HomeMy WebLinkAboutPREUSS #4 BLK 7 LT 3Prucss
Block
7
Lot 3
#050-572-37
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program, 4700 Elmore Road ~--
P.O. Box 196650 Anchorage, AK 99507 Page of
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: 050-572-37 PID Number: sw070128
Name:
Mark Monfore Wastewater System: [] New [] Upgrade
Address:
P.O. Box 672598, Chugiak, Alaska ABSORPTION FIELD
Phone: Number of Bedrooms;
360-0500 3 [~ Deep Trench [] Shallow Trench [] Bed [] Mound [] Other:
LEGAL DESCRIPTION Soil Rating: Total Depth f ..... igina, grade:
0.6 GPD/Ft~ 7.3 - 9.9 Ft.
Block: 7 Lot: 3 Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe:
Preuss #4 1.9 - 4.5 Ft. 5.4 Ft.
Township: Range: Section: Fill added above original grade: Gravel Length:
0 - 1.6 Ft. 70 Ft.
Well: [] New [] Upgrade Grava~ width: Number of Ii .... I Dist .... between Ii ....
3 Ft. I N/A Ft.
Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material:
Ft. Ft. 750 Ff ASTM 3034, F-810
Driller: Date Drilled: Static Water Level: Installer: Date Installed:
Ft. Dean Construction 7/10/07
Yield: GPM Pump Set at: Casing Height Above Ground:
Ft. Ft. TANK
SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other:
T~ To Septic Absorption Lift Holding )ublic/Private Manufacturer: Capacity:
From%
Tank Field Station Tank Sewer Line GaL
Material: Number of Compartments:
well 133+ ft. 110+ ft. N/A N/A 25+ ft.
surface water 100 + ft. 100+ ft. N/A N/A % / LIFT STATION
Size: Manufacturer:
Lot Line 30+ ft. 10+ ft. N/A N/A GaL
/ '~ "Pump on" level at: "Pump off" level at:
Foundation 10+ ft. 15+ ft. N/A N/A in, in. High water alarm at: in
Pump Make & Model Electrical Inspections performed by:
Curtain Drain None known to exist
Remarks:
Existing well documentation is on file with M.O.A. On-site Services. BENCH MARK
Location and Description:
Septic tank is an existing Sunset Plastic 1000 gallon tank. Cement slab at bottom of back porch stairs.
Assumed Elevation:
Fill added above original grade around clean-out #2 and 100.00 Ft.
monitoring tube #2.
Inspections performed by: Fred Kenley Dates: 1st 7/09/07 -*~ O~ ~, . '
Development
Services
Department
Approval
Reviewed and approved by: Date: /
/
/
~ 'A B
DBL C.O. 58.6' 15.7'
B.R.D. 38,7' 16.0'
C,0.-1 18.5' 29.5'
M.T.-1 39.5' 37.7'
M.T.-2 69.0' 68,9'
C.0.-2 69.5' 68.6'
e~-~e// ~
Lot 2 ~ue
Lot 6
/ AREA~
~~.~/
Lot 5
Lot 7
Lot 8
......... ~ \\
-- -- -- ~ _~ 163.33' / ~-_ _ J
~ ~~ × /,//~SEPTIC I \ · s~ Lot 9
.? \ , '~.
163.53'
/
/
/
/
Lot 4
BLOCi~ 7
IUNIT ~
AS-BUILT
DRAWINGS
DOUGLAS T. KENLEY, P.E.
9806E, NORTHSTAR o Palmer, Alaska99645 · (907)746-1073
MARK MONFORE
~*~: PREUSS #4- SUBDIVISION, BLOCK 7, LOT 5
EAGLE RIVER, ALASKA
050-572-37
/
/
/
/
Lot. 2 /os / AREA
'-~,./
- ~ ~ /~, ~
/ ,~W- .~,~SIDENC"Bs._ / X/~DiVE~-?'<_F
~ x - ~- MT-2
~ ~~ 1 65.55~ / ~2~
~ / EPTI
%o~/~ AREA
:SLOC~ 7 -- ~¢~,~
~ ~NT 4¢~''' ~"~,
*.-49TH ...
DOUGLAS T. KENLEY, P.E. c,~,, ~,, .... AS-BUILT
...... "ORT"ST .......... *'.,k, 9964' ','0'~"""" DRAWINGS .":~. . '
LEGAL: PREUSS ~4 SUBDIVISION, BLOCK 7, LOT 3 I"~"'~
.................
EAOLE RIVER, ALASKA I 050-572-57 SW070128
~: 8- 15-07 1 C~CK~: SCAU~: uo~
I ....... ;- ~-o~I ~T~ I 1"= ;o' I o:~1o I~,~T ; 0~
DBL-CO
4" PVC FROM TANK }~
DIVERTER
VALVE
NNG/L 97.6'
OTES: 1. Item #1 on sheet 2 is an existing lO00-gollon Sunset plastic tank.
2. Item #2 on sheet 2 is the existing 5' W x 5' E.D. x 45' L leach field.
5. Water level in MT on 6/14/07.
4. The other half of the DBL-CO is the existing after-tank CO facing
toward leach field.
5. 1.6' of fill was added over the area of C0-2 & MT-2.
~TO FLOW SPLITTER
~--93.97'
(~)PROFILE LAST HALF OF DOUBLE CO & DIVERTER
ORIGINAL
MT-I~ fi--- C0-1 T.H.
co-2 note O/L
GRADE~ G/L 97.6'~ ~ ~ ffG/L 97.6' ffG/L 96.6' (see ff 95.5'
~ ~ W/L 82.46'
(see note
87.66'~
87.70'~ I
BACKHOE
BUCKET
()PROFILE OF NEW LEACH FIELD
4 OF 4
AS-BUILT
DOUGLAS T. KENLEY, P.E. c,v,, Eng, ....
98D6 E. ,ORTHSTAR o Palraer, Alaska 99645 · {907} 746.1075 DRAWING
cuE'T:MARK MONFORE
~E°^L'PREUSS #4 SUBDIVISION, BLOCK 7, LOT 5
',,u,~: SW070128
07110 I SHEET
EAGLE RIVER, ALASKA I~'~ NU~: 050-572-37
..... 8-7-07 I ....... 3-18-091 ........ DTK I ...... NTS
~81.13'
ARCTIC PUMP & WELL INC.
Jim Sullivan, CPI
PO Box 770197
Eagle River, AK 99577
(907) 688-2510
(907) 258-2510
apw@gci.net
Pump Installation Log
Well Drilling Permit Number: SW
Parcel Identification Number:
Date of Issue:
Legal Description:Preuss#4
Lot:3
Block:7
Property Owner Name & Address
Mark Monfore
PO BX 672598
~hn c~ ~lc Al(
Pump Installation Date: 7-2007
Pump Intake Depth Below Top of Well Casing:
Feet
Pump Manufacturer's Name:
Pump Size:
Pump Model:
hp
Pitless Adapter Burial Depth:
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer:
feet
Arctic Pump & Well, Inc.
Well Disinfected Upon Completion? Yes
Method of Disinfection: Chlorine
Comments:
Well permanently decommissioned by procedurel 5.55.060L. c.
Pump Installer Name:
Arctic Pump & Well, Inc.
Arctic Pump & Well, Inc.
Page 1 of 1
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK gg51g..6650
(907) 343-7g04
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Jun 26, 2007
Expiration Date: Jun 25, 2008
Permit Number: SW070128
Legal Description: PREUSS f~t BLK 7 LT 3
Design Engineer: 0069 DOUGLAS T. KENLEY
Owner Name: MARK MONFORE
Owner Address: PO BOX 672598
CHUGIAK, AK 99567-
Parcel ID: 050-572-37
Site Address: 010207 WREN LN
Lot Size: 19600 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] 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 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 I~
Issued By:.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(9O7) 343-79O4
ON-SITE SEPTICANELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. /~'5~ - ,,_,~'..~ -,5 ~
Property owner(s) ,"/..~,~,'~ ,,,-.~a,,j,.~-,¢,~-~- Day phone ~
Mailing address ~. ~'~ ~ ~'~-~, ~ Zip ~de ~d~ ..
