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PREUSS #3 BLK 11 LT 1A
Onsite File Preuss #3 Block 11 Lot 1A #050-572-65 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221048 PID Number: 050-572-65 Dwelling: Z Single Family (SF) n with ADU n Duplex (D) n Two Single Family Project: [:1 New Upgrade Name STEPHEN & CRUCELINA VRABEL FIELD E Deep Trench n Wide Trench [:1 Bed El Mound _ABSORPTION Site Address 20413 LUCAS AVENUE, EAGLE RIVER, AK El Other Phone Number of Bedrooms Soil Rating Total depth from original grade 1 3 0.6 GPD/SFI 8 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.5 Ft. Gravel depth beneath pipe 4.5 Ft. Subdivision Block Lot PREUSS#3 11 1A Fill added above original grade VARIES 0.1'- 0.29 Ft. Gravel length (3 TRENCHES) 84 Ft. Township Range Section Gravel width 2 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 750Ft2 3 10 Ft. Well 200'+ 25'+ TANK El Septic [:1 S.T.E.P. E:1 Holding El Other Manufacturer Capacity Gal. Surface Water 100'+ Material Number of compartments Lot Line 5'+ NA 2 Foundation 10'+ LIFT STATION Manufacturer Capacity Gal. Remarks 3 -WAY SPUTTER INSTALLED TO NEW FIELDS. Alarm location Electrical installed by Installer JRS PIPE MATERIAL House to tank 3034 drainfield Tankto 3034 Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspdates:ection 1$t 4/29/22 2nd 4/29/22 Location and description 3`d 4/30/22 4'h 5/2/22 ITOP OF MANHOLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL Ak"I Conditional Approval: Date 7H .... .... . ......... . ............ Septic System Approved -• Curtis Huffman Date CE 128991 6//2 7/22 low ;Pei - — AMW �' kPROFEMO Note: this approval does not include well permit requirements. -------------- k, 4— (Rev ub/u2/1 8) PID: 050-572-65 PERMIT: A—C=45,5' CO MT 99.54 TH172-1 B—C=23,7' 99.37 A—D=56,3' B—D=45.9' -3' A—E=57,7' B—E=49,6' A—F=53,4' B—F=60,7' 1 11 A—G=52,1' 95.87 95.87 B—G=62,5' SM/GM A—H=61.5' SEWER ROCK B—H=87,3' A—I=61.9' B—I=87,5' A—J=65,5' 99.60 MT FINAL GRADE CO MT 99.66 B—J=73,1' A—K=72.5' 99.37 B—K=93,7' A—L=73,4' 11 ORIGINAL GRADE B—L=94,3' A—M=77,9' 11 6' B—M=82,4' A—N=86,6' 83.37/BOH B—N=102,5' A-0=85,4' 95.87 95.87 B-0=101,8' FLAT GRADE OSP221048 H DRIVEWAY CO MT \\� w K I G \ Z CO 0 3 WA1� J MT SPLITTER \ COL CO F E \ DIV W IZI FCO INSIDE FOUNDATION EXISTING TANK SEPTIC SECTION SCALEI NTS 3 TRENCHES 4'+ TO BOTTOM 28' LONG X OF FIELD TO 2'W X 4.5'ED OBSERVED -8' TOTAL GROUNDWATER DEPTH. 5/2/22. ® , D E 3BR HOUSE >>00 \EXISTING CON�RETE TANK ��PPROX.WATERL LOCAD AT CONSTRUCTION MT CO MT 99.47 FINAL GRADE FILTER FABRIC 95.87 95.87 SEWER ROCK 99'59 CO MT FINAL GRADE CO MT 99.54 TH172-1 99.37 ORIGINAL GRADE/ -3' ORG/OL FILTER FABRIC 1 11 95.87 95.87 SM/GM SEWER ROCK 4.5' 91.37 91.37 99.60 MT FINAL GRADE CO MT 99.66 99.37 11 ORIGINAL GRADE 11 6' 1 FILTER FABRIC 83.37/BOH RELATIVE ELEV. 95.87 95.87 FLAT GRADE SEWER ROCK 4.5' 91.37 91.37 THS -1 GRND. WTR. DRY 3/4/22 & 0 13' 5/2/22 PREUSS #3 BLK 11 LT 1A SUPPORT RVICES: PREPARED FOR: STEPHEN JOHN & CRUCELINA VRABEL F N - 5 20413 LUCAS AVE C EAGLE RIVER, AK 99577 FIRST WATER CONSULTING 1DATE: 7/05/2022 3030 Sues Way SURVEY. HOLT Anchorage, Alaska 99516 DRAWN: FWCS (907)350-9566 SCALE: 1" = 30' firstwaterAK®amail.com �qt TH tis Huffman CE 128991 4% 100 7/5/2022 e MUNICI PAL17Y OF ANCKORAGE -Siiiu Water & Wastewater Program PO Box 196850 4706 Elrname Rctud Arwharapa, Masks 9951 -�l Phone, [9WF 34.3-7944 Fix; (947) 343jW htlp:a ww.munl.org�anslta On -Site Wastewater Disposal System Permit Permit Number, CkSP221048 Work Type: Septic Upgrade Tax Code Number: 05057265040 Sloes Legal Addrass, RREUSS 03OLK 11 LT 1A C:4056 Site Malling Address: 20413 LUCAS AVE, Eagle River Owner. VRA13EL STEPHEN JOHN $ Dosig n Enalnim%rr FI RST WAT5 R OONSU LTI NG This ptrmit i!, for the construction