HomeMy WebLinkAboutPREUSS #2 BLK 1 LT 11Preuss #2 Lot 11 Block 1 #050-571-17 Municipality of Anchorage Page _L_0 Z DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW 9 2 4040 3 PID Number: OSOSi Nama /�ppyr I.t�l.le� �ry� Wastewater System: ❑ New Upgrade AaRo310 -Dil-VI 7 ABSORPTION FIELD Phone: No. or Bed�Fs: " eep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: (0 Total Depth from original gratle' / GPDrS FI Lot I Block: A nsion: I e -z_ Deplh to pope bottom from ongmal grad 2 Gravel depth beneath pipe FI AG FI Township: Range: Section: Fill added above original gradee / I•S Gravel length: 45 if)'— FI Ft WELL ❑New ❑Upgrade Gravel width: Number of lines: Distance betweenflines ! Ft 2 10 FI Classification (Private. A. C): {Fi Total Depth: Cased To: Total absorption area�7� 'rJd Pipe material: 61 ail 1�'f Ft. Ft. SO Ft P*f" Driller Dale Drilled: Static Water Level. Installer: CC-C-Genl�yl� Date installed: Gj Ft. Yield'. Pump Set al: I Casing Heigm Above Ground TANK GPM Ft FI. SEPARATION DISTANCES Septic ❑Holding ❑S.T.E.P. To Septic Absorption Lill Holding PubliclPrivate Manufacturer: Capacity In gallons: From Tank Field Sutton Tena Sewer L.ries wM .a+ ry E 1�+ t Ono Well 1050, 100/ �. 2Sf Maler5:��, Number of Compartments: SurfacWater lacca- IC04- '" -- — LIFTSTATIO Lot^ / / Size in gallons: Manufacturer: Line 1 I t r' Foundation /-/ lot ^ 'Pump on" level at: " um off' level at: High water alarm at: Curtainks� O"6 Pump Ma ked el I Electrical Inspections performed by: Drain Remarks: Lj BENCH MARK 1 G`.Ot-��ki.kT HIT-=� •'l7i to+J Location and Descrtpbon: C7e� r �l,l�- 6 L.,.D lztc�c%► Gtl aon/cfo Assumed Elevation: n - too Ft S' [J ��Gvl / % 54k//D /7/IJ�vf EN+INEF�R'S SEALI .wi .Y E OF A�i,� i tea, vG W ✓ lCGrav✓G h�P� .•g•'f-i,.9If or �r S R S ElIGINEERING Inspections performed by: U034-ragle Riveroop Road3K;1st S"IP�-�i� •• ••••••••••�- •j••• EagleRlver,Alaska99577 2nd i•• "• '••"•"•`•~ts` . I RobaA A. Sbafe- ./ Department of Health and Human Services approval r`", �., 8-91 l�\ Reviewed and approved by: Date: y -------------- M-0140 (A. 9191) MOA 25 . Permit No. SW920403 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 a Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report on tree c! tonlvtcln.l n, nnv r nr. . pt!on: ---- ---- - - ---- 001 FATAL GRADE MTI CO2 110.2' 108.8' W 1000 AL 105.8' SEPTIC; SR 105.5' SP SCALE 1* - to PID No.: 106.6' FINAL GRADE `1 103.1' '_98.1' A 94.1' WATER FOUND !-013 A (Rev. 9/91) MCA 25 DAVID AVENUE NEW 1000 GAL C01 9' 25.5' SEPTIC TANK CO2 22.5' 14' qE ' TRENCt E CO3 43.5' 48' cmcot 3 BDRM C04 40.6' 12' ` W1 HOUSE C05 49' 42.5' �_ MTI 21.5' CO2 MT2 40' 11. 11.5' DECK (b N y�4NE%SSEAL �g (tov or vEt a y: ET i t %%'t.'4 �Yd ; o. 1 0 .... .., �s -i WELL ,��P� WELL{7 l OF 10- U'1'IL E MT. .. .............. ----- ---- ----- ---/-- 1457-2 4'-w ". t' . M' SCALE r� ,.�. •�,\•�tQ� � Pip••......• p�. .. !-013 A (Rev. 9/91) MCA 25 A./ May 29, 1993 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAX 694-1211 RECEIVED HEALTHAUTHORITY APPROVALS JUN 31993 Municipality of Anchorage htu,uapalltyofAnchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES Dept. Health & Human Services SEWER &WATER P.O. Box 196650 MAIN EXTENSIONS Anchorage, Alaska 99519 SEWER & WATER INSPECTION REFERENCE: Pruess Subdivision 12, Block 1, Lot 11 ENGINEERING STUDIES ANDREPORTS A Conditional Health Authority Approval (HAA) was issued on December 21, 1992, for the referenced property. All work WELL INSPECTION required for the Conditional HAA has been completed. & FLOW TEST Attached is the On-site Wastewater Disposal System and/or Well Inspection Report for your approval. We request you issue a Final Health Authority Approval for the referenced SITE PLANS property. If you have any questions or require any additional information, please contact us. ROAD DESIGN 7elr7ely SOILTEST ,4,Afo414'rt A. Shafer, P.E. PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSALSYSTEM DESIGN �Q e10t f� Q, C'C n , 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920403 DATE ISSUED:12/03/92 DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE:12/03/93 OWNER NAME:JONES ROBERT & NANCY OWNER ADDRESS:20310 DAVID AVE 3 Pw, s�R/g3 EAGLE RIVER, AK 99577 17,.,f PARCEL ID:05057117 LEGAL DESCRIPTION: PREUSS #!2 BLK 1 LT 11 3orYl LOT SIZE: 25181 (SQ. FT.) �# NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ALL PERFORATED PIPE AND GRAVEL MUST BE REMOVED FROM THE EXISTING TRENCH AND REPLACED WITH INSITU SOILS COMPACTED EVERY TWO FEET. RECEIVED BY: ` DATE • DATE: r, mUPGRADE SCALE ¥ /22C"00 -`a �)9%©a0 0CD BIB _ — y | m©0rn C400a _( ,* , ( ( | 00 a L,�°»ZZ §m d��to r o = ( f^00 Me� r- < \ • Y) -- E % | s ® B@ § m m§ % $ o o PB \ 2 � | R } @ m " % A / %k / \ %b. | |k��A § (\ 2�§; 2� k k}� �j� § | � § k | \ | &tom M % R ) 4 :b G �m�� o. rei ) § gyp• [ £ ■ a ®a % �i ,mss■■ 2 m n \ � & �f2 M � / C, aI '�/ �A � \ � ` iz m « _ , /�Kri•✓1 'z�V US -`dui /%i O,� fk^�i�f C7','e,;p) Msoc'irrr �t;t•l j a %tai is /C m cj U a v Q N V m L� m ual c� <m u= W L� V W W A a- .54) c= M« �a a) HEALTH AUTHORITY APPROVALS SEWERS WATER MAIN EXTENSIONS SEWER►WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION 8 FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSYSTEM DESIGN November 2, 1992 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, AK 99519-6650 REFERENCE: Pruess Subdivision, Block 1, Lot 11 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 6941211 We request you issue a permit to upgrade the septic system serving the referenced property. During an inspection of the existing septic system for a Health Authority Approval, the existing system was found to be in a state of failure. A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your review, please contact us. Sincerely, �r Roger J. Sh fer, P.E. RJS/LSU/lsu 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 m•30' | | umaE t ) e §( | ( -4rrl� &§/ | � §%tq k %\f \ ) e §( k � !