HomeMy WebLinkAboutPREUSS #2 BLK 4 LTS 7 & 8Onsite File
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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: OSP241060 PID Number: 050-571-59
Dwelling.- RN Single Family (SF) El with ADU R Duplex (D) R Two Single Family Project: R New M Upgrade
Name
Brian Midyett
ABSORPTION FIELD
R Deep Trench 9 Wide Trench F-1 Bed El Mound
Site Address
10226 George Place
E] Other
Phone
Number of Bedrooms
Soil Rating
depth from original grade
1 4
1.2 GPD/SF
JTotal
10.6 / 10.5 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
8.3/8.5 Ft.
Gravel depth beneath pipe
2.3 / 2.0 Ft.
Subdivision Block Lot
Preuss #2 4 7 & 8
Fill added above original grade
0.3/0.6 Ft.
Gravel length
40 / 42 Ft.
Township Range Section
Gravel width
5/5 Ft.
Beds: Number of Lines
N/A
Distance between lines
N/A Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
2
Dist. between trenches
From
Tank
Field
Tank
Line
588 Ft2
9.0 Ft.
Well
>100'
>100'
N/A
N/A
>25'
TWWI-,o Septic E] S.T.E.P. [I Holding 171 Other
Manufacturer
Capacity
Surface Water
>1 00'
>100'
N/A
N/A
Gal]
Material
of compartments
Lot Line
>5'
>10'
N/A
N/A
NA
Foundation
>101
>10'
N/A
N/A
LIFT STATION
95-11�rer�..
Capacity Gal.
I
I
I
I
Remarks Trenches labeled North South.
Alarm location
I installed by
PIPE MATERIAL House to tank D3034 d Tank to D3034
rainfield
Installer
Hiland Excavation
Drainfield D3034 CO/MT D3034
Inspector J.0pheirn
BENCH MARK (Assumed elevation) 100 ft
Inspectetion 1�t 6/10/2024 6/11/2024
Location and description
2nd
das:
th
Bottom of Garage Siding @ B
3rd 4
ON -SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
OF A4,
Conditional Approval- Date
49 TH
71...
f
..........
6enjan
Septic System
(L
tR Schiller
CE 12592
—
Approved Date
U-�, 6/21/2024 "w
FS
*' A-'
0
PROFE A0-
klk�, SV'� -
Note.- this approval does not include well permit requirementl.
Rev 05102/18)
Benjamin Schiller
CE 12592
R
E
G
ISTEREDPROFE S S I O N A L E N GINEER
1"=50'
1x 40' LONG x 5' WIDE, 2' EFFECTIVE
DEPTH ABSORPTION TRENCHES
1x 42' LONG X 5' WIDE, 2' EFFECTIVE
DEPTH ABSORPTION TRENCH
EX. 1250 GAL TANK
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
PERMIT # OSP241060 PID # 050-571-59
PREUSS #2, BLOCK 4 LOTS 7 & 8
A B
70.2
SV 65.1
58.8
A
B
17.6
CO1 17.9
MT2 54.2
CO2 55.2
24.1
22.4
17.9
63.5
66.0
78.6
77.6
FEET
0 50 100
GE
O
R
G
E
P
L
A
C
E
4-BDRM HOME
780
PLAN AS-BUILT
6/25/24
10
'
U
T
I
L
I
T
Y
E
A
S
E
M
E
N
T
DECK
GARAGE
775
775
780
780
775
770
765
760
FS
CO1
CO3
CO2
CO4
MT1
MT3 MT2
MT4
CONFIRMATION TEST HOLE
2CO2
2CO1
MT1
MT3 27.9
CO3 28.8
79.4
81.5
MT4 58.8
CO4 59.2
90.5
89.7
FS 38.576.4
2CO2
2CO1
SV
BM
DECOMMISSIONED
CRIB AND TRENCH
OLD PIPES WITH
METAL CAPS
ABANDONED IN PLACE
PROFILE AS-BUILT
(NO SCALE)
PERMIT # OSP241060 PID # 050-571-59
PREUSS #2, BLOCK 4 LOTS 7 & 8
98.4 FINISH GRADE
42'
DRAINFIELD ROCK
MT
3
TH
#
1
NO GROUNDWATER 5/31/24
87.3
89.3
CO
3
CO
4
80.8
87.3
89.3
97.8 ORIGINAL GRADE MT
4
Benjamin Schiller
CE 12592
R
E
GISTEREDPROFE S S I O N A L E N GINEER
6/25/24
SOUTH TRENCH
98.8 FINISH GRADE
40'
DRAINFIELD ROCK
MT
1
TH
#
1
NO GROUNDWATER 5/31/24
87.9
90.2
CO
1
CO
2
81.5
87.9
90.2
98.5 ORIGINAL GRADE MT
2
NORTH TRENCH
N 89 59' w 18850
18.6
WELL
72.4
•
LOT 7
N 89 59' W 188.50
---------------------- --------------------------
cP��.
<< 0?
�T
A
g GPFP ti ,? NOTE.
Q ; ; AS OF THIS DATE, THESE SEWER COMPONENTS
AREABANDONDED,' 6.2024
Q
•
•
V
LOT 8
000000�� N 89 59' W 188.50
_o
OF
TH's'��0
� .
� o � 49
FND YPC 5 3631' E 0.76' a
FROM COMPUTED POSITION
NOTE
CORNER DESTROYED BY EXCA VA TOR CD
SINCEAPRIL 12024SURVEY QO` N SHANE A. HOLT
r
LS-6914 c�
�°fessiona\ \—a
��DO000��
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES.
EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN
HEREON ( UNLESS INDICATED)
NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE.
ONLY VISIBLE IMPROVEMENTS ARE SHOWN HEREON
BLOCKFOUNDAT/ON
66.3
ELOCKRET WALL
tiq�r
Oh,,GFGG
q`
THE SURVEY DATA AND MEASUREMENTS HEREON ARE PREPARED FOR THE
OWNER OF RECORD AS OF THE DATE OF THIS SURVEY.
ANY USE OF THIS DRAWING BY THIRD PARTIES IS PROHIBITED UNLESS
WRITTEN PERMISSION IS PROVIDED.
AS-BU/L T SURVEY 1 " = 20'
NO CORNERS SET THIS DATE
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOL L OWING DESCRIBED PROPERTY
L0TS7AND8 9LOCK4 PREUSS SUB. UNIT2
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THA T THE
VISIBLE IMPROVEMENTS SI TUA TED THEREON ARE WI THIN
THE PROPER TY L INES A ND NO VISIBL E ENCROA CHMEN TS
EXIST OTHER THAN NOTED.
