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HomeMy WebLinkAboutPREUSS #1 BLK 1 LT 5 REMPreuss #1 Block 1 Lot 5 REM #050-571-05 Municipality of Anchorage ! Development Services Department Building Safety Division On-site Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 Page of www ci anchorage.ak us (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW060201 PID Number: 050-571.05 Na,,* JERRY PASHECO Wastewater System: ❑ New ❑ Upgrade Apaess 20209 EAGLE RIVER RD ABSORPTION FIELD Prom Number d Baboana 4 0 Deep Trandl 0 snalq Trencrl 0 Ba,i 0 Mwnp gnar LEGAL DESCRIPTION SW Rmaq abok 1 Lw 5 SlDprvngh PRUESS#1 GPW, Dagn 10 psro Oonom nom orpna W'T /11 Ft. °I Capin eergam P" townanp Rage Ssaron Fu amap aoovs alpha FI Cw" Length Ft. Ft. Well: ❑ New ❑ Upgrade °vN Yn01n N=W dvea Dmarae between blas ClasMratwn (P ende. A. e. C) Taa Capin sap b EXISTING PRIVATE F. T" absagan a FI Ppe Haien, FI. Ft pis IFVL 503 q'Wate Drag Si"C Waa Level kola Dal•nstaw FI Yarp Pump sa a Camp Nepm Above "xa GPM FI. FI TANK SEPARATION DISTANCES 0 Septic ❑ Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption Lit Holding lubliciPtivate uaca y From Tank Field Station Tank Sewer Line GREER 1250 Gal Well 100'+ 25'+ Maieral POLYETHYLENE N.W d Coprinwas 2SQ anm sunacew.la 100+ 100'+ LIFT STATION Ld Lne 5•+ 10'4 Gal FpMBlgn 5'+ 10'+ O� a Pranp �' M.gtl wales alae at n n Curran pan NONE KNOWN A°"p Ma1i° Ebmrrai lnspectans Pertomrep by R s LgGE0 S W1 G n!!f f1 A/ 0 BENCH MARK Lorstm as Desapan •- C. O •D C O. CONCRETE SLAB AT BACK DOOR A)4 Kraan 100 FL Inspections performed by: S 8 S ENGINEERING Dates: 1" O $ Engineer's Stamp 2ne O D E q iIr Development Services Department Approva ��P .e.eeeee• a•�s lot 00 'V 4 Conditional Approval Date: ; ft .. ..... ......».»i... � t ••o'ne A. shotty • �°/F •. a. 1477.1 ;_yl` `l+ Reviewed and approved by: Date: '30'408 e� IlyFCp llt v 0-M)Z OfESS't=�.� PERMIT NO. SWXXXXXX PAGE 2 OF 4 Municipality of Anchorage DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET Pn. Box 196650 *Anchorage, Alaska 99519-6650 •Telephone (907) 343-7904 •wwwci.anchorage.ak.us ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 5, BLOCK.1, PREUSS S/D#1 P.I.D. NO. XXX—XXX—XX ----------- ---------------------'----------- 10' Util Esmt. EXISTING TRENCH 'EX NEW 1250 GAL SEPTIC NK ABANDONED DBLId AND CRUSNCD FOLLY TANK v rrr INSTALL r LOT I 4 BEDROOM HOUSE of N JN 3W r 3 x o W O Oiv I 4U .•'•.• EEOI.'.. 4z' %lp 1 ►l .. 0. „0. All, ,,•...•. n r i ti j •• 0 i w c �" •�QT. r ti='k . AAAA.. AAAA.. ...1 » .w ' n A. •shafa -- -----------°'• Ka 1437-6 •�'�I \0N`FEssk I. PERMIT NO. SWXXXXXX PAGE 3 OF 4 Municipality of Anchorage DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET P n. Box 196650 *Anchor oqe, Alaska 99519-6(,50 • Telephone: (907) 343-7904 • www. ci.anchorage.ak.us ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 5, BLOCK 1 PRUESS S/D//1 P.I.D. NO. XXX—XXX—XX PERMIT NO. SWXXXXXX PACE 4 OF Municipality of Anchorage DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET n Box 195650 • Anchorage, Ataska 99519-6650 • Telephone (907) 343-7904 • www.ci.anchorage.ak.us ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 5, BLOCK 1 PRUESS S/D#1 P.I.D. NO. XXX—XXX-XX MUNICIPALITY OF ANCHORAGE Development Services Department Orr -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SWO80201 Legal Description: PREUSS #1 BLK 1 LT 5 REM Design Engineer: 0003 S 8, S ENGINEERING Owner Name: JERRY PASHECO Owner Address: 20209 EAGLE RIVER ROAD EAGLE RIVER, AK 99577 - 3:00 Date Issued: Sep 18, 2008 Expiration Date: Sep 18, 2009 Parcel ID: 050-571-05 Site Address: 020209 EAGLE RIVER RD Lot Size: 23838 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field g Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified In Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3_ The engineer must notify DSD at feast 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By. Date: ��` Date: g!/C� Municipality of Anchorage Development Services Department �•''" Building Safety Division On -Site Water and Wastewater Program ` 4700 Elmore Road "' IT P.O. Box 196650 Anchorage, Alaska 99507 www.muni.org/onsite (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Property owner(s) JERRY PASHECO Day phone Mailing address 20209 EAGLE RIVER RD Zip Code sssn Site address Zip Code Legal description (Sub'd., Block & Lot) LOT 5, BLOCK 1, PREUSS S/D #1 Legal description (Township, Range & Section) Lot Size- P,3, 3,� Sq. Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field E3 Septic Tank El Holding Tank El Privy Private Well Water Storage I certify that the above infor Single Family Dwelling and Number of Bedrooms 4 THIS APPLICATION IS AN: Initial El Upgrade ID Renewal El correct. I urther certify that this application is being made for a rdance th applicable Municipal Codes. (Signature of property owtr6 authon agent) i Permit/Rush Fees: _ Waiver Fees: Date of Payment: /(� 0o Date of Payment: Receipt Number. pry Receipt Number: (Rev. 11/05) IVIUIVIUIt'AI_I I Y Ut- ANUHUHAUt DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name _ DISTANCES I TO SEPTIC ABSORPTION Address FROM TANK FIELD WELL S oIL—_415WELL ) � Phone(s) Permit No. No. of Bedr00000 s LEGAL DESCRIPTION LOT LINE Gf Lot Block I Subdue FOUNDATION Township, Range, Section 1 Gil i AS -BUILT DIAGRAM (Show location of weu, septic system, property lines, foundation, I� JG�i driveway, water bodies, etc.) TANKS SEPTIC ❑ HOLDING Manufac to er Capacity In gallons do Material No. of Compartments TYPE OF SYSTEM ;KTRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from Total depth from original grade original grade p� FT I FT Fill added above original grade Gravel depth beneath pipe 'I OFT FT I v Gravel length Gravel width OP6 FT 2,15FT t f I Total absorption area I Distance between lines n BiOOSQ FT t4 FT Number of ones Soil rating Pipe material >� SQ FTt� l7 Installer n/LA LLz3_x2'z.'LA -F ard�jJ 1 le�d WELLS RIVATE ❑ OTHER (Identity) n ) Classification (A, B, C) Total Dep[hCasetl to � t I FT FT vr Installei Date Installed: Z REMARKS: Scale:,I,s, '-ENGINEER;S SEAL Inspections P, r ed by: `i®1\, 501Z'5 Iej r0111SIS 7;41.