HomeMy WebLinkAboutPREUSS #4 BLK 8 LT 1Preuss #4
Block 8
Lot 1
#050-572-49
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: 6W970031 PIDNumber: 05U-$7�'Y9
Name:wl t � Cm v1 St
ff Y I
cc.C�t trv�
Wastewater System: New ❑ Upgrade
Address: i2L'✓er' 995
Pct 3 D
ABSORPTION FIELD
Phone:�� C�
No. of Bedrooms:5
Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating: Q
Total Depth from original grade:
B•
•B GPD/Sq. Ft.
Lot: Block: Subdivision: 7t&
Depth to pipe bottom from original grade:
Gravel depth beneath pipe4!5/ ^� ,
Ft.
! Ft.
Township:
Range:
Section:
Fill a4ded above original grade:
Gravel length:7ren / 99.
'
vari-es ( —' Ft.
Tc -e4 2 :?–Ft.
WELL: ❑ Ne ❑ Upgrade
Gravel width: ��jj
Number o.yyflines:
Distance between lines:
�� of
p� Ft.
OS
Ft.
Classification (Private, A,B
Total Depth:
Caled To:Total
absorption area:
Pipe material:
�✓o �v
F .
Ft.
7'J SQ. Ft.
l7
Driller:
Date Drill
Static Water Level:
Installer:
Cc.C, 60�n,5 kuCtx;,
Date installed: Q
,; h o
Ft.
1
Yield:
Pump Set at:
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION DISTANCES
XSeptic ❑ Holding ❑ S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Man facture :
_
Capacity in gallons:/:,,,,
From
Tank
Field
Station
Tank
Sewer Lines
Material:
Number of Compartments: q
WeIPSurfac
B
/00'4-
1,904+
—
—
/vD -P
LIFT STATION
Water
Lot
t
Size in gallons:
Manuf urer:
Line
Foundation
�(] '
/U
"Pumpon" lev at:
"Pump off" level at:
High water alarm at:
Curtain4
5 (�'+
SU
Pump oke & Model
Electrical Inspe ns performed by:
Drain
BENCH MARK
Remarks: ,
Location and Description:/
ID 10�"�
O LICL
Zr V coy-Oer Orr &IC-/ 1/w/ n
Assumed Ele ati
%Q
EN SEAL
OF q �
e�
• •s `
••y
49L14 *,1
Inspections performed by: Dates: 1st_*
2nd-S;��1�
$ �(97r1�jjjt.
Department of Health and H man Services approval
4 �y
Reviewed and approved by: Date: Z:�d
72-013 (Rev. 9/91) MOA 25
AS -BUILT SYSTEM DETAILS/SITE PLAN Permit #SW970039
PREUSS SUBDIVSI❑N #4, LOT 1, BLOCK 8 PID#050-572-49
Lucas Avenue
j WATER LINE 3
2
EL=97.10 EL=100.00
I
BLK 8
9 08 \ SPLITTER
I
LOT 6
E3 W
CL
INSULATION
GJ!
