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HomeMy WebLinkAboutPREUSS #3 BLK 5 LT 1Preuss #3 Block 5 Lot 1 #050-571-38 Municipality of Anchorage Page 1 ofd_ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW940236 PID Number: 05057138 Name: Wastewater System: ❑ New R] Upgrade Jack W. & Rosetta A. Yandell Address: ABSORPTION FIELD 20148 Lucas Avenue nKXX No. of Bedrooms: 1 ❑ Deep Trench EkShallow Trench ❑ Bed ❑ Mound ❑ Other Eagle River, AK 99577 3 LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: 0.6 GPD/Sq. Ft. 1 Lot; Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe 1 5 Preuss #3 0 Ft. 1 Ft. Township: Range: Section: Fill added above original grade: Gravel length: -- -- -- 2.2 - 3 Ft. 150 Ft. Gravel width: Number of lines: Distance between lines: WELL:❑New ❑Upgrade • Ft. 4 10Ft. Classification (Private, A,B,C): exist. Total Depth: I Cased To: Total absorption area: - Pipe material: SCh. 40 PVC Private 120 Ft. 40+ Ft. 750 so. Ft. A M D3034 P. Driller: Date Drilled: Static Water Level: Installer: Date installed: Sullivan Water Wells 5/81 1 90 Ft. Tweed Excavating 8-18-94 Yield: Pump Set at: Casing Height Above Ground: TANK 6.lGPM u k Ft. 2.5 Ft. SEPARATION DISTANCES R Septic Exist. ❑ Holding S.T.E.P. Exist. To Septic Absorption Lift Holding Public/Private[Material: ufacturer: Capacity in gallons: 1000 From Tank Field Station Tank Sewer Lines Greer Number of Compartments: Well' 110' 100' 117' -- 25+1 Steel 2 Surface LIFT STATION Water '+ 100, -- -- Lot Size in gallons: Manufacturer: Line I AA , , 1 41 "Pump on" level at: "Pump off" level at: High water alarm at: Foundation „ 1 1 3411 1 1 __ __ 1 All Curtain down Pump Make & Model Electrical Inspections performed by: Drain -- None -- ------ -- OSI L. S. approved by M-O.A. BENCH MARK Remarks: Existing septic tank Location and Description: and lift station verified. TBM - To of manhole of q_T_F_P_ Ram neck installed on inspection ports Assumed Elevation: and watertight couplings installed on C.O. 100.00 E,SEAL NGINNGI Jf 14LC 3(,. 'An z � Ely aFt � F7 G b' a 82 9 Inspections performed by: S & S Engineering Dates: 1st 8-15-94 - ®ao:.�a>e: aye caorawaosroan3so ky. 17034 N. Eagle River Loop 2nd - - .S3~ - { P ` Eagle River, AK 99577 3rd 8-17- 4 tea. IA4 £ C' 3 v� Department of He nd Hum rvice� appr v <tr�3 Reviewed and approved by: Date: U c 72-013 (Rev. 9/91) MOA 25 Permit No. SW940236 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 * Anchorage, Alaska 99519-6650 e Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal DescriptionFREUSS SUBD. No.3; BLOCK 5, LOT I PID No.: 05057138 CO3 1C 2 i FINAL GRADE 104.7 MH 105.6' DRAINFIELDS I SCALE I" = 40' 72-013 A (1193) - �600 GAL 99.01/ SEPTIC LA F: SYSTE N FINAL GRADE a _6' TOPSOIL AND: SEED Z' INBUIATIO I 99.2' . 1 99.8' 1 8 MIL VI 98.9 99.01 FILTER FABRIC 9.4' IMPERME BARRIER MT7 MTS ..................... MT6 MT5 fT3 . ............................. T4 MT1 MT2 . .. ..... . . .......... ........... .........................37 . ............ .... ................. ..... . ........ 95.8' 95.8' 95.7,' 1" DIA. LATERAL .8' 96 95.8' �, 6. 0 9 1.8 95.8' 96.7' 81 0. 96.8' FROM S.T.E.P. 1. 9 Z4. SOLID MANIFOLD 4' TO GROUND WATER ....... -6,+ To BE:DROCK-- ROCK a A B FCO 17.0 6.0 C01 17.0 P.5 CO2 18.9 15.5 CO3 20.6 17.7 ......... ................ 1,000 -GAL. EXIST 50b,_GAL GAL .. .. .. ............ M.H. 22.5 19.7 SEPTIC TANK S.T.E'P. U) MT1 32.1 81.0 MT2 44.2 43.7 E - MT 3 17 13�1 .35 DME MT415 0�4 f2 8 MT5 20.9 42.0 MT6 54.5 64.5 MT7 38.5 0.0 ...... .................. ..... .......... XXISTIw MTS 61:0 ':5 3 HDRU HOUSE co MM L cot DRAINFIELDS I SCALE I" = 40' 72-013 A (1193) - PAGE 1 OF 1 - �sr MUNICIPALITY OF ANCHORAGE $ S W DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940236 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:YANDELL JACK W & ROSETTA A OWNER ADDRESS:20148 LUCAS AVE EAGLE RIVER, AK 99577 PARCEL ID:05057138 LEGAL DESCRIPTION: PREUSS #3 BLK 5 LT LOT SIZE: 22890 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 1 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 7/13/94 EXPIRATION DATE: 7/13/95 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) . 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ��J RECEIVED BY: iV DATE: T �1 ISSUED BY: DATE: / G ngr�� June 26, 1994 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 ` "'"ER A`r Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH AUTHORITY APPROVALS 825 L Street Anchorage, Alaska 99519-6650 SEWER & WATER MAIN EXTENSIONS REFERENCE. Preuss Subdivision #3, Block 5, Lot 1 SEWER WATER We request you issue a permit to upgrade the septic system serving the INSPECTION three bedroom house on the referenced property. The existing septic system was installed in 1990 and is partially saturated. An ENGINEERING STUDIES upgrade of the septic system is required The onlyarea available for the septic ANDREPORTS system upgrade is as shown on the attached site plan. A reduction factor as not utilized to reduce the length of the system, in order to obtain maximum absorption in the area available. W ELLINSPECTION & FLOW TEST Test holes were excavated and percolation tests performed in the area of the proposed upgrade. The approximate location of the test holes are also located on the attached site plan. At the time of excavation water was encountered at SITE PLANS 5 feet and after seven day water monitoring, water was found at 5 feet. An old septic trench, installed in 1981 was partially located in the approximate area of the proposed upgrade, however, this system was taken out of use in ROADDESIGN 1990 and has been dormant for the past four years. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. SOILTEST If you have any questions, or require additional information for your review, PERCOLATION TEST please co t us. C1 orole STRUCTURAL& MECHANICAL n/ A. Shafer, P.E. INSPECTIONS ONSITE WASTE WATER DISPOSAL SYSTEM DESIGN I - 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Z CD SCtaV B}'I AFf F—�� `'9°'Nt t e,e=kit• :a P: •e op' d .: ¢ H r QzO ZWO U] El Z2 WLZ I qq 43 9g 2FI i .(b, i Ul A F W"'" ( A 1- Q O W..0. w W WU¢w� 'lei O 'J C o F, W W H 'I., Z £ W� QUZ F, -, e 9r4 ho cpOf bra'`\ �s ¢ y4< ] a z 1,4 a^ q 8 c a wE a O q OO�j A wZ03 U W a mz ww o wc�o a w e as w O Z d' F4E- 0 O O Z I W Z U - 0 O 2 O CY< O U S Z Q 0 Z ~ N �OW W' 00 0 --_—_—_ _ LLI zW? Z2inW OQQ/�o��I I Iz d. W �' m O d' Z W p OQ Z Z O O -1 J W N N�� 0>-� z HBO -'F Ur_j / _ / 1 p N d O I-- / -/ m o a W O U S OUJ o uiV) Ld rL� �z�Y o O F Qco wC) ZOUY I U - - w t!i F— LLI 0 0 0 IL� xw a a a o ( ) y� N% W Z 3bZ �Op=p WI}i Wj 0HwEl by U U Z V) F-- W Z afk F7... vi � 0 N > � Z U c5 E -I � vwi... 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The scope of this project includes the installation of a pressurized absorption bed to serve the three bedroom residence located on the referenced property. The existing septic tank and lift station are to be excavated to verify their integrity. If of poor integrity, the tanks are to be pumped and removed and a new 1250 gallon septic tank effluent pumping (S.T.E.P.) system installed. The existing leachfield is to be abandoned such that it may be used in the future. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. Page Two Preuss Subdivision #3, Block 5, Lot 1 June 26, 1994 3. A# standplpes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. 7. Septic tank effluent pumping (S. T. E. P) systems will be manufactured by Anchorage Tank with Orenco controls and pump. All wiring will be performed by a license electrician. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (roughed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Page Three Preuss Subdivision #3, Block 5, Lot 1 June 26, 1994 4. Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank, septic tank effluent pumping (S. T. E. P) system, or lift station proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes SCH 40 (PVC) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). Page Four Preuss Subdivision #3, Block 5, Lot 1 June 26, 1994 5. A permeable nontoxic silt barrier (Typar 3401, Wall 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, it's gradation specifications must conform to current M.O.A. or D.E.C. requirements. INSPECTIONS. Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The owner's engineer will not coordinate, direct or control in any way the contractors activities. Page Four Preuss Subdivision #3, Block 5, Lot 1 June 26, 1994 The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be a contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall not be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner's inspecting engineer if any and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of any other persons performing work on this project or the failure of other contractors or engineers to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project as it relates to other contractors or engineers. ori • h Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 r 3 SOILS LOG — PERCOLATION TEST PERFORMED FOR: G�� 0'1A DA E PE ,FiTVIED;' -JC.J LEGAL DESCRIPTION: � -,!VC-1L 4 TI Township, Range, Section: ' SCOPE �j SITE PLAN 2 "/t 1 3 4- 6- 7 67 - 2,0.44 8 9- 10- 11 1011 12 13- 14- 15- 16- 17- 18- '91 3141516171819 20 COMMENTS GROUNDWAS • - • ■■■■■■■■■■ I ■■■■■■■■■■ ■■■■■■■.■. IF YES, AT WHAT DEPTH? 4 Depth to Water After Monitoring? Date: M=Mmm� 4% _ d PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN F FT C C4 .52 PERFORMED BY: `/ 4 "/ "�� I NISIERTIFY THAT HIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI EFF ON THIS DATE. DATE: 72-008 (Rev. 4/85) 4% _ d PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN F FT C C4 .52 PERFORMED BY: `/ 4 "/ "�� I NISIERTIFY THAT HIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI EFF ON THIS DATE. DATE: 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE 66-6 -S71-36, ` , DEPARTMENT OF HEALTH AND HUMAN SERVICES KJ Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name - 1 DISTANCES �n"1l rel �� ~ Tp SEPTIC ABSORPTION Addr ss FROM TANK FIELD WELL Phone(s) Permit No. No. of Bedrooms WELL (2' 12-1 g u:;3 ti o LEGAL DESCRIPTION LOT LINE�— Lot Block Subtlivisi 5 ',_'`P,,:,. FOUNDATION ► 1 Township, Range, Section {7 1 1 \ j� AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, 1 w i� driveway, water bodies, etc.) TANKS x`SEPTIC LI;: -'r ❑ HOLDING M�ufayturer Dapaat Ingallons Y�r.1L_r.�/�iV �no �C�D ocJ TYPE OF SYSTEM ❑ TRENCH ❑ BED W. DRAIN ❑ OTHER Depth to pipe bottom from Total depth from original grade original grade 'r <1_>.A57�FT t5) FT Fill added above original grade Gravel depth beneath pipe �f FT O "5� FT Gravel length Gravel width -7-b FT � FT Total absorption area Distance between lines . ► 080 FT �2+ FT Q Number of linesSoil rating PIsal b k'5 t'> SO FT Insta �i f /'� _ I -1 Date Installed 0 WELLS PRIVATE ❑ OTHER (IdentilIvIt I REMARKS: FTI FT f 17054 Eagle River Loop Road No. 204 a Eagle River, Municipal and State guidelines in effect on this da!� , Health Department 72-013 !3/851 Inspections rnJeQ,by: — Date: `Qr1��C18G�r90 f this inspection was performed according to all r Date: N� I (�� � to U SCALE c AS -BURT OI r D 0 ::E D 2 r Im Go l Go 2 G -n3 Gni' V'1'rl M l� PIC— y2- 8 1' ,y O t rt5L1L. \Go G!