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HomeMy WebLinkAboutPREUSS #4 BLK 7 LT 2
Municipality of Anchorage Page
' 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: .~'b.) ~,C~ 0 15~} PID Number: C)~O--
Name: .~ ~ ~./q~ E~,~ Wastewater System: ~New ~ Upgrade
Address: ~~ ~;~~ ~ ~e~j~il ABSORPTION FIELD
Phone:~ '7~'-~/~7 . No. of Bedrooms:~ ~ Deep Trench D Shallow Trench DBed DMound DOther
LEGAL DESCRIPTION So,lRating: 0~6' GPD/Sq. Ft. Total Depthfromoriginalgrad~:),
Lot: ~ Block:7 Subdiv~ion: -- Depth to pipe bo.om from original grade: Gravel depth beneath pipe~ ~
Township: IRange: ISection: Filladdedaboveoriginalgrade:o.&~ -- ~ Ft. Gravellength:
WELL: U New C Upg Gravelw~dth: ~' Ft. I~t Ft.
lassification(Private, A,B,C); ~ Cased To: Total absorption are~ Pipe materiah
Driller: ~ Date Drilled: Static Water Level:Ft. Inst.:/~''~xC~Ti~J~ /, Date installed:; ~/
Yie,d: ~ I ,um~ S,~ at: C~,~n, Hei,~*bov~ ~o,,d: TAN K
~ GPM I Ft. Ft.
SEPARATION DISTANCES ~Septic D Ho~ding ~ S.T.E.P.
TO Septic Absorption Lift Holding Public/Private Manufacturer: ~ ~ Capacity in gallons:
From Tank Field Station Tank Sewer Lines ~~
{~ [~[~ Material: ~/ Number of Compa~ments: ~
Wel~ ....
SudaCewater ~0'~ ~O~t~ L~Fm STATION
Line .~0~ ~ Size in gallo~s: Manufacturer:
Gu~ainDrain '~ ~ ~ ~ ~0~ ~ ~ ~ ~ ~ Electrical Inspoction~ p*~orm~d ~y:
Remarks: ~Pt'r,o,~'~c ~.~ c r~r7 BENCH MARK
Location and Description: ~0~ ~
~10~4 E.Ob ~iv~r Loop ~o~d, N~, ~ ~.._~..],;~..~,,,,.~...~,~ .....
~nspections pe~ormed by: ~.m~.r,~k.~ ..... Dates: ~st ~-1 ~_~o/ ~-~..~ ~ ~t~
Department of Health and Human Se~ices approval · ,~:,.%..
Reviewed and approved by~~ ~ ~~ate: ~' ~ '~? ',~,.,c;;,_
72-013 (Rev. 9/91) MOA 25
~'~,EMIT '~0. SW990150 PAGE 2
. Mun~i._cip.~_~iC.y__o.F Anchor'~Qe
DEPARTHEN/ oh H~AL/H AND HUI~AN SERVICES
ENVIRONMENTAL SERVICES DIVISION
p,FI, Box 196650 oAnchoea©e, Alaska 99519-6650eTeleohone, 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
~.~.aAL LOT 2, BLOCK 7, PREUSS S/D #4 P.I.D. NO. 050-572-38
LOT 1 II LOT 6
I I
' I I
~> ~ LOT 7
o lO0' k/ELL R~DIUS_~. [~~[
I
~ I I LOT 8
~ I ~~/.,.~...,~...:
I I
PERMIT NO. SW990150 PAGE 5 OF 5
Hunicip, 9Li~. y_o. F Anchoroee
DEPARTMENT OF HP_AL/H AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P,E], Box 196650 ®Anchorage, AL~sk~ 99519-6650·Te[ephone, 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION
REPORT
LECAL LOT 2, BLOCK 7, PREUSS S/D #4 P.I.~}. NO. 050-572-58
ST1
ST2 /FINAL
100.9'
--~ "NEW "~-~4
1000 GAL
SEPTIC .0'
TANK
GRADE
A B
FCO 8.0' 24.0'
ST1 37.0' 35.5'
ST2 43.0' 40.0'
DBL1 44.5' 41.0'
DBL2 45.5' 42.0'
DV 47.5' 44.0'
C01 27.5' 50.0'
C02 80.5' 73.0'
MT1 28.0' 49.5'
MT2 78.5' 71.5'
MT3 95.0' 71.0'
COl=lO0.1'
2= 1015'.
FINAL GRADE
MT1 =88.5'
MT2=88.6'
C01 =94.0'
CO2=94.0'
·
NO WATER FOUND
82.5' B.O.H.
~f-,V~, ............. :."... L%~
~ ~ ~ ROBERT C. COWAN /,~ ~
LEGAL DESCRIPTION: ~r2; ~¢/K ~;~/s~Township, Range, Section:
SLOPE SITE PLAN
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
2
3
4
8
10
It
12
~3
14
17
20
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT ..,..,./ OL
DEPTH? p
E
Deplh to Waler A,er .../ /~//,~/~
Monitoring? Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
,/,c/9+ o - -
.30 3o~m 7'/4" I V4"
PERCOLATION RATE ~- ~Z
TEST RUN BETWEEN 5
__ (minutes/inch) PERC HOLE DIAMETER
_ FT AND "7Z- FT
72-008 (Rev. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Jun 18, 1999
Expiration Date: Jun 17, 2000
Permit Number: SW990150
Legal Description: PREUSS CfA BLK 7 LT 2
Design Engineer: 0003 S & S Engineering
Owner Name: Marsha Buck
Owner Address: 8445 KIMBERLY STREET
JUNEAU , AK 99801-9161
Parcel ID: 050-572-38
Site Address: 010227 WERN LN
Lot Size: 19600 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field r~ SepticTank [] Holding Tank [] 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 DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 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.