■ -4rrl� &§/ §%tq k %\f \ \Jf k k � !■ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR�yJ'�1 C.�--�� DATE LEGAL DESCRIPTION:I�11 �, "1� — S� Township, Range, Section: 1 15- 16- 17- 18- 1'1 �.s 2 Q 3- 4 M � 1ir 5- 6 6 �d 7 8 9 e ;d, 10- 11 1z pr r 13 14- 4 1516171819 20 COMMENTS SLOPE WAS GROUND WATER +I'' ENCOUNTERED? S IF YES, AT WHAT ( L DEPTH? p E Depth to Water After 1 Monitoring? I� Date: SITE h PERCOLATION RATE 2^0 tmmutesimch))PPERC HOLE DIAMETER IE TEST RUN BETWEEN FT AND 7 FT PERFORMED BY: S & S ENGINEERING CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eagle River Loop Road No. 20 ACCORDANCE GUIDELINK IN EFFECT ON THIS DATE. DATE: 1 72-M (Rev. 4,85) \ / MUNICIPALITY OF ANCHORAGE 1 • DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION a ENVIRONMENTAL ENGINEERING DIVISION i 825 L Street - Anchorage, Alaska 89501 Telephone 264-0720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME p 49- N 11 '17 /( '! A., lV A, tj X. PHONE NEW ❑ UPGRADE MAILING ADDRESS '60'60 LEGAL DESCRIPTI N y� p A e 7- lC7 C o C / �G i v c- 5— LOCATION_ 67< NO. ROOMS DISTANCE TO: Well/ O/' Absorptioryarea r `�' Dwelling PENNO. 'We 7 S '7 U Y WQ Manufacturer � p/��sr�� /7 � e [ aterial �i' No. of co art ments f i/ ^/ l T Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth d Y DISTANCE TO: Well Dwelling PERMIT NO. J 2 $ Manufacturer Material Liquid capacity in gallons W = DISTANCE TO: W bell Foun o% � �' 1Near st of Im '�-- %' PERMIT NO. LL Z No. of lines Length ch line Total length 'dT / qf,e of lines Trench Distance between lines F2W Y i inches Q i- O Top of tile to finish gradev F Material beneath the I7 ms's .r a Total effective absorption area p r / inches W Length Width Depth PERMIT NO. <s- W� Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot line PERMIT NO. pO ? p tJ O DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS L 1 t. t to I� 1t Lr / 44: / Jt� ELL DATE LEGAL O -7- )PHOVED 72-O (Rev. 3/78) ns C7�_�TJ 7 vY 3. I i=+!.- T T'r• =�F Hr1C'k 1ClT= n- 473 �c Q( q -a': L% Ll t HE ENVIRONMENTAL - t 'TM=ti[ OF HEALTH AND E.i'r IF,'i �`;i iE.IThi_ FF. _�T=: �:T_OFI �t�G% 825 'L' STREET, ANCHORAGE, A:. 99501 264-4720 t�IELL FAr4F> CSM—=•ITE F1�lEF=' F='EF 'M :C T PERMIT NO < 720789 FiPPLIr_ANT DONALD ZIMMERMAN JR, FOX 556 EAGLE RIVER 594 925'* LOCATION DAVID ST LEGAL L11 61 PP.UESS S/D LOT SIZE 210:+0 SOUHRE FEET TYPE OF SOIL ABSOR,BTION SYSTEM IS: TRENCH MAN,IPUJM NUMBER OF BEDROOMS = 3 SOIL RATING CSC! FT/BR)= 150 .THE N.EOUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: L 7n 1>EE'TF i= * LEhCi1�r"- `1S �R_ti'•.'F=l_ C?El=' T -H= �F THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIF_LD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND HND 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 HND THE BOTTOM OF THE EXCAVATION <IN FEET). t=-: F= �_-t �_� I F<_ E G• _• E= F=' T 1. r T t� tom! E � =• I � E = 1_ rr, �-_� �_� ri H L !— � t-! :PERMIT APPLICANT HAS THE RESPONSIBILITY 10 INFORM THIS DEPARTMENT DURING THF .INSIHLLHTION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE PAJMBER OF RESIDENCES THHT THE WELL WILL SERVE. ? I t t t E �_ T 1 �_� t ! _• ti f E F=_ F_ �_ ! ISI I F<: E C• — — — HHCKFILLING OF HNY 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 100 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATION_ AND CONSTRUCTION DIAGRAM'S ARE HVAILHBLE TO INSURE PROPER INSTALLATION. F FEF:M I T -:1s Z'=+ 71L* I CERTIFY THAT 1: I AM FAMILIAR WITH THE REOUIPEMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REOUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. _, I LINED (fuuaA4_c+._`_�,^•�-7.'['Sa.eiY.._l� HPPLICHNT &Or ALL) ZIMMERP i JR Y 3g ` � GLtr- ---1- ISSUED BY---- ---------------DATE--v ------------ ten,"" 4('Slp._2e � _, I 59 ^, RSM CONSULTANTS. INC. 1014 COROOVA • 60. we) • ..CwoRAG.. ALASKA 11112 • •N. 901-27V 0.41 • TL%. 