/�tSD u moo? of d cn 9 a A MUN1C1F*LITY OF A���O��G� Department of Health & Human Services 825 L Street' Anchorage, Alaska 99501 0 ON~SITE SEWER PERMIT Permit Number: 900324 Upgrade [\[\ Uate Issued: 10/02/90 Engineer Designed Owner YANDELL 8wner Address: 20148 LUCAS AVENUE EASLE RIVER, AK 99577 Parce| Id: O50~571~38 /,ot Legal: Subdivision: PREUSS #3 Loi: 1 Block: 5 Section: 8 Township: 14N Range: 1W |.ot Size 22890 (in q"ft" or acres> Max Bedrooms: This Permii: 3 Total Capac�ty: 3 Day Pho:e: 278~9631 Pao T}C TANK: Minimum total septic tank capacit),: 1,0O0 gallons. Each septic tank musthave at least 2 compartments` Depth to top o� septic tank(s) < 4.0 fe�t requires insulation over tank(s). THIS WPM ET EXPIRES 12/31/90 AND VALID FOR A SINGLE FAMILY HOME. CUNS[rot it; T PER ENGlNEER'S ATTACHE) DESIGN, [NFURM 0.H.H,S. PRIOR TO lNSPECTIONS 8Y INGINEERr IF AFTER [CE HOUKS; CALL 343~4681 AND LEAVE A MESSAGE. l C�RTIFY [HAl: 1. l all fan1i11ar with the requirements r on-site sewers and wells as set {orth by the Municipality of Anchorage (MOA> and the State o[ Alaska" 2. 1 wil1 install 1.11e system in accopdance with all MOA codes and rogulations, anJ in compliance with the design criLeria oF this permit, 3, I wilk adhere to all MOA and State oA Alaska requirements [or the set back distances from any existing well, wastewater disposal system or public seweron this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum 0 I 3 bedrooms, I also understa/�d that the capacity of the total system is 3 bedrooms and any enl uire an additional permit" ~..... ... -~�- (Dwner) Y LL =- JRTK���� cn x SCALE C9 15��E � � l cn x :t r. �k r + , •a Y' f 1F �yy�9 .d )Y • [[- 77 t " gip`•`• Za 1f 1 •; ; AOF • r lvv MSN I N z cn x �k Y' f 1F �yy�9 .d )Y • [[- edt t " gip`•`• Za 1f 1 •; ; AOF 9 (ENGiNEEFi S $€A�) a Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES `y 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST rtiM r b' �t x PERFORMED FOR: �LJC...L. ttAcr— E -A DATE PERFORMED'1 ' LEGAL DESCRIPTION: !1., 1315 1 %+$ Township, Range, Section: .9.E P.TH CIZ 1 2 _ 3- 4- 5 4 5 6 v a 7 n � a r 8 �Q 9- 1011 10- 11 12- 13- 14- 15- 16- 17 21314151617 81920 18- 19- 20-4 COMMENTS SLOPE WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L DEPTH? �� _ O P E Depth to Water After t Monitoring? A- Date: -5-4"c—i0 SITE n Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN T AND FT 711 , 1411 ai I7 PERFORMED BY, 17034 Eagle River Loop (toad No, 204 tagie Kiver, 1 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELII 72-008 (Rev. 4/85) R CERTIFY THAT THIS T T WAS PERFORMED IN ON THIS DATE. DATE:Ci �D a Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: : p —S DATE PER. LEGAL DESCRIPTION:3Township, Range, Section: E PoKU SLOPE SITE -PLA Ll 9 10 WAS GROUND WATER ENCOUNTERED? 11 S L IF YES, AT WHAT •'5 O 12 DEPTH? E E Depth to Water After t 13 Monitoring? "+' Dale: y-�0-�0 14- 15- 16- 17 4151617 81920 18- 19- 20 COMMENTS Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN ai" 19-90 PERFORMED BY: '17014 Eagia River Loop Read No, 204 Eagle river, Alaakza 995577 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIN� 72-008 (Rev. 4/85) 1 (minutes/inch) PERC HOLE DIAMETER T AND FT CERTIFY THAT T IS TEST WAS PERFORMED IN ON THIS DATE. DATE: —11— 3- 4- 4 i `ice d,P �ryp'r 6 42- Ll 9 10 WAS GROUND WATER ENCOUNTERED? 11 S L IF YES, AT WHAT •'5 O 12 DEPTH? E E Depth to Water After t 13 Monitoring? "+' Dale: y-�0-�0 14- 15- 16- 17 4151617 81920 18- 19- 20 COMMENTS Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN ai" 19-90 PERFORMED BY: '17014 Eagia River Loop Read No, 204 Eagle river, Alaakza 995577 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIN� 72-008 (Rev. 4/85) 1 (minutes/inch) PERC HOLE DIAMETER T AND FT CERTIFY THAT T IS TEST WAS PERFORMED IN ON THIS DATE. DATE: Fq�1 F RIVER, HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANDREPORTS W ELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSALSYSTEM DESIGN . A. Ms. Lynda Banner JACK WHITE COMPANY 10928 Eagle River Road Eagle River, Ata4ka 99577 June 11, 1990 REFERENCE: Lox 1; Stock 5; Preuss Subdivision; 20148 Lucas Avenue Dean Lynda, ROBERT SHAFER, P.E. ROGER SHAFER CIVIL ENGINEtHS (907) 694.2979 FAX 694.1211 At your request we have penbormed 4oit,6 testing on the rebereneed property bot purposes ob upgrading the on-site septic system as pen the condition. Hea-eth Authotity approvat dated February 28, 1990. Four teat holes were excavated in the backyard wcth,i.n, the Southeast portion ob the property in the toeation ob the proposed upgrade. Unbortunateey two ob the test Wes reveated an undocumented septic system, the third teat hole was saturated with 4ewage Brom the existing dnain6ietd, and the bourth teat hote showed groundwater at 3 it. beCow the ground 4unbace just under. the bitt and organic tayer. We then excavated two test hotel .in the bnont yard within the Northeast portion ob the property. These teat holes had acceptable 4oits, however, the groundwater depth was monitored at bout beet below the ground 4urbace. Therebone, the septic upgrade w tt consist ob two mounded drainb.ietds .in the bnont yard more or tua parattet to Lucas Avenue. A sewage tibt station w tt be requited to maintain a 4 it. veht.ica2 4eparation to groundwater. We estimate the cost ob this upgrade at $7,070.00 .inc uding engineehi.ng and permit bees. IS you have any questions, on wish " to proceed with obtaining the upgrade permit, pt.ease contact us. gm , P. E. 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN September 27, 1990 ROBERT SHAFER, P.E. ROGER SHAFER CIVIL ENGINEERS (907) 694.2979 FAX 694-1211 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECFIO14 Ms. Susan 04watt SEP 2 '199-0 Munic.ipat ity og Anchorage RECEIVE D DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.U. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 1; B.2ock 5; Preuss Subdivision #3 Dean Susan, Regerenee our telephone conversation this date, the upgrade og the on-site wastewater di6posat system on this property is required under a eond.itiona2 Health Authority Approval .issued in February 1990. Soil tests were perbormed in May og this yeah and a design was based upon the Munk pat ordinance that existed at that time. Funds were e.6erowed based upon engineered estimates Ooh design and construction. The total Bunds escrowed 6or this project exceeded the low bid and consequently the excavator has agreed to modi4 ied his price to allow construction .in accordance with the attached designs. Engineering and design was prepaid .in accordance with design requiuments which existed when the escrow was estabP%s hed. The new ordinance w,i Pt require a more extensive design ej4ort. There are no bunds avaitabte to pay this additional cost. Since this entire transaction was eonsumated, escrow accounts estabUs hed and designs eompteted based upon an ordinance which existed until recently we request that the permit be issued as is. I$ we may be ob 4urtheA service, please contact us. 5.6tety / )q6 lb I ERT A. SHAFER, P.E. 0 /gm 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 jfF_O f/ELp /ifi SuR/ M�NTf 7-O ALL_ SrU4?ROcr.v�J,,�, - I 2001--R1kq-Vn I -- il o 697.1 v,vr of so/c iii- - -- -- --- - -.- T Flo X/ U E/p P/$/57ox - TES 1 S /�l, ---Noc ES 7-� — -- -- NOL ES OA., SITE___�L�1v ---------------- ---- ---- -. ---- _ A!Z N 4f I,t/ ,c E P rLc 7 -Am Iv& 1 SSS.-%/IC�A010T l etc) (A elf __-.4 ae- S, 0�0/�E V r Su �L __I�xYT1N�s 1`a sig -4L L__Srt�L� k r�-- E Foff"ngjP of/tib 1_ PF2ro-/�tT�fD__ 1°MFHOLA - - — - - lil ------ ---- -- TF s% Goa/ 'FvR R ortrs_ 3 0. -, L L. )P*RT; OF tiFiEC�__/�` ash t3� G-LT��v_.---—-- it • Ili -- ----- 7 I 1 /K ON! TGIQ .1LL L=S Mum E._�'iG CZdJ e -- ---�'-_-- -- 1qE -QO -._- 1071 s I -.I I MUNICIPALITY OF ANCHORAGE L DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION l� ENVIRONMENTAL ENGINEERING DIVISION 825 LStreet -Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME�/ /J lj(� i `-� ''{, / PHONE `g(.l-c�IYo ® NEW ❑UPGRADE MAILING ADDR S LEGAL DESCRIPTION 9 G/ 45 LOCATIOI`(� OC,(.c.N� r-- NO. OF BEDROOMS 03 y DISTANCE TO: Well Absorption area Dwelling _ PERMIT NO. c e t" c Q wF Manufacture r`%� ` J`-�I Ma No. of compartments N Liq. cap .tt inJyallons CJ< IF HOMEMADE: Inside length Width - -- Liquepth id..d 6Y J C7 Z DISTANCE TO: Well Dwelling _ - _ PERMIT NO. = Z H Ma"etarer — --- erial� Liquid capacity in`gatIons----� LU DISTANCE TO: e 11) n Foundation h(G) Nearest lot line O t PERMIT NO. y� d 116 J iL z F z w No. of lines /') Length of each line _ S 7 Total length of lines 7 Trench width -, inches Distance etween lines /( q_�l F. Top of tile to finish grade Material beneath tile #-r inches Total effectiv absorption area C. LU 0 Length Width Depth PERMIT NO. Q F- as w Type of Crib di moCer Crib depth Tot effective absorption - -_'ID DISTANCE T Well ng foundation Barest lot I _ "IN i ss L��L(J" Depth Driller Distance to lot line PERMIT NO. C 8r'Cc� S) [ W DISTANCE TO: Building foundation Sewer line Septic tank 62� Absorption area(s) r f d u OTHER PIPE MATERIALS SOIL TEST RATING () INSTALLER P �, •�_ REMARKS "J6 ooe er d r s I APPROVED DATE LEGAL 72-013 (Rev. 3§8) P THE REQUIRED SIZE OF THE. 'SOIL ABSORPTION `'r''rTEM IS: &_ate 9 E a I=— F ''TF- E—! - -4- THE LENGTH D I Y'1EPIS I ON IES THE LENGTH (IN FEET) OF THE TRENCH OR f_:,RH I NF I ELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GRCIIIY,D AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL F'IF'E AND THE BOTTOM OF THE EXCAVATION (IN FEET). F:" E--- 9--! LJX IF? F•= r -a _O=» �: F" _6_.:T i— - -F F-9 PA K ' =_ 1 E=_ I_ aria f6=- a -e �� � R. L,_ �_..H P _� °==^ PERMIT APPLICANT- HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE. I Yd'_;�TALLFAT- I Ol'-.1 INSPECTIONS CSF ANY WELLS ADJACENT TO THIS PROPERTY AND THE Y'di_IMBER OF RESIDENCES THAT THE WELL WILL 'SERVE. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPEC:TION AND APPF'O1, AL BY THIS DEPARTMENT- WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A I. -JELL AND Ahd'•r ON—:;:ITE SEkIAGE DISF'OSAL. SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC: WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM D I' TfNC:E FROM H PRIVATE WELL TO A PRIVATE 'EWER LINE I '25 FEET AND TO A COMMUNITY SEWER LINE IS FEET. HELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN `_ 0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. IF " E" =" Ir -1 :1 -€" E:_ n :„ F° :1 F'_' E "= IIT=a I-- C. E. @'^1 E --"F-"- _. �: 1 = __L »=5A E311_ I CERTIFY THAT 1: I AM FAh1 I L I rid. Fd I TES TETE REQUIREMENTS FOR ON—SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. I WILL I NsTALL. THE SYSTEM IN ACCORDANCE 1,11,TH THE CODES. _ : I UNDERSTAND THAT THE ON—SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN BEDROOMS. ICiYaEC:': -------------_.----_. AF'P 1 AY'dT t'•AYNE I_I:USINEAU T= I.1EC:' E'r'_ '" te a__ n --__—__DATE_._ b# 0 ! -E:Lr r"im ! 1'imrj 1 ne-n L_ i n r-1 F?a:' c111' 1 ! na_ r -'_' I r'_ ! d!'I's '-[ I LJ J 825 ' 1. STREET: ANCHORAGE, AK. 99 J_ j 5F 264-4720 II=.I I=— II__ L_ F=1 V-A E. -o -p PA - °w I T- E: _"E.'F_ L. -I �' F__, F" E: F_: 6'4L-A PERMIT NO. :: :1.x:456 APPL.I�_ANT I.dFI'�r NE � OU'SINEAU BO;> 63 EAGLE RI�S'ERLO ATION ER RD/ER LANE LEGAL. Li B5 FURL IES :E,BD LOT SI=E '?'v,_;R=0� TYPE OF SOIL ABSORPTION SYSTEM I S : TRENCH MAXIMUM NUMBER CSF' BEDROOM' = T SOIL RATIN (SO F T/BR::' = 1-4-0 THE REQUIRED SIZE OF THE. 'SOIL ABSORPTION `'r''rTEM IS: &_ate 9 E a I=— F ''TF- E—! - -4- THE LENGTH D I Y'1EPIS I ON IES THE LENGTH (IN FEET) OF THE TRENCH OR f_:,RH I NF I ELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GRCIIIY,D AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL F'IF'E AND THE BOTTOM OF THE EXCAVATION (IN FEET). F:" E--- 9--! LJX IF? F•= r -a _O=» �: F" _6_.:T i— - -F F-9 PA K ' =_ 1 E=_ I_ aria f6=- a -e �� � R. L,_ �_..H P _� °==^ PERMIT APPLICANT- HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE. I Yd'_;�TALLFAT- I Ol'-.1 INSPECTIONS CSF ANY WELLS ADJACENT TO THIS PROPERTY AND THE Y'di_IMBER OF RESIDENCES THAT THE WELL WILL 'SERVE. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPEC:TION AND APPF'O1, AL BY THIS DEPARTMENT- WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A I. -JELL AND Ahd'•r ON—:;:ITE SEkIAGE DISF'OSAL. SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC: WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM D I' TfNC:E FROM H PRIVATE WELL TO A PRIVATE 'EWER LINE I '25 FEET AND TO A COMMUNITY SEWER LINE IS FEET. HELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN `_ 0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. IF " E" =" Ir -1 :1 -€" E:_ n :„ F° :1 F'_' E "= IIT=a I-- C. E. @'^1 E --"F-"- _. �: 1 = __L »=5A E311_ I CERTIFY THAT 1: I AM FAh1 I L I rid. Fd I TES TETE REQUIREMENTS FOR ON—SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. I WILL I NsTALL. THE SYSTEM IN ACCORDANCE 1,11,TH THE CODES. _ : I UNDERSTAND THAT THE ON—SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN BEDROOMS. ICiYaEC:': -------------_.----_. AF'P 1 AY'dT t'•AYNE I_I:USINEAU T= I.1EC:' E'r'_ '" te a__ n --__—__DATE_._ b# 0 O & E ENGAEERING & ®EVELOi-RENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 nn�� �SiO�II ,L LOG 688-2280 Performed for: Name: ✓�ie�'���`��'� Tel. No. Mailing Address: `�= � rvtt='� Legal Description: L per` IF Depth (feet) Soil Characteristics 0 1 `T P� « • FA 3 4 v/ -S d "6Y 5 8 10 11 % lVe n9 12 A 13 VP'" 14 15 16 PLOT PLAN i PERC. TEST SA�y1 / 7 y -2 Ground Water Encountered: Yes ' No If yes, what depth j� Proposed Installation: Seepage Pit Drain Field Comments: Performed by: Date: / �� I by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759 OWNER OF LAND ADDRESS " ' LEGAL DESCRIPTION DATE • StartedEnded' PERMIT NUMBER s �'v- =r -Ai-el DEPTH OF WELL STATIC LEVEL OF WATER FT. DRAW DOWN FT. GALS. PER HR = KIND OF CASING KIND OF FORMATION: From Ft. to Ft. "' From Ft. to Ft. From Ft. to Ft. ti = From Ft. to Ft. From Ft. to Ft. From - Ft. to Ft. From Ft. to Ft. " ' From Ft. to Ft From Ft. to ' Ft. ° * ` " " l From -Ft.- to Ft From Ft. to Ft. `%`=`•'• r? ``'''' From Ft. to Ft. From_ Ft. to ' ` " Ft. 1; 41 From Ft. to Ft. From Ft. to Ft c t fi` < <:'` From Ft. to Ft. From Ft. to ' ^'' Ft x, ' ' �f` From Ft. to Ft. From Ft. to Ft. From - Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From - Ft. to -Ft. From Ft. to Ft. From -Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft MISCL. INFORMATION: DRILLER'S NAME • • 4 Q V P •F _ Municipality of Anchorage A `~ ,.'`°- �Z On-Site Water and Wastewater Program ihia•-_,-- 6 (907) 343-7904 SA ETY CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 050-571-38 Expiration Date: 7r.aJ — g 1. GENERAL INFORMATION Complete legal description PREUSS#3 BLOCK 5,LOT 1 Location (site address) 20148 LUCAS AVENUE,EAGLE RIVER,AK 99577 Current Property owner(s) MICHAEL & ASHLEY STRAW Day phone Mailing address 20148 LUCAS AVENUE,EAGLE RIVER,AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: Z Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual El Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: /44,/ . Date: ,�� /I y COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ .e?-(c, — Waiver Fee $ Date of Payment It 2-0, Date of Payment �34r Receipt Number Oy "Vcb P°* Receipt Number COSA# OSC I f1 5.3 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377 Address 20441 PTARMIGAN BLVD,EAGLE RIVER,AK 99577 Engineer's Printed Name MICHAEL N.ANDERSON,PE Date 04/19/2018 IRA lo�-• ' c^�ti' e `J ;J, `{vc(1f 1 f .�� o •0 0 0 0 • 0 0 0 0 0 0 0 0 00 0.0 ♦.•000 0 0 0••00000 0°0 0 0.. �. 6. DSD SIGNATURE 'il System#1 Approved for bedrooms. %iT •• �7 '' • System#2 Approved for bedrooms. �4C�� Disapproved. Conditional approval for bedrooms, with the following stipulations: \'\• C)F q'vC6, = ON-SITE %) WATER AND WASTEWATE PROGRAM R kir p I\l c' 4.r- By: "� Original Certificate Date: L? 2 3 _1 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_1O-10-12.doc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system _ Certificate of On-Site Systems Approval Checklist Legal Description: PREUSS#3 BLOCK 5,LOT 1 Parcel ID: 050-571-38 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 5/1981_ Sanitary seal (Y/N)Y Wires properly protected (Y/N) Y Total depth 120 ft. Cased to 40+ ft. Casing height(above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 511981 3/1412018 Static water level 70 ft. 79 ft. Well production 10 g.p.m. 4.4+ _ g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 7.86 mg/L Arsenic: ND ug/L Date of sample: 3/1412018 Collected by: Mike Anderson B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEP/STEEL _ Date installed` 4 t 0- J'-9'E) Tank size _ 1000+500(STEP) gal. Number of Compartments 2 Cleanouts (Y/N) Y __ Foundation cleanout (Y/N)Y Depression over tank (Y/N) N High water alarm (Y/N) Y Date of pumping 3/14/2018 Pumper ALASKA QUALTIY PUMPING C. ABSORPTION FIELD DATA Date installed 811811994 Soil rating (g.p.d./ft2 .r ft2/bdrm) 0.6 System type SHALLOW TRENCHES Length (18'-36'-48'-48') 150 TOTAL ft. Width 5 ft. Gravel below pipe 1 ft. Total depth 3.5-4 ft. Eff. absorption area 750 ft2 Monitoring tube Y Depression over field N Date of adequacy test 3/14/2018 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0-0 -2.3 in.Water added 4.50_gal. New depth 1 -1 -4-6 in. Elapsed Time: 1400 min. Final fluid depth 0-0-2.3 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) N If yes, give date D. LIFT STATION Date installed 8/18/1994 Size in gallons 500 Manhole/Access (Y/N) Y "Pump on" level at 26 in. "Pump off' level at 18 in. High water alarm level at 34 in. Datum _Bottom of Tank Cycles tested 2 Meets alarm&circuit requirements? Y E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 100'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 10'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ 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 10'+ Curtain drain 50'+(None Known) Wells on adjacent lots 1001+ F. COMMENTS OFA 1k1 G. ENGINEER'S CERTIFICATION P SP��• ;c + 57 I certify that I have determined through field inspections and "4 9TH •. review of Municipal records that the above systems are in j' /'. conformance with MOA COSA guidelines in effect on this date. • ��i;S••• • '. • MICHAEL _SCN Engineer's Printed Name MICHAEL N.ANDERSON,PE ciA. C t • 1•• ,. . • Date 04/1912018 1�'F�pR� '` 4 ' COSA canary sheet_2-6-15.doc MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT � • �'��. 