(/ *so,4 Date: , � • e4(-re4(—rs 2, S ENGINEERING 17034 Eagle River Looe Road No. 204 Eagle Alaska 99577 cerlily I at this ins ection ww�s performed according to all f *• •• rF.....�,¢ , �i drJ iA.% Municipal and Slate guidelines in effect on this date: O .3�i," ZHealth Department Approv�e: � 72-013 (3/85) - Municipality of. Anchorage Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 January 9, 1989 R.E. Leighton PO Box 226 - Old Saybrook, CT 06475 Subject: Lot 5 Block 1 Preuss Subdivision #1 Permit #880172, P.I.D. #050-571-05 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1988. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed.by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as -built inspection report (three-part form) must be sent to this office for review and approval, and for documentation. When applying for a new permit, the fees are: $90.00 for an on-site sewer permit; $50.00 for a well permit; $140.00 for a combined sewer and well permit. If there are any further questions, please call this office at 343-4744. Sincerely, Daniel J. both Acting Program Manager On-site Services Section DJR/ljw enc: Copy of Permit MUN �® DEPARTMENT E 825 "L" Street, An ON—SITE SEWAGE DISPOSA tQ4 L�i Su�Co l ��� REPORT Name . G S ES Address `' {SORPTION WELL .O. X 2210 o S otL - )Q CY�� t S1 REPO r Phone(s) Permn No. No. of'6 \ 1 ­7� Q�1� l� a�rcc-:� LEGAL DESCRIPTION Lot Block Subdjyisp , ' Z r -' �Tt/ I / Township, Range, Section G/1 i fj apbc system. property lines, foundation, TANKSp -----__ . SEPTIC ❑ HOLDING Manula urer Capacity in gallons Material of Compartments GO Z -<No. 1 / TYPE OF SYSTEM ) r� ;9TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from Total depth from original grade original grade FT � FT Fill added above original grade O FT Gravel depth beneath pipe / � FT o Gravel leng:h P�(o Gravel width FTZr J� FT t f Total absorption area I Distance between lines OtOOSO FT A FT Number of lines Sod rating Pipe material q SQ FT 1-0 J% Installer nQ..\ 1 _ _ =fit 9� led G WELLS RIVATE ❑ OTHER (Identifv) Z) Classification (A.B.C) Total DepthCased to j —Gp I z FT FT Instauer Date installed. ' REMARKS: 5 T`rluFF; UScalei,,, Inspections P rrned by: ENGINEER'S SEAL„ Date: j �.' � •tir �9, ��� 8—Z� _ 3g � ENGINEERING tk 17034 Eagle River Loop Road No. 204 4 — Eagle River, Ala��a 99577 certify t t This ins eclion WAS performed according to all /p Municipal and Stale guidelines in effect on this date: Health Department Approval: Date: •s;• L . •. ";, w 72-013 (3/85) I MUNICIPALITY OF ANCHORAGE Department o| Health & Human Services � 825 L Street, Anchoraqje, Alayca 99t01 340-4720 O N ~ S I T E SE W E R P E R M I T Permit Number: 880172 Upgrade Date Issued: 08/25/88 Engineer Designed Owner Name: R, E IGHTON Day Phone: Owner Address: PO BOX 226 2O3-388~6175 OLD SAYBROOK, CT 06475 Parcel Id: 050-571-05 Lot Legal: SubdiYision: PREUSS #1 Lot: 5 Block: 1 Section: 8 Township: 14N Range: 11W L.Q. Size 25048 (sq^."t" or a( --.res) 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 Wet requires insulation over tank(s)" INSTALL PER ENGINEERS ATTACHED DESIGN, TRENCH: 76/ LONG WITH 5' GRAVEL DEPTH. THIS PERMIT IS ISSSUED FOR A SINGLE FAMILY DWELLING ONLY AND EXPIRES 12/31/88, NOTIFY DHHS PRIOR TO EACH INSPECTION^ I CERTIFY THAT: 1, I am Iamiliar with the requirements for on. -site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the 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 An, the set back distances from any existing wellv wastewater disposal system or public sewerage system on this or any adjacent or nearby lot, 4, I understand that ermit is valid for a maximum of 4 bedrooms" I also unders capacity of the total system is 4 bedroo0s and Signed: ............. DATE: ____.�.�___ (Owner) R"EEIGHTDN ' Issued By: ^p DATE: SCALE xky�ac-, m GST i G�>L CIO ar�bL/ all S G- i1zzp Jai v r � D Z r - tL i rFIX W it t. e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR:. �. ✓%ICS' Of� DATE PER LEGAL DESCRIPTION: 1� 1�JI � 7s ' Township, Range, Section: T, .5Ewfi' IG SLOPE 3 � o <<� 4 5 a 6 7 4; r P 8 g v 10-- 12 0 -12 l 13 O` 14-- 15- 16- 17 4151617 18 19 20 COMMENTS S� C --,F- G M 2✓E A. thollim �P (( �Oae, wos6i� Fwd ter' WAS GROUND WATER ENCOUNTERED? \I1� IF YES, AT WHAT DEPTH? ` Depth to Water After Monitoring? Date: Reading Date Gross Time Net Time Depth to Water Net Drop I p, (, .z') PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN T AND FT 17034 Eagle River Loop Road No, 204 PERFORMED biQ le River, Maska 995" ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINE IN l� 72-008 (Rev. 4/85) CERTIFY TFTTIS TES' WAS ERFORMED IN