5. The following special provisions.
AT THE TIME OF CONSTRUCTION THE ENGINEER SHALL PERFORM AN ADDITIONAL PERCOLATION
TEST/SOILS TEST AT THE WEST END OF THE PROPOSED ABSORPTION TRENCH.
Received BV~'-"~'-'---'-
Issued By:
825 "L" Street
Rick Mystrom. P.O. Box 196650 Anchorage. Alaska 99519-6650
Mayor
http://www.ci.anchorage.ak.us
June 21, 1999
Robert C Cowan, PE
S & S Engineering
17034 Eagle River Loop Road
Suite 204
Eagle River, Alaska 99577
Subject:
Waiver Request for Lot 2 Block 7 Preuss #4
Waiver Request #WR990033
Parcel ID #050-572-38
SW990150
Dear Mr. Cowan:
Your request for a waiver of the required 10 feet horizontal separation from the
on-site wastewater disposal system to property line has been approved. The approved
separation distance is 1.0 feet. This separation waiver pertains to the new leachfield and
north property line..
This waiver approval applies to the existing on-sitewastewater disposal system to
property line separation only. Any future upgrade to the on-site wastewater disposal
system will require all separation distances be met or another approval from this
department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-4744.
Sincerely,
Daniel J. Roth
Civil Engineer
On-Site Water Quality Program
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR~[,>~(h~%[~ PID~ 050-572-38 HA~
Date Received: June 9, 1999
Legal Description: Lot 2 Block 7 Preuss #4
Engineer:
Applicant:
Robert C Cowan, PE, S & S Engineering
17034 Eagle River Loop Road, Suite 204, Eagle River, Alaska 99577
Marsha Buck
Wai, ver Requested:
leachfield (new)
Lot line waiver of 1 foot from the north property line to the
Criteria: 1. Geology: Points:
A. Water Table
B. Soil sorption
c. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
2. Special Conditions:
3. Other:
Waiver is Granted: ~ Waiver is NOT Granted:
List Conditions or Reasons for above: ~F~ f~6/~f£~ ~£~
Date: ~--/~-?~ By: /~
Amount: $ 115o00
Rec ~: 04919/5212
Name of Reviewer
Date Paid: 6-9-99
HEALTH ALffHORITY
APPROVN_S
SEWER &WATER
MAIN EXTENSIONS
SEWER&WATER
INSPECTION
ENGINEERINGSTUDIES
ANOREPORTS
WELLINSPECTION
&FLOWTEST
SITE PLANS
ROAD DESIGN
SOILTEST
PEROOLATION
TEST
STRUOTUFiAL&
MECHANICAL
INSPECTION~
ONSITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
ROBERT C. COWAN, P.E.
June 7, 1999
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 2, Block 7, Preuss Subdivision
Request you issue a permit to install a septic system to serve the existing three
bedroom dwelling on the refere.,n, ced prope~,r~;
One test hole was excavated and percolation tests performed. The approximate location
of the test hole is located on the attached site plan.
At the time of excavation, 5-28-99 water was not found. After seven days of ground
water monitoring the monitoring tube was dry.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserye
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the
adjacent properties.
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
RCC/bjj
Enclosure
JUN 09 1999
,v~uNICIPALITY OF ANCHORAGE
:~qViRONMENTAL SERVICES DIVISION
17034 NORTH EAGLE RIVER LOOP ~ SUITE 204 * EAGLE RIVER. ALASKA 99577
~O
1" = 40' DESIGN SITE-PLAN
SCALE '
....
'
~0' UTZL~TY EASEBENT
}0' UTZL~TY EASBHENT
Municipality of Anchorage.
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
2
3 ~.~
4
7
g
10
13
14
15
17
18-
19-
20-
.....
Township, Range, Section:
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT ~ O
DEPTH? p
E
Depth to Water After,
Monitoring? .},.~ y Date:
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE o~ '7 (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FT AND ? FT
COMMENTS
PERFORMED BY: '~70~4 Eag;e ~iver Loop [~oad No. 2~ I ,_ . CERTIFY THAT THiS TEST WAS PERFORMED IN
ACCORDANCE WIF~~O~AL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~ /~ / ~
72-008 (Rev. 4/85) . 't? .
