HomeMy WebLinkAboutPREUSS #4 BLK 9 LT 9Preuss #4 Block 9 Lot 9 #050-572-'63 oN,c,Pni `roe MUNICIPALITY OF ANCHORAGE as On-Site Water&Wastewater Program S�� 4 .ate`, PO Box 196650 4700 Elmore Road _ ta' Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 ,�y http://www.muni.orgtonsite ''"+ �• \ � �.. ' t)elxirttnent 4'vC$ORIS On-Site Water & Wastewater System Permit Permit Number: OSP191383 Effective Date: 9/11/2019 Work Type: WellSeptic Upgrade Expiration Date: 9/10/2020 Tax Code Number: 05057263000 Site Legal Address: PREUSS #4 BLK 9 LT 9 G:0056 Site Mailing Address: 10144 PREUSS LN, Eagle River Owner: WHITLOCK KENNETH L & DESALYN R Lot Size in Sq Ft: 19600 Design Engineer: NORTH RIM ENGINEERING Total Bedrooms: 4 This permit is for the construction of: 0 Disposal Field El Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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 Special Provisions: 1. The Engineer needs to do a test hole prior to the construction of the septic field. Construction may proceed at your own risk before the 7 day water monitoring is complete. Please submit stamped and signed results with the As-built Inspection Report. If the results require a design change, construction of the system will stop pending On-Site review and approval. 2. Prior to construction, the existing field is to be located. Include the northwestern corner of the dogleg. Received By: _ Date: ' �7 Issued By: �7) / - Date: 9//7/9 • .r -'i;, ; Municipality of Anchorage 5� "sem Department • P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax(907) 343-7997 http://www.muni.org/Onsite Development Services Division On-Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** Waiver#: OSV191076 COSA#: Permit#: OSP191383 PID#: 050-572-63 Legal Description: Pruess#4 BIk 9 Lt 9 Engineer: North Rim Engineering 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 5.0 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. ' Waiver is Granted: X Waiver is not Granted: Date: CV /Of//Of Approved by: /5Q?' / Name of Reviewer •� **** VARIANCE/WAIVER REVIEW ***'k MUNICIPALITY OF ANCHORAGE 1 • ,I Awe';\ Development Services Department `� �,/ Phone: 907-343-7904 On-Site Water & Wastewater Section . "9® 11-7997 • S Z ON-SITE SEPTIC/WELL PERMIT APPLICATION a AUG 282019 1.3 Parcel I.D. 050-572-63 lz '9/ 6 8 L 9 c;\ Property owner(s) WHITLOCK KENNETH Day phone 307-214-247 Mailing address 10144 Preuss Ln Site address same Legal description (Sub'd., Block & Lot) PREUSS #4 BLK 9 LT 9 Legal description (Township, Range & Section) Lot Size 19,600 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field n Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank x Upgrade n Duplex (D) Holding Tank ❑ Renewal .— Multiple Dwellings ❑ Privy n (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. L (Sign. ure of property owner or authorized agent) Permit/Rush Fees: 595- Waiver Fees: 09. 6-- Date of Payment: '/2' /J3 Date of Payment: 1/2711 l Q Receipt Number: Z Q,356 Receipt Number: /� 04 t/13D Permit No. d5P 9/3 Y3 Waiver No. 06V141 IO% G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc TERI M ENGINEERING SteveEng.com Steve Eng,PE, PH PO Box 770724, Eagle River AK 99577 907-694-7028 SteveEngPE@gmail.com Date: 8/27/19 Number of Pages: To: MOA On-Site Services Subject: Preuss #4 Block 9 Lot 9 Septic System Upgrade The subject property has been served by a septic system for a number of years. The septic tank is to be decommissioned and a new Advantex/Trench installed. The existing trench to be connected via diverter valve. The entire subdivision is on private wells and septic systems. The terrain slopes south as indicated. Lot line waiver to/lidue to the limited area. t1onw pei 5.6. Please review the wastewater system design for the existing 4-bedroom home. I have included design plans & specs, design guidelines. If there is need for additional information or clarification please give me a call. Thanks-Steve \TR1IV ���INEERING SteveEng.com Preuss #4 Block 9 Lot 9 SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: This is an existing 4-bedroom, single family home. The septic system is failing. The owner wants to upgrade the system to a Category III Advantex. A design is submitted for a new trench & new Advantex. The neighboring lots are developed as indicated in the drawing. Previous test hole being used- no groundwater. A 6' deep trench will be excavated. The easements are located on the drawing and are not encroached upon. An additional test hole will be completed during construction. A Category III application rate of 4 GPD/FT2.Trench Length= 150 FT2/3'x 2=25'; 1 line @ 25'. No bedrock was encountered. A perk rate of 28 min/inch was used from previous soil test. Old trench will be connected via diverter valve. A lot line waiver to 5' is required to maintain trench separation. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. • Connect New Trench To Advantex. Install Valve To Previous Trench For Possible Later Use.Watertight couplings on inlet& outlet • 5' minimum between the tank and bed. 10' to property lines. • 3' of cover is required for trench or add insulation board. • Solid pipe must be set on well compacted, stable soil • 4' of cover or insulation is required for tank; an equivalent of 1" insulation for 1' foot soil cover. Tank & solid pipe must be set on well compacted, stable soil. • 4" diameter cleanouts with airtight caps are required l' to 4' from foundation wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field, not more than 10' from the tank positioned to provide cleanout access towards the tank and towards the absorption field. • All cleanouts must extend to at least ground level. • In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron. • Trench to be placed level, minimum of 4' to groundwater, 6' to bedrock from drain-rock • Drain rock to be ' inch to 2 inch screened. Drain rock to be distributed uniformly throughout the trench. • Silt barrier(filter fabric) to be installed above the drain rock • Smeared trench sides must be raked or scarified before drain rock placement • Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, PVC Schedule 40. • Sewer Service Line is minimum 2% slope • Septic Tank to be pumped every two years or when required (* 49t *irC *�• 1E-c_R6 1 • DESIGN NOTES: 1. Existing Trench Remains In Place. 2. Sewer Service Line minimum 2'. - ••e. 3. Decommission Existing 5-: is Per UPC. Connect Advontex T. xisting Trench Vio Diverter Valve. 4. Lots Served by P ' ate Water Wells. 5. No Conflicts W' in 200'. Mork 100' Well •. . 6. Check Condi 'on Of Sewer Servic- ne- Replace If Necessa •. 7. Depth Of -w Trench © 6'. 8. Measure 'eporations Prio o Construction. 9. Lot Lin: Waiver To 5' I 10. Add T's To Old ench For Lo/+otidn. Lot 8 Lot 3 5% Slope O I I R101 Well +' Deck Secti•n 0 °i o R101 Sill @ 6" El-vati.. c, a, Well cs c a UI J . 5% Slog 4 Bdrr1 157. Slop- � Lot 4 -P I 4c>.‘ Q) i o- +s �� a- 0Apaiiii..0 Dec0rlrli-,s'. i : liverte Valve Septi To Existin. Trend T Hca TE \4iigmoil S din ►_ Tr^ a/CO W th 1540 G r`-a. New 1 AX- c.<<0n w Tr, —_ p � c`'p ��� eav�Tek L10 Se 'tt— t p 20% SlOpe�Cu O 57. Sloe 30%4Slope� Cut a I ` 5% Slope Lot 5 Lot J ` o Well NORTHRIM ; E ° . 444;.! PREUSS #4 1" = 40' ENGINEERING P t SteveEng. com ;* 9rFl• *`; BLOCK 9 LOT 9 DESIGN PO Box 770724 •�i,�6 'ogle River, Alosko 99577 •.`' «: '= WASTEWATER UPGRADE LAYOUT 907. 694. 7028 ��''. 9%6%19 ' ADVANTEX UPGRADE Dote: 9/6/19 IHEEOf 3 Foundation Cleanout 1 AX-20 Filter Pod ADVANTEX OSULATC0 A%20 P00 ROM-7 17 M. 1 VIIIIIIIIIIIIMMIIPOMMOMMINIIIIR i ' 1 r l liverter Valve To ...w.w.w.w.w.w.w.wam 11. i Existing Trench —, cKLQN I.JL M.STTe lM'TSTATON /y(/ illbh. • 4 . a / 12' DESIGN NOTES: 1500 GALLON Monitor Tube AdvonTex 1. Depth of New Trenche is 6'. Final Ground CO Slope 2. Advo.ntex & Solid Pipe to be Placed on Compacted, � I I Stable Soil, Free from Boulders. X111•■ 3. Sewer Service Line is Minimum 27. Slope & 3' Cover. iiilli 4. Water-Tight Couplings. 3 origin, Groun� 5. See Specification Sheet. Filter 6. All Work To Conform to Municipality of Anchorage (AMC) Fabric .� . Requirements & Specifications. IA �� ���� 7. Maintain 3' Cover Over Trench Or Insulate. Effective Depth it �����4 P 8. Private Water Wells. 3' IP X * 9. Install Diverter Valve To Old Trench. I -v 4 WI I_Flik 10. Decommission Old Septic Tank Per UPC. :d O:'a=l=I-' 3' NOR THRIM :.\�o� ..g ENGINEERING Of,) .• • TRENCH END VIEW PREUSS 444 SteveEng. com * *$ Po Box 70724 $ ., ADVANTEX PROFILE BLOCK 9 LOT 9 Eagle River. Alaska 99577 ••., « p= SEPTIC SYSTEM 907.694.7028 `'4� 914/19"r I I P r,R A D F Dote, / °ror'" 8 7-SE__—lso°�" 1• = 5 1-W t.'3 of' 3 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 7 Day of Scft*n/Lc- of 20 /'Y , by and between 44 ,rt-1 L. GA/A:t-Joh , 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,Hd✓an fie{' located at(legal description) u Lar q Pock ' Preuss ! 