Site address ~ ~ ~ ~ ~t ~z ~ ~ ~Zip Code ~
Legal description (Sub'd, Block & Lot) ~ ~ ~, ~ ~,~
Legal description (Township, Section & Range)
Lot Size_ /q[~07) Sq. Ft.
Number of Bedrooms
THIS APPLICATION IS FOR (C~all that apply):
Absorption Field
Septic Tank
Holding Tank
PHvy
Private Well
Water Storage
THIS APPLICATION IS AN:
Initial
Upgrade
Renewal
I certify that the above information is correct. I fudher certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment: ~
Receipt Number:
(Rev. 11/05)
Waiver Fees:
Date of Payment:
__ Receipt Number:
Douglas T. Kenley, P.E. 9806 E, Norlh Star Circle. Palmer. AJaska 99645 (907) 746-1073
June 18,2007
Municipality of Anchorage
On-Site Services
4700 South Bmgaw
Anchorage, Alaska
Re: Mr. Mark Monfore, Owner
Lot 3, Block 7, Preuss #4 Subdivision
10207 Wren Lane
Eagle River, Alaska
PERCOLATION TEST RESULTS
AND
GENERAL SITE INVESTIGATION REPORT
This letter is a request for a septic permit on the above-referenced property. The lot, which is
located on Wren Lane between David Avenue and Lucas Avenue, is approximately 19,560 square
feet, moderately treed with birch and spruce, with a three-bedroom residence.
On June 1, 2007, an inspection was made on the septic system for the purpose of performing an
adequacy test. The system was found to be in a surcharged condition with approximately eight
inches ofwater in the two clean-outs, which matched the elevation in the monitoring tube. On June
7, 2007, a perc test was performed (see attached soil log). The test was done to a depth of 14.4 feet.
Ground water was encountered at 13.8 feet from ground level. The perc rate was 17 minutes per
inch. The seven-day monitoring period revealed ground water at 13.08 feet. The septic tank is a
1000 gallon Sunset Plastic tank with just one clean-out past the tank. A new double clean-out will
be installed down line from the tank. /% inspection will be made on the existing tank.
There are two wells on the lot. One was listed as temporarily abandoned in 1987; however, a cap
was just welded on top of the well casing. The well will be abandoned permanently by Sullivan's
Wells according to MOA standards at the time the new leach field is put in, which is scheduled as
soon as the permit is issued.
The space for a new septic systqm is confined to a small area in the southeast coruer of the lot.
Sheds present on the lot do not have foundations. A bull run or equivalent diversion valve is to be
installed to facilitate the use ofthe old system in the future.
On-site observation and physical survey show that there are no water wells or private wastewater
disposal systems within a 100' radius of the proposed system. Research was done on Lot 9, Block
7, which showed that a 75 foot well to tank waiver is on file with the MOA; however, according to
the surveyor's as-built, a 100 foot radius will not impact Lot 3's proposed leach field placement.
The
Municipality of Anchorage
Lot 3, Block 7, Preuss #4 Subdivision
Page 2
proposed system will have no measurable impact on surface or sub-surface drainage, or on drainage
from adjacent lots. It appears that thereis no potential for contamination ofadjacent waterwells or
streams from known sources. Also, the proposed development will not prohibit future development
of any neighboring lots.
Attached please find proposed design drawings for the deep trench system. If there should be any
questions concerning the percolation rate or characteristics of the site, please call me at (907) 746-
1073 or 243-5372.
Sincerely,
,O'Ogt
/
/
/
/
I
/
I
\ EINVI N':IEIM ~10 3NI9 qJ
---~ 1- /
'3'd 'A3'lN3)~ 'J. Svlonoa I
NOISIAIOI31'qS ~'# S$fl":l~d 'L :~:)O"18 '~ J. Ol
':l~OJ NOl~i )~Vlq
Z
I
N01SIAIOSns t,~ ssn3ud 'Z :~0018 '~ ,Oa ,' a )
Z
Z
Z
Z
0
C
.. ............
PERFORMED FOR: LARK uONFORe ~ ~74g~ t K ~ ~
LEGAL OEscRmPtmON: PrEUSS 14 S~, BLOCK 7, LOT 3 DAte: 6/14/07 ~...~.., ~
DEP~
GM/Sp SighU7 domp Io touch
m SEE ATTACHED SITE PLAN
DEp~ TO
GROUND~A~R
some boulders to 12' 13.8' 6/07/07
I 1&03' 6/14/07
ll DAtE READluc ~uE NET ~UE WAter LEaL NET Drop
(u~.) reaDm~o 0~.) 0~.)
12 6/07/07 1 2:38 p.m. - .... 8 .....
13 3:08 pm. 30 6-1/4 1-3/4
~ 82.53 2 3:10 p.m. - ....
8
14
3;40 p.m. 59 6-3/16 1-13/16
15 5 5:42 p.m. - .... 8 .....
16 4:12 p.m. 30 6-1/4 1-3/4
17
18 PERcOLATiON ra~ ~7 (umN./mN.) PETE. H~[ DIA. 6' (IN.)
TEST RuN BE~EN 5 FT. AND 5-1/2 FT.
19 PRESOAKED FOR FOUR HOURS ~S ~ NO
2
COMMENTs:BENCH MARK CEMENT SLAB ~ STAIRS OFF DECK I00.0'
PERFORMED BY: FRED KENLEY I, LOU~AS T. KENLEY, CER~FY THAT ~IS ~AS PERFORMED mN ACCORDANCE
~ ALL STA~ ~ uuNmQPAL ~mDEUNES IH EFFECT ON ~IS LATE:, ~ · I~. m ~
I ~] ) ~ ~ DOUGLAS T. KENLEY C.E. 1876
~ )~ ~ ~ c~,ul,~ e.~,~
DEPIH TO DATE
GROUNDWATER
13.8' 6/07/07
13.03' 6/14/07
~ ~ DE' ~TMENT OF HEALTH AND HUMAN SERV '~S
~' '~ ~' Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
/~4 r- Y-/,~, ~ ~ , DISTANCES
Address ~ TO SEPTIC ABSORPTION
~ ~ ~ ~~ ~y~ ~'~-~kflum ~ TANK FIELO WELL
Phone's' I Permit No. J No. o' Bedrooms WELL
~4-~/~ ~ 70/~ ~ 1~ / /
L~nL mC~PT~O. LOT LINE
~°~ ~ ~'°c~ ~ ~. ~ FOUNDATION
T .... hip, Range, Section /~ /~ / ~ /
~/~ N ~ / M ~ ~ O. ~ AS-BUILT DIAGRAM (Show Iocahon of welt, septic system, property hnes, loundaeon,
TANKS
-~ SEPTIC ~x.,~F ~ HOLDING
~TRENCH D BED D W. DRAIN ~ OTHER
Depth to p,pe bottom from Total depth from orig,na, grade ~
original grade ~ I
/~FT ~ FT
~ rave~l~gtl~' Gravel width
~ SO FT ~' FT
WELLS
~ PRIVATE ~ OTHER (Identify)
Ciassdicahon (A,B,C) ' Total Depth I Cased to
REMARKS: ~ '-
~' ~¢~ ~'~' ~ ~-¢~J~¢- In ~ ~ ed b ' ENGINEER'S SEAL
Date: EagJe Riv0r, AK 99577 , ,
~/ ~
I cagily Ihal this inspection was pBH~rmed accBrding
Municipal ~nd Stale guidelines in ellecl ~n lMs date: ~/~ ~'~, ~ ~ ~' ,~-=~, ' ".' ;', .'
