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PREUSS #3 BLK 11 LT 6
Preuss #3 Lot 6 Block 11 #050-572-29 Municipality of -Anchorage ••:: - ,a Development Services Department Building Safety Division On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage. AK 9951M650 Page of www.ci.anchorage.ak.us (907) 343-7904 I ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: 0q00:3 "T PID Number: Name: n t",efe a r- Wastewater System: ❑ New �. Upgrade . Address: p aD07Lan. /ive efcive 9qS ABSORPTION FIELD Phone: Number of Bedroorre O Deep Tnxdi $fShabw Trend, O Bed ❑Mound O Other. LEGAL DESCRIPTION SodRatn¢Tow Depth hm originai pade: DI Gpiwe �/ Ft. &pelt: Lot: Subdivision• Depth to pipe bottom from original �. Gravel depth beneath pipe: Flo -3 Ft. Township: Range: Section: Fill added above original grade: t � Fl. Gravel Length: 70 Ft. Well: ❑ NewUpgrade Gare( wadK Fl. " rrwex Distance between bines: ❑ --��' Ft. as90cabon (Private. A. B. C): Total Depth: Cased to:.. --- Total absorption are: e Mat Ft. Fl= Driller. -Date-Druted: Static Water Level: Installer l Date installed: Yea: Pumn p Set at CasmgHeigMAbovgGroundFl. 'ef )� aJ1a GPM Ft.FL TANK SEPARATION DISTANCES 0 Septic ❑ Herding I•S.T.E.P. ❑ Other. To Septic Absorption Uft Holding 3ub9dPrivate n paotr: From Tank Field Field Station Tank ^SeeweerLine Pre -VII a/,�PIC.S / GS 1304 Gat. Well I W + ( i /1� % I V O'1' �� O(J � Menet: ^ 1 ee "� or Cariparunents: Surface Water 11 0 (/ I DG'•� 10/ ) 4-1 �/ LIFT STATION of Lot Line �F ` 16' 0' I �DO Gal. P \ \ i 'Pump On' lewd at: •Pump off' level at High water alarm aC Foundation Tmin � /. S h. a.-1/114 in. Curtain Oran jaMake a Model Electrical 6}ZrOCpOS RSIn.G�vl Remrris: J BENCH MARK ��G{ ✓1 t...�q L,crY� �� London and Desa+pbon: IL ec ll r S 7 iZ I li i 0 P! 4, „ Assumes evauon: /t -s 3 0 0!» 145 Ft. 3/i6fr D,,A . S/°A��EU a. 3 r o _C S & S ENGINEERING i .''. ,• • �� 17034 Eagle River Loop Road, No. 204 '' // >- - >_'%/ > • ••»«.•>:•_•.,.ap Inspections performed by: Dates: 1� 3-.3 —O7 GFS', ' ..'✓�_ 2nd q—I _0q till ROBERT G COWAN• r OZ- Development Z-Develo ment Services Department ApproZl P���`�• c`"8aol ,.••'���r i Reviewed and approved by:Date -� I PERMIT N0. SW040035 PAGE 2 OF 3 MunicipaUtAof Anchora e DEPARTMENT OF HETH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Te'l�ephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 6, BLOCK 1 1 , PREUSS S/D ##3 P.I.D. NO. 050-572-29 10' UTILITY EASEMENT EXISTING TH#1 TRENCH MT2PPOLER MT1 • r 7��RENCH DV 1 DV2 Q 2 \w TBM k J 13/, A B Q3Q EXISTING 3 BEDROOM HOUSE LOT 5 LOT LOT "7 FCO T STI ° WIGARAGE H DECK MH C 3� 3I SEPTIC h, � c AREA y LUCAS AVENUE SCALE: 1" = 40' :f: Fri•',. �..,L,� ROBERT C. COWAN f CE LOT 6 -8801 .'�`•e� . f PERMIT NO. SW040035 PAGE 3 OF 3 Municipalit of Anchora e DEPARTMENT OF HEATH AND HURAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Tel 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 6, BLOCK 11, PREUSS S/D #3 P.I.D. NO. 050-572-29 FINAL GRADE ST1 MH ,-90.3 NEW 87.3' 1300 GALLON POLYETHYLENE SEPTIC TANK MT2 MT1 MT2 = 101.9' MT1 = 101.8' 98.5'9: SR DISTRIBUTION PIPE 2" INSULATION FINAL GRADE 2" INSULATION MT2 = 95.5' -� "-MTI = 95.5' NO WATER FOUND 89.0' B.O.H. N. T. S. A B C FCO - 38.5 22.5 ST1 - 47.5'_19.5 MH - 51.0'17.5 MT - 42.5 23.0 DV 1 38.5 14.0 - DV2 39.5 15.0 - MT1 42.0 25.5 - MT2 42.0 6',1.0 - N. T. S. 1 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW040035 Legal DescriptionIPREUSS#3 BLk�-.1.11T:76-p Design Engineer: 0003 S & S Engineering Owner Name: Peter Muller Owner Address: 20607 Lucas Drive Eagle River , AK 99577 - 14) ?--1 T)q aK Date Issued: Mar 24, 2004 Expiration Date: Mar 24, 2005 Parcel ID: 050-572-29 Site Address: 020607 LUCAS AVE Lot Size: 22531 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: 0 Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. ❑ Private Well ❑ Water Storage 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 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: Date: kA Issued By: Date: Municipality of Anchorage Development Services Department 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 (07) 343-7904 �- -ON-SITE SEWERPANEL-i.-PERMIT APPC_IG;%.TiL;; FOR A SINGLE FAMILY DWELLING Parcel I.D. �S Z`- Permit Number SW Property owners)r`�— tA uk �--L- �- Day phone � O I (-, C-�- I Mailing address (1) Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) -� pi-eW S -17-3 Legal description (Section, Township & Range) Z��O�� l.l� l K -y /V) U0' Lot Size as . S�_Acre Sq.Ft. Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening'Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. S & S ENGINEERING 17034 Eagle River Loop Road N0. 204 v__1-_Vt.Ar_ 1a%ka 99577 (Signature of property owner or authorized agent) Permit Fees: 4h 1190 Waiver Fees: Date of Payment: -?—s. `-t Date of Payment: Receipt Number: Receipt Number: (Rev. 12/00) S&SN �in��ninG ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CML ENGINEERS (907) 694-2979 FAX (907) 694-1211 March 16, 2004 HEALTH AUTHORITY APPROVALS MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 SEWER&WATER Anchorage, AK 99519 MAIN EXTENSIONS REFERENCE: Lot 6; Block 11; Preuss Subdivision 43 SEWER & WATER INSPECTION It is requested that you issue a permit to install a new trench to serve the existing three bedroom dwelling on the referenced property. ENGINEERING STUDIES The test holes and percolation tests were performed in April 1990 by Mr. Lou Butera P.E. AND REPORTS The test hole logs report finding ground water, but the depth was not recorded. The original pipe for ground water monitoring was monitored and found to be dry. WELL INSPECTION The design is based on the assumption that the test,holes were stopped at the level of the & FLOW TEST ground water found. The new system is placed so the bottom of the gravel is 6 feet above the test hole bottom. SITED This lot as well as lots on either side are served by the AWWU Public water system, therefore contamination of wells is not a critical factor. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed trench. The installation of this trench will not prevent any MAD DESIGN future development on any of the adjacent properties. If you require additional information, please contact us. SOILTEST Sincerely, PERCOLATION/!/ 7 v r TEST Robert C. Cowan, P.E. RCC/bj j Enclosure STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUfTE 204 • EAGLE RIVER, ALASKA 99577 DESIGN �N -0 m� SITE -PLAN –2W^ —vLnw ;N. Mco -r S' o I O Ou ►� � O O U7 - ►� a rZi�> <� m PNwI �j r Om0 -*� > �—+ �,_� rq JC)ID > r, m Z m m ../ 7<- -y 1�0 NNr �rn p D 0 -i�< rnO'- �140$ m N Z;O;u 40 J��o Z G SNN N=� Ori On, o-+ z22C7 z > C7 CA Cj = y owmm D�� MZ N z C� X Ul >mCD►- Mco -r CONE to IA *aD IC � mO O—m C� MZ 1i ;� IIS • I\ II\No 0Rn O n O N 0 F_0X Im D IU) m xm N Z �v I CONE to IA *aD A4N-(Aw d T,LnO � O—m C� l � • VIN 1 % �, � z 1i ;� IIS • I\ II\No r, ztnZ Zmrr- SII OII �Dc) ZN -i�< rnO'- ui Dm m�cn Z;O;u M MM D� ^O mcg SNN N=� o z22C7 z > '-; CA n �O = O MZ N z Z= c) X m � c0 Fri ^m^ -c 0 �f./) 'L1 Mm -° M D w cn Im D IU) m xm N Z �v A4N-(Aw d T,LnO � O—m C� l � • VIN 1 % �, � z 1i ;� IIS • I\ II\No r, p bo m SII OII Ln 00� C) L-4 -o o CA O Lm ANT m O X Fri ^m^ 0 h--� 'L1 g w cn I cn co I C/) 0 . C7 v. pEm0 -1 Z ;o Ej N M Z D C 1 c o y o >F r z-1 �N O M X p 00a ami CA o z o ij trn" l � • VIN 1 % �, � z 1i ;� IIS • I\ SOILS LOG — MUNICIPALITY OF ANCHORAGE PERCOLATION % ,�,• DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 825 L. Street, Anchorage, Alaska 99601 264.4720 ��-- SOILS LOG — PERCOLATION TEST ;1 DATE PERFORMED: Z/,L/f 0 Of PERFORMED FOR: J�Orrr, r - LEGAL DESCRIPTION: >` �J-94eXX SLOPE SITE PLAN P::Pp 12 54,.�sl� Grw✓e/ 1"'1�g3 N -'tr. Os y�� "L 13 4 fir' " cQ'U.•q„o..�.,,s? `�4 does, S WAS GROUND WATER yES l ENCOUNTERED? ��.— 0 /P IF YES, AT WHAT Nit ►..i.r�>Niy E DEPTH? Grose Nat Depth to Net Roedin0 Deta IT me Time Weser Drop 72.000 (61791 I Saba* 0se.o.• . �t �b I%41 �� • ........ ....... o 17 �t G'yL t •�.:; ?ultra w� rl �' $ = S' �G �s �� Q ��l''• •• N A iJ FP.S �r0i S 19 LEI 3-8 /6 /6 20 PERCOLATION RATE $r N (minutes/inch) FT TEST RUN BETWEEN ..----� – FT AND COMMENTS K efrv41'..,a 6Xq ��"'� OT ma••/ r d!t rrJ v d•,t✓.T, G✓ .r dG✓iyc+Y I�•_�•c.ar7` ` PATE: r^ PERFORMED BY:^,_ /f,04/Pe_CERTIFIEDBY: 72.000 (61791 I 0 SOILS LOG MUNICIPALITY OF ANCHORAGE f • } DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION lTEST 826 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: �orn+� e,r DATE PERFORMED: f/Ae>/so LEGAL DESCRIPTION: 1-,07,-.1 �K / ,���M I I SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 SAP.,Wy d-/4YG/ w,i� aGC�.is: 17 � �•��..es..�a.''Y�1,1_ as ^0pROFESS�ON;i'O"' a04oa�n.•s�•• WAS GROUND WATER S ENCOUNTERED? yEs 0 B. - P IF YES, AT WHAT N•t DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop FTI 1-77 20 S H.oa .. J -/.. UPERCOLATION RATE /lJ_(minutes/inch) TEST RUN BETWEEN FT AND V_ FT COMMENTS 15A e/iy'. f,. a �h e1/+•.-fr Rti /y r1- At �7i� ifarY cr �or 6 rW- 41.f avr ul.✓rv�'' 1-��j are✓�./�" PERFORMED BY: /e•N ee CERTIFIED BY: r.f.-7 - DATE: -el � 72.008 (6/79) HEALTH AJf HORITY APPROVALS SEWERMATER WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELLINSPECTION d FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSYSTEM DESIGN S&S1 1 -in epung ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 6, Block 11, Preuss Subdivision #3 March 16, 2004 GENERAL: ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 1. The scope of this project includes the installation of a pressurized drainfield to serve the existing three bedroom residence located on the 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 applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Page 2 Lot 6, Block 11, Preuss Subdivision #3 March 16.2004 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. 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 holes faced downward. The distribution piping is to be of PVC (ASTM D3034 or equal). All joints are to be solvent cemented. 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. 5. 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. MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. Page 3 Lot 6, Block 11, Preuss Subdivision #3 March 16, 2004 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Tie of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) 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 MON, 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 M.O.A. or D.E.C. requirements, which ever specifications applies. Page 4 Lot 6, Block 11, Preuss Subdivision #3 March 16, 2004 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: 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 M.O.A. 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 and the M.O.A. 