HomeMy WebLinkAboutPREUSS #3 BLK 6 LT 1Preuss #3 Block 6 Lot 1 #050-571-28 Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191223 PID Number: 050-571-28 Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade Name: Name:ON BARNES JAMIESAddress ABSORPTION FIELD - EXISTING ® Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound 20252 LUCAS AVENUE, EAGLE RIVER, AK ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 4 0.6 GPD/SF JTotal 9 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2 Ft. Gravel depth beneath pipe 7 Ft. Subdivision Block Lot PREUSS #3 6 1 Fill added above original grade VARIES 3.6 - 5.6 Ft. Gravel length 80 Ft. Township Range Section Gravel width 3-5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES Tol Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 1120 Ft' Ft. Well 1001+ 1001+ NA NA NA TANK ® Septic ® S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCHORAGE TANK Capacity 1500 Gal. Surface Water 1001+ 1001+ NA NA Material STEEL Number of compartments 2 Lot Line 5'+ 10'+ NA NA NA Foundation 10'+ 10'+ NA NA LIFT STATION Manufacturer ANCHORAGE TANK Capacity 1500 Gal. Curtain Drain i NA I *NA NA NA Remarks Existing septic tank decommissioned Pump on level at 44 in. Pump off level at 42 in. High water alarm at 48 in. per UPC. Deep burial tank. *None known. Pump make and model Electrical 1. Sia(kee. y Franklin 2445040117— 1/2HP;5� u Installer MIKE N. ANDERSON PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Drainfieid 3034 Co/MT 3034 Inspector MNA BENCH MARK (Assumed elevation) 99.5 ft Inspect 1" 7/22/19 7/23/2019 Location and description es: 2nd 3`d 7/24/19 4°i 7/24/19 BOTTOM OF SIDING COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Conditional Approval: Date *�49 THWN MICHAEL N. ANDERSON- fA No. CE 9469 w 7/26/ 1.9 .. c Approved . _.. �,,.. �` - Date 7 y' mspecuon mepoq_ra- i- iz.aoc PREUSS #3 BLOCK 6, LOT 1 PID: 050-571-28 PERMIT: OSP191223 PREPARED FOR: �)ur-rvK i®�tKviut�: JAMIESON L. BARNES �, OF 4,, ' PREUSS #3 BLOCK 6, LOT 1 20252 LUCAS AVE., EAGLE RIVER, AK 99577 * 4 TH 9 Michael N. Anderson, P.E. DATE:MICHAEL N. ANDERSON 7�26�2019 ¢ No. CE 9469 4661 Natrona Ave. Ja DRAWN: FWCS E3p� 7/26/19 U: Anchorage, Alaska 99516 0 (907)727 8864/FAX: (907)345 1391 SCALE: 1" = 30' p�FESS[O�I+V dV JI.HL L� 1 - JU A -D=26.8' B -D=25.4' A -E=35.9' FCO CO CO MH � MT MT MT FINAL GRADE B - E = 2 8.7' 99.7 99.8 CO 102.7 104.7 99.1 ORIGINAL GRADE RELATIVE ELEVATION A - F = 4 2.3' 93.98 FILTER ORG 1976 TH B -F=27,5' FABRIC 2.O ML A-0=68.3' 93-4/ N 87.1 97_1 6.0 GM B-0=47-2' DEEP BURIAL STEEL STEP SEWER ROCK SP B -H=36.6' 90.1 90.1 It TH 1989 DRY C -H=38.2' a BOH CM 85.1 SEPTIC SECTION 841 DRY 7/1976 SCALE: NTS PREPARED FOR: �)ur-rvK i®�tKviut�: JAMIESON L. BARNES �, OF 4,, ' PREUSS #3 BLOCK 6, LOT 1 20252 LUCAS AVE., EAGLE RIVER, AK 99577 * 4 TH 9 Michael N. Anderson, P.E. DATE:MICHAEL N. ANDERSON 7�26�2019 ¢ No. CE 9469 4661 Natrona Ave. Ja DRAWN: FWCS E3p� 7/26/19 U: Anchorage, Alaska 99516 0 (907)727 8864/FAX: (907)345 1391 SCALE: 1" = 30' p�FESS[O�I+V dV July 26th, 2019 Rising Son Electric Services LLC. 36784 Eklutna Lake Rd. Chugiak, AK 99567 (907) 622-6777 Re: 20252 Lucas Ave Eagle River, AK 99577 Two whom it may concern: The lift station at the above referenced address has been wired in accordance with NEC and State/Local codes and is wired to the manufactures standards. Please contact Dakota Keller with Rising Son Electric Services LLC with any questions or concerns at (907) 622-6777. Thank you for your business. Sincerely, Dakota Keller, Owner Administrator License Number 2065 Specialty Contractor license Number 38497 (907) 622-6777 0 C N 0 m� f d ("'� 0 WELL ASPHALT DRIVEWAY 2I 2.009.4' bA 0 38.0' 01 O 0 1.7'x2.6' CANT O 10.3'08.3' p DECK LO Lri I I 25.0' II I `'SOAP LUCAS\4VENUE Lot 1 22,922 S.F. 77.5' I T N w MR Lot 6 N 89'59'00"W 191.02' Lot 2 10' UTILITY EASEMENTS � I Lot 7 PLOT PLAN AS BUILT -2L- SCALE —!L= GRID NW 0056 Project No. 19-356/A1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates inc. (907) 522-6476 Phone 0 (907) 522-4625 Fax oo�o A / 0�4 Professional Land Surveyors kenOlongsurvey.com c —' ., q Q jonathanOlongsurvey.com �0 �,.•' A • .• % I hereby certify that I have surveyed the following described property: DOS`.' LOT 1, BLOCK 6, PREUSS SUBDIVISION - UNIT No. 3 (PLAT No. 71-91) 0 ` 49TH �* Anchorage Recording District, Alaska, and that the Improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that PA no Improvements on the property lying adjacent thereto encroach on the surveyed O'p ....KE �AN6'� premises and that there are no roadways, transmission lines or other visible ^�� easements on sold roe except as Indicated hereon. Dated this the ZPk p Da of C, a0 "� ' •.S- 5202.•' y� � Day ZJ 'I , at Anchorage, Alaskad04 0oR�a510NA� wo It Is the responsibility of the owner to etermine the existence of any easements, DOOONXL covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP191223 Work Type: Septic Upgrade Tax Code Number: 05057128000 Site Legal Address: PREUSS #3 BLK 6 LT 1 G:0056 Site Mailing Address: 20252 LUCAS AVE, Eagle River Owner: BARNES JAMIESON L Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: ent o� �l r t�epartmenf 6/21/2019 6/20/2020 22922 Q Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: The entire drainfield is not within the 30 ft radius of a percolation test. A percolation test shall be completed at time of construction of the drainfield to the drainfield sizing. If results require a design change, construction shall stop pending Onsite review and approval of a change order. Please submit results with the inspection report. Received By: Date: Issued By: Date:64?1� 121 �,vcnt .S Municipality ®f Anchorage P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 a Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Section * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV191045 COSA#: PID#: 050-571-28 Legal Description: Preuss #3 Block 6 Engineer: Mike N. Anderson Applicant: Jamieson Barnes Permit#: OSP191223 Your request for a waiver of the required 14.0 feet horizontal separation from the proposed absorption field to the existing absorption field has been approved. The approved separation distance is 9.0 feet. See engineer's waiver request for justifications. 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. ............................................... ■ ............................. ■ I Waiver is Granted: X Waiver is not Granted: Date: (oX9 Approved by: (� Name of Reviewer ............................................... ■ ............................. ■ 1 **** VARIANCE/WAIVER REVIEW **** I MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTICIWELL PERMIT APPLICATION Parcel I.D. 050-571-28 Property owner(s) JAMIESON BARNES Day phone 9078544700 Mailing address 20229 LUCAS AVENUE, EAGLE RIVER, AK 99577 Site address 20252 LUCAS AVENUE, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) PREUSS #3 B6, L1 Legal description (Township, Range & Section) Lot Size 22922 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ® Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank ElUpgrade ® Duplex (D) ❑ Holding Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES REQUEST FOR: nA /WAIVER Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. FVCS - Brent Western (Signature of property owner or authorized agent) Permit/Rush Fees: 595f Date of Payment:(ALIO aI Receipt Number: 6a6 I10 Permit No. Q S Pr Waiver Fees: Date of Payment: Receipt Number: d 3 5 5D Waiver No. () N M (M 5 GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Michael N. Anderson, P.E. Civil/Structural Engineering and Construction 4661 Natrona Ave. Anchorage, Alaska 99516 Phone 345 -3377 / Fax 345 -1391 Support Services Brent M. Western 907-440-4601 June 19, 2019 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK (OSP191140) & FIELD UPGRADE PERMIT LEGAL: PREUSS #3 BLOCK 6, LOT 1 To whom it may concern: The owner has requested we proceed forward to obtain a septic permit to upgrade the septic field on the subject lot. The septic tank was in the process of being upgraded per the referenced permit when it became apparent that the leach fields were saturated while testing and installing a monitoring tube in the northern trench. We also request a waiver to reduce the required 14’ separation to 9-10’ to the existing second trench to be decommissioned with this design proposal. The likelihood of effluent transference between the proposed trench and decommissioned trench is very unlikely given the slower percolating soils and the 9-10’ separation requested. The proposed trench is more likely to fail in time prior to any trench-to-trench interaction. This excavation showed good soils above the existing saturated field. Therefore we propose to remove the 40’ trench, add sand to elevate existing elevation by 1’ and install a 80’ long by 7’ effective depth pressurized “T” shaped trench as outlined in the attached design. The design is based on the existing test hole data performed in 1989 & 1976. The proposed upgrade will serve the existing 4-bedroom house. The lot and area is served by private and public water and will not impact any of the neighboring properties due to the lot layout. Please contact Brent M. Western or me if you have any questions. Sincerely, Michael N. Anderson, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191223, Rebecca Carroll, 06/21/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191223, Rebecca Carroll, 06/21/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191223, Rebecca Carroll, 06/21/19 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://4vww•muni,orglonsite On -Site 'Wastewater Disposal System Permit Permit Number: OSP191140 Work Type: SepticTank Upgrade Tax Code Number: 05057128000 Site Legal Address: PREUSS ##3 BLK 6 LT 1 G:0056 Site Mailing Address: 20252 LUCAS AVE, Eagle River Owner: BARNES JAMIESON L Design Engineer: AAbtRS0lA C005TRUCT10N + �NGI AEEQ6 This permit is for the construction of: Effective Date: Expiration Date: �aNent 41 n f� V. L tai}artmcttt Lot Size in Sq Ft Total Bedrooms: 5/6/2019 5/5/2020 22922 ❑ Disposal Field © Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: �/6 ` Date: / r Date: �+ ! 4 M UMCPAUTY OF ANCHORAGE Development Services Department \ r� Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-571-28 Property owner(s) JAMIESON BARNES Day phone 9078544700 Mailing address 20229 LUCAS AVENUE, EAGLE RIVER, AK 99577 Site address 20252 LUCAS AVENUE, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) PREUSS #3 B6, L1 Legal description (Township, Range & Section) Lot Size 22922 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (M all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) Septic Tank ® Upgrade F19 (w/wo AD U) Holding Tank ElRenewal ElDuplex (D) El Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. FCS s Brent Western (Signature of property owner or authorized agent) Permit/Rush Fees: 0 (5 Waiver Fees: Date of Payment: 0(1 26!1 0 _ Date of Payment: Receipt Number: 60 q oto 0 Receipt Number: Permit No. QS P rQ l l L1d Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Michael N. Anderson, P.E. Civil/Structural Engineering and Construction 4661 Natrona Ave. Anchorage, Alaska 99516 Phone 345 -3377 / Fax 345 -1391 Support Services Brent M. Western 907-440-4601 April 26, 2019 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: PREUSS #3 BLOCK 6, LOT 1 To whom it may concern: The owner has requested we proceed forward to obtain a septic permit to upgrade the aged septic tank on the subject lot. The proposed upgrade will serve the existing 4- bedroom house. The lot and area is served by a private water and will not impact any of the neighboring properties due to the lot layout. Please contact Brent M. Western or me if you have any questions. Sincerely, Michael N. Anderson, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191140, Rebecca Carroll, 05/06/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191140, Rebecca Carroll, 05/06/19 . Municipality of Anchorage e - ��•� l P.O. Dox 190050 - Anchorage, Alaska 99519.6050 - Telephone (907) 343-&701 - Par (907) SM -8200 4700 Dragnw• Street - Anchorage, Alaska 99507 %�w.munl.org Mayor Mark Begicll Bttll<Llng Safety Division 3/3/2005 Gamess Engineering Group 3701 East Tudor Road, Suite 101 Anchorage, Alaska 99507 Subject: Waiver Request for Preuss #3, Block 6, Lot 2 Waiver Request #WR010044 Parcel ID #050-571-27 HAA# HAO10286 and Pemut # SWO10071 Dear Mr. Gamess: Your request for a waiver of the required 100 feet horizontal separation from the absorption field on Lot 1 to the private well on Lot 2 has been approved. The approved separation distance is 97.0 feet. This waiver approval applies to the existing absorptionfield .to private well separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. - Sincerely, Julie Makela, P.E. Civil Engineer On -Site Water & Wastewater Program Community, Security, Prosperity Municipality of Anchorage George 1. liiterch, dlayor Bttiltlilllg Safety Di- isioti P.O. Box 190650 a 4700 S. Bragaw Street Anchorage, Maska 99519-6650 • (907) 343.8301 h t tp://ttit�r.cl.anc h oragc.nk.us 343-7904 July 9, 2001 Darrel E. & Carmen K. Nagel 20252 Lucas Avenue Eagle River, Alaska 99577-8778 Department of Public VrorlCs Re: Separation Encroachment, Pruess #3 Subdivision Block 6 Lot 1, P.I.N. 050-571-28 Dear Mr. & Mrs. Nagel: The property described as Pruess #3 Subdivision Block 6 Lot 2 recently had the on- site wastewater disposal system and water well evaluated to obtain a Certificate of Health Authority Approval. The engineer performing the evaluation discovered that the well serving the home on this property is being encroached upon by the wastewater system serving the home on Pruess #3 Subdivision Block 6 Lot 1. According to our records you are the owners of Lot 1. The separation is 98.5 feet from your absorption field trench to Lot 2's water well. The required separation distance is 100 feet. This is a violation of Chapter 15.65 of the Anchorage Municipal Code for On -Site Wastewater Disposal Systems. The well on Lot 2 was constructed on August 17, 1978 and the absorption field trench serving the home on Lot 1 was constructed on July 7, 1989. It is the responsibility of the property owner of Lot 1 to resolve this encroachment matter because the well on Lot 2 was in place at the time the absorption field trench on Lot 1 was constructed. Anchorage Municipal Code chapter 15.65.033 requires that all single family homes within the Municipality of Anchorage served by a wastewater disposal system and/or a water well shall obtain a Certificate of Health Authority Approval from the Development Services Department prior to the title transferring. Your property is not eligible to obtain this Certificate of Health Authority Approval until the separation encroachment between your absorption field trench and Lot 2's water well has been resolved. If you have questions of the above, please contact me at 343-7907. Sincerely, D��th amel J. Roth Civil Engineer r. On -Site Services Program ' 019RRF1../VRE[. 