HomeMy WebLinkAboutPREUSS #3 BLK 6 LT 8 Municipality of'Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program, 4700 S. Bmgaw St.
P,O, Box 196650 Anchorage, AK 99519-6650
www. cLand~orage.ak, us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number:
Address: . -- _ __
LEGAL DESCRIPTION
Township: Range:
Well: [] New [] Upgrade
C~flcahon (~vate. A. B. C): / I ToP~a De~th: ICa~-~d I~
.' / UPMI FI.I FL
SEPA~TION DISTANCES
Septic Lift Holding
Tank Statfon Tank
Surface Water
Lot Une
Foun=ahon
Curtain Dram
S & S ENGINEERING
170:~4 Eagle River Loop Roed, N~2.04
Inspections performedb'y: ............ ua[es:
PID Number:.. 0 ~-~"' .~7/- /
Wastewater System: [] New .J~[.Upgrade
ABSORPTION FIELD
,SmlRa~Jng: O'~GPI3/F, '7 Ft.
C.-av~ vad~: ffFt, Nurree~.~O~lines: Distance belween lines:
Tota~ a~=..~ ama: ., Matedat:.
TANK
I~Sepl~c [] Holffmg [] S.TJE.P. [] Other.
LIFT STATION
JCapa~
'~ on' level aC in'~t: in.
BENCH MARK
lOP
Development Services Department Approval .-
Reviewed andaoprovedby: ~,/,/~/,.~/' /~./ ~~ate: ~ /Z'O?
PERI, lIT NO. SW040009 PAOE 2 OF ,3
Nlunicip. o,[i-'cy o-F' A~qchor'o. oe
DEPARTMENT OF HEAl_TH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 eAnchorage, A[ask~ 99519-6650eTe~ephone: 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAl. LOT 8, BLOCK 6, PREUSS S/D #3 P.I.D. No. 050-571-21
~ II ~ oo' W£LL
RADIUS
I m A ~ g __NEW 1250 GiLLON '
~1 / ~ ~ ~ /SEPTIC TANK _LON~ -- I
~' / ~ ~ ~ / / ~ ~~ ~,w~k~ I' t I
FS (FLOW ~T~ .E~'&~U ~
I ~1. SPL~TER)~~~ ~ ~- ~ ~
I ~1 co3' '~ ~ - ~ ,
~ I I SEPTIC~ r X ~D~us '
}~¢ ~ /X X 1 ~~2.;: ......... ':.t7¢~
I I / ~ ~ ~ ~,~ RO~E~? C. COWAN /.m
/ ~,~N ~,~, c~-88o] .z~
,,"
PERMIT NO.SW040009 PAGE 3 OF 3
Hunicip. atit:: oF A choraae
DEPARTMENT OF HEA:[.TH n
AND HUPTAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.D. Box 196650 e Anchor"age, Atask~ 99519-6650·Te!,ephone~ 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION
REPORT
LEGAl., LOT 8, BLOCK 6, PREUSS S/D #3 P.I.D. NO. 050-571--21
FINAL
ST1 ST2 / 97.7'
.... / ~ NEW 1250 I~ ~ ~
95.8"I GALLON I'' 93.6'
I SEPTIC TANK I
CO1 C03
C~02nMTi~co1 = 98.0' C04 MT2 ~,'",",~ - no ,,'
11 IL. = Iq -
' , C03 = 93.0
2 = 93.2 cCo0~3 : 93.0'
~MT1-- 89.2' '~-MT2 ==89.0'
A B C
'FCO 10.5' 17.0' -
ST1 16.0' 28.0' -
ST2 23.5' 34.0' -
DBL1 25.5' ,35.0' -
DBL2 26.5' 36.0' -
DV 27.0' 36.5' -
FS 31.0' 31.0' _
C01 21.5' 18.5' -
C02 54.5' - 60.5'
CO,3 33.0' ,32.0' -
C04 61.0' - 75.0'
MT1 5,3.0' - 59.5'
MT2 59.5' - 7,3.0'
WATER FOUND ®
81.0' B.O.H.
83.0'
N. T. S.
Performed Fnr'
Legal Description:
5-
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COMMENTS
Slope
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci.anchoraqe.ak,us
(9O7) 343-7904
Soils Log - Percolation Test
?~,~c
Date Performed: ~/ /c:~ ~ /O~"/'
/~R ~-v55 '~3 Township, Range. Section:
Site Plan
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT DEPTH? L
O
Depth to Water After ~ p
Monitoring? E
Date: ~
Reading Date Gross Time Net Time Depth to Water Net Drop
o _ _
70 ,~0 ~ Io " ~
3 o ~ ~ '/~" -
~0 10 ~,~ lO '/e~ ~ "
I~0 ~o ~.~
PERCOLATION RATE ] ~ (r~nutes/inch) PERC HOLE DIAMETER ~.,"
TEST RUN BET~VEEN '~ FT AND, ~ FT
PERFORMED 13~'& $ EI~jGIN£ERING I ~Z ~'~__~ CERTIFY THAT THIS TEST WAS,'
PERFORMED II",,I~~~CI~["I~LI~II'~,~IN~O~JNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: J (/' '~..'~ /O '~
Eagle River, Alaska 99577
ROBERT C. COWAN,'RE.
ROBERTA. SHAFER, P.F.
February 3, 2004
CIVIL ENGINEERS
. (907) 694-2979
FAX (907) 694-1211
HEALTH AUTHORI'W
N~W~OVN. S
SEWER & WATER
MAJN EXTENSIONS
SEWER & WATER
INSPECTION
E~IGiNEERING STUOIE$
AND REPORTS
WELL INSPECTION
& FLOWTEST
SITE PLAN~
ROAD DESIGN
~OILTE~T
PEnOCX.ATION
TEST
STRUCTURAL&
MECHANICAL
INS PECT1ONS
ONSlTE
WASTEWATER
[XSPOSAL. SYSTEM
DESIGN
MUNICIPALITY OF ANCHORAGE
Development Services Department
P.O. Box 196650
Anchorage, AK 99519-6650
REFERENCE: Lot 8; Block 6; Preuss Sub&v~s~on
Request you grant a waiver on the referenced property for the horizontal separation
distance between the leachfield and the south property line at 7 feet.
We do not anticipate any adverse effect on the adjacent property.
