Loading...
HomeMy WebLinkAboutPREUSS #3 BLK 11 LT 3Preuss #3 Block 11 Lot 3 #050-572-32 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221104 PID Number: 050-572-32 Dwelling: 9 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑Q Upgrade Name Lucas and Jennifer Barnlund ABSORPTION FIELD El Deep Trench X Wide Trench El Bed El Mound Site Address 20453 Lucas Ave Eagle River ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 4 GPDlSF 4.3-4.8 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.8-4.3 Ft. Gravel depth beneath pipe 0.5 Ft. Subdivision Block Lot Preuss #3 11 3 Fill added above original grade O Ft. Gravel length 30 Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding I Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 150 FtZ Ft. Well >100' >100' NA NA TANK X Septic ❑ S.T.E.P. ❑ Holding Other Manufacturer Orenco FAP Capacity 1500 Gal. Surface Water >100' >100' I NA NA Material Number of compartments Lot Line ! > 10' 7.5' NA NA NA plastic 2 Foundation >10' >10' NA NA AWTTS Capacity Remarks Advantex FAP Anchorage Tank NA Gal. Alarm location laundry room Electrical installed by Power Lighting and Control Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Northern Excavation _ Drainfield 3034 CO/MT3034 Inspector Curtis Townsend BENCH MARK (Assumed elevation) 100 ft Inspection �„ 7/28/2022 2�a 7/29/2022 dates: Location and description 3r1 8/1 /20,�E 41, threshhold of front door ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date Af /.....ax,s�a' Z 9i Septic System Approve t..__-/c Date 13 -az,�%REDPROFESS�y�. Note: this approval does not include well permit requirements. k., v u.n ruI -- ---- | | --r— |Of - — — — 7 — — — — ) — — -�� 10' UTILITY EASEMENT |Df 3 10' UTILITY EASEMENT � REWe:�)Y[D -XIS I� SEP�C TANK 2PLACED NE� /.5OO ��LLOA T00-�D�PAR��ENT QR[NCO F�P T�NK Y0TH �X2O ADYANTE% RLTER pOD AND DED iNTO N�� 0RPTON SYSTE� �RE�OvED L|� ON CONC�ETE CR|B. PUWpED A' NO BxCKF|LLED �ALL CONST�UC��m wmS |m ACCQROANCE v0TH �LL E!,,- SP[C|F|[D |N ANCHORAGE mUN/C|P&L CODE C��PTER� l5�5 AND j'6 0,- D' GzD) S0L P[RCOL���N R�TE� }7| mpi PROpQS[D CxTEQDR, U| �p�L\CA�ON RATE� 4 gpd/u� �RE� REOU|RED� �5O SF 5Y�T[W TvPE. �H�LLOw TRENC� 3O'x 5 , §^�Fr�[DvE DEPT� n�LDS i5O s/ m�xi�Um DEPT� OF 5[wE R ROCx '�--- | ( N86HBDR|m� �EpT|C is > 0' FRO� PRDPERTY UMELot 2A w 2OO W 7. � ------�v, w LU( -',AS AVE S-3puc pfeonrd D*wing prCporeu /n' Lucas and Jennifer BaOl|Und 20453 Lucas Ave Eagle River, Alaska 99577 PRE[]SS #3 BLOCK 11LOT 3 NE|O�BO�/N� FROw PRDPERTy L|NE }OO CO2| ||0f /L [0 UTkN �N�/N��[}/N/` / //` DATE 820202 ^_..�_`/./v/` uv�///x�_�_/�//v��, c-�_\/ -- kJDUNT�|N RO�D DRAVVN� CLT CHU�|AK KA ' O05� � 8CALE� 1"=3� 4�-1 PID: 050-572-32 SHEET 2OF3 _____________ PGZFG 91.8 EXISTING GROUND. SLOPE 1 /9 3.3 — — ------- ORG 89.0 FERC TEST m p i 88.5 Sm 79.8 TH DURING MONTH OF APRIL AND GROUNDWATER WAS ENCOUNTERED AT 11' SECTION A—A 96.5 1500 gal ORENCO FAP TANK W/ AX20 FILTER MARK A 8 TANK MH 15'-11" 23'-4" MT1 43'-10" 76'-2" C01 45'-5" 77'-7" MT2 54'-11" 75'-1" CO2 53'-7" 73* -2" Septic 'Record Drown no PreDcred 4or Lucas and Jennifer Barnlund 20453 Lucas Ave Eagle River, Alaska 99577 PREUSS #3 BLOCK 11 LOT 3 OSP221104 EKLUTNA ENGINEERING, LLC DATE: 8/26/2022 --2 �vl U 3 0,AD 3 U DRAWN: CLT 9 -5 6 SCALE: 1 1/2" = 1' PID: 050-572-32 SHEET 3 OF 3 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 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221104 Work Type: Septic Upgrade Tax Code Number: 05057232000 Site Legal Address: PREUSS #3 BLK 11 LT 3 G:0056 Site Mailing Address: 20453 LUCAS AVE, Eagle River Owner: BARNLUND LUCAS W & JENNIFER L Design Engineer: EKLUTNA ENGINEERING, LLC" This permit is for the construction of: Q Disposal Field PdSeptic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: 5/16/2022 5/16/2023 Lot Size in Sq Ft: 22672 Total Bedrooms: 4 ❑ 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 Received B) Issued By: a8 M rt/ Date: `(_0 �2z Date: _� � >.