MAI LING ADDRESS
LEGAL DESCRIPTION
I DISTANCE TO: ~./6 'T
~ ~ I Manufacturer ~
"Liq/a~ ~ ~allons IF HOMEMADE W dth
~ ~ ~ Manufacturer /C
I I
~ ~ Top of ti e ~ finish grade
I
Length
Width
~ ~ Type of crib Crib diamet~ /
~ Well
~ ~ DISTANCE TO:
~ ~ D~STANCE TO Building foundation
~'~/ MUNICIPALITY OF ANCFIORAGE '~._..:
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
Inside length
Dwelling
I Material
FO u nd. ation~:~ /~.~
Total le3t~h ~line,~,/. Trenc.~width t(
· -- "- I ~-~ O inches
Material beneath.tile ~
Depth
Crib depth
Building foundation
Driller
Sewer Hne Septic tank
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
APPROV, ED / / / //
l/ ~',
72-013 (Rev. 3178]
DATE
LEGAL
NO, OF BEDROOMS
No. of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERiVLLTNQ. ~ d ' ~,~ ~
D i st a'n c e b~e o?~ n~s/~.
Total effective a'b~sorption, area/'
Total effective absorption area
Nearest lot line
Distance to lot line PERMIT NO.
Absorption area(s)
~ & S Eng/neering
PERMIT NO.
DEPARTMENT ' HEALTH AND ENVIRONMENTAL OTECTION
,=,.=.._, STREET., RNCHORAQE., AK. '-99~.¢.,'1
264-4720
( 8r"104_-',.'i )
APPLICANT
LOCATION
LEGAL
ERIC:KSON¢S BACKHOE
EAGLE RIVER
L2 B? PRUESS
SR BOX D0~0 CHUGIAK
LOT SIZE
688-3280
22000 SQURRE FEET
TYPE OF SOIL RBSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS
SOIL RATING
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
[)EF'T~-I= :L ~--~ LF~-~L3TH= 5~:-] ~3 F..' R '-.." E L C¢EPTH= 5
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.-
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE
INSTRLLRTION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR R PRIVRTE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE T~PE OF PUBLIC WELL
MINIMUM DISTRNCE FROM A PRIVRTE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO R COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS RRE
RVRILRBLE TO INSURE PROPER INSTALLATION.
F'EF:~"I I: T E:=-::F' '~' F:EL--]. [:.ECE~'-IE:EF:~: _---:-"- ::L ..
I CERTIFY THAT
t: I RM FRMILtRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I HILL INSTALL THE SYSTEM IN RCCORDRNCE WITH THE CODES:
3:: I UNDERSTFIND THAT THE ON-SITE SEWER S'¢STEM MRY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS.
..........
PERFORMED FOR:_
.LEGAL DESCRIPTION:-__
1
2
3
4
5
7-
8
9
.~....~10"
11
12
13
14
15-
16-
17-
18
19
2O
COMMENTS
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-S50. Anchorage. Alaska 99502 276-222~' · ,
SOILS LOG -- PERCOLATION TEsT
Rob~:r t A.
No. 1457-~
SLOPE
72-003 {7/76)
PERCOLATION
TEST
DATE PERFORMED: "~ ' · )
ENCOUNTERED? O~
IF YES. AT WHAT
Gross Net Depth to Net
Reading Date Time Time Water Drop
~ERCOLATION RATE
TEST RUN BE~EEN ~ FT AND
KIND OF FORMATION:
From
Ft.' to
From
Ft. to
`-�
Ft.
Ft. 'to
From
�= t
Ft. to�
Ft.'to
Ft.
✓
From
° '
Ft. to
L� Q
Ft.
`
From 2``
Ft. to
Ft.
Ft
From
Ft. to
f is `
Ft.
From
" �
Ft. to r.- 9k
Ft.
r* r -1 r
From
L •la
Ft. to
0I I
Ft.
V
From
i'. ? i
Ft. to
• Ft.
v
4 ;
From
I`Q.
Ft. to
_03
Ft.
a4
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-
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Ft.
/vi t X E
From
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From
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Ft.
{75
From 2 j.
Ft. to--a/—Ft.
S ri
From
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From 91
Ft. to
q�I0 Ft.
From
7i,-.1
Ft. to - u a
Ft.
From
Ft. to
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From Ft. to Ft
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From
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From Ft. to Ft
Certificate of On -Site Systems Approval
Parcel I.D. 050-572-38
Legal description PREUSS #4 BLK 7 LT 2
Site address 10227 WREN LN Eagle River AK
Current property owner(s) O'ROURKE
Expiration Date: 4/11 /2025
X The On -site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
c
Original Certificate Date: 5/24/2024
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA Approval_June 2022
{���jj �{'" {� ,(9; fir+
F'J��� L7 � G �i"�r" p ez��. ¢7 PA L e �5:.� Y �+�� E-^ ANCHORAGE
ryL � .l
Development Services Department w Rhone: 907-34-3-7904
On -Site Water & Wastewater Section � � Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 050-572-38
Complete legal description PREUSS #4; BLOCK 7, LOT 2
Location (site address) 10227 WREN LANE, EAGLE RIVER, AK 99577
Current property owners) HUNTER O'ROURKE
2. ON -SITE SYSTEMS SIZED FOR 3 BEDROOMS
Day phone 1-254-368-0861
3. TYPE OF WATER SUPPLY: a Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age <25 - See advisory if steel older than ZO years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed H Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On -site staff
to verify the accuracy of the information provided.
