HomeMy WebLinkAboutPREUSS #3 BLK 5 LT 10Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201209 PID Number: 050-571-33 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name WIGGINS SABRINA & O'HARA KATHERINE ABSORPTION FIELD Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 20213 David Avenue Eagle River AK 99577 ❑ Other Phone Number of Bedrooms Soil RatingTotal depth from original grade 3 0.8 GPD/SF 10 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade PRESSURIZED Ft. Gravel depth beneath pipe ' 7 Ft. Subdivision Block Lot PREUSS #3 5 10 Fill added above original grade 1.0-3.0 Ft. Gravel length 40.5 FL Township Range Section Gravel width 2.5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 567 Ft z 1 Ft. Well >1 00' >10 0, TANK ❑ Septic ❑e S.T.E.P. ❑ Holding ❑ Other Manufacturer greer Capacity 1250 Gal. Surface Water >1 00' >1 00' Material Number of compartments Lot Line I >10' I >10' I NA PLASTIC 2 Foundation I >1 0' >1 0' LIFT STATION Manufacturer G RE E R Capacity 1250 Gal. Remarks Alarm location ON HOUSE Electrical installed by Rising Sun Electric PIPE MATERIAL House to tank 3034Tank to 3034 drainfield Installer Whitters Excavating Drainfield 3034 co/MT3034 Inspector Curtis Townsend BENCH MARK (Assumed elevation) 100 ft Inspection es: Im 7/17/2020 2�e 7/20/2020 Location and description 3d 7/23/2C6 4" 7/25/2019 BOTTOM OF SIDING, POINT B ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineers Stamp ' Conditional Approval: Date Q •• �... • l�•T ' • • �F. 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Q a m Co I i QLLJ /J I �• _M ----- --- _—_T _ — —_OJi N LO n o 00'OZ L 3.001,20.00S CD 0 i �� 0 C, m ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-571-33-000 Property owner(s) WIGGINS SABRINA & O'HARA KATHERINE Day phone Mailing address 20213 David Avenue Eagle River AK 99577 Site address 20213 David Avenue Eagle River AK 99577 Legal description (Sub'd., Block & Lot) PREUSS #3 BLK 5 LT 10 Legal description (Township, Range & Section) Lot Size 22,890 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field 0 Initial ❑ Single Fa (SF) PI AD (w/ Septic Tank Fx� Upgrade 0 Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the ab ve information is correct. I further certify that this is in accordance with applicable Munici I odes. (Signature of property owner or authorized agent Permit/Rush F 5 Waiver Fees: Date of Payment: 6136 1®Z0zo Date of Payment: Receipt Number: 00;2:21b Receipt Number: Permit No. O S e 2 0 l 209 Waiver No. GADevelopment ServicesTuilding SafetylOn Site Water and WastewaterTorms\Client FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201209, Rebecca Carroll, 07/09/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201209, Rebecca Carroll, 07/09/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201209, Rebecca Carroll, 07/09/20 Pump Selection for a Pressurized System - Single Family Residence Project David Ave - 3 BR / Eagle River AK Parameters Discharge Assembly Size Transport Length Transport Pipe Class Transport Line Size Distributing Valve Model Max Elevation Lift Manifold Length Manifold Pipe Class Manifold Pipe Size Number of Laterals per Cell Lateral Length Lateral Pipe Class Lateral Pipe Size Orifice Size Orifice Spacing Residual Head Flow Meter 'Add-on' Friction Losses 1.25 70 40 2.00 None 5 0 40 2.00 1 40.5 40 2.00 3/16 4 41 None 0 inches feet inches feet feet inches feet inches inches feet feet inches feet Calculations Minimum Flow Rate per Orifice Number of Orifices per Zone Total Flow Rate per Zone Number of Laterals per Zone % Flow Differential 1st/Last Orifice Transport Velocity 2.79 11 30.7 1 0.3 2.9 gpm gpm % fps Frictional Head Losses Loss through Discharge Loss in Transport Loss through Valve Loss in Manifold Loss in Laterals Loss through Flowmeter 'Add-on' Friction Losses 6.6 1.1 0.0 0.0 0.3 0.0 0.0 feet feet feet feet feet feet feet Pipe Volumes Vol of Transport Line Vol of Manifold Vol of Laterals per Zone Total Volume 12.2 0.0 7.1 19.3 gals gals gals gals Minimum Pump Requirements Design Flow Rate Total Dynamic Head 30.7 54.0 gpm feet 0 5 10 15 20 25 30 35 40 0 50 100 150 200 250 300 Net Discharge (gpm) PumpData PF3005 High Head Effluent Pump 30 GPM, 1/2HP 115/230V 1Ø 60Hz, 200V 3Ø 60Hz Legend System Curve: Pump Curve: Pump Optimal Range: Operating Point: Design Point: I Municipality of Anchorage Page _ ~ of 7__ 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: ~ ~ PIDNumbef:_~ Name: "~l-~..~ ~::>~'~J~-.