HomeMy WebLinkAboutPREUSS #1 BLK 2 LT 3
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmenlal Heallh Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
.a..e DISTANCES
AddressFROM -'~.. TANK FIELD WELL
Phone(s) ]Permit NO. ]No. of Bedrooms WELL
LEGAL DESCRiPTiON LOT LINE //
FOUNDATION
Township, Range, Section
AS-BUILT DIAGRAM (Show location of well, septic system, property lines, foundation,
TANKS N
[] SEPTIC ~r,:~ [] HOLDING
Manufacturer Capacity in gallons
Material No. of Compartments
TYPE OF SYSTEM
Depth to pipe bottom from Total depth from original grade / ~ [~ ! ~ ~., ~.
Fill added ab°ye °rigina' grade ~ FT Gravel depth beneath pipe ~ F'
Total absorption area Distance between ,,nes
7~o SQ FT /~ FT
Installer
WELLS
~ PRIVATE ~ OTHER (Identify)
~ ~ ~ FT FT
I /~~ cedily that this inspe~io~ was pedormed according 1o all
Health Depadment Approval: Date'
72-013 (3/85)
Name? ." Vt!i:'T'Ei]:~Pd',I$~ ADM I N I L:;TRA"F l ON
INF'[iI:RM D.F.I,,H.,S. F'RIOF?. 'f'O :L$~;"I" fi;: 2ND ]:NE~PIZCT]:ONS BY ENE'~]:NIEEF;'., IF
']"FILS F:'EF:;'.H:[T lii!:XF:':l:l::~l!i~::~i; :l.;',?/::S:l./ii!l? (.'~hlD VAL. I.'0 I.::E)F~ [:~ :-3iN,'.:i.;L..E.:. F::'ANII...Y HOME:,,
t..,E:.F. [ ..1. , T'H[q'T:
Fo' r't.h [:}y 'l:.h(~) Mun :Lc: ""' :,"
2,, I v,~i ]. I :i.r~t~H'..~:~l I t. he:, sy~4t.~m irt ~t~c:c:(::)t"~::!~ttr'~(:::e~ w:i.t.h ~?,:t. t MOA
.t~,, ]: NJ. ii. .:':tu:i!ln(~.:H~e~ 'ii.c).~].]. J"lO~:~ ~al"ld ~;'~:.~'~:.(.z.) (::){' (~l~:?~J.::~:t r~::lL.~ii'~:~r'~.~J"~'l:.~ (CH" t.f't~:~:' ~':.:.~'t.. ~:)~'a(::t.::
d i ' ',~' F , ,
Z).,, :[ L.U'lCJ~2i~fi~t.,3.1qCI t.h~t'L El' is t::)~.?r'mi'L J.~ raj. id For, a m~.x imum
Tom Fink,
Mayor
.Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
May 8, 1989
Lou Butera, P.E.
Eagle River Engineering Services
PO Box 773294
Eagle River, Alaska 99577
Subject: Waiver Request for Lot 3 B~ock 2 Preuss Subdivision
Waiver Request ~WR890019, Permit #890062, PID #050-572-06
Dear M~. Butera:
Your request for waiver of the required 10 foot separation
between a septic system and a lot line has been approved.
waived distance is 5 to neighboring Lot ;2 Block 2.
The
This approval applies to the existing septic system lot line
separation only. Any future upgrade to the septic system will
require all separations be met or another approval from this
department.
Sincerely,
Daniel J. Roth
Civil Engineer
On-site Services
DJR/ljw$7
EAGLE RIVER ENGINEERING SERVICES
Lou Butera, P.E.
P.O. Box 773294
Eagle River, Alaska 99577
Telephone {907} 694-5195
April 2!, 1989
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
Mr. Dan Roth
Civil Engineer
P.O. Box 196650
Anchorage, AM. 99519-6650
/\PR 2 1 1989
RECEIVED
RE: Lot 3 Block 2 Pruess Sub.
V.A. Property
Dear Mr. Roth
I am applying for a septic upgrade permit for the above referenced
lot. The design calls for two beds with a 5' lot line setback. Due to
terrain, house location, soil type, I am limited in my design options.
The terraced bed will allow using the good soil layer while avoiding a
large cut into the slope. A bed system requires minimum setback and
neighbors septic location should not be impacted. There is available
alternative septic area. Our design calls for 6' separation between
terraced sections.
I have contacted the Lot 2 owne~ Mr. Richard McSrad¥ and he appears
to have no objection to the waiver and would like you to call him at
694-3290.
If you have any questions please call me at 694-5195.
Sincerely,
Louis Butera, P.E.
SO LS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION [] PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
DATE PERFORMED:.
2
3
4
5
6
7
8
g
SLOPE SITE PLAN
11 GROUND WATER S
ENCOUNTERED? t~_~'j- oL
P
;, AT WHAT ,"
/
PERCO
Gross' Net Depth to Net
Reading Date Tim~ Time Water Drop
14
15,
16-
17
18
19.
20 " .3 /~ .~ , ~ G - 5- /~/'/~ ,¢/1~ '.
COLATION RATE ZJ~ (minutes/inch)
TEST RUN BETWEEN ~' FT AND 7 . FT
COMMENTS
PERFORMED BY: Eagle River Engineering Services CERTIFIED BY: DATE:
P. 0. box 773294
Eagle River, AK 99577
694~5195
72-008
· ' ~ 130,00'
.. ~_10' UTILITY EASEMENT
I
~ LOT 4 \'
· 5'. , voo~ fENcE ·
k_~.~ ~s~,~ ~s :: --
~/i~X~ TERRA,ED 0~ SLOPE .
~; 'OVE~FLO~ L]~E
' ,, L--4 I I
', '% ~RESSURE. ~ I GARAGE
~ ~' LINE lO' ~ I'
L]~ ~ ~'~'~ ,.~.~ :.
· ~V , ' _ ~ ·
. · ~ ~ ~' .
'..'~ ~ ~ . .,K
,..... . . ..
