HomeMy WebLinkAboutPREUSS #2 BLK 1 LT 10  :~ ; MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT MAILING ADDRESS, . LEGAL DESCRIPTION I Well area Dwelling P~T NO. ~ Manufacturer ~ _ Material No. of compartments i Liq. capacity in ~allons IF HOME,DE: Inside length Width Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. 0 z 4 Manufacturer Material Liquid capacity in gallons ' [ ~ .o.?f lines Length ~h ~ne Tot~t~of lines /0 ' ~ , ' Tren~th[ , inches Distance ~7~es ~ ¢ Materi~l beneath tile ~ Top of tile t~nish ~ade~ .~ ~''inches Total e~v?bso rpti ~ a Length Width Depth PERMIT NO. ~ ~ TgOe of crib Crib diameter h ~ Total effective absorption area m Well ~uilding foundation Nearest lot line ~ DISTANCE TO: ~ Class/~ ~ j ~~--~~ Driller Distance tolotHne PERMITNO. ~ DISTANCE TO; Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS / PERMIT NO: DRTE ISSUED: DEF'ARTMENT OF HERLTH AND ENYIRONMENTRL PROTEZ:TION 8:>5 L STREET.. RNCHORRGE., RK 9950i 264-4?20 RPPLI CRNT: R[:,[:,RESS: CONTRCT PHONE: MRRK WEBER P.O. BOX ERGLE RIVER, RK 694-686? 0~577 LE~HL DE-,_.RIF: LOT _-.I~.E. SLIBDIYISION: c'C'llc.-'- SECTION: 8 TOWNSHIP: tSN · 5R (SL~. FT. OR RCRES) LOT: t0 RRHGE: iW E, LLI..~ .... :.1. I CERTIFY THRT: 1. I RM FRMILIRR WITH THE REL.,LIREMENT=, FOR ON-qlTE SEWERS RND WELLS RS SET FORTH BY THE MLINICIPRLITY OF RNCHORRGE ,.'.MOA) RND THE STRTE OF RLRSKR. 2 I WILL IN_TRLL THE _,Y~TEM IN RCC:OF.:[:,RNCE WITH RLL MOR CODES RND REGULRTIONS., RND IN L:_IMPLIHNCE WITH THE DESIGN CRITERIR OF THIS PERMIT. _..-.'r I WILL RD, HERE TO RLL MOB RND STRTE OF RLRSKR REQUIREMENTS FOR THE '_-mET BH_.K-P" DISTRNCES FROM RNY EXISTIHG WELL, WRSTEWRTER DISPOSRL SYSTEM OR PUBLIC SEWERRGE '-';YSTEM ON THIS OR RNY RDJRI"':ENT OR NERRBY LOT. IF R LIFT z, THTION IS INSTRLLED IN RN RRER COVERED E:Y MOR BUILDING CO[:,E'Z,. THEN (~) RN ELECTRICRL PERMIT RN[:, INSPECTION MUST BE OBTRINECu (2) RS-BLIILTS · WILL NOT BE RFFRE' ' 9,,' ,ED, WITHOUT RN ELECTRICRL INz, PE..TIUN'- P -REPORT.; RND ',~..-' THE ELEC:TRIC:RL Wm]RK MUST 'BE ~)ONE E:Y R LICENSED ELEC:TRICIRN. StUHED" . ~/ *~ [,RTE: ~/~/~ ' n' MRR~.~-~EBER HPPLI _.HNT: I / I_,_.LED B"r' DRTE:  'X._, MUNICIPALITY OF ANCHORAGE ~... " DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ~ ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE / [] UPGRADE W~ -- ~ / Absorption area Dwelling t PERMIT NO. ~ ~ DISTANCE TO: ~7.~ ~ / /~ 7~ ~ ~Z Manufacturer~ ~~~ Material ~~ No. of compartments ~ ~ N Liq. c~n gallons IF HOMEMADE: Inside length Width Liquid depth ~ ~ Well Dwelling PERMIT NO, DISTANCE TO: ~ ~ ~ Manufacturer Material Liquid capacity in gallons ~ Well ~ /~ Foundation t Nearest~l~e PERMIT NO. Length of each line Total lengt~o~ Fines Trench width Distance between lines No. of lines / ~2 ' ~ ~ ' ~> inches ~ ~ ~ Top of tile to finish grade ~ ~ M~terial beneath tile Total effective ~bsorption ~re~ ~~ ~ inches Length Width Depth PERMIT NO, ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot Hne PERMIT NO. ~ DISTANCE TO: Building foundation Sewer Hne Septic tank Absorption area(s) OTHER .- . ~ PIPE MATERIALS L~ ,~ ~_~ ~ 1. SOIL TEST RATING ./ INSTALLER ~ ~MA~KS ,~/. ~ ~ ~ APPROVED DATE LEGAL 72-013 (Rev. 3/78) ']'!..Ii!: !....E:NG'T'H E:, :[ HEi'.,r:'i!; :!: C~N IS THE L.E:N(H'H ,.': :1:1'.,! F'EE.::T::, O1:::' "l"l..-I!iE TF:Ei',ICH OIE: TH.E: E:,!i!H::'T!..! 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Z F' THE s .......... ..................................... ................. ............................................................... .' .. I::IF',":'I T F:t::li'.,r'" I"' "' i"~ ;;:'" "' HI:::' :;'1"11:: ",I~' ."i;;' .,: SS,_,E[.: ~::~....i.,.............~f(.:...:....~......~...~ ............................................... :H. ~:........~ ................................................ ':."::. )RING NUMBER ]- Date Completed:5~12-?8 SOIL DESCRIPTION ORGANIC SOIL __025, SANDY GRAVEL (GW) Brown, Dry --3.5' GRAVELLY SAND WITH TRACE SILT (SW) Some Cobbles, Sandy Lenses Gray, Dry LOCATION SKETCH Z. oT' No Scale 10' SANDY GRAVEL WITH TRACE SILT (GW) Dry, Gray ' 12'! No Water Table Encountered Lot Shape & Dimensions Unknown NOTE; DISTANCES SHOWN ARE APPROXIMATE AND HAVE NOT BEEN MEASURED BY SURVEYING METHODS. EXPLANATION r--UNFRO2'£N 6ROUND ORGANIC MATERIAL Little Visible Ice 0:10' Vx ~ A,8. ~--ICE DESCRIPTION ~- SAMPLE NUMBER (})Ss, 72, 57. I%, 85.9 pcf L. DRY DENSITY LWATER CONTENT ! ~ BAOWS/FOOT ~ SAMPLER TYPE BEDROCK '--FROZEN GROUND ~O.