2. Maintenance,Repairs and Alterations. (Owner is required to read, understand and initial each section) K(z 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. /(,J 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). //r/ 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. ,,j 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 1 of 3 �l w Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. ,f'tH/ Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. /ec r✓ Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. „/ Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On-Site Systems Approval. kt A/ 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. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER: By: /�-►�' (signature) Date: '/r/! K,441.1.: Z. 14417-As6 (print name) STATE OF aIAtIe•A ) COu pFa=e4. ) ss. The foregoing instrument was acknowledged before me this °I day of Se-pi-VA 8 Se-pi-VVFit 20101 ,by &.tv,J F't'1.1 L. W 41T LOCAL,,,, OTARY PUBLIC FOR . PLO 21 O A 'ar� Nofer}p(ibWcSti�eofFbtau r'ti Dura AANonrse 1 My Commission expires: A; . 5 011 y Deka nan�r,+ ,�o:; • Expire►'1,19+A o -1.. } „1�>>I111111111111`' MUNICIPALITY: By: ' / �, �._ , (signature) Date: VOA' (print name) Title: (rev. 05/18/2018) Page 3 of 3 ' ` -` MUNICIPALITY OF ANCHORAGE �/ ® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME 1� I O 14G� I� f yM .`� PHONE `��C1� EW ❑ UPGRADE MAILING ADDRESS � r'.p- C ,t LEGAL DESCRIPTION L 9 LOCATION NO. OF BEDROOMS DISTANCE TO: Wellry� Absorpti rea Dwelling PERMIT NO. Uy I a Q Manufacturer Material No. of comp rtments wF �e— rn Lie. capacity in Ilon � IF HOMEMADE: Inside length Width Liquid depth o y DIST CE TO: Well Dwelling PERMIT NO.' Jaz T.� Oz ufacturer Material Liquid capacity in gallons DISTANCE TO: Well /o0 Foundation Nearest lot line PERMIT NO. = L) No. of lines ength of eac line Total len thf lines Trench width Distance bgt�een lines - LU -'inches // FTop of tile to finish grade F, Material beneathlfile 1 Total effective algorption area ,74 Z31 Length Width Depth PERMIT NO. Lu C7 Q H Type of c ' Crib diameter Crib depth Total effective absorption area wa wWell 0)DISTANCE Building found Yon Nearest lot line TO: _j Iqlass Depth Driller Distance to lot line PERMIT NO. -j Lj !L W � Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALS .v SOIL TEST RATING 5 V AdIrn a INSTALLER U h J REMARKS c� f L DATELEGAL APPROVEDjj J/11 ���� 72-013 (Rev. 3/78) WELL LOG Wheaton Water Wells, Inc. Rax s+,wmm*- %:Z I WASILLA, ALASKA 99687 376-2041 OWNER & UCL /S y@ ADDRESS A!; t2,4 y � Ae NELL—SITE SA,4, R_ RF USS Sdb, kof-9 )31k -q DATE -,?C-- P/ KIND OF FORMATION: DEPTH OF WELL _lam STATIC LEVEL 30 GALS. PER MIN. Vii- %^ SIZE OF CASING L� �' 17.46 FROM Q Ft. to /d- Ft. ve L FROM Ft. to Ft. FROM Ft, to , !� Ft. FROM Ft. to Ft. FROM —L,4 -Ft. to 12p, Ft. SAA -0.1 GA,4vel- FROM Ft. to Ft. FROM Ft. to 13 Ft. dA -r/ 104 AZ FROM Ft. to Ft. FROM QO Ft. to _ Ft. FROM Ft. to Ft. FROM o5S Ft. to Ft. GPAVel 'L4,19 -4 -e -z-- FROM Ft. to Ft. FROM Ft. to Ft. FROM Ft. to Ft. FROM Ft. to Ft. FROM Ft. to Ft. FROM Ft. to Ft. FROM Ft. to Ft. FROM Ft. to Ft. FROM Ft. to Ft. FROM Ft. to Ft. FROM Ft. to Ft. CONTRACTOR C: F7'OARTt'1EPdl" C•.✓HEALTH AClC� EP�vlF:i={NdttEtdTL I. ,�ITE R� "CI%�p� /tom- ' - 'L-" STREET: ANCHORAGE, AIS:. _=x_9501 �.� 264-4720 �.°.� F-*::- 9 L_ F-i P-a E� Cl INI — 7 - T _T*F " t 4 FEE Imo: MUNICIPALITY OF ANGHORAGE J ,�._��� • `'-'� PERCOLATION \\ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST s +, `•� 825 L. Strout, Anchorne, Ai;.ska 00501 26.1-4720 SOILS I..O _ PERCOLATION TEST .. -t--/ ---------l PERFORMEDFOR:—_Y;sLDATEPEROF: 3 LEGAL. DESCRIPTION:_y_ __._—�._�—___..� _� __� ...__� v.�L__ `` .��____------.--_.-- SLOPE SITE PLAN 2 a G fi 9 10 11 12 13 14 15 16 17 18 19 20 00) k1) ` 4,l 6,CAArt AL1 e�•'�.s,s. WAS GROUND W�tr-.A S ENCOUNTERED? „__ z3c _ 1. O P E IF YES, AT V'di1AI DEPTH? 'Kdr T Reading Date Gros Time Net Time Depth to Water Not _Drop 1 2:F{ 3• l f t? F+. t! v _4r 34 PERCOLATION RATE _ (minutes/inch) TEST NUN BETWEEN FT AND FT COMMENTS.._...__..—.____..-----------�_�.�.�..—._..�__�-__--- ---.'--- ---T' PERFORMED BY: L � • [�§,.,.yr__�_._„�,>d,.CERTIFIED BY: 12-008 (Fii'tl DATF i C :i -f� / Tl U7L � I LP ICJ y� \I 1 l � ;� �° { � �;i (� { "( !'' l Ill .;. � }5 1 -1 �i f r�•� «. i '"..:'....- Y Municipality of Anchorage TYPE OF WASTEWATER DISPOSAL: Development Services Department i.