;:,. ~ , ~ ~,' k~ - J~l ~/ . ~ ';..~:".".
· ~[~ · ~ :: I . ,"1~1
//.
'~ ' .:' ~ ", Xt · .--,,
' I ' WELL '".:
~ 130.00' ' /
i '
-- ~ -- EASEHENT
EXISTING LEACH F[~9
NE~ LEACH F[EL9 ::::::::- ,
CLEANDUT -~
ECALE~ [~ = 30~
~ELL AND SEPTZC .S[TE PLAN ' ~;'~¢~ ' '
=~.%...........¢~ ~. .
¢5%.. A :".. ~ ,, .
2EGAL~ LDT 3.3EK B PRUESS SU3V, ~.* ~'".~'* ·
DWNER, VA ~-~ ,_ ~.,~
CBNTRACTDR~ N/A ~ '~'~:'"" ~'~"'"~'""~ ~
'~.. ~ouisA,~ul~r., ~ ~ .' ·
EAGLE RZVER ENG]NEERZNG SERVZCES -~...
EAGLE RIVER, AK. 995.77 ~x~(~&~
SV
130.00'
3 - ~renche~
I4' LENGTH
~' T,IL
,/
!
130.00'
EASEMENT .......
[2X;~T]NO L£ACM FIELD
CL£ANI3W? - ·
~WELL AND SEPTIC SITE PLAN
LEGAL, LDT 3 BLK 8 PRUESS SUDV,
O~/NER, VA
CDNTRACTDR, N/A
EAGLE RIVER ENGINEERING SERVICES
PD BX 773894
EAGLE RIVER, AK, 99577
694-5195
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL= LOT 3, BLOCK 2, PREUSS SUBDIVISION
GENERAL
The we'll and septic plan ape for a single family residence only.
2. The drawing and or site plan shall be a part of thfs specification.
3. All materials and workmanship shall meet the Anchorage Department of
Health and State Department of Envffronmenta] Conservation
requirements.
All soil tests are advisory to the design and are to be verified or
modified in the field by the engineer.
All excavations and depths are advisory and are to be verified or
modified in the field by the contractor to meet Municipality of
Anchorage, Department of Environmental Conservation requirements.
The excavation is to be exactly in the area shown on the site plan,
any deviation requires engineer approval.
It is always recommended that a surveyor locate the nearest lot line
position and the ]ocatfion of any ea,sements.
BED
1. The beds are to be terraced on the existing slope so thc( uphill
total depth o¢ the bed bottom does not exceed 3' depth.
2. The bottom of the bed shall be ]eve], plus or minus 1.5"
S. The total depth of the bed excavation is not to exceed S' at any
point.
4. The sewer ]fine 'is to replace the existing sewer line that leads to
the existing ]eachfield.
5. The bed grave] is to be covered with typar fabric material.
6. Soil or combination of soil and extruded board insulation to a depth
of 4' or equivalent is to be placed over the leachfield.
7. The area over the bed is to be finish graded to prevent ponding of
surface watep runoff.
8. The septic tank and ]eachfie]d must not be closer than 100' to any
existing private well, 150' to any Class "C" well, or 200 feet to any
community well.
RECOMMENDED LEACHFIELO DIMENSIONS
TOTAL DEPTH = 3' GRAVEL DEPTH = 6" BED LENGTH = 38' total BED WIDTH= 12'
Bed to be instaqled as 2 - 12'x19' beds in terraced configuration~
Soil Rating = 100
Bedroom Capacity
Septic Tank Size
IOO0
***NOTE: REQUIRES 5' LOT LINE WAVIER.
***NOTE: LIFT STATION REQUIRED.
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL= LOT 3, BLOCK 2, PREUSS SUBDIVISION
GENERAL
1.
2.
3.
The we]] and septic plan are for a single family residence only.
The drawing and or site plan shall be a part of this specification.
All materials and workmanship shall meet the Anchorage Department of
Health and State Department of Environmental Conservation
requirements.
4. All soil tests are advisory to the design and are to be verified or
modified in the field by the engineer.
5. All excavations and depths are advisory and are to be verified or
modified in the field by the contractor to meet Municipality of
Anchorage, Department of Environmental Conservation requirements.
6. The excavation is to be exactly in the area shown on the site plan,
any deviation requires engineer approval.
?. It is always recommended that a surveyor locate the nearest lot line
position and the location of any easements.
B. Contractor to locate any underground utilities.
TRENCH
1. The trenches are to be terraced on the existing slope. ~onnection to
each trench from uphill trench is with overflow type distribution
piping arrangement.
2. The bottom of the trench shall be level, plus or minus 1.5".
3. The total depth of the trench excavation is not to exceed ~' at any
point.
4. The sewer line is to replace the existing sewer line that leads to
the existing ]eachfield.
5. The bed gravel is to be covered with typar fabric material.
6. Soil or combination of soil and extruded board insulation to a depth
of 4' or equivalent is to be placed over the leachfield.
?. The area over the bed is to be finish graded to prevent ponding of
surface water runoff.
8. The septic tank and leachfield must not be closer than 100' to any
existing private well, 150' to any Class "C" well, or 200 feet to any
community well.
RECOMMENDED LEACHFIELD DIMENSIONS
TOTAL DEPTH = 9' GRAVEL DEPTH = 8' TRENCH LENGTH= 42' total TENCH WIDTH= 3'
Trench to be installed' as 3 - 15'trenches in terraced configuration.
Soil Rating = 237 average
Bedroom Capacity = 3
Septic Tank Size = 1000
***NOTE: REQUIRES 5' LOT LINE WAVIER. DO NOT ENTER OR IMPACT NEIGHBORS
PROPERTY.
~NOTE: LIFT STATION REQUIRED, PRESSURE DISTRIBUTION LINE TO BE BURIED A
MINIMUM OF S' WITH 2" INSULATIOh~ WITH SLOPE TO DRAINBACK.