ON THIS DATE. DATE: SS GRER ANCHORAGE AREA BCS HUGH • Department of Environmental Quality -" 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME Mn Zimmerman MAILING ADDRESS Gen Del Faq]e River PHONE 694-9636 LOCATION Eagle River Road LEGAL DESCRIPTION Lot 5, Block 1, Preuss Sub, SEPTIC TANK: UL#185151 DISTANCE NUMBER OF FROM WELL 00' MANUFACTURER Stack Steel MATERIAL Steel COMPARTMENTS 2 INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY 1250 GALLONS. SEEPAGE PIT: NUMBER OF PITS_. DIAMETER 941 OR WIDTH 20_1, LENGTH--zl DEPTH —91 LINING MATERIAL Log CRIB SIZE: DIAMETER 84 DEPTH 6' DISTANCE FROM: WELL TOTAL EFFECTIVE BUILDING FOUNDATION 20', NEAREST LOT LINE 11 ABSORPTION AREA (WALL AREA) 504 ADDITIONAL ABSORPTION WELL: TYPE Drilled BUILDING FOUNDATION CESSPOOL APPROVED DISTANCES: CONSTRUCTION NEAREST LOT LINE OTHER SOURCES DISAPPROVED INSTALLED BY: Frontier Excavating PIPE MATERIAL: Cast Iron LOT SLOPE: REMARKS: Form No. EQ -031 Standard NEAREST SEWER LINE REMA DEPTH SEPTIC TANK_ DIAGRAM OF SYSTEM FT. DISTANCE FROM: SEEPAGE SYSTEM k D. re 0o0 00: 6�. R&M ENGINEERING & GEOLOGICAL CONSULTANTS 229 EAST 51st. AVE. - P.O. BOX 6087 - ANCHORAGE, ALASKA 99503 TELEPHONE 907-279-0483 TELEX 090-35419 Civil Engineers JAMES W. ROONEY, P. E. MALCOLM A. MENZIES, P.E., L.S. JAMES H. WELLMAN, P.E. August 21, 1974 Mr. Don Zimmerman P.O. Box 596 Eagle River, Alaska Geologists R & M No. 462067 Re: Test Hole and Soil Log Report for Sanitary System Lot 5 Block 1 Pruess Subdivision Dear Mr. Zimmerman: Land Surveyors RALPH R. MIGLIACCIO Engineering GOOIO915L We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This investigation was performed in accordance with your request of August 15, 1974, and those procedures outlined in a letter dated September 13, 1971 by Mr. Rolf Strickland of the Greater Anchorage Area Borough Department of Environmental Quality. A single test hole was put down within the Lot 5 area for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with a tractor -mounted backhoe and the test hole was extended to a total depth of 16.0 feet below ground surface. The final log prepared for the test hole has been included in Drawing A-01. Ground water was not encountered in the test hole. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R & M ENGINEERING &..GEOLOGICAL CONSULTANTS, INC. James W. Rooney JWR:kd xc: GAAB 1 j TH-1 8-26-74 0.0! SANDY SILT W/SOME-TRACE ORGANICS (ML)- 0.5! . p o. SANDY GRAVEL W/TRACE SILTY (SP) :ago 2.0' d -oa •o o. . o• o; o. o•�• GRAVELLY SAND W/TRACE SILT (SP) 'o/ o ••0.0 o. iA• 6 .0' oa.° SANDY GRAVEL W/TRACE SILT (GW) 6 .5' a_ d6. 'o o GRAVELLY SAND W/TRACE SILT (SP) o%. 0 V0. 8 .5' •o . :p ,0 0 t?ptl SANDY GRAVEL W/TRACE SILT (GW) SILT (SP) o• • o. .tl ; - o .o c "• SAND W/SOME GRAVEL &TRACE j., 6.0' T.D. HO WATER TABLE NOTE: Test hole excavated with tractor -mounted backhoe. MR, DON ZIMMERMAN PROPERTY Engineering & Geological Consultants Inc. P.O. BOX 596 ANCHORAGE FAIRBANKS ALASKA JUNEAU EAGLE RIVER, ALASKA SILT (SP) o• - o c "• 1 Lil'`+`� :t: / R15 L�� S, REE SVA ANJCHORAGE, ALASKA 99501 (9(I1) 264.-1111 1 61 01'ce Al. stat -i /VAN, '14/1 YOR ')f ' .i _.:.'I u1-;IFFVLI11 LtVVJHOfNuGN T,,V[ PROTFCII(wJ January 4, 1982 Al Larson Area Realtors P.O. Box 249 Eagle River, AK 99577 Permit 4 811149 Subject: L5 Bl PRUESS S/D A permit issued by this department for a well and/or sewer system has expired as of December 31, 1981. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please call this office at 264-4720. Sincerely, r4' 666 u_ju� Les N. BuchholzR. Program Manager Sewer and Water Program Enclosure: Copy of Permit LOG Of DRI LJNG by A 4:1 L DRILL11 a COMPANY OWNER OF LAND 1_fTZF7097&C.K'_._ ........ ADDRESS ..... A --------------------- WELL SITE ......x,r ........9_0 ....... n .... DATE -STARTED ...... �../L/ 4 -------- ------------------------- ............. DATE -ENDED . ----..4... 7..1----------------------- ------------ I .............. KIND OF FORMATION; FROM__(2 .............FT. TO ..... 1.5.0 .......... FT_..Ajp� ... ... FROM 7.............FT. TO............ ........ FROM_.{ ....... __FT. TO.o)57 ..... ------ ..... FROM ....... ....... .........FT. TO---- .........---------- FT.------. .............. FROM------- 91 -5.,.... -FT. TO ----5.3 ... ------ .A a U4,04faM ................... --XT. TO----- - FT "Ar mom..25�3.... ------ FT. TO----- 6.p .......... FTSAv--o_.-6XAv-f4 * 60OFROM.-_ ................... FT. TO ........................FT.---.. --------------- FROM. !kPFT. TO.4:F..'j_ ..... ..... FT.. jq.off,Q w ri FROM ........................ FT. TO ........................ FT._... WA rcAe FROM..... TO.-Jx_ ------- _FT.ayu FROM ........... ........ FT. TO ....... ................ FT.-_ .................. FROM.!q.5 ...... ----.FT. TO ---- FROM.. -. -- --- ---FT. TO._-- --------- - FT.--- -. ............... FROM ... t.94 -----_FT. TO -'3t 13t .... ..... FT.50!0 ... MISCL. INFORMATION: buf 4 19 Afc Aroe jq DEPTH OF WELL ......1._6 ..9)- ............... STATIC LEVEL OF WATER FT. _.d -Ir:, ............. . DRAW DOWN FT. ----- --------- --------------- --------- --- _ ------- GALS. PER HR..3. JL 0 ........_. .._ ............. KIND OF CASING ----- ....... KIND OF FORMATION; FROM__(2 .............FT. TO ..... 1.5.0 .......... FT_..Ajp� ... ... FROM 7.............FT. TO............ ........ FROM_.{ ....... __FT. TO.o)57 ..... ------ ..... FROM ....... ....... .........FT. TO---- .........