DATED A T ANCHORAGE,ALASKA THIS 20 TH DA Y OF
JUNE , 2024
HOL T LAND SURVEYING
9309 GROVER DRIVE
ANCHORAGE,AK 99507
223-8615
16021 236-17 237-62
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
t)rlartmscnt
On -Site Wastewater Disposal System Permit
Permit Number: OSP241060 Effective Date: 4/30/2024
Work Type: Septic Upgrade Expiration Date: 4/30/2025
Tax Code Number: 05057159000
Site Legal Address: PREUSS #2 BLK 4 LTS 7 & 8 G:0056
Site Mailing Address: 10226 GEORGE PL, Eagle River
Owner: MIDYETT BRIAN Lot Size in Sq Ft: 45240
Design Engineer: FORGE ENGINEERING Total Bedrooms: 4
This permit is for the construction of:
Q Disposal Field ❑ 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:
• A test hole is required prior to construction of the absorption field, in the location shown on the site plan, to
confirm minimum separation to impermeable soil and seasonal high groundwater, as well as percolation
rate. Construction may proceed at your own risk prior to 7 -day groundwater monitoring. 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).
P)4 u"'
Co DCy(J✓1 ChcrG/7/,q
QQcetved'$y:4 c) f Of Date:
Issued By: Date:
Ptr�
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 050-571-59
Property owner(s) Brian Midyett Day phone
Mailing address 10226 George Place, Eagle River, AK 99577
Site address 10226 George Place, Eagle River, AK 99577
Legal description (Sub'd., Block & Lot) Preuss #2 Block 4 Lots 7&8
Legal description (Township, Range & Section)
Lot Size 45,240 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN: TYPE OF DWELLING:
(N all that apply)
Absorption Field
❑X
Initial ❑ Single Family (SF) ❑x
Septic Tank
1:1Upgrade
R(w/wo ADU)
Holding Tank
ElRenewal
ElDuplex (D) El
Privy
❑
Multiple Dwellings ❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
i
(Signature of property owner or authorized agent)
Permit/Rush Fees: �_5 Waiver Fees:
Date of Payment: 'W7— 140Z y Date of Payment:
Receipt Number:
Permit No. ()EP Z L/ / D f7
Permit App_'-'-:- :'-,,:c;
Receipt Number:
Waiver No.
April 30, 2024
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Preuss #2 Block 4 Lots 7 & 8 - George Place
Septic system design
Dear On-Site Services Engineer:
The septic system on the above lot has failed, so we are submitting this permit application for the
construction of a new septic system. The attached site plan identifies the location of the home as
well as the existing and proposed systems. No conflicts exist between this proposed system and
any other well or septic system, whether on this lot or adjacent lots.
The ground surface on the lot is fairly flat in the northeast, but then starts to slope down in the
southwest corner at between 10-25%. Right in the area of the trench the slope approaches or
exceeds 25%, but it flattens again downhill from that. The trench will be installed in accord with
the code for steep slopes, including measuring the vertical separation from the appropriate high or
low sides of the trench (which we will confirm when we dig the test hole). Contours are shown on
the site plan showing the grade and direction of flow. Stormwater drainage will not impact this
septic system. The new trench will be constructed parallel to the slope as much as possible. We
have designed this system using the existing test hole information on file due to the record snowfall
this year, but we have specified digging a new test hole prior to installation and anticipate that to
be completed reasonably soon after the lot is easily accessible.
As part of this replacement, the existing field and concrete crib will need to be decommissioned
per code. The concrete tank can remain; however, we will need to install or fix the foundation
cleanout (or place a double cleanout before the tank).
Wells on this and adjacent lots are shown. The new system will be a minimum of 100’ from all
wells and surface water, and more than 5’ away from the septic tank. Please refer to the attached
plan and profile pages for the septic design. If this design is followed, there will be no adverse
impacts to adjacent properties.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241060, Deb Wockenfuss, 04/30/24
PREUSS #2, BLOCK 4 LOTS 7 & 8 cc)--;5r 1
I:
" I
,LOT i i
Ll®
LOT 2
r
NEW FCO DECK
OR 2C BEFORE TANKI L
f I
EX. 1250 GAL TANK TO ��� -,.. � �LOT 71 (
'REMAIN IN SERVICE
i
LU
4-13DRM HOME
LLJw,
LOQ" 3 LU
TIC FIELD
AND CRIB -
F NEW 2CO EXIST SEP
TO � I
o j DECOMMISSIONED 1
GARAGE PER CODES o i
INSULATE LINE UNDER LOT S I
PAVEMENTS I
Ls
t C 12.7
12.0 MT I
0
MT .
1
0 �.
CONFIRMATION TEST HOLE J
---------- 1--------
(2) NEW,40' LONG x 5' WIDE, 2'
EFFECTIVE DEPTH ABSORPTION
TRENCHES. MIN 6' SEPARATION
LOT
LOT I I I L
} I
(VACANT)
_ I I
GE I
I I
ii ENGINEEPING I - - � I
NOTE:
4l THE NEW LINE UNDER THE DRIVEWAY IS TO BE INSULATED LEGEND
* `� TM � 9*�r SEPTIC PLAN LEANOUT
CO
CO CO- CLEANOUT
FCO - FOUNDATION CLEANOUT
� r
FS - FLOW SPLITTER VALVE
Benja i Schiller / MH - MANHOLE
r� ��'• CE 2592 �� r 0 50 100 MT - MONITORING TUBE
' c�Xlle,• 4119/24 .•�(�AW 1 FEET
F�pROfESS10NP`,``�-►'SV - SEPTIC VENT
1"=50' TH - TEST HOLE
PREUSS #2, BLOCK 4 LOTS 7 & 8 co'Z7 (
DESIGN FACTORS:
600 GPD PEAK FLOW
PERK RATE: 1.3 MIN/IN
APPLICATION RATE: 1.2 GPD/SF
SYSTEM REQUIREMENTS:
5' WIDE TRENCH SYSTEM
EX. 1250 -GAL SEPTIC TANK
600 GPD / 1.2 GPD/SF / 5' WIDE * 0.7 RED FACTOR [2 DEEP] = 70 LF TRENCH REQUIRED (80
LF SPECIFIED)
BOTTOM OF TRENCH: 11' BELOW GRADE
FLOW LINE ELEVATION: 9' BELOW GRADE
PROVIDE ADDITIONAL FILL TO
ACCOUNT FOR SETTLEMENT
GEOTEXTILE FABRIC
4" PERFORATED PVC (HOLES DOWN)
DRAINFIELD ROCK
TYPICAL TRENCH SECTION
(NO SCALE)
NOTES:
1. GRADE AREA OVER TRENCH TO DRAIN AWAY
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2'
WITH 2" OF INSULATION
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
E N G �"�
749 7H
• ' • • Benja. - Schiller • '
f,��c�sl •
CE
12592 •c��<`�`�o
,•
��1��� PROFESSIONP��,►'�
DEPTH
(feet)
1-
2
3
4
5
10
11
12
13
14
15
16
17
18
1
SOILS LOG AND PERCOLATION TEST
E N G I N E E 0.I N G
LEGAL DESCRIPTION: PREUSS #2 BLOCK 4 LOTS 7818
PERFORMED FOR: H ILAND EXCAVATION
DATE: 5/24/2024 PARCEL ID#: 050-571-59
TEST HOLE 1
m
SILTY GRAVEL W/ ORGANICS
(BACKFILL)
NO WAS WATER ENCOUNTERED?
- IF YES @ WHAT DEPTH?
NONE DEPTH TO WATER AFTER MONITORING
5/31/2024 DATE OF MONITORING
DATE
READING
START TIME
NET TIME
(MINUTES)
WATER
(INCHES)
NET DROP
(INCHES)
5/24
1
10:38
10
1 -06-
7-116
6 0
2
10:42
10
1 16
716
616
3
10:46
10
1 16
7 0
6 0
4
10:51
10
1 0
7 0
6 -s
5
10:58
10
1 106
716
616
6
11:05
10
1 0
7 0
6 0
PERCOLATION RATE: 1.3 (MIN/INCH)
COMMENTS: USCS SOIL CLASSIFICATION WAS VISUALLY DETERMINED
SITE PLAN
TECHNICIAN: J. OPH E I M
WELL
72.4
N 89 59' w 18850
LOT 7
� Q
t
I �
I
J
p •
PPnPFPTV L LALF N 89 59'W 188.50
18.6
cP'
0�
LOT 8
V
000000�� N 89 59' W 188.50
_o
OF
*'
� . TH-� �O
FND. )`PCS 3631' E 0.76' a O
FROM COMPUTED POSITION a
�0
Vo SHANE A. HOLT�)
r
LS -6914 ��oO
�°fessiona\ \"a
��DO000��
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES.
EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN
HEREON ( UNLESS INDICATED)
NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE.
ONLY VISIBLE IMPROVEMENTS ARE SHOWN HEREON
BLOCKFOUNDAT/ON
66.3
ELOCKRET WALL
'qso
tiq�r
THE SURVEY DATA AND MEASUREMENTS HEREON ARE PREPARED FOR THE
OWNER OF RECORD AS OF THE DATE OF THIS SURVEY.
ANY USE OF THIS DRAWING BY THIRD PARTIES IS PROHIBITED UNLESS
WRITTEN PERMISSION IS PROVIDED.
AS-BU/L T SURVEY 1" =20'
NO CORNERS SET THIS DATE
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOL L OWING DESCRIBED PROPERTY
L0TS7ANO8 9LOCK4 PREUSS SUB. UNI T2
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THA T THE
VISIBLE IMPROVEMENTS SI TUA TED THEREON ARE WI THIN
THE PROPER TYLINESANDNO VISIBL E ENCROA CHMEN TS
EXIST OTHER THAN NOTED.
DATED A T ANCHORAGE,ALASKA THIS 15T DA Y OF
APRIL 2024
16021 236-17
HOL T LAND SURVEYING
9309 GROVER DRIVE
ANCHORAGE,AK 99507
223-8615
9,rA
TA
GP
c
LOT 8
V
000000�� N 89 59' W 188.50
_o
OF
*'
� . TH-� �O
FND. )`PCS 3631' E 0.76' a O
FROM COMPUTED POSITION a
�0
Vo SHANE A. HOLT�)
r
LS -6914 ��oO
�°fessiona\ \"a
��DO000��
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES.
EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN
HEREON ( UNLESS INDICATED)
NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE.
ONLY VISIBLE IMPROVEMENTS ARE SHOWN HEREON
BLOCKFOUNDAT/ON
66.3
ELOCKRET WALL
'qso
tiq�r
THE SURVEY DATA AND MEASUREMENTS HEREON ARE PREPARED FOR THE
OWNER OF RECORD AS OF THE DATE OF THIS SURVEY.
ANY USE OF THIS DRAWING BY THIRD PARTIES IS PROHIBITED UNLESS
WRITTEN PERMISSION IS PROVIDED.
AS-BU/L T SURVEY 1" =20'
NO CORNERS SET THIS DATE
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOL L OWING DESCRIBED PROPERTY
L0TS7ANO8 9LOCK4 PREUSS SUB. UNI T2
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THA T THE
VISIBLE IMPROVEMENTS SI TUA TED THEREON ARE WI THIN
THE PROPER TYLINESANDNO VISIBL E ENCROA CHMEN TS
EXIST OTHER THAN NOTED.
DATED A T ANCHORAGE,ALASKA THIS 15T DA Y OF
APRIL 2024
16021 236-17
HOL T LAND SURVEYING
9309 GROVER DRIVE
ANCHORAGE,AK 99507
223-8615
1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name DISTANCES
o AN R �1�E �� TO SEPTIC ABSORPTION
Address FROM WELL
6303 /t/ /zA %td0 TANK FIELD
Phone(s) fc;`
rmit No. o. of B dr c rs WELL /'7
69� 52 o:� 900'7 7 !p It
LEGAL DESCRIPTION LOT LINE
Lot Block Sub - isn r�
J FOUNDATION 1"2
T nship, Range, Section
! �� ] f Q AS-BUILT DIAGRAM (Show location of well, septic system, property lines, foundation,
i !tel/ U U driveway, water bodies, etc.)
TANKS _ -1 /j'. 2 S: e
SEPTIC ❑ HOLDING S /✓ G % O G C' _ L
Manufacturer Capacity in gallons i / �+
GG !< 2-5Z L
�a
M iat No. of Compartments
Nc°2�TE
TYPE OF SYSTEM GI e
XI TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Tf
Depth to pipe bottom from Total depth from original grade
original grade FT 2 / FT B
Fill added above original grade Gravel depth beneath pipe 1 �=
D.S FT `j / FT Z
Gravel length Gravel width
Z FT Z FT n • °'
Total absorption grea Distance between lies
SO FT /v '44 FT 4
Number of lines Soil rating Pipe material
Z2(�s SOFT y]3 dG 5 3 I O C2 TV
Instal Y 75 ;�—� �Date Installed _
2.0 L
WELLS S l/` /G $ 2
x
PRIVATE ❑ OTHER (Identity — 2 r' JA•
Classification (A, B,C) Total Dept_ Cased to 1iUj !,L
FT FT 3 Alf41
Installer /"➢ Date Installed:
REMARKS:rrls 711j,05-
ro NC- Ie l `f}%✓� oaiUv O r� �i X Sale:
Pe ed y: s EN61NEEH'S;SEAG
Ci �G680)bOJ cif
a 2SU Date: 2-12-917 f „a°' £t FEZ-tR�.e,
Q1 r n Of F Ve{bN}4Y
I certify that this inspection was performed according to all
ee- n:,... cao-. r,•a aeino
Mu fpal and State guidelines in effect an this IGt EgRING Z-- 2- -- 0 � • _, , rasa, i .tl• Tatrx•X:e � ,rr;.
34 Emile l.ve Loop
E
Health Department Approval: 9 Date:
72-013 (3/85)
MUNICIPALITY OF ANCHORAGE
Department A Hesolth & HU0wn Sevvices5
825 L Street, Anchorage, Alaska 99501
17�4'
ON - SITE SEWER PERMIT
Permit Number: 89O007 Enlargement
Date Issued: 01/2�/89 EngiDeeP Designed
Owner Name: FEDRAL HOME LOAN MORTGAGE CORP,
Owner Address: 15303 VENTURA BLVD. #500
SHERMAN OAKS, CA 914O3
Parcel Id: 05 1^41
Lot Lega1: Subdivision: PREUSS #2 Lot: 7/8 Block: 4
Section: 8 Township: 15N Range: 1W
Lot Size 45240 (sq,ft, or, acres)
Max Bedrooms:
PAIS Permit: 1 Total Capacity: 4
Day Phone:
694-5500
SEPTIC TANK: Minimum total septic tank capacity: 1,250 gallons" Each septic
tank must have at least 2 compartments. Depth to top cd septic tank(s) < 4"O
{eet requires insulation over tank(s>"
INSTALL PER ENGINEERG ATTACHED DESIGN. NOTIFY DHHS PRIOR TO
EACH INSPECTION" THIS PERMIT IS ISSUED FOR THE EXISTING 4 BDRM"
SINGLE FAMILY RESIDENCE ONLY AND EXPIRES ON 12/31/89"
I CERTIFY THAT:
1. I am f amiliar with the reCjuIi. rements ior on^site sewers and wells as set
Wrth by the Municipality of Anchorage (MOA) and the State o{ Alaska.
2. I will install the system in accordance with all MOA codes and regulationsp
and in compliance with the design criteria of this permit"
3" I will adhere to all MOA and State CH Alaska requirements for the set back
distances [rom any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot,
4" I understand that I ts permit is valid f,(: -,)r a maximum o{ 1 bedrooms" I
also underIii t the capacity of the total system is A. bedrooms and
any enlarg( wiV rire an additional permit"
Signed:
(Ovjiner) CORP"
Issued By:
DATE:
/
DATE:
X
Y
U
TWOS
' �I
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
lA
825 "L" Street, Anchorage, Alaska 99502-0650 �,`t'" :� A. Aheef;c�°V< a�4
SOILS LOG - PERCOLATION TEST
I + "7 A
PERFORMED FOR: I�•�/r,��•t�+��-- ��Y��N"1'i�� DATE
PERFORMED:
LEGAL DESCRIPTION:Li-7 F7 T J �_�
\TiL/JW
_ SLOPE SITE PLAN
1 v Jr[
2-
3-
4-
5-0o
6 b
7
8 (�
9AV
�1
10
,fJ
11 �r
12
13 rd
14
r
L
15 O
L
d-
16-
17-
18-
19-
20
6
17181920
COMMENTS
111M■■
It■ii1■11■!■�■�■
M■■■■■■11■■
Net
Time
■■■■
Net
Drop
N■
111M■■■■■■■■
11MMEM■■■■■
132009FI■■■■■
11■lS`■■■■■■n
Y
83
t yH
uii■■■■■■M_
WAS GROUND WATER
ENCOUNTERED? �
S
IF YES, AT WHAT L
O k
DEPTH? P
E
Depth to Water Afte�rr,��
Monitoring? �q Date:
Reading Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
Y
83
t yH
N
PERCOLATION RATE Z2- (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN 4 FT AND k 'C—> FT
PERFORMED BY17034 Eagle River Loop Road No. 204
Eagle River, Alaska 99577
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEL16
72-008 (Rev. 4/85)
CERTIFY THAT THI TEST WAS PERFORMED IN
ON THIS DATE. DATE: Z •'/
DEPT. OF HEALTH. et
M —W DRILLING, Inc. ' ENVIRONMENTAL PRONCTION
" P. O. Box 4-1224 • 1310C International Airport Road `,
(907) 274-4611 MAY 20
ANCHORAGE, ALASKA 99509
RECEIVED
DRILLINGLOG
Well Owner Use of Well
Location (address of: Township, Range, Section, if known; or distance main road -
Size of casing " Depth of Hole -2 -/-6feet Cased to '' ' feet
Static water level ft. (ab'oVe) (below) land surface. Finish of well (check one) open end
Screen ( ); Perforated
Describe screen or perforation
Well pumping test at ' " gallons per (h6iif)- (minute) for ----------hours with ft.
of drawdown from static level.
Date of completion n,
WELL LOG
Depth in feet from
ground surface
Give details of formations penetrated, size of material, color and hardness
TO
„ t
TO
- TO
TO
TO
TO
TO
t C; •... f; on <
G{-rtficace Nds.
TO-
O
TO-
TO
2
2 — STATE
1-°l 00 P-4 1 ®:w; 1 y=91__ I -1'- e" e"e s*# 1 F=n p--# C, 1- FA 9:3 F"
DEPART ME NT HEALTH FIND ENVIRONMENTAL rjTECT I ON333o C s'rRE:ET: ANCHORAGE, ALASKA 95,50
274-4561
PERMIT NO. (76000)
LAWRENCE _i SH OSHANd I ANJ BOX 1:166 •— EAGLE RIVE 6949671
LCC_:ATION,! GEORGE PLACE. OFF EAGLE RIV LFI
LEGAL_ L.' B4 PF-.:EI_ISS :-,I_IBD #1
LOT SIZE 22620 -OFT
MINIMUM DISTANCE FROM 14ELL TO ANY 'SEPTIC TANdlt/PACN::FIGE PLANT OR SOIL AE:SORPTI ON
SYSTEM IS _L•G. 0 FT F[.,R A PR I VATEWELL AND 200 FT FOR A PUBLIC WELL.
WELL. LOGS MUST BE. RETURNED To THE DEPARTMENT WITHIN•! `:0 DAYS OF 'FHE WELL
COMPLETION.
SPEC IF'f.t FITIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER
INSTALLATION.
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE 'SEWERS AND baELLS
AS SETFORTH BY THE MUNICIPALITY CIF' ANCHORAGE FIND WILL INSTALL I N ACCORDANCE
WITH T•HE C:CiG'
e
ISSUED BY. DATE...
e-e'c, f :
i
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. 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 Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
* 491
I� �a+ maoAn t AM
S. DSD SIGNATUREis .• CE.438
/ � iF •.1-16 -D
_� Approved for `T bedrooms. 444411m `t'
Disapproved. T
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: Original Certificate Dater"vZ��D
(R.v IM5)
Municipality of Anchorage ..
Development Services Department
Building Safety Division
On -Site Water& Wastewater Program •• "`
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519.6650
www.muni.org/onsfte
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lots 7 & e, Block 4. Reuss Subdivision No. 2 Parcel ID: OW -571-59
A. WELL DATA
Well type Private If A, B, or C provide PWSID #_
Date completed 10/512005 Sanitary seal (Y/N) v
Total depth 378 fL Cased to 375.5 ft.
FROM WELL LOG
Date of test 312906
Static water level 340 R
Well production
WATER SAMPLE RESULTS:
10
Well Log (YIN) Y
Wires property protected (YM) Y
Casing height (above ground) >36 in.
AT INSPECTION
71212008
328.7 fL
g.p.m. s.9s g.p.m.
Coliform 0 colonies/100 mL Nitrate 1.04 mg/L
Arsenic: PUD mg/I Date of sample: BMW
B. SEPTICIHOLDING TANK DATA
Tank Type/Matedal SepddConcrete
Tank size 1.250 gala Number of Compartments -One
Other bacteria 0 colonies/100 mL
Collected by: J. LeOoux
Date installed 1973
Cleanouts (YM) Y
Foundation cleanout (Y/N)Y_' Depression over tank (YM) N High water alarm (Y/N) N
Date of pumping 12ro5ro7 Pumper Sanitary Pumpers
C. ABSORPTION FIELD DATA
Date installed '1973:2/12/89 Soil rating (g.p.d.tft2 orft2/bdrm)225 sFA30Rnt System type 73-Gth '89awltlnh ch
Length 24 1L Width 2 ft. Gravel below pipe 5 R
Total depth 12.5 . ft Eff. absorption area 240 ft2 Monitoring tube Y Depression overfiekl N
Date of adequacy test 71212008 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test 17 in. Water added 1.430 gala 'New depth 48 in.
Elapsed Time: 1.320 min. Final fluid depth 14 in.
Any rejuvenation treatment (past 12 mo.) ('Y/N & type)
Absorption rate >= 600 g.p.d.
If yes, give date
F
D. LIFT STATION
430
Date installed Size in gallons
Manhole/Access (Y/N)
'Pump on' level at _ in. 'Pump off' level at_
In. High water alarm level at in.
Datum Cycles tested
Meets alar 8 circuit requirements?
E. SEPARATIONDISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot >100'
On adjacent lots >100'
Absorption field on lot >100'
On adjacent lots >100'
Public sewer main NIA
Public sewer manhole/cleanout NIA
Sewer/septic service line >25'
Holding tank NIA
Animal containment areas None
Manure/animal excrete storage areas None
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line >T
Absorption field >6
Water main NIA Water service line
>1T Surface water >100'
Wells on adjacent lots >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10' Building foundation >10' Water main >10'
Water Service line >10' Surface water >100'
Driveway. parking/vehicle storage 0'
Curtain drain 'None Noted Wells on adjacent lots
>100'
F. COMMENTS: Existing Absorption Trench Under Driveway/Parking Area. Size of Existing Absorption Ph Unknown. No Exterior
Foundation Cleanout. Access to Line From House to Tank From Cleanout Inside Garage.
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineers Printed Name Michael E. Anderson, P.E.
Date 7/712008
COSA Fee $
430
Date of Payment
/ ' 02
Receipt Number
�•� 3
(Rev. 11/05)
Waiver Fee $ _
Date of Payment
Receipt Number,
*? 4918
;i :A381
7-ZS--�
Q
a
6•d ZW-469106 usanc% uemc riti� on nn ��
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOTS 7 AMD 9, BLOCK 4, PREUSS SUBDIVISION
PERFORMED FOR: DFNNIS AND LINDA FAIRBANKS
DATE: 7/23/08 PROJECT No.:
PARCELID#: 'TECHNICIAN: S. GILBERT
DEPTH TEST HOLE A
(rccI)
1
OB/OG
SLOPE
SITE PAN
ORGANICS
2
a FILL
3
4
•d
5
e
SEE SITE PLAN
y
'
SILTY SAND
6
WITH GRAVEL
A
SW/SM
7
DRY
8
a
9
a
MEDIUM DENSE
10
a ,
WAS GROUND WATER ENCOUNTERED?
No
A
IF YES ®WHAT DEPnil
DEPTH OF WATER AFTER MONITORING:
NONE
2%
I 1
BOH @ 11.5'
DATE OF MONITORIIJG. 7,26,06
12
13
DATE
READING
G
OSS TIME NET TIME
DEPTH To
WATER
INET DROP
MINUTES)
(MINUTES)
(INCHES)
(INCHES)
14
TEST HOLE PRESOAKED
PRIOR TO TESTING:
15
7/23
1
4:17
6.00"
16
2
4:47
30
3.00"
3.00"
3
4:47
6.00"
17
4
5:17
30
3.75"
2.25"
18
5
5:17
6.00"
19
6
5:47
30
3.75"1
2.25"
20
PERCOLATION RATE• 13.3 (MIN/NCH) PERC. HOLE DIA 8. �'(INCHES)
TEST RUN BETWEEN: 4.5 FT. and 5.5 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED N ACCORDANCE WITH ALL STATE AND MUMCIPLE GUIDELINES N EFFECT ON THIS
DATE: 7/25/2008
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 FAX
MEMORANDUM
DATE: July 28, 2008
TO: Jeff Poet
FROM: Mike Anderson, P.E.
SUBJECT: Lots 7 and 8, Preuss Subdivision No. 2
COSA
The following revisions have been made in accordance with your comments:
1. The surveyor has completed a new as as built for the property. It shows more
than 100' from the well to the septic tank. A copy is attached for your review
and files.
2. A new test hole was placed on the lot and a reserve septic system site designed
off of the driveway. No groundwater was found in the hole and none developed
during the monitoring period.
3. The gravel width in the existing trench has been changed to 2'.
4. The well static level has been changed to 340'.
We have now satisfied all the requirements for issuance of a COSA for this property.
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE,. AK 99524
522-7773 677-7766 FAX
MEMORANDUM
DATE: July 16, 2008
TO: Jeff Poet
FROM: Mike Anderson, P.E.
SUBJECT: Lots 7 and 8, Preuss Subdivision No. 2
Existing Absorption Trench
The existing absorption trench on the subject property was constructed in February of
1989. Shortly thereafter a shop was built on the lot and a driveway constructed over
the trench. Paving sleeves were placed at each cleanout and monitor tube. The trench
has remained in place since that time. A recent adequacy test indicated the trench is
currently operating as designed and is capable of absorbing 150 gallons of water per
day per bedroom.
The total cover over the absorption trench distribution line is at least 8' which is more
than enough to prevent freezing. The homeowner has stated that no freezing problems
have occurred with the septic system since its construction in 1989. We therefore
request the absorption trench be allowed to remain in its current location under the
paved driveway.
Parcel I.D. 050-571-59
Certificate of On -Site Systems Approval
Expiration Date: 2/8/2025
Legal description PREUSS #2 BLK 4 LTS 7 & 8
Site address 10226 GEORGE PL Eagle River AK 99577
Current property owner(s) M I DYETT
X The On -site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
Original Certificate Date: 6/26/2024
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA Approval_June 2022
MUNICIPALITY OF ANCHORAGE
11 g,
----------
Development Services Department Phone:907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 050-571-59
Complete legal description
Preuss #2 Block 4 Lots 7 & 8
Location (site address) 10226 George Place, Eagle River, AK 99577
Current property owner(s) Brian Midyett Day phone
2. ON -SITE SYSTEMS SIZED FOR 4 BEDROOMS
3. TYPE OF WATER SUPPLY: FE� Private Well E] Private Well serving 2 dwelling units
F1 Private Well serving 3+ dwelling units F Community Well or Public
F-1 Water Storage
4. TYPE OF WASTEWATER DISPOSAL: JN_J Private Septic ❑ Private Septic serving 2 dwelling units
El Holding Tank F1 Community Septic or Public Sewer
5. SEPTIC TANK: R Steel n Plastic nN Concrete F-1 Fiberglass
Age 51 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS F-1 Bed E] Deep Trench [E_� Wide Trench El Seepage Pit
Waiver request for:
Expedited review requested: X
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On -site staff
to verify the accuracy of the information provided.
COSA Fee $ �J
Z -_2Z)
Date of Payment / 7
COSA # 05 C 2-13
Waiver Fee $
Date of Payment
Waiver #
COSA ApplicationJune2022
Forge Engineering
2/28/24
5/23/24 JR's
N/A N/A
N/A
New Installation
>
(907) 522-7773
Benjamin Schiller, P.E.
MUNICIPALITY OF ANCHORAGE �}
• Department of Health & Human Services j
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # C)60 - S`l 1 - LAC' Lo Ll l HAA # 0 C) q01 Cmc)
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lots 7 & 8 • B.2ock 4 • P)teu66 Subdivizion
Location (address or directions)
NHN Geonyie Stxeet
(b) Property owner Freddie Mac Telephone: (home) Business
Mailing Address #326068163C
(c) Lending Institution Fedenat Cned2.t Union Telephone
Mailing Address Loan #62204112
(d) Real Estate Company and Agent JACK WHITE COMPANY/Lynda Banners
Address 10928 -Eriii 5-1
Telephone
(e) Mail the HAA to the following address: (or check here ®, if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-FamilyXX Number of bedrooms 4
3. WATER SUPPLY
Individual WeIIXX Community ❑ Public ❑
Note:. if community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-sitegR Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (Rev. viae) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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 disposal system is safe,
functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection. (� G
Name of FirmTelephone
5 & 5 ENGINEffR_ING
Address 17034 Eagle River Loop Road No, 204
Eagle River, Alaska 99577l r 9
Date
e, ,
6. DHHS APPROVAL
Approved for'bedrooms by/��"/� Date C
Approved Disapproved Conditional
Terms of Conditional Approval
CAUTION,
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
or analyze data before a certificate is issued. The Mun icipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88) Back Page 2 of 2
D
MUNICIPALITY OF ANCHORAGE (MOA)
NAUNIQ � Ar<c o :,���,ealth Authority Approval (HAA) +
envr;:�w,... _ ,` cs olvi.�CKLIST -FEBRUARY 1984 —
343-4744
.(. Legal Desc ' t/iion: � / °� /6
A. WELL DATA �p
Well Classification �U� 1 / If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y N) Date Completed delle Yield 2 G�
r /
Total Depth 2 Cased to — Depth of Grouting
/ r CSC (it
Static Water Level Pump Set At
Casing Height Above Ground l rt "� Sanitary Seal on Casin(Y )
Electrical Wiring in Conduit (Y/ ) (Z Depression Around Wellhead ('Y N) w
SEPARATION DISTANCES FROM WELL:
/ r
To Septic/Holding Tank on Lot O ; On Adjoining Lots `Qo
To Nearest Edge of Absorption Field on Lot r ; On Adjoining Lots
To Nearest Public Sewer Line �/ T N t P bl' Se er Cleanout/Manhole
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments
U eares u (c w
2
B. SEPTIC/HOLDING TANK DATA
Date Installed �3 Size 1_22 No. of Compartments
(Y
Standpipe ) —Air -tight Cap (Y/ ) Foundation Cleanout (6D_2__2_
Depression over Tank (Y N) 't-) Date Last Pumped Z `2
Pumping/Maintenance Contact on File (Y/N) ��`� ; for �—
Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) ✓�
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
r
To Water -Supply Well `D 0/_To Building Foundation �d
r
To Property Line !O To Disposal Field /y f
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Comments �� C �� "` ������` �/lJc� C v l
cvNc�F7�
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Gp _ 6-i,3 Type of System Design
Date Installed !'9�3r2lR�/98 % %/C�%�� Length of Field z
Width of Field 2 Depth of Field 12
i
Gravel Bed Thickness
Square Feet of Absortion Area 2 �o'�� '' Statndpipes Presen (Y/ )
Depression over Field (Y/N /J Date of Last Adequacy Test /z
Results of Last Adequacy Test P6 re i3�_ ����G�4 ��,J
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well /Ott To Property Line la r
To Building Foundation
✓ 2� (� T E t' Ab d d S t
Lot (a
To Water Main/Service Line
0
V xis (ng or an one ys em on
On Adjoining Lots
To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course I
To Driveway, Parking Area, or Vehicle Storage Area 14
Comments /N F -S) O
D. LIFT STATION
Dat stalled
Size in Gallon
"Pump On" Level at —
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
y_"Pump Off" Level at
Vent(Y/N)
Pumping Cycles during Adequacy Test.