70
30
2O
10
0.01 0.001
,.." SILT .]~ ,-." CLAY
Z =',a i DZ.';O D 1 5
.1],,.'~, O '._ ~'-
-
MATERIAL DESCF:I PTI OH
SP A- 1 -b
,-~--FF~L-IF;LY L'-iF:¢fE. IE:i] SF~t. II~ AI'-.II)GRAVEL
' I
" '~" ~-== -- ~:' '"" '2 l':;I:it'il::'LE BEPTFI 1-2'
Prc, jec'b. F~,I ............... LOT -~.: ......... ,.. ....
2 L,:,c:~,.f:ic, r"~: TEE?l" HOLE .~ !I
GRAIN SIZ~ BI.~TP, i~:,I_ I IOH TEST REPOF:T h
,,c ¢~RQIJ;.,t SIZE DI:-]TRI'RLITION TEST REPORT
E Et". c ,x,®
80
,-'-0
I'--
r,
10
.10.0 1.0 .0.1
7~','''Tu F:IZE -
001
,.." S I L.T
'0. 10,68
Cc C: u.
1.02 53. 1
HATER ]: AL. BESE:R I F'T ]: ON I-IH._ i'l/U
WELL
Pr ,2 j ect Nc, ,, ." f-".rF,-Ed24
A-l-z**
Loc~.t ion: 'rEST HEiL_E
~ ,, ~'-~:,-:'.-*;,,:;'
:,~.,: ~.:. ....._~,:_,_~ ........................................................................................
GRAIN 'SI~E D]::E;TF'.IB!JTION TEST REPORT JJ
....
)J'.".':;AHF::'LE ]]EF'"I'i'4 2-'2~
igu. r'e No. i
GRAIN SIZE DISTRIBUTION TEST DATA Test No.: 3
:,~te: 3-27-89
Project No.: 89-024
P~oject: PRU'ESS LOT 3, BLK 2
Sempt e
L::cetion o¢ Sample: TEST HOLE
Se. mp]e Description: POORLY GRADED SAND AND GRAVe__
USCS Class: SP Liquid limit: N/A
AASHTO C~ass: A-l-b Pqas~fic~y index: NP
Notes
Remarks: SAMPLE DEPTH 1-2'
Mechanical Ana~ysffs Data
sample and tare:: !247.70
1,3:-,e, = 271.60
sample weight - 976.!0
for cumulatfive ~efight retained= 271.6
Sieve Cumu]. Ut. Percent
9.375 ~nchas 478.60
q 4 580.60 68.3
t! 10 745.80 5!.4
~ 40 9~2. I0 27.2
~ 69 !053.fi0 !9.9
Fractffona] Components
? ' ':' ir;. 0.C
GRAVEL = 3! .7
SAND = ~ 6
~'" -: -~ ~" q '~ D 5
D3O~ 0.505! D!5-
.... 944 * C~¢ =
3 r'TS DS0= i cea
C'. 16157 DIO= 0.08777
35°0?52
Project
Project:
GRAIN SIZE DISTRIBUTION TEST DATA
3-2?-89
89-024
PRUESS LOT 3, BLK 2
Test No.: 4
Sample Data
Locatfion of Samp]e: TEST HOLE
Sample Description: WELl_ GRADED SAND WITH GRAVEL
USCS Class: SW Liquid ]imit: N/A
AASHTO Class: A-!-a Plasticity inde;<: NP
Notes
Remarks: SAMPLE DEPTH 2-2.5'
Fig. No.: !&
Mechanical Analysis Data
!nitfia]
Dry sample end tare= 11!0.00
Ta~e = 27!.60
Dry sample we:!ght = 838.40
lane for cumulative v,,ei6hr :"?xa!~.Pd= 271.6
Sieve CL~NL]n. !,{~:. Percent
:-etainc'd
9,375 inches 398. 59
q a 552. O0
"~ 4.0 905.90
!7 (~," 95,0.`. !(
{% '{'12 1001 .5['
F 221 !052:.09
5 5 6
Fractional Components
~ = I O Z o c. {] L:
O. ~855~, ~,'--- ~r". 10678
23_!!P~
SV
130.00'
I-~-. !.0- :_. ~Z.I: L .]:_ .T~_ ._E:. 3_S:._E:._',_E. _N, _T. ...........
5'4
1~ '3 ~- "LENGTH
I ' 9' T.D,
~ I.OT 4
/
130,00'
EASEMENT
£XISTINO LEACH-FIELD
CLEANDUT -.
SCAL£, 1' = $0'
WELL AND SEPTIC SITE PLAN
LEGAL, LOT 3 BLK B PRUESS SUDV,
D~NERJ VA
CDNTRACTDR~ N/A
EAGLE RIVER ENGINEERING SERVICES
PD BX 773294
EAGLE RIVER, AK, 99577
694-5195
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION I~ PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
DATE PERFORMED:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
SLOPE SITE PLAN
~T.-'
WAS ~
d .. , IF YE
DEPT
,
~~ PERC(
/{'e~b -
WAS GROUND WATER S
FERED? )/~'J~ OL
P
, AT WHAT ~r~ ~e ~ ~- E
Gross Net Depth to Net
Reading Date Time Time Water Drop
ATION RATE Z~:) (minutes/inch)
TEST RUN BETWEEN ~ FT AND ~ FT
COMMENTS
PERFORMED 9Y:
72-008 (6/79J
Eagle River Engineering Se~ices
P. u. Box 173294
Eagle River, AK 99577
694~5195
CERTIFIED BY:
DATE:
. ~_: MUNICIPALITY OF ANCHORAGE
· · DEPARTMENT OF HEALTH & ENVIRONMENTAL PRoTEcTiON
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
NAME ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
' IPHONE I [~'I~Ew
-~ C~c--. '.~ .~t.-'~ N,..~'~V,,~,.~.v.._ ~_~O C~ ~ ~"..~ ~ ~'~' ~ UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATIO~
: .o.