1500 GAL.
L
SEPTIC
UI
TANK
A -C=37.9
d 1
RENCH 2
B -C=9.3
RESERVE
I TH
�- I
#97-
A -D=41.7
H
B -D=12.3
I
Co MT
A -E=49,9
j
1 0
B -E=19.75
— j
EL=87.30
A -F=27.7
B -F=47.4
j
A -G=24.4
0 j
��- 9NTTGN
SYSTEM
B-6=25,2
A -H=14.6
B -H=54.5
9 08 \ SPLITTER
V
Zt 9�A� 95.2
SCALE; NTS
LOT 6
E3 W
CL
INSULATION
� o
1500 GAL.
L
SEPTIC
Rj
q o,
TANK
V
Zt 9�A� 95.2
SCALE; NTS
VACANT n/a
SCALE; I' = 50' N a0H 80.75
94.3
87.E
CLEANOUT
96.53
OF AL
,49 TH*
I I
_ V.Us
KENNETH MCE-7Wa
1%�y�J
d 1'?OFESSIO�A�
"k
L GRADE
FILTER FABRIC\
SEWER ROCK
TRENCH #1
38.5'
FINAL GRADE
FILTER
94.29 SEWER RUCK
TRENCH #2
29'
REPARED FOR:
MICHAEL QUINN CONSTRUCTION
P.O. BOX 772641
EAGLE RIVER, ALASKA 99577
CLEANOUT
7.13
ARIES
1
0.5'
4.27
7.0'
MONITOR TUBE
98,38
4,26
712 7,]
KND ENGINEERING
20441 PTARMIGAN BLVD
EAGLE RIVER, AK, 99577
(907)696-6111/Fax (907)696-8111
JE: 6/19/97 DRAWINGn
,Al F: AS NOTED 97007 -SI
LOT 6
FC
G C 500 S.T,OTH
#9 -2
D
SEPTIC
SPLITTER-
RESERVE
`.SYSTEM
MT
F RENC 1
4
❑RIGINAI GRADE
e TEsiNOLE
~L=92.60
C
C:
-
��- 9NTTGN
SYSTEM
VACANT n/a
SCALE; I' = 50' N a0H 80.75
94.3
87.E
CLEANOUT
96.53
OF AL
,49 TH*
I I
_ V.Us
KENNETH MCE-7Wa
1%�y�J
d 1'?OFESSIO�A�
"k
L GRADE
FILTER FABRIC\
SEWER ROCK
TRENCH #1
38.5'
FINAL GRADE
FILTER
94.29 SEWER RUCK
TRENCH #2
29'
REPARED FOR:
MICHAEL QUINN CONSTRUCTION
P.O. BOX 772641
EAGLE RIVER, ALASKA 99577
CLEANOUT
7.13
ARIES
1
0.5'
4.27
7.0'
MONITOR TUBE
98,38
4,26
712 7,]
KND ENGINEERING
20441 PTARMIGAN BLVD
EAGLE RIVER, AK, 99577
(907)696-6111/Fax (907)696-8111
JE: 6/19/97 DRAWINGn
,Al F: AS NOTED 97007 -SI
L
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW970039
DESIGN ENGINEER:KND ENGINEERING
OWNER NAME:LEE DINAH
OWNER ADDRESS:20516 LUCAS AVE
EAGLE RIVER, ALASKA 99567
PARCEL ID:05057249
LEGAL DESCRIPTION:
PREUSS #4 BLK 8 LT 1
LOT SIZE: 19600 (SQ. FT.)
NUMBER OF BEDROOMS: 5 THIS PERMIT: 5
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
PAGE 1 OF
DATE ISSUED: 3/21/97
EXPIRATION DATE: 3/21/98
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY: 4,... ��cu - DATE: 3"�/-&17
ISSUED BY: DATE: 3 -21
�- )
KND ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
/FAX (907)696-8111
March 4, 1997
Municipality of Anchorage
Dept. of Health & Human Services
On -Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519-6650
Subject: Lot 1, Block 8, Preuss Subdivision - Septic Permit
Gentlemen:
Following a request from the owner regarding the proposed development of the
referenced property, we dug two testholes for the proposed system and replacement
field. The results of those tests are attached. The lot will be served by public water.
The system will be placed on the southern portion of the lot. As indicated on the
site plan there is sufficient grade to maintain a gravity system. A 1500 gallon tank
will be installed in anticipation of a 5 bedroom house being constructed. There is
also sufficient area and grade to maintain a replacement gravity fed field.
As indicated by the site plan drainage arrows, natural drainage is away from this site
and will be maintained after construction. There is no surface water within 100' of
the proposed installation. There are no known curtain drains within 50' of the
proposed installation. No wells exist within 100' of the proposed installation. The
system has been placed outside a 50' setback from any slope that exceeds 25%.
Additional re -grading of the site is anticipated in connection with the construction
of the house and driveway. Development of this lot should have no adverse effect
on development of adjacent lots.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
X D Engineering
Kenneth M. Duffus, P.E.
attachments: On -Site Well and Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
WASTEWATER DISP❑SAL SYSTEM/SITE PLAN
PREUSS SUBDIVSI❑N #4, LOT 1, BLOCK 8
Public Water
Public Water
Public Water
Public Water
Public Water
Public Wote
BLK 11 ... .._
BLK 11
BLK 11
BLK 11
BLK 11
BLK
LOT 1A
LOT 2A
LOT 3
LOT 4
LOT 5
LOT
SEPTIC
SEPTIC -
LOT 7
rPLWEL
BOT8
.o
' SEPTIC
SEPTIC --
SEP
SEPTIC
d
MAIN WATER LINE
------------------------------------ T_ ----------
----------- ----------
Lucas
—_—_--_
Lucas Avenue I P PROPOSED WATER LINE 3
EFL =97.10 EL=100.00
BLK8
WELL
i
LOT 6
BLK 7 VACANT
LOT 1 ` SEPTIC
!P rco
BLK 7 TH D 7-1 soo ss�TH H9 -2 SEPTIC
PROPOSE PRIMPRY S STEM r c 6�RES VE ' -.SYSTEM
LOT 6
1 SPurT 9 4 ..--......:
NO SEPTIC SYSTEMS WITHIN 200' OF
PROPOSED WELL, EXCEPT AS NOTED.
NO PRIVATE OR PUBLIC WELLS WITHIN 200' OF
PROPOSED SYSTEM EXCEPT AS NOTED.
F A �\
/ * 491H
I I
I E /
KENNETH M'.
CE -7116 wa
41
IWOFESSIaNA 'ar
0
WELL
0
WELL
O
WELL
DESIGN CRITERIA
1. 5 BEDROOMS X 150 GAL./DAY/BEDROOM = 750 GPD
2. SUITS RATING: 8 MIN./INCH = APPL. RATE 0.8 GPD/SF
3. 750 GPD/0.8 GPD/SF = 937.5 SF
4. 937.5 SF /(2' x 7') = 66.96'L
5. MIN. DESIGN SIZE = 1 TRENCH - 67' LONG x 2' WIDE x 7.0' DEEP
6. DEPTH OF GRAVEL BELOW PIPE IS 7.01.
7. TOTAL DEPTH OF SYSTEM IS 8.0' FROM ORIGINAL GRADE.
N❑TES:
1. TIE INTO TRENCH AT ENDPOINT.
2. USE 1500 GALLON SEPTIC TANK. INSULATE TANK IE <4' COVER.
3. INSULATE TRENCHES WITH 2' HD BURIAL FOAM IE <3' COVER.
4. CONTRACTOR WILL ENSURE MAXIMUM 27 SLOPE INT❑ SEPTIC TANK.
5. INSTALL ZEBCO SPLITTER OR EQUAL
PARED FOR:
MICHAEL QUINN CONSTRUCTION
P.U. BOX 772641
EAGLE RIVER, ALASKA 99577
KND ENGINEERING
20441
PTARMIGAN BLVD
U
V
(907)696-6111/Fax
(907)696-8111
SEPTIC
DRAWING #
:ALE: I'
= 100'
C
BLK 7
SEPTIC `. BLK 7
d�
VACANT
C5
LOT 2
LOT 7
rPLWEL
BOT8
.o
i
SEP
o
d
0)
WELL
C
i
OI
3
�
BLK 7
BLK 7
BLK 8
L 8
LOT
L T 8
LOT 3
L 8
NO SEPTIC SYSTEMS WITHIN 200' OF
PROPOSED WELL, EXCEPT AS NOTED.
NO PRIVATE OR PUBLIC WELLS WITHIN 200' OF
PROPOSED SYSTEM EXCEPT AS NOTED.
F A �\
/ * 491H
I I
I E /
KENNETH M'.
CE -7116 wa
41
IWOFESSIaNA 'ar
0
WELL
0
WELL
O
WELL
DESIGN CRITERIA
1. 5 BEDROOMS X 150 GAL./DAY/BEDROOM = 750 GPD
2. SUITS RATING: 8 MIN./INCH = APPL. RATE 0.8 GPD/SF
3. 750 GPD/0.8 GPD/SF = 937.5 SF
4. 937.5 SF /(2' x 7') = 66.96'L
5. MIN. DESIGN SIZE = 1 TRENCH - 67' LONG x 2' WIDE x 7.0' DEEP
6. DEPTH OF GRAVEL BELOW PIPE IS 7.01.
7. TOTAL DEPTH OF SYSTEM IS 8.0' FROM ORIGINAL GRADE.
N❑TES:
1. TIE INTO TRENCH AT ENDPOINT.
2. USE 1500 GALLON SEPTIC TANK. INSULATE TANK IE <4' COVER.
3. INSULATE TRENCHES WITH 2' HD BURIAL FOAM IE <3' COVER.
4. CONTRACTOR WILL ENSURE MAXIMUM 27 SLOPE INT❑ SEPTIC TANK.
5. INSTALL ZEBCO SPLITTER OR EQUAL
PARED FOR:
MICHAEL QUINN CONSTRUCTION
P.U. BOX 772641
EAGLE RIVER, ALASKA 99577
KND ENGINEERING
20441
PTARMIGAN BLVD
EAGLE
RIVER, AK, 99577
(907)696-6111/Fax
(907)696-8111
E: 3/3/97
DRAWING #
:ALE: I'
= 100'
1 97007-S1
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
• t
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG - PERCOLATION TEST
/YJ,A //IO/(iVl Yl �/%S7� r/��7lOfJ DATE PERI
PERFORMED FOR: !iI
�/� Township Range Section: — /i
LEGAL DESCRIPTION: SLOPE SITE PLAN
DEPTH
C" /2 G
1 5�
2
3
4
5�
6-
7-
8-
9-
10-
11 12-
13-
14-
15-
16-
17 -
2-
13-
14-
15-
16-17•
18-
19-
20-
COMMENTS
8-
19-
20-
COMMENTS
309
WAS GROUND WATER
ENCOUNTERED? O
S
L
IF YES, AT WHAT _ O
DEPTH? P
E
Depth to Water After
Mnnilnrinn? 7 Date:
PERCOLATION RATE (mmules/mCh) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
�ts/l/frJ7� CERI IFY THAT THIS TEST WAS PERFORMED IN
PERFORMED BY
ACCORDANCE W17H ALL STA E AND MUNI ALG
GUIDELINES IN EFFECT ON THIS DATE DATE
0.
PERCOLATION RATE (mmules/mCh) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
�ts/l/frJ7� CERI IFY THAT THIS TEST WAS PERFORMED IN
PERFORMED BY
ACCORDANCE W17H ALL STA E AND MUNI ALG
GUIDELINES IN EFFECT ON THIS DATE DATE
Municipality of Anchorage
2( �� DEPARTMENT OF HEALTH & HUMAN SERVICES
T 825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG – PERCOLATION TEST
PERFORMED FOR:/C//Qti/L.,l�/�-/rI� LA//ST! uGJ/4"t'�� DATE PERF
LEGAL DESCRIPTION:Pde6s '01// Township, Range, Section: /
SLOPE SITE PLAN
DEPTH
2
3
4 /q�r1 0
5 c/G/Ga /J 0�2JJ�/YI/XC�
W/Sa-n �� �G9.Sc Si IE
6-
7
8-
9
10 J WAS GROUND WATER Alp C/GpS/ ��1C ENCOUNTERED? �`/�
11 ���� L
IF YES, AT WHAT O
DEPTH? p
12 E
Depth to Water After Z /�
13 Monitoring? �r Date:
14 %jO, fi,
51617 15-
16-
17
18-
19-
20
81920 1—j
COMMENTS
N
r 11
PERCOLATION RATE `� 101 4 'fmmutesimchl PERC HOLE DIAMETER C
TEST RUN BETWEEN FT AND
PERFORMED BY. _.2ti�� I .[iP/l/J�_ll�� %�*CERT IFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE 3 3 -
io ". I.— . . . I .
Depth to
Water
r 11
PERCOLATION RATE `� 101 4 'fmmutesimchl PERC HOLE DIAMETER C
TEST RUN BETWEEN FT AND
PERFORMED BY. _.2ti�� I .[iP/l/J�_ll�� %�*CERT IFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE 3 3 -
io ". I.— . . . I .
I i.; +�
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. 050-572-49 Expiration Date:
1. GENERAL INFORMATION
Complete legal description PREUSS #4 BLOCK 8, LOT 1
Location (site address) 20516 LUCAS AVENUE, EAGLE RIVER, AK 99577
Current property owner(s) ELDON & ANGELA CRISWELL Day phone
Mailing address
Real estate agent
20516 LUCAS AVENUE. EAGLE RIVER. AK 99577
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 5
4. TYPE OF WATER SUPPLY:
Private Well
❑
Water Storage
❑
Community Well
❑
Public Water System
Public Sewer
Day phone
TYPE OF WASTEWATER DISPOSAL:
Private Septic
Holding Tank
❑
Community
❑
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ -5 -5c) Waiver Fee $
Date of Payment
Receipt Number 2 192S-,5-
COSA #
9255COSA# ()SCal 1359
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm FIRST WATER CONSULTING Phone 907-350.9566
Address 13030 SUES WAY, ANCHORAGE, AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE Date 6/2812021
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. 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, any estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting & NES
6. DSD SIGNATURE
System #1 Approved for
System #2 Approved for
Disapproved
Conditional approval for
S bedrooms
bedrooms
Aw
si
TMH
-49
• Curtis Huffman
i ��s• .CI . ��
Q 28PROFESSO
bedrooms, with the following stipulations:
G)-
5: WATER A Et z
AS M
J - �
J �
q4FNT SEll1�,���
B w•- '� Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Other <,-f l�
—�cr..� M t -
�li ►vw/
f tk
Legal Description: PREUSS #4 BLOCK 8, LOT 1
If more than 1 septic system on lot: COSA Checklist # _of
A. WELL DATA — PUBLIC WATER
❑ Well log is filed with Onsite (or attached)
Date drilled
Total depth _ft
Cased to _ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) _in.
Date of flow test for COSA
Static water level at beginning of test _ft.
Comments
B. TANK DATA
Age of tank(s) 24 years
Tank type/material SEPTIC / STEEL
Measured operating fluid level in septic tank 49"
® Standpipes/foundation cleanout per record drawing
Date of pumping 6/23/2021!
D. ABSORPTION FIELD DATA
Which system tested (date installed) 3/28/1997
® ALL standpipes present per record drawing
Total measured depth from grade 10.7 ft (max)
Measured depth to pipe invert from grade 3.9 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective 6.8' INTO THE 7'ED
Parcel ID: 050-572-49
Structure served by this system _
Well production at time of test _gpm
Water storage tank volume_ gallons
Well disinfected for coliform test? ❑ Yes ❑ N
❑ Coliform bacteria is Negative
Nitrate _mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by
Date of Sample
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material
Comments: SEE ATTACHED MOA TANK ADVISORY
Adequacy test date 6/23/2021
Results 0 Pass For 5 bedrooms
Fluid depth prior to test 8 in
Water added 900 gal
New depth 22 in
Elapsed time 1310 min
® Code -required soil cover over field Final fluid depth 8 in
❑ System presoaked Absorption rate 750 gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N
date of test) If yes, enter date
Gallons introduced gallons
Comments/Deficiencies: TESTED NORTH TRENCH AS PAST COSA — SOUTH TRENCH HAD 39" OF FLUID.
AN
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
® Yes if No ft
Wells on Adjacent Lots:
Community Sewer Manhole/Cleanout > 100'
❑ Yes
if No
ft
❑ Yes
if No
Neighboring Tank > 100' ❑ Yes
if No
ft
Private Sewer/Septic Line > 25' ❑ Yes
if No
Absorption Field on Lot > 100' ❑ Yes
if No
ft
Holding Tank > 100' ❑ Yes
if No
Neighboring Absorption Fields > 100'
Surface Water > 100'
® Yes
Animal Containment > 50' ❑ Yes
if No
❑ Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ❑ Yes
if No
ft
❑ Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ❑ Yes if No *5+ ft Surface Water > 100'
ft
ft
ft
ft
ft
® Yes if No ft
Property Line > 5'
® Yes if No ft
Wells on Adjacent Lots:
Absorption Field > 5'
® Yes if No ft
Private Wells > 100' ® Yes if No _
Water Main > 10'
® Yes if No ft
Community Wells > 200' ® Yes if No _
Water Service Line > 10'
® Yes if No ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
® Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
® Yes
if No
_ ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells > 100' ® Yes if No ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
*PER CODE AT TIME OF INSTALL.
G. ENGINEER'S CERTIFICATION
l certify that l have determined through field inspections and review
of Municipal records that the above systems are in conformance
with MOA COSA guidelines in effect on this date.
Aw
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Septic Tank Advisory
Certificate of On -Site Systems Approval #OSC 211359
Subdivision: Preuss #4 Block 8 Lot 1
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this property is 24 years old. Typical replacement costs range from $8,000 to $11,000
This advisory must be attached to all copies of the subject Certificate of On -Site Systems
Approval.
This is an example of what the metal of a 20 -year-old steel tank MAY look like.
a; g ✓c-�,; a x r a` �, -,gin:-o`er '�t,.e '� + 4 , ,. ,� ;s.,. �s "11" {
hx �� ,� � M�il�ng Address �P� O Box 196650,* Anchorage, Alaslia'99519 6650 *www muni�org � � �"
Municipality of Anchorage ..
Development Services Department
C N / Building Safety Division y
On -Site Water 8 Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.enchorage.ek.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 050-572-49 HAA# t7S��sln
1. GENERAL INFORMATION Expiration Date: % " f! R " 0 G
Complete legal description PREUSS
SUBDIVISION #4:
LOT 1,
BLOCK
8,
Individual On-site
E
Individual Water Storage
❑
Location (site address or directions) _20516
LUCAS
AVENUE •
EAGLE
RIVER, AK. 99577
Current Property owner(s) REGGIE AND PATRICIA ROORDA Day phone - (907) 696-3145
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
20516 LUCAS AVENUE • EAGLE RIVER, AK. 99577
Day phone
PAT ROORDA w/ RUDENTIAL JACK WHITE Day phone
229-3176
16635 CENTERFIELD DRIVE • EAGLE RIVER, AK. 99577
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 5
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
E
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
0
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 samples. (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 GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE. AK 99507
Engineer's Printed Name JEFFREY A. GARNESS. P.E.
Engineer's Comments:
In conducting this evaluation, GEG, Ltd. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational fife of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide
any warranty or future estimate of how long the system wilt continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party Is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for 5 bedrooms.
Disapproved.
Phone 337-6179
Date 1,12q AS
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
WATER AND
PROGRAM
By-. 9 U/. Original Certificate Date: %
(ter 12JOI)
Municipality of Anchorage
' Development Services Department
Building Safety Division `
Onsite Water b Wastewater Program
470D South Bragew St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ei.anchorage.ek.us
(907)343.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: PREUSS SUBDIVISION /4: LOT 1. BLOCK B. Parcel ID: 050-572-49
A. WELL DATA
Well type
Date completed
Date of test
Static water level
Well production
If A, B. or C provide PWSID# _
Sanitary seal
Cased to ft.
FROM WELL LOG
WATER SAMPLE RESULTS:
Coliform colonieWl00 ml. Nitrate
S. SEPTIC/HOLDING TANK DATA
R.
g.p.m.
Date of sample:
Tank Type/Material STEEL / SEPTIC
Tank size 1500 gal. Number of Compartments 2
Foundation deanout (YM) YES Depression over tank (YIN) NO
PUBLIC WATER
Well Log (YIN)
WmM e y Protected (YIN)
Casing height (above ground) in.
AT INSPECTION
R.
—
9 -p.m -PUBLIC WATER
oolonies/100 mi.
Collected by:
Date installed 3/25-28/1997
Cleanouts(Y/N) YES
High water alarm (YM) N/A
Date of pumping 8/11/2005 Pumper JR's PUMPING
C. ABSORPTION FIELD DATA NORTH TRENCH /
Date installed 3/29-28/1997 Soil rating .p.d ftr/bdnn) 0_8 System" SOUTH TRENCH
7'
Length 38_5 ft. Wklth 2 ft. Gravel below pipe 7 ft.
10.79/
Total depth 995 R. FJf. absorption area 945 fe Monitoring tube YES Depreasion over field NO
Date of adequacy test 6/1/2005 Results (Pass/Fail) *PASS For 5 bedrooms
Fluid depth in absorption field before test 51.5 in. Water added 943 gal. New depth 58.5 in.
Elapsed Time: 328 min. Final fluid depth 52 In. Absorption rate >- 750+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) NONE KNOWN If yes, give date
*ONLY THE NORTH TRENCH WAS TESTED, SOUTH TRENCH WAS
COMPLETELY SURCHARGED BEFORE TEST WAS PERFORMED.
D. LIFT STATION
Date installed
"Pump on' level at _in.
E. SEPARATION DISTANCES
Size in gallons
High water alarm level at
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAiR station on lot
Absorption field on lot
Public sewer main
PUBLIC WATER
On adjacent
On
Public sewer manhole/deanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 50+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parkingtvehide storage
Curtain drain NONE KNOWN Wells on adjacent lots 1009+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through held inspectkm and 4 ! '
review of Municipal records that the above systems are in """ "' • .. •"' ..........
conformance with MOA HAA guideBnes in affect on this date.
.. .. .......
aft -
Engineer% Printed Name JEFFREY A. GARNESS 7
1 17Z�
Date � 29 oS '•oa.__ _..d``°
HAA Fee S 42f)
Date of Payment
Receipt Number o i� g�3 �►('n
IROV. 12/01)
Waiver Fee S
Date of Payment
Receipt Number
06-28-05 19:56 FROM-Pudential Jack White Eaale River 2076896499 T-670 P.002/002 F-759
u
iYdP �.�7>fi� /dam .Pj
4SBUILT
HEREBY CERTIFY THAT I HAVE SURVEYED THE
SCALE,SEWARD
14 ASSOCIATES LMSURVEYING 694-(
OLLOWING DESCRIBED PROPERTY,
erF.rrrr� sifori dry
VD
��
+����%%
OF A�
THAT NO ENCROACHMENTS EXIST EXCEPT AS
IDICATED. IT IS THE RESPONSIBILITY OF THE
VNER TO DETERMINE
DATE+
�F
,'
THE EXISTENCE OF ANY
4 rM y •
LSEMENTS, COVENANTS O
ITCH DO NOT APPEAR R RESTRICTIONS
OH THE RECORDED
GRID:
.Y� .ff
" ... d
" '
�
••
SUB
SUBDI-
SION PLAT. UNDER NO CIRCUMSTANCES SHOULD
Y DATA HEREON BE USED FOR CONSTRUCTION
FB:
.��-/ �
I , n,.•n, M„t
FENCE LINES, OR FOR ESTABLISHING BOUND -
Y LINES.
�A'' S .
DRAWN:
���s7xu1L''. r
Qif1f
A'A 7�w � r
5. STATEMENT OF -INSPECTION' BY ENGINEER.
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on -.site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of;this inspection.
KND E inert n
Name of Firm � � Phone � �62044 1 P"an Blvd,
Address Eagle River, AK 99577.8736
Engineer's signature Date G z Ketinelk9
_ .104 G$-
t� R�
nuFESS1� w
6. DHHS SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
By: Date ZjL ZZ
The Municipality of Anchorage Department of Health and Human Services (DHHS) ,issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of, DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-M (Rev.1/91) Back MOA N21 - - - - - -
mums lrnui. — .�_
ENVIRONMENTAL SERVICES DIVISION
Municipality of Anchorage ,JUN 25 1997 N �
DEPARTMENT OF HEALTH & HUMAN SERVICES �►lf
Environmental Services Division " �V 4� Il
/ c i
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) L. V
Health Authority Approval Checklist
Legal Description: �oicSS-tt7 !z!e'e c.�/ ! Parcel I.D.: 05-0 —;: %Z ^ Yg
A. WELL DATA
Well type ?WIL If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Date completed
Cased to
FROM WELL LOG
Nitrate
Casing height (above ground)
Wires properly protected (Y/N)
AT INSPECTION
g.p.m. 9—
p.m-
Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA /
Date installed g Tank size /5pD Number of Compartments Cleanouts,, (,Y�/N)
Foundation cleanout (Y/N) Z Depression (Y/N) � High water alarm (Y/N) �//
Date of Pumping NA Pumper
C. ABSORPTION FIELD
,DATA
�
Date installed -- �� Soil rating (g.p.d./ft2 or ft2/bdrm) System type �ee dY�ich
Length Width,/ �` Gravel thickness below pipe 7 Total depth 0
S — l
Effective absorption area 97 Monitoring Tube present (Y/N)—X— Depression over field (YIN)
Date of adequacy test 41,4 Results (Pass/Fail)
For bedrooms
Fluid depth in absorption field befo a test (in.); Immediately after gal. water added (in.
Fluid depth s) Minutes later: Absorption rate = g.p.d.
Peroxide treent (past 12 months) ( If yes, give date
72-026 (Rev. 3/96)'
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at*
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot Z On adjacent to
Absorption field on lot On adjacent to
Public sewer main Public sewer manhc
Sewer /septic service line Z Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation Property line /U Absorption field /D
Water main/service line .2s Surface water/drainage /00 4 Wells on adjacent lots
"Pump off" level at*
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line /b F Building foundation A0 �f Water main/service line 25�
Surface water / 00 "-/- Driveway, parking/vehicle storage area
Curtain drain /00 Wells on adjacent lots 10,9 ,4
F. ENGINEER'S CERTIFICATION
I certify that f have determined thru field inspections and review of Municipal.
in conformance with MOA NAA guidelines in effect on this date. �y
�O
Signature
0 ue
Engineer's Namenel 'z
Date 4,�2��/9% �d
HAA Fee
Date of Payment C!
Receipt Number
72-026 (Rev. 3/96)*
011
Waiver Fee $
Date of Payment
Receipt Number
biatitc-ha systems are
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44 CE 7116