COSA Fee $`, Waiver Fee $
Date of Payment S/2.0 17-4- Date of Payment
COSA #%C? 46 l I Lo�' Waiver #
sec � p0835C�
COSA Application June 2022
DA 5-/ 1( /? "`
COSA Checklist
Legal Description: PREUSS #4; BLOCK 7, LOT 2
Parcel ID: 050-572-38
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1
A. WELL DATA
9 Well log is filed with Onsite (or attached) Well production at time of test *3•6 gpm
Date drilled 9/18/1980 Total depth 397 ft Water storage tank volume N/A gallons
Cased to LINK ft Well disinfected for coliform test?
ME Sanitary seal is functioning correctly 0 Coliform bacteria is Negative UNKNOWN
M■ Wires are properly protected Nitrate mg/L ■N Nitrate less than MRL (ND)
Casing height (above ground) 18+ in. Arsenic ug/L 0■ Arsenic less than MRL (ND)
Date of flow test for COSA 4/23/2024 Collected by ARCTERRA CONSULTING
Static water level at beginning of test **354.3 ft Date 4/11/2024
Comments *WELL FLOW TEST PERFORMED BY ARCTERRA CONSULTING (SEE ATTACHED REPORT).
**GEG STATIC WATER LEVEL ON 5/16/2024.
B. TANK DATA T STATION
Measured operating fluid level in septic tank 515750" ❑ Require tenance
Date of pumping 4/22/2024 Age of lift station
❑ Required maintenance completed, if AWWTS Lift station al
Comments:
D. ABSORPTION FIELD DATA *DATA BELOW IS FOR 1980 DRAINFIELD.
Which system tested (date installed) *8/29/1980 Adequacy test date *5/10/2024
W ALL standpipes present per record drawing
Total measured depth from grade *10.7 ft (max)
Measured depth to pipe invert from grade *5.7 ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
X Monitor tubes go to bottom of effective.
If not, state depth into effective
❑ Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced 965 gallons 5/10/2024 date
Any rejuvenation treatment (past 12 months) N/A
If yes, enter date
Results Pass
Fluid depth prior to test *39 in
Water added 944 gal
New fluid depth *41.5 in
Elapsed time 120 min
Final fluid depth *26.5 in
Absorption rate 450+ gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) *60 in
Effective depth used *26.5 in
Effective depth remaining *33.5 in
Comments/Deficiencies: *TESTED 1980 DRAINFIELD. PER ARCTERRA REPORT, 1980 DRAINFIELD WAS IN USE
UNTIL 4/16/2024. PERFORMED 965 GALLON PRESOAK ON 5110/2024. PRIOR TO PRESOAK, TRENCH HAD 4.5" OF LIQUID IN IT,
COSA Checklist June 2022
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100'
Community Sewer Manhole/Cleanout > 100'
❑i Yes
if No
ft
FM1 Yes
if No ft
Neighboring Tank > 100' ❑■ Yes
if No
ft
Private Sewer/Septic Line > 25' Q Yes
if No ft
Absorption Field on Lot > 100' 0 Yes
if No
ft
Holding Tank > 100' QYes
if No ft
Neighboring Absorption Fields > 100'
Animal Containment > 50, Q Yes
if No ft
❑i Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ❑■ Yes
if No
ft
❑■ Yes
if No ft
❑ N/A — Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10' 0 Yes if No ft Surface Water > 100' R Yes if No ft
Tank to Property Line > 5'
❑■ Yes if No ft
Field to Property Line > 10'
❑ Yes if No *51 ft
Water Main > 10'
FC Yes if No ft
Water Service Line > 10'
[j] Yes if No ft
F. ENGINEER'S COMMENTS
Wells on Adjacent Lots:
Private Wells > 100' 51 Yes if No
Community Wells > 200' 0 Yes if No
If tank or field is under driveway comment below
*V LOT LINE WAIVER GRANTED FOR 1999 DRAINFIELD. 1999 TRENCH IS IN FAILURE. PER ARM SEPTIC SERVICES, THE DOUBLE CLEANOUTS WERE
WERE REPLACED AND SPUTTER STANDPIPE STAIGHTENED OUT AND THE 1980 DRAINFIELD LINE WAS EXCAVATED, JETTED ALL THE WAY BACK TO THE
SPLITTER, AND REPAIRED. THE ENITRE SEWER LINE FROM SPLITTER TO THE 1980 DRAINFIELD CLEANOUT WAS CAMERAED AND FOUND TO BE FUNCTIONAL.
ft
ft
G. CERTIFICATION & 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, indicates that the on -site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm Gamess Engineering Group LTD. (GEG) Phone 907-337-6179
Engineer's Printed Name Jeffrey A. Garness Date
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in
accordance with the guidelines and regulations established by the Municipality of Anchorage and industry
�obo���0
practices. The reported results describe the condition of the system/s on the date/s of the evaluation.
to identifiable features. Hidden defects or encroachments may
o O F 0�
o C op
Separation distances were measured readily
life septic systems depend
o • S Q
exist that were not identified during the evaluation. The operational of all wells and
levels (that may fluctuate
.
upon a variety of variables, including (but not limited to) soil conditions, groundwater
the of the family utilizing
during the year), quality of construction (materials and workmanship), and water usage
the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not
0• • . • • •I• r • • -• • • . • •
guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding
1
the future performance of the well or septic system. GEG makes no representation whether an alternative well
..... ...........
or septic system can be installed on the property in the event either of the current systems fail to perform
J frey rness:'
QQ '
adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG
to perform the evaluation. Reliance upon the information provided in this report by any other person or party
. CE 795 I
Q s 7 ��G
�4rP�Pf
(including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever.