- _Z_ Municipality ®f Anchorage S rrur 0-j 1>epartinent P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 a Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV221025 COSA#: PID#: 050-572-32 Legal Description: Preuss #3 blk 11 Lt 3 Engineer: Eklutna Engineering Permit#: OSP221104 Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 7.0 feet. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ............................................... ■ ■ ■ ........... ■ ....... ■ .... ■ .. ■ t Waiver, is Granted: X Waiver is not Granted: Date: JZZ Approved by: Name of Reviewer ■ ■ .. ■ ■ ■ ■ ■ ■ . ■ ■ ■ ■ ■ . ■ ■ ■ ■ ■ ■ . ■ ■ ■ ■ . ■ ■ ■ ■ ■ . ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ . ■ . ■ ■ ..... ■ . ■ .. ■ ■ ..... ■ ■ ..... 1 **** VARIAN C E/WAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE Development Services Department p p Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-572-32 Property owner(s) BARNLUND LUCAS & JENNIFER Mailing address 20453 Lucas Avenue Eagle River Site address 20453 Lucas Avenue Eagle River AK 99577 Day phone AK 99577 Legal description (Sub'd., Block & Lot) PREUSS #3 BLK 11 LT Legal description (Township, Range & Section) Lot Size 22;672 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field 0 Initial ❑ Single Family (SF) E Septic Tank J Upgrade 0 (w/wo ADU) Holding Tank ❑ Renewal ❑ Duplex (D) ❑ Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: field to lot line Distance: 71 1 certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property or authorized agent) Permit/Rush Fees: A5C7_'5- Date of Payment: LI -2-9 -?-Z Receipt Number: ( t -/,S—/ � Permit No. 015� P22 1 /0�( 2 312::zZ- Waiver Fees: &61'6) Date of Payment: 41-L Receipt Number: Waiver No. CGU2Z 102 GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc CO-a;x I Eklutna Engineering, LLC curtistownsend@gmail.com May 26, 2022 Subject: Preuss #3 Block 11 Lot 3 New Septic System Permit Request OSP221104 I am writing to request a septic system installation permit for the above referenced property. The proposed system will serve a 4 -bedroom single-family residence. Soil logs, design calculations, site plan and design drawings are enclosed for your review. 1. Soils. In April 2022 groundwater was discovered at a depth of 11'. Adjusted for the month of April, seasonal water elevation is at a depth of 10'. The percolation rate was 17.1 mpi. 2. Soil Absorption System Design. See Sheet 1 of the design package. 3. Wells. This lot and the surrounding lots are served by AWWU. The lots immediately to the south are served by AWWU. The water line running along Lucas is 20' offset from the south property line. There are no wells within 100' of the proposed septic system. The current crib is within 4' of the ground water so it cannot be placed back into service. 4' vertical separation will be maintained above the seasonal high groundwater table with the new trench. 4. Lot Line Waiver: Due to site constraints we are requesting a 7' ± lot line waiver from the south property line to the proposed drainfield. There are no septic systems within 10' of this proposed property line. If we maintain the 10' separation from the property line, then the field will be < 10' from the house foundation. We will still maintain minimum 10' separation from water line or fire hydrant. S. Neighboring Wastewater systems. Immediate neighboring septic systems are all +10' distant from the property lines. 6. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. 7. Topography: The property in the immediate area of the new trench has a slope of 15%. The proposed installation will not affect the future development of this or the surrounding lots. Sincerely, Curtis L. Townsend, P.E. 16A 49 �t • r •`s°. fir• • ae of • • 'SL..T nt �. r'tr•�y i tdo.CE11 E�/90 ia,:_��71van�rsS1� _-�- I Lot 2 10' UTILITY EASEMENT Lot 3 10' UTILITY EASEMENT SCOPE OF WORK 1. REMOVE EXISTING SEPTIC TANK. 2. PLACE NEW 1,500 GALLON TWO—COMPARTMENT TANK WITH ORENCO AX20 ADVANTEX FILTER POD AND TIE INTO REBUILT ABSORPTION SYSTEM. 