Health Depa.ment Approval: w ~, Date: ~-z~-~ '~;~ '/~" '% ............. ' "' '
NLU'i :i C; .i. l:;, a i ;i. ~L y
t..~ :i. 'i',, i'i 'i;. h (:.:, i:f
'
ail l"iEi(.~ arid
(:.i~"i 'f..i'izi. Ei (::)['.
EAGLE RIVER ENGINEERING SEF ~,ES
P.O. Box 773294 '~ -'
EAGLE RIVER, ALASKA 99577
LETTER
Phone 694-53.95
To
ENVIRONMENTAL PROTECTION
~jIJj~ 3 $1987
RECEIVED
Date
MUNICIPALITY OF ANCHO..RA(~,~
DEPT. OF HEA~j~t
please reply
SIGNED
[] No reply necessary
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
~ SOILS LOG
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
9
SLOPE
DATE PERFORMED: ~/-~/~
SITE PLAN
10
11
12
13
14
15
16
17
18
19.,
20-
WAS GROUND WATER
ENCOUNTERED?
' O
P
IF YES, AT WHAT / , E
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
COMMENTS
PERFORMED BY:
72-o08 (6/79)
Eagle RNor Engineering Se~Icas
P, 0. Box 773284
Eagle River, AK 99577
694-5~95
TEST RUN BETWEEN FT AND -- FT
163.33
NO CONFLICTING
LOC.
IO0',,RA]]
TEE
TEMP. ABANDDNED
100' RAD.
RIC~-IT DF NFAY-
EXISTING LEACH FIELD
NEN/ LEACH FIELD
CLEANDUT -.
SCALE~ 1' = 40'
WELL AN]] SEPTIC 'SITE
LEGAL, LDT 3, BLK 7, PRUESS fl4
O~/NER, AUDREY HASDN
CDNTRACTDR: CHUCK 3ARR
EAGLE RIVER ENGINEERING
PD 3X 773294
EAGLE RIVER, AK, 99577
694-5195
SERVICES
PLAN
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMEDFOR: ,~/(~¢~
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16-
17-
18
19
20
COMMENTS
SLOPE
DATE PERFORMED:
SITE PLAN
WAS GROUND WATER
ENCOUNTERED? )/Z~S 8L
' O
P
II Li " ~t~c~v. E
IF YES, AT WHAT
DEPTH? 7
Reading Date Gross Net Depth to Ne{
Time Time Water Drop
~o~
~ ~,6~/~ ~.'v~ ~-,~, ~'-~," 'Y,~
~ " 2; .s'..~ ,t ~c ~ ~, ~/~"
PERCOLATION RATE ~ O (minutes/inch)
TEST RUN BE~EEN ~ FT AND ~ FT
PERFORMED BY:
72-008 (6/79)
Eagle River Engineering Services
P. 0, Box/1a294
Eagle Rive& AK 99577
6~4.5195
CERTIFIED BY: --' DATE:
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL
01[:i'lL[;
: '" ' ' ~ ~(o v,'ii.i or'~f;; ~llc.! '-4,;.r.- iff,(; ,ii'(: ,:~<~.. i ,o~ ~.' ,?:,rid x~i':"~ ~.,.:~ ~(:: '~/~fil- i ~ ~ t~i ~:i
~, ~/ ~,:; ,:'~Oi"~t.i-/~c:l:oi' _,(:, rn(~': ?Ji!l'il :.;:~.i)/i], i ?.',/
7
RECOMMENDED LEACHFIELD DIMENSIONS
THIS UPGRADE IS TO ADD I (ONE) BEDROOM TO EXISTING LEAONFiELD AS PER ADEQUACY
TEST RESULTS ~
TEMP, ADAN~ONED
~et~
163,33
100' RA
NO Ci]NFLICTINO ¥/£LLS
LOC,
I]EI~ l~X2~
100' RAD,
TEE
WELL AND SEPTIC SITE PLAN
LEGAL, LOT 3, BLK
OWNER, AUDREY MASON
CONTRACTOR: CHUCK BARR
EAGLE RIVER ENGINEERING SERVICES
PD BX 773294 ,'
EAGLE RIVER, AK, 99577
694-5195
RIOHT DF WAY
EXISTING LEACH FIELD
NE~! LEACH FIELD ~
CLEANOUT - o
SCALE, 1' = 40'
/~ RIGHT DF WAY-
EXISTING LEACH FIELD ::::::::
CLeAN,UT -
~C~LE~ 1~ = 40'
WELL AND SEPTIC SITE PLaN
LEGAD LDT 3, 3LK 7, PRUESS fi:4
BWNER~ AUDREY MASBN
CBNTRACTBR, CHUCK "ARR
-
EAGLE RIVER ENGINEERING SERVICES
EAGLE ~IVE~, ~K, 99577
6 9 4 - 519 5 ~q~*~ ..~
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 . 264-4720
SOILS LOG- PERCOLATION TEST
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
2
3
4
5-
9
DATE PERFORMED=
SLOPE
SITE PLAN
10
11
12
13
14
15
10
17,
18-
1g.-
2o-
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
3' ,, '--,:-' /JsR /
TEST RUN BETWEEN
PERFORMED BY: Ea01e Rivor Encneerino Services
P. 0. Box 773294
Eagle River, AK 99577
72-008 16/79) 694-5195
.5- ~' ~ .' .7 4 ,,o ~..~, 6
PERCOLATION RATE 7' ~ (minutes/inch)
~¢~ FT AND 7 FT
CERTIFIED By:
· Heal[ and Environmental. Protect
:,,,' ~ ,t Fourth Floe]: West
825 L Street
Anchorage, Alaska 99501
279-2511, x 224, 225
INSPeCT!ON REPORT ON-SITE SEWAGE DISPOSAL SYSTEN'i
SEPTIC TANK:
· ' r-~-PA~ TYJ0~ GALl
INSIDE LENGTH INSIDE WIDIH __ LIQUID DEPTH .... L IQu~.) e*x u
TILE DRAIN FIELD:
. ' ~l tOTAL t_ENGTH I
DISTANCE FROM WELl- L~_~--FOUNDATION .... ~ NEARE51 LO[ LINE _
~ of Lines . 3 ...... DISTANCE BETWEEN LINE% _ ~ [ ~. --TRENClt WtDTH~ IN. TOTAL EFFEC11Vk
ABSORPTION AREA .............. SQ. FT. t [ NGFII OF EACt L INE ~- ~
' [)EPltl OF FILTER
SEEPAGE PIT:
DiAI~,4 ET ER ....
Log Crib ___Rings.__
BUILDING FOUNDATION ..... NEAREST LOT LINE
OR WIDTH ...... LENGTH .... DEPTH
Crib Size: DiAMEIER___DEPfH---- DISTANCE FROM: WELL ......
TOTAL. EFFECTIVE
ABSORPTION AREA (WALL AREA) ,SQ. Fr.
Well
Class: ~ Dept'h:
Well Distance To: Lot Line
Bldg: ~O ~ Sewer Lin :
Pipe Ma~er~-~ls: ~'
~ of Bedrooms:
Installer:
Remarks: L~[I
,, I
F EF..H I T NO,
FFLI_,HN F TOM ROHN
LGI.]:AI" I ('}N PE'I IF'-;':
LEGAl... El'. '='"" FF. IE.::,'-,
..:-.E:k.. 7 "'' '"""-'
P, 0,
E:::.::. ~'.96 E. R.
L.OT tSIZE
NONE
:t4~87 :F.;I:..:!LIRRE FEET
T'T'F'E OF SOIL H6:,DRE, TION "~'"' ....