of; Effective Dme; Expiration Data: tncnr C r+ ^ s r? w �FI]JY1' CI]1�MY� L -Qt Size in Sq Ft; Total BedrQvms; 34 1 012 022 3410f2G23 22693 ® DiSPOSel FieW ❑ Septic Tank ❑ Hord-ig Tank ❑ PriVy ❑ Private Well EI Vdater Storage All construction shall be in accordance with: 1. T'he al!Whed approved design_ 2. All requirements specified In Anchorage Municipal code Chapters 15.55 and 15.65 and tho Stat$ 4f A1e:5ka Wasiewater Disposal Rne Lrleticiris (18AAC72) arrd Drinking VVaiar Raoul0ons (18AA080) 3, Tho WQ&tPWiRtUr rgdu requires inspeuRone during tha Installotlon. The criginccr Shall notify the Dmmlopment Services Vepartment per AMC 15-65. Provide noti€icalion by udling (947) 343-7904 (24R)- 4. From C)ctaber 16 to April 15, a subs face.84il abwrplivn system under consiruction d wring (mexin0 weather shaft be either: a. Opened and Closed on the some day, or b. Govered, sealed, and haalod to prevent frea!ing 'Received Sy_ Issued fly_ Off II YA Date, Date: 0/2 o ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-572-65 Property owner(s) STEPHEN & CRUCELINA VRABEL Day phone Mailing address 20413 LUCAS AVENUE. EAGLE RIVER, AK 99577 Site address 20413 LUCAS AVENUE. EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) PREUSS #3 1311, LOT 1A Legal description (Township, Range & Section) Lot Size 22,693 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field 0 Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank ❑ Upgrade El Duplex (D) ❑ Holding Tank ❑ Renewal ❑ 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. (Signature of property owner or authorized agent) Permit/Rush Fees: 4 5 % 5 Date of Payment: 3 7 1202 Receipt Number: 170 �2 V Permit No. 0 S a 1 Oq E - Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com March 5, 2022 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: PREUSS #3 B11, L1A The property owner has requested we obtain a permit to upgrade the failed septic system of the above referenced lot. We propose to install three deep trenches to serve the existing 3-bedroom residence that is also served by a 1000-concrete tank. The design is based on the recent test hole conducted on February 25, 2022. No groundwater was observed at test hole excavation or monitoring. The slopes are moderate at 1-3% at the proposed upgrade location. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221048, Rebecca Carroll, 03/10/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221048, Rebecca Carroll, 03/10/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221048, Rebecca Carroll, 03/10/22 4661 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 firstwaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: PREUSS #3 B11, LOT 1A PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE 3/4/2022 DEPTH FEET OG SOILS 1 ORG/OL 2 3 4 5 6 7 8 SM/GM 9 10 11 12 13 14 15 16 17 BOH 18 19 20 Reading Date Gross Time Net Time Depth to Water Net Drop 2/25/22 30 min 4 7/16 1 9/16 30 min 4 7/16 1 9/16 30 min 4 8/16 1 8/16 PERCOLATION RATE 20 (MIN / INCH) TEST RUN BEWTWEEN 6 & 7 FT PERC HOLE DIAMETER 6 PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: NO IF YES, AT WHAT DEPTH: NA DEPTH TO WATER AT MONITORING: DRY DATE: 3/4/2022 TESTHOLE # 22-1 DATE PERFORMED: 2/25/22 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: STEVE VARBEL 3/5/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221048, Rebecca Carroll, 03/10/22 IN SURVEY ORDERED BY: amy peltier hometown realty N 89 49'W 103 08 L UC% S % VENUE OF q jq�;4p 49 THG 0 0 0 s SHANE A. HOLT LS -6914 Q�a a o ��n°fessioW �o AS-BUILTSURVEY I" =301 NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT I A BLOCK 11 PREUSS NO. 3 SUB THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE S THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENC ELI VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN NES. EASEMENTS OF RECORD,OR ANY LEGAL ENTITY, OTHER THAN THOSE APPEARING ON THE RECORD PLAT EXIST OTHER THAN NOTED. ARE NOT SHOWN HEREON( UNLESS INDICATED) DATED AT ANCHORAGE,ALASKA THIS 25TH DAY OF NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE JANUARY , 2022 PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. HOL T LAND SURI/EYING THE SURVEYDATA ON THIS DRAWING IS PREPARED FOR THE OWNER OFRECORD ONLY 9309 GROI/ER DRIAE ANYCOPYING, OR UTILIZING THE DATA HEREON IS PROHIBITED UNDER COPYRIGHT LAW ANCHORAGE,AK 99507 15347 FB 220-29 2238615 GF~ i'ER ANCHORAGE AREA BORO~ ', D'~c'"~ARTMENT OF ENVIRONMENTAL 0.UALI~I~ 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 GAAB-HD-I --'~' INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAltING NAME ~,~/'~ /~<?/~'~'~-.~ ADDRESS LOCATION ~'~. ,,.~. LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY //(-~ GALLONS. NUMBER OF / MATERIAL ~'~'~ -~)/J'/Z~'~'.~'~:~S'~ ' COMPARTMENTS ~'~J ~--~'~f~'~ LIQUID INSIDE LENGTH /INSIDE WIDTH ~ DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS LrNING MATERIAL OUTSIDE DIAMETER NEAREST LOT LINE OR WIDTH__ DISTANCE FROM WELT .~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) / / ~,,../- , LENGTH '~'~ , DEPTH , BUILDING F O U N DA TIO N/~"~ M~'~,' SQ. FT, TILE DRAIN FIELD: ,,,"//./,,~'~ DISTANCE FROM WELL ~ NUMBER OF LINE~ DISTANCE BETWEEN LINES ABSORI~4,eb'~ AREA SQ. FT. LENGTH OF EACH LINE TOTAL LENGTH OT LINE . OF LINES TRENCN~WlDTH IN. TOTAL EFFECTIVE DEPTH: TOP OF TILE TO FINISH GRADE. DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE__ WELL: LOT LINE TYPE ,'~',,/~//---'/--~:~;~ DEPTH. NEAREST / ~ SEPTIC ,~c?/L/./~/, , SEWER LINE "/~'~ ~' . TANK DISTANCE FROM , BUILDING FOUNDATION-/':/'/~cJ~ · " SEEPAGE ~'/~ , SYSTEM__ WATER SAMPLE /'V"~ , NEAREST OTHER "'"'~/'//'~- · CESSPOOL /~i,/~P.//~.~,~'Z--, DISTANCES: DIAGRAM OF SYSTEM -' ( ? gre~%br ANCHORAge AREA DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 6-650 ANcHOrAGE, ALASKA 99502 TELEPHONE 279-8686 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT £ / ® LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK ~/~ TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS COMPLETION DATE ANTICIPATED PERMIT NO. 2224 MA,L'NG ADDRESS /Z /o TO BE INSTALLED BY NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL SE SUBJECT TO PROSECUTION. TYPe DIAGRAM OF SYSTEM MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WAle SEPTIC TANK SEEPAGE PIT TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN Field WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, SEEPAGE PIT TO RIVER, LAKE STREAM. DRAIN FIELD , DRAIN FIELD SEEPAGE PIT ALSO CONSIDER AREA WELLS. , SEEPAGE PIT /~0 f · DB^,N PIELD C~AAS7 IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB F EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit FITTed WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO EGUL IONS REGARDING I TALLATION. HEALTH AUTHORITY OR LICENSED DESIGNER I CE~Y T H THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-E8 AND THAT THE ABOVE DE ED SYSTEM IS IN ACCORDANCE WITH SAID CODE. ANCHORAGE, ALASKA 99502 CASE # Performed For DonaldPayes Date Performed 6/9/72 Legal Description: Lot 1 Block 11 Subdivision Preuss This Form Reports Soils-L-~g. ~x Percolation Test De th t Soil Characteristics Brown & Gray Sandy Silt (ML) Gray Silty Sandy Gravel (GM) If Yes, At What Depth? ... Reading Date Gross Time Net Time Depth to H20 Net Drop Percolation Rate Proposed Installation:' Seepage Pit × Drain Field Depth Of Inlet Depth To Bottom Of Pit Or Trench COMMENTS: 225s~o£draina e areais re uired r r es er orme y. Carhsle a a er 1 ~e ~nal Testing- Date: -~EATER ANCHaRAGE AREA BOROL~¥ DEPARTMENT OF ENVIRONMEN"FAL QUALITY 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 CASE # Performed For Wai£ac~ Con~,e~in~ ~ Date Performed ~,~ Legal Oescriotion: Lot I Block Il Subdivision ?