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 cavy 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. CONTRACTOR / INSTALLER Municipality of Anchorage Page of 2 - DEPARTMENT DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 9z19Z37 PID Number: o_-0 X12 - al� Name: � Wastewater System: ❑ New >I -Upgrade Address: q �`iS'Y� Zo CoO �{C,/�S Atlb. �A�P L.6 Qt�k. r, ABSORPTION FIELD Phone:_ ¢_ 31 S 3 No. of Bedrooms: 3 ❑ Deep Trench,'Shallow Trench El Bed D Mound 11 Other W�n1--)970 LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: O. 8 GPD/Sq. . Ft. S Lot: Block: Subdivision: 2 4. Depth to pipe bottom from original grade: Gravel depth beneath pipe 1' puss 3. Ff. 1.5 Ft. Township: Range: Section: p Fill added above original grade: Gravel length: 1.5r ^"00_%s Ft. CSZ5 Ft. WELL: El New ❑Upgrade Gravel width: S Number of lines: Distance between lines: Ft. i Ft. si Cfication (Private, A,B,C): tU Total Depth: Cased To: Total absorption area: / Pipe material: Svc ZkLM- .a PSC -t c_. ( Q *-Mjr— Ft. Ft. S*P3 SQ. Ft. Driller: �Vj L4j t 1 "� Date Drilled: Static Water Level: Installer: Date installed: Ft. /� LIJA4,9G -r _ C0&32.T / 2 — g /% Z Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES 11 Septic ❑Holding >S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines jQ00+AA'_.r-p.m ( Well �^ �� Material: C Number of Compartments: Surface Water (E7p i-}- I olp'-F- t 00�'fi' --" LIFT STATION Lot Size in gallons: Manufacturer: Line f Z, I Z Z _ AAocB_ % r_O /LPAXXo SO' Foundation "Pump on" level at: "Pump off' level at: I High water alarm at: 1 " 4Z 4•Z 4 -4 - Curtain Pump Make & Model Electrical Inspections performed by: Drain i LLx7GO_R.. Remarks: BENCH MARK Location and Description: r_. cR ":--)2,.t U(rr ' -w Assumed Elevation: ENGIAAER a sp a L � Inspections performed by: / Dates: 1st 2nd 5 /9 5Z y, Xr! a Day.!_,\ f=�.yno455I hin t,�i t -P 3D NO.6H 6 0 6 Department of Health and Human Services approval %F'JP'oFrs �t�� Reviewed and approved by: t-- �— Date: 72-013 (Rev. 9/91) MOA 25 V1v Permit No. S 1,/ 172-02-3,7 Page 2' of Z_ Municipalityof Anchorage 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 Legal Description: 1,.>-r 6° 1?)L 11 ulz�s *3 PID No.: 72-013 A (Rev. 9/91) MOA 25 1 11 = z ®, a 14'� _r-j1u Eyd0_ T7,, CxA T7,, A�;�- IoZs 0.YrlCrT' �5.�7 Y'ZSC:> ENGINEER'S SEAL 14 David R. Duyiiia W. aa13,5! �aveoo os oae"°0 E IRP MT -I lot /4>Z77/- 7;v7- (>%/V&11 �"�.kLt�a• hIT TiG.7^)C•bF A...fir-V__ Mri (age n+r'- 54 3 4os V CO) ZI= 455 cO2 2ios 394 C. 0 2 V y 57 003 Q Zos FCO, G03 G 72-013 A (Rev. 9/91) MOA 25 1 11 = z ®, a 14'� _r-j1u Eyd0_ T7,, CxA T7,, A�;�- IoZs 0.YrlCrT' �5.�7 Y'ZSC:> ENGINEER'S SEAL 14 David R. Duyiiia W. aa13,5! �aveoo os oae"°0 E IRP mWAo WAI y&aaa]S �*zz&*c6vzz�\*a Jaws w �ar�a�w r PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE o o MS DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 //�� ANCHORAGE, ALASKA 99519-6650 Cl, ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW9202.37 DESIGN ENGINEER:DAVID R. DAYTON, P.E. OWNER NAME:DORMAIER DOYLE W OWNER ADDRESS:20607 LUCAS AVE EAGLE RIVER, AK 99577 PARCEL ID:05057229 LEGAL DESCRIPTION: PREUSS #3 BLK 11 LT 6 LOT SIZE: 22554 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 DATE ISSUED: 8/18/92 EXPIRATION DATE: 8/18/93 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM 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 FOLLOWING SPECIAL PROVISIONS. SPECIAI, PROVISIONS: THE WELL AND SEPTIC TANK AND SEPTIC SYSTEM UPGRADE MUST BE IN ACCORDANCE WITH THE APPROVED ENGINEER'S DESIGN DATED 8/11/92. n /1 / RECEIVED BY: DATE: ISSUED BY: .._ __ _ DATE: D. R. DAYTDN, P.E., R.L.S. l;RoWxJ 5 Chugiak, Alaska 99567 (907)kx 20210 Donalar St. 696-2417 Design Narrative Lot 6, Blk 11, Preuss Subd. #3 The design presented is an upgrade system to replace a failed absorbtion trench. The new system will be placed on the rear of the lot uphill from the old system, using a STEP tank and pressurized shallow trench. The test holes and percolation tests were performed in April 1990 by Mr. Lou Butera P.E.. The test hole logs report finding ground water but the depth was not recorded. The original pipe for ground water monitoring has been monitered weekly for the past month, showing no ground water. The design is based on the assumption that the test holes were stopped at the level of the ground water found. The new system is placed so the bottom of the gravel is 6 ft. above the test hole bottom. This lot as well as lots on either side are served by the AWWD Public warer system, therefore contamination of wells is not a critical factor. The proposed system will have no measurable impact on reserve space, surface or subsurface, or on drainage. 7 � fit" ACfid;, David R. Dayton 90. 22054 U N LuGA-� ST 5 A-• O To AS /3BLo vV G..�-OUNO Z. Fi [.� wlrr/ Goy/cR-.s r8� /S'f3.G �sv t' �f3-c,ow fi ir-cv u..AO j, Q.sr Ci4s��✓Gr ©F/=- S' g•C�, /Yf/tea'' t • a•u em• ••e inn'• David R. DaylaNO. 2205 W, y� aDPRO...... Tc— /�L Al Z—, 7- '!o 1-1 l / �/Gt-L155 ���✓ id�� David R° Dayten P.•fln 20210 Dmalar St. ChuoRk, Alaab" 8/vhz- �Z 0 lwaN %(l3J 4" Mo.J r—T roan S,Pw ,J i it I/4y Pvc C m T mT Jz/NiiL G>/L.q-0t5 - -- O?-Ld. CnfZUUNa ✓_ ��L��,PJG �Y¢i�A/G 3/C I 'Gar c. vCcrrm n or-rr=?.r •ta-oL-�. 114 P, PLI w/ Y/6",} cis I —`� TAY^J1L_ David R. Dayton P.E. 20210 Donalar St. Chugiak, Alaska 99567. 5�5P7%G SYSTLr'/y1 �iS/6� GUT 4� v l�iDrh1 S/ � G� 5�3 113 src . \ 5 r 2,, _ *7 // I /,E-" -e- z�w^je, /oL B -95:3 �E5 i ovRs /-7rsrto s ' v ea�g� /OB/ori ,q tta� 9< 'kr tfj David A., DaYtca 2205-E �� /YJON TLl!S[3 –L),FIL — SVTs 125 °i. 17s - -B �l �F/LTCB /�9g /,E-" -e- z�w^je, /oL B -95:3 �E5 i ovRs /-7rsrto s ' v ea�g� /OB/ori ,q tta� 9< 'kr tfj David A., DaYtca 2205-E �� /YJON TLl!S[3 �l �F/LTCB /�9g S�� Jl i9 L4a�Tn.�M TLi'S.T FFe�,g. David R. Dayton P.E. 20210 Dangler St. Chuglak, Alaska 99567 7�'z- 2%'40 �Q�.(/GO �umA �J,QooUc,�S �7,S:yyyr� J �U/ei ,Z c J Ac Dovid R. Dffo NQ 22&'5A �pROFc�s10N �ra�a cunat.r s�: 54, Cluyiika j�i�ticr99S6i r SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION � PERCOLATION A* -.-6-D) TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: V/S0�`/O LEGAL DESCRIPTION: 40 7`4 /'rcrex-F SLOPE SITE PLAN 2 - 3 .D . 4 5- 6- 7 67 8 9 d 10 O 11 12 13 14, ffi 15 �ees 16- 17 6 17 ®� 18 19 S4NLly Gr4✓�! 61i/.i/OO/f Lv, 17. dero Y.2 //tyyF�',,,�qqq�R� �•e4,�Qseo00 '���.� (fl 6e e �eec ee.aen oee e_ 7... ............. LOUIS A. P,utero -, CE -6736 ; go eeee�e.HHe'a.. �.�AN a�'ROFESS�ONe�"' WAS GROUND WATER y�P L ENCOUNTERED? O P IF YES, AT WHAT Al, t- m.