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HomeMy WebLinkAboutPREUSS #2 BLK 3 LT 4Preuss #2 Lot 4 Block 3 #050-572-20 Municipality of Anchorage Page A --of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report �� ��� 0z,_6-57,;? -Q0 Permit Number: PID Number: Name: T4k, -t-µo l"M6-3 C D Wastewater System: I New El Upgrade Add P-%Aax ,7701lo /�q-G L;o c�,V �k ii'' f%K �I�S7J ABSORPTION FIELD Phone: 'J (.l �I _ a, (� � `I No. of Bedrooms: O Deep Trench i¢ Shallow Trench O Bed ❑Mound ❑ Other LEGAL DESCRIPTION Soil Rating: �}(y Qs UGPD/S . FI. Total Depth from original grade: 1 Lot: Block:- Subdivislon: 3 Re Depth to pipe bottom from original grad e: Gravel depth beneath pipe � N55#'0� FL Pt. Township: Range: Section: Fill added above original grade: Gravel length: �{j � +� FI. v Ft. WELL: )k New ❑ Upgrade Gravel width: Ft. Number of lines: Distance between lines: Ft. Classiffc(�a�(�lon�(Privatej. A,R, Cj: T'chat t2eptthh: Ft. Cased To: q( p� FL Total absorption area:Pi _ VSO. FL a material: /^ �! teL Drills i P ID14 Ori Date Devilled: Sta,kWater Level: Installer:/ri�� ,IJ Datelostolled' Yield:P'udmp/getat: 6GPM &PW Ca sing freight Above Ground : a TANK ✓ FI. Ft. SEPARATION DISTANCES r� gSeptic El Holding ❑S.T.E.P. To From Septic Tank Absorption Field Lin Station Holding Tank Public/Private Sewer Lines Manu c�ren - 1I__�t a� Capacity in gallons: I �� Well �/� ((JJ ((�k IOOt �S //i�� rs }. Material: �` e� Number of Compartments' Surface Water '0 1t ,,,0 LZJ 1 LIFT STATION Lot /� \ `r` ��^) l Size in gallons: Manu er: Line /} Foundation of 1 1 , 111 "Pump on' level at: "Pu 1" leve High wafer alarm at- CCurtain Curtain Drain Pump Make el Electrical Inspections performed by: Remarks: BENCH MARK Location and Description: TOO 0-f A41-114le Mannered Elevation: (©c Ft EN�{p�q�AL C)F 5 1G S ENGINEERING�,;•., :� r�" � 17034 Eagle River Loop Road, No. 2_Q4 Inspections by:Eagte performed River, Alaska 9957Z Dates: 1s 2ndi..yR.c tit OBERT ca F.`n�l g 11 IOCf Department of Health Human Services "c •., CE - aaoI and approvali�F�:,,• ,meq Reviewed and approved b n -� i-ek o pp y: Date:�'�+ ti�ltJpFOFF"�, 72-013 (Rev. 9/91( MOA 25 PERMIT NO. SWOO0004 PAGE 2 OF 3 Municipalit of Anchorage e DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 (D Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 4 BLOCK 3, PREUSS #2 P.I.D. NO. 050-572-20 LOT 5 � DBL1 & DBL2 NEW 1250 GALLON 10MIN. IF' SEPTIC TANK z w IASPHALT D w RIVEWAY ST2 \\ V) N SCO1 - MT1 \v\ATH#2 I } TBM FCO \N\ A \F\ Z� y�Fp OG tic P� S'0 Zn \ 10' MIN. I C 10' MIN. V MTI ®� TH#1 CO2I I U 11 100' WELL RADIUS 100' WELL RADIUS APPROXIMATE LOCATION SCALE: I" 40' " ,C?LOT 3 I r °84 ROBERT C. COWAN i � / /�� CE -8801 F,t... kkj, +� PERMIT NO. SW000004 PACE 3 OF 3 aQe DEPARTMENT OF Municipalitv HEALTH AN®horHUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 ®N -SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 4, BLOCK 3, PREUSS #2 P.I.D. NO. FINAL GRADE Ifmf 001l:iI!7 ST1 ST2 95.0' NEW 1250 GALLON SEPTIC TANK CO1 MTl CO2 MT2 COI - 100.4' CO2 - 96.8' --FINAL GRADE MT2 = 88.8' 0 NO WATER FOUND 82.8' B.O.H. 100.4' 050-572-20 2" INSULATION N. T. S. A B C FCO 5.5' 33.0' — ST1 22.0' 40.0' — ST2 30.0' 45.5' — DBL1 34.5' 53.0' — DBL2 34.0' 53.0' — CO1 18.5' 50.0' — MT1 20.0' 53.0' — CO2 66.5' — 44.5' MT2 1 67.0' — 46.5' N. T. S. Aug -15-00 03:04P THE THOMAS CO- INC- 694-5202 MunTeipality of Anch"age Department of Health and Human Services 825 " L' Street P.O. Box 196650 Anchorage, Alaska 99519.6650 Rick Mystrom h1tp:JNAvw4.c1.anchorage ak.us Mayor P.03. Permit