=' T ,=I r EM 7 REN--'H
MR>'"IMIJM NI...IME:ER OF BEDF'.uuM... = Z'":
THE REI;!I...IIRED SIZE OF THE '.~.;:IL ABSORF''I--ION S"r'STEM IS:
I"HE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCEE BETWEEN THE SURFRCE OF THE
GROUND RND ]'HE BOTTOM OF THE EXCRVRTiON (IN FEET).
'THERE IS NO SET WIDTH FOR TRENCHES,
THE GRRVEL DEPTH IS 'THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTF'FtLL. PIPE:
RND ]'HE BOTTOM OF' "FHE EXCR',/RTION (IN FEE'T). :~
F"R,:Z: t-=:.:RC-~E: F:'L.Ft~'-~t-F C,F"T' .1.: C, lP41
R PRCKRGE PL.RNT MR"r' BE: INSTRI._I..ED RT THE PERMITTEE'"S OPTION SUBJECT TO TFIE
FOLLCJWING CONDITIONS:
±. EI'I"HEF. t R CLRSS I OF.' II NSSF FIPPROVE[:, F'LRNT MR? BE INSTRLLED.
2. R CONTINLh]U"5 MRINTENRNCE RGREEMENT iS REt-]UIRED. IF R MRINTENRNCE
RGREEMENT IS NOT KEPT CURRENT '¢OU i"IRY BE RE~::~I...IiRED TO ENLRRGE THE SOIL.
RBSORPI"ION SYSTEM RND,.'"OF.: 'T'OU MR~r' BE SU6'JECT TO PROSECI...ITION.
i E:RCKFILLING OF RN~r' S'¢S'FEM WITHOLIT FIHRL INSPEC'TION RN[:, ~FFF.-" '-.t~ ~1..."- B'¢' ]'HI'..=.;
[:'EF'RRI'MENT W I EL BE SUE,'..fEC]T TO F'RO'..'SECU]' I ON.
MINIMIJM DISTRNCE BETWEEN R WEI.J._ FIND RNa' i]N-SII"F SEWRGE [:,ISF'OSRL. '-"- .... ,
· . - :,~.:,FE. tl IS
ZO~ FEET FOR R PRZVRTE WELL. OR 2E~ FEET FOR R F'.EI_~E: WELL.
OTHER RE(;!t.IIREI',IENT~ MR'¢ RPPL'¢. $PEC:IFICRTION$ RND CONSTRUCTION DIRGRRMS RRE
RVRIL. RBLE TO INS_RE PROF'ER INSTRL. LRTZON.
I CERTIF'.r' THRT
].: I Rr'l FRHILIRR WITH ]'HE RE~.]L~IREMEN'TS FOR ON-SITE SEWER'.-] RND WELLS
FORTH 8'¢ THE MUNICIPFtLIT~' OF' RNCHORRGE.
2: I WILL. INSTRL.L ]"HE S"r'STEM IN RCCORDRNCE WITH THE CODES.
2:: I UNDERSTRN[.'.' THFtT THE ON-SITE SEWER !S'¢STEM MR"r' REtT.!UIRE ENLRF..'GEMENT IF THE
..........................
BPPL. ICRNT TOM ROHN
,,'- ......... ...........
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION []
Pouch 6,550, Anchorage, Alaska 99502 276-222I
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
"J SLOPE
12
13
14
15¸
16-
17
18
19
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
Reading Date Gross Net Depth to Net
Time Time Water Drop
2O
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND -- FT
DAVID A. SLENKAMP
ROBERT A. SHAFER
MECHANICAL ENGINEER
694-9055
October !8, 1979
CIVIL ENGINEER
694-2979
MUNICIPALITY OF ANCHOI~AGF-
DEPT.' O1: HEAL'fH &
ENVIRONMENTAL PROTECTION
Curtis L~y±ey
5413 ~'~cen Lane
Ea,;le River, Alaska
99 5?7
OCT 2 1979
RECEIMED
Dear .z,~. Hay!ey~
P~-erence: Lot 3, Block 7; Pruess bro. 4 ,9~.bdivision
At the request of Area Res!tots a se'.,er system adequacy test ¥;~:.s conducted
on the reCere~ced .... pro~e-~ty., _ The teat was cono.~c~ed", ~' on 0~ '~,coo,~er !3~ 1/+~ an~
1~¢ .1979 and included pumping the sep-~ic tank which verified it's
capacity to be lO00 gallons.
The trench (absorption area) was tested by conti~tmous flow of water
through a water meter for a period of 48 hours. ~,.u'ing the first 2/+
hours the flow rate was set to allow 1200 gallons to enter the trm~ch.
At this rate the water level in the Su~? increased. The flo¥.~ rate
was then reduced for the ne~.~ 24 hour period to allow appro~.imstely
617 gallons to e~ter the trench. At this rate the ~ter level in the
sump lowered appro×i~tely 10 ~nches.
It can be co,~cluded from~'*4UL_S test t}~at the septic tank is adequate and
that tt~e absorption trench will provide for percolation in e:,:cess of 206
gallons per bedroom.
system ( septic tank a_.'~d absorption zrencn) is a~,~q.at.e.~ -- =
assz~uaz~ce~ please do not _~s_tuaue to call.
A.
cc.' ~'~'~" ~/~rgaret St~l~mnn
~r~a ~slty
.,,,unmc~_p.~lmty of Az~_chora~-e
Department of Health and Enviornme~ttal Protection
SRB 19GX EAGLE RIVER, ALASKA
ii hereby~ certify
AS-BUILT
that I have surveyed the following
described property:
~¢=_C. , ~-- ,' ,4- ~ ~ ~ .~ ~ ~ ~.~ /
flnehorage ~cording Precinct. Alaska. and that the
m~provements situated thereou are within the property
]h~es and do not overlap or encroach on the property
lying adjacent thereto, tha~ no improvements on prop-
erty lying adjacent thereto eneroaca on the premises in
~uestJon and tha~ there are no yoadways, transmission
lines or other visible easements on said proper~y except
a:~ indicated hereon.
Dated at ~agle River, Al~qka
thistly
ROBERT C. JOHNSON
SCALE: Registered Land Surveyor No,
I" =f~O ' Box 456. Eagle River, Alaska
Phone 694-2543
i'"i Z!: ?.,! :[' ?1LI F'i
:.j.i;i:.il~i[ F:'E:ETI" I:::'O1:~: f:l F'I:~::JZ',,,'I:::I'TE P.IE:!..L. O1:~: ;;;~:,'..'!~l;!!i I:::'li!iZiET F'O.~;;: I::~, I:::'LIE:i.,:t:E: HELl ....
1.4tii:L.l.... L. O(:!i:~i;
Eft::' TIdE
0 T HIEI:;i: t:;i: !i~:%:¢..I
fit',,,?[ :i: t....ffff?J...l!!i: "i"E~
& L DRILLING COMPANY
BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE6f14-2588
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION ~ '7 ,(ffC/d~'~ ~/fl/~'o~3
PER~IT NUMBER '?/ +3~
DEPTH OF WELL
STATIC LEVEL OF WATER FT.
DRAW DOWN FT.
GALS. PER HR
KIND OF CASING
C)
KIND OF FORMATION:
From. I' ) Ft. to -i~' Ft. filL, t, From--Ft. to-
''' ~fl] ]4/'D From__Ft to
From ', Ft. to Ft.
From :? ';'[ Ft. to ,.)c) Ft._ ·
From /~[') Ft. to c[$'~ Ft. (~kt~i~a~;e- ~oo~ From~Ft. to
From .~ ~o Ft. to /O ~' Ft. ,~lj~)O~ ~d<Yt?- T/r,~/7~ From~Ft. to
From /;9~~ Ft. to ]t~° Ft. ~.C~&~ ~L From Ft. to
From /~?0 Ft. to /~]5 Ft. ,~9~d g- ~d~&C From__.Ft. to
From /~ :5 Ft. to [~ Ft. -
From /[~q~ Ft. to /YS~'Ft. ,~A~or3 [o/dv/d/~z- ~l~d~/;~= From__Ft. to
From / I -~ Ft. to , Ft. - From__Ft. to
From ?C, oFt. to '~6"l Ft. ,:/~-~O F~om~Ft. to
'~ ~ 41'0,~, ~? From__Ft. to
From ,3 ~g I Ft. to. Ft.