~ummm This Form Reports Soils Log x Percolation Test 6 7 8 9 10 ~leoth Feet Soil Characteristics ~opsoii SP poorIy g~,aded sand ( ~5o ) Nell graded ~a~ d & gravel Was Ground Water Encountered? If Yes, At what Depth? Readinq Date Gross Time Net ime Depth to H20 Net Drooi .! Percolation Rate Hinute Proposed Installation: Seeoaee Pit Depth of Inlet COMMENTS: ,~ ~ 2 ........ .__ ~ Drain Field Depth To Bottom Of Pit Or Trench Test Performed B.y .,~?~.~..~r~__,<~.~_-~.~.~J Data Certified By: Date: Certificate of On -Site Systems Approval Parcel I.D. 050-572-6 1. GENERAL INFORMATION Complete legal description PREUSS #3 BLOCK 11, LOT 1A Expiration Date: Location (site address) 20413 LUCAS AVENUE, EAGLE RIVER AK 99577 Current property owner(s) STEPHEN & CRUCELINA VRABEL Day phone Mailing address Real estate agent 20413 LUCAS AVENUE, EAGLE RIVER AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ® Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ e=go Ct0 Waiver Fee $ Date of Payment 3- 2Z Date of Payment Receipt Number_ L'L'F 010 Receipt Number COSA # ®�c'_ 2z ( e'7% 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 6/30/22 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 _11\\\\�\ 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 AW Q: • . • �) for current or future occupants or guarantee that no unseen encroachments, deficiencies or j g•• •9`� discrepancies exist can be given by First Water Consulting & k.s ' *• .11-) *' . .......i 6. DSD SIGNATURE �� • • • ' • • • • • •"' Curtis Huffman System #1 Approved for 3 bedrooms �r��F��sTil�, CE 128991 ..ri F,�'•.Q/301?2•'4 r System #2 Approved for bedrooms F�PROFESSIONP 4 Disapproved Conditional approval for bedrooms, with the following stipulations: Jc� ON-SITE WATER AN m %�► ,ST�__ v.'ATER PROUKAM Z -V / 6EKv By: 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: PREUSS #3 BLOCK 11 LOT 1A Parcel ID: 050-572-65 If more than 1 septic system on lot: COSA Checklist # _of A. WELL DATA - CLASS A WELL ❑ 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) 50 years Tank type/material SEPTIC / CONCRETE Measured operating fluid level in septic tank 50" EST. ® Standpipes/foundation cleanout per record drawing Date of pumping TBD D. ABSORPTION FIELD DATA Which system tested (date installed) ® ALL standpipes present per record drawing Total measured depth from grade 8.29 ft (max) Measured depth to pipe invert from grade 3.79 ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective 4.5'ED IR Structure served by this system _ Well production at time of test _gpm Water storage tank volume_ gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ 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: Adequacy test date NEW FIELDS Results ❑ Pass For 3 bedrooms Fluid depth prior to test _in Water added gal New depth in Elapsed time -min ® Code -required soil cover over field Final fluid depth _in ® System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced _gallons If yes, enter date Comments/Deficiencies:. AT DEEPEST GRADE - MT/CO Fes- 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 Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' Water Service Line > 10' ® Yes Animal Containment > 50' ❑ Yes if No ft ❑ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' El Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® 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 G. ENGINEER'S CERTIFICATION I 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. "�Ir V yq���l AW .TH .... ......... .. .. .... ....�. .• Curtis Huffman •;isle � d F • CE 128991 ;'f1�c�• . 6/30/22. . • \R ® l�d��pROFESSItiNP -.