~ ~ DISTANCE TO: ~ Well ~ ~ Absorption area D~e~ling PERMIT ~O.
~ Z Manufact,rer
~ ~ .~ Mater,al No. of compartments
Liq. capacity in gallons ~ Inside length
/ ¢¢ O ' IF HOMEMADE: Width Liquid depth
~ ~ DISTANCE TO: Well Dwelling
~ ~ ~ PERMIT NO.
O ~ ~ Manufacturer
Material Liquid capacity in gallons
Well . Foundation Nearest lot line PERMIT NO.
DISTANCE TO: '~,~ ~
~ ~ No. of lines Length of each line Total length of lines Trench wMth Distance between lines
~ ~ ~ Top or ti~ t~ finish g?" ~-~ , ~t.ri~ b.n~th ti~. ~ ~ G i~h~
Total effective absorption area
~ Length Width Depth
~ PERMIT NO.
~ ~ Type of crib Crib diameter
~ ~ Crib depth Total effective absorption area
~ Well
D~STANCE TO: Building foundation Nearest lot line
~ Class Depth Driller
~ Distance to lot line PERMIT NO.
~ DISTANCE TO: BuiMing foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
Q~O
INSTALLER
REMARKS
....
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
F'ERMI T NE
F F L I _.HN ]
LGCRT I ON
I_EGRL
_,TREET., RNCHORRGE, 264-4728
( 800622: )
DON
,~ I MMERMRN , R
MILE_... ":' ~ ~ E. R.
-"
L_~ B2 FRLE_,S
T'¢PE OF SOIL RE:SORF'TION S'¢STEM lb"]: [:'F.:RINFIELD
MR:..;IMUM NUMBER GF E:EDF.:OOMS = Z SOIL RRTING (SQ FT,-'BR)= ;2_.._
THE REQLIIRED ¢' '~ ,=,rill -c""" ' ' ,-",-'"F',, IS
--,I,~E OF THE H,.,:,URFTION
THE LENGTH DIMENSION IS THE LENGTH (IN FEET::, OF THE TRENC:H OR [:,F.:RINFIEL[:,."xJ'~
THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE
GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET.'.,.
]'t-~E TF-:E;I%~,BH I-.-~ :E [:,-tH :[ "-----; 5. ,.Z"~E-,E~ FEE]'-.
THE GRRVEL. [:,EPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE
RND THE BOTTOM OF THE EXCRVRTION (IN FEET).
F-: [£ ~"::.~ ~_[ .~ RE[:, '--T, EF'T ~: C: TR~'-,~ ?--'.' S ][ ZE:= J_ ~_-'~ El~-.T.:l
PERMIT RPPLICRNT HRS '['HE RESPONSIBILIT'¢ TO INFDRMI ' THiS DEPRRTMENT DURING THE
INSTRLLRTION INSPEZ:TIONS OF RN'¢ 1.4ELLS RDJRCENT TO THIS PROPERT'¢ RND THE
NUMBER OF REsIr:,ENCES THRT THE WELL WILL :,EF..,,,E.
MINIMLIM DISTRNCE BETWEEN R HELL RND RN9 ON-SITE SENBGE DISF'OSRL S'¢STEM IS
!00 FEET FOR R PRIVRTE NELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTRNCE FROM R PRI'¢RTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND
TO Fi COMMUNIT'¢ SENER LINE IS 75 FEET.
WELL LOGS RRE REQUIRED RN[:, MUST BE RETURNED TO THE [:'EPRRTMENT WITHIN ~0 DRb'S
OF THE WELL COMPLETION.
OTHER REQLIIREMENTS MR'¢ RPPL.~'. SPECIFiCRTIONS RND CONSTRUCTION [:,IRGRRMS RRE
R'v'RILRBLE TO INSURE PROPER INSTRLLRTION.
F'EF~' ffl Z T E::4F" I: ,F.:F:~; [:. E C: El f.~ E: EFI 2:1.. :1- ...... '-:~'-'
! CERTIFN' THRT
±: I BM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH BM THE MUNICIPRLITM OF RNCHORRGE.
2: I WILL INSTRLL THE SYSTEM IN BCCORDRNCE NITH THE CODES.
~: I UNDERSTRND THRT THE ON-SITE SEWER SMSTEM MRM REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THRN ~ BEDROOMS.
S ! GNED: .................................................
RPPLICRNT DON ZIMMERMRN ..f'R
ISSUED B'-d_ DRTE_~/ _
V4. 0
ENG.- NEERING & DEVELO'~MENT CO. :~
Box 90, Davis St., Eagle River, Alaska 99577 ~
694-2774 or 688-2280
Russell Oyster Earl Ellis
694-2774 SOIL LOG 688-22e0
Performed for: Name: '~ ~/"/
Mailing Address:
Legal Description: L~ ~
Soil Characteristics
Depth (feet)
0
1
2
...---,3
4__
5__
7__
8 '
9~
10__
11__
?
B
PLOT PLAN
12__
13__
14__
15__
16__
Ground Water Encountered:
Proposed Installation: Seepage Pit
Comments:
Yes / No If yes, what depth
Performed by:
Drain Field
PERC. TEST
0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
INS
• Municipality of Anchorage
On-Site Water and Wastewater Program
(907) 343-7904
S n r r r
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050-572-06 Expiration Date: 9-1 3-1 7
1. GENERAL INFORMATION
Complete legal description PREUSS #1 BLKLOTS
Location (site address) 20513 EAGLE RIVER ROAD,EAGLE RIVER AK
Current Property owner(s) BRAD ALEXANDER _ Day phone
Mailing address SAME
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU) Q�' z 3 4 56,
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex) z o -
0
3. NUMBER OF BEDROOMS: 3 p
4. TYPE OF WATER SUPPLY: TYPE . = ' ER DISPOSAL:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
Waiver/Variance request for: Distance:
Received by: thU . Date: ("7?7 ,72
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ L.l(.(JO Waiver Fee $
Date of Payment �-ll� Date of Payment
Receipt Number f/a A3a Receipt Number
COSA# 4 lq« -tI Waiver#
A. .
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 MIKE N ANDERSON. P.E. Phone 727-8864
Address 4661 NATRONA AVE.