Number: #SW 000004 Date of issue: 1-13-00 Parcel Identification Number: 050-572-20 Date Started: 7-25-00 Date Completed: 8-4-00 Is well located at approved permit location? ® Yes ❑ No Legal Description: Preuss 42 Blk 3 Lt 4 Property Owner Name & Address: Jason Wamer. c% Dick Brown 17034 Eagle River Loop Eagle River, Ak 99577 Borehole Data: Depth (ft) Method of Drilling ® air rotary ❑ cable tool Soil 'lype, Tlticknass & Water Strrata. From 1'o , Casing type: steel stick-up 0 2 Wall Thickness:.025 inches silty gravel gravelly silt silty water sand &gravel perched 2 14 77 14 77 81 Diameter: 6 inches Depth: 280 feet Liner Type: Diameter: inches Ucpth: feet Casing stickup above ground: 2 feet cobbly gravelly silt w/. bldrs gravelly cobbly silt 81 145 145 234 Static water level (from ground level): 227 feet Pumping level: 224 1•eet atter silty sandy gravel & H2O 234 242 2 hours pumping 8 gpm gravelly silt 242 281 Recovery Rate: 8 gpm silt- grey 281 320 Method of Testing: airlift Well Intake Opening Type: ❑ Open trod ❑ Open dole ❑ Screened Slarl legit Stopped feet RECEIVED ® Perforations Start 234 feet Stopped 244 feet Grout Type: WI(ngg J) 8 Volume: "Ib, AUG 78 2000 Depth: Start 0 feel Stopped + fcot Murtici Dept. We la thi& Human Anchorage ry1Ceg Pump: Intake Depth feet Pump size hp Brand Name Well Disinfected Upon Completion? M Yes ❑ No Method of Disinfection: Clorine Tablets Comments: Well Driller: Alpine Drilling & Enterprises P O Box 110496 Anchorage AK 99511 Attention: The well driller shall provide a well log to the property owner within 30 days of completion and the property nvmnr nr thn vmll rlrillnr ch•all nr,,,id... nll Inn to tl o nl m of Unohh R, W.,,, Qnrvirr+c with:, Ao stove of rmm�l.+rinn ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Date Issued: Jan 13, 2000 Expiration Date: Jan 12, 2001 Permit Number: SW000004 Parcel ID: 050-572-20 Legal Description: PREUSS #2 BLK 3 LT 4 Design Engineer: 0003 S & S Engineering Site Address: 010129 PREUSS LN Owner Name: Jason Werner Lot Size: 19665 SQ. FT. Owner Address: c/o Dick Brown, 17034 Eagle River Loop Total Bedrooms: 4 Permit Bedrooms: 4 Eagle River , AK 99577 - This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage All construction must 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 engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: '4 /2- 4.Z_ Date: I --ILI- 00 Date: — 3 OG MUNICIPALITY OF ANCHORAGE Department of Health and Human Services K f{ On -Site Services Program 7, p e j 2- 825 L Street, Room 502 826 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Date Issued: Jan 13, 2000 Expiration Date: Jan 12, 2001 Permit Number: SW000004 Parcel ID: 050-572-20 Legal Description: PREUSS #2 BLK 3 LT 4 Design Engineer: 0003 S & S Engineering Site Address: 010129 PREUSS LN Owner Name: Jason Werner Lot Size: 19665 SQ. FT. Owner Address: c/o Dick Brown, 17034 Eagle River Loop Total Bedrooms: 4 Permit Bedrooms: 4 Eagle River , AK 99577 - This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage All construction must 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 engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: '4 /2- 4.Z_ Date: I --ILI- 00 Date: — 3 OG ROBERT C. CIVIL ENGINEERS (907)694-2979 FAX(907)694-1211 P.E. November 30, 1999 HEALTHAUTHORITY APPROVALS MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 SEWER&WATER Anchorage, AK. 99519 MNNEXTENSIONS REFERENCE: Lot 4, Block 3, Preuss S/D SEWER & WATER INSPECTION It is requested that you issue a permit to install a well and a septic system to serve the proposed