� SURVEY ORDERED BY: amy peltiot hometalm lea* h N 0 z N 89 49' bV 103 08 LUCAS % VENUE THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FEN CELINES. EASEMENTS OF RECORD,OR ANY LEGAL ENTITY, OTHER THAN THOSE APPEARING ON THE RECORD PLAT ARE.. NOT .SHOWN HEREON( UNLESS INDICATED) - - NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. 7FlE SURVEYDATA ON THIS DRAV✓ING IS PREPARED FOR THE OWNER Of RECORD ONLY. ANY COPYING, OR UTILIZING THE DATA HIREON ISPROHIPITED UNDER COPYRIGHT LAW OF qr�s��0 �. 49 TH*, u m o s� SHANE A. HOLT G 04 P P LS -6914 y��0 ��n�°Jessiona� �'cs� A -5 -BUIL T SURVEY f " = 30' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 1 A BLOCK 11 PREUSS NO 3 SUB ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS 18th DAY OF JUNE , 2022 15347 F6220-29 H0L T LAND SURVE;`NG 9303 GRO'rER DRIVE ANCHORAGj�AK 99507 ??38615 �2CN1hI-�) L)Nt1\.— MUNICIPALITY MUNICIPALeITY OF ANCHORAGE Development Services Department r Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-572-65 1. GENERAL INFORMATION Complete legal description PREUSS #3 BLOCK 11, LOT 1A Expiration Date: 1pr 10_-2©22— Location (site address) 20413 LUCAS AVENUE, EAGLE RIVER, AK 99577 Current property owner(s) STEPHEN & CRUCELINA VRABEL Day phone Mailing address Real estate agent 20413 LUCAS AVENUE, EAGLE RIVER AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ® Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ a �" a `� 0 Waiver Fee $ Date of Payment Receipt Number 2 ly 3 y COSA # 0 5 C.2 Q f () r7 �I 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 3/5/2022 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 how long function •�(� '`vq `L FAQ: • • • • • of a system will satisfactory for future ;1 �•' •9 current or occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be by First Water Consulting & *: TH given FKS _49 % 6. �r • • • vw DSD SIGNATURE •. Curtis Huffman System #1 Approved for bedrooms �� �F��s••.•CE128991 .chi System #2 Approved for bedrooms i1,F0PROFESS6 4 Disapproved 2 Conditional approval for J bedrooms, with the following stipulations: hp, gd(W11,- \`` OFA4j ' WATER AND BY 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other • h Legal Description: PREUSS #3 BLOCK 11 LOT 1A Parcel ID: 050-572-65 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _ A. WELL DATA - CLASS A WELL ❑ 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) 50 years Tank type/material SEPTIC / CONCRETE Measured operating fluid level in septic tank 50"EST. ® Standpipes/foundation cleanout per record drawing Date of pumping TBD D. ABSORPTION FIELD DATA Which system tested (date installed) TO BE UPGRADED ® ALL standpipes present per record drawing Total measured depth from grade TBD ft (max) Measured depth to pipe invert from grade TBD ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective ® Code -required soil cover over field ® System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced _gallons Comments/Deficiencies:. Well production at time of test _gpm Water storage tank volume_ gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ 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: Adequacy test date FAILED BY BRANDON SERVICES Results ❑ Pass For _bedrooms Fluid depth prior to test —in Water added gal New depth in Elapsed time -min Final fluid depth _ in Absorption rate gpd Any rejuvenation treatment (past 12 months) N If yes, enter date WE 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 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 G. ENGINEER'S CERTIFICATION , -4.- '11 OF A I certify that 1 have determined through field inspections and review AIW�Q.: •' • • ���� of Municipal records that the above systems are in conformance •:�� with MOA COSA guidelines in effect on this date.: • TH . • , . •': j Curtis Huffman �(� �<��, •. CE 128991 ,• ��`�,�' i��• . 