--I"~ Wastewater System: [] New l~l~pgrade Address: Phone: ~'O'~ ~[~ ~ ABSORPTION FIELD ~ ~ ~j~ ~No. of Bedrooms:~ ~epTrench ~ Shallow Trench DBed ~Mound ~Other LEGAL DESCRIPTION so,, Rating: Total Depth from original grade: Lot: Block: 'Subdiv~ion: ~ /~ GPD/Sq. Ft. ~O ~ Depth to pipe bottom from origina~ grade: Gravel depth beneath pipe Ft Township: Range: Section: Fill added above original grade: GraveJ length: ~.o ~ Ft. Ft WEI [: D New ~ Upgrade Gravel width: Number of lines: ~Distancebe~een lines: Classification (Private,~,B,C): Total Depth: Cased To: ~ ~ ~[ ~ ~ Total absorption area: Pipe material: Ft. Ft ~ 7~ SQ. Ft. A~ ~O~ Drdler: Date Drilled: Static Water Level: Instaffer: ~ Date ~nsta~led: Pump Set at: ~ Casing Height A~ove Ground ~u ~' I ~.TANK SEPARATION DISTANCES ~ ~ ~o~i~g ~ S.T.~.~. To Septic A~sorption Lift Holdin~ Public/Private Manufacturer: WelJ- J~l' ~' ~ ~ Z5 ,~ Material: Z~p__~ Number of Compa~ments: Surface Water ~°t+ to? ~ ~ t¢~'+ LIFT STATION Lot Line ~ ~ ~ ~ ~ ~ Size in galJons: J Manufacturer: ~ p ,, ump on" ~ev~ Foundation ~ ~ ~ ~ ~ ~ ~ ~ f" leve~ at: High water alarm at: Curtain Drai~ ~>~ ~ ~,,~ ~ PU~odel ~ Electrical Inspections performed by: Remarks:~o~ ~ ~,~ o~ BENCH MARK Location and Description: 0 ~ ' JAssumedElevation: Inspections performed by: s $ S ~7034 =~.=. ~;~.~ ~ Dates: 1st ~ ~-~ J~~' .o. ..... Department of Hea~nd. H~an Se~ices approval ~*,~,:'- .... Reviewed and approved by: Date: ~-~ F-~- ~t~ r2-013 {Rev, 9/91) MOA 25 Permit No. SW950229 Page 2 of 2 LOT Legal Description: Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report 10, BLOCK 5, PREUSS #3 05057135 PID No.: CO1 EXISTING 1000 GAL SEPTIC TANK LOT 1 0 EXIST NG ..... 3......BDR~ ........... HOUSE NEW $CAL~ l" = 40' i 72-013 A (1/93) * -NEW TRENCH FINAL \ \ CO 91.3'- 78.3' NO WATER FOUND 8-10-~i5 Al B FCO 27! 4' ST1 551 10' · .s:r2., .40.~- .:1.7.~.. c01, 42~ 19' c02 44~ 21 FD 46¢ 25' C05 35~ 18' C04 15~ 22' ,..i~.!.!.. ..g.Z~..i !51 ROSEt~T C. c~ - ~o~ PAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICEg P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950229 DESIG~ ENGINEER:S & S ENGINEERING OWNER NAME:BRADFORD JOHN E & OWNER ADDRESS:20213 DAVID AVE EAGLE RIVER, AK 99577 PARCEL ID:05057133 1 OF DATE ISSUED: 8/21/95 EXPIRATION DATE: 8/21/96 LEGAL DESCRIPTION: PREUSS #3 BLK 5 LT 10 LOT SIZE: 22890 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 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: RECEIVED BY: HEALTH AUTHORITY APPROVALS SEWER & WATER MAJN EXTENSIONS ROBERTC. COWAN, RE, ROBEFtTA,. SI~,,%FEFT, August 14, 1995 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 10, Block 5, Preuss S/D #3 SEWER&WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL INSPECTION & FLOWTEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS Request you issue a permit to upgrade the septic system serving the three bedroom house on the referenced property. A test hole was excavated and a percolation test performed in the area of the proposed upgrade. The approximate location of the test hole is located on the attached site plan. ~'C?- Cowan~ RCC/gk At the time of excavation no water was encountered in the test hole and after seven day ground water monitoring, the monitoring tube was found to be dry. Attached is the proposed upgrade design. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact us. Sincerely, Enclosure ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 o ~ C) 10' UTIL EASEMENT DRIVE 0 ~m m r- o oX~ ~o m~ LOUIS PLACE Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 %" Street, Anchorage, Alaska 99502-0650 SOILS LOG m PERCOLATION TEST 8 9 10 DATE PERFOF Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? ~-~ C~ SITE PLAN 11 12 13 147 15- 17.- ' ' ' 18: '. 19 20 COMMENTS S & S ENGINEERING S IF YES, AT WHAT L DEPTH? O P E Del]lb to Waler Monitoring::' . ,[A~,( 'Date: Reading Date Gross Net Depth to Net _. Time Time Water Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER L'~" TEST RUN BETWEEN ~' FT AND ~¢' FT PERFORMED BY: "~ ~'~' ~-el- ~;v~r L~op ~gal~ NO, ~{~,~'~ ~ ['~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH A~-~eAI~[v~I~,IJ~hR:::X~7~UiDELiNEs IN EFFECT ON THIS DATE. DATE: ~ ~ t~r,-'Ct5'' 72-008 (Rev. 4/85) HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL INSPECTION & FLOW TEST SITEPLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERT C. COWAN, RE. ROBERTA. ,gHAFER, PI ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE= Lot 10, Block 5, Preuss S/D #3 August 14, 1995 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 GENERAL= 1. e Se Se The scope of this project includes the installation of a leachfield trench to serve the three bedroom residence located on the referenced property and excavation of the existing 1000 gal septic tank to verify its integrity. If the integrity of the ~xisting septic tank is poor the existing septic tank is to be excavated, pumped, crushed, and abandoned in place and a new 1000 gal septic tank installed. The existing leachfield trench is to be abandoned such that it may be used in the future. 