Engineer's Printed Name MIKE N ANDERSON. PE Date 6/6/17
�`P
•• jk •.L, pt
l
; ° 9 111 • t
`)•0 0" ° 0 0 s o•0 0 0 0 0• • y r,
LI
`i r
6. DSD SIGNATURE <• ° ° '
12, !J + AAICHAEL N. ANDERSON
System #1 Approved for 3 bedrooms. ��, CF-94+69•ti ,,•: �}
•
System #2 Approved for bedrooms. t; ti,1r1' l •1�
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
,�����\( OF,gt�C'y0
z�
WATER AN D
,tet WAON-SITESTEWATER
PROGRAM
i
By: Original Certificate Date: G -1 /
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
•
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory.
Septic System Advisory Arsenic AdVistryt
Well Flow Advisory Other •
COSA blue sheer 10.10.12.doc • •r
If more than 1 septic system is on the lot:
COSA Checklist # of
Structure served by this system _
Certificate of On-Site Systems Approval Checklist
Legal Description: PREUSS#1 RLKI.LOTS _ Parcel ID: 050-572-06
A. WELL DATA
Well type Private If A. B. or C provide PWSID # Well Log (YIN) Y
Date completed 1.16-81 Sanitary seal (Y/N) Y Wires properly protected (YIN) Y
Total depth 318 ft. Cased to 318 ft. Casing height (above ground) 12"+
FROM WELL LOG AT INSPECTION
Date of test 1-16.81 512512017
Static water level 301 ft. 300 ft.
Well production 6 g.p.m. 3+ g p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate ND mg/L
Arsenic. _ ND uc.L Date of sample. 5(2512017 Collected by' Mike Anderson
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC 1 STEEL Date installed 5.21.89
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y
Date of pumping 6-7-17 Pumper Alaska Quality Pumping
C. ABSORPTION FIELD DATA— 198t SYSTEM TESTED
Date installed 5.21-89 Soil rating (sf/bedroom) 237 SF System type DEEP TRENCH
Length 15x3=45 ft. Width 3 ft. Gravel below pipe 8 ft.
Total depth *11 ft. Eff absorption area 720 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 5/25/2017 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 66 in. Water added 500+ gal. New depth 82 in.
Elapsed Time: 60 min. Final fluid depth 76 in. Absorption rate >= * 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) UNKNOWN If yes. give date
D. LIFT STATION
Date installed 5-21-89 Size in gallons 500 Manhole/Access (Y/N) Y
"Pump on" level at 27 in. "Pump off' level at 36 in. High water alarm level at 40 in.
Datum BOTTOM Cycles tested 4 Meets alarm&circuit requirements? Y
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
Sewer/septic service line 50'+ Holding tank 100'+
Animal containment areas 100'+ Manure/animal excrete storage areas 100'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5' Property line 5' Absorption field 5'
Water main 100'+ Water service line 25'+ Surface water 100'+
Wells on adjacent lots 100'+
ABSORPTION FIELD ON LOT TO:
Property line 5'+ Building foundation 10 Water main 100'+
Water Service line 10'+ Surface water 1001+ Driveway, parking/vehicle storage 10'+
Curtain drain 501+(None Known) Wells on adjacent lots 1001+
F. COMMENTS
tested the middle trench '4'4 ..4/1 p rn r.� P", ,/'- {� ,.r '2 n� Ri �T p„)(..
G. ENGINEER'S CERTIFICATION
l certify that I have determined through field inspections and *:4 9 T N •
review of Municipal records that the above systems are in `�'Y "
conformance with MOA COSA guidelines in effect on this date. r. r,
f •
� �?• MICHAEL N. ANDERSEN ;t'g
Engineer's Printed Name MIKE N. ANDERSON, PE �r�f•, CE 9 69 .';',.Z7;;
r1 `Q r�t� _ •� y
h r' JJ
Date 61612017 1 b,. •` "
COSA canary sheet_2-6-15.doc
_ Frontier Surveys,LLC Project No:17-072 Date:May 24th,2017
•
NORTH Ordered By:Laney Stapely PIat:69-156 Grid:N/A
Scale I"=35' ,
TRACT B
• N89'S9'00"W 130.00'
—p.—w—w--a.L.f —wC pe 0—wo+ -'. r - -E -.
.—oe
` t/ O O —� ——l- 10 UTILITY ASIMLNE
—1, o
Preuss Subdivision
i R cD Addition#1
v Lot 3 of Block 2
0
24,375 sq.ft.
41 \ 1015 f egaa.e•Wad
:xr.wood r,.m.d nate
% 8.1' .;sec,a,.Ca,e.,,ag. 0
I 4•
% 24.2. 4.�
N
7 e �49AGE — _11d
r
-
26.4' 7
LOT 2 I LO1 4
M
En CONCRETE PAD 515010 dp
i.OUSE
'f S / 25.2
12.2'
—23.7 ++ 1` 11
/ i I
�' r
3 / \ / 3
Lin
g " 4 1
J l a 1
I a
I1 3 (
t f
I + I
,0.;:
l tar weu RADtus r-' — I —1:39. 9:
130.00'
•
I S00"W
1 / cutVERT
I l
I
03 I
o,p /I l
• EDGE OF PAVEMENT
i -. ._ !
----------- - --- - --4 EAGLE RIVER ROAD-- ---------
Legend:
ClectnL Meter/Outside Power C,, Telephone Pole
Gas Meter D Deck -0- Fence oITy 35 70
)" , Septic (7:` Water Well —I"P—Over Hanging Power Feet
General Notes:
I.This document is created for the purpose of a single property transaction and is subject to federal Copyright Law.
2.Excepting for gross negligence,the liability for this survey shall not exceed the cost of preparing this survey.
i.All measurements/set backs are to the visual/apparent building footprint.