four bedroom dwelling on the referenced property. ENGINEERING STUDIES Two test holes were excavated and percolation tests performed. The approximate location ANDREPORTS of the test holes is located on the attached site plan. At the time of excavation, 11-4-99, no water was found. After seven days of ground water monitoring, no water was found. WELL INSPECTION WELOWTEST We do not anticipate an adverse effects on neighboring wells septic stems reserve P Y g p systems, areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. SITE PLANS If you require additional information, please contact us. ROADDESIGN SOILTEST ^Sincerely, Robert C. Cowan, P.E. RCC/bjj PERCOLATION TEST Enclosure - STRUCTURAL& MECHANICAL- ECHANICALINSPECTIONS INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER. ALASKA 99577 P.E. 1 " = 60' 10' UTILITY EASEMENT DESIGN SITE -PLAN U' O O O � V➢W a�mm SCALEJ I ago SNA � � �WCAm � �.oeAJ..�mbA.sxD�a zizNo O jig p(7p II � Nbb9 ,1 �i EoH I � �J➢o oma � ,�.. N� $ n n — — — — — — — — O p O r I 10' UTILITY EASEMENT W I W — — — — — — — — r o_o co O o C) n 3 £ N O G,) a� rDyi � p 0� D p s C J oA a (� o� ® n r c y m D r A OD O Z Cl tJ D � n m_ r^ tiN I O Z _ cn V1 I PREUSS LANE O E pAwo y O �A SAZX ZD u L y �. oco r� f0 n u o OCO yo £ D o� Arn tee' 3Sf1�H L m zyA T1 ��� I Go>3�'g HUM138 N 83Sododd-J 4 A xrA d o" N J r� CIO P)31o! I. wl 10' UTILITY EASEMENT Z' mU ..R ^\� P)31o! I. wl 1" = 30DESIGN SITE—PLAN OOo z Na r q�z 0 0m z mm� O N � PIRIEUSS LANE om < C� u O o V X _ <dd ❑sn❑H D F F] HOUNG❑fi v F n o nF� Q:IS ❑d❑dcl c zom o F �F ti x z oD d y � o o z _ CD 0 0 fU MENT I O O E l O W K , n =off W L I O II o I O rn�nt E l O W K , n O O -ti W L I O II o �co (--)O O O Noce Cd 000 r L., O L� � wy C; CID I O • r• vs'. �a l � A , � K1 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: .a k`5/o1V L-J'e (%' t- g iL LEGAL DESCRIPTION: L'�r3� �xo"C-a S/ ,D R! ©� 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS 4W �VA DATE Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water Aller Monitoring? _ R:4 (LN61141 HIS SLAL) CL -8801 SITE PLAN Nv S 1-1 L O P E Dale: Reading Date Gross Time Net Time Depth to Water Net Drop ��. Otc1�— (illioo D 3 9^ 3" 3-1 PERCOLATION RATE /V (min Wes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 41 FT AND FT S & S ENGINEERING ` i/ A G�Z✓� PERFORMED BY: 1 �.., CERTIFY THAT T IS TE T WAS PERFORMED IN 17034 Eagle River Loop Road No. 204 ACCORDANCE WIgdd&L.I&6 f)EA\1tj9jdL"$tJFJAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) PEHFORMED F Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST 16- 17 18- 19- 20- COMMENTS 81920 COMMENTS /x-50,,) W 1-te e°2 DATE PER P2aF_Ss `16 Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT �'A L t D DEPTH? P E Depth to Water Alter Monitoring?_ Dale: (IJI(AHLLII:-; SCAL) T., ..--- SITE PLAN ROBERT C. COWAN Reading Date L q B 3 LEGAL DESCRIPTION: Net Drop 'PE-TI11 FFT1 Op— 2 3 /- 4 'y 6 f _ >• 7 ` 8- 9 J~ it -r 12 14 15 16- 17 18- 19- 20- COMMENTS 81920 COMMENTS /x-50,,) W 1-te e°2 DATE PER P2aF_Ss `16 Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT �'A L t D DEPTH? P E Depth to Water Alter Monitoring?_ Dale: (IJI(AHLLII:-; SCAL) T., ..