��t+.'er/E DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop $dAAt�/�10 9i 2 3•,a � s 3;vr 3•g„ �,, 7/ ' 3;52 PERCOLATION RATE /O (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS FX elf �4 P,o" 65 �/�. <!z (fSr/- NC'f - /Yis r/ i{zV—� �!' �r.-r e. v✓. %, 4.I �gsp. ���rv��^ !^� j t.P�s'r PERFORMED BY: CERTIFIED BY: DATE: 72.008 (6/79) i MUNICIPALITY OF ANCHORAGE -�-Ig PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG — PERCOLATION TEST / DATE PERFORMED: yl-- 00 0 PERFORMED FOR: �r�"4 / LEGAL DESCRIPTION: lil a./1/ 71-9 ,L3/Gf // 2 ' 3- 4- 4 :vX. 5- 6- 7 67 _ 9d 10 D 11 12 .J4NL�q G/YrY� 7'✓� S�//fit 13 j',ES L ENCOUNTERED? 0 Depth to P Reading Net O. <, 14 C 4`n eco0e oa�b }t C:` y f SoAof 15 o ` no � � � Sy ' ��' •�toa �y ° amoae ro¢ona°e r` 16 Q� ¢ a ..a...... Ls,:; :. '•utero : 'r7 17 G, ° v �� Q�Fhi / °aid 3 �� Z/;a3 a r g u 19 Yucrf3 SLOPE WAS GROUND WATERS j',ES L ENCOUNTERED? 0 Depth to P Reading Net IF YES, AT WHAT Time DEPTH? Drop SITE PLAN 20I s IL_—JI PERCOLATION RATE 8/ Zf (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS _,c tk.ia f.n,.r � dT r r 'UrZ G-, L./,7, Gr r�� ✓v✓er r� �r t ra7�,.i oTdr= a /may DATE: PERFORMED BY: f\ �Pe CERTIFIED BY: 72-008 (6/79) Gross Net Depth to Net Reading Date Time Time Water Drop SoAof If 3 -sem 3:S3 3-F 3 Z/;a3 a r g u 20I s IL_—JI PERCOLATION RATE 8/ Zf (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS _,c tk.ia f.n,.r � dT r r 'UrZ G-, L./,7, Gr r�� ✓v✓er r� �r t ra7�,.i oTdr= a /may DATE: PERFORMED BY: f\ �Pe CERTIFIED BY: 72-008 (6/79) � F GUAM? CR ANCHORAGE ARCA ElMi JGH IBJ Department of Environmental Quality d 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME -V Q �F .14� °C MAILING ADDRESS 110ilY ;/-�° °L/S/PHONE LOCATION " ---_ LEGAL DESCRIP-I ION _`"'._._`�� /� !� �f'� �S� ✓V'"��� `y SEPTIC TANK: DISTANCEQ�f NUMBER OF FROMWELT_ / �_MANUFACTURER�L�_--MATERIAL_ ✓,Tr'--COMPARTMENTS- INSIDE LENGTH— INSIDE. WIDTH _—LIQUID DEPTH — LIQUID CAPACITY_ `� ' ,v GALLONS. SEEPAGE PIT: NUMBER OF PITS _Y— ..,DIAMETER --OR WIDTFI �i, LENGTH G5DEPTH LINING MATERIAL CRIB SIZE: DIAMETT�EIJR—DEPTH* DISTANCE FROM: WELL n TOTAL EFFE BUILDING FOUNDATION __ , NEAREST LOT LINE_/_y_ . ABSORPTIONCA AREA (WALL AREA) -S 54. FT. ADDITIONAL ABSORPTION WELL: TYPE ___—CONSTRUCTION BUILDING NEAREST FOUNDATION LOT LINE -— CESSPOOL APPROVED DISTANCES: INSTALLED BY OTHER SOURCES NE=AREST SEWER LINE DISAPPROVED REMARKS nPI PE MATERIAL: 4 'Y /Z G LOT SLOPE: REMARKS: DATE Form No. EO -037 DEPTH SEPTIC TANK. DISTANCE FROM: SEEPAGE SYSTEM DIAGRAM OF SYSTEM I�y� (ciT' �CI lilt it" - � y.. e��'. y � L'RAi r( rryr J =111•, G.A. W 'A w O O c m y6j 4i C7 � M 0 21 lco For ! a H1 � DEPHRTMENT i HEHLTH HND ENVIRONMENTHL� ]TECTION L� ~ IC', \ 2510 E i�DOR RD . HNCHORFGE/ HK. 9�j87 ` ` + E. � , ~ 276~2221 Cfl �IFZ., ������ PERMIT NO. ( 76412 ) / HPPLICHNT GEORGE 1]0] HTKINSON DR ]�7~2591 LOCAT' ION EAGLE RIVER LEGAL L6 13,11 PRI -[ESS #] LOT SIZE ]]000 SQIF- RE FEET TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR) 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ������������ ����1r�� � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFHCE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET) THERE IS NO SET WIDTH FOR TRENCHE& THE GRHVEL DEPTH IS THE MINIMUM DEPTH 0F GRAVEL BETWEEN THE OUTFALL PIPE HND THE BOTTOM OF THE EXCHVHTIONFEET). �F=l -IL CH IfD 12:9 ������� BACKFILLING OF ANY S9' -STEM WITHOUT FINAL INSPECTION HND RPPROVHL BY THIS DEPHRT| NT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSHL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ]0 DHYS OF THE WELL COMPLETION. SPECIFICATIONS HND CONSTRUCTION DIHGRHMS ARE HVHILHBLE TO INSURE PROPER INSTHLLHTION. P_'> F:- IFR �lr--D U_ '-e FEE F,::l PF -f C-9 IM IF= I CERTIFY THAT / 1� I HM FAMILIAR WITH THE REQUIREMENTSFOR 8N -SITE SEWERS HND WELLS AS SET FORTH BY THE MUNICIPHLIT9 OF ANCHORAGE. 2� I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH THE CODES ]� I UNDERSTHND 'THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE EWLHRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. SIGNED:------~-- ��PPLICHNT JOHN��GEORGE ~� 60nitowatlon gest _LaE "One test is worth a thousand opinions" 2204 Cleveland Anchorage, Alaska 99503 Performed For 71 k1iCmc-?6sro1a 1 Date erformed 2 Z Lenal Descrintion: Lot___&Bloc4:_Subdivision L)C?.SS !S ;j 1-3 f9eu,`f'�� This Form Reports Soils Loq d Percolation Test Oenth Feet Soil Characteristics CQ -s V L- 2— �, h t/�, Z- 7 ---�-�r alp Was Ground Water Encountered?A/3 If Yes, At what Depth? l �� 3j, -6c4 ��GfJV,U 1 �3�c+vv�'l"'7 LDI IMMrc,�.-'�■�r• Readinq I Date I Gross Time I Net Time I Depth to H2O Net Dron Percolation Rate Minute Proposed Installation: Seenaoe Pit Drain Field _ Deoth of Inlet Denth To Bottom Of Pit 0 7rench a —7 Test Performed By 0—t w► VU14L1C, _ Data Certified By: Date: b / u nG£ G1 • '� Municipality of Ancho On -Site Water and Wastewater Prog AUG 2 7 2015. (907) 343-7904 Gree m StD'lef rt 's . E r. CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 050-572-29 1. GENERAL INFORMATION Complete legal description PREUSS #3 BLOCK 11, LOT 6 Expiration Date: 8 –/ � — 1-7— Corn plate _ Location (site address) 20607 LUCAS DRIVE, EAGLE RIVER, AK 99577 Current Property owner(s) WILLIAM J. STREUR Day phone Mailing address Real Estate Agent 2. TYPE OF DWELLING: 20607 LUCAS DRIVE, EAGLE RIVER, AK 99577 ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ Waiver/Variance request for: Distance: Received by: 6d � Date: COSA to be released to the engineer, unlesst e ' e requested by the engineer. COSA Fee $ 52-& Date of Payment all J$ Receipt Number olem COSA# D505 LJto3 Waiver Fee $ Date of Payment Receipt Number Waiver * 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system S(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future r Oh A occupants or can ArcTerra guarantee that no unseen v AZ 4. deficiencies or discrepancies exist. / lZ� S�� 1A n T T I 6. DSD SIGNATURE ?? �ystem #1 Approved for 3 bedrooms. System #2 Approved for bedrooms. Disapproved. P, KENN]irlf Me DVF / 'r ��, Alf 'Ls i'w� i tasroN�' .i Conditional approval for bedrooms, with the following stipulations: By: �/ .