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Home My WebLink AboutPREUSS #4 BLK 9 LT 10Preuss #'4 Lot 10 Block 9 #050-572-64 Municipality of Anchorage Page 1 of 5_ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 345-4744 On-Site Wastewater Disposal System and/or YVell Inspection Report Permit Number: SWO00108 PID Number; 050--572--64 CHAD CONVERSE Wastewater System: [] New · Upgrade Address: 10126 PREUSS LANE EAGLE RIVER. AK ABSORPTION FIELD No. of Bedroome: Ph°ne:~907) 696-- 6912 5 [] Deep Trench · Shallow Trench [] Bed [] Mound [] Other LEGAL DESCRIPTION so,, Rating, 1 .2 DPD/Sq. Ft. Toro' Depth from oi~ginol2.5,grode:_ ~.0' Ft. 10 9 PREUSS //4 0.31' - 1.81' ,t. 2.0 - - - 1.4' - 2.7' rt. 55' WELL: [] New ~ Upgrade 5' ~** 1 - / 593 s~. ~. ASTM D-5054/F810 Ft. GREEN GENERAL 5/24-25/2000 ~.~ .. .. TAN K SEPA~TION DIS'DANCES ~ Septic D Holding · S.T.E,P. Re~ StaUon Tank s,~,, u,,, ANCHORAGE TANK 1500 From Tank Well 100'+ 100'+ 100'+ - 25'+ STEEL 2 Surface 100'+ 100'+ 100'+ - - LIFT STATION Water Line 5'+ 5'+ - - '1500, ANCHORAGE TANK/ORENCO PRODUCTS Foundation 5'+ 10'+ 5'+ - - 45" Drain -- NONE KNOWN -- ~ 20 OSI 05 HHF WALKER ELECTRIC I I Remarks: *PER THE NE~ HOMEOWNER REQUEST. BENCH MARK A 1500 GALLON DUAL OUTL~ S.T.E.P. TANK WAS TOP OF GARAGE S~B INSTALLED. ONE OUTL~ WAS CAPPED OFF AND THE OTHER WAS USED FOR THE NEW SYSTEM. 100.00 F~. · *REQUEST THE 5 FOOT LOT LINE WAIVER BE AMMENDED TO 2 FE~. ~%%~/__ Inspections peformed ,,: AWWC, INC. Dates: lSt2n, 5,2~-25/20~5/2~'2°°°-- ~5;~j~'.)~/ ............. Depa~ment of Health and Human 8e~ices approval '.. Reviewed and approved by: ~/ ~. ~ D~te: ~'/' 0 ~_ PERMIT NUMBER: AS BUILT DRAWING PARCEL ID NUMBER: SWO00108 " 050-§72-64 A B C ST1 33.76 13.43 33.00 / I ',i S12 37.27 19.56 38.07- / PTIC -- __ Ml-I 38.59 21.64 37.32 '~- ~ I FCO 31.44 9.22 31.10 / ARE..~ Ml'l 52.42 60.10 91.47 / I I MT2 18.08 40.31 80.32 / Nm DR^,N~,EID Z m ~ z ~ ~ i , ~ ¢ UNDER DRIVEWAY I ~ , ~m~o ~' i :: :~ I I { / ~/0 STEP TANK -EXISTING DRAINFIELDS I I / ABANDONED IN P~CE __J I / / ,/ / / m ~ / DAVID AVENUE / ,~r/~ .~.~t .... ~ ..,..., ).~ ~ffr ay / ~. A B C SI'I 33.76 13.43 33.00 ST2 37.27 19.56 36.0"7 MH 38.59 21.64 37.32 FCO 31,44 9.22 31.10 MT1 52,4-2 60.10 91.47 MT2 18.08 40.31 80.32 ~,~~ s/~o/~ooo ~------ .____. , DRAWN BY: ALASI{A WATER & WASTEWATER c.J.o. CONSULTANTS, INC. SCALE: ~REPARED FOR: PHONE NUMBER: PAGE NUMBER: CHAD CONVERSE (907) 696-6912 2 OF 3 .EGAL DESCRIPTION: PREUSS SUBDIVISION #4; LOT 10, BLOCK 9, rYPE OF WORK: AS-BUILT OF SEPTIC SYSTEM UPGRADE swooolo8 AS-BUILT DRAWING / -g8,72~98,7'4 / F ~r~ ~ N~W BOO d~ON ,~~ / I0~,¢~-I~,~ BATE: ~ASI~ W~l LR & WASTE~VATER ,o,~: CHAD CONVERSE (907) 696-69~2 5 OF 5 PREUSS SUBDIVISION ¢4; LOT 10, BLOCK 9, ~Pe OF WORK: ~Crofess[O~ PROFILE AS-BUILT OF SEPTIC SYSTEM UPGRADE 05/31/2000 1G:38 907-696-1805 GREEN GENERAL coN'r, PAGE