,
0-2%
TH12-1 3 cu
V) H
\ O p o
>25% SLOPE TOP
S
DECOMMISSION
EXISTING S,T,
c i INSTALL NEW
c 1000 -GAL S.T.
W/ COs & DIS
FLAG PROPERTY LINES, SURFACE WATER
WELL RADII & EASEMENTS
PRIOR TO CONSTRUCTION
TRENCH TO BE INSTALLED 0,5' FROM PROPERTY LINE
i\
OF AL��1'
9TH
m �
KENNETH M. DUF/
C —7116 4
w
tl'D!'ESs101NA1' AV
J
PREPARED FOR
REILLY & PATRICIA BRYANT
PO BOX 671830
CHUGIAK, AK 99567
FIELD BOOKS
B WNOARY..E30UNC
sTAK'No: STAKIt
r WILT: REJ
DWG. nLE:
AGAR FlLE: FILE
COMPUTED:
DRAWN: BMW
D Emm: KMD
DATE 7/3/12
MID: NW155f
" N°: 12-147
4,59'
m.X, . .-
ARC 1 ERRA <y
s* s' 9TH
CONSULTING, INC iS• ••�••••••,�
212 E. 51"Ave, Anchorage, AK. 99503
Office (907) 868-3791, Fax (907) 868-3793 • •'•
Kenneth M.
SOILS PERCOLATION TEST
Performed for: Patty & Reilly Bryant Date
Project: Deer Park Block 3. Lot 5 TEST HOLE # TH 12-1
Depth
(Feet) SEE ATTACHED SITE PLAN
ORG/OL
N I 1 -
FOR HOLE LOCATION
GM w/ sp/gp pockets top 4.5'
B.O.H. X/
aa
71/R/rz
HOLE PRESOAKED
20- PRIOR TO TESTING
Was Ground water encountered? NO What depth? NA
Depth to water after monitoring? 12' Date? 7/3/12
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
1
6/26//12
1:00
6"
_Drop
-
2
1:30
30 min
3 7/16"
2 9116"
3
*
1:31
6"
4
2:01
30 min
38116'
2 8/16'
5
*
2:02
6"
-
6
2:32
30 min
3 8/16"
2 8/16"
7
8
9
10
11
12
*
Water
Added
Percolation Rate 12 (min/in) Pere Hole Diameter 6"
Test Run Between 5.5 feet and 6.5 feet
I, Kenneth M. Duffus, certify that this test was performed in accordance with all State
and Municipal guidelines in effect on this date.
72-013 (3/85)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
DISTANCES
FROM TO
SEPTIC
TANK
ABSORPTION
DION
WELL
Address 1�1lo
S11"V7 pfiLl
WELL
) Vp \
1 O \;
Phones)
Permit No.
No. of Bedrooms
LOT LINE
,fl► i--
l o+
LEGAL DESCRIPTION
Lot BIOCk Subdivision
5 3
t
FOUNDATION
514-S
1
Township. Flange, Section
AS-BUILT DIAGRAM (Show location of well. septic system, property tines, foundation,
driveway. water bodies. etc.)
TAN S
SEPTIC ❑ HOLDING
,.