�Building Safety Division • __ Y... Onsite Water and Wastewater Program ❑ 4700 Elmore Road ❑ P.O. Box 196650 ❑ Anchorage, AK 99507 ❑ www.muni.org/onsite ❑ (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. ..n COSA'# ISI D LLLa Expiration Date: 1. GENERAL INFORMATION ' Complete legal description _ W 9; Block e: Preuss subdivision -*f Location (site address) 10ra4 Preuss Ln• Eagle rarer, AK 99M Current Property owner(s) teeny Dowdy/ Mark Graham Day phone Mailing address Lending agency Day phone Mailing address Real Estate Agent Barbara Bowden Day phone 5623300 Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual Water Storage'' 0 Individual On-site Q ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of Onsite Systems Approval are required for the transfer of We (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 Onsite 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 Firm S s s Engineering Address 15861 S. Birchwood Loop Engineer's Printed Name _ b. DSD SIGNATURE Approved for bedrooms. Disapproved. Phone 694-2979 Da Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X_ Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements . Supplemental Engineer's Report Other By. Original Certificate Date: 12-19-07 (nm. I lm) Municipality of Anchorage • Development Services Department Building Safety Division ` On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-650 www.muni.orglonske (907) 34379W CERTIFICATE OF ON-SITEQS TEMS APPROVALLf CHECKLIST Legal Description: LOT- l�JL 5 Q #Parcel ID: t� �D -S 72 - co 3 eWA:01It07_10 Well typ _ lt//4TE If A, B. or C provide PWSID S = Well Lc (®1) `GS Date completed '409/1811 Sanitary seekON) JZ Wires properly protect) [ E S Total depthR. Cased bo_Eft. Casing height (above ground) I t in. FROM WELOG Date of test 5 ZC) a Static water level .0 ft. Well production aS g.p.m. WATER SAMPLE RESULTS: Coliform 1colonies/100 ml NitratemgIL Arsenic: _K_ug/L date of sample: I 2910 B. SEPTICIHOLDING TANK DATA Tank Type/Material g �( Tank size l% get. Number of Compartments oc AT INS 4 2. R. "T • 7 � g.p.m. LAYnIII b Sy ?OMPa PLLVnBIX76 Other bacteria AK( colonies/100 mL Foundation cleanout 0 Depression over tank ( l�_" u Collected by: 5 *_S 6&414v;'r"_4 Date installed 7 t s I Cleanou4okl) �I�S ,, High water alarm oN11 ? C /t� S � Date of pumping 13 a Pumper C. ABSORPTION FIE ATA !, Date Installed Soil rating (g.p.d lR= /bd 2,�O System type P-6LX H Length 03 / ft. Width '+ ti V�vx ft. Gravel below pipe S R. i ► 14'55 i+r Total depth L ft. Eft. abs rption area M nitoring tube IM Depression over field s I Date of adequacy test I 67G Results (960 rT�% For -L bedrooms Fluid depth in absorption field beforetest —T SO in. Water added, Aal. New depth in. " 466-t d. I Elapsed Time: � min. Final fluid depth �, in. Absorption rate >= g.p. Any rejuvenation treatment (past 12 mo.) (VO type) _�lO If yes, give date I: D. LIFT STATION MIF' Date installed Size in gallons o e/Arxesa (YIN) _ 'Pump on' level at _ in. 'P I at _ in. High water alarm level at Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: I Septic tankAift station on lot ---q' Absorption field on lot Public sewer main Sewer /septic service fine oQS 4 Animal containment areas '56 14 I On adjacent lots I On adjacent lots Public sewer manhole/cle nout l Holding tank L17 Manure/animal sucrate storage areas SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5 r4 Property line —�L * Absorption field S Water main /L) Water service line r� Surface water /CXR Wells on adjacent Sots /tom " SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /© 1 Building foundation /D Water main A.) Water Service line /49 1+1- Surface water /00 f Driveway, parkingivehicle storage A0 Curtain drain Axl KA�Wells on adjacent lots A96 I F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined ugh held inspections and * r review of Municipal records the above Sys are ••• •'•• ••w. w•w.t,*. conformance with MOA COSH u' es ' act is da I ..»».v. Engineer's Printed Name ti r� Date Z /t �� r ,..•''�` COSA Fees 14 V — Date of Payment jj,184n Receipt Number 0o 5 p 17 ) t (Rev. 11106) Waiver Fee $ Data of Payment Receipt Number Nil �/BP� SP ,moi ,0.SBUILT-NO CORNERS SET THIS DATE. I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: ���-�5��.�.0.'�ti:a--yam �lo�-S' .�,�' 9 • AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED, IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. S.EWARD & 'ASSOCIATES LAND SU TrU-VTNG 694-0 SCALE, 4 F �o DATE,/ -(� '� C 4 � GRID: v... - ..... H Oven. Mn.k Ss Ste- 2.S' ddVtF ' LS - 69 • Q� DRAWN!'