From Ft. to Ft. From.~.Ft. to
Ft.
Ft.
Ft.
Ft.
Ft.
Ft.
Ft.
Ft
Ft.
Ft
Ft.
Ft
Ft
Ft
Ft.
~Ft. }
MISCL. INFORMATION:
DRILLER'S NAME
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7904
Parcel I.D.
050-572-37
1. GENERAL INFORMATION
Complete legal description
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
o'se. ti ttqq
Expiration Date: ~- i i- // /
PREUSS #4 LOT 3, BLOCK 7
Location (site address) 10207 WREN LANE, EAGLE RIVER, AK 99577
Current Property owner(s) NATHAN & NICOLE CORLEY Day phone
Mailing address 10207 WREN LANE, EAGLE RIVER, AK 99577
Lending agency
Mailing address
Day phone
Real Estate Agent
Mailing Address
TERRI BARRUS
Day phone
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class__ Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[] Individual Holding Tank
[] Community On-site
[] Public Sewer [-~
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the 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 868-3792
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engiq~.e~ Pri.n,ted,~me ~ KENNETH M. DUFFUS Date 05/03/2011
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.
DSD SIGNATURE
~ Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
A'
Maintenance Agreements
Supplemental Engineer's Report
Other
?/~~~_ Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: PREUSS #4 LOT 3, BLOCK 7
A. WELL DATA
Bm
Well type PRI~ATE IfA, B, or C provide PWSID # __
Date completed 07/1977 Sanitary seal (Y/N) Y
Total depth 1 60 lt. Cased to 140 ft.
FROM WELL LOG
Date of test 7/1977
Static water level 127 lt.
Well production 5 g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100mL Nitrate
Arsenic: N"D .mg/I Date of sample: 4/27/20'11
SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Plastic
Number of Compartments _2
High water alarm (Y/N) N
C. ABSORPTION FIELD DATA
7.42 mg/L
Parcel ID: 050-572-37
Well Log (Y/N) _~
Wires properly protected (Y/N) Y
Casing height (above ground) 24 in.
AT INSPECTION
412912011
127 It.
6.22 g.p.m.
Collected by: ArcTe~xa
Date installed 1977 Tank size 1000 gal.
Cleanouts (Y/N) Y Foundation cleanout (Y/N) X Depression over tank (Y/N) N__
__Date of pumping ~/28/20~1 Pumper IRs
Date installed 7/1012007 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.6 System type Deep Trench
Total depth 8.~9 ft. (Measured 4/29/11)
Length 70 ft. Width --3 It.
Gravel below pipe 5.4 ft.
Eft. absorption area 750 fi2 Monitoring tube Y
Depression over field
Results (Pass/Fail) Pass For 3 bedrooms
in. Water added 780 ga.l:~ Ne~epth~'-24.9
__ in. Absorption rate >= 450~g~'p~: ,;, ~.
Date of adequacy test 4/2912011
Fluid depth in absorption field before test 15.42
Elapsed Time: 1335 min. Final fluid depth 16.2
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N__lf yes, give date --~-
in.
LIFT STATION
Date installed
"Pump on" level at __
Datum
in.
E. SEPARATION DISTANCES
Size in gallons
"Pump off' level at __
Cycles tested
in.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 3`00'+
Public sewer main ~3'+
Sewer/septic service line 25'+
Animal containment areas 50'+
Manhole/Access (Y/N).
High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots 3`00'+
On adjacent lots 3`00'+
Public sewer manhole/cleanout 3`00'+
Holding tank 3.00'+
Manure/animal excrete storage areas
100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 3`0'+ Surface water 3`00'+
Wells on adjacent lots 3`00'+
Property line 3`0'+ Building foundation
Water Service line 3`0'+ Surface water
Curtain drain 50'+ (None Known)
F. COMMENTS
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Water main 3`0'+
Driveway, parking/vehicle storage
Wells on adjacent lots 3`00'+
10'+
Vacant system presoaked with Z000 gallons prior to test.
G. ENGINEER'S CERTIIFICATION
. . :~-'~,~-:-..?~ 'i.~.',
I certify that I have determined through f~eld inspections and
review of Municipal records that the above systems are in
co.,orma, ce in o. th,s dete.
Engineer s Printed Name KENNETH M DUFYUS ·
Date 5/3/11
COSA Fee $490.00
Date of Payment ~
Receipt Number Iql"l
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
SGS Ref.#
Client Name
Project Name/#
Client Sample ID
Matrix
1111584001
ArcTerra Engineering and Surveying
Preuss 4 B7 L3
Preuss 4 B7 L3
Drinking Water
Printed Date/Time
Collected Date/Time
Received Date/Time
Technical Director
05/03/2011 16:39
04/27/2011 15:00
04/27/2011 17:00
Stel>hen C. Ede
PWSID 0
Sample Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic ND 5.00 ug/L EP200.8 C (<10)
04/28/11 05/02/11 NRB
Waters Department
Total Nitrate/Nitrite-N 7.42 0.100
mg/L SM204500NO3-F B (<I0) 04/28/11 AYC
Microbiology Laboratory
E. Coli Negative I 100mL SM20 9223B A 04/27/11 DLC
Total Coliform Negative 1 100mL SM20 9223B A 04/27/11 DLC
Municipality of Anchorage
Community Development Department
Development Services Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On-Site Systems Approval # 111144
A Certificate of On-Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 7, Lot 3 of
Preuss ~ subdivision. This inspection revealed a nitrate concentration of
7.42 milligrams per liter (mg/L) was reported for the property's well water
sample. 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.
85,/E~3/2Elll ZE,: Er_~ 987:34~SR~1 JRS :_--iEPTIC PAGE
J-Rs Pumping
Po }30:< 773415
Eagle RJver~ AK 99577
(19071 ~94-6454
BILL TO:
ArC Terra
20441 Ptarmigan Boulevard
Eagle River, AK 99577
Invoice
Number: 33199
Date; 03-May-2011
P.O. Number:
Job Description: 10009
Order Num 33199
Serviced 28-Apr-201 t
Manifest
JOB {ITE '
DBa
10207 Wren Lane
Eagle River, AK 99577
Qu~,,ntity
Serv!,c, eType .....
Septic Sen/1000K
Amount Tax
$185.00 No
Taxable Amount Tax Rate
$0,00 0
Tax Description
$o.oo
Payment Terms Payment
Net 30 $0,00
Lasl Service *07/06/2007* ltXIOG
Adjustment Late Charge
$0.00 $0.00
Subtotal NonTaxed:
Subtotal Taxable:
Subtotal Tax:
Extensi,, n
$185,0(
$18S.0C
tank mormal
frozen {~ top but pumpable
back flushed 1 time
For your added convenience we accept; Dicover, Visa and Maat~r Card payments over the phone,
After 30 Days account will be t~lrhed over to COLLECTIONS, $30,00 For NSF Checks Returned.