3/5/22 , . • �AW ll� PROFESSIONP�.� III ft N 89 49' I+V 103.08 SURVEY ORDERED BY: AS -BUILT SURVEY f"=30' :�.anne::4i'r NO CORNERS SET THIS DATE i:arnetn:� rea't,�• I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY L07 -IA BLOCK 11 PREUSS /V0 3 SUB ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE THE [NfoaMATIon HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY r0 SHOW ANY VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN C ON LILTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND Is THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FEN CELINES. EASEMENTS OF REC0R D, OR ANY LEGAL ENTITY, OTHER THAN THOSE APPEARING ON THE RECORD PLAT EXIST OTHER THAN NOTED. ARE NOT SHOWN HEREON( UNLESS INDICATED) DATED AT ANCHORAGE,ALASKA THIS 25TH DAY OF NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE JANUARY , 2022 PROPERTYLINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. /- l{L IN1 5 R4L :+Nli THE SURVfYDATA ON THlSD.4AVJ/NGIS PREPARED F0,4 THE ONJNER CFRECORD ONLY, ANYCOPYING, OR UTHIZING TH£ DATA HEREON IS PROHIBITED UNDLR COPYRIGHT IAW ANC- 0 R AG J 6590/ __ 15347FB226-29 Firstti' g C 0 N S U L 7 i N G 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com March 5, 2022 Municipalities of Anchorage On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: CONDITIONAL COSA LEGAL: PREUSS #3 BLOCK 11, LOT IA Due to unprecedented events contributing to material and labor shortages, we are requesting a Conditional COSA for the above referenced property. The pending permitted 3 -bedroom septic system upgrade has been impeded due these conditions and other factors with no known date on when the system components may be available. The system will be installed once the components become available. The system has been working for the occupants and granting of this Conditional COSA will not impact any of the neighboring properties or pose a public health risk. Attached is the awarded bid and escrow letter from title for the pending installation. Please contact us if you have any questions. Sincerely, Curtis Huffinan, P.E. W i ire >EI V n.Es �,, crsF�,reixn MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner ~'."/ ,¢' '/~,'~ ~Lz~t~ Day phone Mailing address Lending agency Mailing address Day phone Agent ~_-~.~,'H~ o~ ~2~ Address ./~ .o/z~'~' ./~,,¢'~'~ ~J ~ Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ,~ N Day phone TYPE OF WATER SUPPLY: Individual well Community well NOTE: Public water ~' If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-~25 (Rev. 1/91) Front MOA#21 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 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 Address Engineer's signature Dsvld R. Dayton P,E. Phone 20210 Donalar St. DHHS SIGNATURE ~ Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: By: .~'~r'.,~f--'~~- '- Date. 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 courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91 ) Back MOA ~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A, Well Data Well type Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height Wires properly protected (WN). Date of test g.p.m. FROM WELL LOG Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line AT INSPECTION ; On adjacent lots g.p.m. z ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~///¢7Z~ Cleanouts (Y/N) ~ High water alarm (Y/N) Date of pumping Tank size / o O~:~ Compartments / Foundation cleanout (Y/N) ,J~ Depression (Y/N) /L,//,-'J- Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Surface water/drainage On adjacent lots Absorption field Foundation Water main/service line CONTINUED ON BACK PAGE 72-026 (3/93)* Front C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D, ABSORPTION FIELD DATA Date installed ~/ ? L- Length ~c~ ' /~ ' Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft2) /':~ 7 5~/~,~,_ System type Width Gravel thickness ~ ~ Total depth ~ Cleanout present (Y/N) ~ Depression over field (Y/N) /' Results (pass/fail) ~¢~ for ~ Bedrooms (~ / After test ¢~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot A- To building foundation On adjacent lots Surface water Curtain drain On adjacent lots A¢//.,/~.