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. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil s ' ettllng. 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. TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Page Two Lot 10, Block 5, Pr,uss S/D #3 August 14, 1995 Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Septic tanks installed with less than 4 ft. of cover shall be insulated. 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. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page Three Lot 10, Block 5, Preuss S/D %3 August 14, 1995 Se Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. ' Se The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Cast Iron ASTM D3034 (PVC) ASTM F810 (HDPE) ASTM D2662 (ABS) Perforated ~olid Yes Yes Yes Yes Yes No Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer~ Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6.. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the %200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Lot 10, Block 5, Preuss S/D #3 August 14, 1995 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. e 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. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. E~pecially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thu~ inspecting engineer is to be contacted at least 24 hours ' the prior to the start of construction. If necessary, a'pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.OoA. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall 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 and the M.O.A. Page Five Lot 10, Block 5, Preuss S/D #3 August 14, 1995 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor 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. CONTRACTOR/INSTALLER ' NAME MAI LING ADDRESS LEGAL DESCRIPTION LOCATION -~?x~ DISTANCE TO: 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 ~ PHONE I [] UPGRADE JWe,, Absorp, ar a /Dwa'"ngPERM,T O. Material ~ Width ~ ~ No, of lines Top of tile to finish grade Length Type of crib DISTANCE TO: Class D STANCE TO: Manufacturer ~,_~ Liq. capacity in gallons ~ I0~(~'~..~ ,,- HOMEMADE: DISTANCE TO: I Well Manufacturer DISTANCE TO: Well Length of each I ne t I Inside length Dwelling I Material Foundation ! I Nearest lot Ii Total length of lines Material beneath tile No. of compa~?ents inches Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. Distance between lines inches ~ Total effective absorption area Depth PERMIT NO, Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line Depth Driller Distance to lot line PERMIT NO. Sewer line Septic tank Building foundation PIPE MATERIALS OTHER SOIL TEST RATING REMARKS 72-013 (Rev; 3/78) DATE LEGAL Absorption area(s) ......... : .::' ~ ::.. :1: :!!!; · 'T'F:E:?'~C:H H!::{;:':;]:?ll...li-,? '-, I_! ','![::?,Fj'.:;: I':F' li~lJ~JE:'~]l:::lt::ll','l'..':.:;, ::ir :~: 'T'H[E F;:: :': ':~ .. ]: Fi:E::2 FJ 'J: 2:F:.~' CIF:' 'T'HE: :/;O :£ L. I:aE"]:':g"'IIE'F'T Z F' N ':::' ':''''''::'['''' " ~"":~ ~:~::::" ~:::::=' -"~r'" . 'i"H!~:J: . ~E '-,ll':~i'.".-... E:, ]: r" FJ'H'j:: T '" N ]: :E; THE: LFEhlCCFH ':: Z lq ::'E:E:T" 01: THE: ""F;'F'~ ....r' F;? DF~ F:I Z '.,II:' 'Z E:..._[' THD: E:,E:F:'TH OF::' l:::1 'FF;;:E:NC:F.I r-~[;? F:']:T 'I"::~ TI-IF:' D [ ~;'FI:~['.,I'j'[:E E:E't"HE'EH TH[:J: :gI. Ji:;~:F:'FiC:E CU::' 'r~::. 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HELL F!I'.E' :LeO F.'E:Ej .... 1::'O~;: !::;i [:'F~:]:¥t::ITI~: [,.IELL..; 13~] ':'~ ...... ri'"'., _ 'J :~ :3 'l"C~ ;;~?~F: F ~.~::. r F:'F;':'r,~ ?I I:::'LIE;LZC: !.,.IEELL E:'[EF::'EI'.~D F,!C~ LI[::'t:'H 'THE: -I"¥F'E OF:' F'(IE...Z :' ~JF:[...[ .... .,.!lj~... I_ L F' ~Ji'J:J; t::IF~:Fj: f;~ [?~'::, .. :' F;' ::'[: F:IHD "'!I...IE];T E',E: F~:EE'T'I...IF;:f-~[::, "I"F~ 'I"HE~ [::'EF:'FIF;~:TI"~E~?.,IT I.=.! ~ 'TI...! :[ ~.,I 2:~2~ .... ~ '"' ~ OF' TI'"I[E I, [:1 t C:OMF:'L. IET:[ ON. - I:, u .::I ]: LI::I[~:L.E: 'I"F' '.,~;l. ll:?