3. REMOVE LID ON CONCRETE CRIB, PUMP AND BACKFILL. 4. ALL CONSTRUCTION TO BE IN ACCORDANCE WITH ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65. 1 1 DESIGN PARAMETERS BEDROOM: 4 (600 GPD) SOIL PERCOLATION RATE: 17.1 mpi PROPOSED CATEGORY III APPLICATION RATE: 4 gpd/sf AREA REQUIRED: 150 SF SYSTEM TYPE: SHALLOW TRENCH ,30'x 5' x 6" EFFECT[' MAXIMUM DEPTH OF /E DEPTH YIELDS 150 sf SEINER ROCK TO BE 5.5'. Z, \ NEIGHBORING SEPTIC IS > 10' FROM PROPERTY LINE Lot 2A G W 7_0.0 G �........ ___ C_ -WI W r� 4 BEDROOM HOME FC 15% SLOP TH 8.3 8.0 W ><— W LUCAS AVE Septic Design Prepared for Lucas and Jennifer Barnlund 20453 Lucas Ave Eagle River, Alaska 99577 PREUSS #3 BLOCK 11 LOT 3 EKLUTNA ENGINEERING, LLC 19162 MOUNTAIN ROAD CHUGIAK, ALASKA 99567 (907) 406-1058 DATE: DRAWN: SCALE: PID: 050-572-32 .0 A i Lot 4 NEIGHBORING SEPTIC IS > 10' FROM PROPERTY LINE -i EXISTING 20' x 24' x 6 EFFECTIVE DEPTH CRIB Lot 4 ------------- FIRE HYDRANT 5.0 W W - OSP221104 5/26/2022 CLT V=30' SHEET 1 OF 3 `�.orDF 14444r# r�trMt AV 49TH �.....::... fi °• s. .... 0 .CURTIS TOWNSENDr i No CE 11904 'Aw w k,�� IN FEBRUARY 2022, THERE WAS APPROXIMATELY 8' OF WATER IN THE EXISTING SUMP OF THE CRIB. EXISTING GROUND SLOPE SHOWN. PROVIDE MINIMUM 3' SOIL COVER OVER THE TOP OF THE DRAINROCK. OUTLINE OF EXISTING CRIB EXISTING GROUND SLOPE 3.0 I I 0.5 GROUNDWATER 10' BELOW GRADE SECTION A—A Septic Design Prepared for Lucas and Jennifer Barnlund 20453 Lucas Ave Eagle River, Alaska 99577 PREUSS #3 BLOCK 11 LOT 3 EKLUTNA ENGINEERING, LLC 19162 MOUNTAIN ROAD CHUGIAK, ALASKA 99567 (907) 406-1058 DATE: DRAWN: SCALE: PID: 050-572-32 OSP221104 5/26/2022 CLT 1 1/2" = 1' SHEET 3 OF 3 500 gal TANK '/ AX20 FILTE SOILS LOG PERCOLATION TEST LAJLIVILI\ I LUI 1 2 3 + 5 6 f B 9 10 11 12 IJ 1+ DATE ORGANICS PERFoRMED: 3/18/2022 WAS GROUND WATER ENCOUNTERED? YES AT 13, BELOW GRADE DEPTH TO WATER AFTER MONITORING? 11' DATE: 4/04/2022 WATER READTNGS ARE TO THE NEAREST 1/16 |NCH. PERCOLATION RATE; 17.1 MIN /INCH PERC HOLE DIAMETER: 6" TEST RUN BETWEEN 3 AND 4 FEET. PERFORMED BY: CURTIS TOWNSEND. I, CURTIS WITH ALL STATE AND MUNICIPAL GUIDELINES IN TOWNSEND, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE EFFECT ON THIS DATE. DATET 4/4/2022 tr 10, UTILIry EASEMENT L\":l Lot 4 EDROO lOME NO DATE CLOCK TIME NET TIME'wtN' WATER LEVEL READING 1 4 /O4 /2022 18:58 /19:28 30 6" - 3 1/8" 2 7/8 2 4 /04 /2022 19:28/2O:58 30 6--35/8" 23/8 3 4 /O4 /2022 20:58 /21:28 JU 6" -37/8"21/8" t 4 /O4 /2022 21:28 /22:58 30 6' - 4 1/8" 1 7/8" 5 4/O4/2022 22'.56 / 2J: 26 3C 6" - +1/4- 1 3/+ 4/04/2022 23:58 /24:28 JO 6" - 4 1/4" 1 3/4" Septic Design Prepored for Lucas and Jennifer Barnlund 20453 Lucas Ave Eagle River, Alaska 99577 PREUSS #3 BLOCK 1 1 LOT 3 osP221104 T.KLUTNA TNGINIIR/NG, LLC 19162 N/OUNTAIN ROAD CHUG AK, ALASKA 99567 (e07) 406- 1 OsB DATE: 511012022 DRAWN: CLT SCALE: 1" = 40' PID: 050-572-32 SHEET 2 OF j Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221104, Deb Wockenfuss, 05/16/22 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this 13 Day of J LM of 2022-, by and between 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 ,AGS V4 y 7-.`X- k' 2-0 located at (legal description) e.y S Ll, f/ L? 3 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement 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). 1, 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. Owner 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 Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. 1-13 Owner acknowledges that the fine for failing to maintain and repair an AWWTS maybe assessed in accordance with AMC 14.60.030. t r3 Owner- agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. 