~- Property line To existing or abandoned system on lot Cutbank ,/L/,,,,//¢-- Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to ali MOA and HAA gu/defines in effect on the date of this inspection. Signature Engineer's Name David R. Dayton P.E. 20210 Donalar St. Date HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back MUNICIPALITY OF ANCHORAGE MEMORANDUM SEPTIC SYSTEM ADVISORY HEALTH AUTHORITY APPROVAL NO. ~//~ Prior to a recent adequacy test on the septic system for __1/1 this lot,~5/Z~inches of standing water was observed in the absorption field. This indicates that approximately 7~_% of the absorption area is inundated. Although this system passed the adequacy test, the remaining life expectancy may be limited. This advisory must be attached to all copies of the subject Health Authority Approval. 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 Date Application '-~/-~/(~' 1. GENERAL INFORMATION (a) Legal j3escription (include lot, block, subdivision, section.~ township, range) Location(address or directions) , ~ u" :~:: ~'~".::: '-- Apphcant Name ..... . : --..- .-- ..~:elephone. Home ~K &~ Bus,ness ~ , : ~ (c) Applicant is (check one): Lending Institution ~; Owner/builder ~; Buyer ~; Other~ (explain); (d) Lending ~E /; - ' '-- ~ -" (e) Real Estate Company and Agent ~*---~,~ ¢~ Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family ¢~ Multi-Family Number of Bedrooms Other WATER SUPPLY Individual WellA Community [] Public E] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5. Ef*IGINEERII',~G FIRIVI PROVIDING !INSPECTIOi'~S, TESTS, FILE SEARCH, DATA AND ~NF©Rt'¢IATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~' ¢ *~ '""~'~(:~V"~:~'~""~ Telephone DHEP APPROVAL Approved for ,.-~ bedrooms by /~%i¢~/:';~%'--~'~':~*¢~,- Date Approved ~, Disapprove8 Cond~bo Terms of Conditional Approval CAUTION 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 [;)HEP 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 o! 2 ~-~,./JNICIPALITY OF ANCHOP, AGE ,~c'HOnA~E IMO,~l DEPT. OF HEALTH & MUNICIPALITY OF ....... .. I~N'IVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 MAY 2 2 lgSb 264-4720 WELL DATA Well Classification .... ~ Well Log Present (Y/I~ Total Depth ~'7 . Cased to Static Water Level ~/~'J~ ~,-~;~/-2~ Casing Height Above Ground Electrical Wiring in Conduit~A)t~ Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole '/'~/"~ If A, B, C, D.E.C. Approved (Y/N) Date Completed ~)/~¢¢~* "/'¢' J-~'.¢,,,l Yield Depth of Grouting ~ Pump Set At ~../¢'C' Sanitary Seal on Casing~/~)~ Depression Around Wellhead.(W-~ ; On Adjoining Lots ,/¢c, / ¢''' ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Water sample Collected by 5',~/5' ,4~',~/~, ,--~.,'~:'¢~.vM~ ; Date Water Sample Test Results Comments ¢¢/ ' -~//,~ ~%~' /~4o ~ ~1~./~,~7~~ ./~'~ i/~'~~//~ SEPTIC/HOLDING TANK DATA Date Installed Standpipes~C~N) Air-tight Ca ps~/~l)' Depression over Tank,0C~J~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well (-~ ¢ To Property Line /~ ! To Water Main/Service Line ~'~ Course Size /~'O ¢2 No. of Compartments Foundation Cleanout,¢¢'/4~) Date Last Pumped '~""- ;for Temporary Holding Tank Permit (Y/N) Comments To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ - ID- - ~/~ Width of Field / '~ Square Feet of Absorption Area Depression over Fiel~ Results of Last A~Jequacy Test Separation Distance from Absorption Field: To Water-Supply Well ,/~'o / c- To Building Foundation 4/0 ~ Lot /'"/~' I ~'c=~ [ ~, ¢-_ Type of System Design ¢_~_ I ~ Length of Field ~O ~ Depth of Field f~ / 4~/'g~:::~ O 4 Gravel Bed Thickness ,~ /~r~ I! Standpipes Present ~ Date of Last Adequacy Test To Water Main/Service Line ,.