[:j' I:::'[~:I:)F'[E[;: Zf',!:?T'I:ILLI::~']"]:I::ii,.,L ' .... Z C:E:F;]:T :[ F:"T' 't'HI::FT' :L' 'j: I:~t'"I F:'F:ff"iZI_.]:F:II:;~: Hi[TH THE: F'~:E~.;:[LI:[F::~E:P'ILCNTE~ F:'("U;? r" ......... F'OF~:TH [, THE: f ILIF,I i L. ].... i:IL ] OF' ::1 ~., OHOF~'F::I 'EE:. . :: ]: ! T 'r ~ · ...... .... LL .......... II!LL.. ~[... :,'r ,1~'1 '~ : ........ :;'E''"J"':' "r ........... -:. ] /h,l[ ..... "". ........... ' ,~ ~IE. L L~E.E..: ..... ~ ......... I.....I,It,,L. fill.fl I'": [J'.4 .......] ].- ,:;:::'[ ~.~:;, ,- ::~ ....... ~- .. h'[" '-: ]' r': [:' ,~ '"'F · ",; :: -" -~ ..- r c .... ,. - - ................ - ............ .................... ~] ~..,',..u.,~:, ~NC:I...Li[::,E: !"IC~F~:E: T~N :~ F:[:'r":;,'"~r'~.,~,~" ....... EF,-.F~::~:JE"iF;L'.FT' ]:F 'I"HFJ / / , ........................ ......... ~,.... ....... ~ .............. ~:"'"':'" ~-~"'"~ ~-~ -.~E~-._. E:, F:FF E BO'RING NUMBER Date Completed: 5-12-78 SOIL DESCRIPTION GRAVELLY SILT (ML) Brown -- --0.5' --2.0' SAND W/TRACE SILT (SW) '3.0' SANDY GRAVEL WITH TRACE SILT (GW) Dry, Gray with lenses of clean sand, Many Cobbles LOCATION SKETCH No Scale Lot Shape & Dimensions Unknown No Water Table Encountered 14!TD NOTE: DISTANCES SHOWN ARE APPROXIMATE AND HAVE NOT eEEN MEASURED BY SURVEYING METHODS. EXPLANATION "l J~ '-. ORGANIC MATERIAL j~, Little Visible Ice 0:10' Vx 'i~ ~ A.B, ~/C£ DESCRIPTION · -~! ~Ss 7~,5Z1% ,85.gpcf I ~ 8~OWS/FOOT BEDROCK TYPICAL SOILS LOG SAMPLER TYPE SYMBOLS BOU£DFRS IlCG MA~SIVF SOIL FI&IV] CONSULTANTS, INC.11 LOT 10, BLOCK 5 PRUEsS SUBDIVISION EAGLE RIVER, ALASKA ~DWG. NO A-O1 J Pitless Adapt¢ :, 18 Gravel, 6~'~ Wate~~ Lot 10, ~.'. cc?: 5 Preu~s ~;ubdivi~ion Rump set at 110' t~ed jacket ~ tiP, 13 stage Pipe galvanized ::ire - ~ 14 3 tend, 5O ~8 IIardpan ~and Bail tested at 20 G.i'.E, Drilled and log. ced by Bii:i o~ten~Mag::uson Drilling. :0 Static water 87, '8 ~4 8ngu].ar grave], and clay Some ~-~'ash gravel and silt Silty sand and gravel Drive shoe at i~w .02 LO8 ~11 MUNICIPALITY OF ANCHORAGE Development Services Department p p � _ Phone: 907-343-7904 On -Site Water & Wastewater Section �J Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-571-33 1. GENERAL INFORMATION Expiration Date: / 1- 3 "© ZC) Complete legal description PREUSS #3 BLK 5 LT 10 Location (site address) 20213 David Avenue Eagle River AK 99577 Current property owner(s) WIGGINS SABRINA & O'HARA KATHERINE Day phone Mailing address Real estate agent 20213 David Avenue Eagle River AK 99577 Angie Ferris 2. TYPE OF DWELLING: 0 Single Family (w wo ADU ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 907.223.5609 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic 0 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 $ ID (CIOV Waiver Fee $ Date of Payment �I a q b U U Date of Payment Receipt Number 03'75 5_ Receipt Number COSA # O S C r2 01 3-79 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 Eklutna Engineering, LLC Phone 907.355.9820 Address 19162 Mountain Rd Chugiak AK 99567 Engineer's Printed Name Curtis Townsend, PE Date .................... 6. DSD SIGNATURE � � 22 System #1 Approved for J bedrooms$ �.. ee •'r .......... rts ' • "� zJZ System #2 Approved for bedrooms Disapproved PROFESSESS Conditional approval for bedrooms, with the following stipulations: `g ON-SITE Gr Original Certificate Date: �3Zv 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 Checklist blue sheet Legal Description: PREUSS #3 BLK 5 LT 10 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA 7 Well log is filed with Onsite (or attached) Date drilled 1978 Total depth 111 ft Cased to 111 ft ❑ Sanitary seal is functioning correctly © Wires are properly protected Casing height (above ground) + 12 in. Date of flow test for COSA 7/812020 Static water level at beginning of test 80 ft. Comments B. TANK DATA Age of tank(s) 1 years Tank type/material STEP p€astic� Measured operating fluid level in septic tank © Standpipes/foundation cleanout per record drawing Date of pumping INSTALLED JULY 2020 D. ABSORPTION FIELD DATA Which system tested (date installed) Ju12020 liffil ALL standpipes present per record drawing Total measured depth from grade 13 ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field X Monitor tubes go to bottom of effective. If not, state depth into effective © Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: NEW FIELD INSTALLED JULY 2020 COSA Checklist yellow sheet Parcel 1D: 050-571-33 Structure served by this system _ Well production at time of test 4.9 gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes Q Nc 0 Coliform bacteria is Negative Nitrate 3.94 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by CURTIS TOWNSEND