03 Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. i -G Owner 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. %43 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 OVNINER: By: U�/G�s U' (signature) Date: Gl�ZZ- z (print name) Z06 -hs 8c4r^410.1a STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this .]V day of 14VI-p- 202-L, byLAACa-S V\r- �v-h (v vi { REBECCA FIELDEN Notary Public NOTARY PUBLIC FOR ALASK,j state of Alaska My Commission expires: (-?S 161 I Zo Ztp My Commission Expires May 1, 2026 MUNICIPALITY: By e/li (signature) (print name) (rev. 05/18/2018) Date: 6 /S ZZ Title: Page 3 of 3 6Rt' tR ANCHORAGE AREA BOF -'1GH ti Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME fit"Atc �O"QtkkZ. MAILING ADDRESS 7 PHONE LOCATION C4cus + RC'AQIJ LEGAL DESCRIPTION 5 ��� « �I I ew64C SEPTIC TANK: DISTANCE �i / J rrpp NUMBER OF FROM WELL MANUFACTURER i><%AIf4L� MATERIAL COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY toxo GALLONS. SEEPAGE PIT: i r � NUMBER OF PITS �. DIAMETER 0pp � OR WIDTH LENGTH Ly,� DEPTH LINING MATERIAL 6'j4o k CRIB SIZE: DIAMETER —DEPTH 6L DISTANCE FROM: WELL P7-9 BUILDING FOUNDATION �� NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) P7-9 SQ. FT. ADDITIONAL ABSORPTION WELL: J/d Gx Afied ark TYPE BUILDING FOUNDATION CESSPOOL _CONSTRUCTION NEAREST LOT LINE OTHER SOURCES NEAREST SEWER LINE , APPROVED DISAPPROVED REMAR DISTANCES: INSTALLED /BY: _} /i r V C Gin �1 PIPE MATERIAL: C�12Gz1 LOT SLOPE: 'a`y )Cuj REMARKS: ac", Itaym DATE % DEPTH SEPTIC TANK_ DISTANCE FROM: SEEPAGE SYSTEM DIAGRAM OF SYSTEM Q% APPR ' 1 / G.A.A.B. Form No. EQ -031 V A � 3G,`--� � W $ APPR ' 1 / G.A.A.B. Form No. EQ -031 V GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 2 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 • ��¢ro nw'�J SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT NAME OF APPLICANT INSTALLATION LOCATION LEGAL DESCRIPTION 6 & INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS COMPLETION DATE ANTICIPATED f/ MAILING ADDRESS V SEEPAGE -PIT DRAIN FIELD TO BE INSTALLED BY A10' PERMIT NO. PHONE OTHER NOTE: THIS PERMIT IS NOT VALID WITHOUT SOI FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE IC526\/TYPE SEEPAGE AREA SIZE TYPE MINIMUM DISTANCES, REQUIREMENTS Ii FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK V , SEEPAGE PIT, DRAIN FIELD TO NEAREST LOT LINE.. WELL TO SEPTIC TANK/ , SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT - DRAIN FIELD . SEPTIC TANK, 166 , SEEPAGE PIT leo DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF XCAVATION 5 FE ET�ZOJJ.61D1$Td1A.BE--B-SOIL. 4 INCH DIAMETER -CCASSTT IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT 'FlFTEB-WiT AIRTIFT- GHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO 130ROUGH/REGULATIONS REGARDING INSTALLATION. 62 '�� Z/, G.A.A.B. OR LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT 1 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. 4 DATE % � '� / APPLICANT'S SIGNATURE y�r/_1//i F(]RM N(f_ EO -!If F U F , GREATER ANCHORAGE ARLA QOROU`-,-,i Department of Environmental Quality 3330 "C" Street Anchorage, Alaska 99503 SOILS LOG -- PEROLATION 'PEST Date Perforrie'j /G-1-7 Performed for `�_ ,_(> 1�-�.G�-e.�.i� -__.-- Legal Description:_— e -5 6�/1��-- �e-use— — -- —v-----.----` This form reports: Sods Iog_�Y Percolation Depth Feet 2- 3- 1 6- 7 9- Date 10 - 11 - SI ope 12 - 13 - 14 Was ground water encountered? )?(>_ _ If yes, at what depth? Reading Date Gross Time Net Time Depth to Water Net Drop t'ercoiation rate III inULe• -Proposed installation: Seepage Pit _ Drain Field Depth of Inlet — _ Depth to bottom of pit or trench COMMENTS: Performed Qy:��/rczv�-.u- _ Certified Qy;.---- �� EQ -040 (6/74) ate :----- --_.