��i� "L�� A r o�Original Certificate Date: The Municipality of of Ancorage 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 theprofessional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.d. If more than 1 septic system is on the lot: COSA Checklist # of _ Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: PREUSS #3 BLOCK 11, LOT 6 Parcel ID: 050.572.29 A. WELL DATA —PUBLIC Well type If A, B, or C provide PWSID # Date completed Sanitary seal (Y/N) Y Total depth ft. Cased to _ft. FROM WELL LOG Date of test Static water level ft. Well production 9.13 -m - WATER SAMPLE RESULTS: Coliform —colonies/100 mL Nitrate _mg/L Arsenic: ug/L Date of sample: B. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTICIHDPE Tank size 1300 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (YIN) N Date of C. ABSORPTION FIELD DATA _ Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) _in. AT INSPECTION 5 Collected by: Date installed 4/112004 Cleanouts (Y/N) Y High water alarm (Y/N) Y Date installed 411/2004 _ Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 System type SHALLOW TRENCH Length 70 ft. Width 5 ft. Gravel below pipe 3 ft. Total depth 5_5 ft. Eff. absorption area 603 ft2 Monitoring tube Y Depression over field N Date of adequacy test 8/19/2015 Results (Pass/Fall) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 1 in. Elapsed Time: 10 min. Final fluid depth 0 in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed 411/2004 Size in gallons 1300 Manhole/Access (Y/N) Y "Pump on" level at 48 in. "Pump off" level at 51.5 in. Datum TOP OF MAN HOLE Cycles tested 2 E. SEPARATION DISTANCES - PUBLIC WATER WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ High water alarm level at 44.5 in. Meets alarm & circuit requirements? Y On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas Absorption field 54 Water main 10'+ Water service line 101+ Surface water 1001+ Wells on adjacent lots 2001+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 104 Water main 104 Water Service line 101+ Surface water. 1001+ Driveway, parkingfvehicle storage 10'+ Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 200'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I ceftffy that I 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 KENNETH M. DUFFU$ Date 8125115 COSA canary sheet,-6-15.doc /��� OF�ALA ', I' Ko o T/ T4 Municipality. of Anchorage • Development Services Department 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) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-572-29 1. GENERAL INFORMATION HAA #_ iDL4 D. V Expiration Date: _;, ± - 1 3 -- [) �. Complete legal description Lot 6; Block 11; Preuss Subdivision #3 Location (site address or directions) 20607 Lucas Dr. Eagle River, AK 99577 Current Property owner(s) Peter -Muller Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Rolf Milton Day phone Day phone 694-4994 11940 Business Blvd. Ste. 202 Eagle River,AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. � � � .41 2. NUMBER OF BEDROOMS:_ 3. _TYPE OF WATER SUPPLY: , TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site g Individual Water Storage El'- 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 Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water 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 Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S & S Engineering Address 17034 N. Eagle River Loop Ste. 204 Eagle Engineer's Printed Name Robert C. Cowan Phone, River, AK 99577 Date /q/0 '�F ..qAlc ��..��'�`l Qui 694-2979 -e i ROBERT C. COWAN F ell- S.- DSD SIGNATURE Approved for 3 bedrooms. `�� s .., Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments "'��c�ni�►Tcc� _ YYHJ PROGRAM JJJJ J�� J,,�,�,�r�� Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate'Date: " " f 3-04 (Rev. 01102) Municipality of Anchorage °E Development Services;De aetment i Building Safety Division On -Site Water.& Wastewater Program S A F E* Y 4700 South Bragaw St. P.O. Box 196650 'Anchorage, AK 99519=6650 www.ci.anchorage.ak!us (907) 343-7904. I HEALTH AUTHORITY APPROVAL�I CHECKLIST I I Legal,Description: _�oT l3Lo ctt 1/_ IR✓vsS w 4 .3 Parcel ID: O f° —S7a I A. WELL DATA, V 13 L.I-C_ L-/ 4--r It 4- : . .Well type If k B, or C provide PWSID # : Well Log (Y/N) R Date completedSanitary seal (Y/N) Wires properly pr d (Y/N) de th p ft. Cased to ft. L i' 3 Casi eight (above ground) Total in. i i;itFROM WELL LOG i AT(INSPECTION f Date of test 1 Static water level ft. i ft. Well production' g.p.m: c g.p.m. WATER SAMPLE R LTS ' `` i € Coliform colonies/100 m1. Nitrate m ./l Other bacteria ' colonies/100 .. 9es/100 mL Ar ic: mg./I. : Date of sample.Collected'by I I B. SEPTIC/HOLDING. , I � TANK DATA I + I I Tank Type/Material ' S7 -h-P )to P f Date installed Tank'slize 13 o o 1 "gal. Number of Compartments S. -- Cleanouts (YEN) y, 'i.t, I. FoundationcleanoutpN) Yts': Depression'overtank (Y/�(j� �'.d High.wateralarm6N) y� ,I li G V �; o P, Date'of pumping' =;N'�u/Pumper i tit ;- `C ABSORPTION FIELD DATA � ! lri I/ 2 2 Date installed = i Soil rating g.p.d.'/f or ft /bdrm) g System type ' Length �p ft. Width i' I { ill i ft. j Gravel below pipe 3 i I I I � 7 I, r Total depth S ft'. Eff' absorption area 'GD 3 ft Monitoring tube ^y �. I Depression over field 2 i j , Date of adequacy test N 1 Nei w Results l(Pass/Fail) 71 is For bedrooms I'i I i , Fluid depth in absorption field before test rin. r er added gal. New depth in. Elapsed Time .min. 