-WH/~.E DR/,' LIN$ TYPICAL SOILS LOG I A.B-AFTERBOR/NG Ss 1,4" SPLIT SPOON WITH 140 £~ HAMMER SAMPLER TYPE SYMBOLS ]  -~ ORGANIC ~ GRAVFA MATER/AL ~ CLAY ~ COBB,'ES& BOULDERS [~"~ SILT ~ BEDROCK ~ SAND I IC~ MA~IVF $O~t SY~8OtS ~ , LOT 10, BLOCK 1 PRUESS SUBDIVISION EAGLE RIVER, ALASKA GRID. PRO,I. NO. ~5111 ,OWG. N~ ~ J (.,~: water well Lot 10, I;-lockl Well f~or foratio 93~96 ' Red Jacket ?ipe - !" Galvanized 3 Static l~vel at 73, ' at 97' MUNICIPALITY CF ANCHORAGE DEPT. C,: ,x-, tx:x:,'~ ~ . CTiON FEB 2 0 '":':: RECEIVED Bail tested at 10 Dill Hagnuson Got ten-M~ .Un,',m on Drilling; Cle~xrx cr~ve! ~ MUNICIPALITY OF ANCHORAGE Development Services Department ` Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I. D. 050-571-18 1. GENERAL INFORMATION Complete legal description PREUSS #2 BLOCK 1 Expiration Date: %. N — ZZ Location (site address) 10050 WREN LANE, EAGLE RIVER, AK 99577 Current property owner(s) JENNIFER & ERIC GIOVANNUCCI Day phone Mailing address Real estate agent 10050 WREN LANE. EAGLE RIVER. AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Waiver Fee $ Date of Payment 329 �ZZ Date of Payment Receipt Number Receipt Number COSA # d S c a 211 1 a 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 3/25/2022 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to ,-W Or—At these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FWCs ` dar, • • • :1,9 }' 'led*' 1N . .. ........ 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms / Curtis Huffman ' VIP. -..CE128991• ..��� ji F�PFp .1125/ o2N����.v >> ROFESSI .. Disapproved Conditional approval for bedrooms, with the following stipulations: OF ANChiU����� P Z•= �NP�ER., SER o= �T^ G ENT SE ,• ��))) 1111\1'f�1�1 •, By: Original Certificate Date: V-2 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 Legal Description: PREUSS #2 BLOCK 1 LOT 10 Parcel ID: 050-571-18 If more than 1 septic system on lot: COSA Checklist # _of Structure served by this system _ A. WELL DATA ® Well log is filed with Onsite (or attached) Well production at time of test 4.7+ gpm Date drilled 5/1978 Water storage tank volume NA gallons Total depth 97 ft Well disinfected for coliform test? ❑ Yes ® Nc Cased to 97 ft ® Coliform bacteria is Negative ® Sanitary seal is functioning correctly Nitrate *18.4 mg/L E]Nitrate less than MRL (ND) ® Wires are properly protected Arsenic ug/L ® Arsenic less than MRL (ND) Casing height (above ground) 18 in. Date of flow test for COSA 3/23/2022 Collected by FW r, Static water level at beginning of test 62 ft. Date of Sample 3/24/2022 Comments *SULLIVAN SCOPED WELL ON 10/31/2018 PER LETTER IN MOA DOCS FOR NITRATES... B. TANK DATA Age of tank(s) 5.5 years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank 49" ® Standpipes/foundation cleanout per record drawing Date of pumping 3/23/2022 D. ABSORPTION FIELD DATA Which system tested (date installed) 6/2/1978 0 ALL standpipes present per record drawing* Total measured depth from grade 11.5 ft (max)* Measured depth to pipe invert from grade 8.5 ft (min)* ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 4' & 3' AT MTs — 6'ED IR C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 03/23/2022 Results R Pass For 3 bedrooms Fluid depth prior to test 34" & 23 in Water added 450 gal New depth 47" & 33 in Elapsed time 1320 min ® Code -required soil cover over field Final fluid depth 32" & 20 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: PIPES FOUND PER 2018 COSA & SEWARD ASB. *FOUND AT GRADE MT2. MT2 PIPE NEAR DRIVE IS 11.5' FROM GRADE. NEXT MT1 / PIPE NEARER TO TANK HAS SMALLER PIPE INSERTED. AN E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No ft Wells on Adjacent Lots: Community Sewer Manhole/Cleanout > 100' ❑ Yes if No 85* ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Surface Water > 100' ® Yes Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ft ft ft ft ft ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No _ Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *PER 2017 IR & MOA W 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.Mi .�4,A�1 Curtis Huffman CE 128991w��/� ° OFESSOV-ti-, ft ft www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC 221112 Subdivision: Preuss #2 Block 1 lot 10 kwater sam,pie revealed a nitrate concentration of 18.4 milligrams per liter (mg/Q. - 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 a.nd 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 gddress P O Box 196650 * Anchorage, Alaska 9,9519 6650 *www muni org 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. 