—_ F MUNICIPALITY OF ANLHORAE r WATER :86,41, G��,PtERESFweR CONNECT PERMIT Q/;2 r/ ALt DATE OF APPLICATION P - e <,n.°FP, a SCHEDULED COMPLETION DATE . WATER & WASTEWATER UTILITY SINGLE FAMILY 3000 ARCTIC BOULEVARD rO MULTIDWELLING -'; - PHONE 786-5557 - No. APTS _ ❑ COMMERCIAL LOT/T-�T '3 �g BLOCK Ham— ❑ INDUSTRIAL SUBDIVISION TAX CODE P1SU'S'%��?a�_GRID v�� 1 DRAWING No. AC O'S BUILDING ADDRESS CA0L63 OWNER CA od ba dl PHONE/ 'Z �S MAIL ADDRESS CONTRACTOR: ASSESSMENTS - -(License & Bond required) - (ON PROPERTY ONLY ❑ Main extension agreement ❑: MAIN TAP—TO PROPERTY LINE ONLY ❑Subdivision agreement (MOA or State ROW Permit Required) ❑ Extended connect agreement *..MAIN TAP & ON PROPERTY CONNECT ❑ Pending L F�MOA or , State ROW P rmij aquired)- -O-W NO. I I W 4 MUNICIPALITY OF ANCHORAGE 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. 050-572-32 Legal description Preuss #3 BLK 11 Lot 3 Site address 20453 Lucas Ave Eagle River Current property owner(s) Barnlund Expiration Date: 7-28-23 X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By: Original Certificate Date: This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA ApprovMjune 2022 Development Services Department f .......... p p -= Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997— Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 050-572-32 Complete legal description PREUSS #3 BLK 11 LT 3 Location (site address) 20453 Lucas Avenue Eagle River AK 99577 Current property owner(s) BARNLUND LUCAS & JENNIFER Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units 0 Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel 0 Plastic ❑ Concrete ❑ Fiberglass Age <1 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑® AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. Homs COSA Fee Waiver Fee $ Date of Payment Date of Payment COSA # Waiver # COSA Application—June 2022 Legal Description: pREUSG#3BLK 11 LT 3 Parcel ID: 050-572-32 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL g is filed Wit ite (or attached) Date drilled Total de ft Cased to fl: FlSanitary seal is functioning correctly RWires are properly protected Casing height (above ground) in. Date offlow test for COSA Static water level atbeginning oftest ft. Comments B. TANK DATA Measured operating fluid level inseptic tank _____ Date ofpumping '-'1 year old FIRequired maintenance completed, ifAWVVTG Comments: (]r8nno FAP D. ABSORPTION FIELD DATA Which system tested (date installed) Ju12022 ��ALL standpipes present per record drawing Total measured depth from grade 48 ft (max) Measured depth to pipe invert from grade 3*8 ft (min) NA\- pressurized field, �l Per record dnawings, field is insulated, Monitor tubes gntobottom of effective. If not, state depth into effective_____ Fl Presoaked required if (Required ifhouse vacant urfield not used for more than 3Odays prior bzdate oftest) Gallons introduced ____Jga||onn date Any rejuvenationtreatment (past 12months) Ifyes, enter date COSAChecklist-June2022 Well production at time oftest ___gpm Water storage tank volume gallons Well disinfected for coliform h*my? [l Yes n No E]Coliform bacteria isNegative Nitr mg/L E] Nitrate less than MRL (ND) Arsenic ED Arsenic less than MRL (NO) Collected by Date STATION [�Requir-ed-ma_intenance completed Age of lift station _ ars Lift station material Adequacy new system Results [__1 Pass Fluid depth prior totest in Water added _____gal New fluid depth _____jn Elapsed time nnin Final fluid depth _in Absorption rate gpd F|ELDSTATUS-POSTRECOVERY Effective depth (per record drawings) Effective depth used in Effective depth remaining in 9 E. SEPARATION DISTANCES Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank tion on Lot > 100' Community Sewer Manhole/Cleanout > 100' F] Yes if No ft El Yes if No ft Neighboring Tank > 100 ❑ Yes ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft olding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' Field