'Final f epth ' rn y 3! Absorption rate >_ g.p,d, F; ; # I I I s , j Any rejuvenation treatment 12 mo, Y/N & e 11- i i� ( typ )' If yes, give date I �i . I•_ ' `; t _ Ijl J it ,� I ',n j 71 ''r'•r�rwl•1lN�• ISI I . I 1 3 - _ E. LIFTSTATION 4/0 / 3 Date installed '� Size in gallons Manhole/Access'&N) "Pump on level at h in. "Pump off' level at ` Lin. High water alarm level at �/ Y. S in. Datum ,T°�' I dF_ MSN �►'�� Cycles tested a I Meets alarm & circuit requirements? ; I ,. y�-S SEPARATION DISTANCES SE PA RATION DISTANCES FROM WELL ON LOT TO: I.I I I k Septic tank/lift station on lot 1' On adjacent lots Abso l ption Ilfield on lot scent lots . t I t 'leanout Public sewer manhole/ c Public sewer main' ' Sewer /septic se Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: j Building foundation $ "I" Property line g AbsoIF rptionlfield I Water main ; 10 r4- Water service line 10 Surface water I I�! ° 4 - Wells on adjacent lots SEPARATION ('DISTANCE FROM ABSORPTION FIELD ON LOTTO: I; Property, line, - G �' Building foundation? 0 Water main 1 c7' I r ,Ili' I ILIII�i r Water Service line '/0 -r Surface water I o . Driveway, parking7vehicle storage %� f I I�NO�at; kNow Curtain dram' r✓ • Wellson adjacent lots /A ,IIII � I �I i , �.• �', � I -� ; 'F. COMMENTS �' Is I, ,I I II , } I I G : ENGINEER'S CERTIFICATION �, �' ,Ii • -z�jt �� �:'`` I'' I�'�� is �..,>� ✓��� ,; I� certify that I have'determined through field inspections and �,v " ..-'7�.»•.• ........,=:.•i..P�+ review of Municipal records that the above systems are in I , !N. s... ..1......�. .,I. •..... C'' IfIj �nIII' cI'eIJ withMOAHAA guidelsin/e1s�T in efCect on t9hi�s✓date. ^t�e.onm�r 'CR�� .Do<:'I!aG'�+CE!d.c..r. -{i'I .n ' COWAN ,AN �{•�• r��f 8n01 Engineer's Printed Name/w�, i 7 Date D I I' I •I i v'� 1 �� 'I I I • s I r I I • 1 P I 1 I I III 30 !� + �i Waiver Fee $ I 1� I HAA Fee $ ' Dater iflPaymelrit Y `l toy Date of Payment It ReceipiltlNumber Receipt Number '� , . , , .;I I, I' •; , 1 .. I I! .' (Rev:12/01) I y II > I I r. f 1 i I 1 1 6' •1 i 1' S i' II of M 12-17,o,ol N 7 - AS -BUILT I hereby certify 'that I' have -surveyed ,the follo*Ing described property:1-Ir Anchorage -Recording Precinct and that the*' improvements situated thereon Ware Within the .property lines and 00- do not overlap 'or encroach on the property.' -Ing, adjacent: thereto, that no improvements on''pro p-` crty lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other Visible easements on said property except nson as,indicated hereon. ^bated at Eagle River, Alaska 7. A this -12 -- day of rt ROBERT C.'JOHNSo Ni N --X& -*- +" SCALE: Registered Land Surveyor No.880-LS,' Box 456, Eagle River, Alaska Phone 694-2543 U - .4•t r peck ,, ;;•-� j - - N WY. G 12-17,o,ol N 7 - AS -BUILT I hereby certify 'that I' have -surveyed ,the follo*Ing described property:1-Ir Anchorage -Recording Precinct and that the*' improvements situated thereon Ware Within the .property lines and 00- do not overlap 'or encroach on the property.' -Ing, adjacent: thereto, that no improvements on''pro p-` crty lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other Visible easements on said property except nson as,indicated hereon. ^bated at Eagle River, Alaska 7. A this -12 -- day of rt ROBERT C.'JOHNSo Ni N --X& -*- +" SCALE: Registered Land Surveyor No.880-LS,' Box 456, Eagle River, Alaska Phone 694-2543 MUNICIPALITY OF ANCHORAGE V� w 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. # y5y HAA # F�ViCLCY�73 1. GENERAL INFORMATION Complete legal description Lot 6, Block 11, Preuss #3 S/D Location (site address or directions) 20607 Lucas Avenue Propertyowner VA % All Star Pat Arnett —Dayphone 561-7827 Mailingaddress 2207 E. Tudor, Suite 33, Anchorage, AK 99507 Lending agency Day phone Mailing address Agent Day phone Address _ Unless otherwise requested, NAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well Public water XXX 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 XXX 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 X21 �i 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverifythat 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 5& 5 ENGINEERING Phone 61 H - a 22 9 17034 Eagle River Loop Road No. 204 Address Engle River Alaska 99542 Engineer's signature 6. DHHS SIGNATURE ✓ Approved for bedrooms. Disapproved. Conditional approval for Additional Comments 0 UITIC Date ROBERT C. COWAN - 4? CE -8801 bedrooms, with the following stipulations: Date 3 — '7-00 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-M(AW.151) Back MOAK21 Municipality of Anchorage C*D DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division ti 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 / Health Authority Approval Checklist Legal Description: Zor Saf_�fI/CL! /l�_�Lr=L SS 74_Parcel LD.: /2,50 -372 9 _ A. WELL DATA Well type A �5z /Cl If A, B; or C, attach ADEC letter. ADEC water system number Log present(Y/N) Total depth _ Sanitary seal (Y/N) Date of test Static water level Well production WATER SAMPLE RESUL Coliform Date of sample: Date completed Cased to FROM WELL LOG Nitrate Casing height (above ground) Wires properly protected (Y/N) g.p.m. Collected by: AT INSPECTION Other bacteria B. SEPTIC/HOLDING TANK DATA \ (( // Date installed q Tank size L7 rJO �' Number of Compartments 2 Cleanouts& 7C Foundation cleanout(o)///,,,Depression (Yo Ao_ High water alarm (Y/N) Date of Pumping / l l/lllJ Pumper V 6 C. ABSORPTION FIELD DATA/ Date installed Soil rating (g.p.d./ft2 or ft2/bclrm) Q6 System typeO/�L�L/Gyf i Length 8� Width _ _ Gravel thickness below pipe �/ / a Total depth Effective absorption area Monitoring Tube presenON)Depression over field (Y/) o Date of adequacy test Results (Pass/Fail) 4-6S For bedrooms Fluid depth in absorption field before test (in.); 0-1Z I r Immediately after 2Vgal. water added (in.): — !U Fluid depth (ins) Minutes later:_ 20 Absorption rate = `,4 ?) g.p.d. Peroxide treatment (past 12 months) (Y/N) /ONE- C_11V6NIN If yes, give date 72-026 (Rev. 3/96)' D. LIFT STATION Date installed Manhole/Access 6k High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* Z "Pump off" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer /septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: i Foundation S Property line y '-4- Absorption field 6"+ Water main/service line O < Surface water/drainage (i� �7 Wells on adjacent lots 0/ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line �� Vit" Building foundation /b /'f Water main/service line /0 d?