0 Film[ Water C0 N S U L T I N G tt 13021 Montego Circle, Anchorage, AK 99516 907-350-9566 / FirstWaterAKPgmail.com April 13, 2022 Municipalities of Anchorage On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: EXISTING WELL NITRATE MITIGATION — PREUSS #2 B1, L10 Per MOA Onsite correspondence and in coordination with Cole Sullivan (Sullivan Water Wells) and Denali Excavation -- the existing wellhead was excavated below 3 feet and bentonite installed. The existing grade and topography was made positive ' and to drain away from the wellhead at final grade per Denali Excavation to protect the wellhead and direct surface water away from the well. We would recommend nitrate testing in the future and during other seasons to verify nitrate levels. The lot and area are served by private water and wastewater. The well will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, 4 �� Curtis Huffman, P.E. • (..—,1c \\ PSE BVi •, t Municipality of Anchorage =" -.--, i_..:_j O On-Site Water and Wastewater Program ����'� (907) 343-7904 S A E T T CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 050-571-18 Expiration Date: \1b 01 i oC 01 I 1. GENERAL INFORMATION Complete legal description PREUSS#2 BLOCK 1,LOT 10 Location (site address) 10050 WREN LANE,EAGLE RIVER,AK 99577 Current Property owner(s) DONNA D.ERICKSON Day phone Mailing address 8501 RIDGEWAY AVENUE,ANCHORAGE,AK 99504 Real Estate Agent . Day phone 2. TYPE OF DWELLING: ® 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 IZ Individual Water Storage ❑ Holding Tank ❑ Community Class_Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Distance: Received by: Date: !I COSA to be relea o the ineer,unless otherwise requested by the engineer. COSA Fee $ 5 oZ t!o Waiver Fee $ Date of Payment tO/3(11 ? Date of Payment Receipt Number 0- /03J Receipt Number COSA# 0SC rt$(5-4-I 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 4640 SHOSHONI DRIVE,ANCHORAGE,AK 99516 Engineer's Printed Name MICHAEL N.ANDERSON,PE Date 10/29/2018 • • 6. iy °ai� 6 ° r• • _ •°0 0 9 0 C 0 0 ,° , rF 6. DSD SIGNATURE ° ° •°° y System #1 Approved for E '�' `" r "''` `' Y pp � bedrooms. � �•° c>=-9 ��; ,T ff,• Wil'l.:i� System #2 Approved for bedrooms. a?;° ea 6���Y Disapproved. 4• Conditional approval for bedrooms, with the following stipulations: QP�\o ur �r `hG N-SITEG , W ATER AN" Wp,S EWATER o • <<‘ pROGR 7aP ? SER\e By: -13/ 0Tim CA II w,d Original Certificate Date: Nov 0 Q018- The 7 18- 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 X Septic System Advisory Arsenic Advisory Well Flow Advisory Other • • COSA blue sheet 10-10-12.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#2 BLOCK 1,LOT 10 Parcel ID: 050-571-18 A. WELL DATA Well type Private If A. B, or C provide PWSID# Well Log (Y/N) Y Date completed 5/1978 Sanitary seal (Y/N)Y Wires properly protected (Y/N)Y Total depth 97 ft. Cased to 97 ft. Casing height(above ground) 24+ in. FROM WELL LOG AT INSPECTION Date of test 5/1978 10/23/2018 Static water level 71 ft. 66 ft. Well production 10 g.p.m. 5.8 g.p.m. WATER SAMPLE RESULTS: Coliform ND colonies/100 mL Nitrate 14.2 mg/L Arsenic: ND ug/L Date of sample: 10/19/2018 Collected by: FIRST WATER CONS.SRV. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 11/3/2016 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 10/22/2018 Pumper ONE STOP C. ABSORPTION FIELD DATA — TESTED ORIGINAL 1978 TRENCH Date installed 6/2/1978 Soil rating (g.p.d./ft2 Qr ft2/bdrrp) 125 System type DEEP TRENCH Length 32 ft. Width 2.5 ft. Gravel below pipe 6 ft. Total depth 11.7 ft. (Measured 10/23/18) Eff. absorption area 384 ft2 Monitoring tube Y Depression over field N Date of adequacy test 10/23/2018 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 470 gal. New depth 6 in. Elapsed Time: 1260 min. Final fluid depth 0 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 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 alarm&circuit requirements?_____ E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 88.8' 2017 WAIVER 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 10'+ 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 100'+ F. COMMENTS Vacant system presoaked per code prior to testing. • G. ENGINEER'S CERTIFICATION -q• F. O f4,{ I certify that I have determined through field inspections and 0, `i.• •:.v ¢ review of Municipal records that the above systems are in * 49TH .-� •. ¢� conformance with MOA COSA guidelines in effect on this date. .:...,r:i, v Engineer's Printed Name MICHAEL N.ANDERSON,PE �� •• gr • -�••MICHAEL N. ANDERSON ;Q Date 1012912018 ¢�f,9.•/CE94Lu]9% VDp/ 1 SSl1 i�� COSA canary sheet_2-6-15.doc MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT ( • r • + ) 907-343-7904 On-Site Water and Wastewater Section s Fax: 343-7997 www.muni.org/onsite Nitrate Advisory Certificate of On-Site Systems Approval # 0SC181571 Subdivision: Preuss #2, Block: 1, Lot: 10 A water sample revealed a nitrate concentration of 14.2 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. Since nitrates are known to slowly increase, we recommend you monitor the water quality. 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 I?ULLI VAN ifle. WATER WELLS Drilling•Piling•Pumps Date: 10-31-18 P.O. Box 670269 Chugiak,AK 99567 P: (907) 688-2759 F: (907) 688-2259 TO: Donna Erickson 10050 Wren Lane Eagle River, AK 99577 Camera Report: Ran camera down 52'—no breaks or perforations in the casing ____ w_ E ny3�'"'� � 1 F , i \ i --...-4'.................... 11,, 'Q, / Ili K c Ij \ ,--, \-..-- / k % .gid ' \b, n v �- �1 \ \ ...., 1r v 4 iii:114"9\ =.,g '0 1 ti:f-------------- ' 4e o see ♦ /J/r3' ;d,1,G o, vl s N ASBUILT-NO CORNERS SET /THIS DATE. SEWARD & ASSOCIATES LAND SURVEYING 688-4566 I HEREBY CERTIFY THAT 1 HAVE SURVEYED THE SCALE: o.04Mrais FOLLOWING DESCRIBED PROPERTY: rpt OF At "wit ,- moi, z-oT/5, - DATE: �'�$.•' •'=.x''1'4! AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE i* .r "' It 4 OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: .r EASEMENTS, COVENANTS, OR RESTRICTIONS '<<S of j ; -',, r- WHICH DO NOT APPEAR ON THE RECORDED SUBDI•- 4 Duane Mark ,S.w rd ': -0 VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' �;,•y• �•�✓�S-44t�' 5°��Q ANY DATA HEREON BE USED FOR CONSTRUCTION ?r � �� OF FENCE LINES, OR FOR ESTABLISHING BOUND- �3Nshxa‘L,°�'`4, �' ARY LINES. DRAWN �'aarse'es'' MUNICIPALITY OF AN ,¢dORAG~: DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P,O, Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # 1. GENERAL INFORI~qATION Complete legai description CERTIFICAY~-~ C,'.F HEAL-i" AUTHORITY APPROVAL FOR A SINGLE Fi.~,MILY DWELLING 050-571'18 - duplicate - : ~ HAA# HA 970107 Lot 10: Block i; Preuss Subdivision #2 Location (site address or directions) 10050 Wren Lane Eagle River, AK Property owner Mailii~g address Lending agency Mailir~:? address Mitch Rob!off & Cathy Boscoe/Rohlof~Day phone 10050 Wren Lane Eaqle River, AK 99577 Seattle Mortgage Day phone 4300 "B" Street Anchorage, AK 99503 694-1161 562-5626 Agent Address Bob Wambel'h/ Remax of Eaqle River Day phone 694-4200 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well Community well Public water xx~ NOTE: If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality ¢~nd status of system. 72~025 (Rev. 1191) Front MOA*Q1 STATEMENT OF INSPECTION BY ENGINEER· As certified by my seal affixed hereto and as of the validation date shown below, I verify that my 'nvestigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I 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 Munici pal and State codes, ordinances, and regulations in effect on the date of this inspection. $ & S ENGINEERING Name of Firm 17034 Eagle River Loop Road No. 204 Phone 6' q ~/ - ~ "~ ¢) Eagle River, Alaska 995~7 Address E nginee r's s ig n atu re r-~~_ v.~,~,v,-~_...~ Date z.//30/9 7 DHHS SIGNATURE Approved for 3 Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Note: The well for this property meets existing State and Additional Comments Municipal Codes. There are nitrates present. It is suggested that a periodic'testing be performed to insure'the well's continued SultaQlllEy. Nitrate concentration is 8.35 mg/l. EVA maximum concentratiu[~ is is 10.0 mg/1. More information on nitrates is available from the On-Site BY' ?'' ~'. · Date -~O - ·: ', /.: I '~'?L ~ '":~he M~nioiCaliw of Anchorage Depa~ment of Health and Human 8e~ic~ (DHHa) i~ues Health Authori~ Approval O~ifioates ~as~ only upon the representations given in paragraph 5 above by an independent profe~onal engm~r registered in the State of Alaska. The DHHS does this as a cou ~esy to purchasem of hom~ and ~heklending idstitutions in order to ~tis~ ce~ain federal and state requirements. Employ~ of DHH8 do not conduct inspeotions or anal~e data before a ce~ificate is issued. The Munioipali~ of Anchorage is not r~ponsible for errors or omi~ions in the profe~ional engine,s work. 72-025 tRey. I/91) Back MOAJY21 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage. Alaska 99519-6650 . ~...::<. ,~ CERTIFICATE OF HEALTH AUTHORITY · ?~,/:' APPROVAL FOR A SINGLE FAMILY DWELLING 1, GENERAL INFORMATION ' - Lot 10; Block 1; Preuss '-Subdivision #2 Complete legal description Location (site address or directions) 10050 Wren Lane Eaale River, AK ?:/l~ro~ertyown'er,.j',_.:~_~._~ch Rohioff & Cathy Boscoe/RohloffDay phone ?"-;,., Eagle River, AK 99577 ,-, ,,, u~- ~~aUln='=H~rAsS ', 10050 Wren Lane 694-1161 ....... Lending ~,, "Mmhng address 'Ag~ nt '~ob ~bol~t/ Address .Day phone Day phone ;94-4200 Id for pickup. Unless otherwise requested, HAA NUMBER OF BEDROOMS: 3 ~' / ~ -TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE:.,. If community well system, provide written confirmation from State ADEC attest- ' lng to the legality and status of system. ?' : F W T~R DIsPosAL:'. . . 4. TYPE 0 ASTEWA . . Individual on-~ite xxx _~ .~,~. .(,. --~ r ' [~. ~ ~ ' ~: ' Holding ta~l~-:'~-:'~-' ':"-:' - .... . - Community:On.Site .... . .... ' ': - Public sewer:..': --' ' '- - . NOTE: If community was~tewater~ system, provide written confirmation from State ADEC ' attesting t° the')~gality and status of system. ' 72-025 (Rev. 1/91 } F~'ont MOA #21 STATEIVIENT OF INSPECTION BY ENGIN,~R. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wasiewater disposal system is safe, functional and adequate for the number of bedrooms ':,nd typo c,~ ~h't ~ct~ m; i~ ~dicated herein. I 'i'urther v:? 15/~i~at bas,.'d on the in'i'ormation obtained from ?~e Mun!,::'Y~ality o1: ;: "~chorage files and from :-,'v i~,v~-~',":igat." :'~nd inspection, the on-site water ~;upply and/or wastewater disposal system is in cornpiiance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm, s & s ENGINEERING Address Eagle Rive[L~)aslca.99577' Fngineer's signature Phone Approved for Disapproved. Conditional approval for bedrooms. '~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 a p~r~d~ ~ng h~ n~r~rm~H ~ '~n~]]r~ th~ ~,~11~ continued suitability. ~rate concentration is 8.35 mg/1. EPA ~ablCfrD~e~~¢~vices Section at DHHS, 343-47~4~2¢~ By: <~1_~<%~..;~ / ~ ~ Date 7 t/ · The Municipali~ of Anchorage Depa~ment of Health and Human Semites (DHHS) issues Health Authori~ Approval Ce~ificates 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 acou~esyto purchase~ of hom~ and their lending institutions in order to ~tis~ certain federal and si:ate requirements. Employes of DHHS do not conduct inspections or anal~e data before a ce~ificate is issued. The Municipali~ of Anchorage is not responsible for errors or omissions in the professional engineeFs work. 72-025 (Rev, 1/91) Back MOA W21 Legal Description: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN ,~ERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) Health Authority Approval Checklist ~--C,~\'O ~'-~t_\ Cg_q, Oq, c_~"~2., Parcell. D.: A. WELL DATA Wellty e Log present (Y(~) Total depth Sauitary seal ~) Date completed Cased to -~ '3 ' If A, B, or C, attach ADEC letter. ADEC water system number Casing height (above ground) } 7~~jc Wires properly Protected {~fl'q) ,~/ AT INSPECTION g.p.m ~, ~ g.p.m. FROM WELL LOG Date of test t~.~{ [ ~1 q ~' Static water level '-1 [ ~ Well production \ C> WATER SAMPLE RESULTS: Coliform '~) Nitrate Date of sample: ,.~ - o~ O- ~'7 B. SEPTIC/HOLDING TANK DATA Date installed (~--2--- "/? Tank size [ oo o Foundation cleanout (Yt~j) ~.[ Depression (Y~)_ ~ DateofPumping '~'"2~l'~q Pumper ~-?~-% ¢O~vl, ft,~L~ C: ABSORPTION FIELD DATA ,,Date installed '~ c/ /~.q Effective absorption area '~ ~ Date of adequacy test ~'%~Q ~ ~ .g&~- Other bacteria Collected by: ~'/-~ ~-/,3/~ Number of Coinpartments ~ Cleanouts~/N)_~ High water alarm (Y/N) "-SIA, Fluid depth in absorption field before test (in.); '~ '7 a Immediately ,'ffter~/5~gal. water added (in.): Soil rating (g.p.d./ft2 or ft2/bdrm) /~9 ~" t System type ~ &M ,~. 5- / Gravel thickness below pipe ~, ~'Total depth /o t //~> / Monitoring Tube present~q)~ Depression over field~q) Results~ail) ~ For ~ bedrooms Fluid depth q I ~ (ins.) Minutes later: '2- / I~ Absorption rate = .g.p.d. Peroxide treatment (past 12 months) (Y~ /,)d~W(.~ //crO'/.~,q,~yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) High water alarm level at* Cyc!~ "Pump on" level at* .~~p off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO'. Septic/holding tank on lot _ Absorption field on lot . . Public sewer main Sewer/septic service line ~_~.. ~"] ~ .~ : On adjacent lots / Oc~ : On adjacent lots Public sewer manhole/cleanout Lift station ~[ 4-- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5" ~ I e, ~' ~' ¢.- I Property line Absorption field Water mail#service line I,o t ~' Surface water/draiuage \ ~,~ t.& Wells on adjacent lots \ Dc:, "i' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Surface water Curtain drain Water main/service line I. 0 Driveway, parking/vehicle storage area Wells ou adjacent lots [o~t ~" Property line \o t 4-- F. ENGINEER'S CERTIFICATION ': I certify that I have determined thru field inspections and ,'eview of Municipal records [,~-t~l~r.a.