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
RCC/ts
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER. ALASKA 99577,
Municipality of Anchorage
Mark Begich, Mayor
Buildhlg Safc~, Dixqsion
P.O. Box 196650 · 4700 Bragaw Strcct
Anchoragc, Alaska 99519-6650 · (907) 343-8301 · F,'ux (907) 3-~3-8200
h ttl~://~v.munt.org
S & S Engineering
ATTN: Robert Cowan, PE '
17034 Eagle River Loop Rd,/1204
Eagle River, AK 99577-
February 11, 2004
Subject: Waiver Request forPREUSS/13 BLK 6 LT 8
Waiver # WR040006 Lot Line Request for Parcel ID 050-571-21
Dear Engineer:
Your request for a waiver of the required 10 feet horizontal separation of the on-site wastewater
disposal system to the lot line has been approved. The approved separation distance is 7 feet.
This waiver approval applies to the current on-site wastewater disposal system and lot line
separation only. Any future upgrade to the on-site wastewater disposal system and lot line will
require all separation distances to be met or another waiver approval from this department.
If there are any further concerns or questions regarding this Waiver, please call our office at
343-4744.
Engineering Technician III
On-Site Water Quality Program
Municipality of. Anchorage
Development'Services Department
Building Safety Division
On-Site Water and Wastewatcr Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci.anchorage, ak. us
(907) 343-7904
Waiver Review Worksheet
WR#: 040006 PID#: 050-571-21
HA#: 040038 Permit: 040009
Date Received: .2/9/04
Legal Description: Preuss #3 Block 6 Lot 8
Engineer: S & S Enqineerin.q
17034 N. EaRle River Loop Ste. 204 EaRle River, Ak. 99577 ..
Applicant: Tim Griffiths
Waiver Requested? feet separation distance absorption field to property line,
Criteria: Geology Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm~mmmmmmmmmmmmmmmmm~mmmmmmmmmmmmmmmmmmmmmmmm
Waiver is Granted: ~_/ Waiver is not Granted:
List Conditions or Reasons for above:
~/~ of Reviewer .
mmmmm~mmmmmmmmm~mmmmmmmmmmmmmmmmmmmmmm)m~`mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm!
Rec-//: 2.9-04 Amount: ~175.00 Date Pald: 2-9-04
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Jan 26, 2004
Expiration Date: Jan 25, 2005
Permit Number: SW040009
Legal Description: ~II:~.REUSS '#3 BI.:K .76/T.78 '
Design Engineer: 0003 S & S Engineering
Owner Name': Tim Griffiths
Owner Address: 10208 Wren Lane
Eagle River, AK 99577-
Parcel ID: 050-571-21
Site Address: 010208 WREN LN
Lot Size: 22922 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
~-~ Disposal Field r7] septic Tank
Holding Tank r'-I Privy
Private Well
[] Water Storage
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 ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By: *'~f'~ ~"~- ~
Date:
/ /' · ~
Date: //Z ~;/O'
/ ~
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
w,c~v.ci.anchorage.ak.us
(907) 343-7904
' ':"'--' ON-SITE SEW~R/VVELL PERMIT APPLtOATIC--4,1-
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
Permit Number SW O'~OO0 ¢~
Property owner(s)
~7--I ~ F:: I "I-'P-I ~' Day phone
Mailing address (1)
Mailing address (2) Zip Code
Legal description (Lot. Block & Sub'd.) L..o'~ ¢! ¢10~. ~"~., P/'-.E.U_~...%
Legal description (Section, Township & Range) / O~O~ ~ ~ ~
Lot Size~, ~ =~ Acr~ Number of Bedrooms, ¢
THIS
APPLICATION IS FOR:
Sewer Only D Well Only r-~
Sewer and Well ['-1 Water Storage []
Sewer Upgrade [~
THIS
PROPERTY CONTAINS:
Hot Tub D Jacuzzi []
Swimming Pool ~ Water Softening Unit []
Therapy Pool E]
C q q-
I certify that the above information is correct. I further cedify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
-. 17034 Eagle River Loop Road No. 204
=.~~. ~t .... ~a;ka 29577
(Signature of property owner or authorized agent) ";~"
Permit Fees: ~ /'¢ ~. 0. ~' o Waiver Fees:
Date of Payment: I / ,3. 3-./o ~¢ Date of Payment:
Receipt Number: (2 ~ ~, ~ '7 '7 C.~'"~. Receipt Number:
(Rev. 12100)
ROBERTC. COWAN, RE.
ROBERTA. SHAFER, RF.
January 22, 2004
CML ENGINEERS
(907) 694-2979
FAX (907) 694-1211
SEWER&WATER
MAJN EXTENSIONS
SEWER&WATER
INSPECTION
ENGINEERING STUOIES
AND REPORTS
WElL INSPECTION
& FLOW TEST
SITE ~.ANS
SOILTEST
TE~T
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTE'WATER
DISPOSN. SYSTEM
DESIGN
MUNICIPALITY OF ANCHORAGE
Development Services Department
PO Box 196650
Anchorage, AK 99519
REFERENCE: Lot 8; Block 6; Preuss Subdivision//3
It is requested that you issue a permit to replace the existing septic tank nvith a new
1300 gallon HDPE septic tank and install new trenches to serve the existing four
bedroom dwelling on the referenced property.
One test hole was excavated and a percolation test performed. A second percolation test
is proposed to be performed during construction, as shown on the test site plan. At the
time of excavation, 1/12/04, no water was found, and after groundwater monitoring,
~vater was found at 13 feet.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas, or drainage patterns by the installation of the proposed septic tank. The
installation of this trench will not prevent any future development on any of the adjacent
properties.
If you require additional information, please contact us.
Sincerely,
Enclosure
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER. ALASKA 99577.
Performed For:
Legal Descdpticn:
10-
11-
12-
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14-
15-
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17-
18-
19-
20-
CO,",tMENTS
Municipality of Anchorage
Development Services Department
Building Safety Divisicn
On-Site Water and Wastewater Program
· 4700 South Eragaw SL
P.O. Box 1-e6650 N~c~crage. AK S9519-6650
www. d.anchcmqe.akus
(~7) 343-7,~4
Soils Log -Percolation Test
'.(~.tF-~ T"H' $
dSG,
Slope
1~~ 5 -~ Township. Range, Sect]cn:
Site Plan
WAS GROUND WATER
E~COU.~ITEF. ED? /~O.