---------- FT.------. .............. FROM------- 91 -5.,.... -FT. TO ----5.3 ... ------ .A a U4,04faM ................... --XT. TO----- - FT "Ar mom..25�3.... ------ FT. TO----- 6.p .......... FTSAv--o_.-6XAv-f4 * 60OFROM.-_ ................... FT. TO ........................FT.---.. --------------- FROM. !kPFT. TO.4:F..'j_ ..... ..... FT.. jq.off,Q w ri FROM ........................ FT. TO ........................ FT._... WA rcAe FROM..... TO.-Jx_ ------- _FT.ayu FROM ........... ........ FT. TO ....... ................ FT.-_ .................. FROM.!q.5 ...... ----.FT. TO ---- FROM.. -. -- --- ---FT. TO._-- --------- - FT.--- -. ............... FROM ... t.94 -----_FT. TO -'3t 13t .... ..... FT.50!0 ... MISCL. INFORMATION: buf 4 19 Afc Aroe jq UNI IPALIT°Y OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-571-05-000 Legal description PREUSS #1 BLK 1 LT 5 REM Expiration Date: 10/5/2024 Site address 20209 EAGLE RIVER RD Eagle River AK 99577 Current property owner(s) JOHNSON DOUGLAS G X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Er Original Certificate Date: 3/22/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE Development Services Department a p p == =-� Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 050-571-05 Complete legal description Preuss #1 Block 1 Lot 5 Location (site address) 20209 Eagle River Rd. Eagle River, AK Current property owner(s) Douglas Johnson Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass Age 15 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed © Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 1 q S Waiver Fee $ Date of Payment ?zo z Z Date of Payment COSA # OSG 2Hl 0 Z Waiver # COSA Application—June 2022 Preuss #1 Block 1 Lot 5 8/3/74 162 162 14 10/13/23 66 7.5 NA Arcterra Consulting 2/14/24 58” 050-571-05 8/27/88 9 4 10/13/23 14 600 36 1440 14 600+ 60 14 46 10/5/23 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. Arcterra Consulting Kenneth Duffus (907)-696-6111 MUNICIPALITY OF ANCHORAGE Development Services Department -T Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-571-05-000 Expiration Date: 10/9/2024 Legal description Preuss #1 Block 1 Lot 5 Rem Site address 20209 Eagle River Rd. Eagle River AK 99577 Current property owner(s) Austin Jenniger & Neil X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for Comments or advisories: A bedrooms, with the following stipulations: Original Certificate Date: 11/6/2023 /This Certificate of On -Site Systems Approval (COSA) is intended'to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA ApprovaLJune 2022 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 050-571-05 Complete legal description Preuss #1 Block i Lot 5 Location (site address) 20209 Eagle River Rd. Eagle River, AK Current property owner(s) Neil & Jennifer Austin Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass Age 15 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed © Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ J 0 Waiver Fee $ Date of Payment L 0 Z - ' � z3 Date of Payment COSA # o S C -3 / 1117- Z Waiver # COSA Application—June 2022 Legal Description: COSA Checklist Preuss #1 Block 1 Lot 5 Parcel ID: _ 050-571-05 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ./❑ Well log is filed with Onsite (or attached) Date drilled 8/3/74—Total depth 162 ft Cased to 162 ft ✓❑ Sanitary seal is functioning correctly © Wires are properly protected Casing height (above ground) 14 in. Date of flow test for COSA 10/13/23 Static water level at beginning of test 66 ft. Comments B. TANK DATA Measured operating fluid level in septic tank 58" Date of pumping ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 8/27188 F ALL standpipes present per record drawing Total measured depth from grade 9 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑✓ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 Well production at time of test 7.5 qpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ./❑ No ✓❑ Coliform bacteria is Negative Nitrate 1.90 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ✓❑ Arsenic less than MRL (ND) Collected by _ _ Arcterra Consulting Date 10/9/23 STATION ❑ Requirealiato Age of lift station Lift station material Comments: ance completed Adequacy test date 10/13/23 Results 2 Pass Fluid depth prior to test 14 in Water added 600 gal New fluid depth 36 in Elapsed time 1440 min Final fluid depth 14 in Absorption rate 600+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 60 Effective depth used 14 in Effective depth remaining 46 in in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) ✓❑ Yes Septic Tank/Lift Station on Lot > 100' ft Surface Water > 100'./❑ Community Sewer Manhole/Cleanout > 100' Tank to Property Line > 5'- ✓❑ Yes if No ft ✓❑ Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25'./❑ Yes if No ft Absorption Field on Lot > 100' ❑✓ Yes if No ft Holding Tank > 100'./❑ Yes if No ft Neighboring Absorption Fields > 100' © Yes if No ft Water Service Line > 10' Animal Containment > 50'✓❑ Yes if No ft ❑✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' [2]Yes if No ft © Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ✓❑ Yes if No ft Surface Water > 100'./❑ Yes if No ft Tank to Property Line > 5'- ❑✓ Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' J❑ Yes if No ft Private Wells > 100'✓❑ Yes if No ft Water Main > 10' // Yes if No ft Community Wells > 200' © Yes if No ft Water Service Line > 10' Q Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Arcterra Consulting Phone (907)-696-6111 Engineer's Printed Name Kenneth Duffus Date ls�.2lr�.7S Engineer's Comments: This investigation was completed.in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may Fluctuate during the year and the water usage of the family being served by the system. 