From: Please detach here and return the bottom portion with your payment. Arc Terra
20441 Pta. tm gan Boulevard [
Eagle River. AK 99277 Order No. Invoice No. Date
33199 33199 03-May-2011 $18S.00
To;
JRs Pumping
PO Box 773415
Eagle River, AK 99577
$185,00
$0.00
$0.00
Parcel .D. #
MUNICIPALITY OFANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
:,_ 343-4744
CERTIFICATE oF HEALTH AUTHORITY
A'PPROvAL FOR'A SINGLE FAMILY DWELLING
050-572-37
HAA# HA940122
1. GENERAL INFORMATION
Complete legal description Lot. 3 :Block, 7 Preuss Subd±vis£on #4
Location (site address or directions) 10207 Wren Lane, Eagle River
Property 'owner
Mailing address
Mark/Beverly Monfore Dayphone 696-2078
10207 Wren Lane, Eagle, River, Alaska 99577 .
Lending agency
Mailing address
Day phone
Agent . Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: Three (3)
TYPE OF WATER SUPPLY:
individual well
Community well
NOTE:
lng to the legality and status of system::
TYPE OF WASTEWATER DISPOSAL:
individual on-site xxxxxx
Holding tank
~XXXX
Public water
If community well system, provide written,confirmation frbm:State AD~C;~ttest- ~ :
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-O25(Rev. 1/91) Front MOAIf21
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 further verify that based on the information obtained from
the Munici pality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in;compliance ~Nith all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection,
NameolFirm Eagle River Engineering Services Phone 694-5195
Alaska' 99577
Address PO Box 773294, Eaqle River,
Engineer's signature
Date
This office has rece~ved~.-.the re-sampling from
the engineering firm (Eagle River Enginee~i~ng~Se~vig~)[!~.
and now'has a full approval. If there ar~an~
questions, please call our office at 343~47~4.
6~
DHHS SIGNATU RE
××× Approved for ,three (3)
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
' '-Additional Comments There was 74 of standing'water ~n the leachf~eld
?'?:~:-'~ '~:i/~ ,.,. ,_. observed durir~,,an adeuqacy test'on 2-24-94. This indicates that
~,~ ~!~!.~_~f the: ~b.sorptionu area:~.~s surcha.rged(under water) therefore the
:::~'~ ~e~ing-l~fe ~the leachfield~may be limited.
The Municipality of Anchoraoo Depa~ment of Hoalth and Human Se~ices (DHHS) issues Health Authority
Approval Ge~ificatos based only upon the roprosontations oivon in paragraph 5 abovo By an indopondont
profossionalon~inoorrooistorodinthoStatoofAaska Tho DHHS doos th s as a cou~esy to purchasors of homos
and thoir Iond n~ nstitufions n order tosatis~'co~ain ~ederal and state requirements. ~mployees o~ DHHS do not · ~ - ~
conduct inspections or analyze.data ~oforo a co~ flcate s ssued Tho Mun cipali~ of Anchoraoo.is not ' '
reSPonsible for errors or omissi0n~ in the professi~fi~l~ehgihee~s wo;k. ' ~' : . '
72~5(Rev. l~l) Back MOA~21 " ".
MUNICIPAL. ITY 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. #
050-572-37
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description
Preuss #4 Lot 3, Block 7
Location (site address or directions)
10207 Wren Lane, Eagle River
Property owner
Mailing address
Lending agency
Mailing address
Agent
Ad dress
Mark & Beverly Monfore Day phone 696-2078
10207 Wren Lane, Eagle River, AK 99577
N/A Day phone
N/A Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
individual well X · i.,,.
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Pubiic sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status 'of system.
72-025 (Rev. 1/91) Front MOA#2~
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 s howe that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein, I further verify that based on the information obtained from
the Municipality of Anchorage files and from my inves.ti_gation and inspection, the on-site water
supply and/or wastewater dis posal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
99577
Phone
Name of Firm Eagle River Engineering Services
Address P.o. Box 773294, Eagle River, AK
Engineer's signature ~'"~~
694-5195
7~ SIGNATURE
Approved for
Disapproved.
,../~' Conditional approval
for
bedrooms.
bedrooms, with the following 'stipulations:
The Municipality o{ 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 DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements' Empl°yees °f DHHS d° n°t
, ., 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
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. Well Data
Well type ,~,g/~.4~'£
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number
)/ES Date completed ~¢ ¢/¢ '~ Driller
/(.cO / Cased to /c/O ' Casing height
)"C' ¢ Wires properly protected (Y/N)
FROM WELL LOG
Date of test (2 ?/'7
Static water level / ¢- '~ /
Well flow ~
Pump level1 /,..~o /
g.p.m,
SEPARATION DISTANCES FROM WELL TO:
Septic/h~ding-tank on lot / S~ '
Absorption field on lot / / <~ /
AT INSPECTION
/~o '
MU[-,[ICI PALl l Y Of
ENVIRONMENTAL SERVICES DIVISION
Public sewer main
Sewer service line
..... 0 1994
g.p.m.
RECEIVED
WATER SAMPLE RESULTS:
Coliform
Date of sample:
B. SEPTIO/HOEEHNG TANK DATA
; On adjacent lots
; On adjacent lots
Date installed / ¢ ¢ "~
Cleanouts (Y/N) Y~ _%
High water alarm (Y/N)
Date of pumping
Public sewer manhole/cleanout
Petroleum tank .A/D/CE
Nitrate './'/', / ?Y/ ~"~ /('..- Other bacteria
0'¢/~1/¢1'/ Collected by:
Tank size / OE)¢ Compartments_ ~-
Foundation cteanout (Y/N) ~¢ 5 Depression (Y/N)
/W/,4 Alarm tested (Y/N) /'-//¢4
~¢ ~/~,~///? ~ Pumper ,--/~,'~ ~
SEPARATION DISTANCES FROM SEPTIC/HObE~FNG TANK TO:
Well(s) on lot /
To property line -~
Surface water/drainage
On adjacent lots / O0 / Foundation
Absorption field ~'/'¢ Water m~+n/service line
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION /V/A
Da"~te4~talled
Size in g~
Vent (Y/N)
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
Surface water
D. ABSORPTION FIELD DATA
Date installed
Length
Total absorption area
Date of adequacy test
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Soil rating (GPD/Ft2) ¢'~, ~' System typ~
Width ..~ ' Gravel thickness ,~ / Total depth
~ '~ ~ Cleanout present (Y/N) /V~ % Depression over field (Y/N)
0 ~./?..~//~ Results (pass/fail) ~2/~ ~,.~ for
/./7''/ Aftertest ~'?"
V/A If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot //
To building foundation
On adjacent lots
Surface water /'/
Curtain drain /~¢/~ ~"
On adjacent lots Y~/(~(~ / Property line
? .~ To existing or abandoned system on lot
Cutbank ./V/~ Water mairr/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines i~ eff..,~qt,.~90..~e,.date of this inspection.
Engineer's Name ~OOlS /~ ~, ~. ~.., x-~:~-; ~:~,;~ .:... ~:~;~.~, ~ ~?,~
Date ~¢'- ''~ --Y~ ~t"~ ~, ~ ~<~ ~
~ ~'¢/"~'~r~ .... ~v.'~'''¢ ~'
HAA Fee $ ,~dP
Date of Payment
Receipt Number
72-026 (3/93)* Back
Waiver Fee $
Date of Payment
Receipt Number
Bedrooms
NORII-tERN
3~0 ~NDU.~IRIAL A~/ENUE
TESTING LABORATORIES, INC.
1%e,,JR BAN KS, p,!~SKA 991[J I 15"~,7 ) 4~3~ 3~, 16, FA~ 456.3125
p.O. ~0~ 773294
Coll~0te~ by:
MMO-MUG (colile~t
Location
D ate
Public Water
Date R~ceive~:
Date ADal~zed:
Da~e Re~ort~d~
Ne~t Sample Due:
03~01/94 Time Received:
O3/01/94 Time ~n~lyzed~ 13~1~
03/0~/94 Time Reporte~: 1~24
ND
old
R =
NT
Confl~Dt Growth
sample Age >30 ~o~uCs ~u~ <48 Hour~,
Rs~ult~ M~F Not B~ Reliabl~
S~mple Ag~ >48 HO~r~. TOO Ol~ For
No Test
* ~ Colonies/100 ml
Lab~
1Pruess ~4 Lot 3 ~lk 7 02/28/94
AB10S? ~D ND N~. NT S
our Lab
Your
Sa~le
NORI'HEt]N TESTING LABORATORIES, INC.