907-343-7904 On-Site Water and Wastewater Section jr Fax: 343-7997 www.muni.org/onsite Septic Tank Advisory Certificate of On-Site Systems Approval # OSC181153 Subdivision: Preuss #3 Block:5, Lot: 1 The septic tank for this property is 28 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. This is an example of what the metal of a 30 year old steel tank may look like! • = t */ ' . • Az. L f`lk,e • b • -411 y /1 11O909TT'���`oo fii cl -S" iN. A41#11 f 3 . Y '�4, ' "F 36}`t % LSV 1 8 ti' 4• 1 7 '10 Mailing Address: P.O. Box 196650* Anchorage,Alaska 99519-6650 *www.muni.org MUNICIPALITY OF ANCHORAGE I Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Lift Station/Pump Vault Maintenance Log Owner fl iC t - S1Y1tv.) Street Address ZOI / LuCA,f ,f/L. _ Septic Tank: •Sludge level r2'inches 'Pumping: required no 'Pumping completed es no Lift station: •Pump basket cleaned. no •Effluent filter cleaned no •Control floats cleaned OD no •Proper float settings confirmed a no 'Operation satisfactory eh no Alarm System: 'Dedicated electrical alarm cir no •Audible and visual alarm inside dwelling e no 'Alarm system operatio satisfacto i not satisfactor Manhole Riser 'Ground water intrusion at riser to tank connection es o -Ground water intrusion around pipe penetrations es •• 'Weep hole functional no 'Manhole lid: Functional est no Insulated es no Properly Secured no Other .All manufacturer required inspections and maintenance completed 05 no Comments: Qualified Maintenance Provider: Technician (2-0V) e (4--)C`t vvil(2-tkr Date of maintenance 3 I1 08 Company /0/1G E O 9Lca it) Signature /Vts-e Date 0 /%) Mailing Address: P. 0. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT • t �' 907-343-7904 On-Site Water and Wastewater Section / Fax: 343-7997 www.muni.org/onsite Nitrate Advisory Certificate of On-Site Systems Approval # 0SC181153 Subdivision: Preuss #3 , Block: 5, Lot: 1 A water sample revealed a nitrate concentration of 7.86 milligrams per liter (mg/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL.) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. Mailing Address: P.O. Box 196650 * Anchorage,Alaska 99519-6650 *www.muni.org Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids,and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Mailing Address: P.0.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org C1,^6 ,SWIRDS–�£l6�1�F��0-05- Municipality of Anchorage -. Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOCR�A SINGLE FAMILY DWELLING Parcell.D. 0.'z 571-3d HAA# 175 -D3 -are Expiration Date: D - a 0-0 ✓� 1. GENERAL INFORMATION v Complete legal description Lot 1, Block 5,4 Subdivision, Addition #3 Location (site address or directions) 20146 Lucas Street, Eagle River, Alaska 99577 Current Property owner(s) Albert Lee Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone 20148 Lucas Street, Eagle River, Alaska 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well I] Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work 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 Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Douglas T. Kenley Phone (907) 745-1073 Address 9960 E. Puffin Dr., Palmer, Alaska 99645 Engineer's Printed Name Douglas T. Kenley Date i' t8 •os rH 5. DSD SIGNATURE + 8.EY Approved for 3 bedrooms. �jiij1i,. CE8178 0 PI Disapproved. . Conditional approval for bedrooms, with the following stipulations: Additional Comments Note: The well for this property meets existing State and Municipal Codes There are nitrates present. It Is suggested that periodic testing be performed to insure the wells continued suitability. Current nitrate concentration Is 6.7 mg/l. EPA maximum concentration Is 10.0 me/1 I%Tore information on nitrates is available from the On -Site Services Program at 343-7904. Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By:Original Certificate Date: (Rw 0IM2) Municipality of Anchorage • Development Services Department Building Safety Division On-site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 9951941650 www.muni.org/onsdo (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST I'yovI's so - S7/ - 3 Legal Description: Lot 1, Block 5,41rrs Subdivision, Addition #3 Parcel ID: t7 g A. WELL DATA We" type R' —" It A, B, or C provide PWSID # Date completed 5/61 Sanitary seat (Y/N) Y Total depth 120 ft. Cased to 40+ ft. FROM WELL LOG Date of test 5/81 Static water level 70 R. Well production 10 9— p.m-WATER SAMPLE RESULTS: Coiform 0 oolonies/100 ml. Nitrate 6.7 mg./1. Arsenic: N/A mg./I. Date of sample: erg B. SEPTICIHOLDING TANK DATA Tank Type/Material STEP/Steel Tank size 1500 gal. Number of Compartments 2 Well Log (Y/N) Y Wires properly protected (YM) Y Casing height (above ground) 12 in. AT INSPECTION 6/26/05 82.4 ft. 5.47 g.p.m. Other bacteria 1-0 oolonies/100 ml. Collected by: Fred Kenley Date installed 8/16/94 Cleanouts (YIN) Y Foundation cteanout (YIN) Y Depression over tank (YIN) N High water alarm (Y/N) Y Date of pumping 6/11/05 Pumper J R Pumpers C. ABSORPTION FIELD DATA Date irgstalled 8118/94 Soil rating (g.p.d.le or fe/bdrm) 0_6 System type trench /fw f ♦yf*44 1 ft Length 150 ft. Width 5 ft. Gravel below pipe Total depth 361044 ft. ER. absorption area 750 fe Monitoring tube Y Depression over heli N Date of adequacy test 6/26/05 Results (Pass/Fail) PaN For 3 bedrooms Fluid depth in absorption field before test u in. Water added 674 gal. New depth 5314 in. Elapsed Time: 247 min. Final fluid depth 21a in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date — D. LIFT STATION Date installed 8/18194 Size in gallons 500 Manhole/Access (Y/N) Y 'Pump on' level at 28 in. 