4.Dimensions to property lines are plus/minus D.ttt.
1vp'99* This survey complies with AWLS Mortgage Location Standards.the survey represents visible improvements and
'4-4:
- 0F A! 4 conditions at the time of the survey.This document does not constitute a boundary survey and is subject to any
,:'{.........L•./ 4 inaccuracies that a subsequent boundary survey may reveal.It is the responsibility of the Owner to determine
Ar, '- r r 4 the existence of any easements,covenants,or restrictions which do not appear on the record plat.Under no
/'i �.,r� circumstances should this document be used for construction or for establishing a boundary or fence line.
r Cr+;,. T N 8
•° k : -• 1—
f..•• f- As-Built Survey of:
%a .r- '- j. 5 Lot 3, Block 2 of Preuss Subdivision,Addition #1
r
• FREctatC W. WA NERC' Al I,Frederic Wagner,hereby certify that I have performed a Mortgage Inspection Survey on the
L -9145 • dr subject property as described above on May 24th,2017
4
Il�itA;•07.....;. , r..." � ' Frontier Surveys,LLC FRONTIER.
-lbr„v,+.s� 650 W.58th Ave.Suite E Anchorage,Alaska 99518 gUrV 8a.„
907.460.1686-info@frontiersurveys.com •
PROFESSIONAL SEAL www.frontiersurveys.com
Municipality o.f Anchorage
Development Servzces Department
~.. u~.~,~
Building Safety Division '~ii~ ~'
On-Site Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.a nchorage.ak.us
(907) 343-79O4
Parcel I.D. 050-572-06
1. GENERAL INFORMATION
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAHILY DWELLING
Expiration Date: J' - ..-~. ~ - O ..~
Complete legal description PREUSS SUBDIVISION ~1: LOT ,3, BLOCK 2.
Location (sJte address or directions) 20513 EAGLE RNER ROAD * EAGLE RIVER, AK g9577
Current Properly owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
LINDA &: ROBERT REMY Day phone 696-2400
20513 EAGLE RIVER ROAD * EAGLE RIVER, AK 99577
Day phone
MARGARET TOVREA w/ PRUDENTIAL J.W. Day phone 229-3355
3201 'C' ST. sUFrE 200 * ANCHORAGE, AK. 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well [~]
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site [~
Individual Holding tank
Community On-site ~r~
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of Issue for properties served by a pdvate or Class C well and may
be reissued with new water sampleS. (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.
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ ~ i~ ,~,O~at, or pdor I
to closing for the enginee#ng services provided.
I
4, STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown be/ow, I vertfy that my
investigation, based on procedures outlined in the Health Authotfty 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 Anchorege t'J/es and frem my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with ali applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phone
Address 6901 OEBARR ROAD. SUITE 2B * ANCHORAOE. AK 99504
Engineer's Printed Name JEFFREY A. OARNESS, P.E. Date
337-6179
Engineer's Comments:
In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
dislances measured to readily identifiable features. The operational life of ali wells and
septic systems depend on the local soils condition, groundwater levels that may
§uctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the contro! of the eva/uator of the system. Satisfactory/test
results do not guarantee future performance of the system, nor do they guarantee that
there ere no hidden defects or encroachments. AKWWC, Inc. can therefore not provide
any warranty or future estimate of how long the system wilt continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the so/e benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any lega! right whatsoever.
5. DSD SIGNATURE
V'"' Approved for 3 bedrooms.
Disapproved,
Conditional approval for
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
bedrooms, with the fllowing stipulations:
Manitenance Agreements
Supplemental Engineer's Reort
Other
Original Certificate Date:
Municipality of Anchorage
Development Services Department
Bundin9 6afe~ O~k~n
On-S~ water & Wa~ewster program
4/00 SOUm 8ragaw 6L
P,O, Box 196650 Anchorage, AK g951g-6650
~wv.ct.ancflomge.ak. us
{~7) S43-7904
Legal Osscllption:
A. WELL DATA
HEALTH AUTHORITY APPROVAL CHECKLIST
PRE'USS SUBDMSION ~11: LOT 3~ BLOCK 2, ParcallD: 050-572-06
Welltype ~mVA~ IfA. 8, ore pmvldePWSlD~ ,N/A
Date completed 1/12-16/81 Sanltewseal (Y/N) ,yEs
Toteldepth 318, ft. Casedte ,318 ft.
Date of test
Static water level
Well production
WATER ,~NVlPLE RESULTS:
Callform I~ colonies/100 mL
Nsanic N/A mg./L
SEPTIC/HOLDING TANK DATA
FROM WELL LOG
/ 2-16/el
,301 it,
6 g.p,m.
Date of sample: 7/23/2002
Tank Type/Mate~l =¥ ~'
TankMze looo gal. Number of Compartmants
Foundation cleanout (Y/N) YES
Date of pumping 7/19/2002
ABSORPTION FIELD DATA
Date Installed e./21/a9
Langlh 45 TOTAL It.
2
Depression over tank (Y/N) NO
well Log (Y/N)
Casing height (above ground)
AT INSPECTION
7/19/02
297 fl.
`3.`31 g.p.m,
YES
YES
12'+
Other becterfla ~ coloniss/100 mi.
Callecte<! by: AKWWC, INC.
Date installed
Cleanoute (Y/N)
High water alarm (Y/N)
Pumper JR'S PUMPINg
~'ESTED MIDDLE TRENCH ONLY
raUng (g.p.d./fl~r~) 237 ~ lype
$~1
Width 3 ff~ Gravel below pipe
Totaldepth lo.e-Il.aft. Eff, abeo~ptJonama 720 ft~ Monlt~tngtube YES'
Date of adequa~ test 7//19/02 Results (Pass/Fall) PASS
Fluid depth in absofpUan field before test 58 in. Water added *B21gal.
