Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
HomeMy WebLinkAboutPREUSS #4 BLK 8 LT 3Preuss #4
Block 8
Lot 3
#050-572-47
Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page of
ON -SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP221427
PID Number: 050-572-47
Dwelling: V Single Family (SF)
E] with ADU E] Duplex (D) E] Two Single Family Project: W New F-1 Upgrade
Name
Jeffrev Kiecker
ABSORPTION FIELD
El Deep Trench 2 Wide Trench Fl Bed El Mound
Site Address
10209 Ronald PI
El Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
6.0 GPDISF
3 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
1.96 Ft.
Gravel depth beneath pipe
1.04 Ft.
Subdivision
Block Lot
Preuss #4
8 3
Fill added above original grade
0.23-0.88 Ft
Gravel length
18 Ft.
Township Range Section
Gravel width
5 Ft.
Beds: Number of Lines
Distance between lines
Ft
SEPARATION DISTANCES
To; Septic Absorption
1 Holding Sewer
Total absorption area
Number of trenches
Dist. between trenches
From Tank Field
Lift Station Tank I Line
102 Ft2
1
Ft -
Well 66'* 86'*
25+
TANK El Septic El S.T.E.P. El Holding [Z Other Advantex FAP
Manufacturer
Greer
Capacity
150OGal,
Su rface Water 100+ 100+
Material
Number of compartments
Lot Line 10+ 10+
NA
Plastic
Foundation 10+ 10+
_�ATIO N
Manufacture
Capa ity
Remarks *Advantex system
Gal
Alarm location
Elect���
ric tied bv
Installer
PIPE MATERIAL House to tank Tank to
D3034 drainfield D3034
JR's
Drainfield DSO-T4' CO/MT D3 1 034
Inspector Arcterra Consulting
BENCH MARK (Assumed elevation) 100 ft
Inspection
dates: 8/7/23
2 d 8 /7/2 3
Location and description
31d 8/8/23
4 th 8/11/23
Bottom corner of house door frame
ON -SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
OF
Conditional Approval:
Date
Aw
493h
Septic System
Approved
Date ZW5
/ts.
KENNET4'm FIFLIS �!ip
CE 7� I*— IN
4w
Note: this approval does not include well permit requireme
�Kev uo/uz/its)
AS —BUILT SYSTEM DETAILS/SITE PLAN Permit OSP221427
PREUSS #4 BLOCK 8, LOT 3 PID# 050-572-47
•n i w Fp
\ a
�i:D cRza �
DECOMMISSIONED
r
A—C=13.9'
B—C=37.4'
A—D=30.0'
B—D=48.9'
A—E=28.9' e
B—E=48.9'
A—F=41.4' o
B—F=63.4'
A—G=41.0' E
B—G=63.4' Eo
am
CXIS rING
Nauss.
E.
sy
-- Fd
1 ' SCALE-
1
Lu ia, I 89.s4 Hen enz.
Ln 44 SCALEt NTS
v OF.AW ....... PREPARED FOR: �Q E' pp
® `� � JEFFREY KIECKER
m.' 10209 RONALD PL "
g * -L� TH �, * �! EAGLE RIVER, AK
a �
r KENNEPH D I FIELD BOOKS co►putm: z
c-7116� BOUNDARY N A °RAY' KSD z
,� °' ^ /
a` f A r' AMIRLT: JLS Dew 8 29 23 `' •...� ��s
1��' 4
EFESSIO .p Dwc. FILE GRID: N WOQ56
'�►
,1'
ACAD RIE FILE 108 N" 22135 �FR K. 9957i'g1�6 �
w
_n
0
J
z
ry
O
O
o
z_N
Q ..
W
M
w0-)
O
� w
<L O
m O
00
O
0
O
2 5'
WELL
S89°59'38"W 164.02'
(S89-59'00"E 163.33' R)
SEPTIC
VENT
(typ)
r\ WELL
GRAVEL C
D /W F'P
CAN
24
LOT 3 GC
BLK 8 oUSEc
N1
VAULTO MH ® 24.0- C;�
S89°56'57"E 163.43'
(S89°59'00" 163.33' R)
ANCHORAGE RECORDING DISTRICT, ALASKA
AS -BUILT OF:
PRIEUSS SUBDIVISION UNIT No4
LOT 3 BLOCK 8 PLAT 72-6
SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a
physical survey of this property as shown on this drawing and that the
improvements situated hereon are within the property lines and no
enchroachments exist other than noted, Under no circumstance shout+
any information on this drawing be used for construction of fences,
structures, improvements, or for establishing boundary lines.
EXCLUSION NOTES: It is the owners responsibility to determine
the existence of any easements, covenants, or restrictions which
do not appear on the recorded subdivision plat.
NOV 14, 2023 1 1 "=30' schullerOak.net
2 3 -116 DRAWN BY: CHECKED eY GRID NVMBEN; BOOK AGE:
JLS NW0056 1 230348
© = FND 518" REBAR
. of ALkk
01
. 49TH
p JgHN L. SCHULLER, o
1�Nr LS-10408 a
�I.4.,.. . '
®e.°fessionai V
A
w
!-n o
Cf)Lw 00 O
U 00
0 P
-� O O
1= z O
� z
�o
1SURV
5
rn n n
1831 Talkeetna Street
Anchorage, Alaska 99508
(907) 227-1455 office
(907) 274-4992 fax
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
hftp://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP221427
Work Type: Septic Upgrade
Tax Code Number: 05057247000
Site Legal Address: PREUSS #4 BLK 8 LT 3 G:0056
Site Mailing Address: 10209 RONALD PL, Eagle River
Owner: KIECKER JEFFREY T
Design Engineer: ARC TERRA CONSULTING INC
This permit is for the construction of:
Effective Date:
Expiration Date
»cnt
G �f'
_ I-
J �
Department
Lot Size in Sq Ft:
Total Bedrooms:
2/9/2023
2/9/2024
19600
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
3
Special Provisions: The extent of the seepage pit is to be located and sewer rock removed if it will be within 12'
of the proposed trench.
Received By:
Issued By:
Date:
Date: Lo Z3
MUNICIPALITY OF ANCHORAGE
Ar EEEMNZ�
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 050-572-47
Property owner(s) Jeffrey Kiecker Day phone
Mailing address _ 10209 Ronald Pl. Eagle River, AK
Site address 10209 Ronald Pl. Eagle River, AK
Legal description (Sub'd., Block & Lot) Preuss #4 Block 8 Lot 3
Legal description (Township, Range & Section)
Lot Size 19,600 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑X
Initial ❑
Single Family (SF) ❑
(w/wo AD U)
Septic Tank
❑X
Upgrade X
pg ❑
(D) El
Holding Tank
❑
Renewal 1-1Duplex
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
Dea Duffus
(Signature of property owner or authorized agent)
Permit/Rush Fees: '�Sl S
Date of Payment: lol 1d22 C;,., -
Receipt
Receipt Number: 0 51 a0
Permit No. --),a IL4d_1
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221427, Curtis Townsend, 02/09/23
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221427, Curtis Townsend, 02/09/23
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221427, Curtis Townsend, 02/09/23
MUNICIPALITY OF ANCHORAGE
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this .L Day ofLla!t!lw!! ,, � of 20�, by and between
!%!/ i��'y /,'eclt! er- , herein the "OWNER," and the Municipality of
Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as Advantex
located at (legal description)
Preuss #4 Blk 8 Lot 3 -10209 Ronald Place, Eagle River
2. Maintenance, Repairs and Alterations.
(Owner is required to read, understand and initial each section)
Al-K—Throughout the term of this Agreement, the Owner shall enter into a service agreement
V --
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
It shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically $400 to $600).
Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
gjv--<3wwner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018) Page I of 3
AX -Owner acknowledges that the Municipality may request records of maintenance and
L7 -
repairs from the manufacturer's representative or maintenance provider.
Aff?(_Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 14.60.030.
ATX Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
wner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
,_A�wner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendor/installer and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owner's AWWTS.
Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018) Page 2 of 3
OWNER:
By: T (signature)
,
,%/ K• -eCk! J (print name)
STATE OF ALASKA )
) ss.
THIRD JUDICIAL DISTRICT )
Date:
The foregoing instrument was acknowledged before me this day of R ,
209�_, by
COSTO
NOT PUBLIC FOR ALASKA � P•'''•�'' �'
My Commission expires: 10 ODS ; J�r o�W'/ sNON `
i y•i P& Co z
i STATE OF 0%��`.
MUNICIPALITY • ,II' 11 s 1110
By: �� (signature)
(print name)
Date: ( l
Title:
(rev. 05/18/2018) Page 3 of 3
GRE.;: ;ER ANCHORAGE AREA BOf UGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME &Ake �'�'rti 6 MAILING ADDRESS 3 ey Jay � f PHONE X79(
LOCATION / �p'{�'f� �`' LEGAL DESCRIPTION v"� -*� f I•n e4
SEPTIC TANK:
DISTANCE NUMBER OF
FROM WELL MANUFACTURER � MATERIAL ��� COMPARTMENTS f
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY le& GALLONS.
SEEPAGE PIT:
NUMBER OF PITS DIAMETER -7V OR WIDTH_, LENGTH—, DEPTH l9'
LINING MATERIAL CRIB SIZE: DIAMETER 0 DEPTH 691 DISTANCE FROM: WELL
TOTAL EFFECTIVE
BUILDING FOUNDATION_, NEAREST LOT LINE ABSORPTION AREA (WALL AREA) (J� SQ. FT.
ADDITIONAL ABSORPTION
WELL -
TYPE —CONSTRUCTION DEPTH
DEPTH
BUILDING J7�
FOUNDATION
CESSPOOL
APPROVED
DISTANCES:
NEAREST
LOT LINE
OTHER SOURCES
DISAPPROVED
DISTANCE FROM:
NEAREST SEPTIC 8 SEEPAGE
SEWER LINE TANK_, SYSTEM
REMAR
Form No. EQ -031
DIAGRAM OF SYSTEM
73 /117/,(APPROVED
16V r
4 e4`
R -e=
IV
INSTALLED BY:
PIPE MATERIAL:
&"
LOT SLOPE:
RE/M-ARKS:
DATE
Form No. EQ -031
DIAGRAM OF SYSTEM
73 /117/,(APPROVED
16V r
4 e4`
a
�` GREA—(ER ANCHORAGE AREA BOROUGH /
DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. l
3500 TUDOR ROAD POUCH 6.650
ANCHORAGE, ALASKA 99502
TELEPHONE 279-8686
SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT
NAME OF APPLICANT Eeltyl�, (9""/,' MAILING ADDRESS 11a7��T'✓' PHONE ZZ - /
INSTALLATION LOCATION
LEGAL DESCRIPTION I y �VVY
INSTALLATION OF:
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
SOIL TEST RESULTS
COMPLETION DATE A
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE /c/poo TYPE "e"-� E;PAG'EE EA. SIZE " : TYPE
MI 4ST*N C 9 ST R El 0 U T - ( WOO` V� IAGRAM OF SYSTEM
//
FOUNDATION TO SEPTIC TANK
'^ I
I OUNDATION TO SEEPAGE PIT 2W . DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL /5-1
SEPTIC TANK —c_, SEEPAGE PIT DRAIN FIELD _
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK 100 SEEPAGE PIT
DRAIN FIELD
WATER MAIN TO SEPTIC TANK
ALSO CONSIDER AREA WELLS.
SEEPAGE PIT
DRAIN FIELD /
�}
SEPTIC TANK, v r SEEPAGE PIT DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OIIT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
CAST IRON SIPHON PIPES ON SEPTIC TAN
FITTED WITH AIRTIGHT REMOVABLE CAPS.
VEL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
HEALTH AUTHORITY
OR
LICENSED DESIGNER
1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
d72 q
DATE 'APPLICANT'S SIGNATURE/,
0 & E EI v GI NEERI NG & DEVEL &MENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 333-5240
Russell Oyster Earl Ellis
694-2774 333-5240
Civil Engineering Surveying
Soils & Foundations Land Development
SOIL LOG
Performed for: Name: ''�737� Tel. No.' -;-5.4.4 `W'Wp
Mailing Address:
Legal Description: i -Or -0,3' �N�- e.Us4
Depth (feet) Soil Characteristics
0
2
3
4
'Y ���Vw� V� ,-rH
6
7 ®�s C' ►�. � � i�tiv. �, tea, � f ie� A
8
9
10
11
cTC-cb M �T
Ground Water Encountered: Yes- No If yes, what depth
Proposed Installation: Seepage Pit Drain Field
Comments:1Z'-A\°Z' �� Aa � `'► �'�,�4s
W"2 , C VZ-6LXVy
Performed by:Date: \\ v H
M -W DRILLING, Inc.
P. O. Box 4-1224 - 1310C International Airport Road
(907)274-4611 -
ANCHORAGE, ALASKA 99509
DRILLING LOG
Well Owner Use of Well [Tcfm
Lo:ation ddress of�Township, Range Sectia ow, or 44 ce main roa�1
Size of casing---� Depth of Hole -214 --feet Cased to---2L-----feet
Static water levet 7 ft. (above) (below) land surface. Finish of well (check one) open end (.x );
Screen ( ); Perforator.(
Describe screen or perforation
Well pumping test at-.,: gallons per fhour..) (minute) for hours with
of drawdown from static level.
Date of completion P-17, 7 9 (
WELL LOG .
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
�' TO '; '�r�a�anic•,
r
,I TO `R 71.1 4•5F L"rn%4cl P. /1c,..,
TO
3-CONTR/ /
M -W DRILLING, Inc.
P. O. Box 4-1224 a 1310C International Airport Road
(907) 274-4611
ANCHORAGE, ALASKA 99509
DRILLING LOG
Well Owner - --
I,o:ation address Township, Range, S e owrl; or y�i take main
of Well
Size of casing -__:__Depth of Hole_'"' feet Cased to_�"' feet
Static water level.--- ----ft. (above) (below) land surface. Finish of well (check one) open end
Screen ( ); Perforated_(
Describe screen or perforation_
Well pumping test at --gallons per (hour) (minute) for hours wither `` j` ft,
of drawdown from static level,
Date of completion_-__
WELL LOG _
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
mn
TO
TO ._
TO---'—
1O_--
i—^---` — MUNIaPAUTY OF
ANex+t�on
-- ``OOP HEALTH &
ENVIRONMENTAL PROTECTION
TO-- _ _ MAY 1 91996
TO-- — -- --E-C
3 — CONTR
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
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-572-47
1. GENERAL INFORMATION
Complete legal description
Location (site address)
COSA# OSC�la.iaal
Expiration Date:�-
Preuss #4 SO, Block 8, Lot 3
10209 Ronald Place, Eagle River, AK 99577
Current Property owner(s)
Steven and Lana Anderson Day phone 694-2319
Mailing address
Same as above
Lending agency
Day. phone
Mailing address
Real Estate Agent
Audrey Mason, ReMax of Eagle River Day phone 622-3344
Mailing Address
10525 Old Glenn Hwy., Eagle River, AK 99577
Unless otherwise requested, COSA will be held by DSD for pickup
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
- -n ivldual Well - — _ - - Individual On-site
Individual Water Storage ❑ Individual Holding Tank ❑
Community Class Well ❑ Community On-site ❑
Public Water System ❑ 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. 1 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
Douglas T. Kenley, P.E.
Address 9806 E. Northstar Circle, Palmer, AK 99645
Engineer's Printed Name Douglas T.
5. DSD SIATURE
S✓/ Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the
Phone (907)746-1073
DateJ Wn__ 131 U rL
z
OFT �
COSA Checklist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By Original Certificate Dater
(Rev. 11/0.5)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program a
4700 Elmore Road
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 a4 S/D, Block 8, Lot 3 Patel ID: 050-572-47
LS'I1�S>!llZ�t•1
Well type fd" t9
Date completed 2/6/76
Total depth 94 ft.
Date of test
Static water level
If A, B, or C provide PWSID #
Sanitary seal (Y/N) Y
Cased to 32 ft.
FROM WELL LOG
2/6/76
75
ft.
Well production 0.5 g.p.m.
WATER SAMPLE RESULTS:
Coliform Negative colonies/100 mL Nitrate 2.03 mg/L
Arsenic: ND ug/L date of sample: 4124/12
B. SEPTICIHOLDING TANK DATA
Tank Type/Material Septic/Steel
Tank size 1000 gal. Number of Compartments 1
Well Log (YIN) Y
Wires properly protected (YIN) Y
Casing height (above ground) 12 in.
AT INSPECTION
5/22/2012
73.8 ft
3.2 g.p.m.
Collected by: F. Kenley
Date installed 8/23173
Cleanouts (Y/N) Y
Foundation cleanout (YM) Y Depression over tank (Y/N) N High water alarm (Y/N) NIA
Date of pumping 4/20/12 Pumper JR5 Pumping
C. ABSORPTION FIELD DATA
Date installed 8/23173 Soil rating (g.p.d./ftz or ft2/bdrm) 150 System type Seepage Pit
Length Unknown ft Width Unknown ft, Gravel below pipe 6 ft.
Total depth 10 ft. Eff. absorption area UK ftz Monitoring tube Y Depression over field N
Date of adequacy test 5/24/12 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 32 in. Water added lsoo gal. New depth 49 in.
Elapsed Time:215 min. Final fluid depth 45'112 in. Absorption rate >= 450
Any rejuvenation treatment (past 12 mo.) (YIN & type) Y If yes, give date Y*
D. LIFT STATION
"Pump on" level at _ in.
Size in gallons
Cycles tested
Manhole/Access (Y/N)
Meets alarm
level at in.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 70 ft. On adjacent lots 100+ft'
Absorption field on lot 1 OO+ft. On adjacent lots 100+ft.
Public sewer main NA Public sewer manhole/cleanout NA
Sewer /septic service line 25+f . Holding tank NA
Animal containment areas 50+fL Manurelanimal excrete storage areas 100+ft.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ft. Property line 10+ft• Absorption field 5+It.
Water main NA Water service line 10+ft. Surface water 100+ft.
Wells on adjacent lots 100+ft.
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10+ft• Building foundation 90+ft• Water main NA
Water Service line 10+11t. Surface water 100+ft. Drivewa rkin 5.n
y pa glvehide storage
Curtain drain None known Wells on adjacent lots
F. COMMENTS _
G. ENGINEER'S CERTIFICATION �`,'` ' N1
I certify that I have determined through field inspections and >k •�49 IH v`'
review of Municipal records that the above systems are in +
conformance with MOA COSA guidelines in effect on this date. •03 ' -. � c ^s
P
Douglas T. Kenley P.E. '
Engineer's Printed Name '•� OEM'd�
KOM
Date �•rw.- 136 'La ('tom �.�
COSA Fee
Date of Payment
Receipt Number ��0q
(Rev. 4110)
Waiver Fee $
Date of Payment
Receipt Number
Cy
0
0
0
Cl'
<
L.Lj
Chi
C))
0
V)
L_J
< 0
M 0
00
0
0
0
0
z
25'
WELL
0
1R4 n?'
Cy
0 0
d •
o
LO 0
CO 0
000
0
00
0
00
71' 0
�':)Ozj izi UU
ANCHORAGE RECORDING DISTRICT, ALASKA
AS -BUILT OF:
PREUSS SUBDIVISION UNIT No4
LOT 3 BLOCK 8 PLAT 72-6
SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a
physical survey of this property as shown on this drawing and that the
2__
improvements situated hereon are within the property lines and no
enchroachments exist other than noted. Under no circumstance shoU14
any information on this drawing be used for construction of fences,
structures, improvements, or for establishing boundary lines.
EXCLUSION NOTES: It is the owners responsibility to determine
the existence of any easements, covenants, or restrictions which
do not appear on the recorded subdivision plat.
WORK ORDER NUMBER: DATE: sckE; E—MAIL.•
JUNE 17, 2022 1 =30' schuller0ok.net
22-063 DRAWN BY. ICHECKED BY: GRID NUMBER: BOtitC AGE
JLS NW0056 220234
10j.jj M)
* == FND 5/8" REBAR
0 4 NX
0� A
W
At W_ ej
11P
49TH
?.......... .. ...
A •� rr^�� Z
.............
*j N L. SCHULLER: 7\� . / 4 .
LS -10408 A0
1.831 Talkeetna Street
ANW Anchorage, Alaska 99508
6
0 'O \ 'Aw
f \
essjon6 10' (907) 227-1455 office
(907) 274-4992 fax
P"Mo r➢P.IWID FLOOREI£V. (ASSUMED)
PROPOSED B NG CgtNER
fl V. (A MW)
ZONING DISTMCT
FRONT BUILDING SETBACK
5DE BVIILp10 SETBACK
REAR WWNG SETBACK(
251
2
I
163.33' S890 59' 00"E
W
GRAVEL
W°LL
U
....
DRIVE ...
_
.
a
23.9
0
`0 26.0 2117
z
EXISTING
N
Q
HOUSE F—
85.5
26.0
OLU
23 9 a
0
I=
LU
n/ 0
0
LL N00
I p
O
O
C. .s
I
0
I
I
N890 59'00"W 163.33'
4
UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES.
THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY.
LISTED DISTANCES PREVAIL OVER SCALING, REPRODUCTION MAY CAUSE ERRORS IN SCALE.
LOT SURVEY SURVEY TYPE
❑ FOUNDATION AS -BUILT
SYMBOLS
❑ FINAL STRUCTURE AS -BUILT
SET REBAR DRAINAGE ASPHALT
El PLOT PLAN ... AS -BUILT ...LOT SURVEY ... TOPOGRAPHY
HY
FOUND REBAR ':^';': '
9'�9 WOOD FENCE I� CONCRETE
IN AS -BUILT ... NO CORNERS SET RECERnFlCATON AS -BUILT ... NO CORNERS SET
00 ff ASSUMED ELEV. v METAL FENCE ® WOOD DECK
PLOT PLANS & LOT SURVEYS
NOTE:
IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE
ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE
SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS,
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
SIDEWALKS, DRIVEWAYS,
ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW
THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS
MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED.
WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED.
SURVEY CERTIFICATION
•••�"
.••�E OF, i,, i
Prepared by
Robert E. Johns, Jr. & Assoc.
PLOT PLAN
Um rot ora.. ana am..eea ... ana that L
"°""""°""°"°""°y"""°
raaaa > ..tmNhm aK °r +ne Lee
����P. ..... �1
'''�.
Professional Land Surveyors
Qea coma.
s .n°.n an me qan ane to th. B.M a my
- ,.•
/ 77
1700 Brink Drive.
ANCHORAGE.
mahwaase and aelltha& an Orn.n.wn. na< n.an
m. noa w° and ea,reet.
•
ALASKA 99504
Scale: 1 LL _ 3�L
Rea. Lot S.F.
Rea. Plat File No.
FOUNDATION
Ar
'••••
AS -BUILT
L. Rol E Bohn.. Jr.. harehy.1ty mat
�••• e• ... ........... .0
Dote Surveyed:
Ye
6/18/12
Drawn by. REJ
Checked b
M1en perbnnh m A.-9vYt wlrw at N.
Wndmlan an We Dat d mat oath.
........ ,...........� •
,''•,o •,
enn and hr .Ikn a..hmm haven
"y°, °"foodl'"'ro w't N.
. BERT : S,
MK
Date Drawn: 6I1 8112
Grid: W
N �56
W.O.
12-186
,'he°,wetnwd
. � ;.
��
FINAL STRUCTURE AS -BUILT
s ''. '4 .' Ae-I
''•., '
"'
Legal Description:
I, Rcbxt E b5n5 w., hrtly artly that
fe ,. ����
Z
he.. perTa,ned an A._B°It .any a m.
eaaaw.. anae KM >.a mat al hm
od d
P •..............• a� .
Lot 3 Block 8
aM we ma n° a a�"aa`a,'0mnti .wt edm
w�°aamim
X11 'ofes sionol L•��
4�....••
PREUSS #4
Douglas T. Kenley, P.E. 9806 E. Northstar Circle, Palmer, Alaska 99645 (907) 746-1073
June 11, 2012
Municipality of Anchorage
On -Site Services
4700 South Bragaw
Anchorage, Alaska
Re: Steven Anderson, Owner
Preuss#4 S/D, Block 8, Lot 3
10209 Ronald Place
Eagle River, Alaska
COMMENT FOR COSA CHECKLIST
This is in reference to the double asterics (**) shown on the tan form (F) Comments section. Lot
2's well was drilled on 8/10/02 subsequent to the installation of the seepage pit on Lot 3 in August
of 1973. During an adequacy test on Lot 3, measurement was made from the well on Lot 2 to the
seepage pit on Lot 3. It measured 100 feet from the well to the stand pipe coming out of the
seepage pit, which means that the 100 foot radius of the well encroaches upon the seepage pit
area. This was brought to the attention of both Jay and Jeff at MOA Onsite Services and they
contacted Michael Anderson, the engineer in charge of the installation of Lot 2's well and septic
system. I was informed that Michael Anderson has recently applied for a waiver.
If you have any questions, please call me at (907) 746-1073 or 243-5372.
Sincerely,
Douglas T. Kenley, P.E.
PE #8176
Douglas T. Kenley, P.E. 9806 E. Northstar Circle, Palmer, Alaska 99645 (907) 746-1073
June 11, 2012
Municipality of Anchorage
On -Site Services
4700 South Bragaw
Anchorage, Alaska
Re: Steven Anderson, Owner
Preuss #4 S/D, Block 8, Lot 3
10209 Ronald Place
Eagle River, Alaska 99577
COMMENT FOR COSA CHECKLIST
This is in reference to the double asteric items shown on the tan form (F) comments section. Lot
2's well was drilled on 8/10/02 subsequent to the installation of the seepage pit on Lot 3 in August
of 1973. During an adequacy test on Lot 3, measurement was made from the well on Lot 2 to the
seepage pit on Lot 3. It measured right at 100 feet from the well to the stand pipe coming out of
the seepage pit, which means that the 100 foot radius of the well encroaches upon the seepage pit
area. This was brought to the attention of both Jay and Jeff at MOA Onsite Services and they
contacted Michael Anderson, the engineer in charge of the installation of Lot 2's well and septic
system. I was informed that Michael Anderson has recently applied for a waiver.
If you have any questions, please call me at (907) 746-1073 or 243-5372.
Sincerely,
Douglas T. Kenley, P.E.
PE #8176
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date 1,9-06
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
I _ z-,:�P) -?o„9;5-c slf�1
Location (address or directions)
(b) Applicant Name L--Al`tf- IacKS7 r3 a N Telephone: Home t0M` Z3kcl Business .(4t`I - TAct to
Applicant Address 5e3 5 S )3 6"Lr A?(Ve--' Ad
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder V; Buyer ❑ ;Other ❑ (explain);
(d) Lending Institution � 1114 rn o C-Cy k6A_ Telephone
Address ' � K
(e) Real Estate Company and Agent N
Address
Telephone
(f) Mail the HAA to the following address:
EAGLE RIVERr AK 99577
2. TYPE OF RESIDENCE
Single -Family Multi -Family ❑
Number of Bedrooms
3. WATER SUPPLY
Other
Individual Well IJ-' Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite E�- 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 t of 2 72-025 (11/84)
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
0
As certified by my seal affixed hereto and as of the validation date shown below, l verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated 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 S & S I: 1r1AjEt.rm Gam_ _— Telephone
Address air
Date
EAGLE RIVER, AK 995.77 MAY 17 Ig%
DHEP APPROVAL
031)
Approved for edrooms by
ApprovedDisapprove
Terms of Conditional Approval
Conditional
dh20
CAUTION
1, ^ __r 1'NTC 1p
- V z,
p A
$%, 1OFF'swk
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
A. WELL DATA
Well Classification
�i MUNICIPALITY OF ANCHORAGE (MO I
MUNICIPALITY VE tORITY APPROVAL (HAA)
DEPT. OF [0jff
ENVIRONMENTAL PRI IST - FEBRUARY 1984
264-4720
AY 19 1986
Legal Description: L 3 C/3
RECEIVED
r,
If A, B, C, D.E.C. Approved (Y/N)
Well Log Presenter Date Completed Z "&" %(a, Yield
Total Depth Cased to 3 Depth of Grouting
Static Water Level 7S Pump Set At
Casing Height Above Ground —
Electrical Wiring in Conduit(Y//m
l'7 // Y
Sanitary Seal on Casing (cm —
Depression Around Wellhead (Y
Separation Distances from Well:
To Septic/Holding Tank on Lot 7a ;On Adjoining Lots
i
To Nearest Edge of Absorption Field on Lot !o ;On Adjoining Lots —
..iJ,a
To Nearest Public Sewer Line To Nearest Public Sewer
t/M hole
To Nearest Sewer Service Line on Lot
CU / -e
3O `
Cleanou an _
Water Sample Collected by SVCS C�6i�'/���b ; Date ' 12 ' g�
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed
8-23-73 size /00,0 No. of Compartments
Standpipes ll N)
Depression over Tank
Air -tight Caps&N) Foundation Cleanout k
Date Last Pumped Is-' / ` (_
Pumping/Maintenance Contract on File (Y/N)
;for
Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank: 9._
To Water -Supply Well 7V I _)� To Building Foundation
To Property Line Zy r 4- To Disposal Field
To Water Main/Service Line �'� } To Stream, Pond, Lake, or Major Drainage
Course
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Type of SyTt Design cZ �Prt9F.
Date Installed "Z 3 �7 " ! 3
Length of Field 41
Width of Field ; UDepth of Field /a 14
Square Feet of Absorption Area
Gravel Bed Thickness
N3 z Standpipes Present (SCiDB�
Depression over Field WX& Date of Last Adequacy Test
Results of Last Adequacy Test I iY,qze v
Separation Distance from Absorption Field:
To Water -Supply Well /UU
To Building Foundation L S-
,I.
Lot
4/1
To Water Main/Service Line
1+
To Stream/Pond/Lake/or Major Drainage Course
To Property Line
To Existing or Abandoned System on
y
On Adjoining Lots xz�
/
To Cutbank (if present) x't
To Driveway, Parking Area, or Vehicle Storage Area
00/ -
Comments 6 �11knrt ire I—f�
D. LIFT STATION
Date Installed
Size in Gallons
Dimensions
Manhole/Access (Y/N)
"Pump On" Level at "Pump Off' Level at
High Water Alarm Level at Vent (Y/N)
Tested for Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
** 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.
SignedS & S ENGINEERING Date MAY 1 7 1986
Compa� 196 MOA No. �r J Cts 3
EAGLE RIVER, AIS 99577
Receipt No. �3`�L���
Date of Payment S "' I d 1 --+�
Amount: $ (<)S C,
Page 2 of 2
72-026 (11/84)