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, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. COSA Checklist—June 2022 0 Ll 49111 .w KENNETH Mus �+ CE 711 1i 4fl0 E"a1�*� w LOT 15( LOT 14 Power I LOT 13 Pole — Wood Fence 3. �1 w 134.30' 10' UTILITY EASEMENT D9 I O N m Clean Out (TYp•) 11 Chain Link Fence PCC Pads LOT 4 R u LMetal Sided 0 Shed 'o to (No Foundation) 0 b 0 z 49TH Lee Knro6elnikof. , No. 3143-S Wood Fence Pad::: Link Fence 0 Split Level Wood Frame House 2.0'x11.4'1 "22 Cantilever 0x16 Cantileverntile� Entrance Q / LOT 5 REMAINDER BLOCK 1 N89'59'00"W �— Found 5/8" Pedestal—/'— edestal Rebar O O LO d' r` Chain Link Fence rs >d :4c 31.9' 3 cV O M N r o LOT 6 R 0 Yard Lamp �— Wood Fence EAGLE RIVER ROAD I hereby certify that an accurate survey of the following described property: PREUSS SUBDIVISION ADDITION NO. 1 (69-156) LOT 5 REMAINDER BLOCK 1 was made on October 12, 2013 and that the improvements situated thereonpare within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Easements other than those shown on the record plat may not appear on this drawing. Anchorage Alaska, this 16th day of October 2013. Chain Link Fence N 0 SCALE : 1 " = 20' 0' 10' 20' 40' • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPRC Parcel I.D. 050-571-05 Expiration Date: 1. GENERAL INFORMATION Complete legal description PREUSS #1 BLOCK 1, LOT 5 REM Location (site address) 20209 EAGLE RIVER ROAD, EAGLE RIVER, AK 99577 Current Property owner(s) DAVID M. KURLE Day phone Mailing address Real Estate Agent 20209 EAGLE RIVER ROAD, EAGLE RIVER, AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class _Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: —Received . _aw. COSA to be released tot ngineer, unless otherwise requested by the engineer. COSA Fee $ `D).(0 Date of Payment Receipt Number COSA# dSGllai3ay Waiver Fee $ Date of Payment Receipt Number 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 ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 4/21/2016 Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen OF A T\ \ encroachments, deficiencies or discrepancies exist. �v L�q� 1 6. DSD SIGNATURE System #1 Approved for bedrooms.+a�� Te u's $ j System #2 Approved for bedrooms. Disapproved. \�`��► Conditional approval for bedrooms, with the following stipulations: PROGRAM 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other — COSA blue sheet G-10-12AW If more than 1 septic system is on the lot: COSA Checklist # _of sy_ Structure served by this stem _ Certificate of On -Site SYsttems Approval Checklist Legal Description: PREUSS #1 BLOCK 1, LOT 5 REM Parcel ID: 050.571-05 A. WELL DATA Well type PRVT Date completed 813/1974 Total depth 162 ft. Date of test Static water level Well production If A, B, or C provide PWSID # _ Sanitary seal (YM) Y Cased to 162 ft. FROM WELL LOG WATER SAMPLE RESULTS: 8/311974 ft. Coliform NOW colonies/100 mL Nitrate t%rj%J mg/L Arsenic: ug/L Date of sample: 7b I B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC / HDPE Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (YIN) Date of pumping lllelAWI& Pumper S Y' C. ABSORPTION FIELD DATA Date installed 8/27/1988 Soil rating (g.p.d./ftZ or fe/bdrm)190 Well Log (YIN) Y Wires properly protected (Y/N) Y Casing height (above ground) 12 in. AT INSPECTION 4114/2016 ft. Collected by: ARCTERRA Date installed 9120/2008 Cleanouts(Y/N) High water alarm (YIN) N System type DEEP TRENCH Pin th a5 ft Width 2.5 - ft Gravel below pine 5 Total depth 8_5 ft. (Measured 4/14/16) Eff. absorption area 860 ft2 Monitoring tube Y Depression over field N Date of adequacy test 411412016 Results (Pass/Fail) PAS$ For 4 bedrooms Fluid depth in absorption field before test 18 in. Water added 68_0 gal New depth 3f in. Elapsed Time:1320"min. Final fluid depth 15 in. Absorption rate >= 600+ g.p.d; Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Datum E. SEPARATION DISTANCES WELL ON LOT TO: Size in gallons "Pump off' level at _ in. Cycles tested Septic tank/lift station on lot 100'+ Absorption field on lot 1001+ Public sewer main 75'+ Sewer /septic service line 254 Animal containment areas 501+ SEPTIC/HOLDING TANK ON LOT TO: ManholetAc6ss (1'/N) High wateratarm level at Meets alarm & circuit requirements? On adjacent lots 1001+ On adjacent lots 1001+ Public sewer manholelcleanout 1001+ Holding tank 1001+ Manure/animal excrete storage areas 1001+ Building foundation 51+ Property line 51+ Absorption field 54 Water main 101+ Water service line 101+ Surface water 100'+ Wells on adjacent lots 1001+ ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 101+ Water main 104 Water Service line 101+ Surface water 1001+ Driveway, parking/vehicle storage 104 Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 1001+ F. COMMENTS G. ENGINEER'S 'CERTIFICATION 1 certifv that t have determined review or municipal recoras mat the above systems are in cc with MOA COSA guidelines in effect on this date. Engineer's Printed Name KENNETH M.DUFFUS