Bi Pho~ 696.,g964 Cd # 10319 Colvilb St, F~O~O ~ ,~g. ~577 To:Greel~ General Contracting PO Box 672125 Chugiak AK 99567 Date :6.1-00 Rcf : 10126 Preuss Lane Eagle River AK 99577 Permit: 'II, is is to certify that on site sewer lift station at above mcntioneA properly has been wired in accordance with thc standards of the National Electrical Code and manufactures specification, Systems were checked and performed as specified in thc systems manual. Clint Walker MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 995~19-6650 ¢O7) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: May 17, 2000 Expiration [:)ate: May 17, 2001 Permit Number: SW000108 Legal Description: PREUSS ~4 BLK 9 LT 10 Design Engineer: 0041 Al( Water & Wastewater Consultant Owner Name: Chad & JoAnn Converse Owner Address: 10126 Preuss Lane Eagle River, AK 99577-8774 Parcel ID: 050-572-64 Site Address: 010126 PREUSS LN Lot Size: 19600 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [./, Disposal Field ~,/] SepticTank L! Holding Tank ~ Privy ~] Private Well [ I 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 Wastewa[er Disposal Regulations ( 18AA072 ) and Drinking Water Regulations ( 18AA080 ). 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: Date: Date: R¢ck Mystrom. Mayor Mmaic tpaiity of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 hltp://www.ci anchorage.sk.us May 17,2000 Jeffrey Garness Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite2-B Anchorage, AK 99504 Subject: Waiver Request for Preuss #4, Lot 10, Block 9 Waiver Request #WR000030 Parcel ID #050-572~64 SW000108 Dear Mr. Garness: Your request for a waiver of the required 10 feet horizontal separation from the on-site wastewater disposal system to property line has been approved. The approved separation distance is 5.0 feet. /~e.-V'/~.' "'/o :2 ~' ~. ? This waiver approval applies to the existing on-sitewastewater disposal system to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Daniel J. Roth Civil Engineer On-Site Water Quality Progn'am WR#: WR000030 Date Received: 5.t5-00 Legal Description: Preus.,i #4~ I.ot 10, Block 9 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services On-Bite Services Waiver Review Worksheet PID#: 050-572-64 HA#: ___ Permit#:_ Engineer: Alaska Water 8, Wastewater Consultants~ Inc. 690'1 Debarr Road, ,"~ulte 2-B, Anchorage, AK 99504 Applicant: Chad & JoAnn Converse Waiver Requested: 5 foot lot-line waiver ~c,'/$c Criteria: 1. Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: 2. Special Conditions: 3. Other: Waiver is Granted: )/-, Waiver is not Granted: ListConditionsorReasonsforabove: $l=.E I~zxf~l~u~_~p~$ ~)'/i-~,NElP Date: _~"- ,~ 7 - Oo Rec#: 06736 Amount: $115.00 By:_~'~ Name of Reviewer Date Paid: 5-'15.00 ALASI(A WATER & WASTEWATER CONSULTANTS, INC. May 11, 2000 Municipality of Anchorage Department of Health & Human Services Division of Environmental Smwices On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic System Upgrade Design for Lot 10, Block 9, Preuss Subdivision #4 To whom it may concern: The existing 3 bedroom house is se~wed by a private well and septic system. The existing septic system consists of a 1000 gallon septic tank and deep trench type drainfields. The existing drainfield is surcharged and is to believed to be encroaching groundwater. A test hole was excavated on the property in the area of the proposed upgrade. The proposed septic system upgrade will be designed around the 30 foot radius of this test hole. We are proposing that a new 1250 gallon S.T.E.P. tank and a five foot wide drainfield be installed. Comments regarding the proposed septic design are summarized as follows: 1. SOILS: Attached is a log which shows the soil classifications, groundwater monitoring, and the percolation test results. The soils below the organic layers are a GM material to a depth of 11 feet (bottom of test hole). Groundwater was encountered at 8.5 feet and seven days later, the monitoring tube was checked and found water to be at 8.0 feet. A percolation test was performed between the depth of 5.5 feet to 6.0 feet which had a percolation rate of 1.3 minute/inch. It is our opinion that due to the overall appearance of the soils, a application rate of 1.2 gallons/day/ft2 should be used. 2. TRENCH DESIGN: a. Percolation Rate: 1.3 minutes/inch b. Allowable Application Rate: 1.2 gallons/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Miuimum Absorption Area: 375 ft2 f. Total Depth: 4.0 feet (maximum - on uphill side) g. Effective Depth: 2.0 feet h. Width: 5 feet i. Reduction Factor: 0.70 Minimum Length: 55 feet long k Effective absorption area = 393 ft2 6901 Debarr Road, Suite 2B - Anchorage, AK 99504 - Ph: (907)337-6179 ~ Fax: (907)338-3246 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: The trench is to be installed on the north side of the driveway. The slope where the trench is to go is a 5 to 10 percent grade running approximately north to south; in short, there are no slope concerns. The trench is to be installed parallel to slope contours. 4. LOT LINE WAIVER REQUEST: We request a 5 foot lot line waiver fi'om the proposed drainfield to the north and east property line. We are unaware of any adverse effects on the neighboring properties with the granting of this waiver. I am unaware of any adverse impacts this installation would have on adjacent xvells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. Presi l~t NOTE: Attached ia' a site plan drawing, a design drawing, a soils log, a~d a 7page construction specificatio~, letter which are all part of the desig~t package for this septic system. 