36/=S70i.. r � O le C3 �,.rrGl � a— �,• Na Rsam Recdq br L%Mt xhe ❑ COD . c Date of Debve Lilt Postage { at r 1 r Ceroaed Fse ra M1 Retwn Rxelpt Fee Hoiss G f-`nOaesawat RepuYea) O ReiZ O G Tod Pmlap. a Few ru ru Nam. (Plww Ptlnl Clwrly) o b oompbted •y awll r) jr Strwt. Apt. No.; or PO Bos o. ti .Corrok0o Norm 1•ndfor 2 for adOw lsallom •Comp.t. Yore 3.4.."4o. •PMI You n.m."•WMA on M f. of Bde form w 1f W ". stun W. card io WAR11h IN loan b tir e9n10l tlw ttu9p4c•, or 9n til. taxis Y.p.c. Clow not • PWMIL Wre.'R.ftun RSONpt R.9ureNCon til. mb%ioos Dhow to ar kk r wtw. The R.tun R.c.ip W plow b Wf tir erlki. w.s d.et+r.d wd ft,%w d@Ww•a 3. Article Addressed to: 4a. Article tr Darrel E. b Carmen K. Nagel 1 7095 20252 Lucas Avenue Eagle River, AK 99577-8778 P`ws�3 Tato W 5.V fved By. (Print Name) Fa r— n .. a t, r, 1� (l. Sip?": (Addresses Or Ayer / PS Form 3811, December 1994 I deo wish to receive the following ser Aces (for an extra foe): 1. ❑ Addressee's Address 2. ❑ Restricted De9very Consult postmaster for tee. 0007 1 Registered ® CertHw le Express Mal ❑ Insured Rsam Recdq br L%Mt xhe ❑ COD Date of Debve Addressee's Address(ONyNrequssNd at and fse B paid) 1 102595-97.8-0179 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES 03--o _ 5-7 _ 2 Environmental Health Division 825 `L' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name �� e:. DISTANCES ,Lddre„ TO SEPTIC ABSORPTION TANK FIELD WELL Pnonels) Permit No. or Bedrooms WELL I 1 p IZ�p r effi c$ "i- LEGAL DESCRIPTION LOT LINE � 1 I� Lot I BIOCM � On FOUNDATION Townsni0. Range. Section AS -BUILT DIAGRAM (Snow IOOSIGin of well, sept, system, p,opeey Ines, founostIon, driveway. water Eod is. etc) TANKS 54- SEPTIC ❑ HOLDING Manu adorer capaoty In gallons I ?--Is Material No, of cq-P&nman4 Z `( TYPE OF SYSTEM 1' FRENCH ❑ BED ❑ W. DRAIN ❑ OTHER ellt Depth 10 PPO bottom from / TOW oeptn Itw Original graos original graor FT Q FT u FIN aooeo abaw aigiMl,grada 1 Gr" depth b"01111 PIPS FT FT t a Grab ver ngm ) G'"width( O FT Z as FT Total absorption area q Dstan,e bet~ Ines E � 1�� SO FT I L� FTif a Number of Fees Sal rating Pipe "laurel ( E Z Z?� SO FT may( O Instar le Insisted '1-9 - gi WELLS 1 .L ,)8::1ERIVATE ❑OTHER (Iden01v) � Claaaibtabon (AB.C) Tots, DepthCased to I44 'o' t�pc\rZ FT FT I '516— Installer Instalbl Dale Inalalao. I Z Q l REMARKS: W Stale: ( �1 $F`AL ....... Inspections by: +.'► OFf Data. 81 tie I 37naA Eeple River Loop Road No. 2(W")Sty the thy Inspection was performed according to ell • •...... �R� QjY�r Alsslas 99577 d.LtN� A. 3.leycr Municipal s1f iA yVroalnls in eltect dee • �, •a• No. 1<J74.# •t 't a D sera ALppR •.., a.r+ health Department Approval: nate: Ely t1.LV �cI��FESSlCT1 •*• 12-013 (3155) M U IJ 1 L 1 P H L I T Y O F A N C H O R A G E Department of Health & Human Services 825 L Street, Anchorage, Alaska 99501 343-4720 O N- S I T E S E W E R P E R M I T Permit Number: 890040 Upgrade SwA 9 CO Ng Date Issued: 04/19/89 Engineer Designed Owner Name: ALASKA HOUSING FINANCE CORPORATION Day Phone: Owner Address: 520 EAST 34TH AVENUE 561-1900 ANCHORAGE, AK 99502 Parcel Id: 050-571-28 Lot Legal: Subdivision:'PREUSS #3 Lot: 1 Slack: 6 Section: 3 Township: 14N Range: 1W Lot Size 22920 (sq.ft. or acres) Max Bedrooms: This Permit: 4 Total Capacity: 4 SEPTIC TANK: Minimum total septic tank capacity: 1,250 gallons. Each septic tank must have at least 2 compartments. Depth to top of septic tank(s) < 4.0 feet requires insulation over tank(s). INFORM D.H.H.S. PRIOR TO IST & 22ND INSPECTIONS BY ENGINEER, IF AFTER OFFICE HOURS, CONTACT 343-4681 AND LEAVE A MESSAGE. CONSTRUCT PER ENGINEERS ATTACHED APPROVED DESIGN. THI£i PERMIT EXPIRES 12/31/89 AND VALID FOR A SINGLE FAMILY HOME. I CERT"IFY THAT: 1. I am familiar with the requirements for on-site sewers; and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 4 bedrooms. I also understath t the capacity of the total system is 4 bedrooms and any enlarge nt wrequire additional permit. Signed: (Owner) Issued By: HOUSINGG% FINANCEE CCOORPPORATION DATE: -cy-! f-1- /e - DATE: T 0 Y U PERFORMED LEGAL DESCRIPTION: 1_- f P—. OiL 1 p:o Net Time 2 •a ; 9- c1- 10 10 va 3 i ZIrt- 12 r .. +•fit..+. ` ^ tr' 4 14 •o so 15- 516171819 Pr" 4 a 2 - 5 17- 18- '91 / o Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST 5. 1p Township, Range, Section: - SLOPE M ro t 7 225"te�2— COMMENTS SRS WAS GROUND WATER ENCOUNTERED? 1\40 S IF YES, AT WHAT L DEPTH? O P E Depth to Water liner Monitoring? _ Data k oe 1�a1-'- Reading Date PERFORMED BY: Eanle River, Alaska 99577 ACCORDANCE WITH ALL STATE AND MUNICIPAL 72-008 (Rev. 4/85) r PLAN _ 7° Net Time 9 � d 9- c1- 10 10 2 11 i ZIrt- 12 b-� .. +•fit..+. ` ^ tr' 13 14 'i so 15- 516171819 Pr" 4 a 2 - 16- 17- 18- '91 20 COMMENTS SRS WAS GROUND WATER ENCOUNTERED? 1\40 S IF YES, AT WHAT L DEPTH? O P E Depth to Water liner Monitoring? _ Data k oe 1�a1-'- Reading Date PERFORMED BY: Eanle River, Alaska 99577 ACCORDANCE WITH ALL STATE AND MUNICIPAL 72-008 (Rev. 4/85) r PLAN PERCOLATION RATE Zc> (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN --4(349� FT CERTIFY THAT/Tr IST WAS PERFORMED IN ON THIS DATE. DATE: �/ iI Gross Time Net Time Depth to Water Net Drop c1- 2 ZIrt- 'J 3 L�iO .. +•fit..+. ` ^ 'i so o Pr" 4 a 2 - PERCOLATION RATE Zc> (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN --4(349� FT CERTIFY THAT/Tr IST WAS PERFORMED IN ON THIS DATE. DATE: �/ iI j GREAt;ER ANCHORAGE AREA BORuJGH n Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 NSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME MAILING ADDRESS 1� PHONE LOCATION o._.� ate- LEGAL DESCRIPTION _4- z (o _PLS Q SEPTIC TANK: DISTANCENUMBER OF Z FROM WELL MANUFACTURER MATERIAL COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH I (QUID CAPACITY 'Z -$-b GALLONS. SEEPAGE PIT: NUMBER OF PITS DIAMETER —OR WIDTH DY LENGTH _�L{ DEPTH C LINING MATERIAL CRIB SIZE: DIAMETER —DEPTH— DISTANCE FROM: WELL. TOTAL EFFECTIVE BUILDING FOUNDATION_, NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT. ADDITIONAL ABSORPTION CO (1" WELL: TYPE CONSTRUCTION DEPTH BUILDING NEAREST NEAREST SEPTIC FOUNDATION LOT LINE , SEWER LINE , TANK_ CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: Form No. EQ -031 DIAGRAM OF SYSTEM DISTANCE FROM: SEEPAGE SYSTEM G.A.A.B. r s 1_1 1. -1 " "t C_l l" r=, I -A 1-:: t-1 Ill t r ,1 DEPARTMENT ►%v HEALTH AND ENVIRONMENTAL F'POTECTION 2507 E. � UDOR RD. , ANCHORAGE, Fil.. ! ',07 p, 27t;-2221 -- 1'"" 4' - F.4EILL Fir -JC• iDr-J—'-ITE EL•JEF: F'LF:r1 I T •PERMIT NO. C 76661 ) v l,ve4/ APPLICANT Y KYN S � 1 682-5125 LOCATION LUCAS A LOIS LEGAL Ll B6 PREU'=S SUED LOT SIZE 15200 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: PIT MANIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SC! FT/BR:)= 140 THE REQUIRED SIZE OF THE SOIL AB'_ORPTION SYSTEM IS: C•EF'TH= 11 LEtJGTH-= 24- r;F<:Ati:'EL C•EF'TH= r. THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF EACH SIDE FOR A SEEPAGE PIT. 