~ INDUSTI{IAL ,.'k%'E~O6 FAIR~AN~S, ALASKA g97.~1 (~)7) 4{~-3116 .F,~,3~3125
25D§ FAI~SANK~ STREET AN~HO~GE, A~ 9~ l~7) 277-~, F~ 27~9~5
=Above Re~ulatoryMax.
~ ~timated Yalue
}~L = ~ethod Deteutton Limit
Unit~ Result ~ MDL P~e~re~ AAalyz~
A129605 EPA 353-3 Nitrate-N mg/l 6.1 1,3 0!/28/g~
Supervisor
4
· 6
7
RECEIVED
MAR 2 1 1994
Ivlun~clpal~ty ol Anch..orag~OTRL p. O1
Dept. Health & Human services
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
['~.,~.Z.~(--)_ ,.~'I,---Q, '~-)-~ HAA# '~-I ~,~c~,('~/-''/~'~ ~
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
Location (address or directions)
10207 Wren Lan~
(b) Property owner
Mailing Address
(c) Lending Institution
Mailing Address
· ~.¢;4l~ T~n~/,n~ Telephone: (home) Business
E,~g~e ~;-~_~-, A~_~x,~- qq577
Telephone
(d) Real Estate Cempany and Agent JACK WHITE COMPANY ATTN: K~h.~ OZmst~.ad
Address I092~ Ee.g.~2. Ri:,~*- Rc,~.~ E~.g.~& ~'~, .'~¢-~¢- 99577
Telephone 69~-5500
(e) Mail the HAA to the following address: (or check here~ if hold for pick up.)
List contact person and day phone number below:
$ & S ENGINEERING
i 703,4 E,,~|,= 2,~.w~- Lc, c,p
Eagle River, Alaska
2. TYPE OF RESIDENCE
Single-Family E~ Number of bedrooms
3. WATER SUPPLY
Individual Well ~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attestingto th legality and status.
4. SEWAGE DISPOSAL
On-site J~2( Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72~025 (Rev. 7/88)
Page 1 of 2
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pu~ led!olunlAI lie q~,!~ eouelldLuoo u! s! LUe~S,~S lesods!p Je],et~e3se/~ Jo/pue Alddns Je),e/~ e),!s-uo eq), 'uo?,oedsu!
puc uo!~,eeRse^u! ,~LU UJO~¢ pu~ Sel!J eeeJoqou¥ jo /q!led!o!unlR eq~ LUOJi peu!e~,qo uop, ettuoJu! eq~, uo peseq
~,eq~/,H~e^ Jeq~Jnt I 'uieJeq pe~eo!pu! eJn~,on~),s jo edA~ pue SLUOOJpeq tO jeqLunu eq], Joj e~enbepe puu leUOp, ounj
'e,tes s! LUe~,S~S lesods!p Je3e~m, se~ Jo/pue ~lddns Je~,e/~ e~!s-uo eq~, ),eq), sMoqs le^o~dd¥ /qpoq~nv q~leeH
s!q~ to uo!),e6Rse^u! ALu leq~ ,~,qJe^ I '~oleq u/~oqs elep uogeP!le^ eq~ to se pue o~e~eq pexijje leas ALU/,q peuRJeo s¥
NOIJ. VINIdOJNI ON¥ VI¥O 'HOOVES ~t'11.4 'SJ.S~]l 'SNOllO:~dSNI 9NlOIAOt:ld IN~I.-I 9NI~]~tNIeN~t
'9
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description: Z__p-/'-
A. WELL DATA
well Classification ~;~ {C- ~'-'t~ t~';l~
Well Log Present (Y/~) ~ Date Completed
Total Depth ./~' Cased to /~O '
Static Water Level / ,~ ~
Casing Height Above Ground ~-
Electrical Wiring in Conduit (Y/N) ~
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot / ~
To Nearest Edge of'Absorption Field on Lot
If A, B, C, D.E.C. Approved (Y/N) ....
"~'/ ~ '~ Yield '~. ~- ~,~N~..
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N) __
-; On Adjoining Lots
/ I~ ' ; On Adjoining Lots / OO !
TO Nearest Public Sewer Line /0/¢t To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot ~ ~' /
Water Sample Collected by .~..~1. ~ ,,~¢;,j/dc_.~C'/~Jc~ 'Date O~. -,¢.~ ~'O
Water Sample Test Results ,~/,ct"~t '~ ¢~C_.."~¢¢.,/ --
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed~ ~' ~ 7 Size
Standpipes (Y/N) ~
Depression over Tank (Y/N)
To WateE-Supply Well
To Property Line
To Water Main/Service Line
Air-tight Caps (Y/N)
Pumping/Maintenance Contact on File (y/N)
Holding Tank High-Water Alarm (Y/N) ~/~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
! ,~ ~ To Building Foundation
!
~ ~- To Disposal Field
./(Z)OO No. of Compartments ~ __
Foundation Cleanout (Y/N)
Date Last Pumped ~. -
;for
Temporary Holding Tank Permit (Y/N) A,)//~
To Stream, Pond, Lake or Major Drainage Course
Comments
72-026 (Rev. 7/88) Front Page 1 of 2.
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed G ~/
Width of Field
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
/ X.~ ~ ~/b~ ,-~ Type of System Design
Length of Field
!
Depth of Field !
I
Gravel Bed Thickness
/~ ~--O Statndpipes Present (Y/N)
/%~ Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
/
To Water-Supply Well / ( ~'
To Building Foundation I ~
Lot I ~
To Water Main/Service Line [O ~r
To Stream, Pond, Lake, or Major Drainage Course A)/~
/
To Driveway, Parking Area, or Vehicle Storage Area / O +
To Property Line //
To Existing or Abandoned System on
; On Adjoining Lots ~0 ~'~
/
To Cutback (if present)
D, LIFT STATION
Date Installed ~%
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this
inspection.
Signed
Company
Date
MOA No.
5 8, S ~NOiNEERING
17034 ',;~gle River Loop Road No. 204
Receipt No.
Date of Payment
Amount: $
72-026 (Rev. 7/88) 8ack
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA,INC.
\ 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343
~..'~-~'o~;,;~',;~% FEDERAL TAX ID # 92-0040440
Date 5spo~% F~.inted:
i, aoorator~ Supervisor ;ST~H~[/ C, ~D~ 1)S ~ g
SpacJ. a.].
Chemlab P~ef 6:900115 gab 31apl
P a.~: a~:'~et er ?csted
Rel~al:k~: 3MffI, E COLLECTED
3. ?e~ts Pezfor~aed ' See Spatial !nstzuction~ M)ove, Ul-Unaveii~bie
NO= None DC;coted ~* See l~ample t~emarks ,%hove
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
TELEPHONE (907) 562-2343 5633 B Street
Anchorage, Alaska 99518
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
PRIVATE WATER SYSTEM
Name
Mailing Address
Phone No.
S & S ENGINEERING
170.14 ,-ay! ...... L,~p R,~a~ No;-204
Eagle River, Alaska 995~
City State
SAMPLE DATE: ~ ~ ~
Mo. Day Year
Zip Code
SAMPLE TYPE:
. Routine
Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
) [] Treated Water
[] Untreated Water
SAMPLE
NO. LOCATION
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
~SSatisfactory
[] Unsatisfactory
[] Samp!e too !cng in transit; sample should
not be over 30 hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received 2-/'2-~/~ C~
Time Received / ~ ~{~
Analytical Method: Membrane Filter
* No. of colonies/100 mi.