Manufacturer
capacity In gallons
a L4
vc •'
Motional
No. of Companmen
FatZ oa` l
It 3
o�
TYPE OF SYSTEM
VTRENCH ❑ BED ❑ W. DRAIN ❑ OTHER
Depth to pipe bottom from Total depth from original grade \
ongmal grade
5.5 FT T
Q
Fill added above original grade Gravel Depth beneath pipe
D FT FT
Gravel length Gravel width
S FT 31or
Total absorption area Distance between lines t O'
P-o
SO FT L O FT
Number of lines Sal rating Pipe material10,
SO FT S
Installer � b1 `, Date Installed
`
- -�-90 1
WELLS
PRIVATE C1 OTHER (Identity) ) 4
IZ
ciass tication ma.c) Total Depth cased to A �" ` t
F
FT FT
Installer Date Installed:
It II
REMARKS:
7
tT
ts►70+ to
Inspections Performed by:
,:
h+ - .. G . 1 , L;.r' y=
0000
R1.5
AlP, , 7S, irk
''• ,r
Date: c —�'1 — Gl O
`.- * � ,spy �i• % l
I
t7__)l��
111SLL__llllll
a a. 40.0404 . •0000Nw03
( 17n34 Eaale River Loop Road No. 2 ty that is Intpedion was performed according to all
•
' z• >tobert .R. Shafa •'� t ,its
E le River Alaska 99577
Municipal and Stale pat�a�nat m .Q.Ian gots d
No, 1<57-E
�� •4PAOF.4
'
F
;S$1
Health Deportment Approval: Date:--ZL/
72-013 (3/85)
r
H U fel 1 C: 1 P A L 1 1 Y LI F i] N U 11 fJ 1� A G E
Departmont of Health 8< Human Services
825 L Street, Anchorage, Alaska 99501 34J-4720
O N- S I T E S E W E R P E R M I T
Permit Number- 90026'4 Upgrade l��L�LOCrA
1)ate Issued: 08/29/90 Engineer Designed
Owner Name: PRIAN DONNELLY Day Phonr:
Owner Address: 11361 SNOWLINE DRIVE 261-3631
ANCHORAGE, AK 99516
Parcel Id. 051-042-43
Lot Legal: Subdivision: DEER PARK EST. Lot: 5 Block::
Section: 4 Township: 1!jN Range: 1W
Lot Size 49837 (sq. It. or acres)
Max Bodrooms: This Permit-: 3 'Total Capacity: 3
SEPTIC 'fAhlk::: Minimum total septic tank capacity: 1,000 gallons. Each septic
tank: must have at least 2 compartments. Depth to top of septic tank (s) < 4.0
feat requires in,ul.tation over tan} --;(s).
SEPT IC TANK TO DE: MOVED OUTSIDE OF' 100 FT. PROTECTIVE WIELL RADII I
!SEPTIC; 1ANf: MUST DE INSPECTED F•OR INTEGRITY AND REPLACED IF'
-+
N;�CESSARY. AS-DUILT SUDMITTAL MUST DOCUMENT' CONDITION OF-m'JI::.
SYSTEM MUST DE CONSTRUCTED IN ACCORDANCE WITH AP'P'ROVED DESIGN,
I CER f If -'Y THAI.
1.. I cam familiar with the requirements for on-site sewers and wells as set
forth by the MUnieipality of Anchorage (MOA) and the State of Alaska.
2. 1 will install the system in accordance with all MOA codes arid regulations,
and in compliance with the design criteria of this permit.
I will adhere to all MOA and State of Alaska requirements for the set back:
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for, a maximum of 3 bedroom,. I
also understand that the capacity of the total system is 3 bedrooms and
any enlargement will require an additional permit.
Signed: S S DATE: Z
(Owner) BRIAN DONNEL.LY
Issued Dy:MJ
p DATE: 8 Zej
--.I7-f.__-____-.______--q___--
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a Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:�I/---r-A �GT�fsELI�/ DATE PERFORMED:
LEGAL DESCRIPTION: LS 'I=J3- nShlp, Range, Section:
r SLOPE SITE PLAN
1
,O
2
3
a y'
}f.%
C
4
�
�r
5
' t �/
$
�Op
w'
6
fr
1"
7
8
�•�
d�
10 i•r'/
12-
13
2 13
14-
15-
16-
17-
18-
19-
20
4151617181920 t_]
COMMENTS
C-1 � 1Z7
e r'" — I tao�r—'`/�_-
WAS GROUND WATER Nb
ENCOUNTERED?
IF YES, AT WHAT L
� p�r.1✓�z i_� DEPTH?
E
Depth 10 Wi-� f _ Irl /10
Monitorinp7 .���TY Datc -Yl� �/ 1-11J+'14:F
®®MMM
'(064 _N
PERCOLATION RATE 1 b (minutes/incth)_PERC HOLE DIAMETER I
TEST RUN BETWEEN � FT AND FT
S & S ENGIntr r%liv�
PERFORMED 81�:7yy1 e_"t. River Looe Road No. 204I CERTIFY THAT THIS TEST WAS PERFORMED IN
�� ((��latka 99577
ACCORDANCErP Jl lLr�fATE AND MUNICIPAL GUIDELI N FECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
'(064 _N
PERCOLATION RATE 1 b (minutes/incth)_PERC HOLE DIAMETER I
TEST RUN BETWEEN � FT AND FT
S & S ENGIntr r%liv�
PERFORMED 81�:7yy1 e_"t. River Looe Road No. 204I CERTIFY THAT THIS TEST WAS PERFORMED IN
�� ((��latka 99577
ACCORDANCErP Jl lLr�fATE AND MUNICIPAL GUIDELI N FECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
• %t l MUNICIPALITY OF ANCHORAGE
had 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
NAME
--zi.
PHONE
C1-
NEW
❑ UPGRADE
MAILING Ad RESS
l7 a
-77
LEGAL DESCETION
LOCATION
NO. OF BEDROOMS
V Y
DISTANCE TO:
Well
4-/o
Absorption area
Dwelling
- (�L
PERMIT NO .
5
CL R
Wf
Manufacturer
Materia
No, of mpartments
in
Liq, capa�t�nyylions
VV
IF HOMEMADE:
Inside length .�
Width
---�.
Liquid depth
1
O Y
J Z Z
DISTANC
Well
Dwelling
PERMIT NO.
_ ... h
Ma curer
uid capac ons
O
w=
DISTANCE TO:
Well /
t-���
Fou�+da(�' - Nearest lot line
✓Y�t%��(M a0
PERMIT NO. p • /
p 1Q�j7Y'
J LL Z
;:.3 W
No. of lines
Length of eac�ne?
J
Total length of li¢es3 Trench wid� �7'
a tRGI�eS
Distance betwee lin s
2 H
p
Top of tile to finish grade
Material beneath tilr
Ver?w, .� inches
Total effective a s r tion area
W
Length
Width
Depth
PERMIT NO.
aI-
WLUo
Type of crib
Crib diameter
Crib depth
Total effective absorption area
rn
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
J
Class
Depth
Driller
Distance to lot line
PERMIT NO. O J`
W
3
DISTANCE T0:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
ZD 303
SOIL TEST RATING
7
INSTA R/�
t%•W
REMARKS
t
ta
APPROVED n
GATE LEGAL � n
-71--1� ► _ 5 g 3
72-013(Ra6.3/78) 61
�(TUK. TOt Olvldon of D•ologIcal o nrflul Survey/ (ISM)
T` 7001 Porcupine Orly (T�n•: 277-4415)
Anchorage. AISOM 99501
`D5 - 0lfz —soWATER VILL RECORD
grilling Coap*ny M. Cotten-Magnti on D//r�ill nr,
(CATION OF WELL Please,couple Q La{
R r[L pi of-)
JSTATE ALASKA
gAIMCMT Of MATUIUM. RESOURCES
JI IN 4 1982 /SSW
Diie;i�li��eo�opwa NA: .
b
/
I<. breegh
Subdivision
Tlevr or-
I oak
14. Inti ion
Sett len No.
r a
ia.nsn 1p
IV -41«f9
Merge
4
No101en
VJ'
Ic. Distance and Direction frw, Road Intersections
Street Address and Area of Well Locetlon
7. DINNER Or VELLtFr, Terrell Prii'! c'•
Address: �.
P`OT 4 , CK .
y;
m_
Z. WELL LOG Feat Nlon'
Surface
Material To" oo b[:w
4. WELL DEPTH: (coag lo:ed)
:il
ft.
Surface Elevation
•---
114 to of
[o.o,alw
v
Q`67 2
1('4 •'
=1 i
eO
af
❑Cable tool 'ORotary O0rlven 00"
❑Auger []JettedClbred ❑Other:
TA�1CS.
26
ray: . Z
1. USES .0 Dorstic OFubl1<Sapply 0Industry
0I"Isatlen I]N«nary. Ot000arclet
[]Tot Well OOther• .
PALITY
EWI ..
7. CASING: 0Thrudad :OWelded
�In. to Ulf t. Depth Weight albs/ft.
_In, to ft. Depth
p •'~
:uv`
a. FINISH Or WELL:(' ero
Type: (' •:t, n Dla.eter:
Slot/Msh Size: Length:.
Set betusen ft. and ft.
Fittings:
`
9. STATIC Wits LEVELS ft.
0
0 Above611o., land turbo
Type of noNsvrelYnti
10. fONFING LEVEL Melon land surface /
ft. *rise nes. empire g.p•a.
ft. after hes. punning g.p,..
11. WELL NEAR [0.11,171011: U In Approved pit
E)Fltless Adapter inches above grade
12. GROUTING: Well Grouted: Elves pia
Materlai: ❑Nut Consent ❑ other•
17. PUMP: (If available) M►
Length of Drop Flpe ft. capacity Lo.
Type: •OSub..rslbl• ❑Kaci orecating
❑Jet ❑Other:
14. REMARKS:
wflgn.a:�•'
•f [
i,lkl
15. WATER WELL CONTRACTOR'S CERTIFICATION:
This Neil see 111r111•d ander ap Jurisdlctloo and this report Is true to the best of •y lumledge and belief;
Cottenizagnuson Drillinw 689-31,19, 1,". i7�`5
star saes. la.. 1$'r'S•-0/2/ •neat mann v..er
Address: P.C. Pox 504 Earle River, A::. 5`7
i i s Dat•: Jt313E a'3a
.. t thx t pr.,.n r..
turn 02 -VIAL ,�, Copy Olstrl Mrtlool WITC • Sato DGGS, L FINK - Driller. CAAAAY - Custom, rA
F1
rel u rel I c: I �a n L I -r- is r- n rel c H.� n r E
DEPARTMENT l HEALTH AND ENVIRONMENTAL .OTECTION r�S
' 825 'L' STREET, ANCHORAGE, AK. 99501
' 264-4720
44ELL Rr-aC} I TE F='EF;R.mr•7 I T 1
PERMIT NO. C 810574 ) I O�
�---)
APPLICANT TERRELL W. BAILEY GENERAL DELIVERY 99577 694-2141
LOCATION
LEGAL 'L 5 B 3 DEEP. PARK ESTATES LOT SIZE 6000 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD
MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING CSO FT/BR)= 117
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: df��I�utst
53
GEP TH= •=• LEh�IiGTH= _I=Z� OF= nVal C-EF„TH= Z�
THE LENGTH DIMENSION IS THE LENGTH CIN 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).
THE TFREr-Ir1H 4-J I LATH I's Z5. 0-7100 FEET.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION CIN FEET).
Mal. tiU I F= E:C� = EF='T I r,� -rn"FC 1E,00 i3ALL0 ":
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER. OF RESIDENCES THAT THE WELL WILL SERVE.
--- -rL4 C 2:> I "—<--F='Ei:::T I C -1"f RFS E RE01_I I F:;?-aE> ---
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
i
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTAFICE FROM A PRIVATE WELL TO A PRIVATE SEWER LIFIE IS 25 FEET AND
TO A COMMUNITY SEWER LIFIE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
OTHER, REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F=`EI:Z!rh I T EXF=' I FEES G'�EC,DE:ME:EF;:.o = 1. :�L_+:= 1
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 IFI ACCORDANCE WITH THE CODES.
3: 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS.
SIGNED:__-_ n /
APPL I CA1IT TERRELL W. BAILEY 11 pS cc??
h
ISSUED BY------------------------------DATE-L= �_--_ V4.0
i~UNICIPALITY OF ANCHORAGE()
Department of Health and Environmental Protection
825 L Street, Anchorage, AK. 99501
264-4720
* * * HANDWRITTEN PERMIT
WELL AND/OR ON-SITE SEWER PERMIT
Applicant: _Ferr^e� ;��p./ Mailing Address: reo,btL,
Location: lees' t'nrk 1=r�. 1 r"sT (2�. Phone Number: 6qq -,21yJ
Legal Description: L .S ({ Lot Size: O
Type of Soil Absorption System Is:
Trench: Drainfield: k//— Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: q Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is: Cc
DEPTH LENGTH S. 3a�'•. GRAVEL DEPTH .��- WIDTH
The length dimension is the leength(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTICEHOtDtN6- TANK SIZE = OO0 GALLONS
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO M INSPECTIONS ARE REQUIRED * #
Backfilling of any system without final inspection and approval by this departmen-
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fee
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 3 1
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that 3 bedrooms.
g _��-,}ZD
Si ned Issued by :
Applicant
Date:
SWP/024(1/81)
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION x PERCOLATION
825 L. Street, Anchorage, Alaska 99501 2644720
SOILS LOG — PERCOLATION TEST
76 i -re //
PERFORMED FOR: 6;!-f7Y`3' —1 Ral& DATE PERFORMED: 16 � Ll
—
LEGAL DESCRIPTION: LS 83 /
DEPTH
1 •� � J
2�
0
3 � °�•a /Oo
O,
5 ._
77
9
12
i 13
14
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
i X 15-
6
s:%,.... OF At,
16
r �� . f±� •. Sf �R!
•
P
��P
`1::� t,
Ia
J7 2-
//gu
IF YES, AT WHAT E
DEPTH?
18
L
F Rebert A. Shale w 10
No. 1457-
457-iah^FESS\
19 -
it 10h ^FESS\
20
!�
9
COMMENTS
E
ZITF PI AN
WAS GROUND WATER S
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
/U
ENCOUNTERED? L
O
6
P
Ia
J7 2-
//gu
IF YES, AT WHAT E
DEPTH?
L
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
6
2
3o
J7 2-
//gu
3
L
!�
9
/L) .,
�,41
PERCOLATION RATE r (minutes/inch) �s
TEST RUN BETWEEN J FT AND FT / ,lam - /6 fa
PERFORMED BY: T& S EIIQ1A92nnQ CERTIFIED
72-008 (6/79)
DATE -/j UU"' n
r
h MUNICIPALITY OF ANCHORAGE
• "' DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel l.D. # OSI — 0 4 Z — ti 3 HAA # V+J Zs 1l„ t IA 2k S
1. GENERAL INFORMATION
Complete legal description Lot 5; Stock 3; 'Deet Patk SubdivL6ion
Location (site address or directions) 22227 Deet PaAk DtLve
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
?2-=(R".1/91) Front MOA Kt
Chuc iak AK
Property owner "% Stephen Lakatena
Day phone 688-4442
Mailing address.' •22227 Deet Patk Dttve Chug.i•ak,
AK 99567
Lending agency
Day phone
Mailing address
Agent Gte4 Hxnitton/ C-21 Ctaw((otd Reat E6tate
Day phone 562-5592
Address
Unless otherwise requested, HAA will be held for pickup.
2.
NUMBER OF BEDROOMS: 3
3.
TYPE OF WATER SUPPLY:
Individual well XXX
Community well
Public water
;.
NOTE: If community well system, provide written confirmation from State ADEC attest -
Ing to the legality and status of system.
4.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site XXX
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
?2-=(R".1/91) Front MOA Kt
i
5. STATEMENT OF INSPECTION BY ENGINEER.
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
Investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify 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 phone G ctY — ;)_9 7 %
17034 Eagle River Loop Road No. 204
Address Eagle River, Ala! J a 99577 f
Engineees signature
6. DHHS SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments
\.
MTI r
Date c7 fir/ q
OF
-A\
ROBERT C. COWM
L cs CE . 8801
!� ♦ ✓. 4i
bedrooms, with the following stipulations:
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
rrzoas PUv. ui) Back MOA m
/+NCMQIL4G@
ENYIRONMENTAL SERVICES DIVISION
SEP 25
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICEgZ E C E' V C D
Environmental Services Division G G
I&
825 L Street, Room 502 a Anchorage, Alaska 99501 a (907) 343-4744
Health Authority Approval Checklist
Legal Description: ►mot 5 &.Y= -3 f- eP&941--'fie Parcel I.D.: 0'r / - O `/�L -y-3
A. WELL DATA
Well type If A, B, or C, attach ADEC letter. ADEC water system number
Log present a) Date completed to 'Z'3 -5 l
Total depth 3 82 1
Cased to a Casing height (above ground) /i
Sanitary sealION) x) Wires properly protectedON) _
Date of test
FROM WELL LOG
6---43-9I
Static water level J V! -
Well production lt7 . u g.p.m.
WATER SAMPLE RESULTS:
AT INSPECTION
di 2zi `il.
ss'
S 0 g.p.m.
Collform u Nitrate j /(> Other bacteria a
Date of sample: / - z 'SL Collected by: S & S ENGINEERING
17034 Eagle River Loop Road No. 204
B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577
Dateinstalled 07�51 Tanksize tvoa Number of Compartments Z Cleanouts&N)-Y-
Foundation cleanout (94) Depression High water alarm (Y/N) At
Date of Pumping` I�'�S ia_ Pumper
C. ABSORPTION FIELD DATA
Date installed ' P/ 9j Sou rating (g.p.d./W or ft2/bdrm) AZUL='- System type td loo- Dvj.* .
Length Width Gravel thickness below pipe _ _Tota depth —
Effective absorption area �� 95 Monitoring Tube presentQN)--(— Depression over field (Yo
�DD 1
Data of adequacy test ��� -r1 Results iq 7Jb� For 3 bedrool114 � �1(
Fluid depth in absorption field before test pn.); Z2 N Immediately after `�7a gal. /water added (in.): 6 , r +�
Fluid depth �_ (ins) Minutes later: % Absorption rate - yS0 + a.p d.
Peraodde treatment (past 12 months) ()j /1b^k- 14404 yes, give date -J/�
72.028 (Rev. 3198)•
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level a
--� es tested
E. SEPARATION DISTANCES
"Pump on"
'Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
olding tank on lot
106,
Size in gallons
On adjacent lots
off" level at'
/00 1 4 -
Absorption field on lot / a o On adjacent lots /° a y
Public sewer main if Public sewer manhole/cleanout fj/
9L
Sewer /septic service line Lift station P-14
SEPARATION DISTANCES FROM EiPT HOLDING TANK ON LOT TO:
Foundation 14-
# Property line /J / Absorption field S
Water main/service line /a Surface water/drainage Wells on adjacent lots /04) t
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line p, Building foundation /10 Water main/service line
Surface water 140 l F
Driveway, parking/vehicle storage area
Curtain drain 10JA Wells on adjacent lots
F ENGINEER'S CERTIFICATION
I certify that / have determined tbru field inspections and review of Municipal
in conformance witlIMOA HAAquid lines in effect on this date.
Signature Avz.
Engineer
Name Ras*.. - C. C a v4. -
Date q /X34 q(.
HAA Fee $ 3 " e 01"
Date of Payment 'T1gS h r,
Receipt Number y� Sf' � J
72-026 (Rev. 3/96)'
Waiver Fee $
Date of Payment
Receipt Number
/cam d f-
6ah9ia-Nstems are
Pt,\ ROWT C. COWAN �Q
I ox +� CE - 8801 �
^,
'kZ
' MUNICIPALITY OF ANCHORAGE
• -� Department of Health & Human Services &
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # CA 1 — 0 Q A - I -A 2) HAA # "PN Rn
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 5; Btock 3; Deen Pa)tk Estates
Location (address or directions)
22227 Veen Pa,%k D4ive, Peters Creek, Atasha
(b) Property owner Bn•r_an 9 Nancy Donnetty Telephone : (home) 346-1401 Business 261-3631
(c) Lending Inst�lition
Mailing Address
MAC
(d) Real Estate Company and Agent
Address
Telephone
Telephone
(e) Mail the HAA to the following address: (or check here ❑, if hold for pick up.)
List contact person and day phone number below:
S & S ENGINEERING
17034 Eagle River Loop Road No. 2p4
Eagle River, Alaska 99577
2. TYPE OF RESIDENCE
Single-FamilyKI Number of bedrooms 3
3. WATER SUPPLY
Individual Well t Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site M Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (Rev. 7188) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
Name of Firm
Address
Date
S FNGINEErtkia Telephone
17034 Eagta River Loop Road No. -04
0
i `• •7 �
? o(eA A. S% 6C
r
No. 1d57•E
eA
OF C.
6. DHHS APPROVAL
Approved for 3 bedrooms by Al 'Gil ate
Approved Disapproved Conditional
Terms of Conditional Approval
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
oranalyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88) Back Page 2 of 2
r.
A. WELL DA�4
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description:
Lar 5 3L-0�&1
Well Classification If A, B, C, D.E.C. Approved (Y/N) f41A
Well Log Present &N) _Y Date Completed Yield, 5,4 lm2M
Total DepthSZ- Cased to4.o1} Depth of Grouting
Static Water Level .� Pump Set At uK
Casing Height Above Ground I Z.� Sanitary Seal on Casing40N) V
Electrical Wiring in Conduit (DN) V Depression Around Wellhead (Y,Qi Id
SEPARATION DISTANCES FROM WELL: .
To Septic/Holding Tank on Lot 10o On Adjoining Lots
To Nearest Edge of Absorption Field on Lot 1 oft ; On Adjoining Lots' tt7D
To Nearest Public Sewer Line Q To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot
Water Sample Collected by Date -1 -31-S o
Water Sample Test Results k- n 7 5*e-7r - tTV—A.YCVS
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed -gl Size 10 o No. of Compartments 7,
Standpipes6)N) —Air -tight Caps (DN) V Foundation CleanoutOY. N) �
Depression over Tank (YA@ Date Last Pumped
Pumping/Maintenance Contact on File (Y/N) I for
Holding Tank High Water Alarm (Y/N) ►— Temporary Holding Tank Permit (Y/N) t3�
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Well loot To Building Foundation
-To Property Line 1 Z�� To Disposal Field ,S14 -
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course 1 o o ~
Comments
loo' Sf�$Aen1 T>(5!eE
�J t�1'Pf-9 ��a �"1z.(S GI✓ �5 t�� PJM P(,�G ' . .
72-026 (Rev. 7/88) Font Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 1 �S 'J — Type of System Design 'T -9-;C-. to ,
Date Installed 9 7 -qo Length of Field
Width of Field. 3�`� Depth of Field Ot
Gravel Bed Thickness �•S
Square Feet of Absortion Area g9S� Statndpipes Present 6)N)
Depression over Field (YO Date of Last Adequacy Test t Ar
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well 104 To Property Line 10 ~
To Building Foundation to I} ` To Existing or Abandoned System on
Lot t o� On Adjoining Lots Sat }
To Water Main/Service Line To Cutback (if present) f
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Dat Installed `
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for_
Meets MOA Electrical Co I•
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off e e
Vent (Y/N)
Pumping Cycles during Adequacy Test.
"Check Permitted Bedroom Rating Against HAA Request'
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this
inspection.
Signed S & S ENGINEERING
17034 Eagle River LwV Rudd No.;ju.4
Company 577
Date a
MOA No. o 00
Receipt No. �'� % y �3 049 7 ' , Receipt No.
Date of Payment 7- 'l, — — U Waiver Fee. $
Amount: $ / 7 D
Date of Payment
72-028 (Rev. 7/88) Back Page 2 of 2
+ APPLI(� NT FILLS OUT UPPER HAI`ONLY
Property Owner "rA t� Phone
\
Mailing Address ter) Ar, • ` Zip Code
Beyer C)R1AIv oonnE—(,L ?
Address I Zip Code
Lending Institution n+R n b n
Phone
Address jQ )T cc -w E ,LL ZlpCode
Realty Co. S Agent r'UL 1.n N 0
Phone
Address 0 nlJ 1 • ) Zip Code qC r
8
Leg al Description,- ----
}-t--,r- 1_S g 3 �eF � tY�►�� ES ► /STC S s'?Q/moi �.i'
Street Location
Type of Residence Lam'
X Single Family
❑ Multiple Family No. o1 Bedrooms
❑ Other
Water Supply
)< Individual
ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975.
❑ Community
For wells drilled prior to that date, give well depth (attach log If available).
ity
1111 1
Year Individual Installed:I�1�>I/ I
ity When Connected to Public Utility:
A
nk
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
Field Notes:
APR O 5 10
"Munidpatlity of Anchorape"
"Dept o/ lieft &
( ) APPROVED BEDROOMS
*CONDITIONS OF A jFmiu l ftftft-
( ) DISAPPROVED
( ► CONDITIONAL APPROVAL'
DATE
BY:
Soils Rating
Date Sewer Installed�/
Well To Absorption Area
Well Log Received
-*, r'�Vj
Well to Tank
Septic Tank Size q-�
t1000 d
nazi 118T
a
V? YT P.O. BOX 754
EAGLE RIVER, ALASKA 99577
1�{� ® '• �,I '(907) 694-2131
�jJ•41!