Date.412112010 COSA canary_ sheet_2.6-16idoe U 11 FLS p Q V • Municipality of Anchorage a On -Site Water and Wastewater Program 'a (907)343-7904 Certificate of On -Site Systems Approval / Parcel I.D. 050-571-05 Expiration Date: / — — / 1 GENERAL INFORMATION Complete legal description Preuss #1, Block 1, Lot 5 REM Location (site address) 20209 Eagle River Rd. Current Property owner(s) Gerald Pacheco & Dawn Campbell Day phone Mailing address Real Estate Agent PO Box 772863 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: Individual Well El Individual I] Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request i Received by: ��-G-'� ( Date: COSA to be released to the'Orligineer, unless otherwise requested by the engineer. COSA Fee $ `-t 9 U/ Date of Payment Receipt Number cfr (a (J a U COSA# (3,55 Waiver Fee $ Date of Payment Receipt Number 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 Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 10/3/13 6. DSD SJGNATURE _VL/ System #1 Approved for )�- bedrooms System #2 Approved for _ bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: By Original Certificate Date: Z0-1 6-13 Theni �a�i Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r c 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: Preuss #1, Block 1, Lot 5 REM Parcel ID: 050-571-05 A. WELL DATA Well type Private If A, B. or C provide PWSID # Date completed 8/3/74 Sanitary seal (YIN) Y Total depth 162 ft. Cased to 162 ft. FROM WELL LOG Date of test 8/3/74 Static water level 89 Well production 5 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 12 in. AT INSPECTION 10/2/13 ft. 66 ft. g.p.m. 5.9 g. p. m. WATER SAMPLE RESULTS: Coliform iJ�%� colonies/100 mL Nitrate 3C mg/L n C Arsenic _N ug/L Date of sample: (� 2 Z 013 Collected by: C Z5 J B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Polyethylene 9/20/08 Date installed Tank size 1,250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) N Date of pumping a 2Ae,, 1 Z 0l .3 Pumper C. ABSORPTION FIELD DATA Date installed 8/27/88 Length 86 ft. Soil rating (g.p.d./ft2 or ftz/bdrm) 190 System type Deep Trench Width 2.5 ft. Gravel below pipe 5 ft. Total depth 8.6 ft. Eff. absorption area 860 ft2 Monitoring tube Y Depression over field N Date of adequacy test 10/2/13 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 6 in. Water added 656 gal. New depth 24 in. Elapsed Time: 290 min. Final fluid depth 6 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No 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 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access (Y/N) in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ Building foundation 5+ Property line 5+ Water main 10+ 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 50+ Wells on adjacent lots 100+ 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 COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 10/3/13 COSA brown sheet 10-10-12.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage11 0+ in. Municipality of Anchorage Development Services Department Building Safety Division e: On -Site Water and Wastewater Program , . . r . 4700 South Bragaw St P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING, / // Parcel I.D..OSO sql -OS HAA# A . DolZ6l�r7 Expiration Date: 43 - z Ll — O -.7- 1. GENERAL INFORMATION Complete legal description o r 5 i PfzEL(SS�— Location (site address or directions) 7-0y� a4 L� RtUM Current Property owner(s) Kl nE'rcp�Scj�j Day phone Mailing address vr-v— ReM_�- /4'V_ `1�77 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 4 ` 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY:' TYPE OF WASTEWATER DISPOSAL: Individual Well 12� 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 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 prcperties 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 wcrk. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the.validabon date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply -and/or wastewater disposal system Is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm RR,51 T P C)ei�=tJ P. E�7. Phone :34(!— 3`1'7'% Address 2&qO 9jZ oo k_S-rz_-tJG Imo() A-06c'6�RAz' E � QS[S Engineer's Printed Name 02 EIJT P EA -ET I'J Date —Ire—OZ 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By:"^ ""� //;/ Original Certificate Date: M.. O1M) Municipality of Anchorage Y •.'` '`,<< • Development Services Department Building Safety Division 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: LOT 5 P2WCk-J-- P?-�C,l55 4L-1 Parcel ID: Oso -S'71 -05 A. WELL DATA Well type fAN ATC If A, B, or C provide PWSID # _ Well Log (YIN) Date completed J'n' Sanitary seal (YM) Wires properly Protected (YM) _ Total depth lk7--ft Cased to q d ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION `L Date of test S -3 - i 4 - d 7-- Static water level �q ! R Well production J� g.p.m. 9— p.m-WATER SAMPLE RESULTS: Coliform __Q_colonies/100 ml. Nitrate �#�mg.fi. Other bacteria colonies/100 ml. Arsenic: = mg.A. Date of sample: _3-02- Collected by: 09COf CAf&J B. SEPTIC/HOLDING TANK DATA Tank Type/Material 2 L _ Date installed �" r Tank size � gal. Number of Compartments = Cleanouts (Y/N If' unda�tiewcleanout (YM) , I Depression over tank (YM) High water alarm (YIN ` Date of pumping -;4 -©,�7— Pumper JP—r5 SCPilG PUPAPIK15�1 C. ABSORPT}j,�FIELD DA)rA Date installed gAoii rating (g.p.d./ft? or