to Property Line > 10' Animal Con nt > 50' ❑ Yes if No ft ❑ Yes if No ft ft Private Wells > 100' Yes if No ft Manure/Animal Excreta Stora 00' Community Sewer Main > 75' ❑ Yes if No ft _ Yes " o ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' Fm -]Yes if No ft Surface Water > 100' R Yes if No ft Tank to Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑ Yes if No 7.5 ft Private Wells > 100' Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm _ Leif Nle C G !,,,i {Zlr C Phone 907.406.1058 Engineer's Printed Name Cu Date Id . ' Q �� ENGINEER'S ... Deb W"y�' . •, .•til. �. COSA Checklist June 2022 CHAINLINK S 89059'00"E 129.00' LUCAS A VENUE ZD M co I- r W 0 0 J. OF q �gsp00 ,0.-' 49 1H - SHANE A. HOLT �� G �4 e LS -6914 sional �a AS-BU/LT SURVEY I" =301 NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 3 BLOCK 11 PRUESS N0. 3 SUB THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FEN[ELINES. THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS 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 3RD DAY OF NOTE: FENCELINES THATMAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE AUGUST , 2022 PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS - ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. HOL T LAND SURVEYING THE COPYI G OR ON ITHISZIN DRAVANG /SPRfPARED FOR THEOWNER OFRfCURD ONLY. 9309 GROVER DRIVE ANYCOPY/NG, OR UT/UZING THE DATA HfREON l5 PROH/SITED UNDER COPYRIGHT LAW ANCHORAGEAK 99507 6226 131-77 226-41 223-8615 OWNER: i By:� / (signature) Date: Zv2'Z / V I0 i O/ Ac 2,� Ei(%FJ� (print'name) STATE OF ALASKA ) THIRD JUDICIAL DISTRICT ) ss. The foregoing instrument was acknowledged before me this day of� , 20,-79 by,_1�� r - Notary Public NOT PuBut FOR ALASKA JOAN A. JOHNSON My Commission expires: 3 36 Sate of Alaska My Commission cxp4m march 30,2M MTJNICIPALI B signature) (print name) Date: l 2— Title: Title: 5/1.8/201.8 sPage 3 of 3 C Municipality of Anchorage Development Services Department C Building Safety Division �33LL On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.aSO—S7o1-32 COSA# bRoogn Expiration Date: 1. GENERAL INFORMATION Complete legal description jOi?Gy,SS 3 S4 00,/4 // / L e7-3 Location (site address) 7 0 Y4 ! UCAS Current Property owner(s) IS 0 B >i L 4.F 2 J' Day phone r!941- 03 9 2, Mailing address Lending agency Mailing address Day phone Real Estate Agent 4'g0f—a 1 6'*cr / LJ.-' Day phone 2qA(—y-?s 7 Mailing Address i!FXL!) fe— Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System P9 Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Address Firm R 45ola Phone 69U— iv z� ?0 90 k %76) d tl Engineer's Printed Name S TFcJF_ F_.c2 G- Date ,j'- Io'- o S. DSD SIGNATURE V Approved for IV— bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: Original Certificate Date: -.Z 2 — 0 g (R1v T7)05( Municipality of Anchorage • Development Services Department ` Building Safety Division On -Site s.. Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description:P%?1550.5-S' 19�?o, 00//- /-o 7- ParcellD:Qso-S7?-32 A. WELL DATA /�vBLIc f.J/4TFrz- (sjwc aUJ Well type If A. B, or C provide P ID # _ Well Log (Y! ) Date completed _ Sanitary se /N) _ Wires properly tected (YIN) Total depth ft. Cased ft. Casing h ' t (above ground) in. FROM WELL LOG AT INSPECTION Date of test' Static water level Well production ft. 9 P.M. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic: uglL date of sample: _ B. SEPTIC/HOLDING TANK DATA Tank Type/Material SePZIS- 72AJf"--- 1,.4te4ee Tank size 12 So gal. _ ' Number of Compartments ft. Other bac a Co cted by: _ colonies/100 mL Date installed Z `% 74'� Cleanouts (YIN) Foundation cleanout (YIN) Y Depression over tank (YM) .�.� High water alarm (YIN) Date of pumping / Pumper 5��� Tom' y / �✓ J C. ABSORPTION FIELD DATA Date installed - Soil rating (g.