--- SITE PLAN ROBERT C. COWAN Reading Date Gross Time Net Time Depth to Water Net Drop 'y 7D �N r -J >• Z " PERCOLATION RATE `Z (minutes/inch) PERC HOLE DIAMETER {' TEST RUN BETWEEN FT AND `s-- FT PERFORMED BY: 7S7&$S ENG�INEERINGpp N (JAI � R(- CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITFf A950 kJA IE ARND HIUNLC1ppL GUI % 2t3ES IN EFFECT ON THIS DATE. DATE: (� Eag a ever, Alaska 99$77 72-008 (Rev. 4185) S&S\ pneeR1no ROBERT C. CIVIL ENGINEERS (907)694-2979 FAX(907)694-1211 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 ON-SITE WASTEWATER DISPOSAL SYSTEM APPROVALS Ri VHORItt CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS SEWER 8 WATER MAINEXTENSIONS REFERENCE: Lot 4, Block 3, Preuss S/D November 30, 1999 SEWERGWATER INSPECTION L+ i��T GENERAL: 1. The scope of this project includes the installation of a 1250 gallon septic tank and leachfield trench for the proposed four bedroom house located on the ENGINEERINGSTUDIES ANDREPORTS referenced property. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all WELLINSPECTION a ELOWTEST applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground SITE PLANS utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. ROADOESIGN 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing SOIL TEST their own systems must also receive prior approval from the Municipal Health Department. PERCOLATION SEPTIC TANK INSTALLATION: TEST 1. A septic tank is to be constructed by a certified septic tank manufacturer. STRUCTURAL& Construction shall include two 4" cleanouts for pumping access. MECHANICAL INSPECTIONS 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Page 2 Lot 4, Block 3, Preuss S/D November 30, 1999 All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page 3 Lot 4, Block 3, Preuss SID November 30, 1999 MINIMUM MATERIAL SPECIFICATIONS: L Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Tyne of Pine Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (] DPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current MOA or ADEC requirements, which ever requirement applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: Page 4 Lot 4, Block 3, Preuss SID November 30, 1999 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre - construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached MOA permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTORANSTALLER 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. 050-572-20-000 Expiration Date: 1/24/2024 Legal description PREUSS #2 BLK 3 LT 4 Site address 10129 PREUSS LN Eagle River AK 99577 Current property owner(s) JOHN DAVID W & CARRIE A X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 10/24/2023 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 X Arsenic Advisory Other COSA Approval_June 2022 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 Application 1. GENERAL INFORMATION Parcel I.D. 050-572-20 Complete legal description PREUSS #2 BLOCK 3, LOT 4 Location (site address) 10129 PREUSS LANE, EAGLE RIVER, AK 99577 Current property owner(s) DAVID & CARRIE JOHN 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 ❑ 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 ❑ Plastic ❑ Concrete ❑ Fiberglass Age 23 - 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. COSA Fee $ .� Waiver Fee $ Date of Payment t7 (Z 4 2Date of Payment COSA # S S- i 36 9 2' Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: PREUSS #2, BLOCK 3, LOT 4 Parcel ID: 050-572-20 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 8/4/2000 Total depth 320 ft Cased to 280 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 10/04/2023 Static water level at beginning of test 225 ft. Well production at time of test 4.8 gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 4.10 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 10/09/2023 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank 49” Date of pumping 9/25/23 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 