0*0.551:0 •NO CNv1019 P role o+• PLANN4 i4 KURVITOPS August 23, 1978 R&M No. 851140 Mr. Don Zimmerman, Jr. Box 596 Eagle River, Alaska 99577 Subject: Soil Investigation for Sanitary Sewer System, Lot 11, Block 1, Pruess Subdivision, Eagle River, Alaska Dear Mr. Zimmerman: At your request of August 21, 1978, we conducted a subsurface soils investi- gation at the proposed location of the sanitary sewer system on the subject. lot. The investigation complied with those procedures required by the Municipality of Anchorage Department of Health and Environmental Protection. This investigation, which was accomplished on August 22, 1978, consisted of a test hole excavated to a depth of 12 feet below the existing ground surface. The test hole was sited according to your instructions and its location is shown in attached Drawing A-01. Excavation was accomplished with a backhoe. A sample was taken at the depths shown on the soils log in Drawing A-01. The sample will be held in storage at our lab for approximately six months. In addition, all material excavated was continuously monitored by an experienced engineering geologist. The topography at the excavation site is generally horizontal. At the time of the investigation the site had been stripped. The top of the test hole was located at original ground surface. The soils encountered in the excavation are shown in the test hole log in Drawing A-01. This log displays specific conditions encountered at the test location. However, subsurface conditions may vary in other parts of the lot without any apparent surficial evidence of the change. Groundwater and bedrock were not encountered. At the time the hole was excavated seasonal frost was not present and permafrost was not encountered. Based on the visual classification of the soil and the requirements set forth by the Muncipality of Anchorage, a percolation test was not 'necessary within the test hole on the subject lot. ANCHORAGE IAIROANKS 'IUNCAU VALDES WASRLA r`, August 23, 1978 Mr. Don Zimmerman, Jr. Page -2- rAQ We appreciated this opportunity to be of service to you. Please contact us if you have any questions concerning this letter or if we can be of addi- tional service. Very truly yours, R&M CONSULTANTS, INC. Lynne Kosikowski Staff Geologist GS:LK/kky/12-D CM) ary Smith i Project Manager BORING. NUMBER 1 Date Completed: 8-22-78 r=� Little Visible Ice 0-10 VX DATE. a-22-78 F s �� SOIL DESCRIPTION C P� 3 ao L WATER CONffNT v u�u ]1 SAMPLER TYPE '^•':: SANDY ORGANIC MATERIAL Z4PPROX STRA/A CHANGE ' Reddish -Brown, Dry, Soft 1.0' SAND W/TRACE GRAVEL (SP) ; :*A: , Reddish -Brown, Dry, Dense 3.01 3•. 1 SAND W/SOME GRAVEL p;Z TO GRAVELLY SAND (SP -SW) ;. Gray, Dry to Slightly Moist, •;:�. Dense 6" Trace Silt at 7' bq - :eF re • . 12.01 No Water Table Encountered I$ DWN LMK CKQ Little Visible Ice 0-10 VX DATE. a-22-78 SCALE. NTS l-ksoi1�y LOCATION SKETCH No Scale Lot 11 u u w u 0 T.H.1 q 65' 20' NOTE: DISTANCE$ SHOWN ARE APPROXIMATE AND HAVE NOT BEEN MEASURED BY SURVEYING METHODS. EXPLANATION r'-✓N� Ja < 'RODND �"'0.. GROUND WA-WN/LE BOOING TYPICAL SOILS LOG AB -AFTER BORING Ss A4'SPLIT SPOON M'ITN /IO LB MANNER Se /.1' SPLIT SPOON WITH SIO LB. MANNER 31 2S' SPLIT SPOON WITH SIO LB HAMMER SP £.B' SPLIT SPOON, PUSHED A AUGER SAMPLE Ts SHELBY TI/SE T" MODIFIED SHELBY TUBE B, BULK SAMPLE SAMPLER TYPE SYMBOLS ORGANIC °e'.'� 6RAVFL N"' MATERIAL e ® CLAY ® COBBLES B BOBBLERSS ® SILT ® BEDROCK SAND ® ICE, MASSIVE SOIL SYMbOLS a� ORGANIC MATERIAL Little Visible Ice 0-10 VX �. 0 AB �-KE DESCRIPTION ` oa SAMPLE NUMBER �Ss,72,57.1w/o,8S.9 a° Dcf CORY o� GENS/TY I I L— 3 ao L WATER CONffNT BLOWS/FOOT L Oa. SAMPLER TYPE WO. WATER TABLE Z4PPROX STRA/A CHANGE BEDROCK t� o Lot 11, Block 1 EB. F16M CONSULTANTS, INC. Pruess Subdivision DRIQ ......... ......�... KAHN... .,N,V.VOO. SOILS LOG Eagle River, Alaska PRO. NQ 851140 DWG.NQ A-01 C7" L4� C.Z �act i j- 7 X10 �x0..v� r- / a) , In �r4 I' 1 7 W RSM CONSULTANTS. INC. •NO.Nee Re DenLeOo.e RLwNNens •�RvevoR• September 27, 1978 n, 9020 CORDOVA • •O% {00] • /1NCNOR41C. ALASKA 00102 • 0N. 007-210.0101 • TL%. 000.25210 Mr. Don Zimmerman, Jr. Box 596 Eagle River, Alaska 99577 R&M No. 851140 Subject: Soil Investigation for Sanitary Sewer System, Lot 11, Block 1, Preuss Subdivision, Eagle River, Alaska Dear Mr. Zimmerman: This letter is prepared as a supplement to our original soils report for the subject property dated August 22, 1978. Observations were made this date of a 12 -foot deep backhoe trench to determine the expected groundwater conditions and verify the suitability of a septic system absorption field with a maximum depth of ten feet. Soil conditions in the trench are the same as shown in the original report. Based on the results of soil tests on several nearby lots, the type and uniformity of the exposed soils and the moisture content of the soils at 12 feet, we can conclude that any groundwater at the site would be expected at a depth greater than 14 feet. We appreciate this opportunity to be of service to you. Please contact us if you have any questions regarding this letter or if we can be of additional service to you. Very truly yours, R&M NSULTANTS, INC. Gary Smith Sen or Geologist GS/db xc: Municipality of Anchorage Dept. of Health and Environmental Protection wNCNORwGC IAIROANKS JUNCAU VALDC2 WASILLA ,. Ir -` -- W A T C A W( L L R (: 0 R D I I;., Con,.n, seems Cotten -Magnuson Drilling l� It,'TICN Of717 Orillinq hrwa N.woo —4F629, p'rd0. A0. �__/'__'•., [,1. ,.. ..� ureas, h ..O4 i Ilion lot 11 I«e 1 fuactiOnAnc Section No, io.n R.nq• Mrid;,n - •rl Distance and Dlr«sl•n 1. Roed In ursectlows Sl ... t Address and A... or call toc,tlon ) C'.