$
--'-' L
IF YES. AT ~T DEP~? O
Depth toWater A~er · I p
Monitoring? I ~ E
Gross Time
0
Net Time
7'0
0 0
~o
FF.R~OLATIC,'I PATE ! '~ =~-'~ctes.~,ch) r'" FERC HOLE DI.Z~'JETE.=,
TESTRUN ~.EP,~-~t', ~FT AND 5' ¢ Fi'
Depth to Water
P~-P, FORMF?.DBY: ~ ~"~'~,,,.)6~1,J~[_/~¥ 2.,~, ~'~,,~ CF_RTI~Y THAT THIS TES,~ WAS/
· ~ ' ~ ~A~ ~',,D~'U,'qCIPALGUD LINESIHE"' C, ONTnlSDA,E DAT
P~RFOR ~I=_D IN AcCo~ANCE~/ITHA--S- -E ' ,, =_ ' , ~E - '~ .- .
ROBERT C. COWAN, RE.
ROBERTA. SHAFER, RF.
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
II, INN EXTENSIONS
SEWER&WATER
INSPECTION
ENGINEERING STUOIES
AND REPORTS
WELl. INSPECIION
& FLOW TEST
~ITE FI. ANS
ROAD DESIGN
SC)IL'TEST
PERCOLATION
TEST
8TRUCTUP. AL &
MECHANICAL
INSPECTIONS
ON SITE
WA~TEWATER
DISPOSALSYSTEM
IF_SIGN
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
REFERENCE: Lot 8; Block 6; Preuss Subdivision #3
January 16, 2004
GENERAL:
The scope of this project includes the replacement of the existing septic tank
with a 1300 gallon HDPE septic tank and installation of new trenches to serve
the existing four bedroom residence located on the referenced Property.
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 settling.
e
Contractors installing 'wastewater disposal systems must be certified by the
Municipal Health Department for system installations. Owners installing their
own systems must also receive prior approval from the Municipal Health
Department.
SEPTIC TANK INSTALLATION:
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 s~ttling or shifting of
the tank.
17034 NORTH EAGLE RIVER LOOP · SUITE204 * EAGLE RIVER. ALASKA 99577,
Page 2
Lot 8, Block 6, Preuss Subdivision #3
January 16, 2004
All 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:
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.
o
Once the gravel is installed, the distribution pipe is to be installed level with the
perforations faced doxvnward. Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
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.
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.
Page 3
Lot 8, Block 6, Preuss Subdivision #3
January 16, 2004
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
.Type of Pipe
Cast Iron
ASTM D3034 (PVC)
ASTM F810 (HDPE)
ASTM D2662 (ABS)
Perforated Solid
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).
Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or
equal).
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.
All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3%
passing the #200 sieve.
When sand is being used as a filter material, its gradation specifications must conform to
current M.O.A. or D.E.C. requirements, which ever requirement applies.
Page 4
Lot 8, Block 6, Preuss Subdi¥1slon #3
January 16, 2004
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:
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.
The second inspection must be conducted after the placement of the silt barrier,
gravel, distribution lines, standpipes, cleanouts, and insulation, but before the
placement of any other backfill.
3. The final inspection is to occur upon final grading of the proPerty.
Often there will be more than these 3 inspections required. Especially with the installation of
multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer
is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-
construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or
control in any xvay 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.O.A. 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.
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
'. ' o GRB :R ANCHORAGE AREA BOk%. ~$H
/ ~ Department of Environmental Quality
3330 13 Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DIS,POSAL SYSTEM
NAM~0mf~f~._ d"~'f~r/(MAILINGADDRESS /I ~ C~i uiLLc f~,~
SEPTIC TANK:
DISTANCE /(~
FROM WELL
INSIDE LENGTH
~'/~INSIDE WIDTH ,/~LIQUID DEPTH LIQUID CAPACIT/_~-~::~LLONS.
TILE DRAIN FIELD: f
DISTANCE FROM WELL rio FOUNDATION
NUMBER OF LINES / DISTANCE BETWEEN LINES
ABSORPTION AREA ~ ? ~----~
£
NEAREST LOT LINE
OF LINES ,.~ ~,~
t~//~ TRENCH WlDTH~IN. TOTAL EFFECTIVE
SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE~_~MATERIAL BENEATH TI IN.
WELL, .
TYPE~~-~~ CONSTRUCTION ~~ DEPTH ~ } DISTANCE FROM:
BUILDING
FOUNDATION
NEAREST ~' NEAREST
LOT LINE I ~ , SEWER LINE
CESSPOOL ~ , OTHER SOURCES
APPROVED ~.O~ SAPPROVED
SEPTIC/o~ I SEEPAGE
TANK , SYSTEM
REMARKS
DISTANCES:
SEWER LINE DEPTH:
PIPE MATERIAL: j~~
REMARKS: ¢)~/Z
DIAGRAM OF SYSTEM
~,Z= ?
DATE ~/~//~¢APPROVED ~~~ <
Form EQ-032
I- EP. i' I.[ T
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i - , - '- F' E F:'[::'
THE aI:,I4,E.L [:,EI::'TH IS THE HIN]:HLIH [:,EF'TH OF _~F;..-t,E.L BETt,.IEEN THE OUTFFH-I ....
RN.F.:, THE E',OTTOH (iF "I"HE E::.,X'.::Fi',,,'F:IT ]: ON ,'.:[ I'.,I FEIET ::,.
'qF D..-.ll ,-~, ,:: ;22: z:, IL' E'-,4i ~2~; F" ~E ,3Z: -'~'"' ~: L. D-,,~ .::. F~ ~;~:; ~:: ...............
E:FaCH:ZF I L..L I NG OF FtN"r'
DEF'RRTHEN'f' I.,.I :1: L..L E:E SUE:.]'ECT TO F'[~:O2];EIZ:I...IT ]: O~'~.
H]:NZMUH [:,ISTFINCE E',ETHE:EN Ft 14El. J... RN[:, RN"r' Ob4-S]:'T'IE EF!.,.IRGE E,]:%[::'O%I:IL ' .... :"
:LOO FEET FOR FI F'I:~:Z',,,'IaTE HELL. DR' 2EO FEET FOR R F'UEL]'C t.,.IEI..J ....
HEI..J~.. LOG:5 RRE RIEQLIZI:~:EE:' F¢'4[:' Ftl...I:~ST E:E: R:E:TI.JR:NE[:' TO THE [::,EF'IRF:THENT Hi"t"FIZN ':~:O E,FI"r':~;
OF THE WELL
5;F'E C Z F ]: E:F~T ]: Ot",IS
[ NS"f'RLLF]T I ON.