8/07/2000 ALL standpipes present per record drawing Total measured depth from grade 11.6 ft (max) Measured depth to pipe invert from grade 4.2 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 10/04/23 Results Pass Fluid depth prior to test 29 in Water added 650 gal New fluid depth 40 in Elapsed time 1425 min Final fluid depth 29 in Absorption rate 600 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 48 in (MOA 4’ ED) Effective depth used 29 in (Final Fluid Depth) Effective depth (ED) remaining 19 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots & appears there is approximately 4’+ ED. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No 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’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ 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 FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 10/23/2023 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 10/23/23 MUHMG°AUTY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT o ,� _t�' On -Site Water and Wastewater Section T, www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval # OSC231398 Subdivision: Preuss #2 Block:3, Lot: 4 907-343-7904 Fax: 343-7997 The septic tank for this property is 23 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $10,000 or more, not including engineering, surveying or MOA permitting fees. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. Parcel I.D. 050-572-20 1 Municipality of Anchorage r On -Site Water and Wastewater Program <' (907) 343-7904 s x E r r Certificate of On -Site Systems Approval Expiration Date: GENERAL INFORMATION Complete legal description Preuss #2, Block 3, Lot 4 Location (site address) 10129 Preuss Ln Current Property owners) Jason & Renae Werner Mailing address 10129 Preuss Ln. Day phone - 3 o / 5— Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) SU13MIT ❑ DuplexTAL t3CT � .3 �Qf� ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual 7 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance Received by: WA u " Date: 101911,261V COSA to be released tote gineer, unless otherwise requested by the engineer. COSA Fee $ 5 Waiver Fee $ Date of Payment Date of Payment Receipt Number baa JFS Receipt Number COSA # 0'5C l y 1-55-? Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we Cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for __q_- bedrooms System #2 Approved for bedrooms Disapproved Date 10/17/2014 VNI .Steven .*Pony CE -8149 Conditional approval for bedrooms, with the following stipulations: By: / 2/,14 / Gv • Original Certificate Date: / The Municipality of A orage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only, upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professionaf engineer's work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet t , If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system I Certificate of On -Site Systems Approval Checklist Legal Description: Preuss #2, Block 3, Lot 4 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed $/4/2000 Sanitary seal (YIN) Y Total depth 320 ft. Cased to 280 ft. FROM WELL LOG Date of test 8/4/2000 Static water level 227 Well production ft. 9.p -m. WATER SAMPLE RESULTS: Coliform 44 colonies/100 mL Nitrate 3-7'y mg/L Arsenic /l b ug/L Date of sample: 10/17/2014 B. SEPTICIHOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,250 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (YIN) N Date of pumping 6/13/2014 Pumper JR's Pumping Parcel ID: 050-572-20 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. AT