~..~ ~.~t~.a,'e in co,;)brmance with ~lOzt Zf~clelines. in e&ct on this date. HAAFee $ ~ ' (~ Waiver FeeS Date of Payment ~/~7 Date of Payment Receipt Number ~ ~ }~ q~ Receipt NumBer Rev. 8/95 eSS: haa.wk.doc Municipality of Anchorage Department of Health and Human Services 825 "L" Street Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor SCALE SITE-PLAN ztr~ CT&E E~lvironmental Services Inc. CT&E Ref,# Client Name Project Name/ff Client Sample ID Matrix Ordered By PWSm 971922002 S a S Engineering & Preu$$ S/D ss S/D #2 Drinking Water Client PO# Printed Date/Time 04t24/97 15:31 Colle~te(1 Date/Time 04/22/97 14:00 Received Date/Time 04123/97 09:45 Technical Direcior: Stephen C. Erie Sample Remarks: Sample collected by; J.M. ~itrate-N Eesu[ts 8.19 PQL Units Method AllowabLe Prep Analya{s Limits Date Date Init 0.500 mg/L SM18 4500-NO3F 10 max 04/25/97 JBL TOTAL P. 02 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING I~)~(~ - _~'-h ~ - ~ HAA# ~ ~'~c~ ~{© ~ °~ '-'~ 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Oc,~P~ --,¢/~7"/.,. Mailing address / Z,~,5" Lending agency Mailing address Day phone Z'°4;/) d Day phone Agent E~--m~A~ Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91) Front MOA 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verifythat my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein, lfurtherverifythat 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 Phone Address Engineer's signature Date David R. Dayton P.E. 20210 Dc.':.'-]ar St. Chu, ca'k, Alaska 99567' DHHS SIGNATURE XX Approved for Three (3) bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional CommentsNote: The well for this property meets existing State and Municipal Codes. There are nitrates present. It is .... ~ ~=~ .... ~,~4~ tcsting ~ ~v ' +h~ wells su~ ........... r ......... performed continued suitability. Nitrate concentration is 6.02 mg/1. EPA maximin concen~zaLion is I0.0. rog/1. By: ' Date /~-2'¢2 72-025 (Rev 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type Log present(Y/N) If A, B, or C, attach ADEC letter. Date completed Cased to ¢¢ ~" Total depth Sanitary seal (Y/N) Parcel I.D. ADEC water system number Casing height ,~ ; Wires properly protected (Y/N) ~/ FROM WELL LOG Date of test Static water level Well flow Pump level ~ ~_.~' SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line g.p.m. AT INSPECTION g'P'~ ~ [o/F/,;~cr/-~ ¢~ ~%;,); On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank ~,4~ WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate (.~, 0 Z_ Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size /'~ o~ C0mpartm?r~ts ~ Foundation cleanout (Y/N) ,~ Depression (Y/N) 'X'J/ Alarm tested (Y/N) ' '~//~ (//z-..~/,~ z~ Pumper ~'f'~), ~-/z.~ ~-~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~,.~ On adjacent lots //~¢:>~ ~- ~:~ Foundation To property line ./,~ ~'/" Absorption field .~' Water main/service line Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots __ Surface water D. ABSORPTION FIELD DATA Total absorption area Depression over field (Y/N) Results (pass/fail) Date installed /q~ Length ~'z, 0,~1,¢~ Width Peroxide treatment (past 12 months) (Y/N) Soil rating / Gravel thickness ~¢'¢,~/~ Total depth Cleanouts present (Y/N) Date of adequacy test for __ If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~o¢-~ -~' To building foundation '~P On adjacent lots Surface water Curtain drain On adjacent lots Io¢'t __ Property line IO ~ To existing or abandoned system on lot ~¢' '~ ,,x4~..r¢~,~.~ Cutbank /¢"¢~'~' Water main/service line ~. I o~ .4~ Driveway, parking/vehicle storage area I~ '~ · E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. David R. Dayton P.E. Engineer's Name HAA Fee $ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number D. R. DAYTON, P.E., R.L.S. ~~~ Chugiak, Alaska 99567 20210 Donalar St. (907) IFS~Lm,~ ~x 696-2417 November 20, 1992 Adequacy Test Legal Description: Lot 10, Block 1, Preuss Subdivision #2 Date of Test: November 20, 1992 Septic Tank: 1,000 gallon, 2 compartment, steel tank Absorbtion System: 32' x 6' trench and 29' x 4.5' trench Soils Rating: 125 sq. ft. per bedroom Daily Design Flow: 3 bedroom - 450 gallons per day (DHHS Records) (DHHS Records) (DHHS Records) Test: As the house has been vacant for about a month, the ab~orbt~on system was pre-soaked with 1090 gallons of water for 24 hrs. before-~ testing. The test consisted of injecting 675 gallons of water into the