%EA Of WELL 'Donald Go ZimmermaII Mr. Y.O. Boz 596 Eagle River Aka 99577 3 WILL Loc ne serlJ ire. ft. 6.Iw T¢o bltm Thickness store+ E LELL DEPTH: (to.Olwted) 190 rt. S.rf.c• [ LN,tlon est. of Co.p leilio NA 9-14-78 GRVL 1-61 61 5 EJ C,t It tool ©Ao[er, Drie's 00.2 D A.,.r LI/.tted �Derad 11other: Blue Clay 61-64 3 b 24 6 USE: El 0. tic ON,bllc S.Ppl( 0Ini.1Vy 1:1Ir,ig.t ion D A,chars. ICVr...rcl.i C3Test ..It Otho': L U —94 6 TlLr- A, A, 16 ] CASINO; 0Thr•.d.4 ®Welded Neight' EAb*V. 06.1w 11 6 In. to 190 It. Depth ,arra. 2 /t. — In. to fl. O.Oth ...Ont IN/!t. 0,1,. Shoal 'l Yet ~° ••"� J - —4— 6 FINISH Of WtLLI Type: Open hole oi,.asr: 601 Slot/.eth Site L.rgth Set D•tIe n ft• end ft. fitl.ngt: 5 STATIC WATER LEVEL: 7F , ft. soli.. Q Delo. I.Ad c.rf,<• T,p. of ....... At ID IUnFlk6 LEVEL t.lo. I.nd d.rf.c. Bail tested 100 ft. after 1 hrt. OVnping 5 o. q... It. aft., ors. O.Ning 9.O.e• 11 WELL hEAa Can ILCTION: rrp�tt 131.A90rored Pit M Pitlec. Aa,pter L: IE" Aws. and. 10 CACaTINC: Well Cro.t•d: Uyes ho Ire oriel: ❑hfet C.—.t 0at",: Id SANITARY: Nears's Sort• of Possiblt Cont•wl nsClon 1 LCL—f..1 N Oir«tinnSCPt is T(ot Well disinftcted aeon c<nplet,on © Yes U NV IL hmp: (It 6u11.04) Nr Length of Drop pipe i3$t. c.O.titY 5 <.p••• T,p.I ElSubns rflbl. Other: El Jet A.cioroca inq " 15 REILARks: Clteetlen, .ours, of date. meter a,.elltr test., etc. Bottom of well sealed with cement in gravel. perforations between. 90-93' 16 WAT[A WELL COhTAACTOR'S CERTIFICATION: Thls wit we drilled vender .Y Jurisdiction one this report Is true to the 0•R of a, knwledgo and toilet: Coen-fl'a aeon Dai (Ling 76-77-5385 6V11nU1 Mr k0ntrat Men's FR..pV Addr.ls: P.O. Box -Vi 6ugle R.i.v A. 9957 signed:V d��C.Cc��:�� list. eP , A.thdr .4 A. d..n llr�� for. OE -KA h Municipality of Anchorage Preuss #2 S/D, Block 1, Lot 11 TYPE OF WASTEWATER DISPOSAL: Location (site address) Development Services Department u(It- z" Building Safety Division Frank and Peggy Shaskan Day phone (907) 351-9250 On -Site Water and Wastewater Program Individual Holding Tank 4700 Elmore Road Lending agency P.O. Box 196650 Mailing address Anchorage, AK 99507 Public Water System www.muni.org/onsite Audrey Mason, ReMax of Eagle River Day phone 622-3344 (907) 343-7904 11525 Old Seward Highway, Eagle River, Alaska 99577 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.Q. 050-571-17 COSA# 1309 Expiration Date: /0 -3/-1,2- 3/`f1. 1. GENERAL INFORMATION Complete legal description Preuss #2 S/D, Block 1, Lot 11 TYPE OF WASTEWATER DISPOSAL: Location (site address) 20310 David Avenue, Eagle River, Alaska Individual On-site Current Property owner(s) Frank and Peggy Shaskan Day phone (907) 351-9250 Mailing address Individual Holding Tank ❑ Lending agency Day phone Mailing address ❑ Public Water System Real Estate Agent Audrey Mason, ReMax of Eagle River Day phone 622-3344 Mailing Address 11525 Old Seward Highway, Eagle River, Alaska 99577 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well✓[) Individual On-site ❑✓ Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new Water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 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. 1 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. Name of Firm Douglas T. Kenley, P.E. Address 9806 E. Northstar Circle, Palmer, AK 99645 Engineer's Printed Name Douglas T. Kenley Phone (907) 746-1073 Date 7. r.1t2 S. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory xx Other By: 4 Original Certificate Date: Z— (R. 11105) Municipality of Anchorage Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Preuss #2 S/0, Block 1, Lot II Parcel ID: 050-571-17 A. WELL DATA Well type Private Date completed 9NA778 Total depth 190 ft. Date of test Static water level Well production If A, B, or C provide PWSID # Sanitary seal (Y/N) Y Cased to 190' ft. FROM WELL LOG 9/14/78 78 g 5.0 9 - p.m - WATER SAMPLE RESULTS: Coliform Negative colonies/100 mL Nitrate 6.4 mg/L Arsenic: No ug/L date of sample: 7/20112 B. SEPTICIHOLDING TANK DATA Well Log (Y/N) Y Wires property protected (Y/N) Y Casing height (above ground) 24 in. AT INSPECTION 7/21/12 67.3 ft. 3.3 g.p.m. Collected by. F. Kenley Tank Type/Material . Septic/Steel Date installed 5/18/93 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) NIA Date of pumping 11/15/2011 Pumper JR'SPumping C. ABSORPTION FIELD DATA Date installed 5/20/93 Soil rating (g.p.d./le or fe/bdrm) 0.6 System type Trench Length 33+42=75 ftWidth 3 ft. Gravel below pipe 5 ft. Total depth 7 ft. Eff. absorption area 750 fl? Monitoring tube Y Depression over field N Results (Pass/Fail) Pass For 3 bedrooms Date of adequacy test 7/21/12 Fluid depth in absorption field before test W28 in. 5� •'/s�H3 Elapsed Time: 150 _min. Final fluid depth _ in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Water added 820 gal. New depth_ in. Absorption rate >= 450 g.p.d, N If yes, give date D. LIFT STATION Date installed "Pump on" level at Size in gallons in. 'Pump off" Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100+ ft. Absorption field on lot 100+ ft. Public sewer main -' A%F Sewer /septic service line• Animal containment areas 50+ ft. Manhole/Access (YIN) alar level at in. Meets alarm & circuit requirements? On adjacent lots On adjacent lots 100+ ft. 100+ ft. Public sewer manhole/cleanout Holding tank N/A N/A Manure/animal excrete storage areas 100+ ft. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ ft. Property line 10+ ft• Absorption fiel Water main NSA Water service line 10+ ft. Surface water 5+ ft. 100+ R. Wells on adjacent tots 100+ R SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10+ ft. Building foundation 10+ ft- Water main N/A Water Service line 10+ ft. Surfacewater 100+ ft. Driveway. parking/vehicle storage 5+n. Curtain drain None Known Wells on adjacent lots 100+ ft. F. COMMENTS �+�1010r`�% sph G. ENGINEER'S CERTIFICATION* s' `H I certify that 1 have determined through field inspections and' • �' ' " review of Municipal records that the above systems are in ys� •yr * , conformance with MOA COSA guidelines in effect on this date. „K T KEW. r Douglas T. Kenley P.E. Engineer's Printed Name S'� . ' , �? Z� •• � Date 7`ZT dL h'a •„• 4 .. COSA Fee $ c/96,10 Waiver Fee $ Date of Payment U2 2// 0 Date of Payment Receipt Number ansa U Receipt Number (Rev. 4110) Municipality of Anchorage Community Development Department Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # osc121309 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 11 of Preuss #2 subdivision. This inspection revealed a nitrate concentration of 8.44 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Douglas T. Kenley P.E. 8176 9806 E Northstar Circle Palmer Alaska 99645 (907) 746-1076 WELL AND SEPTIC ADEQUACY TEST Legal: Preuss #2 SID, Block 1 Lot 11 Address: 201310 David Avenue, Eagle River, AK Applicant: Frank Shaskan Phone: 622-2054/H 351-9245/M Work Order#. 12110 Date of Test: 21 -Jul -12 Tank Level (in.) 50 System Data: Tank Volume (gallons): 1,000 Absorption System: Trench Number of Bedrooms: 3 Absorption Required (150 gal X #bedrooms) 450 Depth of well (ft.): 190 Depth of Casing (ft.): 90 Static Water Level (f1): 67.3 Height of Casing (inches above ground): 24 Time Net Time (min.) Meter Reading al. Incremental Volume al. Total (gal.) Flow (gpm) Well Level 11 Delta Well Level (ft) Monitor #1 Tube Level (in. Monitor #2 Tube Level in. 12:26 - 31286 - - 67.3 - 56 28 12:36 10 31294 8 8 0.8 - 0.0 56-1/2 27-1/2 12:46 10 31334 40 48 4.0 -- 58-3/4 28-1/4 12:56 10 31375 41 89 4.1 70.7 -0.1 59 29-3/8 1:06 10 31403 28 117 2.8 71.5 0.0 60-1/2 39-1/4 1:16 10 31434 31 148 3.1 69.4 60-1/2 31 1:26 10 31474 40 188 4.0 72.4 60-3/4 32-1/8 1:48 22 31548 74 262 &4 70.4 0.0 60-3/4 35-718 2:10 22 31620 72 334 3.3 70.0 0.0 51 38-1/8 2:26 16 31673 53 387 3.3 70.8 0.0 61-3/4 40-3/8 2:46 20 31739 66 453 3.3 1 72.3 61-3/4 42-1/8 3:06 20 31804 65 518 3.3 71.1 0.2 1 61-5/8 43-1/2 3:26 20 31870 66 584 3.3 69.1 0.0 62 43-5/8- 3:56 30 31968 98 682 3.3 70.2 61-1/2, -45-718 4:28 32 32076 108 790 3.4 73.4 60-3/4 47-3/4 6:28 67.2 6:58 56-1/2 43 System Passed X System Failed Additional Comments: End of test on well and septic. The well produced 790 gallons in 4 hours and 2 minutes for an average GPM of 3.3. Before the test the leachfield measured 56" and 28" in the two trenches. The upper 33' trench (MT -1) has only 2" left. Roughly 600 gallons of water spilled over to the lower 42' trench (MT -2) leaving the final readings as 60-3/4" and 47-3/4". After 150 minutes, the readings were 56-1/2" and 43". Municipality of Anchorage Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING ParcelI.D, COSA# (G04gS Expiration Date: l a — :t-- S— (0 1. GENERAL INFORMATION Complete legal description Locaton(siteaddress) Curt f?{oP�rty owners) o+��o p' e,�vY Srorx�m e d Day phone 74✓8— 4:r9-fle Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 Day phone Day phone 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: , Individual Well Qr Individual On-site [� Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineeuegisteredin the &tate-oLRaska—Cerbficates9LQn--Site..SystemsAppr9vaLare requirediorshe_tr-ansfecof title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of Onsite 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 T, �'N 4.4' PhonCr o1% 79 Address9Bo6 G—'A%-c7-W rg.�c'�.c, er�4ri45Sf. 4k Engineer's Printed Name L7oAc4.os 7''Ac!f�A-4 Y Date 01 • l f -0(0 5. DSD SIGNATURE Approved for �_ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory K T. lt>ERM WATER AND PROGRAM X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report By (/4^ Original Certificate Date: 0 G (R". 11105) Municipality of Anchorage • '� Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsfte (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: L.r // du'r'e / O'rwyw 'F.z � Parcel ID: 1) 5-0 - 5- 71=17 A. WELL DATA Well typePsf"r ' If A, B, or C provide PW SID # _ Date completed iSos Sanitary seal (YM) Total depth /90 ft. Cased to 11f ft. FROM WELL LOG Date of test 9/1,1178 Static water level 79? ft. Well production S% to g.p.m. WATER SAMPLE RESULTS: Coliform %A coionies/100 mL Nitrate %, Oomg/L Arsenic: _ mgll Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material sEir��rBsL Tank size /&ec gal. Number of Compartments x Well Log (YIN) Y Wires properly protected (Y/N) Y Casing height (above ground) AO in. AT INSPECTION 7/,3 g.p.m. Other bacteria $ colonies/100 mL Collected by: Date installed 01-RAr Cleanouts (Y/N) Y Foundation cleanout (Y/N) _V Depression over tank (YM) Al High water alarm (YIN) 'y14 Datrp:of purOpirtg • 7�/ 2 ob Pumper ✓R i fsvric C. ABSORPTION FIELD DATA Date installed.