� / y ' Surface water � Driveway, parking/vehicle storage area Curtain drain ND7UL ��it/d7idit! Wells on adjacent lots MIA - F. ENGINEER'S CERTIFICATION / certify that / have determined thru field inspections and review of Municipal in conformance wit MOA gXl� ines in effect on this date. 2 Signature Engineer's Name (�. Co wAl.) Date 2/�Lt/0 0 HAA Fee $ 3p-n.c Date of Payment aI�ct (3D Receipt Number �,(Pa C 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number ROBERT C. COWANF,+ CE - 8801 % are 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 F IUIPALITY of ANCHURAUJ NMPN1AL ftnylcu iiIVl5li�ry MAY 22 1997 REcr1V CERTIFICATE OF HEALTH AUTHORITY - L. U APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. It - Iz _1 % HAA It 4a2 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Day I.Jwne Mailing address Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. RECEIVED 2. NUMI3ER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: MAY 22 1997 Municof Anchorge Individual well D pt.Heath(&HumanServiices Community well Public water / 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: Indivirl-n! nn -sitar. 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(Rml/91( From MOAn21 5. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. i further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Phone Address el E�PL' f Engineer's signature I w< a - L —Date- 6A ate 6 �hF ♦a':)1 t i'slazi�se qy••t�` r�` '• Cv8176 6. DHHS SIGNATURE �� `"%r; ...... Approved for E 3 bedrooms. Disapproved. 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. 7244 Re,1l91) Back MOAN21 Municipality of Anchorage MUNICIPALITY Of ANC DEPARTMENT OF HEALTH & HUMAN SERVICE IRONMENTAL URVIC Environmental Services Division env 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-&42 19� Health Authority Approval Checklist RECEIVED Legal Description: Lor do <, e / / = ter„s 11./ Parcel I.D.: DSD —,a XZ — -Z A. WELL DATA Well type A Log present(Y/N) Y Total depth Sanitary seal (Y/N) _ Date of test _ Static water level Well production WATER SAMPLE RESI Coliform If A, B, or C, attach ADEC letter. ADEC water system number Date completed _ _ Cased to FROM WELL LOG 9— p.m-Nitrate Casing height (above Wires properly of sample: Collected by: B. SEPTIC/HOLDING TANK DATA AT Other bacteria 7 - iDdO /• Date installed /� _Tank size Number of Compartments z Cleanouts (Y/N)_ Y _ Foundation cleanout (Y/N) _ Y _ Depression (Y/N) A) High water alarm (Y/N) Y Date of Pumping _ r''�97 Pumper C. ABSORPTION FIELD DATA Date installed %�9 _ Soil rating (g.p.d./ft2 or ftz/bdrm) System types Length _ Y��i Width %f _Gravel thickness below pipe_ / 5 �� Total depth _ ft Effective absorption area 5 -e -f 2. Monitoring Tube present (Y/N) Y Depression over field (Y/N) _Y _ Date of adequacy test _/ /-v v eYS7 Results (Pass/Fail)Y51 _ For _ _bedrooms Fluid depth in absorption field before test (in.); /--f Immediately afterY” `gal. water added (in.): �9 Fluid depth _ (ins) Minutes later: /J Peroxide treatment (past 12 months) (Y/N) 72.026 (Rev. 3/96)" Absorption rate =E'Y If yes, give date - D. LIFT STATION Date installed %Y -419x— Size in gallons .25 0 Manhole/Access (Y/N) Z "Pump on" level at* "Pump off' level at* yZ High water alarm level at* *Datum RECEIVED ECEIVED Cycles tested __? E. SEPARATION DISTANCES MAY 22 1997 Municipality of Anchorage SEPARATION DISTANCES FROM WELL ON LOT TO: Dept. Health & Human Services Septic/holding tank on lot On adjacent lots Absorption field on lot On adjacent to Public sewer main Public sewer manhole/cleanout Sewer / eptic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation Property line /,2 F'/- Absorption field Water main/service line -2.9" y JSurface water/drainage Wells on adjacent lots �00 /. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line /Z Surface water Building foundation Curtain drain L�10101La r'o 1='X15 F. ENGINEER'S CERTIFICATION �� cf Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots 000 `f I certify that f have determined thru field inspections and review of Municipal record70t I in conformance with OA HAA guidelines in effect on this date. i+w. ° to Signature Engineer's Name P. Date h- L2 • °1'1ti ux4.� �1iCa HAA Fee $ `'e) Date of Payment �P2��6-,:: r Receipt Number a�� � Uo?�% 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 4e 0 /-, are MUNICIPALITY OF ANCHORAGE • T DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services •�t 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 l.D.#-a-Q\c+ HAA# 0Q(U1Afnic,l j 1. GENERAL INFORMATION p 9 P ow- 6- �?a Complete legal description L�^�- � t i�/�t,L�-� Location (site address or directions) s oGco"j Luh_ 1xu-- La Av-Mz-, At, `%9577 Property owner Dc) YL -Lm LA01 `�-�rin�ar� Day phone Mailing address 2-0L�c,-1 l_u-ems No a- /Ei .tz )eaves, A ;e- 41#57'7 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well Public water X 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 X 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 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulbt;WaRilbgW6gtpQe. the date of this inspection. 