°�tyz. TOTAL P.O2 9 Municipality of Anchorage ''pl BLi • Development Services beodrtment : Building Safety Division On -Site Water and Wastewater Program ` 4700 South Bragaw St. P.O. Box 196650 Anchorage, Ak 99519-6650 www.ci.anchorage.ak.Us (907) 344904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-572-63 HAA#_ f7 i� 0 0 9 CI Expiration Date: t'n —- 073 1. GENERAL INFORMATION Complete legal description Lot 9; Block 9; Preuss 414 Location (site address or directions) 10144 Preuss Lane, Eagle River, AK 99577 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Dwight Bowden Day phone Day phone Dayphone 562-3300 Mailing Address 3380 C St., Anchorage, AK 999550033 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well EN Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal andlor water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certirid'ates are valid tof 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 seat affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my Investigation and Inspection, the on-site water supply and/or wastewater disposal system is(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of FirmS&S Engineering Phone 6q4-9979 Address 17034 N. Eagle River LID RT), Eagle River AK 99577 Engineer's Printed Name Robert C. Cowan Date 36_0/0 3 , .. .......... 5. DSD SIGNATURE 1,ij cs aoaCc 880oi/AN Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other //lll l r.• By: E Original Certificate Date: 3 — a. Ll ` 0 3 1R". 171001 Municipality of Anchorage *A1 a4l� If ' Development Services Department Building Safety Division On -Site Water & Wastewater Program . 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 995196650 www.d.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ZvT- 9f A-yc.KQ Aeus's #4 Parcel ID:i 50 1 A. WELL DATA Well type � If A, B, or C provide PWSID # Well Log (Y/N) y Date completed �f'i8 / Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth —A —Fft. Cased to �ft. Casing height (above ground) ,Z�in. FROM WELL LOG AT INSPECTION ! Date of test I _ �rz S 1 03 Static water level 30 ft. �i 3 Z ft. Well production Z i g.p.m. + g.p.m. -4A-Jn�T4e WATER SAMPLE RESULTS: Coliform CJ colonies/100 mi. Nitrate :,,S 2. mg./I. Other bacteria C_ colonies/100 mi. Arsenic: mg./I. Date of sample: S/n3 Collected by: S��j 6nt6/NC- r t P44, B. SEPTIC/HOLDING TANK DATA Tank Type/Material Tt Date installed '4 1 erf 1 S I Tank size 000 gal. Number of Compartments 2 Cleanouts (Y/N) y Foundation cleanout (Y/N) Depression over tank (YIN) ,.i High water alarm (YIN) Date of pumping `Z t 0 1 P3 Pumper T2 Is. C. ABSORPTION FIELD DATA Date installed ► Soil rating (g.p.d./fe or b ) J:�.7 System type e'–? -!- Length 3 ft. Width ^- Z L1n//C ft. Gravel below pipe Sr ft. >TL rtss r1 C--> Total depth La. ft. Eff. absorption area (eft Monitoring tube `� Depression over field At Date of adequacy test ;t lip o 3 Results (Pass/Fail),1 Fcr A bedrooms Fluid depth in absorption field before test 4_ in. Water added gal. New depth in. Elapsed Time: 1196n. Final fluid depth �0 in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) Al If yes, give date * w a-T-&� I+ik-v-4` /P44 ', &rrz.u,w.. D. UFT STATION Date installed �4 'Pump on" level at Datum E. SEPARATION DISTANCES Size in gallons 'Pump off level at _ in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift�s>;atti5n on lot q-,-xAbsorption field on lot /b4 I -#.- Public sewer main Spwr/septic service line Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots /00 On adjacent lots / i t' Public sewer manholetcleanout Holding tank SEPARATION DISTANCES FROM SEPTICH Q�MG TANK ON LOT TO: Building foundation S i+ Property line r * Absorption field S '7 - WaterWater main fJ1A Water service line� Surface water /00 rT� Wells on adjacent lots (OO r+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10 4— Building foundation / Water main ^/ r / Water Service line / D Surface water / dC% +- Driveway, parkingivehicle storage / 0 1 i�- Curtain drain L►Wr2 )r./o.Py>,JWells on adjacent lots IGb I'r F. COMMENTS ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA NAA guidelines in effect on this date. Engineer's Printed Name R0fftt C • Cy&a4,-J Date 3/20f03 HAA Fee $ 3 7 // 5. 0,3 Waiver Fee $ _ Date of Payment 3! aL° ` ° 3 Date of Payment Receipt Number o 3;)75-Y- Receipt Number (Rev. 12/01) • •...;;' a -� •'• RECOV. 5i£' RBA^ E' CIL FENCE t - i t Well C t t t f t t t 1 t � 1 M O �0 ` i N 4 I 3 3 j t w N co Q 1 o g t a� Z J F— O RECOV. I PIPE ABANDONED FLOOR. I S 89059'E 163.34' (R) c N CANTILEVER 5E.2' EXISTING HOUSE z Aq.f' ASPHA'_i DRIVE N i 0- 0 O D 4PVC SEPTIC i� STD—PIPES (TYP)\ v O S 890591 163.34' (R) S 89059'00"E 162.63' (M) BASIS RECOV. 