- L Soil rating (g.pAJI12 or ft2/bdrm) 0-4 System type-XZakW-,V 3efy�'O7s' ..1?.; Length ft. Width ! ft. Gravel below pipe ,?' ft. ('J Total depth 8 ft. Eff. absorption area Zr ftZ Monitoring tube y Depression over field N Date of adequacy test �Tz yResults (Pass/Fail) A..>s For Y bed s field Fluid depth in absorption before test V, in. Water added $'/Pgal. New depth. Elapsed Time: min. Final fluid depth 'eA4 in. Absorption rate >= 4/0-e g.p.d. • Any rejuvenation treatment (past 12 mo.) (YIN & type) A% If yes, give date D. LIFT STATION "Pump on' level at _ in. Datum E. SEPARATION DISTANCES Size in gallons Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankflift station on lot / 3 yF� Absorption field on lot /a.2 XV Public sewer main Sewer /septic service line Animal containment areas Manhole/Access (Y/N) level at Meets alarm & circuit On adjacent lots On adjacent lots Public sewer manholeldeanout lin Holding tank "1q Manurelanimal excrete storage areas /Id'"Fr SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 6.4f Property line 30 *f4 Absorption field A vr'lc�4 Water main Alle Water service line %LSff� Surface water 104,6C24 Wells on adjacent lots /flo iF SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 417"74 Building foundation /O`I Water main A-1 4 Water Service line 9,4�,ocl' Surface water SOD �L�� /Driveway, parking/vehicle storage3� NlAlef amu® 4d-1 /Otis f'�Y Curtain drain Ya 6Xir7" Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through &H 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 Oo cicu.t 7�,.t kA.JZ-OX Date -1 • 1t . O V COSA Fee $ Waiver Fee $ _ Date of Payment 9�i�0 �a Date of Payment Receipt Number ��� Receipt Number (Rev. 11105) M 0 CE417111 Municipality of Anchorage -� • ..r a .,.. ;,. 4. Development Services Department / Building Safety Division ' On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 060445 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 11 of Preuss #2 subdivision. This inspection revealed a nitrate concentration of 7.9 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. SOS Reta 1065171001 Client Name Douglas Kcnlcy P.E. Project Name/K LI I BKI Prcuss SD No 2 Client Sample ID LI 11)KI Prcuss SD No 2 Matrix Drinking Watcr PIN'SID 0 Sample Remarks: Parameter Metals by SCP/MS Arsenic 09/01/2006 16:12 Waters Department 09/01/2006 16:50 Nitratc-N Stephen C. Ede Microbiolocy Laboratory Total Colirorm Results PQL ND 5.00 7.90 1 OD, No Coli 0.100 All Dates/Iima are Alaska Standard Time Printed Date/rime 09/20/2006 11:32 CollectedDate/Iime 09/01/2006 16:12 Received Date/Time 09/01/2006 16:50 Technical Director Stephen C. Ede Allowable Prep Analysis Units Method Container ID Limits Date Date Init ug/L EP200.9 mg/L EPA 353.2 C (<10) 09/06/06 09/17/06 WAW D (<10) col/100mL SN1209222O A (<I) 09/01/06 ALR 09/01/06 TLF 71- /a- 2-00,0 MUNICIPALITY OF ANCHORAGE • ~' DEPARTMENT OF HEALTH & HUMAN SERVICES AEML Division of Environmental Services On -Site Services Section P.O..Sox 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING y► Parcel l.D.# 056 _67/ -/7 HAA# HA Q 60000 1 1. GENERAL INFORMATION Complete legal description Location (site address or directions) 2 °3 -o l�.+.".o .0 G'-oc,e d�JEe property owner Day phone Mailing address 16 ZG �.v J46�C Awe ..<l w, .. ti oAtM l�.o �! �G. .3._ 907 Lending agency Day phone Mailing address Agent' : Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well K Community well Public water NOTE: Af 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 x 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. 7MS(R..1/91) Front MOA921 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. l 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 -dZf T, .'e�.y46Y Phone�9B�JyyG-i°�� Address Engineers signature 6. DHHS SIGNATURE Approved for Disapproved. 3 bedrooms. Conditional approval for 17 9'.6 Date 1 -7 O D .jr, T.r.'cNLEY:E CE6116. ::.s bedrooms, with the following stipulations: Additional Comments Note: The well for this property meets existing State and Municipal Codes. Mere are nitrates present. It is suggested that periodic testing be ' wormed to insure -the wells continued suitability. Current nitrate information on nitrates is available from the On-site Services Program, -4744 _ /)// _ (e/. /-- Date J=JO-00 4 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineers work. r -MM.. VWI 8. MOAm Municipality of Anchorage JAN 07 2W DEPARTMENT OF HEALTH & HUMAN SERVI rr uF An,rw Environmental Services Division se;xvKs to A§ 825 L Street, Room 502 ' Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: L.riZ 0�-oe,Z � 1�gw4frs 10Z Parcel I.D.: A. WELL DATA Well type rar If A, B, or C, attach ADEC letter. ADEC water system number Log present (YM) Y Date completed Total depth / 90 Cased to / 4c ' 4o' 9 Casing height (above ground) X 4" Sanitary seal (Y/N) Y Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test 4/1111778 3, "eve, Static water level Well production f do DOM. WATER SAMPLE RESULTS: Collorm -,P- Nitrate 7. f - 46•y g.p.m. Other bacteria 1 Date of sample: -✓-'AJ 's C C'o Collected try: 1-*C,6a 44-�. B. SEPTIGHOLDINGTANK DATA Date installed f"V" Tank stze --Oem Number of Compartments Z Cleanouts (Y/N) Y Foundation cleanout (Y" X Depression (YM) A-,/ High water alarm (Y/N) Date