F" EE fl~: ~'""~ % 'T' %-" F~ L... :[ ~::" F-' fl:'jZN ~:~: C~ ~,,H ~% %.." E: ~2~ ~;~;: F" ~:~:: ~':"jH k"-D % ?:: ':::~; L..ll lEE
:[ _.ED. t ]. F THFIT
:L: I F1M FFli"I]:L. IFfl:;-: HITH THE. F.:EQL.I.T.I;.:EHIEI'.,ITS FOF.: EH'.4-E;ITE :SEt.,.tti.-;:F::S f:l~.4[::, WF:.::LJ...S R~.:; E;E'T'
FORTI~I E:"r' THE f'lUl",l :[ C ]: I::'FIL I T"r' CIF: FII'..!CHOI';.:FIGE.
2: I HILL :(NSTRL. L- THE '"_'-;'-r'STEH ]:1"4 FtCCEIF.':[:'RNCE !.,.II:TH THE "'.3t)ES.
.:, 'r ..., f Ei'l HFI'T' R'IE[.:!L.I :[ I;~:E: Ei'.41....F:tR:GI:Z!'IE:f'4T '[ F 'T'HE
2:: ~ UNDEF:'.STFII",ID THFFf' THE' ON'-':.'?;.1: 'FE SEWEF.: '-" ,c'"' , . ..
RES :[ [:,ENE:E I'..:.; I:~'EHO[:'EI E E:' TO :[ NCLUDE HOF'.':E "FHIgN 4 E;E[:'Fi:L3(Eff'I::-;.
"One test is worth a thousand opinions"
/204 Cleveland Anchorage, Alaska 99503- _j/
Performed For /~~"~~F~F.~ Date Performed F/~//;~
Leaal ~escription: Lot F Block Subdivision~~
This ~orm Renorts Soils Loq' ~ Percolation Test
~enth
Feet &~_~ Soil Characteristics
2 -- ~'~
4
6
8
18.
2O
Was Ground Water Encountered?~__~
I¢ Yes,~ At what Denth?
--Readinq Date Gross Time Net Time Depth to H20 Net Dron
Percolation Rate Hinute
Proposed Installation: Seenaoe Pit Drain Field
Den, th of Inlet . Deoi;h To Bottom~Of Pit Or Trench
T-~s~ Performed Data Certified BY:
J-o f ~5'"~'~- / Date:
DP, ILLI
~ ' '~ '~)RILLING
Owner ,'J' i,~ ..... ~':
~Lo~ation (add)'ess of: Township, Range,
( : );
rHstance malrt
Lot 8 Block 6 ProOfs r ~ ~ ~
,., ?._. ,- .... :. -., .~ ~;. C,-';~' ~7';%' :)'?~' ',~ d,¥~'.-,~;'~:;/~'/t~~
~pth o( Hol,
Perforated
test at 5 gallons t
from static
Ion,
WELL LO(}
mrfece Give details of tormatlom ~netr~t~, ~lze of mate~al, color ~d ]
97
102
,.Wet firav~!
• Municipality of Anchorage =�a
On -Site Water and Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050-571-21
1. GENERAL INFORMATION
Complete legal description Preuss #3 Block 6 Lot 8
Location (site address) 10208 Wren
Expiration Date: (p _3 C9 _2c9 20
Current Property owner(s) Curt & Kelley Strobel Day phone
Mailing address
Real Estate Agent
10208 Wren Lane Eagle River, AK
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
WaiverNariance request for:
4
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual
Holding Tank
❑
Community
❑
Public Sewer
❑
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 55-0 Waiver Fee $
Date of Payment J? 1 /-9 ()o2y
Receipt Number Zt q2Q
Date of Payment
Receipt Number
COSA # dS cab r 072 Waiver #
Distance:
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 ARCTERRA CONSULTING INC.
Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577
Phone 696-6111
Engineer's Printed Name KENNETH M. DUFFUS Date
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate
during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are
subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future ® �®
occupants or can ArcTerra guarantee that no unseen lap, OF A�
encroachments, deficiencies or discrepancies exist. O ,, I
6. DSD SIGNATURE
System #1 Approved for.
bedrooms.
System #2 Approved for bedrooms.
Disapproved.
KENNETH M. L U
71
'OFE, s t0 �� E
Conditional approval for bedrooms, with the following stipulations:
,�� xT*,( OFtier (
By: ' �__e
`.
Nz
ON -Sl t t
MATER AND c"
W WASTEVATER z
Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10-10-12.doc
COSA Checklist
Legal Description: Preuss #3 Block 6 Lot 8 Parcel ID: 050-571-21
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system 1
A. WELL DATA
N Well log is filed with Onsite (or attached)
Date drilled 5/16/77
Total depth 340 ft
Cased to 340 ft
® Sanitary seal is functioning correctly
® Wires are properly protected
-Casing height (above ground) 29 in.
Date of flow test for COSA 3/4/20
Static water level at beginning of test 98 ft.
Comments Well scoped to 40' per MOA code
B. TANK DATA
Age of tank(s) 1/29/04 years
Tank type/material Septic/Steel
Measured operating fluid level in septic tank 44"
® Standpipes/foundation cleanout per record drawing
Date of pumping � '? —2Z Z@
D. ABSORPTION FIELD DATA
Which system tested (date installed) 1/30/04
® ALL standpipes present per record drawing
Total measured depth from grade 8 ft (max)
Measured depth to pipe invert from grade 5 ft (min)
- ❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective 3'
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:
COSA Checklist yellow sheet
Well production at time of test 4.4 gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes N Nc
® Coliform bacteria is Negative
Nitrate 11.8 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L 2 Arsenic less than MRL (ND)
Collected by Arcterra Consulting
Date of Sample 3/4/20
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 3/4/20
Results ❑✓ Pass For 4 bedrooms
Fluid depth prior to test 0 in
Water added 600 gal
New depth 0 in
Elapsed time 1- min
Final fluid depth 0 in
Absorption rate 600+ 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'
® Yes
if No
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
[0 Yes
if No ft
Neighboring Tank > 100' .® Yes
if No
ft
Private Sewer/Septic Line > 25'V Yes
if No ft
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' ® Yes
if No ft
® Yes
if No
ft
ft
if septic tank is under driveway
comment below
Manure/Animal Excreta Storage > 10Q'
Community Sewer Main > 75' ®Yes
if No
ft
® Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
® Yes
if No
ft
Surface Water > 100'
® Yes if No ft
Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
ft Community Wells > 200' ® Yes if No ft
Absorption Field > 5'
® Yes
if No
ft
Private Wells > 100'
® Yes if No ft
Water Main > 10'
® Yes
if No
ft
Community Wells > 200'
® Yes if No ft
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'
❑ Yes
if No V7'
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 ft
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
1: Waiver was granted in 2004 Waiver r WR040006
G. ENGINEER'S CERTIFICATION
1 certify that 1 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.