20210 Danalar St. phone ' ge,-as-i7 Name of Firm k„-ggS .7 Address Engineer' 6. D HS SIGNATURE" Approved for �f" ' al bedrooms. Disapproved. Conditional approval for Additional Comments M11. nr V;<j j c • an.+'.+f Dlo. 21^Crc � t" 'a 40 .Y °rROF�ss�oe'�o.� bedrooms, with the following stipulations: By: -.-- C! a u a !� Date 1IITIF The Municipality of Anchorage Department of Health and Human Services ((:)HHS) 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. 7M25(R.V.1/91) Back MOAH21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: oT- Par ill 1211 466{ " Parcel I.D. 0 A. WELL DATA Well type Log present(Y/N)_ Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level If A, 13, or C, attach ADEC letter. ADEC water system number A•usWU, Date completed FROM WELL. LOG Driller Casing height Wires properly protected (Y/N) AT INSPECTION MUNICIPALITY OF ANCHORAGE o INV RONMENTAL SERVICES DIVISION g.p.m. 6MVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot On adjacent lots Absorption field on lot Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed Tank size 239D PSL Compartments Depression (Y/N) 4/ Cleanouts (Y/N) Foundation cleanout (Y/N) High water alarm (Y/N) Y Alarm tested (Y/N) Date of pumping /VCr✓'yYrsrvi Pumper SEPARATION DISTANCES FROM SEPTIC/H(),!= H Gi TANK TO: Wel I(s)onlotN��Onadjacent lots" -Foundation 12,1 To property line /Z_ Absorption field -5-2 " Watermaia/service linerVo ;,r - Surface water/drainageIdem'-- 72-026(RCV. 7/91)Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed I9�9 L Manufacturer I+A1t44 ��uw� 1d2t�2uc� Size in gallons 1 opt '4 Manhole/Access (Y/N) Y Vent (Y/N)__ "Pump on" level at ¢Z "Pump off' level at aoz`° High water alarm level At Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: / Well on lot 000 On adjacent lots _ ����urface water /00 D. ABSORPTION FIELD DATA Date installedq Ij�9 Soil rating 0' 9 /'lw System type T2&M10H r Length Width Gravel thickness r Total depth Total absorption area �5-e-.3 Cleanouts present (Y/N) Depression over field (Y/N) Results (pass/fail) Date of adequacy test A&eo �5z5T1z»� for Peroxide treatment (past 12 months) (Y/N) dV& If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot Moni1>- On adjacent lots �' Property Ii To building foundation ;:�5_ To existing or abandoned system on lot lL` On adjacent lots /V/h+vr6 Cutbank /490 -/- Water main/service line Z '— Surface water iDr) , /- Driveway, parking/vehicle storage area 7S Curtain drain /✓vU� /7 NuuJ� E. ENGINEER'S CERTIFICATION bedrooms I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature LLwvvi +/// v y. Engineer's Name Dwtf) 72, GzJ�3 Date Dov"d It. Dayton e` k `(, J� eo NLI. 2205E e° 06 gP.. rssoeaP����A.: HAA Fee $ / / u Waiver Fee: $ — Date of Payment -9 -9 Date of Payment Receipt Number � _o7 Rel / i�03 �% Receipt Number 72-026 IRe, 3/91) Back MOA 21 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY- Sewer and Water Section ?,ck3cQxFcxdasx�A�1P.t�ex�#seat§c�;3�c4c�cx:2�Z�m2�2�2�x�cx�3 825 "L" Street, Fourth Floor, Anchorage, Ak. 99503 279-2511 Ext. 229 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: /CMRO _ VA - _ FHA CONY 2. Property Owner: ani/n Mailing Address:Ate"" ��&0 � E 7/ _ Day Phone 3. Name of Buyer:. J`n �! _ –ve 42 Mailing Address: 'ctpJ)g� __ Day Phone 4. Name of Lending Institution: _ �Pa/i�5 &,2M, 2:44�9V ---- Mailing Address: 3 !? ?_L C �–' _S'ef,�r,9 1' Phone 5. Name of Realtor or Agent: N1 7. E Mailing Address: Phone Legal Description: 6 7– _—1 ✓ ze _�l Location: 4.1 Al AZ e� g_& 5 —� Type of Facility to be inspected: 2�'& _ No. Bdrms. Water Supply Type of Supply: Public Utility Individual __x If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: Public Utility If Individual, date of installation EQ -037 (1/74) Individual (on-site) MUNICIPALITY OF ANCHORAGE � D`PA OF HEALTH AND ENVIRONMEN,.,..;_ PROTECTION 9J� 825 L treet, Anchoramn. Alaska 99501 I J�cfJ� 264-4720 �1� � l� F8Wednesday Date Received: January 31, 1978 #1: Time 3:0 #2: Time k��,'] �yyL� #3: Time Date 2-1Date l _ 77 - j` �-�.i rs , Date Insp Pr tt Insp A.;•,z`�-�'.- Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIESII 1. Lending Institution Request: Spokane Mortgage Company Mailing Address: 3201 C Street, Suite 250 Phone: 2. Property Owner: John C. George Mailing Address: Post Office Box 1474 3. Legal Description: Lot 6 Block 11 Preuss Subdivision #3 4: Single Family Residence: (X) Multiple Family Residence: ( ) Number of Bedrooms: Two Number of Bedrooms: 5. Well System: Individual Well (x)) Community/Public System ( ) Permit # Construction Depth of Well 405' '1� no Well Log on File ( ) Bacterial Analysis 6. Sewage Disposal System: On-site System (x4 Permit # Installed 1976 7 Public Utility ( ) Installer Septic Tank Size Zyti Manufacturer Absorption Area Soils Rate Material Distances: Well to Septic Tank to Absorption Area to Sewer Line to Nearest Lot Line Nearest Lot line Absorption Area Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 6 Block 11 Preuss Subdivision #3 - Comments: Affadavit Attached:/ (/) v Letter Attached: ( ) 1SOd 1 01 1N3S od Snld) ;SOC—IIVW UTA11830 80A 1dl3038 C - Approved: ,� ate Disapproved: _ Date: Department Worksheets £6L -09P �O ZL61 a Od0 0 11VW IVNOIIVN831N1 NOA 10N IL6I 'jdV 0080 (ap!s .eyjo eaS)—0301AM 30MA00 30Nvuml ON w,ud Sd .............. I..................... (Pel!nbei eej njlxe) AHAI13alV OM _ — _ pOS"" """'...- '.'.."".. '.". .........'-" A1N0 33553 i100tl Ol 83AI130 ° 098 """""" A100 3*SS0JPPe 01 AiaA!lap QMS301AH3S $99 " PaiaAIIBP OJ94M PUB a19P 'wOgM 01 SMO4S 'Z M303N O'9 """""" AIuO OOSSaippe 01 AIaAIIap 41!M •1 NH0138 PST�"'�'�"" PGJBA!IaP aleP Pue waNM 01 SMOLIS 933 IVN0wan N01 MIMS 1VNO11d0 3000 dIZ ONJ 31tl1S "0'd J 'ON ONV 133HIS W 1SOd 1 01 1N3S od Snld) ;SOC—IIVW UTA11830 80A 1dl3038