of Pumpfflg Pumper✓ -f, ,Ssos-'e- C. ABSORPTION FIELD DATA Date installed R `Iz' l Sop reUttp (gam or fl•/bdrm) 49,4 System type" -N Length 411#6h � / Gravel thickness below pipe S Total depth 40 Effective absorption area 7'f0 ff 2 Monitoring Vibe present (YM)__Z_ Depression over field (YM) // Date of adequacy test �1-41-zfao Results (Pass/Faiq �^ Xy For bedrooms Fluid depth in absorption field before test (in.). Immediately after gal. water added (in.): Fluid depth 1640 (ins) Minutes later: 6 B Absorption rate . f/s'© a.p.d. Peroxide treatment (past 12 months) (YM) N If yes, give date 72-026 (Rev. 3196)' D. UFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump On" tev�� 8l'_ �u levet at' /i High water alar level er Datum Cycles ed E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: SeptictholdUp tank on lot y' On adjacent lots /,c o jF-/ Absorption field on lot /1011 - Public ®z Public sewer main 'J/R On adjacent lots / c 10 �F Public sewer manhole/deanout v/ v Sewer /septic service line ' ��% Lilt station SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Foundation G Property Brie 94p /�e Absorption field .0.0' Water main/servloe 9ne : 'F-/ Surface water/drainage /c ° jF/ Wells on adjacent lots / o o j« SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property Ine Surface water Building foundation / rmo , f14- Curtain drain ✓.Mc yu JrXes'' F. ENGINEER'S CERTIFICATION Water main/service line z jr- f, Driveway, parkIM"hide storage area Wells on adjacent lots I certify Mat I have determined thru field inspections and review of MuniciW In conformance wfM M01 HAA gu elines in effect on Mis date. Signature Engineers Name Date ( • -? . 80 CE 9176 HAA Fee $ 2 O o Waiver Fee $ Date of Payment 0/— ©j' — Ott_ y j ) Date of Payment Receipt Number / o l 3 ©1� / Receipt Number 72-026 (Rev. 3/96)• 01-07-00 09:17 FROM -CTE ENVIROMIEMTAI .AAL ME Environmental Services Inc. CT&EReLW 1000002001 ClieatNalue Douglas Kenley P.E. Project Namam L 11. Bk 1 Preuss No. 2 S/D Client Sample 1D L 11. Bk 1 Preuss No. 2 S/D ATatris Drinking Water Ordered By PWS1D 0 $615301 T-004 P-02/03 F-365 Client POW Printed Date rime Collected Date rime Received Date/time Technical Director RCICased By A 01/07/2000 9:14 01/032000 15:30 01/042000 8.25 Stephen C. Ede Parameter Resutta Pot UnitsAt 10.abte Prep Analysis Metnad Limlis Date Date Init vATERS DEPT Mltrate•M 7.54 0.500 snit EPA 300.0 (410) 01/04/00 01/07/00 D[P MICRO LAA Total Coliform 0 col/100(a 5910 92226 of/ot/oD CAP MUNICIPALANCHORAGE O DEPARTMENT HEALTHEALTH HUMAN SERVICES of 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 I.D. # C!541 _ 4-) 1 -1-1 1. GENERAL INFORMATION Complete legal description Lot 11 HAA # 11052OLD�_ Btoch 1; P4eu64 Subd.Lv.i.6.Lon 41, Location (site address or directions) 20310 David Avenue Property owner RobeAt E. d Nancy M. JoneA Day phone - 11 -wk: 267-8172 W-wh:265-6132 Mailing address 90310 David Avonno Faglo Rivoa, AlaAba 99577 Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 V --e' 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-0231A.+1/91) front MOA121 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 c .+. S ENGINEERING Phone 170]A t2agle Rlver 00 p Koad No. Address ;.yam 9)var Alaska 99577 Engineer's signature St.�`120401 vote-,rae 6. DHHS SIGNATURE 22 Approved for bedrooms. Disapproved. Conditional approval for 2%P_ 1eaZ"Z< a, eeje y rnu Qk.Y� '01a ex i'7 e'e'la&i Date rZ— NA- -'*l 2 bedrooms, with the following stipulations: � �ir) 7thn 7' Jlz,,Zdlo/el-e�77ti/" ✓' a7O'f 7.�4 aerls' 4&e /114e00% The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72 M (R.. 191) Gwk MOA W21 V Municipality of Anchorage ARL Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LD•<\\ \ Parcel I.D. A. WELL DATA Well type 'PP-1\Jbefit, If A, B, or C, attach ADEC letter. ADEC water system number Log present /N) V Date completed -� 8 Driller 011-bJ i�l►�aJSa.t Total depth 11 o' Cased to PtRF. til o' `lam -`ts Casing height Sanitary seal) _\ SSE PnTK-�f� Wires properly protected (ya 1 Sir -a FROM WELL LOG AT INSPECTION Date of test �1- 1A -1p, Static water level S o 5•3+ r Well flow, g.p.m. g.p.m.rn Pump level Q 0V_ (0-1 4 11771 ...- m SEPARATION DISTANCES FROM WELL TO:, C o Septic/holding tank on lot t `�otr tT N ; On adjacent lots Absorption field on lot it Vo ti-; On adjacent lots loo 'SI" Public sewer main Public sewer manhole/cleanout Sewer service line -2,51, Petroleum tank Zst+ WATER SAMPLE RESULTS: {{ Coliform > 4or.9. Nitrate Other bacteria iAca-c t Date of sample: 12 - t o- `-1 Z— Collected by: S t S ENGINEERING 17034 Eagle River Loop Read NO, 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date Installed k`t1 a Tank size t t>C� Compartments Z Cleanouts Q1N) \1 Foundation cleanout!] 