COSA Checklist yellow sheet
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 907-343-7904
On -Site water and wastewater Section Fax: 343-7997
www.muni.org/onsite
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC201098
Subdivision: Preuss #3, Block: 6 , Lot: 8
A water sample revealed a nitrate concentration of 11.8 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 and can therefore be used to gauge the relative quality of water
from private wells. Please see the attached "Nitrate Fact Sheet" for important
information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
Madmg Address P t0 Box 196650 *Anchorage, Alaska 94519 6650 * www muni or`g
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.
Ma�hng Address P� O�Box 196650 * Anchorage,�Alaska 99519 6650 * www muni org S
gni-.-..J ..'�.� wsr"�. b,w ,. �%..°�.v. �d a.. ^�? _ ....'-a.. a,,;'v,.� �5w �:�„`:.,.. a �.. .zant S•J'mati• .Alw .a,=: F ^,�sa�.w.sm...,:� .:. '.:.,5.,. �� .. .�,.�.v..x..<;=�.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage. AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AU'I"HORITY APPROVAL-
FoA A SINGLE FAMILY DWELLING
Parcel I.D. 050-571-21
GENERAL INFORMATION
Complete legal description Lot. 8; Block 6;
Location (site address or directions) ' 10208 Wren
Expiration Date:
Preus s"Subdivi sion
Ln. Eagle River~ AK
Current Property owner(s) Tim Grif~iths
Day phone 325-206-1234
Mailing address
Lending agency
Day phone
Mailing address
Real Estate Agent L-I ,, W,r,-'~ ,', ,-,-,',,-, Day phone ~;/, ,;-an '~ 5
Mailing Address Dynamic Prop. 702 Barrow St~ Anchorage, AK 99501
Unless otherwise requesled, HCA will De held by DSO for pickup.
2; NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
~ Individual On-site ~
[] Individual Holding tank .'. []
[] Community On-site [--I
[] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Cedificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of A~aska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for propedies served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon reqdest, to homeowners. Cedificatbs of Health Authority Approval are
valid for 90 days from the date of issue for propedies served by a private or Class C well and may be reissued with
ne,,,/water sample results. (Certificates may be reissued for a period of up Io one year.with valid water samples.)
Certificates are valid for one year for propedies served by Class A or B wells or a public water System. The
Municipality of Anchorage is not responsible for errors o? omissions in the pro[essional engineer's work.
Municipality: ot' Anchorage
Development ServiCes Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw st.
P.O. Box 196650 Anchbrage, AK 99519-6650
vvww.ci.anchorage.ak.us
(907) 343-7904
Bo
HEALTH AUTHORITY APPROVAL CHECKLIST
· - . .. N..z,
Legal ,Description: L.O i- ~ J';J L. oC,'/,C C ~/~ ~ uS ..( ~1 '-~/O Parcel ID:
WELL: DATA
Well type
Date completed
Total depth '3 ~ O ft.
Date of test
Static water level
Well production
If A, B, or C provide PWSID # ~
Saniiary seal CN) ¥/-"J'
Cased to ~ Ct'/- ft.
FROM WELL LOG
ft.
g.p.m.
WATER SAMPLE RESULTS:
,. Well Log ii,N) "Y~: J'
Wires properly protected~)N) '~'g-J'
Casing height (above ground) 1 ~'"J in.
AT INSPECTION
g.p.m.
Coliform O colonies/100 mi.
Arse ' ~QJ~""'"~mg./I.
SEPTIC/HOLDING TANK DATA
Tank Type/Material ,~ £A F'~ c. /
Tank size ) 0%~'0. gal.
Nitrate ,S"- '7 mg./I..
Date of sample: //~-~/~
Number of Compartments
Other bacteria 0 coloniesflO0 mi.
Collected b~' &_S ENGINEERING
17034 Eagle' River Loop Road No. 204
Eagle Riverw.Alaska 99577
Date installed / /'~ 0 /O "/
Cleanouts (~'/N) ~ J' :
Foundation cleanout (~/N))'¢-J' Depression over tank (Y.i~ ~' O High water alarm (Y/¢ .,v O
Date of pumping ~/4 - ~6.~ ~umper ~
ABSORPTION FIELD DATA
/_/
~ O. ~ Y~4 ~o~
Date installed ~{~0/or Soil rating ~or fCNdrm) System type ~,,,~ ~
Length ~ ~8'¢~t. Width ~ ft. Gravel below pipe ~ ft.
Total depth P~ ft. Eft. absorption area~ ~0 ft= blonitoring tube Y~ Depression over field ~ o
Date of adequacy test ~[4 - ~ ~ ¢ Results (Pass/Fail) For ~ bedrooms
RuM depth in absorption field be[or ~al. ~ew depth in.
Any r juv ' n treatment (past ~2 mo.) (Y/~ ~ type) ff yes, ~ive date
1--~g--OA;10:I4AM;
;gO7 5615301 ~ 1/
CT&E Environmental Services'Inc.
200 W. Potter'_Drive
200 W. PoRer D;'ive
:inking Water Anaiysis Report for Total Coliform B'act~ria
· ' ' teli'(§07~ S62-2343 - '
.."::-." ",,~'-'.'~ -'' : -: '~., ' ,~ , : ', .... " · ' · · ~, · .{ 07}.S61~S301
Unsati.s£actdW'
S~pl6.over ~'0' hbitr$ o~d, ~rcsults ma~
.I
0 $¢ndR.~ule$
~ .Yendlnvol~t
SAlVIPI~ DATI~: '
SAMPLE TYPE: .';" ' · '
~ Ro,~tlne . ' '
~ It.e~e':it Sample (for rO~ff~e sa_.h~le
withal'ab r.~.f.-ixo.; [0,~: o"} '7 ii' i)
m .gpeclhl Purp.ose
SA1VIPLE,LQCATION
Treated War. er
l~.ntreated.Water
Ti.me Coliected
1 04041 7 IN
Result* Analyst
mci Fbks Jun []
Faxt~!
