HomeMy WebLinkAboutPREUSS #4 BLK 8 LT 10Preuss #4 Block 8 Lot 10 x#050-572-54 Municipality of Anchorage Page of 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.l e')CAMF6 PID Number: _Cf3]—ES72-69 Name: 94/r,A/c fr N iu AK.�t' /�osk! Wastewater System: ❑New V3 Upgrade Address: d^as''9 ev/�/ ,AA ;,e-e ABSORPTION FIELD Phone: 2P06 Nq. of Bedrooms: ©Deep Trench ❑Shallow Trench ❑Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade:✓P r, i 42- GPD/ Ft I-, em G.0 to 7,. Lot:/0 Block: bdivision: Depth k7 Dips bottom from original grade:f Gravel depth beneath pipe Ft Ft Township: RA Range: Section: rHN Fill added above original grade: Gravel length: -4- r nL Ft G� Ft WELL: 6,r4,'oq ❑ New ❑ Upgrade Gravel width: Numberoflines: DetancebeMmWbs Classification (Private, AAQ: Total Depth: Cased To: IF Ft `F Ft Total absorption area: / Ft Pipe material: /y '� h✓C Q,Qe rr n� 39/ Ft. 'r]/Of Ft. � Jr40 S Ft 51i/. 'r%lo%S 30"A ivrf Driller. Date Drilled: static Weter Levec sr//.'v,+n bl/Ater 61/e//s /0/,?/ F0 .6H9 Ft. Installer. OeAr nsfr nn Date installed: eJ�:9�e4 Yield:Pump /5 Set at: I Casing Height Above Ground: TANK GPM ,n K0 n Ft. -/r Ft. SEPARATION DISTANCES E3 Septic 0Holding V3S.T.E.P. To From septic Absorption Lih Holding b"UPdvate Manufacturer. Capacity in gallons: Tank Field station Tank sewer Linea well / •, 1Pr „ �, sf, Material: Number of Compartments: /Y/A ` Surface to a /��+' /nvf' /oof' 4111, LIFT STATION Lot, Line 33+ Mt / 3;y' N/A V Size In gallons: /j-00 Manufacturer. Ancbdreo OfAnk Foundation 3' V4 II 'ri0 f / f / \ "Pump on" level at: •Pump Off" level at: High water alarm at: 4,a y� -� 36 „ ys.,, Curtain Drain /✓an /Cnuru o 7c, a /'J f \ Pump Make&Model Elect (Inspections ormedD Y Z,=_FPe eel ,r 1 5ca .Qt7Wchr, /eYrer Remarks: BENCH MARK Location and Description: u Assumed Elevation: Ft .ZWt s S •• 1� 1 � 9TH,�.. Inspections performed by: _Fri S f(Pn /�/� Dates: is ,1eW 2nd 2�71�'y Department of Hea th and Human Services approval C DOt1CU�ST.�' � `'• CE 8176 � ...• ' Reviewed and approved by: Date:, / xs ng. : 1 911:--:— . . ..... I .:� .. . . . . . . . . . . . L3l 1 . 1 I /. .lot .° . . ' 'A UNIT 4 1 I ' Let 9 : . I . I .Lot 4 . . . _ • . c . I . 1.l 1 . IF ./ BLOCK? . . . . . �. Existing. I 1 I I. I � /7 . . I Well 1 t I 11' i' I • 153.31 III 153.3] . \ . . . . . . t 1 D. . . DR Ay S°.I .I Existing is\ / D. 3 tiM I . I . Well . . I. t 9ESOCK I �0 AREA, 1 H LARREEA� \ I ' I l 6 A.+ .,�� �OF (,/, m - _ ` �� —_ _ �f Ln+E OE• avro Aw+uE� \ 1- — -- — -- —\co 9TH . 7 m - - - -'-ExiTsting 1' Lot 13. Lot 12 Well l Lot 11 • v UNIT 2 ASEPTIC SYSTEM • PLAN DESIGN ExWell g BLOCK 3 ' '�— . y . r>n- : 80' d' 40' : 80' 160' SCALE 1'=80'-0' D. j/KT_NLE CE -1876 r CD U3 0 a 70 m C -- C> 0 z O SWING TIES . . . . .dtl (NIDNTAL EKS10N5) DY.,. . . .0 • TRV DESCRCMM A fl C E . 2154T- 434 J, T� 01AN na 617• 47.3 •.• 1 ❑Ei TAnON YANH 63:T 485 S YT -I 6•1 J WY65 LYa CO. v 7 YT -2 O Y 7 r • c� EnS'.NG.J AY. z..D. WELL � xs ng. : 1 911:--:— . . ..... I .:� .. . . . . . . . . . . . L3l 1 . 1 I /. .lot .° . . ' 'A UNIT 4 1 I ' Let 9 : . I . I .Lot 4 . . . _ • . c . I . 1.l 1 . IF ./ BLOCK? . . . . . �. Existing. I 1 I I. I � /7 . . I Well 1 t I 11' i' I • 153.31 III 153.3] . \ . . . . . . t 1 D. . . DR Ay S°.I .I Existing is\ / D. 3 tiM I . I . Well . . I. t 9ESOCK I �0 AREA, 1 H LARREEA� \ I ' I l 6 A.+ .,�� �OF (,/, m - _ ` �� —_ _ �f Ln+E OE• avro Aw+uE� \ 1- — -- — -- —\co 9TH . 7 m - - - -'-ExiTsting 1' Lot 13. Lot 12 Well l Lot 11 • v UNIT 2 ASEPTIC SYSTEM • PLAN DESIGN ExWell g BLOCK 3 ' '�— . y . r>n- : 80' d' 40' : 80' 160' SCALE 1'=80'-0' D. j/KT_NLE CE -1876 r CD U3 0 a 70 m C -- C> 0 z O CD N -� (D o o� v O CD c) fD rmrlG 1 -1 (mZ o �m to 'L7 Z O � O Br K -n n N D o o rrl Z=� D D o N `G E- f"�� N o (n 2 0 3 ;o > ca < Z D Q cn Civ n 7 CD r 0 0 o v�� D �C'D Zo N0 CD O (n tin _ s o Z M � O y cCDD < N -p (D w -th. n ri 0 w N O 04h. � (D A 0 . FCO ........95.or. Lo.P. .................. TC -2 .I 444---JJJ o.L L — 95.29' TOP OF TAI . NEW 1,500 WON SEPTIC . �. TANK. MANHOLE M . 1-1/4' PVC m NEw LEACH FIELD . . 1-1%4' PVC TO UMMO 4- DNI. C.O. . 4• TO CLD LEACH FIELD . ......90E B ................ NOT: SEE ATTACHED DATA FROM ANGICRA[E TANK . . . . . . . . BO1T0M Or TANK: BOTTOM Or TANK . . n ABSORPTION SYSTEM SECTION (ASBUILT) vanru caNtrsa . todar PATIO WALK ON FAST SDE OF KU* co O z i2 ZE cn r*T n O z L•..: O I v � Ul ,y: (D Z o 0 O v co OD rt M f X D Fri I oz <i ��� v. rn O D v c o KOn. N o z Z 'O —� Amo D rr 'H (n2O 3 o rrl 0c�i+ <Z n v o =3co N = o 0 O 0 <D° rn m NZ zm —� N tD u a M _ Ln ° v T (D (D I A O rt �I1. 7p IJ1 a� �•. Y lU . . . . . . . . . . . . . . FINAL GRADE . 1025' BACKFLL ORtONAL GRADE2' INSULATION . . . . . . . . . . . . . 100.5'. 77\ ... '. pl LOWER END . 1-1/4' P;X FROM TANK �4 1-1/4' DIA. PERFORATED PIPE�w' :i• :•'�••�S5 • LAYS LEVEL WITH 3/16 HOLES. : •:. !•�� •• 30' APART. •r _•' ••>:ti:'•:'. OF q 11► ..........j.1 .. 4Vj i w\49TH /1 �1 A 9+t CE -1676 •••''........ •yy\ N • "��•• •F:-� N ' D T '•a TOP CF PIPE 100.16' FILTER FABRIC— B.0.T..95.9Y ill I 4 Iv �} . VERTICAL CONTROL.- 100.00' - PATIO WALK ON EAST SIDE OF HOUSE F9Ul(ORIGINAL GRADE 104.5 . . . . . . . . BOTTOM OF PIPE 99.97 ABSORPTION SYSTEM SECTION •(ASBUILT) • • • ' NTS l: • m r O n co m c N N N C m 0 5 N 0 Z v Z 0 O w ' O v o m rn m v x D m A o rn Z� 0c Z C7� n 05 O y o rn Z2"a — DDrt �v ,• N 2 0 • p m :1 D :5z> - 0 0 n o m =r o CL O o O �CIo SDm Z I" � mn N e `Ds zm o � A m I u �_ N A O A 1 � A 0 0 03/18/2005 08:42 FAX 907 269 6057 CSED ACCOUNTING 0002 September 2004 To Who It May Concern, Re: Elcctrical work for the Residential Liftstation located at 20549 David Ave, Eagle River, Alaska The wiring was done in compliance with the National Electric Codc as well as state and local codes and in accordant o Manufacturer Instructions. Thane II scn, MUNICIPALITY OF ANCHORAGE Development Services Department Onsite Water 6 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Permit Number: SW040385 Legal Description: PREUSS #4 BLK 8 LT 10 Design Engineer: 0069 Douglas T. Kenley, PE Owner Name: DALE JAKABOSKY Owner Address: 20549 DAVID AVENUE EAGLE RIVER, AK 99577-8755 Date Issued: Sep 14, 2004 Expiration Date: Sep 14, 2005 Parcel ID: 050-572-54 Site Address: 020549 DAVID AVE Lot Size: 19600 SO. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: ❑✓ Disposal Field Q 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. 5. The following special provisions. THE LOCATION OF THE PROPOSED TRENCH NEEDS TO BE TWO TIMES THE DEPTH OF THE GRAVEL BELOW THE LEVEL OF THE HORIZONTAL PERFORATED PIPE OR TEN FEET, WHICH EVER IS GREATER, FROM ANY EXISTING OR ABANDONED SUBSURFACE DISPOSAL FIELD 9/zyl0vI - 1`rcEo kbdcey S IUC•q let, Nrhr DrSAr �N1nctS Te L /N4 nNo PEgF NPE. N,C'V 'DA3"; j AIA.,e Received Issued %KEhCN DI S7R ISY7ION Date: %G1e Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program ° 4700 South Bragaw St. " "' P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. OSO - 77Z -J `� Permit Number SW Property owner(s)_.-�+z.> X,AAo„,?cyDay phone S0'—RsT7 Mailing address (1) zoJ'y9 o«.d.4�F �y��E-��� '-e 995 7 Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size_ / y. LOT 0 AcresCE) THIS APPLICATION IS FOR: Number of Bedrooms" el Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further 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 Fees: 14&0 ,60 Waiver Fees: Date of Payment: 9G//3 /09 Date of Payment: Receipt Number: Receipt Number: (Rev. 12/00) Douglas T. Kenley. P.E. 9960 E. Puffin Drive. Palmer, Alaska 99645 (907) 746-1073 August 21, 2004 Municipality of Anchorage On -Site Services 4700 South Bragaw Anchorage, Alaska Re: Mr. David Jakabosky, Owner Lot 10, Block 8, Preuss #4 Subdivision 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 David Avenue and the intersection of Donald Street, is approximately 19,560 square feet, with a four bedroom residence. On August 6, 2004, an adequacy test was performed on the septic system. Five hundred fifteen gallons of water was introduced, at which time it was noted that water was backing up into the tank. After more careful inspection, the invert of the drain pipe was located in the 6" sump, which confirmed that water was above the invert of the pipe. A new 2" monitoring tube was installed, which facilitated a better reading. A subsequent test was performed on August 20, 2004, and water was introduced at a much slower flow rate, less than two gallons per minute. After only 425 gallons, the water rose above the distribution pipe. A reading was taken 24 -hours later and it was determined that approximately only 250 gallons had been absorbed. Perc tests were performed on August 30, and September 8, 2004, (see attached soil logs). The test hole was dug to a depth of 17' and three different perc sites were tested. The test on August 30'h resulted in a 40 minute per inch perc rate. This would have required a trench length of over 160' with 4' of E.D. Multiple trenches are not possible because of the limited space available. Neither is the 160' trench a viable option. Using a deeper E.D. of gravel would mean the bottom of the trench would be at depths 14' to 15.5' to have any significant impact on the length of the trench because of the higher elevation of the replacement site. On September 8'h, two more holes were perked at the 2.5' and 4.5' level. The perc rates at these two locations were both in the 2+ minutes per inch range. It is proposed to use a 3' wide x 4' E.D. x 65' trench that will be in soils of 1.2 GPD/SF range. A 5' wide trench was considered, which would have resulted in only 50' being required with 4' E.D., but it was felt that it would be better to have the longer length of absorption out the side than to have the additional width of absorption out of the bottom and closer to the tighter soils. A new 1500 -gallon STEP tank will replace the existing 1250 -gallon tank that was found to have holes when an inspection was preformed. Municipality of Anchorage, On-site Services Lot 10, Block 8, Preuss #4 Subdivision page 2 The soils where the old system was installed had a perc rate of 30 minutes per inch. For some unknown reason, the leach field was installed with an absorption area of only 375 sq. 1t. 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. The proposed system will have no measurable impact on surface or sub -surface drainage, or on drainage from adjacent lots. It appears that there is no potential for contamination of adjacent water wells 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, Douglas T. Kenley, Py PE#8176 — o ff mis014 m V) -c m K a_ s t j DAVE JAKABOSKY DOUGLAS T. KENLEY, P.E. w w� Vqp A LOT 10, BLOCK 8, PREUSS /4 SUBDIVISION EA= RIVER, ALASKA 13 rnD z p �- 32 A rn> Dy DD 0 3 (� r r rn T rn rrnn zi O rn= < O r O nl Rl r Q m N ° O d -i r m@ x 3m> OZA3 O L � • rn r"SAO o, v!orr ANN r° AQP ri OOzz D xOA �Uern s o TO rn� D 'nip D rn-0i �< y O m �� z a: N M DO D n%� 3�' @ .QtzD x nrnrn z r Z n 0 m D (J1 Ti a r0- cD <3 rn �r .� O m d N ZA cN I rn 3 > D -� z D N _ czuli n rn-i -n Q �rn OD —fl O n 3 `` U) i --- N Z � C Z � 1 1 l0 i --- n Z C � 1 1 o . 1 I 11 1 oeeseeeeee� n C � 1 1 o . I 11 1 / M g a Y M � � 1 1 1 1 1 I$ , / s ♦ DALE JAKABOSKY DOUGLAS T. KENLEY, P.E. aw egin.. p= c LOT 10, BLOCK 8, PREUSS ADD. /4 SUBOIMSION ' EAGLE RIVER. ALASKA n C � 1 1 o . I 11 1 / 1 1 1 1 1 I$ , / s ♦ DALE JAKABOSKY DOUGLAS T. KENLEY, P.E. aw egin.. p= c LOT 10, BLOCK 8, PREUSS ADD. /4 SUBOIMSION ' EAGLE RIVER. ALASKA I 0 / Ln D r W m o II` O O ®o®o Ole o®®oi X P � P r X Y m i \ m \ D I \ �I m v E5 ;a i m0 J z 0 I p) .S m w \ J O'OF i,+ 4� 0 _ N 00 LINE OF DONALD PLACE } t y DALE JAKABOSKY DOUGLAS T. KENLEY, P.E. tM uyr�.. V pp 1„ a LOT 10. BLOCK B. PREUSS ADD. 14 SUBDIVISION EAGLE RIVER. ALASKA Tm m Cf) c / m 0 g A I diI I � GALE JAKABOSKY 1 DOUGLAS T. KENLEY. P.E. . E _ i w ow LOT 10. BLOCK 8, PREUSS ADD. /4 SUBDIVISION EAGLE wVM. ALASKA 0 / V/ ^ V ) z t !{1 DAVE JAKABOSKY DOUGLAS T. KENLEY, P.E. 4 Ep R t LOT 10, BLOCK 8, PREUSS /4 SUBDIVISION V EAGLE RIVER, ALASKA Municipality of Anchorage Development Services Department Buildng Safety DKisicn s1 On -Site water and wastewater Program 4760 Swth eragaw SL P.O. Box 196650 Arr: araye. AK 995196650 wwwc anchcrace.ak.us (907) 3137964 . Soils Log - Percolation Test Performed For. Leval Description: 17.oc.E c%o.�..�yosKY der/0,9�.ed.�RP� Township. Range. Section: T rr//C1-0- 1 ,S.euoY 6.' dc.1GL. 5ccJ vr:s GROUND VIATEA � 7. VXCL:.i� D? NO Stir Y lR�V IFY-MATMATDEP-M ai.2,4 t1GL Fto��tor:ny? pp� .tr,vc/ / Re_1m2 Gross Time Net Time Death to Water Net Drop `Data /,Z E y .,O f/i,✓ % �� / v 3e.ai, F_?:CLAiIC21 i?iT= �� (raatnhc�l FEnC YCLE DIA; �_rci �!/ T_Si F.CR9TS?'ctl 6 r ANO—lo VzFr COMMENTS �.QGY60.4Ce�0 �o.e 'S/sJ���S PERFORMED BY: 4CEO I CERTIFY THAT THIS TEST WAS PERFOR%IFD IN ACCORDANCE V;9TH A.LL STATER\7 A'U`:ICIPAL GUID�-LItiES IDI EFFECT ON THS DATE DATE: Municipality of Anchorage SSP G Development Services Department 8LJVM Safety DM*n44 • �.� On -Site Water and Wastewater Program . 4700 South Bragaw SL •� P.O. Box 1966..`0 Andtorape, AK 99519.6650 www d xncharace.ak.us DOW (L4n 3537904 Soils Log - Percolation Test Performed For. OA e. er .✓oK4p'oS.rL y Date Pertc Legal Description: tto &::e 6?1 A�;%,P" '�r~7 Township. Range, Section: 5cpe 1 F—T—T— Depth 2- 3- 4- 5- 7- -3 4 5-7- O ro 8 Do• • D- /q 10- 11- O 12- oA T7 13- 14- Opo 1 s- .�► O,�G'r4.4�/L.'f -i ,u S�•->y Sa.uo tti�G,t�Atl6G So,�s deSdY COUMENTS VrA.SG?At,?a)WATEA ESCC4^,T= X77 ' s WYES,ATWrATOE?TM L 0 Depth to Wattt Aner i Morhorin9? E Date ClEA1111 INEE 'S S T. CE 6176 ' •� f rrwn Reading Data Gross rime Net Time Depth to Water Net Drop VIA," ,e :s " . `/-a t F=i-CLW-"c?j FAT= .l. V -k :wsvxh) FERC F.'CLE CUMSTER 16 // TEST FIN Scoric=NF. ANO .Zjz -FT PERFORMED BY: ZZ, ��.c�tt�f CERTIFY THAT THIS TEST WAS PERFOPL%IED Itl ACCOP,OAAICE WITH A.LL STAT° ASD t1UNIOPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: Municipality of Anchorage -` G! R• Development Services Department �%��;• ��) BwVM wety Davison owal: • >� On -Site Water and Wastewater Program T}{ 4700 Swei Engaw SL • •. •r o' /.LC( X5/1:, P.O. Box 1966FA Anrtaage, AK 9951?b6 C • W �YY "/ www.d.anchcrace.ak.vs . � T � ! j/ ••CE 6tt8 Soils Log - Percolation Test ••'• . Performed For /7.o/Dat.P.r.M,.r.n• Legal DescrtpGcn: Ler /O, d� e/C.Qr!rAP" '�// � Township, Range, Section: IV S'.Q" Site Plan �tY HDLtC .L m --- T-1 .11111111111 O•eG.4.v/ e S $a.Jat/ G".r�av6� 5uJ ,Sit ry-5.AAro oJ�G.uv�L '57 a1e,<y/ Ho.rr- ra oFy� VAS GROI-M Y/AM �O E4CCle'VTi=71 ' s IFYES,ATWrATDEPiH! L DeyO to Wats ARsr —�� C mon11erin9T (' j E Dat ReaCng Date Gross Time NelTinne Depal to Water Net Drop 0 /O I %/ by XX F -" =Mk ,Cm Ft4TE /. 7 (rM& st-6) F: -=RC WAF DW. rER T_$TF.U%,E_TY' N_SFT AND jPf?-Z' .FT COMMENTS fy�'1f104.r1E�0 �O�/�/Yi PERFOPJAED BY: FK.60 e�,Gn<Ej/I CERTIFY THAT THIS TEST WAS PERFOP.MED IN ACCOROANCE WITH P.LL STATE A.%D>.,U`l1GPAL GUIDE-UNES IN EFFECT ON TH!S DAT'ce. DATE: Pw GREk,-tR ANCHORAGE AREA BORV.„IGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME �� �% he MAILING ADDRESS j a �;Py AV cA:PHONE 1'�� "� y LOCATION 01VV' I} /rl S� LEGAL DESCRIPTIONS SEPTIC TANK: DISTANCE% NUMBER OF FROM WELL Cp MANUFACTURER MATERIAL MATERIAL �r COMPARTMENTS— INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITYaL, GALLONS. TILE DRAIN FIELD: f TOTAL LENGTH nlc-r Kli c cDnnn �ni�i � � 7 FnI INnATI(1N NFARFST I OT I INF if OF LINES NUMBER OF LINES r -/DISTANCE BETWEEN LINES TRENCH WIDTH31IN. TOTAL EFFECTIVE ABSORPTION AREA L SQ. FT. LENGTH OF EACH LINE �i DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE �+� MATERIAL BENEATH TILE_ IN. ABOVE TILE WELL TYPE - CONSTRUCTION IN. DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION LOT LINE , SEWER LINE , TANK , SYSTEM CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED DISTANCES: INSTALLED BY: 41 � � 0 e 3 F SEWER LINE DEPTH: PIPE MATERIAL:k'6511- LOT SLOPE REMARKS: Form EQ -032 REMARKS DIAGRAM OF SYSTEM DATE/� APPROVED_`` ;. G.A.A.B. V-1 U r'-4 1K� I F:�l_I-VPrl #---RF7 F:lP--lC_F—m C-3- PE DEPHRMENT HEALTH AND ENVIRONMENTFIL'�:�OTECTION ' ^ \\ 2516 E. TUDOR RD.. ANCHORAGE., 8K 99507 \` ` 276~2221 ' 9:3 P-4 I_r IE FEE L-A ff. F." ��F—:- FR. 0-11 7' PERMIT NO. < 76755 ) » APPLICANT BOX 692 694~2476 LOCATION DAVID & DONALD ST. LEGAL L10 88 PRUESS SUB LOT SIZE 19560 SQUARE FEET TYPE OF SOIL HBS8RBTI8N SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/0R)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C4=F`7-"� � 15.^ !�!:-s H VEPAI:37r"� �47� 1:!F_4l=���F-1 �E-= F=� -F�= � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF G 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 OUTFH IPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). �&= C -!U 1 F --"E-: E -o fiF E: F" -F I f--- ����� ��1 = FE HD 92-:9 C-1 �F--f L_ I . az:# PA"E. _r 0�j F --u m", ;2 > 1 "!S-7 F'E: C--- -Ir I Cl ir-4 �_-- F::l FRAH:_ F -ft F—= C_! U I F:"F:'E-u BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON—SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL SPEC IFICHTI8NS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. lCm ��F-_4 I _'. f_-=- U E-� I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY 'OF ANCHORAGE. 2: I WILL INSTALL THE 'SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON—SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. SIGNED: .",L^^^�� .`.., C�ST ISSUED BY--- �� ^ ' d Or £t E OE0�—IZCHNI CAL & DEVEL,,-.-PMENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 Soils Et Foundations Land Development Performed for: Name: �� � u :� Tel. No. Mailing Address: l rsx &q z �A 1-g- �-, \ °' 77 Legal Description: ���� � 7:<- 5�. , Death (feet) Soil Characteristics 0- 3- 4 34 5 7 8 9. lam"' rr 10., 12 N °z� C�~`tz AiC `� i7 �Z�►,�/\�� ai i�s'r 13 ®. 14 15 16 Ground Water Encountered: Yes- No !/ If yes, what depth Proposed Installation: Seepage Pit Drain Field r Comments: � . , m�<�,.az.�,-� __ � f i $ � •� i �,,J �:7,�, Performed by: 1 i, Date: V 1A i.� M U " I 0:�* I F-"" I I -IF a -e 9_3 F-_ P1 rA I-- �-lv"�t-1 Ui 1�- . DEPHRTMENT C /HEALTH AND ENVIRONMENTAL i.JTECTI8N 825 'L' STREET, HM��HO�i�fGE/ HK. 99501 " - 264~4720 APPLICANT PEOPLES BANK & TRUST LOCATION EAGLE RIVER LEGAL LOT 10 BLOCK 8 PREBSS S/D POUCH 7-007 99510 LOT SIZE 32670 SQUARE FEET MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM XS 100 FEET FOR H PRIVATE WELL OR 158 TO 280 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TQ INSURE PROPER INSTALLATION. �����­F ���I FR r-z':F. ����Irl ��� �A , ��t_:=: C__ff I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR 8N -SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. SIGNED APPLICANT PEOPLES BANK & TRUST L CiEF'HF' 1 M�td I l" ntnL I n. nlv�u, •r i r.� n u n_n i i ,� , �: .._, SYSTEM IS.: ANCHORAGE, AE<::. 3_ 1 CIF -'f -'f L_ •_r-4—�j r = 11 PERMIT NO. c :'F'LIC:AtJT PeOpl,°S TV -LUT � e� ?bo?, ( L� C�q --40 iC:NTICIN (LLVV2 'S•I ice/ I='URRE FEET =GAL LoT j0 & (3Lb P2CE�Ss Sf1J LUT E r'PE CIF SI-1IL AEtSCIRPTIC1N SYSTEM IS: t;;It11_g1 rJUt•1BER CIF BEDRC+1-M' _ lL EATING ISO FTiF:F)- - iE F:EOU I REG '_• I ZE OF THE S + I L.. AE-.CIRFT I CIN SYSTEM IS.: QEF -'TF --i CIF -'f -'f L_ E--EF---r- THE LENGTH DIMENS ICIN IS. THE LENGTH <:Itd FEET? OF- THE TF'EtJCH CiR DRHINFIE!_D. THE DEPTH OF R TRENCH OR PIT IS THE C'IS'RtJCE BETWEEN THE SURFACE CIF THE GRAUND AND THE BOTTOM OF THE E?CCA'v'ATION k.IN FEET). THERE I= NO SET WIDTH FOR TRENCHE.. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE E`<:CA'dAT I OtJ " I N FEET ). IJ 11 F=' F- C- -• !�= F= T I �� T r r-4 F-= !L-- X '' C: _ C- r + t__ L_. Rr1 I 7 f'1PPL I CAtJT Hf'15 THE RESF'OPl'=; I B I L I TY TO INF ORM THIS .. DEPARTMENT C'UR I Nr, > EiE ?STALE_ATICiN INS.PECTIONS OF ANY WELL'S ADJACENT TCI THIS PRCIPERTY AND THE .111BER OF RESIDENCES THAT THE WELL WILL SERVE. i- F=• E'. T �� t -! _• I 1 F=- F _ I ==� �I I F<: E= -w — — — t!=k'FILL-11 i CIF RtJ'i SYS T EN W I THC+UT F I NAL INSPECTION AND APPRC VAL BY TH I S :PARTMENT WILE_ BE ;IE;.TEI- T TO PRC ISECUT I ON. N I MLIrl C' I STFtFJ+= E BETWEEN A WELL HND ANY ON-SITE SEWAGE D I =•PCI S AL S':'_ I I'=• IC, FEET FCIE A PRIVATE WELL OR J50 TO 200 FEET FF'1-1(•1 A PUBLIC WELL DEPENDING 'CItJ THE TYPE OF PUBLIC* WELL. ?II1-1111-1DI`,TF 7E FRCIM R PRP/ATE WELL TCI A PRI'v'ATE SEWER LINE IS :" FEE=T ANC' I A I OMMUNITY _•EWER LINE I: 7`_• FEET. LL (_Cn'c• RF'E FEI!LIREC ANE) MUST BE F'ETIJF'tJEC:' TC! THE DEPART?IEPJT WITHIN3Fi+ DH'r'=• THE iJELL C OMPLET I CIN. HEP REI=!U I F'Et•1EPJT5 MAY APPLY. SPEC= I F I I -:AT I CiNS ANC- CCINSTr_'LICT I C N DIAGRAM, Hf --,E AIL -ABLE T IPL'=:I-IF'E FF IEEE: IN TAI_L.ATIIIFJ. F=• FT_ F=: C.1 I T CERTIFY THAT I HM FAMILIAR WITH THE REQUIREMENTS FOF: Otd-=;ITE SEWERS AND WELLS AS:. S•E T" IRTH BY THE. 1•111IN I C: I EAE_ I TY OF ANF:HCIRAGE. I WIl_IIF?' THI_C_ THE '•':_TEt'i IF? HCC Of'C?R?JCE bJITH THE COC'E_. I LR?DEF=TAFJG THAT THE CN -SITE SENFR '..T' TEM MAY F'E=GUIRE EtJLAFTjEttEPJT IF THE S I C:EFJCE i' REMODELED TCI INIl_I_IDE 1`'11 IRE THAN BEDF'Ci0r4=. APPL.IC:HtIT %:k rt tr" `t rb l5ritting I by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 272, CHUGIAK, ALASKA 99567 * TELEPHONE 688-2759 OWNER OF LAND ADDRESS LEGAL DESCRIPTION DATE, - Started Ended PERMIT NUMBER KIND OF FORMATION: From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to -Ft, Ft. From Ft. to Ft. From From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. MISCL. INFORMATION: DEPTH OF WELL STATIC LEVEL OF WATER FT DRAW DOWN FT. GALS. PER HR KIND OF CASING From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. DRILLER'S NAME MUNICIPALITY OF ANCHORAGE o� Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-572-54-000 Expiration Date: Legal description PREUSS #4 BILK 8 LT 10 Site address 20549 DAVID AVE Eagle River AK 99577 Current property owner(s) RUTTLE THOMAS E & ROBIN A 9/21/2023 X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 6/21/2023 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 x Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 09'C3 Vie' Wit_ ANCHORAGE OyAG' Development Services Department Phone: 907-343-7904 On -Site Water &. Wastewater Section --" Fax: 907-343-7997 Certificate of On -Site Systems Approval Application I. GENERAL INFORMATION Parcel I.D. 050-572-54 Complete legal description PREUSS #4; BLOCK 8, LOT 10 Location (site address) 20549 DAVID AVE., EAGLE RIVER, AK 99577 Current property owner(s) ROBIN RUTTLE 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 907-317-8834 3. TYPE OF WATER SUPPLY: Q 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: H Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: N Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age <19 -See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed 0 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 Paymentr/s� 3 Date of Payment COSA# �5c7 3 / IC( (� Waiver COSA Applicalion_June 2022 COSA Checklist Legal Description: PREUSS #4; BLOCK 8, LOT 10 Parcel ID: 050-572-54 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 A. WELL DATA FE -1 Well log is filed with Onsite (or attached) Date drilled 10/9/1980 Total depth 392 ft Cased to UNK ft ❑■ Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) *0 in. Date of flow test for COSA 3/7/2023 Collected by GEG, LTD. Static water level at beginning of test 339.7 ft. Date 5/31/2023 Comments *WELL IN DRIVEWAY UNDER STEEL MONIRTING WELL COVER - WELL PIT HAS A DRAIN THAT DAYLIGHTS. Well production at time of test 4.8+ Spm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes Q No 9 Coliform bacteria is Negative Nitrate 5.47 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L Q Arsenic less than MRL (ND) B. TANK DATA Measured operating fluid level in septic tank 47.25" Date of pumping (o / q J ZJ ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA d Which system tested (date installed) 9/27/2004 ❑■ ALL standpipes present per record drawing Total measured depth from grade 8.7 ft (max) Measured depth to pipe invert from grade ft (min) A N/A - pressurized field. Q Per record drawings, field is insulated. FE -1 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 1886 gallons 6/16/23 date Any rejuvenation treatment (past 12 months) NONE If yes, enter date C. LIFT STATION X Required maintenance completed Age of lift station <19 years Lift station material STEEL Comments: Z, b0 0 6o.c► Adequacy test date 6/16/23 Results 0 Pass Fluid depth prior to test Water added 714' : gal New fluid depth 26.75 it Elapsed time 155 min 24.75 in �`— a��' r $ 5 to --.Lon1 pns—S-D Final fluid depth 14 in Absorption rate 600+ gpd FIELD STATUS - POST RECOVERY Effective depth (per record drawings) 48 in Effective depth used 14 in Effective depth remaining 34 in Comments/Deficiencies: DID NOT TEST 1976 DRAINFIELD. 18.5" OF STANDING LIQUID IN SUMP FOR 1976 DRAINFIELD. NO LIQUID CHANGE IN THIS DRAINFIELD WHILE TESTING 2004 DRAINFIELD. COSA Checklist June 2022 E. SEPARATION DISTANCES t 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' ❑■ Yes if No ft 0 Yes if No — * — Neighboring Tank > 100' ❑■ > Yes if No ft Private Sewer/Septic Line > 25' ❑■ Yes if No Absorption Field on Lot > 100' E Yes if No ft Holding Tank > 100' Yes if No Neighboring Absorption Fields > 100' * Animal Containment > 50' 0 Yes if No — L_ ❑■ Yes if No ft Manure/Animal Excreta Storage > 100' A � Community Sewer Main > 75' ❑■ Yes if No ft 0 Yes if No — J7 In ❑ N/A –Served by Community Well (not on lot) or Public Water (M From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) If Building Foundations > 10' ❑■ Yes if No ft Surface Water > 100' Z Yes if No — `� Tank to Property Line > 5' ❑■ Yes if No ft Wells on Adjacent Lots: rc Field to Property Line > 10' ❑ Yes if No *** ft Private Wells > 100' Yes if No �I Water Main > 10' ❑N Yes if No ft Community Wells > 200' ❑� Yes if No — on _ Water Service Line > 10' ❑� Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *PHYSICALL�MEAS��RED 04'+ FROM WELL TO CLOSEST SEPTIC PIPE ON LOT 9. **1976 INSPECTION REPORT FOR A__ THIS PROPERTY SHOWED THE TRENCH TO WELL WAS 99'+; HOWEVER, IT APPEARS THE 1976 TRENCH IS 100+ FEET FROM WELL BASED UPON SUMP LOCATION. ***3 -FOOT LOT LINE WAIVER GRANTED (WR0500014) FROM LOT LINE TO 1976 TRENCH. ft ft ft ft ft ft 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 Garness 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 practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding 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 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 (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. COSA Checklist June 2022 LII.CIVJG ' #AECC884 zll Nitrate Advisory Certificate of On -Site Systems Approval # OSC231199 Subdivision: Preuss #4, Block: 8, Lot: 10 A water sample revealed a nitrate concentration of 5.47 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. ;Mailing Address P O Box 196650 *Anchorage, Alaska 99519,6650 *www muni org t3 N ------------ ©- 6.1 30V7d G7VNOG f0CL r • Ln _j' _ CL 0 0014� tti cy CIN tt!, tU 00*0G M-00.90 oOON 0.01 rf ✓ry PF Q Q L `�. to •.� 41 � j �• zLn VLM ' ns j p � ! •. 4a testi F- \� C7IU f}fiJ 'S; Co44 b Q4v / cv Q ort 3.00.80 0005 U a ZJ (o C"q GS oa -i i! uj CN UL LU LU Lul 0\0- _uj co f Ui t9 u ,,,, Xj9 okt MJ 0 co •"J L t3 N ©- 6.1 f0CL r • _j' _ CL tti cy Cl) `'' tt!, tU rf ✓ry PF L •.� 41 VLM ns j p � ■ . iiia F- \� C7IU f}fiJ (Viii {}ifLJ {7tiU C1Ht1 iNtU ifll C?tftl tNttl!- / Q ort 3.00.80 0005 C"q GS oa i! Q C t�U CD i UP4 cc MM 0 E E « 4 E . T Cll CL C.) 21 *- p ? "a �- 0 .a ca)V v Z) L- w c Ec •— � 3 � o fee)4)4)4)°'c 0- V) ;> -o _ V) aU)00o 3 2 Co 4) C. © 0 . z to 4) C C7 ' a 0 4 v co M tv C -v o ... C: C _! t1) C 4)) V 0 4 a- � E t� ,N J t39 � .� � ""� � tti 0 0 E d �!� - Q tf3u .4. !— 'C7 C :1) p to tU 4-1 0 a E � C 0 �� -C i ft7 "Li tU p C/)> C C_+ au � <W0 .►_. to if! C { cn C > N Q 4 p G C V coL = c tlt F— u- 0) W C cs. a ,.. co CL C Lim�� r _ c ,, o ?'► t� _ iii ,""^+• •"�' • i ' ` AW, 10 r ~ ~' CC L CL • i • ;i 0CL• q�CLi • �W • •�"' t• ��j' • moi" LU +-+ m Q LL C s) y 4-J z 0 cif • • • • . " tit M _. -°» to_ • i QAC AW (A Aft - i1) X . W"'- � t / s- tat CY5 vi Municipality of Anchorage • -� Development Services Depattmen Building Safety Division On -Site Water and Wastewater Program . 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. HAA# Expiration Date: 1. GENERAL INFORMATION QCoi1� Complete legal descriptiori - Lor` /o, 8/e ck.F Location (site address or directions) Current Propertyowner(s) D Ie, f ,',Y<rWeY06w&rAosfhY Day phone 496 3Poo Mailing address + Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by�/or pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone 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 Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 Health Authority 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 Z9aa!zA:5 74' fret? /ey Phone 57,09. 94'6 -/0 V.? Address 9960 -c:�. Ra X%e 4V6W Engineer's Printed Name /Joan/h+sn/P7 Date W, 1g, sn 5. DSD SIGNATURE v'f Approved for 4_ bedrooms. ltltt(iffflf/�j� ,'P. CEetrs OF AQDisapproved. `\��QPJ,.•....•••O.$� 1� �\ Conditional approval for �xoorr&y&he fojl�rmg stipulations: MRA"� 40•..6.0 Additional Comments This Certificate of Health Authority Approval the wastewater disposal system installed in September 2004 and water supply well installed in October 1980. A lot line waiver is beino issned insnpi..nnri nn ..+a. .x.+.. nee for the absorption field installed in October 1976. It should be noted that the October 1976 absorption field don, not r tha minimum el e requirement.- - - - - bedroom dwelling. Granting of this HAA does not constitute approval of the October 1974 absorptlea fields Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: �, , ,Qom, A -AN �� Original Certificate Date: xa«.010M Municipality of Anchorage Development Services Department Building Safety Division On-SBe Water & Wastewater Program ' " •' 4700 South Bragaw, St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: La 7` '/o, "�3/0� K ST,: PrP +mss , �� Parcel 113: 050 ^$7e9 ! A. WELL DATA Well type .,ar4vF /e If A, B, or C provide PWSID # _ Well Log (YIN) _V Date completed/t-/ Sanitary seal (Y/N) Wires property Protected/N— Total depth _3y/ ft. Cased to �Of ft. Casing height (above ground) $ in. FROM WELL LOG AT INSPECTION Date of test yz/ /b-'/ Static water level 3 �/� ft. 5 y�7 ft. Well production /✓` g.p.m. 5,:7 g.p.m. WATER SAMPLE RESULTS: Coliform :9!colonies/100 ml. Nitrate mg.n. Other bacteria E" colonies/100 mi. Arsenic: mg./I. Date of sample: Collected by: trealf%n 1C� B. SEPTICIHOLDING TANK DATA Tank TypetMaterial S" 11-" , <_ le e / Date installed Tank size lScr.) gal. Number of Compartments Cleanouts (Y/N) Foundation cleanout (YM) Y Depression over tank (Y/N) High water alarm (Y/N) Date of pumping Neu/ Sy3ttv7 Pumper C. ABSORPTION FIELD DATA New sysle " Date installed M-mLW ' Sou rating g.p.d. or fe/bdrm) �- 2 System type arc n t J? Length '✓ ft. Width A, ft. Gravel below pipe ft. uwrlCc H°^` p Total depth f. . ft. Eff. absorption area o ftp Monitoring tube _i Depression over field IV u /Vew f ys tem Date of adequacy acy test Results (Pass/Fail) For -!!Z- bedrooms Fluid depth in absorption field before test _ in. Water Elapsed Time: _ min. __-E0aI*Ad-de0lF-- in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) 0.L—gets New depth_ in. Absorption rate >= g.p.d. If yes, give date D. LIFT STATION Date installed n d 71oy Size in gallons 45 O0 Manhole/Access (YIN) �u -Pump on" level at -Ile,) in. 'Pump off" level at ?G in. High water alarm level at f/S in. Datum ho Nem of f'.a n k Cycles tested 3 Meets alarm a circuit requirements? y E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO Septic lank/lift station on lot On adjacent lots / e, O +` Absorption field on lot / / �z On adjacent lots / D o , ' Public sewer main /1'%A Public sewer manholelcleanout 4114 Sewer /septic service line f7 Holding tank /ISA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 3 y ± Property line , 3 f ' Absorption field /5 Water main N/A Water service line 0'16' f Surface water Wells on adjacent lots /a o t SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line �Q� v Building foundation Ile � Water main 41111 Water Service line asf , Surface water / C U Driveway, parkinghrehide storage nonc Knc[dn Curtain drain to Gxir t Wells on adjacent lots /oOf F. COMMENTS ,9F�/re v>`e of GAs het,, n2190(e t° I7i0'I9 iar v �e %,Circ da/lrUer on rhe 6eIe G. ENGINEER'S CERTIFICATION 10 ��•�- `•., "I I certify that 1 have determined through field ins " ions and g � «; review of Municipal records that the above systems are in i ;t `� • • • •• conformance with MOA HAA guidelines in effect on this date. g V �ectl En ineer's Printed Name 'I, •' CE 11 r Date "U r A 1 q rIt f HAA Fee $ f / Waiver Fee $ e6 Date of Payment `� D S Date of Payment Receipt Number /0-5189 Receipt Number L.Slr�i (Rev. 12/01) . Me SCS Ref.# Client Name Project Name/# Client Sample ID Matrix Sample Remarks: 1051259001 Douglas Kenley P.E. Lot 10 Bk 8 Preuss S/D Lot 10 Bk 8 Preuss S/D Drinking Water All Dates/Times are Alaska Standard Time Printed Date/time 03/11/2005 14:40 Collected Date/time 03/09/2005 12:35 Received Date/time 03/09/200; 13:23 Technical Director i Stephyt 9' Ede Released Panmcta Results P L Units Method Container ID Allowable Prep Analysis Q I imits Date Date Init Waters Department Nitrate -N 0.100 U 0.100 Microbiology Laboratory Total Coliform 0 mg/L EPA 300.0 B (<=(0) col/100mL SM209222B A (<=1) 03/09/05 CAM 03/09/05 DKC Municipality of Anchorage (` P.O. Ikn lW)50 • Anchoragc, Alaska 99a19.6C50 • Telephone (907) 343.8301 • Pae ((X)7) 3538.°00 _ 4700 Bm9aw Street • Anchorage, Alaska 99507 Mayor Mark Begich •�+'•munl.org Building Safcty Division 3/25/2005 Douglas T. Kenley 9960 East Puffin Drive Palmer, Alaska 99645 Subject: Waiver Request for Preuss Subdivision #4, Block 8, Lot 10 Waiver Request #WR050014 Parcel ID #050-572-54 HAM HA050106 Dear Mr. Kenley: Your request for a waiver of the required 10 feet horizontal separation from the 1976 absorption field to the property line has been approved. The approved separation distance is 3.0 feet This waiver approval applies to the existing absorption field 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 343-7904. - .. . . Sincerely, Julie Makela, P.E. Civil Engineer On -Site Water & Wastewater Program Community, Security, Prosperity IM .T 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.ci.anchorage.ak.us (907)347-7904 Waiver Review Worksheet WRO5001 PIEW ..:312312005 Legal Description: Prouss Subdivision #4. Week 8, Lot 10 Engineer Douglas T. Kenle Criteria: •.•a ut• u u rr lc vu • r i A. Water Table B. Soil Sorption C. Pemteability D. Water Table Gradient E. Horizontal Separation Total: Points: Waiver Is Granted: J� Waiver Is not Granted. List Conditions or Reasons for above: Date:./QeS/p'A=5 By: Red* IM Arnounl• $175.00 Date waves ... DouglasT.Kcnley SQ.E�Pnffin�trect.Palmer`Alaska.99645 l4QZ�Z46107� March 21, 2005 Municipality of Anchorage On-site Water and Wastewater 4700 Bragaw Street Anchorage, Alaska 99507 Re: Lot Line Waiver for Lot 10, Block 8, Pruess Unit #4 Subdivision, Eagle River, Alaska The original septic system on the above-described property was installed in 1976, but is only 3 feet from the lot line. A replacement septic system was installed in September of 2004. Both systems will continue to be used through a diversion valve. This is a request for a lot line waiver on the original system. A copy of the surveyor's As -built is attached. There is no adverse impact to adjacent lots. If anything else is required in order to grant the waiver, please contact me. Sincerely, �U Douglas T. Kenley,P I 5. LEGAL DESCRIPTION OftfON APPOINTMENTS DATE RECEIVED TIME - I STREET LOCATION TIME TIME NUMBER OF,BEDROOMS 1� ❑ One ❑ Four El Other i.®ti F>c DATE ❑ MULTIPLE FAMILY DATE 7. WATER SUPP DATE For INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY I NSPECTVW 8. SEWAGE DISPOSAL SYSTEM INSPECTOR INSPECTO p 'YEAR ON-SITE SYSTEM WAS INSTALLED. MUNICIPALITY OF ANCHORAGE L4UCIPALITY'N AGE DEPT. OF R, -:';LTi', & DEPARTMENT OF HEALT ONMENTAL PROTE�,- _ �Ri�N,V�ENT,� r C_;i�-CTION 825 L S - nchorage, Alaska 99501 • 11 IRONMENTAL SANITATION DIVISION Telephone 264.4720 _ REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEEQIUS DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER PHONE P4 6,r ^� x f ! Re -is MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE L �°�'��sJ L o r3,/ 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION 1 PHONE 4j5 MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS - 5. LEGAL DESCRIPTION L o 134i� AP, cls STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ One ❑ Four El Other ®SINGLE FAMILY Cl Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPP , For INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM /'J INDIVIDUAL/ON-SITE** 'YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79)