•
LICENSE4 aprofess,c)
���Op�o�o
COSA Checklist —June 2022
#AECC8U
MUNICIPALITY F ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT `I i '� 907-343-7904
On -Site Water and Wastewater Section �R Fax: 343-7997
www.muni.org/onsite
Septic Tank Advisory
Certificate of On -Site Systems Approval #OSC 2 Y 11 Y g
Subdivision: Preuss #4 Block 7 Lot 2
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this COSA / property iS Uyears old. A leaking septic tank may be a source of contamination to
the aquifer. Typical replacement costs range from $10,000to $15,000
This advisory must be attached to all copies of the subject Certificate of On -Site Systems
Approval.
This is an example of a 16-year-old septic tank.
04 RCPTER��
ARc T irmRA
CONSULTING INC
20441 Ptarmigan Blvd Eagle River, AK 99577
Office (907) 868-3791 Fax (907) 868-3793
April 29, 2024
Hunter O'Rourke
10227 Wren Lane
Eagle River, AK 99577
RE: PREUSS SUBD. #4 BLOCK 7 LOT 2
ON -SITE WELL & SEPTIC SYSTEM INSPECTION
Per your request, we have inspected the on -site water and wastewater systems of the
above referenced 3-bedroom property. This investigation was based on observations of
the day in which the septic adequacy and well flow tests were performed and according
to available Municipality of Anchorage (MOA) record documents. This is to certify that
as of the date of this letter, the subject on -site well appears to meet or exceed minimum
state and municipal requirements. The on -site septic system field failed to absorb the
required volume of water to meet minimum MOA requirements for a COSA.
Record on -site wastewater documents were found at the Municipality of Anchorage
(MOA). Those records show the septic system consists of a 1000-gallon steel septic tank
with a diverter valve between two separate septic trenches: trench 91 is 63' long x 5'
wide x 3.0' effective depth per MOA records and was approved in 1983, while trench 92
is 69' long x 2.5' wide x 5.5' effective depth (with available monitoring of 5.25') was
installed in 1999. The tank effluent was directed to the 1983 held when we made our
first inspection on 4/ 16/24 and we found effluent standing in the post tank cleanouts.
Although the original design and subsequent COSA in 1985 showed a CO/MT during
our inspection we found no visible pipes for the 1983 trench which would allow us to
conduct an adequacy test. Based on these observations on April 16" we switched the
diverter, thereby diverting effluent to the 1999 field. We did not observe a drop in the
post tank cleanouts at that time. This may indicate that settlement has occurred post tank
and before the diverter. On April 161" we measured 50" of effluent in the 1999 trench
out of a measured total of 63" in the monitoring tube. On 4/23/24 we conducted an
adequacy test of the 1999 trench where we added the required amount of 450 gallons of
water into the field and the water level increased in the monitoring tube to 64" which
was above the lateral distribution pipe. Upon inspection 24 hours later the water level in
Preuss #4 Blk 7 Lot 2
April 29, 2024
Page 2 of 2
this field measured 60" and had not returned to pre -test levels, thus failing to absorb the
required amount of water for this system.
A well flow test was conducted at the same time of the septic adequacy test. The well
produced a constant flow of 3.6 gallons per minute, which is well above state standards,
The wellhead stickup was 27" from grade, with a seal and conduit. Water samples were
drawn and submitted to SGS Laboratory for bacteriological, nitrate and arsenic levels.
The results of this water analysis states either `non -detect' or negative and are attached.
Therefore the water quality meets or exceeds MOA /State requirements.
The assessment of the condition of the well and septic applies only to the conditions as
of the day tested. The flow and absorption rates may change due to subsurface conditions
that may not be observed from the surface, changes in land use, local soil characteristics,
groundwater levels that may fluctuate during the year 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 cannot give any estimate of how long a system will function
satisfactorily for current or future occupants or can ArcTerra guarantee that no unseen
encroachments, deficiencies or discrepancies exist.
If after review of these records you or any of the underwriters have any questions
regarding the adequacy of these systems or the methods and/or procedures employed
during our inspection or evaluation, please feel free to contact me at (907) 696-6111,
Fax (907) 868-3793.
Respectfully,
1
r
ArcTerra Consulting, Inc.
Kenneth M. Duffus, P.E.
Attachments: Water Analysis (SGS)
Invoice
Y
KENNETH
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GE @�
Municipality of Anchorage °
U
On -Site Water and Wastewater Program s
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050-572-38 _ Expiration Date: ZZ
1. GENERAL INFORMATION
Complete legal description Preuss #4 Block 7 Lot 2
Location (site address) 10227 Wren Ln. Eagle River, AK _
Current Property owner(s) Stacy Sandoval Day phone
Mailing address
Real Estate Agent
10227 Wren Ln. 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
0
Individual Water Storage
❑
Community Class _ Well
❑
Public Water System
❑
Waiver/Variance request for:
3
___ 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 $ S5 0 _ Waiver Fee $
Date of Payment 3� /2z Date of Payment
Receipt Number O�75()r, Receipt Number
COSA # 0 S C-)") 1 (0 ( (a Waiver #
istance:
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. Phone 696-6111
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 _
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 �..,
encroachments, deficiencies or discrepancies exist. Ul ;1L,<fv\,
AIK
I n T E -f
6. DSD SIGNATURE
System #1 Approved for �__ bedrooms.