fe/bdrm) L90 System type TR --l• C,&f Length N_ fL width 2.5 ft. Gravel below pipe 5 ft. Total depth ft. Eft. absorption area %0 ftp Monitoring tube -i— Depression over field Date of adequacy test 13, Results (Pass/Fail) PAS / goo For' beds gips Fluid depth in absorption field before test -& Water;addedL0 g.al Rho New depths Elapsed Time: 1,50 min. Final fluid depth Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) IJQ= If yes, give date WT KT2 D. LIFT STATION Date installed 'Pump on' level at _ in. Datum E. SEPARATION DISTANCES Sae in gallons in. High water alar level at in. Cycles tested Meets alar d circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: r Septic tank0liftsiation on lot 00 Absorption field on lot 1 ,;2LO r Public sewer main NIA -Sewer/septic service line Ng5 On adjacent lots •MSO I On adjacent lots ,1.11 Public sewer manhole/cleanout Holding tank W JA SEPARATION DISTANCES FROM_$EPTIC/H6t01140-TANK ON LOT TO: �i Building foundation ^' Property line Absorption field g / Water main 1,4 Water service line ^-40' Surface water zPAIA r Wells on adjacent lots T too SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line O / Building foundation ^ r Water main IJ' / r Water Service line 'yk Surface water ® Driveway, parkingh ehide storage ��f� r Curtain drain t-4lk — Wells on adjacent Ift I Go F. COMMENTS G. ENGINEER'S CERTIFICATION I cer* 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 Date /,> — 10- V2-� HAA Fee $ 375 • oo Waiver Fee $ _ Date of Payment - / Z Date of Payment Receipt Number Z / 3 S _ Receipt Number (Rev. 72001) •, n� 9th kms•'• abirl NO. BCD., ; AS -BUILT 1 hereby certify that 1 have pgurveyyed the following described property: -Le± �� 9 pe.4 )Ag Sud e4d� NG, Anchorage Recording Precinct, Alaska, and that the improve- ments situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no Improvements on property lying adjacent thereto encroach on the premises In question and that there are no roadways, tragsmission lines or other visible easements on said property except as indicated hereon. Dated at Eagle River, Alaska J thisl f i day of—0 C- 19 � ROOERT C. JOHNSONC•$• SCALE: Registered Land Surveyor o: St1D-LS 1•• -3o J Box 77.0456, Eagle River, Alaska 99577 . a... a =° AAL ME Environmental Services Inc. Ct&E Ref .# 1023128001 Client Name Eaton, Brent Project Name/# L5, BI Preuss #I Client Sample ID 1-5, BI Preuss #1 Matrix Drinking Water Ordered By PWSID 0 Sample Remarks: All Dates/Pimes are Alaska Standard Time Printed Date/time 06/05/2002 13:45 Collected DateMme 06/03/2002 14:40 Received Date/time 06103/2002 14:40 Technical Directs Stephey2-fde Released By Allocable Prep Analysis Parameter Results PQL Units Method Limits Date Date Init Waters Department Nitrate -N, Microbiology Laboratory Total Coliform 0.413 0.200 mglL EPA 300.0 (<10) 06/03/02 JDT %�,, coUl00mL SM189222B (<I) 06/03/02 KAP /-TV' 57� A.-V*i jv e-17-02;10:57AM; ;907 8e1 5301 • 1/ t s ME Environmental Services Inc. fl® laboratory Division rvioeiise.�s�eiioviiiiio►ssieiaiieiessieiisoiiea : ng Water Analysis Report for Total Coliform Bacteria READ INSTRUC77ONS ONREVEBSE SME BEFORE COLLECTINGS.AMPLE . LETED BY WATER SUPPLIER TO BE COMI 200 W. Potter Drive 'iI Anchorage, AK 99518-1605 C Tel: 1907) 562-2343 ff0 Fax: (907! 661-5301 i� cTpn RV LARORATORY MUST BE COMP LE t b , O PUBLIC WATER SYSTEM I.D. 0 XPRIVATE WATER SYSTEM Send Reasba O Sendrnrerce alysts shows MISWater SA MP o e. ' Satisfactory O Unsatisfactory p Sample over 30 hours old, results may be unreliable D Sample too lona in transit; sample should not be over.310mun old at examination to indicate reliable results. Please send :new sample via special ds ti Datelte"Mved ((�� Time Received, l� Analysts Began 1,.00 • '1 Analytical Method: 1p�-MMO-MUca Filter • Number of colonies/100m1. Result* Analyst SAMPLE DATE: � 1023313 K� Day Year SAMPLE TYPE: '0 D Routine O J R I Treated Water 111" reb Pbka J°" Fared O Repeat Sample (for routine sample Untreated Water Date. Time: with lab ref. no. ) Special Purpose Time Collected Client notified of uniatisfactory results:, SAMPLE LOCATION Collected By ❑ — -- 0 Phoned 'Spoke wtth Fazed I Time: N.." tMr BACTERIOLOGICAL WATER ANALYSIS RECORD MM -MUG Result: Total Coliform ( E. Cof! O Membrane FlIter. Direct Count Coloolea1100 ml � 7tVEC-7w Nsnwt r-00wr verification: LTB BGB COLIFIRM OB-ora.B.>..t. Fecal Coliform Confirmation Final Membrane Filter Results Collform/100 ml R orted By , Date Time bra' i Commrnts��c•. /L� S t� ri �iC� lJ 0% ry E^S Member of the SGS Group JSoeidtd Glnlrala de Surveitlane9) . ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI. NEW JERSEY, OHIO, WEST VIRGINIA =' I� CESSPOOL .....�. s.,...�V �7—�--v-- ALASKA Y9377 P.O. BOX 773511 • EAGtt RNER' PAGE �1J1 DRIVER i M INVOICE DATE OF SERVICE TIME . v ( Pump Septic Tank w/up to 3 Backwashes D Pump Holding Tank D Extra Time / Backwashes Required AUTO ❑ JR's recommends your next pumping in L VJe will call or send a reminder at that time. F-3 Standpipe(s) needs repair; missing / crimped / broken / no caps Only one standpipe onseptictank Tank appears to be 1`0 gallons / crib leach CS]Last PuITIPSR YY���' # of gallons Other IV Gallons Pumpea _ Extra Time / Backwashes Other: Total Amount Due: Payment Terms: 30 days from invoice date -1.5% per month late fee w.^r-1_ ---- Xt , .11 r^i, ornorl NCF rhG3rkS 1 ` a i MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, tywvvTj�st Z_ Location (address or directions) � 2 (b) Applicant Nam X, G e69G15�y Telephone: Home Applicant Address Application Date J� range) e .57-f S Business (c) Applicant is (check one): Lending Institution ❑ ; Owner/buildekv; Buyer ® ; Other ❑ (explain); Lending Institution Address Real Estate Company and Agent Address Telephone g Oly " 7a % Z T le hone 1—go (f�_ he HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsit � Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) i 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION Ll As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. 8 at PMOIFSEMIKQ Name of Firm 'qgni 196X Telephone i.„,0LE FlIVERC ALA%iKA �v'u978 Address DLAFc1r1_2�3714 Date DHEP APPROV Approved for 'e bedroo Approved Disal Terms of Conditional Approval _ CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 A� PRt�T N MUNICIPALITY OF ANCHORAGE (MOA) �t HEALTH AUTHORITY APPROVAL (HAA) 1 J� . CHECKLIST- FEBRUARY 1984 RECEIVED 4720 Legal Descriptio�Bl(1 1.Z.�YcSS ��O A. WELL DATA Well Classification �Q t i�T If A, B, C, D.E.C. Approved Y/N) Well Log Present oy Date Completed 9-3 --1 ¢ Yield 465a0.5r a 4r G jP'xA_ Total Depth . &X Cased to Depth of Grouting Static Water Level 8q z Pump Set At �« Casing Height Above Ground /.'2 // h Sanitary Seal on Casing (9bNj Electrical Wiring in Conduit (�W _ Separation Distances from Well: To Septic/Holding Tank on Lot f Depression Around Wellhead (Y-& i F On Adjoining Lots duo To Nearest Edge of Absorption Field on Lot /fid z '� On Adjoining Lots /001" To Nearest Public Sewer Line �.4 To Nearest Public Sewer S�t.4 /d Cleanout/Manhole 1' To Nearest Sewer Service Line on Lot Water Sample Collected by 5 9�4 Date Water Sample Test Results P+7!J Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size No. of Compartments o1 Standpipestu' >4— Air -tight Caps ( Foundation Cleanout,( -Po Depression over Tank,(Y&- ) Date Last Pumped : � Pumping/Maintenance Contract on File (Y/N) A ; for "s, Holding Tank High -Water Alarm (Y/N)_7�4Temporary Holding Tank Permit (Y/N) b Separation Distances from Septic/Holding Tank: To Water -Supply Well 1 6 To Building Foundation To Property Line zf'r To Disposal Field %S To Water Main/Service Line Course Comments Page 1 of 2 72-026(11/84) r t Al To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata — M5 411%%e Type of System Design C��B Date Installed ig - / 6.- 7 y Length of Field ate' Width of Field Z D ' Depth of Field 9 Gravel Bed Thickness / Square Feet of Absorptions Area �y �� Standpipes Presentaw Depression over Field ,(*4- Date of Last Adequacy Test Results of Last Adequacy Test S' A L' �dAe Separation Distance from Absorption Field: To Water -Supply Well / d To Property Line To Building Foundation d To Existing or Abandoned System on Lot On Adjoining Lots S6 To Water Main/Service Line f To Cutbank (if prese t) To Stream/Pond/Lake/or Major Drainage Course �� To Driveway, Parking Area, or Vehicle Storage Area 6� Comments D. LIFT STATION Date Installed Size in Gallons Dimensions Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test, Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MO and H A guidelines in effect on the date of this inspection. Signed % �WjNo Date �^ Sft� '�gGti _ CompanyZfA 01 E L AI-AI$440sw MOA No. Receipt No. .IAC1%-Z'rA Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received 11/5/74 Time of Inspection Date of Inspection 11/5/74 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR VA 1. Approval requested by: Don Zimmerman Mailing Address: Box 596 Eagle River 2. Property Owner: Same Mailing Address: 3. Legal Description: Lot 5, Block 1, Pruess Sub. 4. Location: Eagle River Road 5. Type of facility to be inspected Single 6. Well Data: A. Type uriiiea C. Construction Standatfd 7. Sewage Disposal System: Phone: Phone: No. of bedrooms 4 B. Depth D. Bacterial Analysis Satisfactory A. Installed 1974 B. Installer Frontier Excavating C. Septic Tank: 1. Size 1250 gals 2. Manufacturer Stack Steel D. Seepage Pit: 1. Absorption Area 20x22x9' 2. Material Log E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank 93' , Absorption area 95' Sewer Lines , Nearest lot line Other contamination B. Foundation to septic tank Absorption area 20' C. Absorption area to nearest lot line 11' EQ -034 (1/74) Page 1 of two pages Page 2 of two pages - Req, st for Approval of Individual S,_ ,r & Water Facilities Legal Description Lot 5, Block 1, Pruess Subdivision Comments Approv n uisapproved Date 11/19/74 Approval,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM --el Lr ry LriaL- uie rnrornrdLJon containea in tnis request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ -034 (1/74) -Ay 159 1974 Veterans Administration 429 D. Street Anchorage AK 99501 SUBJECT: Lot 5, Block 1, Preuss SuLdivisicn, hear Sir: The subject lot is not availuLile to Public sewer, and it is nut Liconoid4cally feasible CO serve- the lot With E,ublic sewer at this Lirie. The sewer system, if iilstallcd to local specificaLiore,, should provide adequate 4uwage disPusal until such tiinc as Public sewer is availt-jo le. The water supply, which must be an individually drilled well Placed at least 100 feet from tile: sewer system, should provide a potable supply of water if installed to state and local specifications. Sincerely, John R. Lee, R.S. Eagle river District Sanitarian sr