'Pump otr level at�8 in. High water alarm level at 34 in. Datum bottom of tank Cycles tested 4 Meets alarm & circuit requirements? Y E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankilif station on lot 110+' On adjacent lots 100+' Absorption field on lot 102+' On adjacent lob 100.' Public sewer main NIA Public sewer manhole/cleanout N/A Sewer /septic service line 25+' Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10+1 Property line 25+' Absorption held 10' Water main NIA Water service line 25+' Surface water 100+' Wells on adjacent lots 100+' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10' Building foundation 20+' Water main N/A Water Service line 25+' Surface water 100+' D6v&waY. )1arldnpWahide storage 50+' Curtain drain None ImiNwr to axis) Wel)s on adjacent lots too** F. COMMENTS G. ENGINEER'S CERTIFICATION0.1 40 C + I cenW that I have determined through field inspections and .. ATH + ,i review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. OGvCr T. r::ay. . Engineer'sPrinted Name Douglas T. Kenley /�, U 8174 "J l$ OS Date � '•• ••••• 4 HAA Fee $ ' Date of Payment Receipt Number (Rw. 12101) Waiver Fee $ Date of Payment Receipt Number R ,J ".. �NzP- EN�\Ru MUNICIPALITY OF ANCHORAGE l�A Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES] 343-4744 CE�iEIATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF R C� SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. � i• — S1 � — HAA # 4 (:� S L) -),1 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) 20148 Luca3 Stneet (b) Property owner vande2.2 Telephone: (home) Business 278-9631 Mailing Address 90149 ltfoaA FagPo Riuo�. AOaAka 99577 (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent JACK (UNITE COMPANY ATTN: Lynda Banners Address 10928 Eagle Riven Road Eagle Rivet, A 6ka 99577 Telephone 694-5500 (e) Mail the HAA to the following address: (or check here 1xif hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Eagle Rinner Loop Road No. 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-FamilyXI Number of bedrooms 3 3. WATER SUPPLY Individual Well rbc 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.Kk 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 (Ftev. 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, 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. Name of Firm Address Date .ache River, 4las1,<a 99577 Telephone THE SEPTIC SYSTEM HAS BEEN UPGRADED TO MEET THE CONDITIONS OF THE PREVIOUS HEALTH AUTHORITY APPROVAL. SEE AS -BUILT ATTACHED. L A ;f 6. DHHS APPROVAL Approved for 3 bedrooms by Date Approved Disapproved Conditional Terms of Conditional Approval Note: The and Municipal that periodic suitability. concentration well for this property meets existing State Codes. There are nitrates present. It is suggested testing be performed to insure the well's continued Nitrate concentration is 5.6 mg/1. EPA maximum is 10.0 mg/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 (Rei. 7188) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services t ` DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcell.D.# 050-571-38 HAA# HA900080 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 1 Block 5 Preuss Subdivision #3 Location (address or directions) 148 Lucas (b) Property owner Joyce Moon Telephone:(home)694-4556 Business 271-5377 Mailing Address 20148 Lucas Eagle River Alaska 99577 (c) Lending Institution Telephone - Mailing Address (d) Real Estate Company and Agent Lynda Banner % Jack White Company Address 10928 Eagle River Road, Eagle River, Alaska _99577 Telephone 694-5500 (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 -Family Number of bedrooms three (3 ) 3. WATER SUPPLY Individual Welles Community ❑ Public O 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 [fix 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. 7/88) 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. Name of Firm S & S Engineerin Address 17034 Eagle. River Date February 28, 1990 Telephone 694-2979 Road, Eagle River Alaska 99577 Engineer's Seal 7 6. DHHS APPROVAL A j �j XXXXXX bedrooms by 0Z1-"` Date June 28, 1990 YA'7§UXXXXXXXXXDisapproved XXX Conditional Terms of Conditional Approval Conditions set forth on the Conditional Approval of March 2, 1990 have not been met. Jly'i.! ?J' g.,. 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 MUNICIPALITYORA(MUNICIPALITY OF ANCHORAGE (MOA) DEPT. o Health Authority Approval (HAA) L�'> ENVIRONMEN ION CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: RECEIVED A. WELL DATA rJ Well Classification 1 �� w ��J If A, B, C, D.E.C. Approved (Y/N) A Well Log Presentc i;N) Date Completed `s r S� Yield la GSM Total DepthV� .Cased to Depth of Grouting Static Water Level 83 u Pump Set At t )Y - Casing Height Above Ground 2 -A-Sanitary Seal on CasingN) Electrical Wiring in Conduit(�VN) Depression Around Wellhead (YL4iCp SEPARATION DISTANCES FROM WELL: f I,t.. To Septic/Holding Tank on Lot L1A9;X1 ; On Adjoining Lots 1 To Nearest Edge of Absorption Fielc{ n Lot �2 t ; On Adjoining Lots To Nearest Public Sewer Line N & To NIarest Public Sewer Cleanout/Manhole To Nearest Sewer Service Li e on Lot -2� 4 - Water Water Sample Collected by e' —;Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed(o'�'gl Size1 c:::A�No. of Compartments 2- Standpipes(WN) Air-tight `C/aps(PPN) y�Foundation Cleanout�l) - Depression over Tank (Y/q :/N� Date Last Pumped Pumping/Maintenance Contact on File E ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well 1 5;;?aI 4, To Building Foundation To Property Line 1 dr'� To Disposal Field — To Water Main/Service Line k L_>t 4 - To Stream, Pond, Lake or Major Drainage Course Comments :�_O 'E Q> 72-026 (Rev. vaa) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata CA�� Type of System Design_l__��n el Date Installed Length of Field Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absortion Area �� Statndpipes Preseng;PN) Depression over Field (Y/6tp Date of Last Adequacy Test Results of Last Adequacy Test " C4=0 SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well To Building Foundation Lot ?�r� To Water Main/Service Line L d To Property Line To Existing or Abandoned System on On Adjoining Lots :�4 To Cutback (if present) k To Stream, Pond, Lake, or Major Drainage Course � S�O _�- To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION I _t Date Installed ' D— 1 8 —�1 b Dimensions �, t7�/aF-►E> �-r� Size in Gallons Manhole/Access/N) tl "Pump On" Level at "Pump Off' Level at 28 High Water Alarm Level at I/ i Tested for Meets MOA Electrical Codes&VN) Comments "Check Permitted Bedroom Rating Against HAA Request" Vent FY7N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect, ' of this inspectigo,.c imGI NEF1:i'N � � Signed 170V, F,40 river La®P t�®aa No. 2f) ;rw ;xv haglc diver, A as ,a F7; Company,.' Date�1 �7 %� `' MOA No. C �? 01f --� Receipt No. Date of Payment Amount: $ Receipt No Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services 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. # - "-'� \ -2)g HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) LUT 1; BLOCK 5; PREUSS SUBDIVISION; Location (address or directions) 20148 Lucas (b) Property owner Jnyoo. Moon Telephone: (home) 694-4556 Business 271-5377 Mailing Address 20148 Luc" EagZe Rivek, A.2aska 99577 (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent JACK WHITE COMPANY ATTN: Londa Banners Address 10928 Eagee Rb)a Road, Eag o Rbwq, Agasja 99577 Telephone 694-5500 (e) Mail the HAA to the following address: (or check here, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 2. TYPE OF RESIDENCE Single-FamilygR Number of bedrooms _3 3. WATER SUPPLY Individual Well KX 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,Q Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 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 Firm 5 & 5 ENGINEERENG Telephone 17034 Eagle River Loop Road No. 204 Address Eagle River, Alaska 99577 Date ELD REA ONAL CONDITIONALNI CASINGDANDFPLACINGIWELLAWIRESFINWCONDUIT CONDUIT NOT SED LATER THAN JUNE 15, 1990. -uAX • 6. DHHSAPPROVAL Ga:{Tiavea���`ZD Approved forts _ bedrooms by Date C3isa�pr�ved Conditional 6'x. Terms of Conditional Approval 1 � a L .,is�C Yiy✓t K CDr�fly� %�t%�gr���y• Note: The well for this property meets existing State and Municipal Codes. There are nitrates present, however, it is suggested that periodic testing be performed to insure the wells continued suitability. Nitrate concentration is 4.9 mg/1. EPA maximum concentration is 10.0 mg/1. 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 H�'PGg MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CJS F' p�'� CHECKLIST - FEBRUARY 1984 +f rJNV��,j 2� 343-4744 !"OA Legal Description: Z_or A. WELD Well Classification / N q1e If A, B, C, D.E.C. A Y/N Approved (Y/N) Well Log Present ( ) Date Completed --� Yield Total Depth QCased to t 4o'Depth of Grouting J Static Water Level Pump Set At U /� Casing Height Above Ground ib 2 Sanitary Seal on Casing (Y/N) -- Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) ,t/ SEPARATION DISTANCES FROM WELI / To Septic/Holding Tank on Lot I oo I On Adjoining Lots / Oo To Nearest Edge of Absorption Field on Lot / DO f On Adjoining Lots 100 /fi To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by -S SNR Net r;L) � ;Date Water Sample Test Results *W t1 STiAC-fn Jr, — Q „ _ -F-_ Comments B. SEPTIC/HOLDING TANK DATA Date Installed _(Q � L6 Size No. of Compartments 2— Standpipes Standpipes (Y/N) _Air -tight Caps (Y/N) —ti T_ Foundation Cleanout (Y/N) Depression over Tank (Y/N) N Date Last Pumped Pumping/Maintenance Contact on File (Y/N) for _�IA Holding Tank High Water Alarm (Y/N) —��_ Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well / CO 7 To Building Foundation � � To Property Linea 0, t , To Disposal Field � To Water Main/Service Line /0 To Stream, Pond, Lake or Major Drainage Course 1 CC / f Comments Se 9 hG fit N�� ,9 1) AA,.11 � /A, N 72-026 (Rev. 7/88) Fro,[ Page 1 of 2 C. ABSORPTION FIELD DATAiL RR Type of System Design � Soils Rating in Absorption Strata '1 � _ ,a to - E, _ Length of Field Date Installed 04 Feld Width of Field 3 Depth o ( I Gravel Bed Thickness �f 4 �� d7 Statndpipes Present (Y/N) o Square Feet of Absortion Area Date of Last Adequacy Test Depression over Field (Y/N) y� tj 1�7 Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: 1. O r 00 — To Property Line To Water -Supply Well To Existing or Abandoned System on To Building Foundation 30 On Adjoining Lots / Lot Aa To Water Main/Service Line /� /f — To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course it O To Driveway, Parking Area, or Vehicle Storage Area Comments 0 D. LIFT STATION Date Installed Size in Gallons ,,Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) . "Pump Off" Level at Vent(Y/N) _ D / Pumping Cycles during Adequacy Test. "Check Permitted Bedroom Rating Against HAA Request" d HAA uidelines in effect on I certify that I have checked, verified ins ection or conformed to all MOA an 9 p Signed 5 i kNfyltdlPt9NCa 17034 C act a rver ®op ®a ©. 204 Company Ain, [ a 925Z7 Date MOA No Receipt No. 0,5 `39 s /7 Date of Payment Amount: $ — 72-026 (Rev. PH) Back 0/70,°% Receipt No Waiver Fee: $ — Date of Payment Page 2 of 2 A. this iJ1' in Seal.,., hno•�, e , , v } is}T P � �!U .,✓ , r`'9