absorbtion trenches in a 4 hr. period. Results: The absorbtion system accepted t50% of the daily design flow with a 1.55 ft. rise in the monitor tube liquid level. After water injection was stopped, the monitor tube liquid level returned to the original level in 1 hr. 45 min. Conclusion: The septic system is currently functioning adequately for a 3 bedroom home. D. R. DAYTON, P.E., R.L.S. ~]~~J~ Chugiak, Alaska 99567 20210 Donalar St. (907) ~~]~ 696-2417 November 20, 1992 Well Flow Test Legal Description: Lot 10, Block 1, Preuss Subdivision #2 Date of Test: November 19, 1992 Well Depth: 97 ft. Static Water Level: 60 ft. Requirements: 450 gallons per day for a 3 bedroom home. Test: The well was pumped at varying rates until the drawdown stabilized. Pumping was then continued for 5 hrs. Results: The well produced 2.8 gallons per minute with a d~awdown of 3.4 ft. A total of 1090 gallons were pumped in 6 hrs. 30 min. Conclusion: The well is currently producing adequately for a 3 bedroom home. :~..,' 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 GENERAL INFORMATION (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) ~' ' Applicant Namo.~~ ~J~ TolophonCHome ~/~/-~;L<~c~ ~' Business App~i(~ant Address /C.~ · ~ ._~<~ O ×' ~--~ .. ~'--~'~ · Applicant is (check one): Lending Institution []; Owner/J:zuit~r~; Buyer []; Other [] (d) Lending Institution ~ c~",-¢z ~ Telephone Address , (e) Real Estate Company and Agent TYPE OF RESID/ENCE Single-Family/[~ Multi-Family [] Number of Bedrooms ~ Other SEWAGE DISPOSAL Onsite)~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of En¥ironmental Conservation attesting to the legality and status. Page I of 2 ~2~s¢~4~ WATER SUPPLY Individual Well/~ Community [3 Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conse~.'at[o~ attesting to the legality and status. : : =ENGINEERING FIRM PROVIDIN~(.,--i'NSPECTIONS, TESTS, FILE SEARCH, DA~ AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and a~quate for the number of bedrooms and type of structure indicated herein. I further verity that based on the information obtafned from the Municipality of Anchorage files and from my investigation and inspection, ~he on-site w~ter supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of ~his inspection. ~-- ~,, (~ Te ephone Name of Firm Address ., .5',.',;; f~l~, AL~,.S;G", :;~,~ ;.v DHEP APPROVAL Approved for-1/¢~""/~-~- bedroomsby~. ~'~ ''~' ~'~¢~-~d.~ Date Approved ~ ~l's*a~.~ove d Conditional _ Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon tile 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 (11/84) Well Classification MUNICIPALITY OF ANCHORAGE (MO~/' HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~.~,q- I. ~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present ~1) Date Completed Total Depth ~1 "~ f Cased to ¢f"7 ~ Static Water Level ~ | ~ Casing Height Above Ground Electrical Wiring in Conduit Separation Distances from Well: To Septic/H~ Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ,,~ ~ ~.¢J q~ Yield Depth of Grouting Pump Set At ~::~¢~ Sanitary Seal on CasingCN) Depression Around Wellhead (Y/~ ; On Adjoining Lots ; On Adjoining Lots /,/~ To Nearest Public Sewer ra//4. To Nearest Sewer Service Line on Lot ~--~'j~,~-~ ~.4~.5~,_3¢~c~-~,---.~ ; Date ~~~ ' ~:',~ 1 B. SEPTIC/H~LD;NG TANK DATA Date Installed (~2 Standpipes ~¢~/N) Air-tight Caps(~N) Depression over Tank (Y/~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water A~arm (Y/N) Separation Distances from Septic/'Ho~ Tank: To Water-Supply Well To Property Line To Water Main/Service Line ~,O ~-~ Course Size t¢:~c~ No. of Compartments Foundation Cleanout (Y/z[~ Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~.~¢-.~,,~. Width of Field Square Feet of Absorption Area Depression over Field (Y/~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~ "'"o~ '¥ To Building Foundation Lot t~ )r'~'~P..-~ Type of System Design '"-~'~,~--.-.H, '~'-'~/'Jd._ength of Field ¢~, ~t ~)~~ ~ Depth of Field m~ ~' ~~ ~' Gravel Bed Thickness ~ 1~ , ~~ ~'~ ~ Standpipes Present ~N) Date of Last Adequacy Test ~-~ To Water Main/Service Line t ~ I~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line Lc..