4 Depression (Ya P4 High water alarm (Y ) es Alarm tested (Y/N) Date of pumping gyPumper '1Ia *�'Tb eSC_JP¢.o Dcc-t-C'-%%JtyPt•�y SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot too t I- On adjacent lots It m tI,- Foundation <5 t�- To property line toll Absorptionfield cit Water main/service line tot;' Surface water/drainage l o o %;r- 72-026 JRev. 4' 72-0261Rev. 751) From CONTINUED ON BACK PAGE C. LIFT STATION Date Installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at - mp off"level at High water alarm level Cycles tested Meets MOA electrical codes (Y/ SEPARATION ANCE FROM LIFT STATION TO: W on lot On adjacent lots ` Surface water' D. ABSORPTION FIELDDATA Date Installed CY) la, Soil rating 15246-- System type Length 4qk Wid1. th 3�r Gravel thickness Total depth Lol Total absorption area �Z9§ l�Ad,e_, Cleanouts present (DN) Depression over field (Y& Date of adequacy test 0'`1 Z Results (pas il _�st, anfor bedrooms Peroxide treatment feast 12 monms) (Y F1�J>�� (! rS 'S� (- If yes, give date ;:� Stiff P��e•�c��-lEA l7F s 14 .,� . ' SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot \%t:>a kN_ Onadjacentlots lk� l~ I Property line lOk 4 - To building foundation \o' ~ To existing or abandoned system on lot 30� l0 i1 On adjacent lots Cutbank o. Watermain/service line Surface water �11� l� Driveway, parking/vehicle storage area ZS t + Curtaindrairi' '�l/�- j1..WI►j'f'E2 G•o,�p1-rl,:1t_AS M {_ c^^.+.1'i:•'..i •,.1'7? a� JPS, " -n-hs Ti r,/ie. E. ENGINEER'S CERTIFICATION=Ct ) e l Pt�L�GTt��• I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. 5 & S ENGINEERING •+P'(E•OF,q4q %III 17034 Eagle River Loop Road No. 404 ' oj� •• •.s �•% Signature Ee„lt Iei.r, Alaska 99177 /i'�; 49IF! !��• M•».»•».»• aaa»aaa10 Engineers Namei0pi / Date L2- I (O --1Z_, m �•ROGE J.$MaFER ,mar No. 8 15 HAA Fee $ -/ 7D� O 0 Date of Payment 9 Z - Receipt Number 2U.3 / 72-028 (R».3191( Back MOA 21 Waiver Fee: $~_ Date of Payment Receipt Number From : CITY MORTGAGE CORP EP.OLE RIVER PHONE No. 907 696 2959 Lec.22: 1592 11:11PM P01 .•i 4 . �8®( CITYMORTGAGE C O R P O R A T 1 0 N December 22, 1992 S&S ENGINEERING AND IliVt1ICIPALITY OF ANCHORAGE RS: Lot 11, Block 1, rreuas SID Unit No. 2 20310 David Avenue, Cagle Rivcr, Ala:Ska 99577 Upon rocoipt of tho condiF.ional approval of tho wo]l and acptic fcr the move referencoA proparty, we Vill be eacrowing fuu1S thru the eloaing to be held for co:rpletion of the u 3radao r*Virud to bo complotn3 in the spring of 1993. Sincerely, JC C .CB Branch O)c 696-0701 RECEIVED DEC 2 21992 Municipality of Anchorage Dept. Health & Human Services P.O. Box 92810 • A:vcncimm ALASKA 99509-28 10 • (907) 277.0700 • FAX 7 77.080; �� CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE. ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561.5301 INALIS13 RESULTS for INVOICE 1 61558 Chemlab Ref.1 92.6789 Sample 1 1 Matrix: NATER Client Sample ID : LI1 11 PREU33 S/D 12 PMSID : OA Collected : 12/10/92 4 13:15 hrs. Received : 12/11/92 1 15:30 hre. Preserved with . Analysis Completed : 12/14/92 Laboratory Supervisor : UIPHIN Released By l//� Parameter NIIR►TE-N Results Units 4.59 mg/l Client Nave :3 L S ENGINEERING Client Acct :SNSENCP SPO1 ! Regt : Ordered 1y :R. SRAPER Send Reports to: 1)3 C S ENGINEERING 2) Method .--------------- EPA 353.2/300.0 Allowable Limits 10 POI :NONE RECEIVED Sample ROUTINE SAMPLE COLLECTED RI: RAI. Remarks: .................................................................................................................................... 1 Tests Performed See Special Instructions lbove UA -Unavailable ND- None Detected " See Sample Remarks Above Ilk- Not Analyzed LT -Less Than. CT-Cxeater Than r84m7GS Member of the SGS Group (SociAtd G6n9rale de Surveillance) Oct -k104z- n MUNICIPALITY OF ANCHORAGE k"l,0PAUTY OF ANCHORAGE DEPARTMENT OF HEALTH O ENVIRONMENTAL PROTECTION _� DEPT. OF I I;ALTH 828L Street • Androraae, Alrlu 89601 ENVIRONMENTAL Fn T I • LLJJ�� S ENVIRONMENTAL ENGINEERING DIVISION JAN 10 1979 ry Telephone 2844720 DD CC (('CC �/ REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER KAtLE&Vt D DIRECTIONS: Complete all parts on page 1. Incomplete ragorss will net M proewad. Naw allow len (101 days for processing. 1. PR ERTY OWNERPHONE C3 One ❑ Four ❑ Other SINGLE FAMILY MAILING ADDRESS S h e Cl PROPERTY RESIDENT 111 different from ebo ) HONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE 1 depth (attach log if available.) MAILINGA DRESS 4. REALTOR/AGENT pPHONE . If system is over two (2) years old an adequacy test is required -C? Sto F MAILINGADDRESS Dlu �0LA 3 NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. S. LEGAL DESCRIPTION P STREET LOCATION S. TYPE O ESIDENCE NUMBER C3 One ❑ Four ❑ Other SINGLE FAMILY [i1 Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY (>Z1 INDIVIDUAL' *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) S. SEWAGE DISPOSAL SYSTEM 'elf individual/on•site,give installation date J�%7 53 I$ INDIVIDUAL/ON-SITE" . 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. 72-010(3/78) wig THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ SINGLE FAMILY ❑ ONE ❑ THREE ' ❑ FIVE ❑ OTHER ❑ MULTIPLE FAMILY ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLICUTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED �} O INSTALLER ❑Septic Tank or ❑Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING , Sa TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 1 4. DISTANCES WELLTO: SePUC/HOldina Tank jAbsorption Area Siv,,er Line Nftrnt Lot Line Absorption Area to nearest Lot Line 5. COMMENTS G!I—APPROVED FOR Z BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE - BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78)