1— 112' ALCAP 10 .Ar 30 ', L I LU c o 30 t 9 2/7/03 .AS $U I L-1 58-02 DATE i=LD. Bre. C 0;F • A1 -A n-1714 ImFli , Willi D. Fieming S ession NOTES: Easements not appearing on record subdivision plat are not shown• unless description of �easemeni is provided by -client. It is the responsibility of the owner or builder, :prior -to construction, to verify proposed building made -relative -TO--finish .grade -and utilities r; connections, and -to etermine -the -existence of any easements, covenants, -or restrictions +which sfo not appear .on the recorded subdivision plat. Elevations based on tissumed datum unless otherwise indicated, and bearings and distances :are record data. sas Engineering SSS 17CL EAGLE:RNER LOOP ROAD n9 min) .EAGU =RIN6R 41ASXA'99M (907)694.2979 LEGAL DESCRIPTION LOT 9, BLOCK 9, PREUSS SUBDIVISION UN I7 NO. .4 PLA"/ NO. SCALE GRID -72-6 1" =30' `NW -56 Z o o J N 3 U) ! U) c o 30 t 9 2/7/03 .AS $U I L-1 58-02 DATE i=LD. Bre. C 0;F • A1 -A n-1714 ImFli , Willi D. Fieming S ession NOTES: Easements not appearing on record subdivision plat are not shown• unless description of �easemeni is provided by -client. It is the responsibility of the owner or builder, :prior -to construction, to verify proposed building made -relative -TO--finish .grade -and utilities r; connections, and -to etermine -the -existence of any easements, covenants, -or restrictions +which sfo not appear .on the recorded subdivision plat. Elevations based on tissumed datum unless otherwise indicated, and bearings and distances :are record data. sas Engineering SSS 17CL EAGLE:RNER LOOP ROAD n9 min) .EAGU =RIN6R 41ASXA'99M (907)694.2979 LEGAL DESCRIPTION LOT 9, BLOCK 9, PREUSS SUBDIVISION UN I7 NO. .4 PLA"/ NO. SCALE GRID -72-6 1" =30' `NW -56 ,al_ni� vi -6uvai uu, vuiiwi Ya YAvfl r o— u—ou r 11119Am i Ulv opl I I vrev Kespy 8U73434780i# 2 ✓t' ME Environmental Services Inc. Laboratory DiviaiOn, r�i�vr r Laboratory Analysis Report CT&l= R. -f.# 960455.2163 Client Sample ID L9 89 PR$USS #410435-01 Collected Date 02/12/96 Matrix Dtinl:inS Nater Tecbaical Director PNSID 0 Released Hy Sample Remarh:; QC Attauebie Prop Analysis Parama:ar Results Ousl POL Units Method xitra:e•v — Limits pate Dat! 1n1 52.5 ` 1 mp/L EPA 353.2 NO2JN 112/14/96 02/14%96 EMB 200w, Potter Drive, Anchorage, AK 99518-1608 — Tel:1907) 562.2343 Fax: (907) 581.5301 3190 Pager Road, Fairbanks, AK 99709-5471 —.Tel: (9071474.9858 Fax: (807) 474.9885 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA __.NOTE "if con 4 TYPE OF WAS' t .t 7gh`g✓j ' £[' 1 3Mli ..fig- i_ ii'•"3�Lf F 5z3� €€t t , s °f , : DEPARTMENT -OF HEALTHA HUMAN SERVICES _ ( Division of Environmental Services On -Site Seryices Section n 0`Box 196650. Anchorage,. Alaska 99519-6650 W CERTIFICATE OF HEALTH.AUTHORITY , kPPROVAL FOR A SINGLE FAMILY DWELLING tem, prow , e -written confrrm_atr_on fro status of system - OSAL:,£ - YYY:_ S. STATEMENT OF INSPECTION .BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I. verity 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 forthe number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my invest!qation 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 effecf on the date of this inspection. Name of Firm 5& S ENGINEERING Phone a'% �� 7024 Eagle River 1 sop Reed No. 204 Eagle, River, Alaska"577: Address / % 6. IJHHU 51UNA i UK= .t rr:� •.....»,. •- tip. bedrooms Z�'ativa+�►�< Approved for': , ,vi � Disapproved ;; °bedrooms; with, the "following s Conditional approval for r f Municipality of Anchorage Department of Health and Human Services 44 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: _of 7:%Y�k9;/�reclSs %& Parcel I.D. OSO S ;X2 6.3 A. Well Data Well type Pr,'va �e If A, B, or C, attach ADEC letter. ADEC water system number /V- "/. Log present (Y/N) . Ye.s Date completed Drilled hea.f-or, Water Wells Total depth 61" Cased to 6/ � Casing height 3911 Sanitary seal (Y/N) ! eS Wires properly protected (Y/N) %S Date of test Static water level Well flow Pump levels FROM WELL LOG AT INSPECTION S-zo- 8/ 6-6- 9s 30 y3 ' 2.5 g.p.m. 6. O 9.p -m. vK L) l< SEPARATION DISTANCES FROM WELL TO: Septiclheldittank on lot �- 97 , ; On adjacent lots /0C ' Absorption field on lot /00 ; On adjacent lots /_0 3 Public sewer manhole/cleanout '� le Public sewer main A c i4, Sewer service line 2f Petroleum tank Z ME `' m v � G I gs-M4�L Other bacteria O S & S ENGINEERING z� Collected by: 1203d Page River Loop Road No 204 r� B. SEPTIC/HOL-DM TANK DATA P0 ti p m T / O o O qct./. Compartments