System #2 Approved for bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
— -- ANC/-/"
- ON_S �1D
J� R o
G� P C_
0)))))111
Original Certificate Date: 3 _0 2
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X
Septic System Advisory
Well Flow Advisory _
COSA blue sheet -10-10-12 doc
Nitrate Advisory
Arsenic Advisory
Other S,ec
�drJisivwi'
Legal Description: Pruess #4 Block 7 Lot 2 Parcel ID: 050-572-38
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system
A. WELL DATA
IN Well log is filed with Onsite (or attached)
Well production at time of test 3.0 gpm
Date drilled 9/18/80
Water storage tank volume gallons
Total depth 397 ft
Well disinfected for coliform test? ❑ Yes No
Cased to 40+* ft
0 Coliform bacteria is Negative
Sanitary seal is functioning correctly
Nitrate mg/L 11 Nitrate less than MRL (ND)
Wires are properly protected
Arsenic ug/L PE Arsenic less than MRL (ND)
Casing height (above ground) 30 in.
Collected by Arcterra Consulting
Date of flow test for COSA 2/18/22
Date of Sample 2/11/22
Static water level at beginning of test 368 ft.
Comments *Per 1999 COSA
B. TANK DATA
Age of tank(s) 6/18/99 years
Tank type/material Septic/Steel
Measured operating fluid level in septic tank 49"
10 Standpipes/foundation cleanout per record drawing
Date of pumping 2/14/22
D. ABSORPTION FIELD DATA
Which system tested (date installed) 6/18/99
IN ALL standpipes present per record drawing
Total measured depth from grade 13.25 ft (max)
Measured depth to pipe invert from grade 8 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective 5.25
STATION
❑ Requir aintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 2/18/22
Results FV_1 Pass For 3 bedrooms
Fluid depth prior to test 43 in
Water added 450 gal
New depth 53 in
Elapsed time 1440 min
11 Code -required soil cover over field Final fluid depth 43 in
System presoaked Absorption rate 450+ gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months)
date of test)
Gallons introduced 2000 gallons If yes, enter date
Com ments/Deficiencies:
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
® Yes if No ft
Wells on Adjacent Lots:
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
[7j Yes
if No ft
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25'0 Yes
if No ft
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No ft
Neighboring Absorption Fields > 100'
Surface Water > 100'
® Yes
Animal Containment > 50' ® Yes
if No ft
® Yes
if No
ft
_
Manure/Animal Excreta Storage > 100'
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:
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 5+*
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
*Per 6/18/99 Inspection Report
G. ENGINEER'S CERTIFICATION
I 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.
COSA Checklist yellow sheet
Septic 'Tank Advisory
Certificate of On -Site Systems Approval #OSC 221066
Subdivision: Preuss #4 Block 7 Lot 2
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this COSA / property is 23 years old. A leaking septic tank may be a source of contamination to
the aquifer. Typical replacement costs range from $10,000 to $15,000
This advisory must be attached to all copies of the subject Certificate of On -Site Systems
Approval.
This is an example of a 16 -year-old septic tank.
Madiq Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A S NGLE F^M LV DWELUNG
1. GENERAL INFORMATION
Complet~;'legal description ~-
Location (site address or directions) ,/(~ ~- ~-- ~ /'1//~G'/u/ /
· Property owner
· Mailing address ......
Day phone
rending agency
Mailing address
' :' Day phone
Agent C/~/0 Y
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
Day phone ~'~ ~4¢¢'~
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
NOTE:
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev. 1/91) Front MOA~21
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 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 furtherverify 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.
Nameof ¢ phone
Address 17034 Eagle River Loop Road No, 204
Eagle River, Alaska~957~~.~/~"-'--~
Engineer's signature ~L~-¢ ~ Date '~ / A ?/fi c~'
DHHS SIGNATURE
Approved for -i'"H,gEE bedrooms.
Disapproved.
Conditional approval for
bedrooms, with th-e following stipulations:
Additional Comments
'fA'llifli
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DH H8 does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev, 1/91 ) Back MOA a~21
Do
LIFT STATION
Date installed
Size in gallons
Manhole/Access (Y/N) "Pump on'~Pump off" level at*
High water alarm level at* ~ *Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
/
Foundation 3 a'" Property line ~' ~ Absorption field
Water main/service line ! 0 -F Sudace water/drainage / O ~) q- Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line ~ '~~c$~o°~ :~) Building foundation '~ $- water main/service line
Sudace water / o '0 '-,~ Driveway, parking/vehicle storage area ~- o '~-
Curtain drain A/~ ~ ~.. /~ ,~ ~ ~ ~J Wells on adjacent lots / 0 0 %
ENGINEER'S CERTIFICATION
I certifythatl have determined thru field inspections and review of Municipal
in conformance with MO~ H~ouidoO~gs in effect on this date.
Engineer's Name ~6&~T ~ ~o~
Date "~ ~ ~/~7/~
?Y')O., oO
HAA Fee $
Date of Payment
Receipt Number ~O~(~
Waiver Fee'S
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN'SERVICES JUL ~y
Environmental Services Division ,~UNICIPALITY OF ANCHOR
825 L Street, Room 502 · Anchorage, Alaska 99501 - (9~gq~o~zl~4mu~c~s
Health Authority Approval Checklist
LegalDescription: )-o'V~ /~L-oc~c 7 I /°'P':~s-'~ ~/-/ ParcelI.D.: OS-'0 --~7;)-- ~,~g
A. WELL DATA
Well type J3/~ v At-~
Log present (~YN) 7 ~.- --[
Total depth '~ q 7
Sanitary seal (~N) "7' £J
Date of test
Static water level
Well production
if A, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to ~/0 -~
Casing height (above ground)
Wires properly protected (.~/N)
,/
Y~f
WATER SAMPLE RESULTS:
FROM WELL LOG
AT INSPECTION
'a. 7
Coliform 0 Nitrate
Date of sample: '7/~ ~ ~l~)
B. SEPTIC/HOLDING TANK DATA
Date installed (-,/~'~/ff¢) Tanksize /ooo
C. ABSORPTION FIELD DATA
Date installed ~ //¢ / q (~
Collected by:
Other bacteria 0
$ & S ENGINEERING
i7034 Eagle River Loop Road No, 204
Eagle River, Alaska 99577
Number of Compartments ',,'Z Cleanouts (~/N))'~'3
Foundation cleanout (~/N) ~ J Depression (Y/~
Date of Pumping' ~/fi - ~ ~'~J Pumper -
High water alarm (Y~) w O
· Soil rating ~or fF/bdrm) O. (;' System type
Length- ~ q ~ ' ' "
Width ~ /:' Gravel thickness below pipe '¢' ~/~ / Total depth///,''
Effective absorption area 75-9 ~r t. Monitoring Tube present ~',1). ¥~ Depression over field (Y~
Date of adequacy test/V/,,~ _- ,,L)£',-/ Results (~ / For
Fluid depth in absorption field befo~ / Immediately after gal. water added (in.):
Fluid depth ~s later: Absorption rate = g.p.d.
Peroxide tre..~_~erff (past 12 months) (Y/N) If yes, give date
bedrooms
72-026 (Rev. 3/96)*
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRON}~NTAL HEALTH
DEPARTMENT OF HE~kLTH AND ENVIRONmeNTAL PROTECTION
APPLICATION FOR ~ ~MEALTIt AUTHORITY APPROVAL CERTIFICATE
General Information Application Date
/
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicants Name (<"?,/~,/"'(' "7-,~,
Applicants Address ?/-~ - :../
(c) Applicant is (check one) Lending Institution
Buyer ~ ; Other ~ (explain);
(d) Lending Institution ~ / ~ Telephone
Telephone - 1tome Business
Address
(e) Real Estate Co. & Agent__
(f)
Telephone
Mail the HAA to the following address:
2. Type of Residence
Single-Family~
Number of Bedrooms
Mul~i~Family~--~
Other (describe)
[Page 1 of 2]
3. Water Supply_
Individual Well ~ Community ~ Public ~
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. ~ ,, \llll/ i//
OnsltePnblic EZ2q. olding Tan.
Note: Id community well system, m'~s$ ~,gVO Sz~ttten confirmation from the State
Department of Environmental Conservat~ ~attes~lng to the legality and status.
5. En__gineering Firm Providing Inspections, Tests, File Search, Data and Informati~n ~
As certified by my seal affixed hereto and as of the validation date sho~m below,
verify that my investigation of this Health Authority Approval shows that the on-sft~
water supply and/or wmstewater 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 Mnnicipality of Anchorage files and from my
investigation and inspection, the on-si~e water supply and/or wastewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tious in effect ou the date of this inspection.
Telephone
Approved for~ bedrooms B
Approved //~'/ Disapproved~ ~onditioual
Terms of Conditional Approval
CAUTION
THE bfdNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISS'JES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN LN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIObL%f ENGINEER REGISTERED
IN THE STATE OF ALASKA. THE DHEF DOES THIS AS A COURTESY TO PURCHASERS OF HOblES A_ND
THEIR LENDING INSTITUTIONS //~ ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQULRE-
bIENTSo EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED° T~E MLD~ICIPALI~f OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK°
RR4/ej/D18
ii, [Page 2 of 2]
7-19-84
ALASKA e[1OIROFImeIITAL COFITROL IF1C.
GENE TOBEY
SRA BOX 5415
EAGLE RIVER
ALASKA 99577
SELLER-GENE TOBEY
GENE TOBEY
SRA BOX 5415
EAGLE RIVER
ALASKA 99577
APRIL 4 1985
50016
LEGAL:PRUESS SUBDIVISION BLOCK 7 LOT 2
ADEQUACY TEST FOR SEWER SYSTEM
ADEQUACY TEST DATE-4/2/85
THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 580 SQFT.
THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 449 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
3 BEDROOM HOME.
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR
THIS 3 BEDROOM HOUSE.
THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON 4/3/85 ·
FLOW TEST ON WELL
WELL FLOW DATE-4/2/85
THE WELL FLOW RATE WAS 3 GPM FOR 1.5 HOURS.
THE WELL IS ADEQUATE FOR THIS 3 BEDROOM HOME.
1200 [Uesl 33rd Aucnu¢, ~ait¢ ~ ° Anchoraqe, Alaska 99503 · (907] 276-1361
~'-~"MUNICIPALiTY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH &
HEALTH ~AUT['{ORITY APPROVAL (HAA) [NVIRONMENTAL PROTECTION
- F Ru Y 1984 pp, 5 g85
Date Completed
Pump Set At
Well Classification ~¢.~
Well Log P~esent
Total Depth ,~f ~'¢/. Cased to
Static Water Level
Casing Height Above Ground~r~'~ ''~/
Electrical Wiring in Condui%/~)
Separation Distances fram ~1~:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
Legal Description:[~'~:~<J~g~-,-~ W
If A, B, ~ C, D.E.C. ~p=o~d(Y~)
~pth of ~outing
Sanit~ ~al on ~sing )
~ession ~ound ~l~ead (Y~
; O~ Adjoining Lots ,~//773 ? ~--
TO Newest ~blic ~ Line
C lean~t~a~ole
Wate~ S~le Test ~'ult,
Standpipes ~/N) Ai~-tight Caps
Depression over Tank (Y~)) Date Last Pumped
No. of Cc~,%~artments '-~
Foundation Cleanout (Y~)
Pumping/Maintenance Contract on File (Y/N)I,.:!k ; for (~ ~
Holding Tar~k High-Water Alarm (Y/N) t%li~'~ Temporary Holdipz~ Tar~k Per~t (Y/N)fu/~ l~/
Separation Distances fram SePtic/Holding Tank:
To Water-Supply Well
To Property Line
To Water Maip~Service
course ~ ~ ~ /
To Building Foundation 1~1 j~'
To Disposal Field ~!
To S~eam, Pond, Lake, c~ Major Drainage
[Page 1 of 2]
Receipt 9
Date Paid:
Amount:
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date .Installed
Width of Field
Type of System Design
Length of Field
Depth of Field
Square Feet of Absorption A~ea ~'<~'_% © c/ Standpipes P~esent .~/N)
Depression over Field (~ Date of Last Ad, qume7 Test --
Results of Last Adequacy Test ~.~eD- ~ ~o-~- ~' //.~'~'"
Separation Distance f~Gn A~so~ption Field:
To Water-Supply Well ? ]'-(~! ~ To P~operty Line /0 ~-
TO Building Foundation ~Tf/ ~ To Existing or' Abandoned System cn
Lot ~J lJ,~ ; On Adjoining Lots . ../--~/
To Water Main/Service Line .~-~/~,-- To Cutbank( if present) /3//% "''
TO St~eam/Pond/Lake/c~ Majo~ D~ainage Course '~'l O O (
To D~iveway, Pa~king A~ea, c~ Vehicle Stc~age A~ea /(~/ ~
LI~ STATI~ ~
Date I~talled · ~~ns
"~ ~" ~1 at ~ / ~ ~f" ~vel at____
High ~ter ~ ~vel ~t~/ Ve'~t (Y~)
Tested fo~ / ~ing Cycles ~ing Adeq~ ~st. ~ets ~A
Elec~ical ~
Counts
** Check Permitted Bedroom Rating A~ainst HAA R~quest
I certify that I have checked, verified, or confound to all MOA HAA Guidelines in effect
on the date ~ this inspection.
Signed 1~ ~ Date ~/~
Company
KB1/d5/s
[Page 2 of 2]
2-15-84
· DATE RECEIVED
~ INSPECTION APPOINTMENTS 07---,/~ ~
TIME ': !TIME ,. ~ J~J /~ (,~ TIME
ENVIRONMENTAL SANITATION DIVISION
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DI REOTION8: Complete all parts on page 1. Incomplete reques~ will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER PHONE
BAILI~Q ABBRE88
PROPERTY RESIDENT (If different from above) PHONE
2, BUYER PHONE
MAILING ADDRESS
3. LE~DI~G I~STfTUTIO~
MAI LING ADDRESS
MAILING ADDREgS
5. LEGAL DESCRIPTION
,Z ,r 7 , l, c ,( 7
STREET LOCATION
6, TYPE OF RESIDENCE
JX~' 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**
PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79) .~
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY EZ] ONE [~] THREE [] FIVE EZ] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2, WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
PERMIT NUMBER
3. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON -SITE DATE INSTALLED
' ~ ' ~",O
E~]PUBLIC UTILITY ~.~'~c.~ ~..Z~ ,
Connection Verified INSTALLER
[]Septic Tank or [] Holding Tank ~/'~_.(~:A,.r~-~ -
Size: I 0(~0 If Tank is homemade SOILS RATING
give dimensions: I ~'
TYPE OF TANK MANUFACTURER
TQTAL ABSORPTIO~ AREA MATERIAL
4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line
WELL TO:
I
Absorption Area to nearest Lot Line
5. COMMENTS
E~] APPROVED FOR BEDROOMS
[~' CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY
72-010 (Rev. 6/79)