{ 4WtZ or felbdrm) la S System type S& -p -.004r Length �� ft. Width odd ft. Gravel below pipe 6 ft. Total depthft. Eff. absorption area 52 Monitoring tube Depression over field Aj Date of adequacy test O P Results (Pass/Fail) For bedrooms / Fluid depth in absorption field before test 1/4-n. Water addedgal. New depth 57 in. Elapsed Time:29ff nin. Final fluid depth � in. Absorption rate >= 6 9.P.d• Any rejuvenation treatment (past 12 mo.) (YIN & type) V/V 1< If yes, give date D. LIFT STATION Date installed 'Pump on' eve] at _ in. Datu E. SEPARATION DISTANCES Size in gallons 'Pump off lev at_in. Cycles t ed Manhole/Access (Y/NY High water :�crrcuitvequirements? m el at Meets alarm SEPARATION DISTANCES FROM WELL ON LOT TO: P"31.(c w&77f/L Septic tan/station lot On adjacent lots, Absorptio On adjacent lots, Public se Public sewer mar Sewer /seline Holding tank Animal c ntainment areas Manure/a ' al excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation S ,� Property line /0 i� Absorption field e� Water main 0 r Water service line /6 of Surface water /d O ('v4 Wells on adjacent lots /dCJ If SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /� t Building foundation /D f Water main 0 f Water Service line /0 Surface water it Driveway, parking/vehicle storage Curtain drain140� Wells on adjacent lots _/CIO `t F. COMMENTS F G. ENGINEER'S CERTIFICATION %� '• 1 certify that 1 have determined through field inspections and r i *'491—H 512 ....3 review of Municipal records that the above systems are in �� ..... conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name STB✓f ic/JE, I� ��F :, " +� 6256 ,• :�` l Date COSA Fee $ Date of Payment ?//,I log Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number in. TK YTILITr uea.e»r ---------------------------- El Daca7 N ans r sw»A.S ^�0/ •4 r O rTYMC MOY•C 0 — Soni 1 ►Ano ry 0 1 4 1 i S ©9059'00'E 120.5 LUCAS __._AVENUE ___ m 11.0 IIwOwIwwUCIULLf�JR.LT1[DIO�L.KaO GtEYErT3 AH>H IO�OlC 1:tcC 1pq lOS T10�� !» DAT 11uG� V Atl o11 !E»CEMES EASTYEMS M"Co1 .. CTrt11 T,,,4TTCI3E LIOLYI ON THE 11ECO10EORAr,AAE ADTLOMH.4 NSa•eS!aCrJK' WTe AYrrlKRJlFil01LM IAC LOCITCO AATIOWATT0.r AMDAP[ NOT TOS: 1ACOTOOSTEa ►a OleCTr LSES OM LOCA" Inn"W SS AY! •4III4. S� lIAT K A"N W1Te OLE TO SLW ='0TPW4 cam' rv. �F• •'4.��' 71 Ar Shtftwf /1A61(— BMAME A. MOLT: ` •` L9.6914 G ��(lL•I. • .... -.,W A34.aT SLIMT (MO COZYCRa SET TCS DATE) r•r I M!»!IE CT.11»r 1"' MAI! laMOrAEO A YDATaAGf(1a CTNd T� MIRawG QTCAMED rDf !1. Huss SOS W a Awt»}aADa ASTxpaw pSJA . ALASKA A. T14,T T• r1AAa MOADrl "$ "'Arm rIOTdI AK MT»»M lAD ." L.waa YID AO MLSLE D.CAOACM.4f.T3 VOST OT»TA TM" NOT Q. DATED AT AA'•1DAAOL M ASIA MM 4TM— D1� d MA.. 10M 1.qf lAw'D MMva+ll�w i2feK7A u1.n TR. allaala t a 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # D5'12 S >,Z 3z✓ HAA# 1. GENERAL INFORMATION Complete legal description Lm> de i/ �eo�ss '�9 Soso/rJ�s�otiJ Location (site address or directions) Zo 4rgy' Property owner LlIG /GGC '/p,ef,215 Day phone -Z 7z - yy9r Mailing address Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Z/� Day phone Day phone NOTE: if community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: if community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) Front MOA#21 0. 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 y Phone %yG —moo y Address o f 90 x 6 0,x,11-%; Engineer's signature 6. DHHS SIGNATURE Approved for C4� bedrooms. 0 Disapproved. Date fj30 /q(o Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 921 %` h' i � l Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 921 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICMNICIPAu1Y OF ANCHo Environmental Services Division ENVIRONMENTAL SERVICES 0 1 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 July' 4 1996 Health Authority Approval Checklist RECEIVED Legal Description: L b > 9 �� // o�uEss "'�X �/ Parcel I.D.: o S'10 Y7Z 3 -;—� A. WELL DATA Well type �u��/e- If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) '4-11% Date completed Total depth Sanitary seal (Y/N). Date of test Static water level Well production WATER SAMPLE oiforCma m: Cased to Casing height (above ground) Wires properly protected N) FROM WELL LOG INSPECTION Nf g.p.m. g.p.m. Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Tank size iz3'd Number of Compartments / Cleanouts (Y/N) Y Foundation cleanout (Y/1) A) Depression (Y/1) A� High water alarm (Y/N) '/� Date of Pumping Q/ZL 19,r Pumper Pu�a�i r f G C. ABSORPTION FIELD DATA Date installed / 97y Soil rating (g.p.d.V or ft2/bdrm) /z-4� System type Length Zo ,-�t Width Zo Ff Gravel thickness below pipe Total depth Effective absorption area a9',Z8 FAZMonitoring Tube present(Y/1) N Depression over field (Y/N) 2 cell: Date of adequacy test `Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test (in.); ✓rte o �tilmmediately after 11V gal. water added (in.): 6 9 rz Fluid depth S (ins.) Minutes later: "Ile Absorption rate = 6 / E�? g•p•d• Peroxide treatment (past 12 months) (Y/N) No If yes, give date D. ]LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* p o ' level at* High water alarm level at**Dahm/A C e E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot, ; On adjacent lots Absorption field on lot ; On adjacent lots Public sewer main Public sewer manhole/cleanout is service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 6 F-/ Property line i.1— f F� Absorption field, ,zz F�Z Water main/service line Z,f-/F-/Surface water/drainage Wells on adjacent lots _ ✓1,9 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Surface water Alm �E Curtain drain .t% v� F. ENGINEER'S CERTIFICATION Property Line Water main/service line 2j— "� 7/ - Driveway, parking/vehicle storage area / tK. / Wells on adjacent lots Al✓� I certify that I have determined thru field inspections and review ofMunicipal records th f ie� ped are in conformance with MOA HAA guidelines in effect on this date. lz2 :1?1 . ........ � Signature Engineer's Name Date SV 3 D. q (e HAA Fee $ = U . rJ Date of Payment Receipt Number Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number Cf; �1'TG HUSTON.XLS Douglas T. Kenley Civil Engineer State of Alaska C.E. 8176 SEPTIC SYSTEM ADEQUACY TEST Legal Description i Applicant 4Ue',L��y�/o�2�S Date of Test ,+,f q y ,�V SYSTEM DATA Tank Volume /,z 4—,o G,v Number of Bedrooms .41 Absorption system Number of Bedrooms Absorption required (1.5 daily flow) eo ox0 F=TIMEFLOW VOL. (gals) TEST DATA TANK LEVEL TUBE LEVEL COMMENTS 9eAd' d"a L7% r/ irk .Z.7 i9BG / .i 6 Tom/ %B `{AFL 404 z•� .� �8i ��185 System Passed ✓ Sysytem Failed: Comments IL zz " �-14 /cam, — -- — — r 1 � 4,y r = ter---. — — •. ice` ^ � � 4 � r S 7 t 1 Page 1 ov Douglas T. Kenley Civil Engineer State of Alaska C.E. 8176 HUSTON.XLS SEPTIC SYSTEM ADEQUACY TEST Legal Description Applicant Date of Test �.g v zB g9k r SYSTEM DATA Tank Volume /Z.V— �s,L Number of Bedrooms -171 Absorption system �,,�,0 Number of Bedrooms Absorption required (1.5 daily flow) (oOCJ Q4 TIME FLOW (gpm) VOL. (gals) TEST DATA TANK LEVEL TUBE LEVEL COMMENTS /99 a 7,v S2A z• -/9966 6S B e el,I s 944'el 1d4% fs'L g -d ,Z, .Z,B 2vaz Zmo� / 69 4 4f ?oa p zmivo 70V (a '/ 6 yb Z, ,20. ii 69 B i.�j System Passed ✓ Sysytem Failed. Comments Page�a<� M Douglas T. Kenley Civil Engineer State of Alaska C.E. 8176 HUSTON.XLS SEPTIC SYSTEM ADEQUACY TEST Legal Description Goy- fi B� >/ ,P�/E�s -6'.4 Applicant Date of Test /�/-y SYSTEM DATA Tank Volume Number of Bedrooms Absorption system e,2,s Number of Bedrooms Absorption required (1.5 daily flow) '04 TIME FLOW (gpm) VOL. (gals) TEST DATA TANK LEVEL TUBE LEVEL COMMENTS 7'b 9 zau� 9i" 7,z" 'y t•/ ozz 70%'� 69% zY za p /v1 �ro0 Ed SYS t ! System Passed Comments r4s-sd 6 y9l 42 1Z L /9612 /9a� y Sysylem Failed � Z Page _1,0F 3 P