~Vo / ¢' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) ,-,-/.,_ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) ,AJr//..~ "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA,guideli nes in effect on the date of this inspection. Signed .... Date ~/'Z~ /~ Companv o,-,~ ,~',,~,~,~ ., .. MOA No ~ o D ~ Receipt No. ~H, ~9/~..2~79 ~% Date of Payment ~- - ~ '~%~ Amount: Page 2 of 2 72-026 (11/84) ~ .' APPLI( fiT FILLS'oUT UPPER .HA,' ONLY Address Zip Code Lending Institution Phone Address Zip Code Street Locati~ Type of Resi~nce ~ingle Family ~ Multiple Family No. of Bedroo~ ~ Other Water Supply ~ Individual A~ACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach log if available). ~ Public Utility B Individual Year Individual Installed: ~" Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date inspector Inspector Inspector Inspector (~ ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received we,,toTank Sept,oT ,S, e 72-023 (3182) EXCAVATION ROBERT A. SHAFER WORK July 31, 1983 CIVIL ENGINEER 694-2979 Totem Realty ATTENTION: Audrey Mason P.O. Box 911 Eagle River, Alaska 99577 Dear Audrey, AUG 1 19 3 "'~ilun~o'ipa]i~ o~ Anchorage" "Dspt, of Health & ~nvir[mmental Protection" Reference: Lot 1 and 2: Block 11~ Pruess Subdivision A sewer system adequacy test was performed on the system located on the referenced property as you requested. The septic tank was pumped and verified to have a capacity of 1000 gallons. The seepage pit was charged with 750 gallons of fresh water and after a period of 24 hours all the water which had been added to the crib had peroolated out. It can be concluded from this test that the waste water disposal system serving the three bedroom residence located on this property is currently functioning adequately. However, the system cannot be guaranteed against, subsequent failure. If we may be of further service, please do not hesitate to contact US. sin-6er '," cc: Municipality of Anchorage Department of Health and Environmental Protection SR8 196X EAGLE RIVER, ALASKA · GREATER ANCHORAGE AREA BOROUGH Department of Environmentel Quality 3500 Tudor Road, Anchorage~ Alaska 99507 279~8686 Date Received 7 23Z73 Time of Imspection Date of InspectionJgl~,4~ t973 REQUEST FOR APPROVAL OF INDIVIDUAl, SE~ER & WATER FACILIT%ES FOR Aoproval Requested By: Addr~ss~ St, Rt. BOX 152 Donald W. Payes Eagle River, 99577 2. Prooertv Owner: Same 3. Legal Description: Lot 1 & 2, Elk ll 4. Location: Corner of ~lien &Lucas 5o Type of Facility to be Inspected: Number of Bedrooms: 3 Phone: 694-9371 Phone Preuss Su[,dtvision Well Data: A. Type Drilled C. Construction Single Family ~elling g. Dept~ 675' Bacterial Analys{s' Satisfactory Sewage Disooaal System: A. Installed l°" Installer }!ar~on Const. C. Septic Tank~ 1. Size Do Seepage Pit: 1. Size 2. Manufacturer 2. Material Disposal Field: Total Length of Lines Distances: A. Well To: Septic Tank ..... , Nearest Lot Line Foundation to Septic Tank , AbsorPtion Area , Sewer Lines · Other Contamination · '~ AbSorption Area Absorption Area to Nearest Lot Line ,dividual Sewer & Water Pacili' ~e~est for Approval c Page Two ....... 9. Comments: Disapproved Approved Approval Valid for One Year From Date Signed Greater Anchorage Area Borough, DeFartment of Environmental Quality D~AuRAM OF o~STE~ ] certify that the information contained in this request for approval to be a true and accurate representetion of the sub.~ec~ sewer and water facilities located Signed Date