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 GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). F:E�.!1_1 I F 'EC•-•s=F'T I �C TFIr-JFK 1 I C= 12! CJ Tt.lCa <:a, > I r -J= F~ECT I Or}I!E7 HF -•E F<!FEE C -_1U I F'EC- EACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 20 DAYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'EF:r7 I T %.'nL- I G• F- nF: r_,rJE YEnF;! F-F:clr-1 I �1 1E I CERTIFY THAT 1: I AM FAMILIAR, WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. I (JILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. _. I UNDERSTAND THAT THE ON-SITE SEWER.' SYSTEM MAY R'EQUIR'E ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED;__�n_.n R/="_l! .yC APPLICANT Y __-s�------------- ISSUED EY \ ��%%' =_- =----DATE-_Q-_'524 _-/z F•1 L1tJ I r I F nL_ I TY (GF HtJ(--HC,F-:HCiE nn DEPARTMENT �r`' HEALTH AND ENVIRONMENTALMOTECTION `l,00�QiYL L251E E. UDOR RD., ANCHORAGE, AK. S_S07 276-2221 WELL FitJF? C1tJ-'>ITE A>E44EFQ F•EFQF`1ltz PE r T NO. C 76503 ) APPLICANT KEN SHIVELY 7111 CHAPEL DR, CHUGIRK 99567 682-9125 LOCATION LUiH5 h U 5T LEGAL • L1 B6 PRUESS SUB • LOT SI 192 _ SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 5 SOIL RATING f FT1BR)= 140 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: GEF' -r"= 11 LEtJGTH= :" 1 GF2H -IEL EF'T = THE LENGTH DIMENSION IS THE LEN TH C FJ FEET) OF THE TREF,H OF DRAINFIELD. THE DEPTH OF A TRENCH OR PIT I5 H D _ ANCE BE JEEP) THE -UF' RCE OF THE GROUND AND THE BOTTOM OF THE EXC VATIOPJ IFJ FEET THERE IS NO "'ET WIDTH FOR TRENCH S. THE GRAVEL EPTH IS THE MINIMUM )EPTH OF RAVEL BE WEEN OUTFALL F'IF'E AND THE BOT ON OF THE EXCAVATION (IN FEET)' F<_Era�_i I FS O QEF T I T 04 V& G E_ �C7Ey Ci LO 45 BACKFILLING O ANY SYSTEM WITHO T FI JAL INSPE ION AND R PROVAL :Y THIS DEPARTMENT WI L BE SUBJECT TO PF. SEC ITIOFJ. MINIMUM DISTA ICE BETWEEN A WELL A JD NY ON -SIT SE4IAGE DISF iSAL S!,TEM IS 100 FEET FOR PRIVATE WELL OP. 20 F T FOP. A ZOOMS WELL LOGS ARE REQUIRED AND MUST B RE URNED T THE DEPAR HENT I THIN 30 DAYS OF THE WELL JPIPLETION. SPECIFICATION- AND CONSTRUCTION DIAGRA1S ARE VAILABL TO IF SURE PROPER, INSTALLATION. F'EF_M I T '%0nL_ I F7 F= CJFR C1tJE TER F= Cit'1 I SLUE I CERTIFY THA 1: I AM FAMILI R, WITH THE REQUIFEMENTS FOP, ON SITE WERS AND WELLS AS SET FORTH BY THE MINICIPALITY OF AN HORRGE. 2: I WILL INST L THE SYSTEM IF ACCORDANCE ITH T E CODES. 3: I UNDERSTAND THAT THE ON -SI E SEWER. SYS M M ' REQUIRE ENLARGEMENT IF THE RESIDENCE IS REM DELED TO INC JDE MORE TH 15 B DROOMS. SIGFJED:------------- ----- -- APPLICANT K S ELY_ - ISSUED BY -_1J± _ CL �" `"" I ------ _J) TE_ _� 0 Ef E GEO. CCHNI CAL & DEVEL:,PMENT CO. ` Box 90, Davis St., Eagle River, Alaska 99577 694.2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 Soils Et Foundations Land Development Performed for: Name:mt<. \<4-.) Tel. No. 68g'�► Mailing Address:_%111 Cv AP4L 721 �.0 tq\ilaµ �lcjsa{�7 Legal Description: L(S-%; -N `r vc�r—� (a �c�v.ESs -4;!.0 .sn Depth (feet) Soil Characteristics 0 1 �tr"• �.�—; ......... 2 3 4 GM- S\�cY �r,�D(�ocAJ2� �7/Cs�6F5�5 -o lot t 5 6 7 8 9 10 12 13 MJ-D%UM SL':r,L —� (� %rzoe Co "', -QCT e 1!L---.- 16 tZ Ground Water Encountered: Yes No If yes, what depth Proposed Installation: Seepage Pit Drain Field Comments: Nc M4ASH:�4a l�TT2ox\M�A�«�1 �ot I'?� Performed by: Date: vw \°\i% .f M -W DRILLING, INC.0 3 UU0 DRILLING LOG PMIC1PALTY OF A` a"Y DEPT. O' Ff°, IH F, EWh�Y.:1:"iih N07ZCT JUN 31:77 RECEIVED Well Owner Dan Shivelv Use of Well Tlnm. Location (address of: Township, Range, Section, if known; or distance main roars Lot 1 Block 6 Preuss Subdivision Size of casing 6" nepth of Hole `162 feet Cased to 461 .6 feet Static water levet ft. (above) (below) land surface. Finish of well (check one) open end ( ) ; Screen ( ); Perforated ( ). Describe screen or perforation 1: /A Well pumping test at 15 gallons per (1 ours (minute) for 1 ►ours with 1 nn tt, of drawdown from static level. Date of completion 3V25/77 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 0 TO 2 --2—TO 20 20 TO 22 22 , 60 60 TO GO 'O TO 165 165 1.0190 190 rn = 220 TO 328 3283 TO329 329 TO?.50 350 TO 370 370 TO43 4P TO441 nat TOA c;7 Casinn Stickiin Silty rravpl Siltv aravel and cobbles Silty aravel and cobblps Gravellv hard pan and bnulrler!� Gravellv hard pnn and cobble,, Loose aravel Gravelly hard pan Hard Pan and cobbles MXY. Rnvlrior Grrvelly hard nan NWWA Certified Contractor Loertlitcate Nos. 614 & Jr 2 —STATE /.'_) M -W DRILLING, INC.(J DRILLING LOG VPJNICIPALITY OF AN O DEPT. Or HEALTH F, iNv1ROt:YZNTAL KOTcCTI^,.4 ,!UPI 61977 RECEIVED Well Owner Dan Shively nrne 2 Use of Well Location (address of: Township, Range, Section, if known; or distance main road Size of casing Depth of Hole feet Cased to feet Static water level tt. (above) (below) land surface. Finish of well (check one) open end ( ); Screen ( ); Perforated ( ). Describe screen or perforation• Well pumping test at gallons per (hour) (minute) for hours with ft, of drawdown from static level. Date of completion WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 1�7 T0460 Plater ran l and riravel. 15 r7nrn 460 T0462 B�rtrock TO TO TO TO TO TO TO TO TO TO TO TO TO lk' l 1,1,'1 Cc+rt't1.•.i r'nntnirtnr Certificate No's. 61$ & W3 2 —STATE MUNICIPALITY OF ANCHORAGE Development Services Department j Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 050-571-28 Certificate of On -Site Systems Approval Expiration Date: t �, , o 9. GENERAL INFORMATION Complete legal description PREUSS #3 BLK 6 LT 1 Location (site address) 20252 LUCAS AVE, EAGLE RIVER AK Current property owner(s) WHARTON Day phone Mailing address SAME 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 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment ��� TO,2 0� a Date of Payment Receipt Number 0 � 1 6 a Receipt Number COSA # 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 fifes 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 MIKE N ANDERSON, P.E. phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 5-24-22 OF '.;Z ••, ,`'.•49TH " 6. DSD SIGNATURE d• • • .... • . .....". r.....s•ra♦••s........e.. 4 V System #1 Approved for bedrooms �¢ VO MICHAEL N..4F:aERVGh:- System #2 Approved for _ bedrooms ��%�.� CET9 9 Disapproved Conditional approval for bedrooms, with the following stipulation'}'�'°►'rsz�.m"� ,ttlltttt(t((lr�,. r o WAST'=v�IATER o PROGFAM n J By: 1y,,U Original Certificate Date: bw 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 Checklist blue sheet COSA Checklist Legal Description: PREUSS #3 BLK 6 LT 1 If more than 1 septic system on lot: COSA Checklist # _of A. WELL DATA M Well log is filed with Onsite (or attached) Date drilled 3/25/77 Total depth 462 ft Cased to 461.5 ft ❑� Sanitary seal is functioning correctly ❑� Wires are properly protected Casing height (above ground) 24"+ in. Date of flow test for COSA 5/13/22 Static water level at beginning of test 369 ft Comments B. TANK DATA Age oftank(s) 2019 years Tank type/material T° Measured operating fluid level in septic tank 42 X Standpipes/foundation cleanout per record drawing Date of pumping 5/13/22 D. ABSORPTION FIELD DATA Which system tested (date installed) 7/20/19 ❑M ALL standpipes present per record drawing Total measured depth from grade 14.6 ft (max) Measured depth to pipe invert from grade ft (min) ❑0 N/A— pressurized field 0 Monitor tubes go to bottom of effective. If not, state depth into effective ❑N Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons COSA Checklist yellow sheet Parcel ID; 050-571-28 Structure served by this system Well production at time of test 3.0+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑O No ❑N Coliform bacteria is Negative Nitrate Arsenic Collected by mg/L Nitrate less than MRL (ND) _ ug/L❑ Arsenic less than MRL (ND) M NA Date of Sample 5/13/22 C. LIFT STATION N Required maintenance completed Age of lift station 2019 years Lift station material STEEL Comments: SEE MAINTENANCE RECORD Adequacy test date 5/13/22 Results Q✓ Pass For 4 bedrooms Fluid depth prior to test 6 in Water added 600 gal New depth 9 in Elapsed time 1440 min Final fluid depth 6 in Absorption rate 600 gpd Any rejuvenation treatment (past 12 months) 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' Q Yes Community Sewer Manhole/Cleanout > 100' ft Wells on Adjacent Lots.- ots:Water Q Yes if No ft M Yes if No ft Neighboring Tank > 100' �y�y- MND Yes if No ft if No ft Community Wells > 200' Surface Water > 100' Yes if No Private Sewer/Septic Line > 25' F✓ Yes if No ft Absorption Field on Lot > 100' QQ Yes if No ft Holding Tank > 100'[}✓ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Yes if No ft 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' [✓ Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No ft Private Wells > 100' ® Yes if No ft tiny ,1c, ,;.. n ....., f�,u,,, - ,, v Yes if No ft Gomm��nity Wells > ?0 _ - 0' �✓ Yes if No ft Water Service Line > 10' ® 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' 21 Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots.- ots:Water WaterMain > 10'✓[] Yes : if No ft Private Wells > 100' Water Service Line > 10'✓Q Yes if No ft Community Wells > 200' Surface Water > 100' Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that l 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 U Yes if No ft [] Yes if No ft EN s 0 :. • ►4t� A TRSON ; $; . CE - 9469 :: s MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Lift Station/Pump Vault Maintenance Log rn1 Owner Street Address 2WS-Z �-UC.GS rule Septic Tank: -Sludge level inches -Pumping: required yes n -Pumping completedev s no Lift station: -Pump basket cleanedSeno n*Effluent filter cleaned es no -Control floats cleaned -Proper float settings confirmed es no -Operation satisfactory es no Alarm Svstem: -Dedicated electrical alarm circuit es no -Audible and visual alarm inside dwelling a no -Alarm system operation atisfactory not satisfacto Manhole Riser -Ground water intrusion at riser to tank connection yes n -Ground water intrusion around pipe penetrations yeso -Manhole lid: Functional (& no Insulated es no Other -Weep hole functional es no Properly Secured es no -All manufacturer required inspections and maintenance completed Comments: Qualified Maintenance Provider: Technician Lj-j t­r� t j (2c,, -\J5 _)e— Company e— Company �, 4-4-; Sexy \ eL v5 Signature es no Date of MUNICIPALITY OF ANCHORAGE 0 Development Services Department _7 On -Site Water & Wastewater Section Certificate of On -Site Systems Approval Parcel I.D. 050-571-28 1. GENERAL INFORMATION Complete legal description PREUSS #3 BLOCK 6, LOT 1 Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: 10_ JD` pct Location (site address) 20252 LUCAS AVENUE, EAGLE RIVER, AK 99577 Current property owner(s) JAMIESON BARNES Day phone Mailing address Real estate agent 20252 LUCAS AVENUE, EAGLE RIVER, AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. p vasµ COSA Fee $ 4 '10; V11 -Waiver Fee $ Date of Payment �� Date of Payment Number Receipt p �����.� Receipt Number, COSA # 06 C IQ f n(D 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 ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377 Address 4661 NATRONA DRIVE, ANCHORAGE, AK 99516 Engineer's Printed Name MICHAEL N. ANDERSON, PE Date 7/19/2019 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic ` applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, AW OF / �� "' ryS� 1 local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory * : 4 9 MW ,/ for current or future occupants or guarantee that no unseen encroachments, deficiencies or / discrepancies exist can be given by FWPS and Anderson Construction & Engineering. MICHAEL N. ANDERSON: 6. DSD SIGNATUREAV No. CE 9469 4— System #1 Approved for bedrooms \����•i System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the folio ;\Pll( ON-SITE 0 M/ACTT=tA1ATCn By: Original Certificate Date: 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 Checklist blue sheet Legal Description: PREUSS #3 BLOCK 6, LOT 1 Parcel ID: 050-571-28 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 3/25/1977 Total depth 462 ft Cased to 461.5 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 6/5/2019 Static water level at beginning of test 370 ft. Well production at time of test 3.8 gpm Comments B. TANK DATA — 7/20/2019 - NEW 1500 -GAL STEP Age of tank(s) 0 years Tank type/material STEP / STEEL Measured operating fluid level in septic tank ® Standpipes/foundation cleanout per record drawing Date of pumping NA — NEW TANK Structure served by this system Water storage tank volume_ gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate mg/L ® Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) FWCS Collected by Date of Sample 7/12/2019 C. LIFT STATION ❑ Required maintenance completed Age of lift station 0 years Lift station material STEEL Comments: D. ABSORPTION FIELD DATA — 80'L x 2-5'W x 7'ED — 0.6 GPD/SF = 1120 SF Which system tested (date installed) NA — NEW FIELD ® ALL standpipes present per record drawing Total measured depth from grade 14.6 ft (max) Measured depth to pipe invert from grade _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 copy 4.docx Adequacy test date NA — NEW FIELD Results ❑ Pass For 4 bedrooms Fluid depth prior to test — in Water added _ gal New depth _ in Elapsed time min Final fluid depth _ in Absorption rate gpd Any rejuvenation treatment (past 12 months) N 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 ft Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' F. ENGINEER'S COMMENTS Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ft ft ft ft ft ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells >100' ® Yes if No Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No. Water Service Line > 10' ® 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' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No _ ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS OF AL,4 G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review 49 TH of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. ".160.0" MICHAEL N. ANDERSON: No. CE 9469 wQ 7/26/19.••• o� COSA Checklist copy 4.docx` FESSIO�� ft I ft o-°£ 9� • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 s 1 ' Certificate of On -Site Systems Approval Parcel I.D. 050-571-28 Expiration Date: l ® --a — 1. GENERAL INFORMATION Com=' ' legaldescription Lot 1, Block 6, Preuss .+ _._.., _..._ .. _ !#.bcation (site address) 20252 Lucas Ave, Eagle River, Alaska 99577 ib} ' Stacy & Laura Peterson (907) 726-0580 t:° Current Property owner(s) y Day phone Mailing address 20252 Lucas Ave, Eagle River, Alaska 99577 Real Estate Agent Brooke Stiltner @ RE/MAX 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well El Individual Water Storage ❑ Community Class Well ❑ Public VYater System ❑ WaiverNariance request for: Received by: rd Day phone (907) 244-6742 TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ t Lt0 Waiver Fee $ Date of Payment ( 1 )J IX 100 Date of Payment Receipt Number 1(2224-1 3O Receipt Number COSA # OSC-1 J k a K Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pinard Engineering Phone (907) 357-3647 Address PO Box 871347, Wasilla, AK 99687 Engineer's Printed Name Paul E. Pinard, P.E. 6. DSD SIGNATURE _System #1 Approved for bedrooms Date System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following CE -4793 By: azz/ :ice/`V=� Original Certificate Date: The uicipalityof Arte rage nDevelopment 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSAbluesheer r ! - If more than 1 septic system is on the lot: COSA Checklist # of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Lot 1, Block 6, Preuss SUM, Unit #3 A. WELL DATA Parcel ID: 050-571-28 Well type P If A, B, or C provide PWSID # Y Date completed 3/25/77 Sanitary seal (Y/N) Y Total depth 462 ft. Cased to 461.5 ft FROM WELL LOG Date of test 3/25/77 Static water level Not Reported ft Well production 15 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate ND mg/L Arsenic ND ug/L Date of sample: 6/10/13 B. SEPTIC/HOLDING TANK DATA Well Log (YIN) Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. AT INSPECTION 6/17/13 359.6 ft 4.0 9 - p.m -Collected by: Pinard Engineering Tank Type/Material Septic/Steel Date installed 7/9/89 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) Date of pumping 6/24/13 Pumper Denali Pumping rew,l �7:7i�N7:�yl��r7�73�1 No Date installed 7/9/89 Soil rating (g.p.d./f:2 or ftzlbdrm) 225 sf/bdrm System type Trench (2) Length 90 ft. Width 2.5 ft. Gravel below pipe 5 ft. Total depth 10 ft. Eff. absorption area 900 fe Monitoring tube Y Depression over field N Date of adequacy test 6/18/13 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 32 in. Water added 960 gal. New depth 41 in. Elapsed Time: 870 min. Final fluid depth 35 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) None Known If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons _ in. "Pump off' level at Cycles tested _ E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line _ 0 Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? 100'+ On adjacent lots 100'+ 10,0,,'+� S /D On adjacent lots 100'+ 'e+ 7�� Pr/' Public sewer manholelcleanout 100'+ 50'+ Holding tank 100'+ Animal containment areas U oc�e� Manure/animal excrete storage areas 100+ P, t'• SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10'+ Property line 10'+ Water main 100'+ Water service line 10'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water Service line 10'+ Surface water 100'+ Curtain drain NA Wells on adjacent lots 98.5 Absorption field 10'+ Surface water 100'+ Water main 100'+ Driveway, parking/vehicle storage 25'+ F. COMMENTS A separation distance waiver was granted by the MOA with it's letter of 3/3/05 for this lesser separation. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Paul E. Pinard, P.E. Date 6/22/13 COSA brown sheet -1 0-10-1 2.doc BEY. iA�TfBI ------_--LUCAS --_--i_ AVENUE "^" •"n'° g'°"' I 191.02' S890 WOVE LU p WELL ............. o �. �gp o 1 o.. ..... o LD Z sr: ......... N 38,01 45.0' 24. .IEXISTING GARAGEb O6 HOUSE o_ - LU 0 0 I N SD O 25' 'o 0 v7 Ij C. s I I N89' 59' 00"W 191.02' I I I 2 7 UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCAUNG. REPRODUCTION MAY CAUSE ERRORS IN SCALE, GTstimEr SURVEY TYPE SYMBOLS POUIgATIDN As-mur ❑ nm&KOT meucnwE SET REBAR ASPHALT � Ss LT . ❑ PLOT P1.1r1 ... AS-BULT .. , WT S4R1EY ... AIPOGRAMIr O FOUND REBAR 6--0—+ iV000 FENCE CONCRETE WOODDRAINAGENCE Fl A T.. c6e+ER5 SLT Rom ..eve tbs ASSUMED ELEV. *--X—* METAL FENCE ® WOOD DECK PLOT PLANS & LOT SURVEYS NOTE: IT 15 THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL Be TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE SHOWN. FENCES. WELLS, SEPTIC OLEAHOUTS, SIDEWALKS, DRIVEWAYS, ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WH10H DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTiERVWSE NOTED. SURVEY CERTIFICATION��<.v.>.i��ra�, Prepared by PLOT PLAN �►•'�G O ••• Robert E. Johns, Jr. & Assoc. •'' •.•., J~�_�1� Professional Land Surveyors a.r eons a rover ma w r emw een w w w ewt a nT �. vJ •'•' . C-_) 1700 Brink Drive. a.e tl w�ar'aa sera. nw e.., AV ANCHORAGE. ALASKA 98504 Seolel ,� e _ 4�, Ree. Lot $.F. Ree. Plat File No. FOUNDATION AS -BUILT ..a' -9th ... •••••• ••.. + ...., Oote Sur eTaO: 05/30/13 flown DY• REJ DNeeked bJMK AW.• E ANn f, 1•e!r Ma eee 5»" ....... . .... R 'ROGER of m me••e..4 �Y ••i•Y Ej'� OHMS." • Dote Drown: 05/31/13 Gr"` N W056 W.G. 13-225 n�M a '• FpIK 9 UCWRM AS—BUILT t � E enr a, aw1TT wNry art I "' ` ` �� ��j CoA '''••..• •,:: � �i,� �� Legal Da3crlPtlOn: °. �W M^:eja ` ��+>P a ........' Lot 1 BLOCK S eP.n ovw.rFe.e.Ia . wove reser e.eN°"»ee..Aneb.w""" er �.• t1,` ¢aa,an a.��• PREUSS#3 -; PINARD ENGINEERING `•' ,' P.O. Box 871347 Wasilla, AK 99687 (907) 357-ENGR (3647) 1 ADEQUACY TEST LOCATION: Lot 1, Block 6, Pruess Subdivision, Unit #3 APPLICANT: Stacy & Laura Peterson 20252 Lucas Ave Eagle River, Alaska 99577 SEPTIC TANK TYPEl5[ZE: Steel/1260 Gallons, per MOA Records ABSORPTION SYSTEM: Deep Trench, per MOA Records DAILY FLOW: 4 BEDROOMS x 150 GALIBR = 600 Gallons TEST DATA E JOB NUMBER: 13-171 DATE OF TEST: 6/16113 FIELD STAFF: PJ Pinard NUMBER OF BEDROOMS: 4 SCUM: 0.3' SLUDGE: 0.2' NEEDS TO BE PUMPED: Yes XX No CURRENTLY IN USE: Yes XX No Time Flow Rate Volume Cumuladve Volume Septic Tank Septic Tank Soil Absorption System Comments pM (GPM) (GALS) (GALS) Liquid Level " A Level Monitor Tube 1' A SAS Level Monitor Tube 2' A SAS Level 5:45 5.3 - - 4.0' - 2.7' - 0.0' - Start Flow- Meter 80760 6:005.3 80 80 4.1' 0.1' 2.8' 0.1' 0.1' 0.I, 80840 6:15 5.3 80 160 4.1' 0.0' 2.8' 0.0' 0.1' 0.0' 80920 630 5.3 80 240 4.1' 0.0' 2.9' 0.1' 0.2' 0.1' 87000 645 5.3 80 320 4.1' 0.0' 2,9' 0.0' 0.2' 0.0' 81080 7:15 5.3 160 480 4.1' 0.0' 3.0' 0.1' 0.3' 0.1' 81240 7:45 5.3 160 640 4.1' 0.0' 3.2' 0:2' 0.3' -81400 R 15 5.3 760 800 4.1' 0.0' 3.3' 0.1' 0.5' 0.2' 81560 845 160 960 4.1' 0.0' 3.4' 0.1' 0.7' 0.2' Stop Test- 81720 RFrr1VFRv Date Time SAS MTt SAS MT2 6119 11:15 2.9'1-0.5 02'/-0.5AM' `ALL MEASUREMENTS IN FT. TEST: PASSED XXX FAILED COMMENTS: This system was found to be operating satisfactorily, having adequate absorption at the higher level of the SAS. A total of 960 gallons was added to the system for the test (significantly more than the design daily flow). A recovery measurement, taken 12.5 hours after stopping the test flow, showed in excess of 600 gallons was absorbed during that period. Reviewed by: Paul Pinard571D Date: W22113 '7� PINARD ENGINEERING P.O. Box 871347 Wasilla, AK 99687 (907) 357-ENGR (3647) WELL FLOW TEST LOCATION: Lot 1, Block 6, Preuss Subdivision, Unit k3 DRILLER: M -W Drilling DATE WELL COMPLETED: 3125177 WELL DEPTH: 462' STATIC WATER LEVEL (top of casing): 359.6' JOB NUMBER: 13-171 DATE OF TEST: 6/17113 FIELD STAFF: PJ Pinard 1�► Time Elapsed Time (Minutes) Static Water Level Flow Rate m Cumulative Gallons Pumped Remarks 6:15 PM - 359.6' 4.0 - Start Test - Meter 80000 6:30 15 365.1' 4.0 60 80060 6:45 30 369.5' 4.0 120 80120 7:00 45 371.9' 4.0 180 80180 7:15 60 373.0' 4.0 240 80240 7:30 75 374.9' 4.0 1 300 80300 7:45 90 376.7' 4.0 360 80360 8:00 105 377.4' 4.0 420 80420 8:15 120 378.7' 4.0 480 80480 8:30 135 380.4' 4.0 540 80540 8:45 150 382.6' 4.0 600 80600 9:00 165 384.3'4.0 660 80660 9:15 180 386.0' - 720 Stop Test - 80720 RECOVERY 9:40 PM 25 372.9' All well protection features are adequate. 3:00 PM 1065 356.9' Measurement taken the following afternoon. Average Flow Rate: 4.0 gpm Comments: DURING THIS TEST, THIS WATER SUPPLY WELL WAS CAPABLE OF fl PRODUCING 4.0 GPM FOR LIMITED PERIODS. THIS TEST DOES NOT Reviewed by: Paul Pinard NOT CONSTITUTE A WARRANTY OR GUARANTEE THAT THE WATER SUPPLY SYSTEM WILL CONTINUE TO FUNCTION AND PRODUCE AT THIS RATE, Date: 6122113 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. oSoS712-1 HAA# r75 r'�17D Expiration Date: 7 — d .5 1. GENERAL INFORMATION Complete legal description• PULASS 3 L I $ & 1�6'4cation. (site address or directions) 2QZ57 L a iCAS A06, 12$ Current f'ropertyowne'r(s)h&QREr G,4� PMEN PA4EL Dayphone 5,Mailing address 202 5 t L4C&5 s}.tti Lending agency, Day phone Mailing address Real Estate Agent uj1>2Hhenrrr4t Dayphone�a5—/80< Mailing Address tac, LE 1 2y Jb Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 14 3. TYPE OF WATER SUPPLY: Individual Well ' 02-1� Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site (� Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of 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 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 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 Stale codes, ordinances, and regulations in effect at the time of installation. Name of Firm Eagle River Engineering Services 10491 VFW Suite 201 Phone 6 9 y- Sl 115– Address Eagle River. AK�Uoars Engineer's Printed Name r H 2 ST0Ptf612 R. lJooD Date 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the follom Additional Comments Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: — A nom; Original Certificate Date: ,/,-/ �d 40, (Rw. 01J02) Municipality of Anchorage ., • '� Development Services Department � � 'T" " ° Building Safety Division , • , 9 , , ° On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: P(ZEtAo 63 L I L3 6 Parcel Id: 05n 57 /ZS A. WELL DATA Well type w► cur If A, B. or C provide PWSID # _ Well Log &N) Date completed �s�7J Sanitary seal ©N) JC5 Wires properly protected DN) YC5 Total depth —qL2 ft. Cased to t. Casing height (above ground) Z!in. FROM WELL LOG AT INSPECTION Date of test I/Zr/7-7 3 /bt l' Static water level A/ei ayl:'P l fi �) ft. ISS ft. Well production �5 9 P -m. 3.0 g.p.m. WATER SAMPLE RESULTS: Coliform —0--_colonies/100 mi. Nitrate �[ mg./l. Other bacteria _71d_ colonies/100 ml. Arsenic: mg./l. Date of sample: 3/,ol/0ar Collected by: 'forfAl IIAYW Al B. SEPTIC/HOteM TANK DATA Temit y e/Material ' ST, 9 L Date installed '7 1/41 Tank size (256 gal. Number of Compartments Cleanouts ON) YC5 Foundation cleanout N) _YC`> Depression over tank (Y/& _g2 High water alarm (YAW No Date of pumping 3/. //OS Pumper r S C. ABSORPTION FIELD DATA Date installed_VAJJ Soil rating (9+"' or ftp/bdrm) jos System type T QENGff Length ---CLQ— ft. Width 7.•5— ft. Gravel below pipe ft. Total depth 10 ft. Eff. absorption area gO�ft2 Monitoring tube s Depression over field _ALV_ Date of adequacy test 3/ &55 Results (Pass/Fehr P+5S For L bedrooms Fluid depth in absorption field before test _(a in. Water added_�ZQgal. New depth in. Elapsed Timer min. Final fluid depth �5 in. Absorption rate >= gaD g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/ & type) AJO If yes, give date N14 D. LIFT STATION Date installed Size in gallons '/ Manhole/Access (Y/ 'Pump on" level at_ in. "Pum off"I in. High water alarm level at in. Datum Cycles tested , Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: i Septic tank/lift-statim on lot 1/n Absorption field on lot 1 W If Public sewer main + $o Sewer /septic service line It %p r / On adjacent lots On adjacent lots +160 1 Public sewer manhole/cleanout - 'f /Ofd - Holding tank '1"/yp r . SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Zo Property line Z 6" Absorption field /0 r r Water main t / /oD Water service line t- /D Surface water -1-100 Wells on adjacent lots + /OD 1 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1-/D 1 Building foundation r ZO I Water main 'r too r Water Service line '•/' /0 r Surface water d-• fry r Driveway. parking/vehicle storage _ fi 2Z / Curtain drain ' t SO 1 Wells on adjacent lots 9 4•S 1(Se:E w R* o 1 ooYY) dleud; F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name g to rSroPJJM I?- Webb Date 3 /ZZ/o S HAA Fee S a-7-1) . aO Date of Payment Receipt Number (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number nil Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Septic System Advisory Health Authority Approval # 050120 During a recent adequacy test on the septic system for Block 6, Lot 1 of Pruesss #3 subdivision, 55 inches of standing water was observed in the absorption field. This indicates that approximately 92% of the absorption area is inundated. Although this system passed the adequacy test, the remaining life expectancy may be limited. This advisory must be attached to all copies of the subject Health Authority Approval. :4xe' �YB�'s9 �1 a .' Y' vz. • /G D ti u ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 694-08: 1 HEREBY CERTIFY -THAT 1 HAVE SURVEYED THE SCALE] FOLLOWING DESCRIBED PROPERTY: • �~ �Zt OFAtq � . ���r/6?ar�irvo T�o�/, Bim. DATE, AND THAT NO ENCRO M_ENTS EXIST EXCEPT AS J�/�' jr INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRID' •••••• ; e EASEMENTS, COVENANTS, OR RESTRICTIONS Nw•�� i :I WHICH DO NOT APPEAR ON THE RECORDED SUBDI- . D.,en. Merk S.w.rd Ar VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' ••. LS -6918 ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- 4� A.e•.•... ARY LINES. DRAWN �0...��skx MUNICIPALITY OF ANCHORAGE y • �• Department of Health 8 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 l.D.if -G11-Q8 HAAff U,a'Rrif�4(0Ss 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 1; Bloch 6; Paeusd Subdivx64on 03; Location (address or directions) (b) Property owner A,H.F_C #93766 Telephone: (home) Business- 561-1900 Mailing Address 520 Eadt 34th Street. Anchokage. Ah. 99502 (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent JACK WHITE COA(PANY ATTN: Lynda Bannea Telephone 694-5500 (e) Mail the HAA to the following address: (or check here BDG if hold for pick up.) List contact person and day phone number below: S E S ENGINEERING ! 7034-fiag"lwr- oo fa -Road N"04 — Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family bc Number of bedrooms 4 3. WATER SUPPLY Individual WeIDIX Community ❑ Public ❑ Note: If community well.system, must have written confirmation from the State Department of Environmental Conservation attesting to lh legality and status. 4. SEWAGE DISPOSAL On-site 05C 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. YD02s(R". tree) 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 verifyt hat 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. 1 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 & S ENGINEERINj —a 7034 Eagle River I —P k Eagle River, Alaska 99577 6. DHHS APPROVAL Approved for _ bedrooms Telephone Approved Disapproved Conditional Terms of Conditional Approval 7� CAUTION 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 or analyze data before a certificate Is Issued. The Municipality of Anchorage is not responsible forerrors or omissions In the professional engineer's work. 72025(Ra.?M) Back Page 2 of 2 • V'�5�cN1UNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) vP CHECKLIST- FEBRUARY 19f �9 343-4744 Legal Description: _40 6 I A. WELL DATA Well Classification q If A, B, C, D.E.C. Approved (Y/N) —*A Well Log Present (Y/N) Date Completed 3 —2 S — 21" Yield Total Depth.4&2ZCased to_Depth of Grouting Static Water Level 3 Sfi Pump Set At u K Casing Height Above Ground ► f Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot Ito ; On Adjoining Lots / OU t To Nearest Edge of Absorption Field on Lot t 2 D ; On Adjoining Lots 100 t To Nearest Public Sewer Line VA To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot �2 S 't- -- Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA — ; Date / I — / 3 — 89 Date Installed Size - 1,;Z SO No. of Compartments Standpipes (Y/N) yAir-tight Caps (Y/N y Foundation Cleanout (Y/N) -� Depression over Tank (Y/N) Date Last Pumped. /U(� = N e w Pumping/Maintenance Contact on File (Y/N) ti JA ; for Holding Tank High -Water Alarm (Y/N) AIMTemporaryHolding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well' lin' To Building Foundation _7S O �= To Property Line / O + To Disposal Field S ,� To Water Main/Service Line to I To Stream, Pond, Lake or Major -Drainage Course (DO t 1 Comments SepAl St S ti+a� bC�u iN i)= ;rJ e , 1 "JAS 72-M (R«.7M) Fwl Page 1 of 2 C. ABSORPTION FIELD DATA _ Soils Rating in Absorption Strata 5 g Type of System Design Date Installed Length of Field 4o SOS = qO Width of Field • 5 Depth of Field /0 Gravel Bed Thickness 5 Square Feet of Absortion Area rfO0 Statndpipes Present (Y/N) Depression over Field (Y/N) A) Date of Last Adequacy Test �)e ul Results of Last Adequacy Test A46 Ne i„1 SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well / a O To Property Line �� 7 ,r To Building Foundation 40 To Existing or Abandoned System on Lot / o i ; On Adjoining Lots t To Water Main/Service Line / 0 r To Cutback (if present) lA r To Stream, Pond, Lake, or Major Drainage Course / e2c' t To Driveway, Parking Area, or Vehicle Storage Area 't Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Check Permitted Bedroom Rating Against HAA Request' "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this r; Inspection. Signed S 8 5 ENGINEERING Company 17034 Eagle RiverQ�p7Road No. 204 Eagle Date �� MOA No. e� q��3 Receipt No. y 7 Date of Payment r% Amount: $ �Jd . 72-026 (A". 7/66) Beck Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 i ' DATE RECEIVED INSPECTION APPOINTMENTS Subdivision #3 TIME TIME TIME 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS 9:30 a.m. MEET DATE DATE DATE ❑ MULTIPLE FAMILY ❑ Three ❑ Six August 21, 1980 Thurs. INSPECTOR INSPECTOR INSPECTOR O COMMUNITY since June 1975. For wells drilled prior to that date, give well Pratt MUNICIPALITY OF ANCHORAGE DEPT. OF 1'."',LTi 18 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI(W• C 12^tvtJ'ENTAL i.'T=CTtON 825 L Street •Anchorage, Alaska 99501 \\1 1976 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLICUTILITY AUG 18 1980 ENVIRONMENTALSANITATION DIVISION \� Telephone 284.4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER PHONE Clayton/Connie Coonce MAI LING ADDRESS 8 Area, Inc. Realtors, Post Office Box 249 99577 PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE Myrna Johnston/Susan Gallion 694-9555 MAILING ADDRESS Post Office Box 249 99577 5. LEGAL DESCRIPTION Lot 1 Block 6 Preuss Subdivision #3 STREET LOCATION Lucas and Louis Streets 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ®C SINGLE FAMILY ❑ One [Nx Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY 5DC INDIVIDUAL' ' ATTACH WELL LOG. A well log is required for all wells drilled O COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM RX INDIVIDUAL/ON-SITE" 1976 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLICUTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATEDL 72010 (Rev. 8/79) '4� 1 \ 1_ OU _M/'V„Y1J e "-1k� ' MUNICIPALITY OF ANCIIORAGE Mp DEPARTMENT OF HEALTH R ENVIRONMENTAL PRI1N I AITY CF ANCHORAGE Lr OF I'.' `,ETI I \ 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL �; T TION X i 'ra^ ENVIRONMENTAL ENGINEERING DIVISION -' �•. .-...-"�. Telephone 2G4.4720 AUG 18 1980 - REQUEST FOR APPROVAL OF INDIVIDUAL WATER ANDRE&LfEgAVEE)IES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allose ten (10) days for processing. 1. PROPE RTVOtaNER eC n,C Y7.0 IV e I PHONE MAILING ADDHESS C/O AREA, Inc. Realtors, P. 0. Box 249 Eagle River Ak., 99577 PROPERTY RESIDENT (11 ddlerent Irom above) Lucas Street, Eagle River, See map on reverse PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. R:'; TOR/AGENT Myrna Johnston / Susan Gallion PRUNE 694-9555 MAILtNG&DDB oX 249, Eagle River, Alaska 99577 5. LEGAL DESCRIPTION STREET LOCATION Lucas Street,�F. leRver See Map on reverse 6. TYPE OF RESIDENCE NUMBEH OF BEDHOUA15 One El Four ❑ Other $1 SINGLE FAMILY❑ ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY Q INDIVIDUAL' ' ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells (frilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM X3 INDIVIDUAL/ON-SITE" "If individual/on-site,givninstallation date - If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. - NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72010 ( Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ ❑ TWO ❑ THREE ❑ FIVE ❑ OTHER FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLICUTILITY Connection Verified PERMITNUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED e) Co INSTALLER ❑SepticTankor ❑Holding Tank Size: / ASO if Tank is homemade give dimensions: SOILS RATING A � Mp TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL r nn 1, 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Seer Line w Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS r -'APPROVED FOR _ BEDROOMS ❑ CONDITIONAL APPROVAL (letter mus c mpany certificate) ❑ DISAPPROVED DATE -- D / — (on — �O BY /.� / �, / 72010 ( Rev. 6/79) n MUNICIPALITY OF ANCHORAGE.,., DEPARTME?'OF HEALTH AND ENVIRONMENT ! PROTECTION 825 L Street, Anchorage, Alaska •99501 279-2511, ext. 224 or 225 Date Received: April 18, 1977 #1: Time #2: Time A a�()p,yj # 3 : Time Date % Date J -1-M-1701 �1 unS Date Insp I Insp 0,.ftEt Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES L-xj fIv ajb QkLL, AL 4'1dt( 7YLL f4 -ID- n.ud A:_t_t t4. e%cic/ 1. Lending Institution Request: Alaska Pacific Bank Mailing Address: _601 West 5th Avenue Phone: 276-3110 2. Property Owner: Dan Shively Phone: 279-6622/541 Mailing Address: % Don Davis 276-7777 r nop 3. Legal Description: Lot 1 Block 6 Pruess Subdivision 4: Single Family Residence: ( :4 Number of Bedrooms: 4 Multiple Family Residence: ( ) Number of Bedrooms: 5. Well System: Public/Community System: ( ) Individual Well: g Permit # Depth of Well Well Log on File ( ) Construction Bacterial Analysis 6. Sewage Disposal System: On-site System ( :4 Public Utility ( ) Permit # ilnrn0-, InstalleFl -1 (n Installer Septic Tank Size 2 �! �! Manufacturer Absorption Area �j�_ Soils Rate �Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 1 Block 6 Preuss Subdivision Comments: Affadavit Attached: %(1) Letter Attached: ( ) Approved: lqe-C (t- Date: Disapproved: Date: Department Worksheet: 9'� MUNICIPAurt CF Ar:Q Z. MUNICIPALITY OF ANCHORAGE 0EPT• a' trntr,r a [NII:ONtaerU.�l r� x:cilCN DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 APR 18 1917 \ REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES RECEIVED 1. Type of Inspection: CMRO VA FHA CONY f 2. Property Owner: LbAN SN (VC_LV Mailing Address: / Day Phone: 3. Name of Buyer: CiANITO M R 1< �o ,. ,, w �• 66C) A,r rc Mailing Address: Day Phone: 4. Name of Lending Institution:jQLASKA PA(✓%Ft<, �7 Mailing Address: 1e01 W, S Phone: Z710 -.3/ I O 5. Name of Realtor or Agent: rfu Mailing Address: 2910 Ca ST' Phone: ZZL 777 6. Legal Description: 1(,,-7-1. Location: S.F. Ca,.ma Levis ZOCAS 7. Type of Facility to be Inspected: S' 64tf FAr"'LY No. Bdrms. c% &bu'°'1 B. Water Supply Type of Supply: Public Utility Individual wELt- If Individual, number of dwellings presently served 6^ iL If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility Individual (on-site)SfOric If Individual, date of installation 72003(3/76)