Cleanouts&/ I) '" �1CS Foundation cleanout (Y/N) YeS Depression (Y/N) IVO High water alarm (Y/N). -/V i%. Alarm tested (Y/N) to Z SEPARAT.ION'DISTANC.E,$ FROM SEPTIC/HetBtNB TANK TO: Cn ti To property line /0 Absorption field ffWater main/service line L6 v G <0 v' m O Z Absorption field on lot /00 ; On adjacent lots /_0 I� Public sewer manhole/cleanout '� le Public sewer main i4, Sewer service line 2f Petroleum tank Z ME R RESULTS: Coliform �17) Nitrate G I gs-M4�L Other bacteria O S & S ENGINEERING Date of sample: 6 — 6 — 9 S Collected by: 1203d Page River Loop Road No 204 Eagle River, Alaska 99577 B. SEPTIC/HOL-DM TANK DATA Date installed 8/ ;,.Tank Tank size / O o O qct./. Compartments Cleanouts&/ I) '" �1CS Foundation cleanout (Y/N) YeS Depression (Y/N) IVO High water alarm (Y/N). -/V i%. Alarm tested (Y/N) Date of pumping G - 6 - '175 -Pumper roe's Pc, <.� A SEPARAT.ION'DISTANC.E,$ FROM SEPTIC/HetBtNB TANK TO: Well(s) on lote , 9 On adjacent lots /00/ Foundation %5 To property line /0 Absorption field ffWater main/service line L6 S rtacewater/drainage /06 r ,f�'? 1 -�-y -raS' 72-026 (3tM)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed N - Manufacturer Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical odes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: D. ABSORPTION FIELD DATA Manhole/Access (Y/N) off" Level at tested On adjacent lots Surface water Date installed G - 9 - 8/ Soil rating (GPD/Ft') 2 So -Ff 15)? System type %REA/c Length 1O3 ITrj7A-L.Width till-, Gravel thickness-� Total depth /O r Total absorption area 1030 `Z Cleanout present ON) over field (Y/N) IVO Date of adequacy test 6 - 6 - 9s Results (pass/fail) �o G ss for .3 Bedrooms Water level in absorption field before test 9 " After test 3- i %z Peroxide treatment (past 12 months) (Ya i✓oyE kNc w�/ If yes, give date N. . SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /00 On adjacent lots /00/ Property line /0 11 To building foundation /S / To existing or abandoned system on lot 1I1On/6' k -/yd wN On adjacent lots /o 0 / f Cutbank /V, A. Water main/service line /o Surface water /66 � Driveway, parking/vehicle storage area 2. -.;-1 Curtain drain Z� E. ENGINEER'S CERTIFICATION 1 certify that l have checked, verified, or conformed to all MOA and HAA guidelines in eff Signature Engineer's Name Date 6 /iu HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back 0 Waiver Fee $ Date of Payment Receipt Number this inspection. Rd9'ERl'* C11'.0 aA.?!'V ! 4� CE -8801 1/ I MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION RIZ'Y APPROVAL CERTIFICATE APPLICATION FOR HEALTH AUTHO 1. General Information 0 Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions)! (b) Applicants Namess Applicants Address ® Home Busin7­_230� (c) Applicant is (check one) Lending Institution • Owner/j�uilder Buyer g Other AA!! ``(explain), m (� (d) Lending Institution IVU Crnp�,, }i�CXbe� O N�Ga/ -C& Telephone276- Address FOLAC/� e f'i 9�4J ��O (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. Tvpe of Residence Single -Family 7J Multi®Family Other (describe) Number of Bedrooms 3. Water Suppiy Individual Well Community Public Note: If communi y well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite Public Community Holding Tank Note: I£ community well system, must have written confirmation from the State bepartment of Environmental Conservation attesting to the legality and status. [Page 1 of 21 1 .�! 5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information ; As certified by my seal affixed hereto and as of the validation date shown below, T verify that my investigation of this Health Authority Approval shows that the onsite 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 regula- tions in effect on the date of this inspection. i Name of Firm �lF � C (, tC'_ Telephone `j • /-, 0':Z t Address OF Date q� � ; ,a.a®."o ®® ® .°�' J AA A�n�OO .0 BABA Y �VA (ENGINEER SEAL) CDaGfa 00 $Ae 80688. C9 e neo e.•• 9i C� o aCLer 4. . GC. Reid, Jr. 6. DHEP Approval Q �j°oo R . 