Date: _. . T~me: ~
· Client no~lf/.ed of~satisfactory ~esul~s:
1171ment$:
M~O-MUG'I~esuIt: Toial.Ci~ilfo~m
Membratte Fll'tir: Dltect C.~unt
· Verification: LTB
FecalColiform Confirmation ,..
Final Membrane l~ilter Results
Reported By. '~ ~'T
0 ' COl0nles/l~O mi
BGB · COLWmM
Time
Collform/l 0 0 mi
~a~ed
T, VT C-,?o Nume,~ut To Count
Olt ' Other Bucl~rln
01-26-04 01:16PM FROM-CT&E ESI, SGS ENV SERVICES 90?5615301 T-183 P.02/03 F-154
SGS Ref.#
Client Name
Project Name/#
CLient Sample ID
Matrix
1040378O01
S & S Engineering
LB; B§: Preuss S/D #3
LB; B6; Preuss S/D #3
Drinking Water
Sample R~marks:
All Dates/Times are Alaska Standard Time
Printed Date/Time 01/23/2004 17:04
Collected Date/Time 01/20/2004 10:30
Received Date/Time 01/20/2004 11:15
Technical Director _ _ StepJ~n C. Ede
Allowable Prep Analysi~
Parameter Results PQL Units Method Container ID Limits Date Dat~ Init
Waters Department
Nitra~-N
5.70 0.100 mg/t. EPA300.0 B · (<=10~ 01/20/04 JJl
Microbiology Laboratory
Tolal Coliform
SMI8 9222B A (<=-1) 01/20/04
Feb 05 04 09:08p p.
Sent BV: NINE J CORPORATION; 907 694 g210; Feb-5-04 5:O7PM; Page 111
FEB 1Z 1998
Municipality o[ Anchorage
DEPARTMENT OF HEALTH & HUMAN SEFIVIGEt~ E C E J V E D
Environmental Services Division
825 L $treot, Room 502 · Anchorage, AlasKa 99501 · (D07) 343-4744
Health Authority Approval Checklist
LegalDescription: ~r~:~-~C ~2~F72,~ff:~c-~ ParcelI.D.:
A. WELL DATA
Log present (Y/N) Y
Total depth
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ~ //~/
3 ~ ~ ~' Cased to ~-~'~P~ ~- Casing height (above ground)
Sanitary seal (Y/N)
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
FROM WELL LOG
5//p/77
g.p.m.
Wires properly protected (Y/N)
AT INSPECTION
g.p.m.
Coliform t~)
Date of sample: //~,~ /(~ f
Nitrate
'7 /¢ / Other bacteria ~
Collected by: %,I[ ~ / ~{~'¢~ ~'/~'~--~
B. SEPTIC/HOLDING TANK DATA
Date installed -~//;( /'? 7 Tanksize ~"~'~) Number of Compartments ~ Cleanouts(Y/N)y
Foundation cleanout (Y/N) 7 Depression (Y/N) ~ High water alarm (Y/N)
Date of pumping ~I~., Y). 1 ~/~:~' PumperJ ~ &')~
C. ADSORPTION FIELD DATAr' ~__ ~ ~
Date installed ~"*'~"~ Sci! rating (g.p.d./fFor ft2/bdrm) ~5 ~Systemtype
~'/ .,
Length ~'~ ,~/ ' Width ~ (~ Gravel thickness below pipe & O Total depth
Effective absorption area '~O~ ~, Monitoring Tube present (Y/N) ~' Depression over field (Y/N)
Date of adequacy test/l ]'?~-~ c~ _~ Results (Pass/Fail) F ~ ~9 ,~ For '~ bedrooms
Fluid depth in absorption field before test (in.); O Immediately after ~) (~gal. water added (in.):
Fluid depth '~,,-~ (ins) Minutes later: ~/--¢ Absorption rate = ~% ~)t~ g.p.d.
Peroxide treatment (past 12 months) (Y/N) ~¢~':/') ~ 0'~ If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Size in gallons
Manhole/Access (Y/N)
"Pump on" level at*
"Pump off" level at*
High water alarm level at*
*Datum
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
On adjacent lots
On adjacent lots
Public sewer main /~/ k Public sewer manhole/cleanout
Sewer/septic service line C/(~ Lift station /'~? / ~:~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation [.4~L./ ~2 Property line ~ ~ I Absorption field ,/~. ~
Water main/service line
Surface wateddrainage
/
Wells on adjacent lots %/~)
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ~-~r ') Water main/service line
Building foundation _~- :.~/¢*'
Surface water /k~ ~ i~/.~..~ Driveway, parking/vehicle storage area
Curtain drain ~'k) U, fl ('~ ["I'i I 1(., ~,.~" [""1 Wells on adjacent lots ~'
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal records that the above, systems are
in confnrmann, with MOA HAA~,~uidelit~es in effect on this date
'/'?"1]
Date
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
/t~ll~ CT&E Environmental Services Inc.
CT&E Ref.# 980035002
Client Name James Sizemore & Associates
Project Name/// N/A
Client Sample ID L 8, B1 6, Preuss #3,
Matrix Drinking Water
Ordered By
PWSID 0
Sample Remarks:
Client PO#
Printed Date/Time 01/07/98 16:28
Collected Date/Time 01/05/98 11:50
Received Date/Time 01/05/98 15:00
Technical Director: Stephen C. Ede
Sampled by: James Sizemore
Parameter Results PQL Units
Allowable Prep Analysis
Method Limits Date Date Init
Nitrate-N
Waters Department Analyses
lotal Coliform
7.81
0.100
mg/L
EPA 300.0 10 max 01/05/98 GCP
0 cot/lOOmL SM18 9222B 01/05/98 THU
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)
Pr~ess Sub. Lot 8, Block 6 ~_~ T14N,R1W, Sec.8
(b)
(c)
Location (address or directions)
10208 Wren Eaqle River, AK
Property owner H.U.D.
Mailing Address 222 W. 8th Ave
Lending Institution
(Box
Telephone: (home) Business271-4342
N-64) Anchorage, AK · 99813
Telephone
Mailing Address
(d)
(e)
Real Estate Company and Agent Associated Brokers
Address 640 N. 36th Ave., Suite #1 Anchoraqe,
Telephone 563-333
Mail the HAA to the following address: (or check here[] , if hold for pick up.)
List contact person and day phone number below:
Pick-up by Engineer
AK 99503
2. TYPE OF RESIDENCE
Single-FamilyF'~ / Number of bedrooms
WATER SUPPLY
IndividuaIWellJ~ /'Community[] Public [3
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
SEWAGE DI~.~OSAL
On-site:[3 Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72~25 (Rev. 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
NameofFirm f~ag.].e River,Engineering SrVSTelephone 694-5195
Address P.O.B. 773294 Eagle River, AK 99577
Date
D.*S APP.OVAL
Approved for 7~--___ bedrooms~' ' //~'~//Y/'/'-
Approved /-/' Disapproved Conditional
Terms of Conditional Approval ~~
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph S above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHHSdo not conduct inspections
or analyze data before a certificate is issued. The MunicipalityofAnchorageisnot responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88) Back Page 2 of 2
~ MUNICIPALITY OF ANCHORAGE (MOA)
(,'--~""',/ Health Authority Approval (HAA)
~,,,~UNiCl PALtT ~t~E~K~.~I~IG~ F E B R U A RY 1984
ENVIRONMENTAL SERVICES D1~44
1 7 :]989 Legal Description:
A. WELLDATA ' ',~F~V~~_ ~./" ......
Classification ~ ~ /IRA, B, O, D.E.o. Approved (Y/N)
Well
m Yield
Well Log Present (Y/N)/~ Date pleted
Total Depth 3~'~ Cased to ~.~ Depth of Grouting
Static Water Level ~ 2 ~ Pump Set At t~z ~
Casing Height Above Ground ~'~ z Sanitary Seal on Casing (Y/N)
ElectriCal Wiring in Conduit (Y/N) ~ Depression Around Wellhead (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot //~- /
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments
; On Adjoining Lots ~'/¢~
1.2S' / / ; On Adjoining Lots ~'/~'~
To Nearest Public Sewer Cleanout/Manhole
B. SEPTIC/HOLDING TAN~jDATA /
Date Installed /?? ? '~ize /,,~.~-~.,~ N. o. of Compartments
Standpipes (Y/N) ~' Air-tight Caps (Y/N)
Depression over Tank (Y/N) ///
Pumping/Maintenance Contact on File (Y/N) /z./~
Holding Tank High-Water Alarm (Y/N) '~'./4
Foundation Cleanout (Y/N)
Date Last Pumped ~//'~P~
; for
Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well //"~ ~ ~ To Building Foundation
To Property Line -¢'/¢' / ~
To Water Main/Service Line Z~'-5-) c--
To Stream, Pond, Lake or Major Drainage Course
To Disposal Field
Comments
72-026 {Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed /,¢? ? ,-¢'(~,1
Width of Field
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Type of System Design/
Length of Field ~:3 //'
Depth of Field
Gravel Bed Thickness
Statndpipes Present (Y/N)
Date of Last Adequacy Test
To Water-Supply Well
To Building Foundation 3'd/ /'
Lot
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
SEPARATION DISTANCE FROM ABSORPTION FIELD:
/¢p.¢. /
To Property Line ~'/'~
_To Existing or Abandoned System on
; On Adjoining Lots ~'- -~o /
To Cutback (if present)
Comments
D. LIFT STATION . /~/,,4
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.
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
**Check Permitted Bedroom Rating Against HAA Request**
I certify that l have checked, verified, or conformed to all MOA and NAA guideline~$--ir~;'~i'fb'b'~/~ ':t"l:i~.date
of
this
inspection.
Signed ~ .... , ,..,~ ,r~
Company,~// EagleP' O.River,gC× AK7'329499577 ~e ~gj B,e~¢ ..~ Seal
MOA No. ~-~d~
Receipt No. ~/~ Receipt No.
~/7-'C~ Waiver Fee: $
/P~' ~ Date of Payment
Page 2 of 2
Tom Fink,
Mayor
unicipality of nchor ¢
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
September 8, 1989
Secretary of H.U.D.
605 West 4th Avenue
Suite 81
Anchorage, Alaska 99501
Subject: Lot 8 Block 6 Preuss Subdivision #3
HA890323, PID ~050-571-21
A Health Authority Approval was issued on this property
on August 18, 1989. This letter is additional information
regarding this property.
Note: The well for this property meets existing State and
Municipal Codes. There are nitrates present, however,
it is suggested that periodic testing be performed to
insure the wells continued suitability. Nitrate
concentration is 5.3 mg/1. EPA maximum concentration is
10.0 mg/1.
If there are any questions, please call our office at
343-4744.
Sincerely, //~
Robert W.Robinson
Civil Engineer II
On-site Services
RWR/ljm
~J~ MUNICIPALITY OF ANCHORAGE ~-~?
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
1
Location (address or directions)
(b) Applicant Name ~ /_._c_/,-~¢z.4z.g~ Telephone: Home ~¢:J/-~- 2--'7z~ Business ~,-~-
Applicant Address '~-~¢-- ~1~-~ ¢P-d~'~-~'"T-' ~ ~'~">~-~¢--' t~--~v,~j /~
(c) Applicant is (check one): Lending Institution []; Owner/buHder.~; Buyer []; Other [] (explain);
(d) Lending Institution ,~'¢-,
Address
(e) Real Estate Company and Agent
Address ~, ~,
Telephone
(f) ~e HAA to the following address:
~F;H, 694-297cj
TYPE OF RESIDENCE
Single-Family,' Multi-Family []
Number of Bedrooms '~
Telephone
Other
WATER SUPPLY
Individual Well J~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4, SEWAGE DISPOSAL
Onsite ~ Public [] Community [] Holding Tank []
Note: if community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (lV84)
~,./~
ENGINEERING FIRM PROVIDI~ INSPECTIONS, TESTS, FILE SEARCH, DATA AND t~{FORMAT1Ohl
As certified by my seal affixed hereto and as of the validation date shown below, I verify that m? ir~ve~:ig~dcn of th!s Hea~th
'Authority Approval shows that the on-site water supply and/or wastewater disposal system ~s safe, fun c.'.;on¢~ and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on -'_he ~nforrr adon ob.~ed
from the Municipality of Anchorage files and from my investigation and inspection, the o,~,-5¢~e .,,~z:er suppJ7 and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinance-% and reg,~'a~or~s ir~ effs$1 on
the date of this inspection.
Name of Firm
Address
Date
_ Telephone
,~pproved for ~',~iP ~ ~~e' ' bedrooms by ~
Approved ' Disap~
Terms of Conditional. APProval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHF-P) ~$su~ ~e~:~t~ A~r~ty
Approval certificates based solely upon the representations given in paragraph 5 above I~y an [ndep~'~ prcde~s[or~l
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchg~s ~! h~m~ a~J ~h~r le~dirt~j
institutions in order to satisfy certain federal and state requirements, Employees of DHEP do not conduct ~r~s~,~"~o~ or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsi~e ~'or e~rors or omissions ~,~ ti~.e
professional engineer's work.
Page 2 of 2
72-025 ~ 11184)
MUNICIPALITY OF ANCHORAGE (MO~7/
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: ~ ~:~
.... '~' PROT£CTIo~,,,t
,: ? '.l 0 1985,:
WELL DATA
Well Classification
Well Log Present~_~'N)
If A, B, C, D.E.C. Approved (Y/N)
Date Completed ~5~ -tCc~ ~ "7'7 Yield
Total Depth ~-~' Cased
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit ~!¥N)
Separation Distances from Well:
To Septic/l~ Tank on Lot
Depth of Grouting -----'
Pump Set At
Sanitary Seal on CasingdcY~)
Depression Around Wellhead (Y/~
; On Adjoining Lots ~ ~=~ ,'-~ '-~
To Nearest Edge of Absorption Field on Lot t I. ~:~ ; On Adjoining Lots
~'~/~' To Nearest Public Sewer
To Nearest Public Sewer Line i'~/,~ ~.-75; '-~
Cleanout/Manhole To Nearest Sewer Service Line on Lot
Water Sample Collected by ~'~', '~ ~"~'~%~-~~ ; Date ~ ~(~:~ ~ ~ ......
Water Sample Test Results --~/~'rq 5=~'/'~=~"l-Z-~z'~ ~''
Comments ~ k¢.../~4-- ~/t ~ "1~=::~"~' ~ ~-.~,-~,,,,,.~--o ~ \,~--~'~.-~-
~::~7-~:>~ ,.~c..,¢. f ,...5 ~ ~=,~_~.~. ,,~ ._ ~C~G~---~ ~'
B. SEPTIC~ TANK DATA
Date Installed .~¢~(
Standpipes ~/N)
Depression over Tank (Y/~)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/,r-4, o!di,qg T_a~nk:
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
Size ~¢_~--o ~ No. of Compartments
Air-tight Caps ~-~/N) Foundation Cleanoutd[~/N)
Date Last Pumped ~ ~t~
t-~/,,~. ; 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
72-026t11/84)
ABSORPTION FIELD DATA , ~
Soils Rating in Absorption Strata ~.f .~-4::, I~r/''~ Type of System Design
Date Installed ~'~ ~, (-~ "'/'-/ Length of Field ".~"~
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 L ,:==, ~
To Building Foundation ~'~c:~
Depth of Field ~
Gravel Bed Thickness ""/~-
Standpipes Present ggJN)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots '~oc:,
~ l,~ Cutbank (if present)
Lot /O/~
To Water Main/Service Line \-c~ A~
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to ail M CA an, d HAA guidelines in effect on the date of this inspection.
S~gnee '~ ....... ;:~ :.}} ;,/.! i~,~ Date
Receipt No. *~ ~ (5 ~ ~1~
Date of Payment
Amount: $
Page 2 of 2
72-026 (1~/84)
gl: Time
Date
Insp
DEPARTMEN'k.¢F HEALTH AND. ENVIRONMENTA, /PROTECTION
825 ~ Street, Anchorage. Alask~~ 99501
264-4720
Date Received: October 28, 1977
9:30 a.m. #2: Time #3: Time
11-1-77 Tuesday Date Date
Willis Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. Lending Institution Request: Alaska State Bank
Mailing Address: 310 East Northern Lights Blvd.
Phone:
2. Property Owner: Jimmy/Deborah Clark
Mailing Address: 114 Colville 99577
Phone: 694-2747
3. Legal Description: Lot 8 Block 6 Preuss Subdivision
4: Single Family Residence: (x) Number of Bedrooms:
Multiple-Family Residence: ( ) Number of Bedrooms:
o
Three
Well System:~.Individual well (x) Community/Public~. ~ _ System (File) (~')~,'-~'~
Permit # '~i~?~0''~ D~epth of W~el~i 3~O Well Log on
Construction ~.~3~j <: ~]\.~,.:'~(%I~Bacterial Analysts
Sewage Disposal System: On-site System (x)
Permit # ~O~ Installed 1977
Septic Tank Size
Absorption Area
Distances: Well to Septic Tank /~ 7
to Sewer Line ~-~ Nearest Lot line
Public Utility ( )
Installer
Manufacturer
Soils Rate ~Ma~eria±
to Absorption Area /~
] ~ Absorption Area
to Nearest Lot Line
Page Tg6
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 8 Block 6 Preuss Subdivision
comments:
Affadavit Attached: ( )
Approved: ~
Disapproved:
Letter Attached: )
Date:
Date:
Department Work s h.ee.t~.' ~ ~
~MUNICIPALITY OF ANCHORAGL~__~
/f~,~\ 825 L Street, Anchorage, Alaska
~quest for Approval of Individual Sewer and Wate~'~,t~,es
- ~
1. Property Owner: ~-~.t ~zh ~,~. ~ ~
Mailing Address: [~% ~~ ~L~. ~Phone: .~
2 o
o
Name of Buyer:
Mailing Address:
Lending Institution:
Mailing Address: _~,
Realtor/Agent:
Phone:
Phone:
Mailing Address:
Phone:
5. Legal Description: -- ~lOc~ ~0~ ~
6. Single Family Residence: (V~ Number of Bedrooms:
7 0
Multiple Family Residence: ( ) Number of Bedrooms:
Water Supply: *Individual Well (~/ Public/Community System ( )
If Individual Well, well depth ~0
If Conm~unity System, name of system
8. Sewage Disposal System: *~n-site System (~) Public System ( )
If On-site System, date of installation: ~ ~
*NOTE: A well log is required on ALL wells drilled since 6/75.
** If on-site sewer system is over two(2) years old, an adequacy
test is required by this department.
A fee of $25.00 must accompany each request before processing
can be initiated.
3/77