6.l nc�j" az C � \ y �. ,y�,/ 70NY KNUWLES.
�
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
April 7, 1983
*Terrell Bailey
General Delivery
Eagle River, Alaska 99577
SUBJECT: Lot 5 Block 3 Deer Park Estates
Approval for the individual sewer and water facilities cannot be
granted until the following items have been completed:
The top of the well casing sealed with a sanitary seal so that it
is water tight and no exposed access holes.
Exposed electrical wires to the well head are in violation of the
Municipality of Anchorage codes and must be encased in conduit
attached to the well seal.
Please notify this department for a reinspection when the noted
descrepancies have been corrected. If there are any further
questions, please call this office at 694-2131.
Sincerely,
64sBi chholz
Environmental Divisio
Eagle River Office
EXCAVATION
ERA Finis Realty
ATTENTION: Carolyn
Mile 20, Old Glenn Iiighway
Chugiak, Alaska 99567
WORK
r
February 15, 1983
ROBERT A. SHAFER
CIVIL ENGINEER
694.2979
Dear Carolyn,
Reference: Dailey Property; Lot 5; Block 3: Deer Park Subdivision
A sewer system adequacy test was performed on the system located
on the referenced property as you requested. The septic tank was
pumped and verified to have a capacity of 1000 gallons. The
absorption trench was tested by a continuous flow of water over
a period of 48 hours without any adverse effect on the system.
It can be concluded from this test that the waste water disposal
system serving the three bedroom residence located on this property
is currently functioning adequately. However, the system cannot
be guaranteed against subsequent failures.
If we may be of further service, please do not hesitate to contact
US.
Sincer ly,
I� E P A. FER, P. E.
S/ss
cc: Municipality of Anchorage
Department of Health and Environmental Protection
MUNICIPALITY OF ANCHORAGE
DFPT Or ,,T • ''
ENVIR'.Y1:.'.:I.:A... .0 = TION
F31 8 1933
RECEIVED
SRB 196X EAGLE RIVER, ALASKA
10 ft�A
Time ,e
Date Date Date
Inspector Inspector Inspector
r
Date Sewer Installed �-� � Permit No. Septic Tank Size � d)O o
_ S I Holding Tank Size
Soils Rating Well To Absorption Area 10 Q Well Log Received
Well to Tank Gf'V
APPLICANT FILLS OUT LOWER HALF ONLY
Property Owner 161Z7Z&// W 6!//1-1 ry g- ;?/yy
Mailing Address GE•v • D&-1 . EP 61- E Rj ✓EiZ , ,A� 5 Si % B-/ 3 SA w
Address
Lending Institution HZ 1151'V'H A7 U / u"4c- /-5 /-' A/ "N Phone
Address 'AGC -F 7
Realty Co. BAgent Phone
Address
Legal Description VeerL ;FS?,q SZV•
Street Location ZRN E
Single Family 10�
❑ Multiple Family No. of Bedrooms
+ ❑ Other
1J Individual
ATTACH WELL LOG. A well log Is required for all wells drilled since June
❑ Community
1975. For wells drilled prior to that date, give well depth (attach log If
❑ Public Utility
available.
Sew�pe Disposal
/ S
'❑ Indlvidual
Year Individual Installed:
❑ Public Utility
When Connocted to Public Utility
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
i
March 15, 19£12
Terrell 41. Bailey
General Delivery
Eagle River, AK 99577
Subjects Lot 5 Block 3 Deer Park Estates
Approval for the individual sewer and water facilities cannot
be granted until the following itens have been completed:
• A well log submitted to this office for our files and
review.
° The depression or pit around the well casing needs to be
filled with impervious type soil so that it slopes away
from the well casing.
° Exposed electrical wires to the well head are in violation
of the Municipality of Anchorage codes and must be encased
in conduit.
° The water analysis report needs to be submitted to this
office from the Chem Lab, 5633 B Street, for our review.
Please notify this department for a reinspection when the
noted discrepancies have been corrected. If there are any
further questions, please call this office at 264-4720.
RP59/p/Eli
Sinc ely,
C'(
Robert C. Pratt
Associate Environmental Specialist