~ ~+. To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ('~ & ,... LqG,h,~,_ ,Nt~ Date Receipt No. ,%1~A Date of Payment ~'~D- ~ Page 2 of 2 72-026 (11/84) HEALTH AUTHORITY APPROVALS SEWER & WATER MAiN EXTENSIONS SEWER & WATER INSPECTION SYSTEM DESIGN WELL INSPECTION & FLOW TEST SITE PLANS ROAO DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM MUNICIPALITY OF ANCHOPJ~GE DEPT. OF HEALTH & ROBERTA. SHAFER ~NVII(r-)NMi:NrAL PROTECTION CIVIL ENGINEER 694-2979 August 16, 19esAU 1 1985 RECEIVED Municipality of Anchorage Department of Health and Environmental Protection 825 L Street Anchorage, Alaska 99501 ATTENTION: Susan Oswalt REFERENCE: Lot 10; Block 1; Preuss Subdivision Request you issue the attached Health Authority Approval and approve a waiver for the existing septic tank located 92 feet from the existing well. The existing on-site waste water disposal system was installed in June of 1978 and upgraded in August of 1984. James Hostman, while working for the Municipality in conjunction with Joe Blair of the Municipality authorized a waiver on this property on May 31, 1978. It is our opinion that the horizontal separation distances prescribed by 18AAC72.021 are not required in this case. The existing well was drilled to a depth of 97 feet and has a static water level at approximately 71 feet. The topography in the area between the on-site waste water disposal and the well is generally flat. At the time the septic systgm was upgraded water tight seals were._i~d on the septic tank. Included for your review, in addition to the HAA application are the following documents: A. A copy of committment to waiver signed by James Hostman on May 31, 1978 B. Copy of well log C. Recent total coliform bacteria analysis D. Soil logs and on-site inspection reports If you require additional information, please contact us. P.O. BOX 6650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOWLES, MA YOFI DEPARTMENT OF HEALTH & HUla, AN SERVICE~,~ August 28, 1985 Mr. Robert A. Shafer S & S Engineering SR Box 196-X Eagle River, Alaska 99577 Subject: Lot 10 Block 1Preuss Subdivision Dear Mr. Shafer: This Department hereby grants a waiver to 92 feet for the separation distance between the existing septict tank and well on the subject lot. This waiver is valid for a three bedroom single family dwelling only. Sincerely, Stephen S. Morris Civil Engineer On-site Services SSM/ljw ROBERTA. SHAFER CIVIL ENGINEER 694-2979 May 26, 1984 ADEQUACY TEST WATER AND SEWER INSPECTION WELL INSPECTIONS AND FLOW TEST SITE PLANS ROAD DESIGN SOILTEST ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN EXCAVATION WORK MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION.' MAY 2 g 1984 RECEIVED Mr. Mark Weber Box 596 Eagle River, Alaska 99577 REFERENCE: Lot 10; Block 1; Pruess Subdivision Dear Mr. Weber, A sewer system adequacy test was performed on the system located on the referenced property, as you requested. The septic tank was pumped and verified to have a capacity of 1000 gallons. The absorption trench was tested by a continuous flow of water through the absorption trench over a period of 24 hours. Approximately 662 gallons of water was added to the trench with approximately 500 gallons backing up into the septic tank. As a result of this test it can be concluded that the septic tank is large enough and adequate for your three bedroom home. However, I regret to inform you that the absorption trench appears to only be adequate for approximately one bedroom. It will be necessary for you to obtain a permit and have the absorption area upgraded before it can be considered adequate for three bedrooms. If we may be of further service, please do not hesitate to contact Sin~'~r~ly, o~,,o cc: Municipality of Anchorage Department of Health and Environmental Protection SRB 196X EAGLE RIVER, ALASKA 99577 ~3 MUNICIPALITY OF ANCHORAGE ~ ENVIRONMENTAL ENG NEaRiNG D~V~SION ~ REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. incomplete requests will not be processed, Please allow ten (10) days for processing, 1. PROPERTY OWNER PHONE MAILINGADDRESS' PROPERTY RESiDENT{If different from above] t / PHONE 2. BUYER PHONE , MAILING ADDRESS MAILING ADDRESS 4. REALTOR/AGENT ~ [ PHONE I MAI LING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [] Four ~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY *ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY **If individual/on-site, give installation date [C{"~ ~- If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FiVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PER'~iT NUMBER -' 2, WATER SUPPLY [] INDIVI DUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER I~]INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Vel'ified INSTALLER []Septic Tank or []HoldingTank Size: /0C)~'} If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION~'R EA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS I~/ APPROVED FOR ~;~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78)