"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
& 5 ENGINEERING OF �
g 17034 Engive,, 1'� ,..o..,.�4'.fi y �.
Company —€agle River, Alaska 99577 _`'>°4H $ v'f1
D ,
Date
geer §'
t
MOA No. 6 Cdyo
Receipt No. Receipt No. ` {
Date of Payment �Waiver Fee: $
Amount: $
Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
MUNICIPALITY OF ANCHORAGE
• Department of Health & Human Services Mei
` DIVISION OF ENVIRONMENTAL SERVICES —
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # ��f —�D�`/� HAA # -CS71
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Property owners e��w� Telephone: (home) - Business .
Mailing Address
(c) Lending Institution ��� l°�'� 'telephone
Mailing Address
(d) Real Estate Company and Agent
Address d
Telephone (�, 9 SS60
(e) Mail the HAA to the following address: (or check here J, if hold for pick up.)
List contact person and day phone number below:
/, 9'-/- 1? -7 q
S &.S ENGINEERING
104
Eaqle River, Alaska 99577
2. TYPE OF RESIDENCE a
Single -Family Number of bedrooms
3. WATER SUPPLY
Individual Well Community ❑ Public ❑
Note: If community well .system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site, Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (Rev. nae) - Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
Name of Firm
S & 5 ENGINEERING
Address
Eagle River, Alaska 99577
Date
Telephone
Recomend approval on the following conditions:
1. Septic tank cleanout is found and extended above
ground.
2. The septic tank is pumped.
Work to be completed after spring break-up.
0
P1Crc%e"'
0
6. DHHS APPROVAL
Approved for l �_ bedrooms byDate
Appfeved, •Disapproved— Conditional
Terms of Conditional Approval
GI viG��OGCiHfJ •7aA,1/f 1,1D / 7--r-l— '7-11Q/2
- - • 11 1 CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88) Back Page 2 of 2
MYNICIPALITY OF ANCHORAGE (MOA)
e NG, ealth Authority Approval (HAA)
CHECKLIST -FEBRUARY 1984
343-4744
ENS
Legal Description: LX44,2
A. WELL DATA
tN
Well Classifications [ ��V�Q`�A`� If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (9/N) — Date Completed'5r 7 O Yield
Total Depth k Cased to "J?1 U7_ Depth of Grouting ''
Static Water Level �� Pump Set At
tI
Casing Height Above Ground 4- Sanitary Seal on Casing (VN)
Electrical Wiring in Conduit �39/1\1) % Depression Around Wellhead (Y/QI
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot kr�1-- ; On Adjoining Lots k C--::�I+
To Nearest Edge of Absorption Fie lcj n Lot b� I ; On Adjoining Lots
To Nearest Public Sewer Line �' To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot
Water Sample Collected by Date
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed '� Size I OIO No. of Compartments j
Standpipes O/N) _ _—Air -tight Caps O/N) Foundation 5"A/Z out (Yo
Depression over Tank (Y/0) Date Last Pumped
Pumping/Maintenance Contact on File (Y/N) is ; for
Holding Tank High -Water Alarm (Y/N) i Temporary Holding Tank Permit (Y/N) N
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Well � o�l_�- To Building Foundationt tet+
To Property Line d t,i To Disposal Field o 1
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Comments �brjl� C-0. /J6525
A2�o nie-, 7nij D ea -'5C24
72-026 (Rev. 7/88) Front Page 1:of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 4;�f — C t1 Type of System Design G�f2
Date Installed
Width of Field
Length of Field
Depth of Field
Gravel Bed Thickness
Square Feet of Absortion Area Statndpipes Present/N) X
Depression over Field (Y/ Date of Last Adequacy Test
Results of Last Adequacy TestGi—
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well C To Property Line t
To Building Foundation -2—o To Existing or Abandoned System on
Lot r�I� ; On Adjoining Lots ->)C,1,_�
To Water Main/Service Line To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course liv
)
To Driveway, Parking Area, or Vehicle Storage Area 1
Comments
D. LIFT STATION
ate Installed
Size in ons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Check Permitted Bedroom Rating Against HAA Request"
"Pump Off" Level at
Vent
Pumping Cycles du
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines i
inspection.
Signed 5 & S ENGINEERING
17034 Eagle River Loop Road No—
X04—
Company task 99577
Date 7��
MOA No. �� �!J
roo S
Receipt No. / 6"
Date of Payment ` ct `C)- L —`�
Amount: $ r9 C)
Receipt No,
Waiver Fee: $
Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
Test.
a .,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 Z3 r� .6
1 GENERAL INFORMATION
(a)'.,Legal Description (include lot block, su division, section, town h' , range)
s�D
Location (address or directions)
(b) 4/_ o ✓i G- $ t9✓ O Lr �. 7' �7
licant Name Telephone: Home /6j�`�-�Sa1'— Business
Applicant Address 3 Z 3 3 Ca"mom /c c - -� �'v/✓L
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ., Buyer ❑ ; Other ❑ (explain);
(d) ; Lending Institution Telephone
Address
(e). Real Estate Company and Agent
Address �� N
Telephone
(f)'r Mail the HAA to the following address:
& S Engineering
R -13 1961t
Eagle River, Alaska 99577
e
2 TYPE'OF RESIDENCE, -
tr"-:,, j$"5 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION .,
As`certif)ed by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequa�e
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 & 5 Engineering Telephone
Address SRB 196x
Eagle River, Alaska 99577 Z— G
Date
.K
+� @
r b Y�
d
e - e s ue fiPe•Ye�re • �qJ ..
a .. $ .eo�w•r
p Robert A.-Sha
p C� .• No. 1457-8
-
Faree, -_ •aNa �-
4
6. DHEP APPROVA
Approved for t�J bedrooms by Date U
Approved Disapproved Conditional
Terms of Conditional Approval
dhep
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 (11784)
DEPr. Ur ncnun «
MUNICIPALITY OF ANCHORAGE (MOAN � ENVIRONMENTAL PROTECTION
HEALTH AUTHORITY APPROVAL (HAA) i EB O 3
CHECKLIST - FEBRUARY 1984
264-4720
Legal Descriptiory, �� �I d
A. WELL DATA
Well Classification
i C21\(44lz� If A, B, C, D.E.C. Approved (Y/N) �A�
Well Log Presentto//wy- Date Completed ,� �i�a - � Yield 25- f G 1�����
Total Depth �— Cased to J ���
�Depth of Grouting
Static Water Level 3yoPump Set At
Casing Height Above Ground Sanitary Seal on Casing6)k
Electrical Wiring in Conduit &< Depression Around Wellhead
Separation Distances from Well: J
To Septic/Holding Tank on Lot Liu On Adjoining Lots — j
To Nearest Edge of Absorption Field on of lOa ` ; On Adjoining Lots �
To Nearest Public Sewer Line To Nearest Public Sewer
Cleanout/Manhole To Nearest Sewer Service Line on Lot S
Water Sample Collected by c/A t ; Date -' a "9 G.
Water Sample Test Results -S- % i s / ��� y
Comments
B. SEPTIC/HOLDING TANK DATA
D t '-failed ��?'f Size 119oa No. of Compartments
i
a n
Standpipes&K Air -tight Caps (jC{K- Foundation Cleanout
Depression over Tank Date Last Pumped
Pumping/Maintenance Contract on File (Y/N); for
/(�/ T
Holding Tank High -Water Alarm (Y/N) emporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well yb{% To Building Foundation
To Property Line To Disposal Field
Lb r i
To Water A42+n/Service Line
y To Stream, Pond, Lake, or Major Drainage
171 -
Course Course
Comments
Page 1 of 2
72-026(11/64)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata -16AA Type of System Design r�Ae
Date Installed /9173 Length of Field AXI
Width of Field
Depth of Field
Gravel Bed Thickness
J
Square Feet of Absorption Area Standpipes Present0y W l
Depression over Field (-Y& Date of Last Adequacy Test / sg-
Results of Last Adequacy Test 1e
Separation Distance from Absorption Field:
To Water -Supply Well /Ub 1-#4—
To
h
To Building Foundation
Lot 'A
To Water4Aarn/Service Line 30 0'L
To Stream/Pond/Lake/or Major Drainage Course _
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Installed
Size in Gallons
To Property Line /01
To Existing or Abandoned System on
On Adjoining Lots Ir—
To Cutbank (if present) N
1 d_
Dimensions
Manhole/Access (Y/N)
"Pump On" Level at "Pump Off' Level at
High Water Alarm Level at Vent (Y/N)
Tested for Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
ngineering _ G
Signed S EDate Z �
Cr_r3 •1962C _
Company _ A?..s'ca MOA No.
Receipt No. ')) `1 (-) %0?__7
Date of Payment .L _1�
Amount: $ � SU'
Page 2 of 2
72-026 (11/84(
Time
APPLIC AT FILLS OUT UPPER HAL ONLY
Time
Pr'o'perly Owner
� � � fl" ��
� � � b � � 'j i-�t N �f j �
+>+
Phone
Mailing Address
C
(%{/7 fij Zip Code y y Q
�' �- �G li
Buyer
Inspector
Inspector
cr
Fi�eldN�o�tes: -7
—el
Address
Zip Code
Lending Institution
�I�C /��
C C� f7 ! f ; �y//-C iA/44 )O /v
Phone
Address
.? (=: C�
Vic;/; G--' �' / Zip Code 1 f j �'�
16 5-100
Realty Co. & Agent
/
!v
Phone
Address
Zip Code
Legal Description
f
84 /z,
Well To Absorption Area .-' <";
Street Location
�G; (J/•`
f�; -
Type( of Residence
Well to Tank ./,O S �
iK` Single Family
3
❑ Multiple Family
No. of Bedrooms
❑ Other
Water Supply
Individual
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
❑ Community
For wells drilled prior to that date, give well depth (attach log
if available).
❑ Public Utility
- �~,!" �7 /0 G
Sewer Disposal
' CJ '�
1
). Individual
Year Individual Installed:
❑ Public Utility.
When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Tr
Time
Date
Date
Date
Date nn
' \ Lam! 10
Inspector
Inspector
Inspector
Inspector
��//__��JJ
Fi�eldN�o�tes: -7
—el
j
01
( ) APPROVED BEDROOMS
( ) DISAPPROVED
�OF/APPROVAL .�
�. ' i *CONDITIONS
(l�O CONDITIONAL APPROVAL'
DATE ✓ '-� � � �� �
'�/
_P—
Soils Rating
Date Sewer
Installed
Well To Absorption Area .-' <";
Well Log Receivad �2
Septic Tank Size
Well to Tank ./,O S �
72023 (3182)
d
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 _ 264-4720
SOILS LOG - PERCOLATION TEST —7
�
DATE PERFORMED:
13
`- SLOPE SITE PLAN
ozfiY.
PERFORMED BY: --z',';
72-008 (6/79) j
7 g" /170
4a 0 L� 1
X25
]igbeii' R. Shy'°e, a kr
4 6.�
WAS GROUND WATERS
Al
ENCOUNTERED?
L
O
Depth to
Water
P
9.
f.�
E
IF YES, AT WHAT
DEPTH?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
9.
f.�
E�
v
PERCOLATION RATE / (minutes/inch)
TEST RUN TWEEN FT AND FT
CERTIFIED
���DATEi