HomeMy WebLinkAboutPREUSS #2 BLK 3 LT 6Onsite File
Preuss #2
Block 3
Lot 6
#050-572-22
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Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3
ON-SITE
WASTEWATER INSPECTION REPORT
Permit Number: 0SP221277
PID Number: 05057222000
Dwelling: ❑■ Single Family (SF)
❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑■ Upgrade
Name
DIETZ JULIE
ABSORPTION FIELD
XDeep Trench El Wide Trench El Bed El Mound
Site Address
e
102 PREUSS LN
❑ Other
Phone
Number of Bedrooms
Soil Rating
depth from original grade
223-7232
4
2 GPD/SF
JTotal
9 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
4 Ft.
Gravel depth beneath pipe
5 Ft.
Subdivision
Block Lot
PREUSS #2 BLK 3 LT 6
Fill added above original grade
- Ft.
Gravel length
32 Fl,
Township Range Section
Gravel width
3 Ft.
Beds; Number of Lines
-
Distance between lines
- Ft,
SEPARATION DISTANCES
To, Septic ' Absorption
Lift Station
Molding Sewer
Total absorption area
Number of trenches
Dist. between trenches
From Tank Field
Tank Line
320 Ft`
1
- Ft.
Well 50'+ 50'+
na
na 2�'
TANK 19 Septic ❑ S.T.E.P. ❑ Holding Kother
Manufacturer Tank w/AX 20
ADVANTEX Pod
Capacity
1500 Gal.
Surface Nater ' 1001+ j 100,+
na
na
Material�r�� �a
l<mber of compartments
Lot Line 10,+ 10,+
na
I na NA
Pistc
5. 2
d
Foundation 0'-I- 0'-}
na
na
LIFT STATION
Manufacturer
Capacity
Remarks
Ga I.
Alarm location
Electrical installed by
DRS Electric
Installer
PIPE MATERIAL House to tank [}3034 Tank to D3034
drainfield
.JRlS
Drainfield co1MT D3034
Inspector NOrthRim Eng.
BENCH MARK (Assumed elevation) 100 ft
Inspection v, 9!6122
9/$/22
Location and description
z c
Deck
Y, 919122
4"'
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval:
Date
F �11
eV k44
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.......f
Septic System
�, Steve Eng 0.
A P� roved
Date /q 2.
�i
Note: this approval doe not include well permit requirements.
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Lot\ 7
R5
he
R5
o Replacement
Trench \
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C DEC park
a OUBA
9 0`' ❑/MT2
0 Sup T 0
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WAY .: m
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Trenches
R5
Lot 5
10' UTILITY EASEMENT
4
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NORTHRIM ;'.°F�q�',p PREUSS #2
ENGINEERING
'RECORD
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PO Box 770724 i= w *
" LAYOUT
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Eagle River, Alaska 99577 WASTEWATER UPGRADE
907.694.7028 �i9/18/23" ADVANTEX UPGRADE 9/18/23 2 of 3
Tract 3
Lot 4
A
B
dco
25
12
T1
23
13
T2
21
15
CO/MT2
14
20
C❑/MT1
27
48
Lot\ 7
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Trench \
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WIVEHAL o
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Lot 5
10' UTILITY EASEMENT
4
'��E,wrwww%M1 304` N _ '
NORTHRIM ;'.°F�q�',p PREUSS #2
ENGINEERING
'RECORD
SteveEng. com ; BLOCK 3 LOT 6
PO Box 770724 i= w *
" LAYOUT
s
Eagle River, Alaska 99577 WASTEWATER UPGRADE
907.694.7028 �i9/18/23" ADVANTEX UPGRADE 9/18/23 2 of 3
Tract 3
Lot 4
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FSI kNEERING
S❑ILS LOG - PERC❑LATI❑N TEST
Performed For: Owner
Legal Description: L6
1 —
2 —
3 —
4 —
5 —
6 —
7 —
8 —
9 —
10 —
11 —
12 —
13 —
14 —
15 —
16 —
17 —
18 —
19 —
20 —
DEPTH
(FEET)
Organic
SM Silty Sand
Date Perf ormed; 8/31/22
TR Location: See Attached Test
Boring Location Map
W/ Groundwater? No
Depth --
Gravel Water Depth
After Monitoring, None Date: 9/8/22
#
Date
Gross Time
Net Time
Depth
Net Drop
1
8/31
0
--
6"
--
2
8/31
10
10 min,
4//
2"
3
8/31
10
--
6"
--
4
8/31
20
10 min,
4//
2"
5
8/31
20
--
6//
--
6
8/31
30
10 min,
2//
4"
7
8/31
30
--
6"
--
8
8/31
40
10 min,
2"
4"
g
8/31
40
--
6"
--
10
8/31
50
10 min,
2"
4"
11
8/31
50
--
6"
--
12
8/31
60
10 min,
2"
4"
21 - ' Percolation Rate 2,5 min/in Perc Hole Diameter 6"
Test Run Between 3' & 4'
Comments: Measured To The Nearest 1/16",
Performed By NorthRim Eng, I CERTIFY THAT THIS TEST WAS
Perf ormed in Accordance with All State/Municipal Guidelines in Ef f ect
ON THIS DATE, DATE:
NOR THRI M •+'''6F
ENGINEERING s`'�49m*+f� PREUSS #2 THS
Ste veEnq.com """' " BLOCK 3 LOT 6
f 1
PO Box 770724 f;p mw s
Eagle River. Alaska 99577 1 �-6�6. ' ir T E S T H❑ L E LOG
907.694.7028 8% 31 / 2 2` Dote; m*
GE❑TECHNICAL 8/31/22 2
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3.0' PROWCANT
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o 47.3
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Lot 7
x
\ 12.3'x12.3' SHED
M
I Lot 6
19,711 S. F.
DECK�SEPTIC
PIPES
38.2' 1,6.5' I�I
.5' CANT
z>nNno
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F F( 16.5'
ASPHALT- \ k
DRIVEWAY
O
PIPES
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12.4'x16.4' SHED
I 151.53 r- • — —IIIS
CHAIN-LINKTx •) F
FENCE
Lot 5
I
10' UTILITY EASEMENT
Tract 3
T
0
0
O
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0
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`TREATMENT
POD
Lot 4
PLOT PLAN ___ AS BUILT _X— SCALE --I—" __ 40__ GRID __NW 0056__ Project No.
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, inc. (907) 522-6476 Phone 000O�p��
(907) 522-4625 Fax oo
Professional Land Surveyors kenolangsurvey.com o �F...... �
jonathan®longsurvey.com O � ....
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I hereby certify that I have surveyed the following described property: 49TH O
LOT 6, BLOCK 3, PREUSS SUBDIVISION — UNIT No. 2 (PLAT No. 70-42)
Anchorage Recording District, Alaska, and that the improvements situated thereon are 7' ••l
within the property lines and do not encroach onto the property adjacent thereto, that I( :.!� � � � � ��
no Improvements on the property lying adjacent thereto encroach on the surveyedp KENNETH G. NG a
premises and that there are no roadways, transmission lines or other visible O `A o G
easements on said property except as indicated hereon. OO
a, „ 0 F '•.LS— 202.•'' y�o�
Dated this the _= __ Day of ___�L �Sw� �-�-'L____,-�_`_-1__, at Anchorage, Alaska Q NO . • .". foo
�44'QOFESSIONA� �o
It is the responsibility of the owner to determine the existence of any easements, �4ppp000
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP221277
Work Type: Septic Upgrade
Tax Code Number: 05057222000
Site Legal Address: PREUSS #2 BLK 3 LT 6 G:0056
Site Mailing Address: 10213 PREUSS LN, Eagle River
Owner: DIETZ JULIE M
Design Engineer: NORTH RIM ENGINEERING
This permit is for the construction of:
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
ent S
ti°
v
DepartUnent
7/29/2022
7/29/2023
19711
Q Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions:
1) A test hole is required prior to construction of the absorption field to confirm separation to seasonal high
groundwater and percolation rate. Test hole shall be located so that entire field is within the 30 ft radius of the
percolation test. If results require a design change, construction shall stop pending approval of a change order.
Please submit results with the inspection report (or change order, if required).
2) The location of both the existing 95 ft trench section and the existing 25 ft trench section shall be determined
during construction. Any portion of the 95 ft trench that is within 10 ft of the new trench shall be excavated out
and backfilled with MOA sand. Any portion of the 25 ft trench section that is within 14 ft of the new trench shall
be excavated out and backfilled with MOA sand.
4
1 II olI km w
Ca -z i �i ef� maveU ..4c- +o 'occs-i-too 6� GX��frn� 7F►^enc he S 9/6�zz
�F an1c fD meet )Q 1 5e/,20' -floe -to ctdd Abn 5�/IpOrf 5
Received By: Date:
Issued By: Date: 7
MUNICIPALITY OF ANCHORAGE
Development Services Departments Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTICM/ELL PERMIT APPLICATION
Parcel I.D. 05057222
Property owner(s) DIETZ JULIE
Mailing address 10213 PREUSS LN
Site address Same
Day phone 223-7232
Legal description (Sub's., Block & Lot) PREUSS #213LK 3 LT 6
Legal description (Township, Range & Section)
Lot Size 19,711 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(N all that apply)
Absorption Field
0
Initial ❑
Single Family (SF) El
(w/wo ADU)
Septic Tank
El
Upgrade 0
(D) E]❑
Holding Tank
❑
RenewalDuplex
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
1Z,
(Signature of property owner or authorized agent)
Permit/Rush Fees:,4 59 5
Date of Payment: :71=1a �) 2
Receipt Number: 5 ('I�
Permit No. nSPa,�Z1 2 V
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
SteveEng.com Preuss #2 B3 L6
SPECIFICATIONS & DESIGN GUIDELINES
Wastewater System Sizing: This is an existing 4-bedroom, single family home. A new
Advantex w/Trench is currently planned; existing tank/trench will be decommissioned
per UPC. Neighbor lots are served by septic systems and public water/private wells; there
are no conflicts. The topography is flat in the vicinity of the septic system. A soil test
conducted in 1985 reveals GM soil, no groundwater encountered. A CAT III application
rate of 2 GPD/FT² will be used for the trench. Trench Length = 300 FT²/(5 x 2) = 30
trench, 3' wide, 5 effective depth, 9 total depth. Additional test hole may be completed
during construction if necessary. Separation distances from wells & neighbor septic
systems are maintained with this design.
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 Advantex w/Lift Station, 1 AX-20 Filter Pod.
5 minimum between the tank and trench. 10 minimum to property lines tank/trench.
4 of cover and insulation is required for force main; 2 Minimum thickness for
insulation.
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.
All cleanouts must extend to at least ground level.
In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.
Trench to be placed level, minimum of 4 to groundwater, 6 to bedrock.
Drain rock to be ½ to 2 screened. Drain rock to be distributed uniformly.
Silt barrier (filter fabric) to be installed above the drain rock.
Smeared bed must be raked or scarified before drain rock placement.
The finish grade must be mounded to promote drainage away from trench.
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
OSP221277, Rebecca Carroll, 07/29/22
7/27/22
DESIGN NOTES:
1. Existing Trench Decommissioned.
2. Sewer Service Line minimum 2% slope.
3. Decommission Existing Septic Tank Per UPC.
4. Lots Served by Private Water Wells.
5. No Conflicts Within 200'.
6. Check Condition Of Sewer Service Line— Replace If Necessary.
7. Depth Of New Trench @ 9'.
8. Measure Separations Prior To Construction.
9. Location Of Existing Trenches To Be Determined During Construction.
If Existing Trench Found Within 14' Of New Trench, Overexcavate & Replace With San
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ENGINEERING Ac",
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PO Box 770724 4% ' Stm El "r
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907.694.7028 +� 9y2722�+3
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Septic
Flat Slope
Replac rye t
C❑/MT Trench
TH2
O 30
New IS
Wl�h 1 AxGal(onC❑/MT
�o FIl Pdv A -H
pn TPx
4 &YrM
Fla- Slope
Decommission Old
Septic Tank
PER UPC
PREUSS #2
-P
0
1' = 30'
BLOCK 3 LOT 6 DESIGN
WASTEWATER UPGRADE LAYOUT
ADVANTEX UPGRADE 9/2/22 r o -F 3
73
N
0-
0 O
75
Flat Slope
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221277, Rebecca Carroll, 07/29/22
F-7
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On
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AS -BUILT
I• hereby. certify that I have sun eyed the folloIx11x19, -
described property: L`r"
Std, $r 7"./ q- IJ,;�' 1
Anchorage Recording Precinct, Alasita, and -that the
improvements situated thereon.,are within the. property
lines and do not overlap or encroach on the property
Iyfng 8dfacent there+o, that, no improvements on prop -
arty lying adjacent thereto encroach ozs the premises in
question. and that there are no roadways, transmission
lines or other visible easements on said property except
as indicated hereon.:
Dated at Eagle River, Alaska,
day of �0 L .
ROBERT C. JOHNSON
SCALE: Registered Lane Surveyor No. 880_:U;
1" - 7-,.p1 Sox 456, Eagle River, 4Laska
Phone ,894-2543
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this <974bay of UtLIA�0_ of 24.)O-, by and between
_L [ ; rk 1]4 f C __, herein the "OWNER," and the Municipality of
Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code
(AMC) 15.55.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as 1 "+1, Ai f-1c_k q �Z 1 P9 PuS;
located at (legal description)
Ca / I�� K pke�ce s g"b ,
2. Maintenance, Repairs and Alterations. T 1 L11V 9 / 641, 5 M
(Owner is required to read, understand and initial each section)
Throughout the term of this Agreement, the Owner shall enter into a service agreement
PJW-with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
I v*,,- 4K
accordance with the equipment's approval for operation in the Municipality.
n
It shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically $oda to $Gaa).
?�)-61 Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
ry� Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018) Page t of 3
ewner acknowledges that the Municipality may request records of maintenance and
pairs from the manufacturer's representative or maintenance provider.
&Owner acknowledges that the fine for failing to maintain and repair an A W WTS may be
assessed in accordance with AMC 14.60.030.
Owner agrees to grant the Municipality reasonable access to test and inspect the
A W WTS. The Municipality will give at least 24-hour notice.
A60nOwer agrees that any sale or transfer of title of the property will not occur without a new
,0 (� Certificate of On -Site Systems Approval.
a Owner agrees that the AW WTS installation and maintenance requirements as provided
U by the AW WTS vendorlinstaller and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owner's A W WTS.
O— Owner agrees to maintain remote monitoring of the AW WTS as required by the
v A W WTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AW WTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 0511 MO 1 g) Page 2 of 3
OWNER:
By:, /yj )-� (signature) Date:
�'jt�. t LQ }� , , i -� Z_ __(print name)
STATE OF ALASKA )
ss.
THIRD JUDICIAL DISTRICT )
The foregoin instrument was acknowledged before me this 2.4 day of _ Jl I ,
20, by
NOTARY PUIrLIC. FOR ALASKA `N%��.rP:•• ''• :�'FQ
My Commission expires: USI , '-a-) arc ; �i�
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MUNICIPALITY: rO AU
By:J�.CI eCC n7�� (signature) Date:
1�ele CCc- 6rro ` ( (print name) Title:
(rev. 05/18/2018) Page 3 of 3
. =x..~, MUNICIPALITY OF ANCHORAGE ~ '"'
i/ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
PHONE I [] NEW
NAME ~J~" ~ ~,)g~g~ ~::)L_~-~ ' ~'~"~:~I ~UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
DISTA~C[ TO: ~ell ~bsorotion area Dwellin~ PEBMIT ~0.
~ ~ Msnufacturor Mstorial ~o. of compartmonls
~ ~ ~iq. caoaciW in ~allons Inside length Width kiquid depth
IF HOM[MADfi:
~ ~ DISTANCE TO: Well ~ ~ Dwelling PERMITNO.
~ ~ ~ Manufacturer__ Material , Liquid capaciW in ~aHons
~ell Foundation~ ~ ~earest lot line~ P[BMII ~0.
DISTANCE TO: ~ ~ ~ I ~ ~
;~, of,.. I i L~.¢~ off,each line Total I~qf lines Trench wid~ ,riches Distance betwee~lin~
~ ~ Top of tile to finish grade , Material beneath tile Total effectiv%a~on area
Length Width Depth PERMIT NO.
~ ~ Tgpe of crib Crib diamoter rib depth Total effective absorption area
m Well Building foundation Nearest lot line
~ DISTANCE TO:
." C,~.~ '~-- ~,hPt~ Driller Distancetolotline PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
~OIL TEST ~TIN~ ~ ~ ~ ~
L_
REMARKS ~ ~ ~ ~
// ~ ~ ~
.[
72-013 (Rev. 3/78)
DEPARTMEN'I" OF HEAL. TH AND 'ENVIRONMENTAL PROTE[]TION
825 L. STREET:, ANCHO. RAGIE... Al< 9950 1
PERM I "[' I',10:
)DATE ISSUED:
APPL I CAIklT:
ADI., [", E,.x:~:
C:ONT'ACT PHONE:
BI.,. 0 CK: 3
4.0 4.0
0.5 3.5
4.5 7.5
5 ,. 0 5.0
29 ,, 0 :Lr, 8 ,. ()
lA,,2 28.2
00(). 0 '~'~"~' I, 000 ,. 0 '~'
284 349
ELECTR I CAI.~
S ]; G N ED
AF:'Pt...ICAf, I]-: MCC
ISSLJED BY
*¢¢ "I"ANI< MUS'I" HAVE AT' L..EAST TWO COMF'AR]"MENTS
I certi~'y tl"'~at,:
1,, I am familiar' with t:he r'equiPements {o1" on-s:i, te sewePs and wells as set
FoRth by tine Municil:)a].ity of' Andnonage (MOA) and 't:.he State of Alaska.
'2,, I will :[ns'Lall the sys'Lem ir'i accor'clanc:e with ail MOA (:odes and pegulations,
and in compliance with the des:i, gn cr'itePia of this per'mit.
3. I w:i. ll adher':e t.o all MOA ar'id St. at.e of Alaska r'equiPements ¢cm the set back
distance~ fr'om any existirig we].]., wast. ewater' d:i. sposal system of public
sewerage sys'Lem (:)r'~ {his o~ any adja(:erYL or' near'by lot.
4. I understar'ld that. this permit, is va].id for' a maximum (3¢ 1 bedr'ooms ar'id
any en].aPgement, will Pequipe an addit, ional penmit.
IF A LIF:'I" STATION IS INSTALLED IN AN AREA COVERED ElY MOA BUII...DING CODES,
THEN (1) AN EB...E']CTRICAL. PERMI'I" AND ,~ ..............
II.IoFE, CI 1LIN MUST BE OB'I"AINED~
, /..~cr-'BU ,[ L I
WIL. I_ NOT L'c. AF:'PR[]VED WITHOUT AN ELE:C]I~ICAI_ INSPE:CTiON REF"ORT; AND (3) 'T'HE
tdUST BE bUIIE BY A t. ICENSED EL. ECT'RICIAN.
..... '----'--'-'-"l...C)t.l(~i~.t C/O S & S ENG'G
~_~.~ .~' . DATE
.DEI:::'TH T'O PIPE BO"I-I'OM (F:'T.) 4.0
GRAVE:]_ DEt::'"f'I"! (F'T.) '7.0
'T'OTAI...: DEPTH (l::"'f'.) 11. ()
GRAVEEL.. WID]"I..~ (l:::"f'.) 2.5
GRAVEL.. I_ENG'T'H (FT.) 25~ 0
GRAVEL. VOL. UME (CU. YDS. ) 17.4.
I"ANK SI ZE (GALS) 1, ()0C~,, () '~".*
SO~I,,.. RAT.f. NG (SQ.FT',, /BR) 3&9 -
LEGAL DESCR I P: SUBD I V I S I ON: PI::;,'ELISS I_OT: 6
SEC]"ION: 8 TOWNSHIP: t5N RANGE,-, :i.W
L. BT Si ZIE: 197.1.0 (!Bt;;!. gf'. OR ACRIES)
I_OT L..C~C..ATIOIq:. ~U::';'; S?:, LANE
MAX BEDF;~OOMS:
L.'istect belc:,w ar'e: tine Ol~'hior~s available to you.in clesigning your sep'Lic
system. Choose t. he option that. best fits your' site.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
[] SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
DATE PERFORMED:
SLOPE SITE PLAN
I0
11
12
13
14
15
16
17
18
19
2O
COMMENTS
~l~,rt A.
No, 14.57-E
PERFORMED BYs ~ D E~GINEERIN(~
'c, ,~E RIVER, A~,~,(A ~577
PR. 694-2979
72-008 (6/79)
ENCOUNTERED?
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE '~ (minutes/inch)
TEST RUN BETWEEN ~ FT AND ('~ FT
CERTIFIE~
QGREA -ER ANCHORAGE AREA BOR ,dGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
· !~ 'J.~, - · .~ ~ ; . . ~ .~'
SEPTIC TANK:
DISTANCE ~ .~
FROM WELL ' '~' ' MANUFACTURER -~¢~//~'?-- MATERIAL
?
INSIDE LENGTH .;¢~') INSIDE WIDTH LIQUID DEPTH
NUMBER OF ~
~2 COMPARTMENTS
LIQUID CAPACITY /~)-%~) GALLONS.
SEEPAGE P2~'~:
NUMBER OF PITS / . DIAMETER
LINING MATERIAL
.. ~CRIB SIZE:
BUILDING FOUNDATION
OR WIDTH '"'"~
DIAMETER __
NEAREST LOT LINE ';)
ADDITIONAL ABSORPTION
? I
LENGTH 7 ~, DEPTH]
.DEPTH ~I~TANCE FROM: WELLf ~/ .
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA) .~ ~'O /'.SQ. FT.
WELL:
TYPE pl/I t/~/t~ CONSTRUCTION
BUILDING NEAREST
FOUNDATION -- LOT LINE
CESSPOOL
OTHER SOURCES
J ~
NEAREST
SEWER LINE
APPROVED DISAPPROVED REMARKS
DEPTH 3 ")~- C) DISTANCE FROM:
SEPTIC SEEPAGE /~
TANK SYSTEM
DISTANCES:
INSTALLED BY: ~
f
LOT SLOPE:
DIAGRAM OF SYSTEM
AN HORA R[A
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
FINANCED THROUGH TO BE INSTALLED BY /'~J / / ~ &~;~ ,~/~"-~ ' //~/~
~OiL TEST RESULTS . '~ ~ ~ ~
:. NOTE: THI~ PER~IT I~ NOT VALID WITHOUT
COMPLETION DATE ANTICIPATED ~//~ ~/ :- :'~)/~ ~J~ ~ /Z / --/~ ~~
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT
SEPTIC TANK~ TO SEEPAGE PIT WALL
WELlTO SEPTICTAnK
SEPTIC TANK SIZE.////~'~ ;~/.,~ :TYPE
MINIMUM DI~TANCE~, REQUIREMENT~ /
., DRAIN FIELD
SEEPAGE PIT ~/ /' ~ DRAIN FIELD
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEPTIC TANK~ SEEFAGE PIT
TO RIVER, LAKE. STREAM.
DIAGRAM OF' SYSTEM
. SEEPAGE PIT
ALSO CO.SIDER AREA WELLS.
SEEPAGE PIT
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL,
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVE~ BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
i CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
DATE APPLICANTS SIGNATURE
~E NO. 28-68 AND THAT THE ABOVE
~ ..... U 8- E GEOTECHNICAL ~t DEVELOPMENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russe# Oyster
694-2774
Soils ~ Foundations
Earl Ellis
688-2280
Land Development
S0ZL LOG
Performed for:
Legal Description:
Depth (feet)
0
1
2
Name: ~,-~ ~ ,~,__. '~ o~_~r~,J Tel. No. ~cN-~"~3'~,
Mailing Address: ~-~<o:~ '~"~.~,v-~-¥ ~-~-F~ ~--~ ~-, ~,<.~R~'TT
Soil Charactertstlc~
4
5
6
7
8
9
12
Ground Water £ncountered~ Yes
Proposed Installation~ Seepage Pit
~ No If yes, what depth
/ Drain Fie~d.
Comments:
Perfo~ed by: ~-. ~..,.,..~,~,
ow~ OF ~ND .........................................................................
ADDRESS
w~.nL SITE ~,~r ~ ,8.~1~ 3 .... f~__Eu.~j__.__.Z_/~_~.
DATE--STA~,T~'-D ...... ~/'-7/:~-~ .....................................................
L
DRI LLF<~3 COMPANY
DE~ OF V,'E~T.
STATIC LEVEL OF WATER FT .... ~-~Z ..................
D~AW DOW~ FT ..... .~.~ ...................
~,.D o~ ~,~,,~ ........ ~__~__e.O
KIND OF FORMATION:
FRoM ......... ~ ........... FT. TO.....~ ................ FT.._...C:~/~_:_r__.~'~,a" %5oM ........................ FT.
FROM ....... 5-"- .......... FT. TO
............................... FROM ........................ FT.
FRoM ....... ~--5 ........... FT. TO__.~.__°_ ............. FT ........ ~.~_~__ FROM ........................ F~.
FROM ...... ~__~ ......... ~. ~O_._..3._..S.'.7_ ......... ~T.--C-~-.~.r--~-.-~'~O'M___.F~_S--._ ...... FT.
................................................................. TO ........................ FT ...............................
............................ /~-. ............... ~o~ ........................ ~T. TO ........................ FT ...............................
~o~.....~_~ ........... ~. ~o e~ ~ ~__ ....... ~t.___g_~i~.~ ~: ~o~ ........................ ~t. to ........................ ~t ...............................
~o~ ....... .2.~ ~. ~o ............. ~ ~_~_._~ ...... ~?.~__~~o~' ........................ ~. ~o ........................ ~ ...............................
MISCL. INFORMATION:
MUNICIPALITY OF ANCHORAGE
Jq.I.,
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. 050-572-22
Legal description PREUSS #2 BLK 3 LT 6
Site address 10213 PREUSS LN
Current property owner(s) D I ETZ JULIE M
Expiration Date: 12/19/2023
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
By: �Original Certificate Date: 9/19/2023
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 Approval_June 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. 05057222000
Complete legal description PREUSS #2BLK 3 LT 6
Location (site address) 10213 PREUSS LN
Current property owner(s) DIETZ JULIE
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
Day phone 223-7232
3. TYPE OF WATER SUPPLY: X 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: X Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel ❑■ Plastic ❑ Concrete ❑ Fiberglass
Age new - 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 $ 2 Waiver Fee $
Date of Payment g, , A Date of Payment
COSA # ODC 2 5) -3 2 4 Waiver #
COSA Application—June 2022
COSA Checklist
Legal Description: PREUSS #2 BLK 3 LT 6 Parcel ID: 05057222000
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _
A. WELL DATA
0 Well log is filed with Onsite (or attached)
Date drilled 9/23/75 Total depth 320 ft
Cased to 320 ft
0 Sanitary seal is functioning correctly
0 Wires are properly protected
Casing height (above ground) 18 in.
Date of flow test for COSA 8/4/23
Static water level at beginning of test 95.5 ft.
Comments
B. TANK DATA
Measured operating fluid level in septic tank na
Date of pumping new
❑ Required maintenance completed, if AWWTS
Comments: Advantex
D. ABSORPTION FIELD DATA
Which system tested (date installed) 9/9/22
Q 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.
0 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: New Drainfield
COSA Checklist June 2022
Well production at time of test 4+ gpm
Water storage tank volume0 gallons
Well disinfected for coliform test? ❑ Yes ❑■ No
0 Coliform bacteria is Negative
Nitrate 0.251 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L 0 Arsenic less than MRL (ND)
Collected by NRimEng
Date 8/4/23
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 8/4/23
Results Q Pass
Fluid depth prior to test
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth 0 in
in
Absorption rate gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 60
Effective depth used 0 in
Effective depth remaining 60 in
in
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please eller distances if less than required or if community well on lot)
Septic Tank]Llft Station on Lot > 100' 0 Community Sewer Ma n h cleJC leanout a 100'
❑ Yes if No ft R Yes if No ft
Neighboring Tank > 100' ■❑ Yes if No ft Private Sewer/Septic Line> 5' ❑■ Yes if No ft
Absorption Field on Let > 100' ■❑ Yes if No ft Holding Tank > 100' MYes if No ft
Neighboring Absorption Fields > 100' Animal Containment > 50' ■❑Yes if No ! ft
❑■ Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ❑■ Yes if No ft R Yes if No
❑ WA — Se,rved by Community Well (not on lot) or Public Water
FrontSeptic/Hold ing Tank ars€# Absorption Fields) on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑■
Yes
if No
ft
Surface Water > 100'
■❑ Yes if No _
Tank to Property Line > 5'
❑■
Yes
if No i
ft
Wells on Adjacent Lots:
Field to Propertyf Line > 10'
■❑
Yes
if Nr:
ft
Private Wells > 100'
■❑ Yes if No _
Water Main > 10'
❑■
Y(:s
ii No
fI
Community Wells > 200'
❑■ Yes if No _
Water Service Line > 10'
[■]
Yes
if No
ft
If tank or field is under driveway comment below
F. ENGINEER'S COMMENTS
ft
ft
tt
ft
G. CERTIFICATION & STATEI%4ENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my inveskigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water
supply andlor wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in affect at the time of installation, unless noted otherv+ise.
Name of Firm NorthRinn Engineering Phone 894-7028
Engineer's Printed Narne Steve Eng Date 8115/23
AV
P�F q�qsk�`�
Ar
s * :49TH
�•�• , ; . ...Steve Eng •�
CE -6256
a
8•/2 /�M
COSA Checklist June 2022
MUNICIPALITY OFANCAORAGE
ADVANCED WASTUNNA1
-'R L ENI ENT
MSIN TENANCT' AND RLPAIRAG
,I[-N'I-. herein the "AGRI'l'SEE SET" nade
i - an d
ol'20,)'� by and between
entered into as of this 0 -�h Day of5torlm-M)c
herein the the Municipality of
Anchorage, herein the -MUNICIPALITY-, in accordance with Anchorage Municipal Code
(AMG) 15.65.365. In consideration ofthe mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. 'File Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as—ra-c-\Sm- un
located at (legal description)
2. Imainteriance. Repairs and Alterations.
(Owner is required to read, understand and initial each section)
Throughout the term of this Agreement, the Owner shall enter into a service agreement
with all AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing
treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
pc�j_ It shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
includes all annual maintenance fee (typically $400 to 5600).
Owner agrees that only maintenance and repair personnel approved by the Municipallry
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
Owner acknowledges that regular maintenance of an ANVWTS reduces the potential
failure of the system, which Could include sewage backup and costly repairs or drainfield
11 -
replacement.
(rev. 05/18/2018) Page I of3
ki Owner acknowledges Illat the NIUM011idity Imly request records of'Imunteriance Jild
repairs from the inanuf3durct's representative or maintenance provider,
Owner acknowledges that the fine I'Or flailing to maintain mid repair an AWWTS may be
assessed in accordance with ANK 14.60.030
Owner agrees to grant the klunicipality reasonable access to test and inspect tile
AWAVTS. The Municipality will give at least 24-hour notice,
Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate ofOn-Site Systems Approval.
Owner agrecs that the AW\V'FS installation and maintenance requirements as provided
by the AWWTS vendor/Installer and approved by the Municipality are tile governing
guidelines for the construction, maintenance and repair of the Owner's AWWTS.
Owncra-rces to maintain remote monitoring of the AWWTS as required by the
AWWTSapproval.
3. Term. The tenn of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonivaiver. The failure of the Municipality at any time to enforce a provision of this
Aurcernent shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the A ),
Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendinent. This Agreement shall only be amended by authorized representatives of
the 0xviler and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brotiolit in the Superior Court for the Third Judicial District of the State ofAlaska at
Anchorage.Z:I
The laws of the State of Alaska shall govern the, rights and obligations of the
parties under this Agreement.
z:I
7. Severability. Any provisions of this Agreement decreed invalid by a court ofcompetent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
rev. I Page 2 of 3
(
OWNER:
By:I`Gt{ (signature) Date: Q?m
(print name)
STATE OF ALASKA
ss.
THIRD JUDICIAL DISTRICT
The foregoing instrument was acknowledged before me this �day of
2011, by r1sd--FraK Ks
DI ARV PUBLIC FOR ALASKA ��J. C. WILLETTE
COmtnission expires: �t e -k Notary Public
rJ State of Alaska
1lUNICIPALI"I'1':
By: ��� (�C/ (signature)
K-- - (print name)
My Commission Expires Mar 1, 2025
Date: q/gO�
Title:
(rev. 05/18/2018) Page 3 of 3
'~-J' 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
Application Date
GENERAL INFORMATION
(a) Legal Description (include Lot~ ~lock, subdivision, section, township, range)
Location (address or d rections)
(b) Applicant Name I'~-~--~'~'"'"~"-~"~'~SCJ~eleph°ne: Home Business ~"~'~'-
Applicant Address '-~c:~ ~1~:) ~ ['~.0'o ~¢?...[~, ~
(c) Applicant is (check one): Lending Institution J~; Owner/builder []; Buyer []; Other [] (explain);
(d) Lending Institution
Address
Telephone
(e) Real Estate Company and Agent
Address
(f)
Telephone
Mail the HAA to the following address:
$ & $ ENGINEERING
17034 Eagle River Loop Road No. 204
TYPE OF RESIDENCE
Single-Family ~ Multi-Family []
Number of Bedrooms '~
Other
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
Onsite,~ 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.
?2-025 (11/84)
Page 1 of 2
ENGINEERING FIRM PROVIDI~%~,iNSPECTIONS, TESTS, FILE SEARCH, D~--.~-~ AND INFORMATION
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 disposat 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.
Name of Firm S & S ENGINEERING
17034 Eagle K[vet' L~Ia R,,ad
Address E=g!e _~;ver: Alaska 99577
Date
Telephone
DHEP APPROVAL
Approved for -/,b.¢~¢.~-~.,~ bedrooms by
Approved ~ Disapproved Conditional
Terms of Conditional Approval
Date
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
72-025 (11184)
-'~EN'r'4~ ~_ 4NC/fn HEALTH AUTHORITY APPROVAL (HAA)
~C,/k,O Legal Description: ~~
WELL DATA
Well Classification
Well Log Present ~'N)
Total Depth .~.~--~-~ / Cased to ~8. C>
Static Water Level /--7 (~ ~
Casing Height Above Ground /~ ~
Electrical Wiring in ConduitlC~/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
/-
To Nearest Edge of Absorption Field on Lot
To Nearest Public SewSr Line Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
If A, B, C, D.E.C. Approved (Y/N)
Date Completed ~-,~,~' _.?~' Yield
Depth of Grouting
Pump Set At
Sanitary Seal on Casin~.~N)
Depression Around Wellhead (Y~)
; On Adjoining Lots
/c~
; On Adjoining Lots
N'/'/~ / To Nearest Public Sewer
*'~?/~ To Nearest Sewer Service Line on Lot
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes ~_-)N) Air-tight Caps~N)
Depression over Tank (Y/[~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N) J"~.,/~'//~'/
Separation Distances from Septic/Holding Tank:
/
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course "~'?"~
Size /oo4'~ No. of Compartments
Foundation Cleanout.
Date Last Pu m pea ~--//'~//~
Temporary Holding Tank Permit (Y/N)
To Building Foundation Z_. ~-
/
To Disposal Field ~- ~
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
72-026(11/84)
ABSORPTION FIELD DATA
Date Installed ' ~# f ! ,,1 7 / //
Width of Field ~ ~ Depth of Field
Gravel Bed Thickness
Square Feet of Absorption Area ~¢~¢ / ~ ~ ¢ Standpipes Present~/N)
/
Depression over Field (Y/~)~
Results of Last Adequacy Test p.%.~f~'7..% ~ ~-/3,~.
Separation Distance from Absorption Field:
To Water-Supply Well //.~ /
To Building Foundation ~-// /
Lot / ~' ~
To Water Main/Service Line ./O
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Date of Last Adequacy Test
'/'
To Property Line /~ 5"
"/0
-- To Existing or Abandoned System on
; On Adjoining Lots .~O
./
To Cutbank (if present)
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test, Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed $ & S EH-c'INEERING ~"'"'" ~"'"' ¢ ~
_Elate
034 Eagle R~,ver L~p Road No. 2o,q,
Compar~y7 ....... t. ~"...'~. MOA NO.
Eagle It~ver, ~"'~.~" '/-&' . ~
Receipt No /00/~ 0 /~
Amount: $ / ~
Page 2 of 2
72-026 (11/84)
F~tUNICtPAM3 Y OF ~NCHORAG:~
HEALTH ~.ND EHVIRON~E~:TAL PROTECTION
i~F~CTIO[~ FOR ~EALTf-i ~L ?~:C,~Ty APPROVAL
(b)
(c)
Location tsddro3s or
Apphcant Name~_~(~M~4~.~p~} .......... Telephone: !-l=~z ...Z~ ~_¢~' ~usinoss
Applicant Address
Applicant is (check one): Lending Institution ~; OwRer~builder~.. E3yer ~; Other ~ (explain);
(d) Lending Institution
Address
(e) Real Estate Company and Agent
Address
Telephone ( ~ ~_~
(f) h¢~] the HAA to the following address:
TYPE OF RESIDENCE
Single-Family,~-. Multi-Family []
Number of Bedrooms ',:2~
Other
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.
SEWAGE DISPOSAL
Onsite'~. 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)
ENGINEERING FIRM PROVIDIN~_j~SPEC¥1ONS, TESTS, FiLE SEARCH, DA'~_,Ai'4D iNFORMATION
As, certified by' my seal affixed hereto and as of the validation date shown below, I verity that my investigation of th~
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adef
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
from the Municipality o¢ Anchorage files and from my investigation and inspection, the on-site water supply and/o~
wastewater d~sposal system is in compliance with all Municipal and State codes, ordinances, and regu!mions in effect
the d~te of this inspection.
Name o~ Firm Telephone
Address ................
Date ~-
Approved ~or
Approv~.d .....
Disapprove8 Condition.~----'~
Terms of Conditional Approval
CAUTION
The 1',4uncipa!ity of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approva! ce,'!.ificates 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 i'.efore a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
profe3sior~a! engineer's work.
Page 2 of 2
~ o~ AMc~O~
Well Classification
Well Log Present (Y/~)
Total Depth f~,~--, Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit
Separation Distances from Well:
MUNICIPALITY OF ANCHORAGE (MOA7
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
If A, B, C, D.E.C. Approved (Y/N)
Date Completed L..), ~,, Yield
To Septic/,Holdlng:Tank on Lot
To Nearest Edge of Absorption Field on Lot I. \ "~'
To Nearest Public Sewer Line
Depth of Grouting
Pump Set At L), 1/-..~
Sanitary Seal on Casing <~N)
Depression Around Wellhead (Y~)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
Cleanout/Manhole
Water Sample Collected by ~..~--~ ~ '.,~,...5~=:,,..-~i,~3(~-~, ; Date
Water Sample Test Results
Comments ,Z~ k~.J~,,l.,.~- -4 1 ~...~f~ '~'"' '~./.4-oV.Ju~"~ "7~¢-C~
To Nearest Sewer Service Line on Lot
B. SEPTIC/-14~L~-N~ TANK DATA
Date Installed
Standpipes(C~N)
Depression over Tank (Y/~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N) "'~//~'
Separation Distances from Septic/I.4o',dlng Tank:
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course /'~ /'~
Size ! d:~c~:::) No. of Compartments 'LJ~¢'~,
Air-tight Caps 4:~;Z~I) Foundation Cleanout (Y/~[~
Date Last Pumped ~'- rT-
,.o/~ ; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation ~'~z
To Disposal Field ~
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata ¢--~¢r~ cfi J~ Type of System Design
Date Installed c...~.~&., - L~, ¢. LS~t?.~,-'E~ I~-l~,~"Length of Field ,c~7~.,¢~ ~o, ~4.. ~¢~.~tz-,'~,'~¢~ - ¢...~"
Width of Field '~-~c:=." Depth of Field
Square Feet of Absorption Area
Depression over Field (Y/~[~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well L ~:~ I-4-
To Building Foundation ~-~"'
Lot ~/~'
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Gravel Bed Thickness ,-->~r..
Standpipes Present
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ~
To. Cutbank (if present)
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Date ¢- J '7 ~ ~d"
Signed S & ~:"~ E;'~GiNEERiN(-~
C°mpa~,C~iVER, ALASKA. '~51~' MOA No. ~ .~ ~ O~ .~
PH,
694..2979
Receipt No. ,~/~ %~'~
Date of Payment ~.. ~4[. ~
Amount: ¢
Page 2 of 2
72-026 (11/84)
s~' ' ~-- ~ DATE RECEIVED
, '~ INSPECTION APPOINTMENTS (~(.~ C.L.~.~,_L.C_-~/.._~(~
TIME TIME TIME
)ATE DATE DATE
NSPECTOR INSPECTOR INSPECTOR
MUNICIPALITY OF ANCHORAge
MUNICIPALITY OF ANCHORAGE DEPT. OF H~ALTH &
) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~IRONMENTAL ', [;OTECTiON
825 L Street - Anchorage, Aleska 9gB01
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720
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.
MAILIN~ ADDRESS
PROPERTY RESIOENT (If different from ~bove) ~HONE
' PHONE
MAILING ADDRESS
3, ~ENDING~STITUTICN ~ · PHONE
MAILING AD~ES~ ~/ - ~
5, LEGAL DESC~RIPTION
;TREET LOC~'~I O N
6. TYPE OF RESIDENCE
I~_-~SING LE FAMILY
[] MULTIPLE FAMILY
NUMBER OF~BEDROOMS
[] One [] Four
[] Two [] Five
~ JThree [] Six
[] Other
7. WATER SUPPLY
[~ INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well 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
~__~A-N DI V i D UA L/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED,
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 [] 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
[] I NDIVI DUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY ~ -- 9K..~
Connection Verified
INSTALLER
[]Septic Tank or [] Holdin§ Tank
Size: /_(~)C) If Tank is homemade SOILS RATING
§ive dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCESwELL TO: Septic/Holdingl ~) Tank !Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
[~PPROV ED FOR ~ BEDROOMS
[~] CONDITIONAL APPROVAL (letter must accompany certificate)
DISAPPROVED
72-010 (Rev. 6/79)
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "c" Street, Anchorage, Alaska 99503 274-4561
Date Received July 1~4, 1976
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
2:30 p.m.
7-15-76 Neale
l. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
3. Legal Description:
Conv.
First National BAnk of Anchorage
Post Office Box 720 Phone:
W. L. Foreman Phone: 694-9056
General Delivery, Eagle River
Lot 6 Block 3 Preuss Subdivision
4. Location:
Preuss Lane
Single Family No. of bedrooms 3
5. Type of facility to be inspected
6. Well Data: Individual
A. Type
C. Construction
Sewage Disposal System:
A. Installed
C. Septic Tank:
D. Seepage Pit: 1.
E. Disposal Field: Total length of lines
B. Depth
D. Bacterial Analysis
R~ On-site system
B. Installer
1. Size 2. Manufacturer
Absorption Area 2. Material
110', Absorption area
, Other contamination
Distances:
A. Well to: Septic tank
Nearest lot line
110'
, Absorption area
B. Foundation to septic tank
C. Absorption area to nearest lot line
Satisfactory
, Sewer Lines
EQ-034 (1/74) Page 1 of two pages
P~ge 2 of two pages - Re ;t for Approval of Individual~ ir & Water Facilities
· L. ega~. ~)es cr i pti on
Lot 6, Block 3, Pruess Subdivision
Comments
Approved
< /~/~~~ ~Disapproved
Date
/
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this 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 (1174)