INSPECTION 10/17/2014 223 5.1+ Collected by: PES ft. 9 - p.m - Date installed 8/7/2000 Cleanouts (YIN) Y High water alarm (Y/N) N C. ABSORPTION FIELD DATA Date installed $/7/2000 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 GPD/SF System type Shallow Trench Length 78 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 9 ft. Eff. absorption area 780 ft Monitoring tube Y Depression over field N Date of adequacy test 10/17/2014 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 27 in. Water added 644 gal. New depth 38 in. Elapsed Time: 1440 min. Final fluid depth 27 in. Absorption rate >= 600+ g p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' level at Datum E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 50+ Manhole/Access (Y/N) _ in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 10/17/2014 COSA brown sheet 10-10-12.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage11 0+ in. Lot 5 S 89°591t30`E 151.37' ; lot 4.1; , cR ive i w ta.e 490 -'..'..-t ; DQ 13.a' •y0"GtasT. r#: [I.:' :-- CS 32.1' .o' j q.t. `• T-'-� � C[ _ - I 01 l( CL az i"i - m EPnG�-i.P- Z:) -' N 8905VOGO W 151.19' - k Y'Zr l ' l0" UTILITY EASEMENT Lot 3- 3ajoo, PLOT PLAN___ kSBUILT SCALE i" ' GRID ' S8 project I+Io LtJti A83QIG�Q�Q�' Tt1%s 11504 Daryl Avenue, Anchorage, Alaska 99 15�r�''� -- 907 522-6476 Phone �b �Regisfired Loud Surveyors (907) 522-4625 Fax 1 heist>y cer8fy that IIhave surveyed the following desoribed propscly �yv�' Lot.4, 91ock 3, PREtISS'SUB0., UNIT No. 2 Anchorage; Recording pistrict, Alaska, and that the improvements actuated (, *� thereon -ore -within the property fines and do not encroach onto the property ! adjacent thereto, thatJ no Improvements on the properly lying adjacent thereto % f encroach on the surveyed premises and that there n a-na roadways, tranamI Ion lines or other visible easements on sold property except ce indicated hereon, y fi HENNETN G. LA 6: p11Jhts the -Z nay of :F.L_ k-)i r 2aoo at Anchorage, Alaska; fLS� - t 4 X0.1'="..� :'rpta it Ls the risponsit>iii l of the owner t� determine the existence of any edsem�rrts;:aoranants. or reshfatiort5 which do not appear on the recorded N Subdivision piafi l �� _ r_ Municipality of Anchorage • Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www. c i. anchorage. ak. us (907)343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY DWELLING Parcel I.D. 050-572-20 HAA# �Gh Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 4, Block 3, Preuss #2 Location (site address or directions) NHN Preuss Lane Current Property owner(s) The Thomas Co. /Mike Thomas Day phone 441-2664 Mailing address PO Box 770110, Eagle River, AK 99577 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address % Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up 2. NUMBER OF BEDROOMS: 4 Si�>y�oc 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 ❑ Public Sewer ❑ The Municipality of Anchorage Department of Health and Human Services (DHHS) 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. 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 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. 72-025 i Rev_ 0 00,' STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. S & S ENGINEERING Name of Firm 17034 Eagle River Loop Road No. 204 Phone 6 CT/1 '1-61 7 C) Address Eagle River, Alaska 99577 Engineer's Printed Name 6. DHHS SIGNATURE Robert Cowan V� Approved for 4_ bedrooms. Disapproved. Date Vji� /6'c c CF q-Ilk GINEER'S Yi^.1 '•. 12. f1 A . r1 -^t R03EERT C. COWAN �.) "•'' '•� CE - 8801 Conditional approval for bedrooms, with the following stipulations. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other ey: /r/ �, ! a�� Original Certificate Date: I - U Expiration Date -5 025 rRev. 01 00)' /' a i - O'� Reissue Date: Municipality of Anchorage • Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-4744 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: I-OTq 13 Lo C K 3 PR4-u-S_S # Z Parcel I.D.: CS -0 --S?;k-ao A. WELL DATA Well type ('R)v &i k If A, B, or C provide PWSID # — Date completed i" Sanitary seal _Y6T Total depth 3a -o ft Cased to ft FROM WELL LOG Date of test `6 ) 40 a Static water level -a- a 7 ft Well production q g.p.m Well Loa '% E- 3 Wires properly protected Y4S Casing height (above ground) of `I in. AT INSPECT ON r! � ft g.p.m WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml Nitrate mg/I Other bacteria O colonies/100 ml Date of sample: 110100 Collected by: S & S ENGINEERING B. SEPTIC/HOLDING TANK DATA 17034Eag1e River Loop Road No. 204 Eagle River; ;Alaska 99577 Tank Type/Material S &)o i) +; S [_ Date installed 9/1/80 Tank size 1 a SO gal Number of Compartments 2 Cleariouts 04 Foundation cleanout 'Yl --S Depression over tank "0 High water alarm A119 Date of pumping 1414 Pumper C. ABSORPTION FIELD DATA S'14 g«a Date installed. I D /0 0 Soil rating g. .d./ft2 or ft2/bdrm) 0. 8 System type c�H Length g ft Width ft Gravel below pipe __�_ft Total depth It i ft Effective absorption area 760 ft2 Monitoring tube Y6S Depression over field Nv Date of adequacy test t)14 " Nky1 Results (Pass/Fail) % For bedrooms Fluid depth in absorption field before test Elapsed Time: min Any rejuvenation 72-026 (Rev. 01/00)' depth 12 mo.) (Y/N & added gal. New depth in. -in Absorption rate >= g.p.d. yes, give date D. LIFT STATION Date installed "Pump on" level at Size in gallons M in "Pump off" in High water alarm level at in Cycles tested Meets alarm & circuit requirements E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot /00,1- On adjacent lots )0014- 1 Absorption 004 - Absorption field on lot /00 4 On adjacent lots ) 00 1/ Public sewer main N 4 Public sewer manhole/cleanout JV1R Sewer /septic service line a S L Holding tank A)14 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line 1 Absorption field Water main of /. Drainage tV'I A l Water service line /D t Wells on adjacent lots J00 4 Surface water J o J a SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line `� / Building foundation / 3 Water main N A Water Service line JrJ t Surface water / 0D -/- Driveway, parking/vehicle storage_ I3 -t- Curtain drain N-n,JYi- K1J01.1/)J Wells on adjacent lots ) O 6 4 F. COMMENTS G. 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 HAAuidelines in effect on this date. """ `"" q pg d+ 4 ROBERT C. COWAN Engineer's Printed Name N �✓3��� �- CdwJ1� 14/s1f�gCE-8801 Date 53 (/16 A 0 1kh�;�ror�ssiottT`� HAA Fee $ 30p, cl� Date of Payment r 1:1 - CT�� Receipt Number C1 72-026 (Rev. 01/00)' Waiver Fee $ Date of Payment Receipt Number ! CT&E Environmental Services Inc. CT&E Ref.# 1004615002 Client PO# Client Name S & S Engineering Printed Date/Time 08/15/2000 15:20 Project Name/# N/A K 2 Collected Date/Time 08/11/2000 14:00 Client Sample ID LA B3; Preuss AS/D Received Datefrime 08/11/2000 16:20 Matrix Drinking Water Technical Director Stephen C. Ede Ordered By PWSID 0 i Released By Sample Remarks: Allowable Prep Analysis Parameter Results PQL Units Method Limits Date Date Init Waters Department Nitrate -N 1.18 0.500 mg/L EPA 300.0 10 max 08/11/00 SCL Microbiology Laboratory Total Coliform 0 col/100mL SM189222B 08/11/00 JDT 0