Date of Sample 7/8/2020 C. LIFT STATION ❑ Required maintenance completed Age of lift station < 1 years Lift station material PLASTIC Comments: INSTALLED JULY 2020 Adequacy test date Results ❑ Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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' Q Yes if No Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft 7 Yes if No Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' Yes if No Absorption Field on Lot > 100' Q Yes if No ft Holding Tank > 100' Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' Yes if No �✓ Yes if No ft if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 7 Yes if No ft Q Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' F✓ Yes if No ft Surface Water > 100' ft ft ft ft ft F✓ Yes if No ft Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No ft Private Wells > 100'dQ Yes if No. Water Main > 10' Q Yes if No ft Community Wells > 200' E✓ 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' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' 0✓ Yes if No Water Service Line > 10' Q Yes if No ft Community Wells > 200' Q Yes if No Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION t certify that / 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. iG?E,t OF Al COSA Checklist yellow sheet ....../ � ............. • ®> Curti; L Tow�so • . 9 Dao z: �+ Oi�, ..No. CES 1��� F ���PROiES510N��..® ft ft ft ft -' ,~;'~,:~'-~'~-~,? ~,- -~ ~*~..~ ~:'-DEPARTM~T OF H~LTH & HUMAN SERVICES?-'~ ~-~',-:~,;~-'~.~;.'.~;'~ ~-,~:~ ~',:.~- - age .... ~...~,;, ........... ., ~.~ .. ,.... ...... , . CERTIFICATE OF H~LTH AUTHORI~ APPROVAL FOR A SING LE FAMILY DWELLING 1. ';;.GENERAL INFORMATION ' ~., ..... ~,~-,;..,.:,, .;~;~ -~ ........ . '! .... ';!" L~catiom(s[te add~es~'br directions) ' · - '~' i ~',-~.. *~. ~. - ,- ' ' · ..... .~' ~, address. ~" ~PE OFWATER.SU 5. STATEMENT.OF INSPECTION BY ENGINEER,:,~..~ As cart f ed by n~y seal'affi~e'd hereto and as of the validation date shown:below, I verify that my 'i': investigation of this Health Authority Approval application shows that the. On-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my inves!i._gation and inspection, the on-site water supply and/or wastewate~ disposal system is n compliance with all Municipal and State codes, ordinances, and regu'iations in effect on the date of this inspection. Name of Firm ' S & s ENGINEERING 17034 Eagle River LoQ~o Reed Ne. ~4 Add tess ...,t~ ~;.~.~ ~..~.- eec~..-¢ Engineer, s signature~ ' .'~.~¢'-' ~.~ _ Phone ~"~'~- ~¢/7 ~ Date c~//~ /'f 5'-- ,,=.. ,~ '. ' ' ' ' Date" - ~-~'-- C_- ~ I'.;.'.~ - -..,..~ ~.., ~, '.,..:, .............. · : ' ' ,,.',:':,~,,,-~,:,,~.,...' - \ .'- The MtSn~ipality of~nChomge Department of Health and Human Seduces (DHHS) ~ssues Health Authon~ , '~,'A~boroval!~ertifi~a't~' ~'~l only' upon the representations given in paragraph 5.above bY an'independent 'I,. '/n~fessio~al ed~r~e~iStered in the State of Alaska, The DHHS does this as a ecu rtesy to purchasers of homes '~T~', ~,~,. ~,,¢,.' ,~:..7.,',~. -,,..-. . . ,.. . . . and t~Jet£11endmg msbtuflons m order to satmfy certmn federal and state requirements. Employees of BI-IHS do not cc~uct nsn~-~ct ons or ana ~Z~' ~l~ta before a certificate is issued. The Municipality of Anchorage is not '* "responsible for arrors~or'omiss~n~ in tb~ profass~ona e~g n~r's work.. .-,: .-.' ~ ': .. ,.:: 'f:.~. ,.~./ Legal Descript:on: Municipality of Anchorage '~°~,~°%,~, DEPARTMENT OF HEALTH & HUMAN SERVICES,, Environmental Services Division ~F/3 ? > . Ull/l~ 825"L" Street, Room 502 * Anchorage, Alaska 99501 · (907) ~}~-4744 Health Authority Approval Checklist A. VOgLL DATA Well type ~l~'.( Log present~Xr) Total depth I [ t ' Sanitary, seal ~rN) FROM WELL LOG If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~>¢-x~ (_,¢-~-"lB Cased to \\\ I Casing height (above ground) Wires properly protected ~ AT INSPECTION Date of test Static water level Well production Co WATER SAMPLE RESULTS: Coliform Nitrate '~,~ Other bacteria c.~ Date of sample: ~3 ~9- 9 ~ qg- SEPTIC/I4ObDD~ TANK DATA Collected by: _q & $ F_NGiI~I;;I=I)IIq¢ 17034 Eagle River Loop Road No. 204 Eagle River, Ala;ka 99577 Date installed Foundation Cl~an0~[ ~ ~// Depression (Y~ Date~t~;;Ump~ig': 5/4 :~d~.~ Pumper ABSOR~!6N. FreED DATA ' Date installed ~ ~ ~ ' Soil rating (g.p.d./fi2 or fi2~drm) Lengh Z~ t' Width ' ~, Y ~ Gravel thic~ess below pipe Effectiv~"gbso~fiOn area. ''~ ~ 7~ ~ Monitoring Tube presen~ Date of adequa~ test M~ ~ ~3~ Results CassWail) Tank size /ooo Number of Compamnents 2- Cleanouts(~x!) ~ High water alarm ~ ~,J /,2. System type ~,~f 77z~,/¢/g t./' '7 ~ Tot~ depth /~ - Depression over field ~ ~ For ~ beseems Fluid depth in absorption field before test (in.); ~ Immediately after gal. water added (in.): Fluid depth ~ Minutes later: (in.) Absorption rate = .- .g.p.d. Peroxide treatment (past 12 months) (Y~) t~j If yes, give date ~ ~'!//& D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES Size in gallons "Pump off' level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/tu~t4ag tattk on lot Absorption field on lot Public sewer main Sewer/septic service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Lift station 5" SEPARATION DISTANCES FROM SEPTIC/ItOLDING TANK ON LOT TO: Foundatiou /3 i Property liue ~5 ' Absorption field Water main/service line lc> t-h Surface water/drainage /oO t ~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation l / t Surface water ]0 0 ~ 4- Curtain drain /do ,,/~ /~/,,,/> ~,/~,J Water main/service line /~ Driveway, parking/vetficle storage area Wells on adjacent lots /o F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of~[unicipal rec~l~ ,.~i,.~v~-~tems are · m conformance with,~lO,~ .r~AJ).j~ideline3g~ effect on this date· Engineer s Name l{')OZ~ &~,'~ z- (~ ~,,,d,,~ ............................................................................ -~-~~ HAA Fee $'~'~ ~'~:=:~(./~ . c~ Waiver Fee $ Date of Payment . Date of Payment ReceiPt Number /c~ 7~"'"'- ~(~c:~(57~ ) Receipt Number Rev. 8/95 OSS: lma.wk.doc ~'~~ CT&E Environmental SerVices Inc. Laboratory Division :'-~ ~.~ ~-~-~ Laboratory Analysis Report C!len~ ~ample ID L~O BLK5 ~REUBB B/D ~3 Name ~ & 8 ~NG~NEBR~NG WOR~ Order i~Oje~t ~ame Collected Date 09/01/9~ ~ 15:40 h~. Teehn£'eal Director STEPMEN C. QC Allowable Ex~. Anal Paramm~sr Re~ult~ Qbal Units Mekhod Limits Date D~na Secondary dilution. GT m G~aa~e~ Than 200 W. Potter Drive, Anchorage, AK 99'618-1605 -- Tel: (907} fi62-23~3 Fax: (907) 561-5301 ~HVLRONMENTA~ FACILIT{~ IN ALASKA. CALI[ORNIA. FLORIDA, ILLINOIS. MARY~ND, MICHIGAN, MIS$OURI, NEW JESSEY. OHIO, WIST VIRGINIA BCE 'ON IIEIP69A86 ~ ~NIISBi ]~I3~BHWO3 AC:SI ~6/I~/6M MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot I0; Block 5; Preuss Subdivision ~3; Location (address or directions) 20213 David Aver~,~e (b) Property owner Metmor International Telephone: (home) Mailing Address Overland, KaMas Business (c) Lending Institution Mailing Address Telephone (d).Real Estate Company and Agent Century 21-1nternational Attn: 1120 Huffman Road, Anchorage, Alaska 99516 Address Janice Mitchell ,?T~lephone 345-1444 (e)'Mail the HAA to the following address: (or check hereX~ if hold for pick up.) List contact person and day phone number below: $ & $ ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family [;~gK Number of bedrooms 3. WATER SUPPLY Individual Well I~x. Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conse~:vation attesting to th legality and statuS. 4. sEWAGE DISPOSAL On-site ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-o25 (Rev. 7/88) Page I 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, l 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 hereim 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 S & S ENGINEF-RING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 9957~7 Telephone 6. DHHS APPROVAL Approved for ~-~ bedrooms by Approved ~/~. Disapproved Terms of Conditiona! Approval Conditional The MunicipalityofAnchorage Department of Healthand Human Services(DHHS) issuesHealthAuthorityApproval cerificated based only upon the representations given in paragraph5abovebyan 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 DHHSdo not conduct inspections or analyze data before a certificate is issued. TheMunicipalityofAnchorageis not responsibleforerrorsoromissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 A. WELL DATA Well Classification Well Log Present (Y/N) ___~___ MUNICIPALITY OF ANCHORAGE (MOA) Health,~l~[ly Approval (HAA) ~NV t~OH~.NT AL ~r"" 343-4744 Legal Description: Date Completed Total Depth / I I Cased to Static Water Level ~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) If A, B, C, D.E.C. Approved (Y/N) ~ ~J_..o--'~'~ Yield -7, '~ · . . Depth of Grouting Pump Set At L.) (.~ ( ~ "~ Sanitary Seal on Casing (Y/N) · ~ Depression Around Wellhead (Y/N) / ; On Adjoining Lots / ~ --~ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole / /oo SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot / --~ --~ To Nearest Edge of Absorption Field o~n Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~-g-'~¢ Size / (~OO No. of Compartments Standpipes (Y/N) ~ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) / Foundation Cleanout (Y/N) Date Last Pumped /L)//~. ,'for Temporary Holding Tank Permit (Y/N) /-)///~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line / ,/0 "f' To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments To Building Foundation To Disposal Field 72-026 (Rev. 7/88) Fronl Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date installed ~¢ - L~,/,~/(~'-~ Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well / ~ ~ Type of System Design Length of Field Depth of Field ~avel Bed Thickness ' {'.2_ .~ (~ Z~ Statndpipes Present (Y/N) ¢~ ..- Date of Last Adequaqy Test To Property Line To Building Foundation Lot ~J/~ ; On Adjoining Lots To Water Main/Service Line / O -k To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ~ ~ -- To Existing or Abandoned System on Comments 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) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all 'MOA and HAA guidelines in effect on the date of this inspection. Signed Company $ & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Aias[(a 9957] Date MOA No. Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order $ 20820 Date Report Printed: APR 5 90 ~ 10:26 Client Sample ID:LiO; BK 5; PREUSS PWSID :UA Collected APR 3 90 @ 12:30 hrs. Received APR 4 90 @ 12:40 P~eserved with :AS REQUIRED Client Name : S & S ENGR Client kcct : SNSENGP P.O.~ NONE RECEIVED Req ~ Ordered By : R. SHAFER Analysis Completed :APR 4 90 Send Reports to: Laboratory Supervi~or.:STgPHEN C. EDE 1)S & S ENGR Special Instruct: Chemlab Ref $: 900788 Lab Smpl ID: I Matrix: WATER Allowable Paramete~ Tested Result Units Method Limits NITRATE-N 2.2 mg/1 EPA 358.2 10 Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY R.D.J. ...... ===== .....==================================================================== .... ========= ...... 1 Tests Performed * See Special Instructions Above UA=Unavailable ND= None Detected ** See Sample Remarks Above NA= Not Analyzed LT~Less Than, GT=Greater Than ~_,~.~; MUNICIPALITY OF ANCHORAGE ~'~r DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) (b) (c) Location (address or directions) Applicant Name ~J~m~l ~ ;~_-,'"i'~ Telephone: Home Business ~%, . Applicant Address li2o ~_"~/¢~.¢~.-tf~-'~.J~,/CC--- Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; OtherJ~ (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) ~AA to the following address: - · 2. TYPE OF RESIDENCE Single-Family~ Multi-Family [] Other ~ Number of Bedrooms '2~ . I _ 3. WATER SUPPLY · Individual Wel~ Community [] Public [] -L -:' : ' ' Note: If community well system, must have written confirmation from tho State Department of Environmental Conservation ' attesting to the legality and status. 4.' SEWAGE DISPOSAL Onsite,~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 12-025 (11/84) Page 1 of 2 ENGINEERING FIRM PROVIDI~-~"INSPECTIONS, TESTS, FILE SEARCH, DA~'~A AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigaticn 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 Telephone S & $ E~gt'neer~r~ Address ~E~ ,,~ .... Date DHEP APPROVAL //,_.-..~ -",,¢~ ~ ' ApproYed for ~, ~.~4edroo ms by/~/~ ~~at Approved ~ ,~ Disapproveq 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 the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 [11/84) WELL DATA Welt Classification Well Log Present(~:N) t Total Depth ~ ~ \ Static Water Level Casing Height Above Ground Electrical Wiring in Conduit Separation Distances from Well: To Septic/l-~ Tank on Lot MUNICIPALITY OF ANCHORAGE (MO"A') HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~ Cased to ~ ~. \ ~4 IfA, B, C, D.E.C. Approved (Y/N) Date Completed '~Z'rc>l'L-' L~ - L, - '7 ~' Yield Depth of Grouting ~ Pump Set At ~ ~ Sanitary Seal on Casing ,~N) Depression Around Wellhead (Y/~ \ '~'¢'~ ; On Adjoining Lots To Nearest Edge of Absorption Field on ct ["~'~ ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole ¢' To Nearest Sewer Service Line on Lot Water Sample Collected by '~-~-~---~ '~1!%~"¢--~'' ; Date ' '~ Water Sample Test Results Comments /~ B. SEPTIC/H.OL-DI~'GCTANK DATA Date Installed 142 ¢~ ""~ ~ Standpipesf.~N) Air-tight Caps CN) Depression over Tank (Y~j~) Pumping/Maintenance Contract on File (Y/N)I,,3 i. Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/HC'4in9 Tank: To Water-Supply Well I 'Z.'~ J Size t ~ No. of Compartments Foundation Cleanout (Y/.~) ~ Date Last Pumped t, ~ ~ \ t,.-~/~ ;for -- -- Temporary Holding Tank Permit (Y/N) To Property Line To Water Main/Service Line Course 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 '~ ~'l¢'~z~"~' Type of System Design Date Installed ~ ~ L4, ~ "'7 ~ Length of Field '~-'Z-~ I Width of Field ~'c::~~ / t-_ Square Feet of Absorption Area Depression over Field (Y(~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line Depth of Field [ "7._- Gravel Bed Thickness r~ Standpipes Presentd~/N) Date of Last Adequacy Test To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line To Existing or Abandoned System on ; On Adjoining Lots .~ t jo To Cutban_k/(if present) f~/~ 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 ** certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed S ~, ~ ~'--, ..... , .... Date Company S~ ~96x MOA No. R ceipt No. Date of Payment ~' J ~ -~ Amount: $ ~ Page 2 of 2 72~026 (11/84) r--' - DA~'~'E RECEIVED TIME TIME \ \ /~ TIME ! INSPECTOR CT I NSPECTO~ MUNICIPALIJY ur ~NCHO~AC~ ~UNIClPALITY OF ANOHOBAgE D~PT. OF HEALTH & DEPArTmENT OF HEALTH & ENVI BON~ENTAL PBOTEOTIO~JRONMENTAL PROTECTION 825 LStreet-Anchorage, Alaska 99501 JUN I 9 1981 ENVIRONMENTAL SANITATION DIVISION ~EQUEST FO~ APPROVAL OF INDIVIDUAL ~ATEB AND 8EWEB FACILITIES DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be pro~essed. Please allow ten (10) days for processing. MAILING AD~ESS PROPERTY RESIDENT (If different from above~ PHONE PHONE MAILING ADDRESS 3, LENDINGINSTITU~ON J PHONE I MAILING ADDRESS 4. REALTOR/AGENT J PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION Z o-~--lb STREET LOCATION 6. TYPE OF RESI~)ENCE J~, SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four [] Two [] Five [~ 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** ~, '~ '~7 g [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL;USE ONLY 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [~] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED.. 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED Connection Verified INSTALLER Size: /Oe~)O If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tan k IAbsorption Area ISewer Line [ Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS [~APPROV ED FOR -~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY 72-010 (Rev. 6/79) 825 "L" STREET ANCHQRAGE, ALASF~A 99501 (907) 264 4111 June 26, 1981 Curt/Darlene Lind % Joe Ravenel Post Office Box 4-1115 Anchorage, Alaska 99509 Subject: Lot 10 Block 5 Preuss Subdivision #3 Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: (1) The water analysis report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. (2) The septic tank pumped with a receipt submitted to this office. If there are any further questions, please call this office at 264,~4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw CC: Alaska Statebank 310 East Northern Lights Boulevard 99503 ~-' ~: ' MUNICIPALITY OF ANCHORAGE t ~" ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION  ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete aH parts on page 1, Incomplete requests will not be processed, Please allow ten (10) davs for processing, PHONE MAI LTNG ADDRESS PROPERTY RESIDENT ( f different from above - ~ PHONE PHONE 2. BUYER MAILING ADDRESS 3. LENDING INSTITUTION I PHONE I MAILING ADDRESS 4. REALTOR/AGENT ~ I MAILING ADDRESS :']:1:5 5. LEGAL DESCRIPTION ;TREET LOCATION 6. TYPE OF RESIDENCE ~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] One [] Four [] Two [] Five ~ Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. Awell 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 [~r INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY **If individual/on-site, give installation date 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, 72~10(3/78) THIS SIDE FOR OFFICIAL USE ONLY DA-iR RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME -- DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [~ SINGLE FAMILY [] ONE J~ THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX WATER SUPPLY ERM,T NU ER [~'IN DIVI DUAL DEPTH OF WELL I11 [] COMMUNITY DATE DRILLED_ [] PUBLIC UTILITY Connection Verified LOG RECEIVED VIDUAL/ON -SITE DATE INSTALLED Connection Verified .. INSTALLER I~eptic Tank or [] Holding Tank G~ Size:_ /©0~ If Tank is homemade SOILSRATIN "· give dimensions: TYP~ MANUFACTUR E~ I 4 DISTANCES ! Septic/Holding Tank JAbsorption Area Sewer Line [ Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS [~]'~-~APP R OV E D FOR ,~._) BEDROOMS [~] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev, 3/78)