Elapsa~ Time: 120 min. Final fluid depth ,62 in. Abeoq3tlon rate
Any rejuvermtlan treatment (past 12 mo.) (Y/N & ~/pe) NONE KNOWN
5/21/89
TRENCH
8 ff.
Depression over field NO
Fo~ 3, bedrooms
New depth ,75 in.
450+ g.p.d.
ff yes, give date -
D. UFT STATION
Date installed 5/21/89
"Pump on" level at 27.,5 in.
Datum BO'rl'OM OF TANK
E, SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Size in gallons 500
"Pump off' level at 35.,5 in.
Cycles tested 3
Septic tank/lift station on lot100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer/septic sowice line 25'+
Manhole/Access (Y/N) YES
High water alarm level at ,39 in.
Meets alarm & circuit requirements?, YES
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/deenout
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+
Water main N/A Water sen, ice line 10'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line '5'+ Building foundation 10'+
Water sewice line 10'+ Surface water 100'+
Curtain drain NONE KNOWN Wells on adjacent lots 100°+
F. COMMENTS
*PER 1989 INSPECTION REPORT
N/A
Absorption fieM 5'+
Sudace water 100'+
Water main N/A
Driveway, parking/vehlcte storage 10'+
G. ENGINEER'S CERTIFICATION
I certify that I have dete~rnined through field inspections and
mwew of Munic~pe/ records that the above systems are in
conformance wfth MOA HAA guidelines in effect on this date.
Engineer's Printec~. Nam9
JEFFREY A. OARNESS
HAA Fee $ 3~'75'
Date of Payment
Receipt Number
(Rev. 12/0t)
Waiver Fee $
Date of Payment
Receipt Number
10/18/02 FR! 16:1~ FA][ 1.907 762.;3169 J~}~ ~}~.T~ Estate. ......... , 1~?~02 _
· .. .., ,, . ~ -,, .~ l~ .... ~ ...... ~ · .. ~ ~, . ~. ~ . . . ,. , . .~ .... ~,
.~-,..*' ~.~ .... .,.-.,~,~..~ ~.-.~.~ .'-,~,*. ~,_'.. ~-.. ~':. *:,..:~.*. ,,~ , ...., .- .~:; ', .' . '- .~..~ :}~
· .:,...:T.,-* ~,~.. r. ~ . - . . .... .. . ,. . = ~. ' ,.. '~,. -, ...:, .,~,/..:,.~.
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..... ".' , :' .....;, '," '., .... · .~'~e~.' ~ k ~,'~,~*~" ':', · *~ . .'~ '~
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~f.. ,~.. ~Z..,,,.~, .,~.. .,,~ .... ~, .,, ~ ..... ., ~ ..... . . . . ,, . ........
~..r~ ,'~ ~ " ~ ~ ,~ ::. .,~:,~ ''..'.~'; ~.F '- · , ..... .' ,,'~. .. '." ~* * ', ~*:g
· .~. .... ~:% · - ,~ ~',~ '-- ' .' .~ ....... kJ! .... :~, * .... ~.
· ~.~.-._ .,.. ....~'~c~_., '~*. . . ,, ,.. '1 ~,. .. '. ,. .... .,.,". .,* -~' · ._.'
.~.-,'. '~*~. ~*" .~..~-~ ~. · * .:.' ;'-i ~ r'.> *.' . '..*'.. .... ~ '~'-~,;-T
~. ~,?;: ....,~ ...-:: fi'- .~..~.,~,?,a' ... -~ ~.* ~.. A?;' · ~ · ' '.: , '.
~,~ ~. ~ ~ .. ~ L~, .. . ., .... . , .,.
.,.. ~, · %. -. ~ ~.{~,..~-~ ~:.~.~. ,~, . .. . ., . ..... . ~;.
:. ·., *"..,~.. ~. ~.~,*...T,~,~% .~ ~. ,.-..,..~ ..:. ~: . ,..... , ~ .~
....... ~....~... ....... *J~~ J. ..t R .., . .. .. . ....
:~.,.'~'~-. ] ~1-~' ~. '~ . ~ .~ T · ~ ~ · · ~" · ·. ,.~
~., ,. ~~..~ ~ '~ 14~ . ?. ~. ~,. . . . ...... : .... , ~
· ,,~. ..V'...~... ~ ~ ~ ':'~"' ,,.. . ., . ~, ., ·
:..,~ · ~.,~-'.' ..... ,.. ~ ~ -'.t :~ , .... .,~. .: T~: : .... - · ~' .~ ,'.~.~
,~..'..:..: ,,~-~ ~.~ ~ ~ · T,.~.~ ,, .,....~ ,..../~: .~.. ,~..-.~...: ...... ,., ...-,,,~
-~......-~ ,,[ .... ~~..~ ~i¥; ,,~.,..~--.,~' .~ - .. ~, .. ...,.
.;..:...~ · ,,,~ ~ , · ~ ~'~:~ ~ ~. ~'.. . ..... -~ . ~. ~ . · .. ,~_
. .. . ', ~ ... ~ .. .'~:e ~'.. .* ~ .... ~..-. ~ . ... · . · . ~ *~.
?..'-. . ' _..,. ~' '.'- .- .... ~ ~ · :~'~e.~'.~. ' .',~,..~:~ .... · . .,~'..
'JUl.-30-02 04:32P~ FRtAI-CTIE EXVIIEM, ENTAL SRV
~tE CT&E Environmental Service,, Inc,
9075615~01
T-305 P.O2/01 F-524
1024555001
AK Water & Wastewater Co~sulta. nts Inc.
P~uss S~ ~t 3 Block2 -- -~
D~g Water
All Doles/Times are Alaska Standard Time
Printed Date/Time 07/30/2002 9:03
Collcctt'd Date/q'lme 07/2'1/2002 9:12
Received Date/Time 0'7/23/2002 13:25
Technical Director
Released By ~~
NiITam-N
0.200 U
Un~n Men.ti
Al~owlble p~ep Analys;*
0.200 mg/L £PA 300.0 {<10) 07/23/02 JDT
leLc=~'ob Lo'~ o~,/ L&borato~y
Total Col,troTh O
co~/I O~mL SMI$ 92220
(<11 07/'23/02 S01!
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
,~_~t~- ~'-l:?----x- f"-'} ,~, NAA# F-I ~ ,,~--~c! ~
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Press Sub. Lot 3 Block 2 T14N, R1W, Sec.8
Location (address or directions)
Eagle River Road Mile 3
(b) Property owne[¢eterans
Mailing Address C/O 4105
(c) Lending Institution
Mailing Address
Administration Telephone: (home) Business
Tudor Centre Drive Anchoraqe, AK 99508
Telephone
(d) Real Estate Company and Agent Bob Martin/Coldwell Banker
Address 4105 Tudor Centre Drive, Anchoraqe, .AK 99508
Telephone 561-2488
(e) Mail the HAA to the following address: (or check here Fl, if hold for pick up.)
List contact person and day phone number below:
Pick-up
by Engineer
2. TYPE OF RESIDENCE
Single-Family ~ Number of bedrooms 3
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 th legality and status.
4. SEWAGE DISPOSAL
On-site ~, 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.
72~025 (Rev. 7/88) Page 1 of 2
a to a a6ed
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MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
R ,crc X/red
A. WELL DATA
Legal Description:
/Y Date Completed 1/¢/
Depth of Grouting
If A, B. C. D.E.C. Approved (Y/N)
Yield ~ ~-p,,~. ,,~-~
Pump Set At ¢ --~,¢ g ·
Sanitary Seal on Casing (Y/N) .Y
Depression Around Wellhead (Y/N)
; On Adjoining Lots ,~o,~
; On Adjoining Lots
Well Classification
Well Log Present (Y/N)
Total Depth --?/'~' Cased to ~,/,~'/
Static Water Level ~3o//
Casing Height Above Ground
Electrical Wiring in Conduit.(Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by /5'~r~'~¢
Water Sample Test Results
To Nearest Public Sewer Cleanout/Manhole
; Date z-/'~ g/,,p
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed /f',~'~ Size
Standpipes (Y/N) /v
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
/~-'¢'~ ~',/' No. of Compartments
Air-tight Caps (Y/N) )/ Foundation Cleanout (Y/N)
Date Last Pumped ,.5-/~
; for
Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well ~-/;~Y' To Building Foundation
/~ / To Disposal Field ' ~:/
To Property Line
To Water Main/Service Line ~-/'¢ /
To Stream, Pond, Lake or Major Drainage Course
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field 3
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well ¢"/~'~
To Building Foundation /~
Lot ¢-,,? z) /
Type of System Design
Length of Field
Depth of Field 2' /
Gravel Bed Thickness
Statndpipes Present (Y/N)
Date of Last Adequacy Test
To Water Main/Service Line ¢-/,¢ /
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Property Line ~--"
To Existing or Abandoned System on
; On Adjoining Lots
To Cutback (if~p-resent)
D. LIFT STATION
Date installed
Size in Gallons
"Fump On" Level at ~ .2.?,.~-
High Water Alarm Level at
Tested for .4..,d~., ~¢.-,~- t-,-,
Dimensions ~¢-',~,- ~-
Manhole/Access (Y/N)
'¢,*//>", "Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
Meets MOA Electrical Codes (Y/N) )/'
Comments .'~"'~--~- 7'~ "J'¥ ,,.~'"~ .,¢~,,¢'---~,.¢,'*~' ~, ~
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA ~l'"]'(f~§ i~ ¢ff~,bt~on the date of this
inspection.
Company Eagle Riv0r Engineering Services
P. 0. u0x 773294 ~~~ ~gineer's Seal
MOA No. ~-~
Receipt No.
Date of Payment
Amount: $
72-026 (Rev 7/88) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
~ · / ' DATE RECEIVED
~' iNSPECTiON APPOINTMENTS~~
DATE DATE DATE
INSPECTOR
INSPECTOR I NSPEC~R
MUNICIPALITY OF ANCHORAGE MUNICIPALI~ OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIONDEPT. OF H~z~,LTH &
825 L Street - Anchorage, Alaska 99501 ~NVJRONMENTAL P;;OTECTION
ENVIRONMENTAL SANITATION DIVISION dl'J 5 i981
Telephone 264-4720
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed, Please allow ten (10) days for processing.
,~HONE
~ROPERTY RESIDENT (If di~f~nt from abo~ PHONE
PHQNE
2. BUYER .
MAILING ADDR E~S
~A LIN~ADDR ' [ ~ ~) .
4.~ REALTO~G ENT '~ , ) PHONE
5. LEGAL,I~ ESCB.IPTION~
TYPE OF RESIDENOE ~ ~'~ NUMBEROF~BEDROOMS
~ One ~ Four .
~ .SINGLE FAMILY ~- Two ~ Five
~ MULTIPLE FAMILY ~ Three ~ Six
[] Other
7. WATER SUPPLY
[~.INDIVIDUAL~
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. Awell Icg is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach Icg if available.)
8. SEWAGE DISPOSAL SYSTEM
{~.,. INDIVIDUAL/ON-SITE** .~C~ YEAR ON-SITE SYSTEM WAS INSTALLED.
[] PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
1, TYPE OF RESIDENCE NUMBER OF BEDROOMS
[~ SINGLE FAMILY [] ONE [] THREE [] FIVE E~ OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
2, WATER SUPPLY PERMIT NUMBER
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUB,,C UT, L,TY /
Connection Verified
INSTALLER
F-ISepticTank or []Holding Tank
Size: ? (:~_~ 0 If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank Absorption Area 1Sewer Line Nearest Lot Line
1
WELL TO:
Absorption Area to nearest lot Line
5, COMMENTS
~ FOR BEDROOMS
/APPROVED
[] CONDITIONAL APPROVAL (letter must accompany certificate)
~] DISAPPROVED
72-010 (Rev. 6/79)