2251-E Approved for bedrooms By '��" - �PR0p Approved Disapproved Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/Dl8 [Page 2 of 2] 7•-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) i; J CHECKLIST - FEBRUARY 1984 Legal Description: Lo Of L'q A. WELL DATA A Well Classification pit V If A, B. or C. D.E.C. Approved(Y/N) w/A C Well Log Present 'Y ) Date Completed Yield Total Depth Cased to (0(/ Depth of 6routing L A Static Water Level gs © Pump Set At uAjAum - Casing Height Above Ground a / Sanitary Seal on Casing JYJN) Electrical Wiring in Conduit KEN) Depression Around Wellhead ( ) Separation Distances from Well: 0 To septic/Holding Tank on Lot ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot /001, ; On Adjoining Lots x/00' To Nearest Public Sewer Line Ajl/c�r- To Nearest Public Sewer Cleancut/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected By ate g5 Water Sample TestO0 Result's SAT IiS-flI 4 rne�1- - Comments I�� P� �1 - A � ► ule 5 Wr" -�e'=l,-'5 Wti` -,�- I vvaac �res- B. SEPTIC/HOLDING TANK DATA Date Installed Size 1 OO b No. of Compartments a Standpipes ) Air -tight Caps(Y)_) Foundation Cleanout Y �) Depression over Tank (Y ) Date Last Pumped V20 /�-S- Pumping/Maintenance Contract on File (YIN)_ N A for A) A - Holding Tank High -Water Alarm (YM) IJ I A-' Temporary Holding Tank Permit Separation Distances from Septic/Holding Tank: To Water -Supply Till I jX-/ To Building To Property Line -I- I ;V' To Disposal To Water Main/Service Line .f -/f} `%t` To Stream, i Foundation Field I Pond, Lake, or Major Drainage Receipt # `N Date Paid: I -�q_-r)� Amount: v#? (Page 1 of 21 1 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata I'm Type of System Design 772f.X14 Date Installed i fs Length of Field ( 6`3 Width of Field b ,�a w,t Depth of Field Gravel Bed Thickness Square Feet of Absorption Area �Q�j�_ Standpipes Present ) Depression over Field (Y ) —�--- Date of Last Adequacy Test ) P S Results of Last Adequacy 'lest 7n —4s �,� � rj��2�Y�r�� Separation Distance from Absorption Field: To Water -Supply Nie11 /DO To Property Line To Building Foundation /15/ To Existing or Abandoned System on Lot IU44- ; On Adjoining Lots —.3p ' •iet To Water Main/Service Line /5, To Cutbank(if present) .N To Stream/Pond/Lake/or Major Drainage Course +1"I ) To Driveway, Parking Area, or Vehicle Storage Area .4 Continents X-h2Fa uoe D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Comments Dimensions Level at Vent (YM) Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroan Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA on the date of this inspection. r— % Signed �, . Date Company MOA No.� 0•Ps • e KB1/d5/s oo.o [Page 2 of 21 'iii iyi s in effect �aaoee®eases �e� �� eeee%� e• % s a• i C. Reid, Jr.. c _No. 2251.E_-,.-*, �s9 ev B�•e e03eeee � G,. n�ro�rss�o��� p J 2-15-84 BILL SHEFFIELD, GOVERNOR ALASKA i DEPT. OF ENVIRONMENTAL CONSERVATION Telephone: (907) Address: ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 274-2533 January 28, 1985 1"'UIMCIPALITY OF AiCHORAGE CEPT. OF VIEALTH & ENVIRONI/ENTAL PROTECTION Ms. Gwen Turner Alaska Environmental Control JA[fJ 2 Services, Inc. 1200 W. 33rd Avenue, Suite B E C El V D Anchorage, Alaska 99503 e SUBJECT: Waiver Horizontal Separation between Well and Septic Tank, Lot 9, Block 9, Pruess Addition #4 Eagle River, Alaska (8521 -WA -098) Dear Ms. Turner: The Department has reviewed the subject waiver request and hereby waives the horizontal separation between the well and septic tank to 97 feet on the subject property for a 3 bedroom single family residence only. Sincerely, teve W. Eng District Engineer SWE/msm T!I 6-0A " Q a/' _" Ak , 5. LEGAL DESCRIPTION DAT RECEIVED INSPECTION APPOINTMENTS v TIME TIME TIME ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six DATE (� DATE \19— DATE -to-- INSPECT R 4INSPECTOR ❑ PUBLIC UTILITY INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE ��r O. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI(A kNVIRONMENL•,_ i::vi[CTION 825 LStreet -Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND S �S DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PTY OWNER /� PHONE ROPE / � n� MAI G ADDRESS0, � 2 �//O C `J�' �—J PHONE PROPERTY RESIDENT (it different from above) PHONE 2. B Y MAILING ADDRESS PHONE 3. LE,CNDD11��QG INSTITUTIO{�� � l GT(„�i-n / �c9L) MAILING ADDRESS - PHONE 4. REALTOR/AGENT MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ One ❑ Four ❑ Other UR--�SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY "' [✓INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM f [0' INDIVIDUAL/ON-SITE** "pl YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) aA--' wi THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED / LOG RECEIVED /n 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED / INSTALLER ❑Septic Tank or ❑ Holding Tank Size: 1000 If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL l 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE ( BY 72-010 (Rev. 6/79)