Result* Analyst
~/0.0175 ?
I
I I-F1
I
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Membrane Filter: Direct Count
Verification: LTB
Final Membrane Filter Results
Reported g~~'~-~,
-~--- Collform/1OOml
TNTC -- Too Numberous To Count
OB = Other Bacteria
BGB
Collform/100ml
Date ~ ' ~ ~'90
Time: I~' .~J~ (~ a.m.
p.m.
"'~? 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
264-472O
Application Date
GENERAL INFORMATION
(a)
(b)
(c)
Legal Description (include lot, block, subdivision, section, township, range)
PREUSS SUBDMSION: Lot 3, Block 7 T14N, RiW, Section 8
Location (address or directions)
10207 WREN LANE: EAOf,Y:. RIVER; ALASKA
Applicant Name AITDRFF¢ MASON Telephone: Home n./a
Applicant Address P_O_ f~ 7778a9= ~AO, T,~ RTX/T~,R; AM 99577
Applicant is Icheck one): Lending Institution []; Owner/builder []; Buyer []; Other~ (explain);
REAT ,TQR
Business 694-4200
(d)
(e)
(f)
Lending Institution TDNI'A~ ~, NTR~ri~f,'FTR3N' Telephone 276-~q5h?
Address Arr'T~f: f,k71~, lq~fx]rl~N h3~0 TA Rq'RF4Tq?'P~ AN(!Nf}RA~., hi( 995Q3
Real Estate Company and Agent R~,AVI'A_1(_ ~'~ ~A(".T.~ RT1/~_.~, Aqmf~f? AT_IT~RI:~' MA.~C)N
Address P.O. ~OY 778h9, ~.n.T.~ _~T~, _~T,ASF_~ 99577
Telephone 694-4200
Mail the HAA to the following address:
FOR PZC~_~ BY F_~_GT.E P_TLnZ_R ~TG~EPZNG SERVICES
2. TYPE OF RESIDENCE
$ingi~'-Family!~ /MultNFamily [] Other
Number of Bed~'oor~s "3
3..- WATER SUPPLY
ndividual W~II ~ . ~m~unity [] Public
Note: If commurlity well sys[em must have wr tten conf rmat on from the State Department of Environmental Conservation
attesting to the egal ty and status.
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 01/84)
ENGINEERING FIRM PROVIDI&~NSPECTIONS, TESTS, FILE SEARCH, D~.._..~I AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm F, AP, T,F, RTt~R 'F~N'C, TN"RRRING SERVICES Telephone 694-5195
Address P.O. ROM 773294; RAP, f ,F, RTVRR; AK 99577
Date ~.//'~ ~-~/~
Engineer's Seal
DHEP APPROVAL
Approved for ~t~'~":""'~2bedrooms by ~'~ ~ ~/~'~ Date
Approved ~ Disapproved Conditional ?
Terms of Conditional Approval
CAUTION
:t"(- I: '"
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
MUNIGIP^LtT¥ O1: ANCk~0'~'41t~fr'JNICIPALITY OF ANCHORAGE (MO~,~F
~.NVt~,oNMENTAL sE~VIC~-$ Di~.TH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
JUN 2 5 1987 2e4-4720
WELL DATA
RECEIVED
Legal Description:
7-/~/~ /¢./~
Well Classification .,
Well Log Present (Y/N)
Total Depth /~'O ' Cased to
Static Water Level /~.~/ t
Casing Height Above Ground
Electrical Wiring in Conduit (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 Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
If A, B, C, D.E.C. Approved (Y/N)
Date Completed 7/? ~ Yield
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots /Z~°' j
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot ~-~
; Date "~.~g'./~"
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N) ,-Y' Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well /~-~g /
To Property Line ~'~ /
To Water Main/Service Line ;w/o /
Course ~
Size /¢¢O e~{ No. of Compartments ~
Foundation Cleanout
Date Last Pumped
;for
Temporary Holding Tank Permit
To Building Foundation /~ /
To Disposal Field _.~.oz//
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Length of
Depth (
Gravel Bed Thick
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well /-/¢ /
To Building Foundation
Lot '/,~¢:' /
To Water Main/Service Line '/-/~
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type )f System Design
eld z-/J.5'- /
Standpil
Date of Las'
To Prop(
; On Adjoining Lc
To Cutba
LIFT STATION ~.~
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimension,,
Manhole/Acces
"Pump Off'l
Vent
Pumpir
** Check Permitted Bedroom Rating Against HAA Request **
certify that I have checked, verified, or conformed to all MOA and HAA gl
Company ~..¢~z/'~/z~_ ,~, MOA NO.
Receipt No. /O
Date of Payment
Amount: $
Field
~ess
~es Present (Y/N)
Adequacy Test
~rty Line
lidelines in effect on the date of this inspection.
72-026 (11/84)
Page 2 of 2
g Cycles during Adequacy Test. Meets MOA
(Y/N)
(Y/N)
evel at
~k (if present)
To Existing or Abandoned System on
ts -,¢--~¢"
~1: Time 10:00 a.m.
Date
Insp Pratt
MUNICIPALITY OF ANCHORAGE
DEPARTME['=~/OF HEALTH AND ENVIRONMENT~=,~~' PROTECTION
825 L Street, Anchorage, Alaska 99501
9-2-77 Friday
279-2511, ext. 224 or 225
Date Received:
~2: Time
Date
Insp
September 1, 1977
#3: Time
Date
Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. Lending Institution Request: Alaska U.S.A. Federal Credit Union
Mailing Address: 777 Juneau 99501
Phone: 278-2804
2. Property Owner: Tom Rohn
Mailing Address: Post Office Box 596 99577
Phone: 277-6206
3. Legal Description: Lot 3 Block 7 Preuss Subdivision
4: Single Family Residence: ~)x Number of Bedrooms: Three
Multiple Family Residence: ( ) Number of Bedrooms:
o
Well System:
Permit #
Construction
Individual well (x) Community/Public System ( )
Depth of Well 146' Well Log on File
Bacterial Analysis
6. Sewage Disposal System:
Permit # 77712
Septic Tank Size
Absorption Area
7. ~stances: Well to Septic Tank
to Sewer Line
to'Nearest'Lot Line
On-site System ~
Installed 1977
1,000 gallons Manufacturer
576 sq.' Soils Rate 125
100'
Nearest Lot line
Public Utility )
Installer Rohn
Sunset Plastic
Material Trench
Absorption Area 100'+
Absorption Area
~- L~qUNICIPALITY OF ANCHORAGE~..¥N"~~:
~ Dep.artment of Health and Environmental Protec{i6'~.
t~]]' 825 L Street, Anchorage, Alaska 9950i
279-2511, ext. 224, 225
~equest for Approval of Individual Sewer and Water
Mailing Address: ~= ,~ ~--g~ ~ ~Phone:
o
o
o
o
o
Na~e of Buyer:
Mailing Address:
Lending Institution:
Mailing Address: 777'
Real tor/Agent: .~/~, .~K~_ f' 2~/
Mailing Address: ~¢~J~'~.- ~"~#~
Legal Description: Z~' ~,~
Street Location: _~;? ~/ .~
Single Family Residence:
Multiple Family Residence:
(~Number of Bedrooms:
( ) Number of Bedrooms:
Water Supply: *Individual Well
If Individual Well, well depth
If Con, unity System, name of system
Phone:
Phone:
Phone:
(~"~Public/Community System
Sewage Disposal System: On-site System
If On-site System, date of installation:
(~lic System
*NOTE: A well log is required on ALL wells drilled since 6/75.
3/77
p-a~e Two'
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 3 Block 7 Preuss Subdivision
comments:
Affadavit Attached: ( )
Approved: ~.c_ q
Disapproved:
Letter Attached: ( )
Date: r--
Date:
Department Worksheet:
