HomeMy WebLinkAboutPREUSS #1 BLK 2 LT 4D,***fDjv,�w 4' I
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP241274
Work Type: SepticTank Upgrade
Tax Code Number: 05057205000
Site Legal Address: PREUSS #1 BLK 2 LT 4 G:0056
Site Mailing Address: 20535 EAGLE RIVER RD, Eagle River
Owner: BLAUM CHRISTY L & ADAM C
Design Engineer: NORTH RIM ENGINEERING
This permit is for the construction of:
Effective Date:
Expiration Date
Lot Size in Sq Ft:
Total Bedrooms:
t)cparern� nr
9/5/2024
9/5/2025
24375
❑ Disposal Field EI Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
�M L Date:
Issued By:=�ld���� �..- Date: C�'� -�-
3
MUNICIPALITY OF ANCHORAGE
/77 77
s
Development Services Department y
X
Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel 1. D. 05057205000
Property owner(s) BLAUM
Mailing address 20535 EAGLE RIVER RD
Site address same
Day phone 351-6138
Legal description (Sub'd., Block & Lot) PREUSS #1 BLK 2 LT 4
Legal description (Township, Range & Section)
Lot Size 24,375 'Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(Z all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF) El
(w/wo, ADU)
Septic Tank
RX
Upgrade El
Duplex (D) ❑
Holding Tank
R
Renewal ❑
Multiple Dwellings El
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Cqdesl. /---
(Signature of property owner or authorized agent)
Permit/Rush Fees: 2 Waiver Fees:
Date of Payment: Date of Payment:
Receipt Number: Receipt Number:
"') S
Permit No. L Waiver No.
GADevelopment Services\Building Safety\On Site Water and WastewaterTorms\Client FormsTermit Application.doc
SteveEng.com Preuss #1 B2 L4
SPECIFICATIONS & DESIGN GUIDELINES
Wastewater System Sizing: This is an existing 3-bedroom, single family home. This is a
developed subdivision. Upgrade new 1500 gallon STEP tank. The existing trenches
remain in place. No adverse impacts are expected from tank upgrade. No conflicts to the
other lots will take place by this septic system construction upgrade. Decommission old
tank per UPC. Easements depicted in the area, private wells serve these lots.
Specification Requirements: All components and work must comply with the
Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water
Regulations and Wastewater Regulations.
New 1500 Gallon STEP tank. MOA-Approved.
Decommission old tank per UPC. MOA-Spec Material Under Tank.
10 minimum between the tank trench, tank to house. 10 to property lines,
3 of cover or insulation is required for trench; 2 Minimum thickness for insulation
can substitute for 1 cover.
Tank & solid pipe must be set on well compacted, stable soil.
4 inch diameter cleanouts with airtight caps are required 1 to 4 from foundation
wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two
adjacent opposing cleanouts between the tank and the absorption field, not more than
10 from the tank positioned to provide cleanout access towards the tank and towards
the absorption field.
All cleanouts must extend to at least ground level.
In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.
Force main to be 1.25 Schedule 40 PVC or equal.
The finish grade must be mounded to promote drainage away from tank.
Insulation must be placed over any pipe installed under driveways or parking areas.
Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789,
ABS ASTM D2661,
Sewer Service Line is minimum 2% slope.
Septic Tank to be pumped every two years or when required.
Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal)
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241274, Deb Wockenfuss, 09/05/24
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241274, Deb Wockenfuss, 09/05/24
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241274, Deb Wockenfuss, 09/05/24
Municipality of Anchorage Page I of 2—
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: Swg30LI(OR PID Number: 0S0.r72o5-
Name:
Wastewater System: ❑ New Upgrade
A�ol-rurJo� 12o Sr�/� ��
ABSORPTION FIELD
Phone:
No. of edrooms:
❑ Deep TrenchShallow Trench ❑Bed ❑Mound 11 Other
LEGAL DESCRIPTION
Soil Rating: dr
Total Depth from origins;
Permit No. SW930469 Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: PREUSS SUBDIVISION #1, BLOCK 2, LOT 4 PID No.: 05057205
Col CO2
98.8'
MT5
FINAL GRADE
M.H.
107.5'
_ 106.8'
NEW
94' 1250 GAL
93.8'
S.T.E.P.
SYSTEM
103.3'
103.3'
103.3'
NEW PRESSURIZED
DISTRIBUTION
DRAINFIELDS 100.3'
100.3' 100.3'
0
0
A 92.3' No WATER FOUND
16' MT5
O
o
1 H':
eT6 =
r
_ MT4 ..27,
N
W w_
A
B
C
o
FCO
3.0'
23.5'
MT3
C01
12.5'
33.5'
CO2
19.0'
40.5'
01
M.H.
21.0'
42.0'
M72
MTI
20.0'
40.0'
MT2
57.0'
15.0'
MT3
46.0'
36.0''
MT4
64.0'
33.0'
EXISTING
MT5
62.0'
46.5'
BDRM
25 DEC
MT6
71.0'
46.0'
25'
Ho
491.5•
co
ANEW
1250 GAL.
15
OF MANHOLE
WELL
SCALE 1" = 40'
72-013 A (2/91) MOA 25
MT1 I
E111,f3MEER'SSEAL
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PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW930469
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:ALASKA HOUSING FINANCE CORP
OWNER ADDRESS:701 EAST TUDOR ROAD, SUITE 100
ANCHORAGE, AK 99503
PARCEL ID:05057205
LEGAL DESCRIPTION: PREUSS #1 BLK 2 LT 4
LOT SIZE: 24375 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
DATE ISSUED:11/04/93
EXPIRATION DATE:11/04/94
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 DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
THE UPPER TRENCHES IN THE DRAIN FIELD SHALL
DEPTH OF 6 FEET, WITH AN EFFECTIVE DEPTH OF
LOWER TRENCH SHALL HAVE A TOTAL DEPTH OF 4
EFFECTIVE DEPTH OF 3 FEET.
RECEIVED BY: I
ISSUED BY:
HAVE A TOTAL
3 FEET. THE
FEET, WITH AN
DATE:
DATE: 'f
rj-
` October 27, 1993
ORA,
ROBERTSHAFER, P.E.
ROGER SHAFER, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
Anchorage, Alaska 99519-6650
SEWER & WATER
MAIN EXTENSIONS
REFERENCE. Preuss Subdivision #1, Block 2, Lot 4
SEWER & WATER
INSPECTION
-
We request you issue a permit to upgrade the septic system serving the
ENGINESTUDIES
three bedroom house on the referenced property.
AND REPORTSPORTS
An adequacy test performed on the existing system for Health Authority Approval
purposes found the absorption capacity of the existing system to be inadequate.
WELL INSPECTION
& FLOW TEST
A test hole was excavated and a percolation test performed in the area of the
proposed upgrade. The approximate location of the test hole is located on the
attached site plan. The monitoring tube within the test hole has been checked
SITE PLANS
and found to be dry. Attached it the proposed upgrade design.
We do not anticipate any adverse effects on neighboring properties by the
installation of the proposed septic system.
ROADDESIGN
If you have any questions, or require additional information for your review,
please contact us.
SOIL TEST
Sincer ly,
PERCOLATION
TEST
A. Shafer, P.E.
STRUCTURAL&
MECHANICAL RAS/LSU/Isu
INSPECTIONS
ONSITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
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In
Municipality of Anchorage a
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "I " Street, Anchorage, Alaska 99502-0650 r° N
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: �L` 4(,,t's1A) G DATPER
LEGAL DESCRIPTION: r r� z%euSS1OWnship, Range, Section: l�
TH Z SLOPE
(FEE
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WAS GROUND WATER �( %�
ENCOUNTERED? � v
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IF YES, AT WHAT L
O
DEPTH? r P
E
Depth to Water After
Monitoring? Date:
F
9•
F
wt PL shvf-x
U
SITE PLAN
Reading
Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
2
Z
Z.
3
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20 PERCOLATION RATE ` % K /�
Q (minutes/inch) PERC HOLE DIAMETER 7
TEST RUN BETWEEN F AND � FT
COMMENTS
GI EERING
PERFORMED BY: p17.024 7 R,a Cts' �p I CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WIT7i%.�'#FffEAA;4& L$MRFF7AL GUIDELIN S EFF CT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
REFERENCE: Lot 4 Block 2 Preuss S/D Add. #1
GENERAL:
1. The scope of this project includes the installation of a
1250 gallon lift station and three five foot wide
drainfields to serve the existing three bedroom residence
on the referenced property. The existing septic tank is
to be abandoned and a new 1250 gallon septic tank
effluent pumping (S.T.E.P.) system installed. The
existing leachfield is to be abandoned in place.
2. Construction shall be in accordance with the approved
site plan and design drawings; Municipal permit with any
special provisions or conditions; and all applicable
State and Municipal Wastewater Disposal Regulations.
3. The contractor shall be responsible for obtaining any
necessary underground utility locates.
4. Unless specifically agreed otherwise, the property owner
shall be responsible for final grading areas subsequently
depressed from soil settling. On all leachfield mound
systems, the property owner shall be responsible for
ensuring a satisfactory vegetation growth over the
mounded area.
5. Contractors installing wastewater disposal systems must
be certified by the Municipal Health Department for
system installations. Owners installing their own
systems must also receive prior approval from the
Municipal Health Department.
SEPTIC TANK INSTALLATION:
1. A septic tank is to be constructed by a certified septic
tank manufacturer. Construction shall include two 4"
cleanouts for pumping access.
2. The septic tank shall be sufficiently bedded to prevent
settling or shifting of the tank.
Page Two
Lot 4 Block 2 Preuss S/D Add. #1
September 23, 1993
3. All standpipes on the septic tank shall extend a minimum
of 12 inches above final grade.
4. Septic tanks installed with less than 4 ft. of cover
shall be insulated.
5. A foundation cleanout shall be installed one to four feet
from the building foundation. In the line between the
tank and the leachfield there shall be two adjacent
cleanouts (unless an effluent pumping system exists
within the septic tank). These cleanouts shall be
located on undisturbed soil not more than 10 ft. from the
tank. The first cleanout, in line, shall be to clean
toward the leachfield. The second cleanout shall be to
clean toward the septic tank.
6. Final grading over the septic tank shall be such that a
positive slope exists away from the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
1. Excavate the proposed trench to the dimensions shown on
the design. The bottom of the excavation shall be within
2 inches of level. If the sidewalls of the excavation
become smeared, they must be raked or scratched (ruffed -
up) before gravel (sewer rock) placement.
2. Once the gravel is installed, the distribution pipe is to
be installed level with the perforations faced downward.
Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
3. A silt barrier must be installed between the final gravel
layer and the native soil backfill. Ensure the silt
barrier covers the entire gravel surface before placing
backfill.
4. Monitor tubes shall be of four (4) inch diameter and
installed approximately in the locations shown on the
design. The portion of the monitoring tube extending
through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This
is equivalent to the effective depth of the gravel as
noted on the design.
Page Three
Lot 4 Block 2 Preuss S/D Add. #1
September 23, 1993
5. Backfill over the final gravel layer must not be less
than twenty-four (24) inches. Insulation must be
installed when the backfill depth is less than thirty-six
(36) inches. The finish grade over the trench must be
mounded to prevent the formation of a depression after
settling.
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation must be
constructed by a Municipally approved septic tank
manufacturer.
2. The following pipe materials are approved for use in
septic system installations in the Municipality of
Anchorage:
Type
of Pipe
Perforated
Solid
Cast
Iron
Yes
Yes
ASTM
D3034
(PVC)
Yes
Yes
ASTM
F810
(HDPE)
Yes
No
ASTM
D2662
(ABS)
Yes
Yes
Use of a type of pipe other than listed above must be
approved by the inspecting engineer.
3. Insulation shall be at least 2" thick extruded direct
burial polystyrene (Dow Chemical Company Styrofoam HI or
equal).
4. Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi
140N, or equal) must be installed between the final
leachfield gravel layer and the native soil backfill.
6. All leachfield gravel (sewer rock) shall be 0.5"-2.5"
screened gravel with less than 3% passing the #200 sieve.
7. When sand is being used as a filter material, it's
gradation specifications must conform to current M.O.A.
or D.E.C. requirements.
Page Four
Lot 4 Block 2
September 23,
INSPECTIONS:
Preuss S/D Add. #1
1993
Typically there will be a minimum of three (3) inspections
required during the installation of the wastewater disposal
system. These inspections will occur as follows:
1. The first inspection must be conducted after the
excavation of ditches, pits, trenches, or beds and
before the installation of any gravel. A septic
tank may be set in place, but may not be backfilled
before this inspection.
2. The second inspection must be conducted after the
placement of the silt barrier, gravel, distribution
lines, standpipes, cleanouts, and insulation, but
before the placement of any other backfill.
3. The final inspection is to occur upon final grading
of the property.
Often there will be more than these 3 inspections required.
Especially with the installation of multiple trenches, sand
filters, pressurized distribution systems, etc. Thus, the
inspecting engineer is to be contacted at least 24 hours prior
to the start of construction. If necessary, a pre -
construction meeting will take place on-site.
aT
E L E C T R I C
Industrial - Commercial - Residential
April 28, 1994
S & S Engineering
17034 North Eagle River Loop Road
Suite 204
Eagle River, Alaska 99577
Dear Sirs:
LICENSED • BONDED • INSURED
3655 Ruth Drive
Wasilla, Alaska 99687-9201
(90 373-4767
FAX 373-7035
R[C�J V ED
APR 2 B 1994
tdiunic,pal,sY u1 anchorage
Dept. Health & Human Services
We have installed a lift station at Lot 4; Block 2; Preuss Subdivision
#1 according to the standards of the National Electrical Code.
Sincerely,
HarryM er
L'--�S b
Municipality ®f Anchorage
Department of Health and Human Services dlihS
825 "L" Street
Tom Fink,
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
January 8, 1990
Michael E. Barnes
20535 Eagle River Road
Eagle River, Alaska 99577
Subject: Lot 4 Block 2 Preuss Subdivision #1
Permit #890141, PID #050-572-05
The subject permit, issued by this office for a single family
well and/or on-site wastewater system has expired as of December
31, 1989.
Permits are issued on a calendar year basis by authority of the
Municipal Code of Regulations. A new permit must be obtained
from this office for an well and/or on-site wastewater system
not installed by the expiration date.
If you have drilled the well, a well log needs to be sent to
this office for documentation of the installation and to close
the permit.
If a private engineer inspected the installation of the on-site
wastewater system, the original as -built inspection report
(three-part form) must be sent to this office for review,
approval and documentation.
When applying for a new permit, the fees are: $90.00 for an
on-site wastewater permit; $50.00 for a well permit; $140.00 for
a combined on-site wastewater and well permit.
If you have any questions, please call this office at 343-4744.
Sincerely,
John Smith, P.E.
Program Manager
On-site Services
JW/ljm:200
enc: Copy of Permit
"Kids Are Our Future"
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^ ~ MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
825 L Street, Anchorage, Alaska 99501 343�4�2�
9 STY
Permit Number: 890141 Upgrade
Date lssued: 08/01/89
WELL PERMIT
dL�`9(l�ql
Owner Name: MICHAEL E, 8A1NES
Owner Address: 20535 EAGLE RIVER RD"
EAGLE RIVER� AK 99577
Parcel Id: O50-572-05
Lot Legal: Subdivision: PREUSG #1 Lot: 4 Block: 2
Section: 8 Township: 14N Range: 1W
Lot Size 24375 (sq.ft" or, acres>
Max Bedrooms: This Permit: 0 Total Capacity: 3
Day Phone:
696-1915
WELL: Log must be submitted to Municipality of Anchora e Department of Health
and Human Services within 30 days of well completion,
THIS PERMIT EXPIRES ON 12/31/89"
I CERTIFY THAT:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality oT Anchorage (MOA> and the State of Alaska.
2. I will install the system in accordance with all MOA codes and reoulations:
and in compliance with the design criteria of' this permit`
3. I will adhere to all MOA and State of Alaska requirements how the set back
distances Trom any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot"
4" l under SS t t t valid Tor a maximum o f 0 bedrooms. I
also undthes CaFlamty of the total system is 3 bedrooms and
any enl additional permit`
Signed: DATE:
...
(Owner) MICHAEL E" BARNES
issued By: DATE:
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Hea 'i and Environmental Prote .on
Fourth Floor West `
y ' ` 825 L Street
Anchorage, Alaska 99501
279-2511, x 224, 225
INSPE TION REPORT ®N -SITE SEWAGE DISPOSAL SYSTEM
NAME( LING ADDRESS -- - `.C_ -_C%' —1 --____iONE�
LOCATION EGAL DESCRIPTION="�%-L��e1i�
SEPTIC TANK:
DISTANCE - %� �� NUMBER OF
FROM WELLMANUFACTURER G/ `r .._ MATE RIAL.--�—COMPARTMEENNTS=
INSIDE LENGTH INSIDE WIDTH�"�_ — LIQUID DEPTH ___ LIQUID CAPACITY �_GALLONS.
TILE DRAIN FIELD:
j TOTAL LENGTH.
DISTANCE FROM WELL -_/4k�-_FOUNDAIION — _-__---NEAREST LOi LINT.OF LINE _ &
DISTANCE BE=TWEEN LINE; ___—_______-_TRENCH WIDTH—_ IN. TOTAL EFFECTIVE
ABSORPTION AREA [ei SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER -
DEPTH: TOP OF TILE lO FINISH GRADE _ MATERIAE- BENEATH TILE_ IN. ABOVE TILE IN.
SEEPAGE PIT:
DIAMETER —OR WIDTH_ LENG'I H__/DEPTH
Log Crib Rings/ --RIB SIZE: DIAMETER ___DEPTH__ DISTANCE FROM: WELL _s
TOTAL_ EFFECTIVE
BUILDING FOUNDATION_., NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT.
Well
Class: Depth:
Well Distance To: Lot Line
Bldg: Sewer Line:
Pipe Materials: �Q,
# of Bedrooms:
Installer: (.-I
Remarks:� �-
�1� _J /jj I
I
DATE ' 31 `7 APPROVED _. _
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DATE ' 31 `7 APPROVED _. _
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F:'EF-A"MIT NO ( 77441 )
HPPLICHNT101.1
11 Fj 1 .1110
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1!1
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LOCHTION
iEGHL
��G[E RlVER RORD
L4 B2 PREUSS SUBD
WITHOUT FINHL INSPECTION
LOT SIZE 24]75
SOUHRE F
TYPE
OF SOIL HBSORBTION SYSTEM
IS� TRENCH
MHXIMUM
NUMBER OF BEDROOMS �
] SOIL
RHTING (SQ FT/BR)�
J�
215 7r
THE
REQUIRED SIZE OF THE SOIi
b
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��IT? ��-1 - 1TE W & W Y 17N IT Ab, FJ 170 12 IT TQ 10 kE7 FT 7? J ^ ��W-1,
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BACKFILLING OF
MAY SYSTEM
WITHOUT FINHL INSPECTION
RND
HPPROVHL BY THIS
DEPHRTMENT WILL
BE SUBJECT
T3 PROSECUTION.
MINIMUM DISTHNCE
BETWEEN H
WELL HND F! IJ ON`SITE
SAE WHGE
DISPOSHL !,-,i; IS
100 FEET FOR
H PRlVHTE WELL
OR 200 FEET FOR 8
PUBLIC
WELL
WB -L LOGS HRE
REQUIRED HND
MUST BE RETURNED TO
SHE DEPHRTMENT
WITHIN % DHYS
OF THE WELL COMPLETION.
REQUIREMENTS
OTHER R
MAY HPPLY�
SPECIFICHTIONS
HND CONSTRUCTION
DIRGRHMS F4 1r:
SUHlLHBLE TO
INSURE PROPER
INSTHLLHTION
��IT? ��-1 - 1TE W & W Y 17N IT Ab, FJ 170 12 IT TQ 10 kE7 FT 7? J ^ ��W-1,
MUNICIPALITY 0- ANCHULKAut;
Departmt�t of Health and Environmental `i-,utection
SOILS LOG
PERCOLATION TEST
11—/0
Performed for tja„ 1 +- (,J i j: wA r i Date Performmed /� 7
Legal Description � g c z L } y Pre
reyr� > ejla
AN
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Municipality of AnchoragK ,
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
S♦
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519.6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-572-05
1. GENERAL INFORMATION
Complete legal description Preuss al SrD, Block 2, Lot 4
COSA# cpoa3
Expiration Date:
Location (site address) 20535 Eagle River Road, Eagle River, Alaska
Current Property owner(s) Jeff 8 Pennie Bames
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Day phone 69(3'11415 W630-6625 Ce"
Day phone
Audrey Mason Day phone 622-3344
11525 Old Glenn Highway, Eagle River, Alaska
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well❑
ID
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
ID
Individual Holding Tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seat 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 Douglas T. Kenley, P.E.
Address 9806 E Northstar Drive, Palmer, Alaska 99645
Engineer's Printed Name Douglas T. Kenley
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Phone (907)746.1073
Date 7 z t O
r►'�"` OF
its
tG •• A4 .
It Vi
•. .n rr1 r e, vre, ew •'
4. Vs -4
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: )Voj-f �_ Original Certificate Date: / -,:2, / "
(R. 1105)
Municipality of Anchorage
•� Development Services Department
Building Safety Division `
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Preuss #1 SID, Block 2, Lot 4 Parcel ID: 050.572-05
A. WELL DATA
Well type Private If A, B, or C provide PWSID # _ Well Log (Y/N) N
Date completed 9.21989 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth ass ft. Cased to 365 ft. Casing height (above ground) 12 in.
FROM WELL LOG AT INSPECTION
Date of test 9-12-1989 630.2009 ,
Static water level 317 estimated ft. 3013 ft.
Well production 20 visual g.p.m. '� ° g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate ND mg/L Other bacteria 0 colonies/100 mL
Arsenic: ±d /v mg/l Date of sample: 711/09 Collected by: F. Kenley
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material •S.T.E.P/Steel Date installed '04-21-1994
Tank size '1250 gal. Number of Compartments 2 Cleanouts (YM) Y
Foundation cleanout (Y/N) Y Depression over tank (YIN) -�:L High water alarm (Y/N) Y
Date of pumping '- 1012712008 Pumper JRs Pumpers
C. ABSORPTION FIELD DATA
Date installed '4-21.1994 Soil rating (g.p.d./ft2 or ft2/)drm)'oe g.p.d.rsq R. System type 'Shallow trench
Length "87 ft. Width .5 ft. Gravel below pipe '3 ft.
Total depth 6.5 ft. Eff, absorption area '7=0 ft2 Monitoring tube Y � Depression over field N
- Date of adequacy test 8.30-2009 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 29-1/MM in. Water added 615 gal. New depth "33-104&1" in.
Elapsed Time: 1460 min. Final fluid depth -29-518140-1/2/0 in. Absorption rate >= 450 g.p.d.
Any rejuvenation treatment (past 12 me.) (Y/N & type) N If yes, give date —
D. LIFT STATION
Date Installed •4-21-1994 Size in gallons •1250 Manhole/Access (YIN) Y
'Pump on' level at 42 in. "Pump off" level at 32 in. High water alarm level at in.
Datum B.O.T. Cycles tested 3 Meets alarm & circuit requirements? Yes
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank lift station on lot 104 ft. On adjacent lots 100+11-
Absorption
00+rt.Absorption field on lot - - l ce Lyll On adjacent lots 100+11.
Public sewer mair13^7}' Public sewer manhole/cleanout Mali.
Sewer /septic service line 40-fv' 215 -*6f, Holding tank NIA
Animal containment areas 50+ ft. Manure/animal excrete storage areas 100+ft.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation /1 ft. Property line 40 e. Absorption field 10+ it.
Water main 25+ft. Water service line 110* ft. Surface water 100+ ft.
Wells on adjacent lots loo+ft.
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10 ft. Building foundation 11 ft. Water main 25+ ft.
Water Service line 10+ ft. Surface water 100+11. Driveway, parkingtvehicle storage 30+ It.
Curtain drain "° kr 100xist Wells on adjacent lots 100+ It.
F. COMMENTS: • From MOA records. •• Readings are from the 3 trenches that make up the 87" requirement. (see S&S asbuit)
Y i }C �s/�.i✓.i�'�e.J va.Jd I*Y G>•fv G�iv.u'Ye✓t7: � I�'r.+gi/�C O/�rnKiOf/fi '
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and o! •J g n{ •..., . o.`f*•+
review of Municipal records that the above systems are In
conformance with MOA COSA guidelines in effect on this date.
)T I(EINiY:
Engineer's Printed Name Douglas T. Kenley�f}a�
Date 712 -7 /C)!9 1►Z
...[ ,
F
COSA Fee $ �f Gl O Waiver Fee $
Date of Payment 7 — i — 9r— Date of Payment
Receipt Number io 2 S G Receipt Number
(Rev. 11105)
NMI
SCS Ret#
1093199001
Client Name
Douglas Kerley P.E.
Project Name/#
Prcuss #I SID
Client Sample ID
Bathroom rauccl D2,1-4
Matrix
Drinking Water
Printed Date/time
07/16/2009 16:15
Collected Date rime
07/01/2009 17:45
Recehtd Date/Time
07/02/2009 14:25
Technical Director
Stephen C. Ede
Sample Remarks:
Allowablc
Prep Analysis
Pummetcr
Results
PQL Units
htctw Container ID
Limits
Dow Date
lnit
Metals by ICP/MS
Arsenic
ND
5.00 uglL
EP200.8
C
(<10)
07/13/09 07/15/09
NRD
Waters Department
Total Nitrate/Nitritc-N
ND
0.100 mg/L
S%1204500NO3-r
D
(<10)
07/07/09
LCE
Microbiology Laboratory
Colony Count
0
wVl00ml.
SN120922211
A
(<200)
07/02/09
DIX
Total Coliform
0
col/100ml.
Sh1209222D
A
(<1)
07/02/09
DLC
rccalColiform
0
coV100ml.
SN120922211
A
(<1)
07/02/09
DLC
JUN -29-2009 14:56 From: To:907 248 5774 P.3/3
266249+ DAAIA FACILITY OF— 7e 00 • m 06-25-2008 22
Y , !
b
.veyv9!*� ,,?a eo
.l-
E.wel6' ,O/IllF,P ,rase
.slCrariFYli�7KLs� !/.1/YY
ASBUILT-N 0 CORNERS SET THIS DATE. SENARD 6 ASSOCIATES LAND SURVEYING 688-4566
1 HEREBY CERTIFY THAT 1 HAVE SURVEYED THE SCALE`
FOLLOWING DESCRIBED PROPERTY:pF A(���
.x��rsrY�s,.ad✓vra/�°Y/�rrr
DATE,� Q( .-•..., qs�'
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS �c%+/y7j ` •' 'f
INDICATED. IT IS THE RESPONSIBILITY OF THE :.�;` 49Tm ; v
OWNER TO DETERMINE THE EXISTENCE OF ANYGRlD '"' • '
EASEMENTS, COVENANTS, OR RESTRICTIONS /vws6 i
WHICH DO NOT APPEAR ON THE RECORDED SUBDI- j 0 '. 0� Auk s.••d
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD F& I�a'•. LS•eo1B
ANY DATA HEREON BE USED FOR CONSTRUCTION yI•J! �1�0�' S�\r
OF FENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN: ��►sT1o�'A"
ARY LINES. L��,,r '`•oma,.+�
MUNICIPALITY OF ANCHORAGE Cb ✓
• '� DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D.# C)c�n-1QQ-L% HAA# V\�"AL \K12)
1. GENERAL INFORMATION
Complete legal description Lot
4; Btock.
2;
Pneus6 Subdivision III
Location (site address or directions)
20535
E-aq&
RivyL Road
Eaa,Pe Ry.ve/, AK
Property owner ALASKA HOUSING C/O REMAX EAGLE RIVb%y phone 694-4200
Mailing address 16600 CentelL4ietd Ditive Eagle Rive/C, AK 99577
Lending agency
Mailing address.
Agent _
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
3
XXX
Day phone
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XXX
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
0
■
0
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an inuependent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (flu, 1191) Hnck MOA 1121
Name of Firm _&* ,-L
Phone
Address 17034 Engle River Loo ad
ago 2I` `-1e r, Ala !ems X77
Engineer's signature _—
Date L
^4
6. DHHS SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
0
■
0
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an inuependent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (flu, 1191) Hnck MOA 1121
Municipality of Anchorage
immm
Department of Health and Human. Services ME
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: `- oT 4 - ??-E Jss S\o '1 Parcel I.D.
A. Well Data
Well type P0,\vk � If A, B, or C, attach ADEC letter. ADEC water system number I 4,
Log present (6VN) Date completed -\2 - bot Driller 'SP -I
Total depth 3VS\ Cased to ��.5 Casing height
Sanitary seal(6�N)
Date of test
Static water level
Well flow
Pump levell
FROM WELL LOG
Wires properly protected ")
AT INSPECTION
1 -P -2--12Y
2�.� V\SJKLm�;S g•p•
g,p.. m.
J 1�
SEPARATION DISTANCES FROM WELL TO:
I r
Septic/holding tank on lot 1 ; On adjacent lots 1 0-0
Absorption field on lot �1 00 ; On adjacent lots 1 00
Public sewer main [ Public sewer manhole/cleanout
Sewer service line 25 \ Petroleum tank 2s 1
WATER SAMPLE RESULTS:
Coliform D Nitrate o ,1 o Other bacteria b
Date of sample: /I G a - 9 Collected by: S & S ENGINEERING
Eagle River Loop Road No. 204
B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577
Date installed 21 Tank size I Zsb Compartments Z
Cleanouts (Y)N) Foundation cleanout (ON) _—TI Depres$ion (YO _
High water alarm (YO) I Alarm tested (Y/N) IA
Date of pumping '� �- .� Fri Pumper A A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot On adjacent lots 19-a> 14- Foundation
0 , Absorption
To property line ption field 1 � �Water main/service line
\A--
Surface water/drainage 1 0 CD
72-026 (3W)* Front
72-o26(3W)•Front CONTINUED ON BACK PAGE
oz
r
O
syn
<z
�I
p
0 O
<�
N
O
2•
Coliform D Nitrate o ,1 o Other bacteria b
Date of sample: /I G a - 9 Collected by: S & S ENGINEERING
Eagle River Loop Road No. 204
B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577
Date installed 21 Tank size I Zsb Compartments Z
Cleanouts (Y)N) Foundation cleanout (ON) _—TI Depres$ion (YO _
High water alarm (YO) I Alarm tested (Y/N) IA
Date of pumping '� �- .� Fri Pumper A A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot On adjacent lots 19-a> 14- Foundation
0 , Absorption
To property line ption field 1 � �Water main/service line
\A--
Surface water/drainage 1 0 CD
72-026 (3W)* Front
72-o26(3W)•Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed 4 - 2-1 -I W' Manufacturer
Size in gallons 1 2"5-b Manhole/Access ON)
Vent (fit) __ "Pump on" level at 4-Z-0 _"Pump off" Level at
High water alarm level #4 // Cycles tested 3 _
Meets MOA electrical codes CY)N) 4
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot \ �::'4, On adjacent lots �� fl� 4- Surface water 1 0 C�,' + _
D. ABSORPTION FIELD DATA
Date installed �l - 21, 1 `i Soil rating (GPD/Ft2) u, System type L-) 1 ¢x-(64
Length €3 7 ' .__Width 57/ Gravel thickness 3 Total depth b, S
_
Total absorption area Cleanout present &/N) Depression over field (Y&) �
Date of adequacy test �� �CJ Results (pass/fail) _ for — Bedrooms
Water level in absorption field before test After test _
Peroxide treatment (past 12 months) (Y If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot I GCS 1 On adjacent lots I C-) <=> Property line I c' _
To building foundation 1 l To existing or abandoned system on lot D _
On adjacent lots3 o _Cutbank -J 6'e, Water main/service line 1 ti
Surface water Q (2 1 + Driveway, parking/vehicle storage area
Curtain drain ^t/
E. ENGINEER'S CERTIFICATION
! certify that I have checked, verified, or conforme
Signature
17034 Eagle Rive p ad No. 204
Engineer's N9R@la-t i
Date / / i Z
HAA Fee $
V fib . eav —
Date of Payment I'
Receipt Number ( 0 2 s (9 2
72.026 (3/93)' Back
MOA and HAA guidelines in effect on the
Waiver Fee $
Date of Payment
Receipt Number
07/13/94 12:08 CT&E ENVIRONMENTAL LAB SERVIC.'ES NO.563 POI.
Commercial Testing & Engineering Co.
Environmental Laborato ervioes
> ori far dotal oliiornl Baeteria
Drinking Water Analysis R
READ INSTRUCTIONS ON REVERSESID c BEFORE COLLECTING SAMPLE
p PUBLIC WATER SYSTEM 1J). 0
PRIVATE WATER SYSTEM
0 SexriResulrs ❑ S2nd invoice
-0n � re IIS
t;AtriG Rim L Fipad No,
M77 y 1, um .r
on• Vn sr ..• f sr, Alaska M
sat,
C1 SendAYPS ENGINFIRRM sendlnvoice
��.LT•.
Eagle River, Alaska 90'577- v� —
SAMPLE DATE:
Fonth
SAMPLE TYFF:
e
G Repeaepee t 5atnpic (for routine santpie
"ith lab ref. no. _ )
❑ Special Purpose
SAMPLE LOCATION
ui, n
ED
Collected
Day
%'edr,
❑
Treated Water
�iJntreated Water
Time
Collected
Collected
By 1
11I V0
_
Neu$ P. ea
5633 6 wtree:
Anchorage, AK 89515-1600
Tel: (907) 562.234'
Fax: (907) 5611 -5301
Analysis shouts this Mate; SAIv'd'LE to be:
X Satisfactory
a Jusatisfac:toy -
r Sample over 30 hours old, results MiaV
be imu eliable
Sarnplc tov lceg in tranS(t; saMP)e Sl°,ould
no: be over 45 hours old at exwruunation
10:r,dicate reliable results. please send
1.
new sample via 90J�»d=.--1 dei Si'eC:�y'CY.'r�:ail
Date Received
T'imeReceived
s t t t
Anal�'sls Segan — 1994
Analytical Method; 4ej membran— Filler
❑ NL.!n• Jt1 G
• ?vv t:ber of colonies/100 m1 -
Lab Ref. No. Result* Analyst
S¢ntto A,D,E.<, t\ncn "oks 3iu7
�} q Faxed
—
Client notified of unsatisfactory results:
0
1 hnncd — e Spoke with Ftxtd
_tett, Time: �—
RACTERIOLOGTC AL, NVATEER ANr AL Y IS RECORD
MM0.mUC Result: Total Coliform .��` 6 ' - F_ Coli
Membrane Filter, Dirt& Caunt Coionles/11000 m!
Verification: LTB 0' BCB COi, FIRIM r L =
Fecal Coliform C0nf1rM8tian
)Final Membrane Filter Results
Reported ByTffi,- t to ^UU�—f_2-19
94Time ��� hrs
Comments:
Member of the SGS Group lSociete ^urn rale de Surveili2 iCe
TNrc-Too Al.at out id Count
ce. � naas.s�re
icoeev nJl') IITnW %n;LGT WlOrlNIti
Commercial Testing & Engineering Co.
Environmental Laboratory Services��oao�or�0000000�o����o�������
SINCE 1908
LABORATORY ANALYSIS REPORT
CT&ERef.#
94.2688-1
Client Sample ID
L4 BLK2 PREUSS S/D #1
Matrix
WATER
ClientName
S & S ENGINEERING
WORK Order
79065
Ordered By
R.J.S.
PrintedDate
06/08/94
@11:31 hrs.
ProjectName
Collected Date
06/02/94
@ his.
Project#
Received Date
06/03/94
@12:30 hrs.
PWSID
UA
Technical Director
STEPHEN
C. EDE
Released By:
Sample Remarks: ROUTINE SAMPLE COLLECTED BY: RAY.
QC Allowable Ext. Anal
Parameter Results Qual Units Method Limits Date Date Init
-------------------------------------------------------------------------- ----R
Nitrate-- 0.10 U mg/L EPA 353.2/300.0 10 06/03/94 CMR
* See Special Instructions Above UA=Unavailable
** See Sample Remarks Above NA=Not Analyzed
U = Undetected, Reported value is the practical quantification limit. LT= Less Than
t
D=Secondary dilution. GT=Greater Than
<a
N
5633 B Street, Anchorage, AK 99518-1600 — Tel: (907) 562-2343 Fax: (907) 561-5301
ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA
-'-u-
-
DATE RECEIVED
INSPECTION
APPOINTMENTS
TIME
TIME/,
iii oc44 (0IM rk-)b 1
TIME
DATE
DATE
DATE
0 MULTIPLE FAMILY
GP9�_Three E] Six
7. WATERS PPLY
INSPECT�QR
INDIVIDUAL* *
INSPECTOR
INSPECTOR
�J!MUNICIPALITY
ED PUBLIC UTILITY
depth (attach log if available.) /77
OF ANCHORAGE
YEAR ON-SITE SYSTEM WAS INSTALLED.
DEPT. 01'
MUNICIPALITY OF ANCHORAGE ENVIRONN'iE. i, '-I ;TION
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
825 L Street - Anchorage, Alaska 99501r. E'B A
ENVIRONMENTAL SANITATION DIVISION
Telephone 264.4720 C E I
REQUEST FOR APPROVAL
OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER
F
PHONE
Jl ���w
L L ail(
L� �` C<
v
MAI: ING ADDRESS
f 9 U C'�E '/ (J
G -1 216
PROPERTY RESIDENT (If different from above)
PHONE
_G
2. BUYER
PHONE
MAI LING ADDRESS
3. LENDING INSTITUTION
PHONE
C p
C 1+ 01- /1-A
MAI LING ADDRESS
/ /
4. REALTOR/AGENT
ij'� Z TIJd�
PHONE
Lq Zzv 6
6z��- -
MAILI ADDRESS
5. LEGAL DESCRIPTIO
/o--
-
Us `
STREET LOCATION
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS
O One 0 Four 0 Other
SINGLE FAMILY
O Two 0 Five
0 MULTIPLE FAMILY
GP9�_Three E] Six
7. WATERS PPLY
INDIVIDUAL* *
ATTACH WELL LOG. A well log is required for all wells drilled
0 COMMUNITY
since June 1975. For wells drilled prior to that date, give well
ED PUBLIC UTILITY
depth (attach log if available.) /77
8. SEWAGE DISPOSAL SYSTEM
YEAR ON-SITE SYSTEM WAS INSTALLED.
INDIVIDUAL/ON-SITE**
El PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑
❑ TWO ❑
THREE ❑ FIVE ❑ OTHER
FOUR ❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLICUTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON -SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATE INSTALLED
INSTALLER
❑Septic Tank or ❑ Holding Tank
Size: If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL TO:
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
V"'-'APPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accomp
❑ DISAPPROVED
certificate)
DATE
—2 '4
BY
72-010 (Rev. 6/79)
February 21, 1900
Alaska national Bank of the North
Pouch 7--010
anchorage, Alaska 99.110
Su`bJecte Lot 4 Mock 2 Prelass Subdivision
approval for they individual sevrer and grater facilities can
not be granted Until the following items have been co:apletedl A -C) v --
.�'e��� U
(1) A well loci submitted to this department.
The grater analysis report be delivered to this office
Lroltl CI -10M Labe 5633 B Street, for our review. �
(3) 'W'i-je ,eptic tank pumped with a receipt subnitted to��
this o£ficc>. oCC-L PP -`;
7L there are any further questions, please contact thisb��}}��
office at 264-4720. 1
sincerely,
Robert c. Pratt, R.S.
Associate Specialist
Rcp/l jar
ccs Linda Grainger
a Tote -ft Realty
post office Box 9chl 99577
Coact mortgage Coivanv-
% Carla
4797 easiness 'Park Boulevard 99503
XVX:ii Li vXVU
OCCUPANCY AGREEi•IENT
•
Quyer '�� Date z
MUNICIPALITY OF ANCHORAGE
DEPT. OF i::=ALTi i &
ENVIRONMENT; ,ACTION
r-EB2 06 #0<U
I/we, the undersigned, agree to pay S_ y / - _ Der day as occupancy charge
on Lot itof /, /-� s S , L from z
until closing (date we start paying interest on our home loan) This occu ancy
charge will be Paid no+� �y�trd—in K nee. 7 n ! , F • / /�
We understand that the occupancy is intended to mainly offset the seller's
interest, taxes, and insurance, and we agree to immediately notify the gas,
electric, water, etc., companies that all charges are to be made to us from
the date of occupancy and we will reimburse seller in the event that we fail
to pay for these utilities or seller is required to pay.
In the event, this transaction cannot be consumated due to inability to
arrange financing or for any other circumstances beyond the control of either
party, including non-payment of occupancy, we agree to the following:
(1) To vacate the premises within ten (10) days after notice.
(2) To pay for all damages to the house during occupancy
for all costs necessary to restore the home to the condition
at the time of initial occupancy as determined by the seller.
(3) To release any claim to improvements made during our occu-
pancy with the understanding that the seller upon selling to a
new buyer will turn over to us any increase in proceeds he is
able to realize due to our improvements, providing all other
terms of this agreement have been complied with.
Buyer
In consideration of the above undertakings, occupancy prior to completed
purchase is hereby granted by seller.
eller.
No. of keys given
Anchorage Administrative Office East Anchorage u Eagle River
4611 Business Park Blvd. Eastgate Office, 5437 E. Northern Lights Parkgate Bldg., P.O. Box 249
(907) 278-4606 (907) 3379424 (907) 6949555