6901 Debarr Road, Suite 2B - Anchorage, AK 99504 ~ Ph: (907)337-6179 ~ Fax: (907)338-3246 , PREUSS S/D /'~4 t I PREUSS S/D #4 i LOT 2, BLOCK 9. I ) LOT 7, BLOCK 9. ....... i .................. F -I PRUEBS S/D #4. , I I ~ LOT 6, BLOCK I PREUSS S/D #4.,'~''l" ) PREUSS S/D #4 /I \ m LOT 8, BLOCK 9, // I,~m~ R~IUS~ ~ PREUSS S/D ~4 ~l PREUS~ S/D ~4 I I X,PREUSS S/D 1~4 X LOT 4, BLOCK 9, I I LOT 9. BLOOK 9, HOUSE , , L~ i .~ ~_ ~-PROPOSED SEPTIC UPO~DE LOT 5, BLOOK 9, - I I . Y~'~- LOT 4, BLOOK ~, ~ [DAVID AVENUE~.'~ I.L --EXISTINGsEPTiC LOT 3, BLOCK LOT 11, 8LOCK2. LOT 10, BLOCK 2, x~. ~¢~B~6~K~, ;>, -~l PR[uss s/p PREUSS S/D ~4 PREUSS S/O ~4 PREUSS S/D ~4 ~m PR[uss s/D CONSULTANTS, INC., 1" i~ '~ REPARED FOR PHONE NUMBER: PAOE NUMBER; y ~ , CHAD · JOANN CONVERSE (907) 696-6912 1 OF 2 '~f~ "., PREUSS SUBDIVISION ¢4; LOT 10, BLOCK 9, (PE OF WORK; ~ si'rE PLAN FOR SEPTIC SYSTEM UPGRADE \ \ PROPOSED P'~ESSURIZED DRAINFIELO.~ EXCAVATE A TRENCH THAT IS 4. FEET DEEP ldAXIMUM (ON UPHILL SIDE) BY / 5 FEET WIDE BY 55 FEET LONG. ADD ~'~'S~PTIC 2 FEET OF CLEAN, WASHED SEWER ~ DRAINROCK. THE OISTRIBUTION LINE~/ ,s 'rD .E ,-1/4. ,NOH SCH 40 PVC ARE~.A_~ WITH 1/4 INCH OIAMETER HOLES --~ I ~ ~t~---~ ...... WI INSULATE UNQER DRNEWAY WITH 4-" x 2' BLUE BOARD, I I / ¢*NN TO I ~ I / oD= .E ^BAN~ED COMP,ETEL¥ ~ I 1250 GALLON ~ ....... -7- / ~/~ ~- - ~/~ NOTE: THE CONT~CTOR SHALL HAVE THE NORTH PROPER~ LINES AND THE 100 FOOT WELL ~DIUS FOR THE REFERENCEO PROPER~ F~GGED BY A REGISTERED ~ND SURV~OR PRIOR TO OONSTRUCTION. I ~ATE: 6/, ,/2000 DRAWN BY: & CO~SUklA~TS, I~C. 1" = 40' 6901 DEBAR ROAD, SUITE 2~ * ANCHO~GEt ~ 99501~ "PHONE (907)3~7-6179 * PREPARED FOR: PHONE NUMBER: NUMBERt CHAD A JOANN CONVERSE (907) 696-6912 2 OF 2 LEOAL DESCRIPTION: PREUSS SUBDIVISION ~4; LOT 10, BLOCK 9, IYPE Of WORK: DESIGN OF SEPTIC SYSTEM UPGRADE ~..~,~_~'~-~, ALASKA WATER & WASTEWATER CONSULTANTS, INC. ,=,~ OF ~#'~ 6901 DEBARR ROAO, SUITE 28 * ANCHORAGE, AK. 99504 ~ ...... PHONE (907) 337-6179 * FAX (907) 338-3246 ~j:~.,~.., ~X.. f~.. LEGAL DESCRIPTION: PREUSS SUBDIVISION #4; LOT 10, BLOCK 9, PERFORMED FOR: OB^D ~ Jo^NN CONVE.BE ,~.. ~ cr.~.~....../.~' -"-~ ..... DEPTH~ TEST HOLE #1 'u%7~,~' ....... 2 SOIL C~SSlFICATIONS ~ ~'~' L ~. ~'~;~' I I LOt 9, BLOCK 9, ~ ~, sw MH ~,, ~C_j~jl=~ ~ 'GM sc ~ , ~o./ 7 ~ ~ DEPTH TO DATE - ~ ~ c~ · GROUNDWATER ~ 8.0' 5/11/00 DAVID AVENUE 10 ~ ' DATE READING CLOCK NET TIHE WATER LEVEL NET DROP TIHE (HINUTES) READING (INCHES) s/~/o_s- ~ - s" _ 2 ...............~_~ 0" 6" 3 ............... ~ ........ ._~'Z .... - ..... 4 - 6 0" 6" 5 - _ 6" _ 6 7 0" 6" '- TEST RUN BETWEEN 5.5 FT, AND 6.0 FT. 8 7 0" 6" 9 - _ 6" _ 12 - 8 O" 6" PERCOLATION RATE 1.3 (HIN./INCH) PERC. HOLE DIA, 6 (INCHES) COHHENTS: PERFORMEB BY A~SKA WATER & WASTEWATER. I, JEFFR~ A. GARNESS, CERTI~ THAT THIS WAS PERFOBM~D IN ACCORBANCE WITH ALL STATE ANB MUNICIPAL GUIBELINES IN EFFECT ON ~,=:_ .~/,,? DEPTH TO DATE GROUNBWATEE 8.5' 5/4/00 8.0' 5/11/00 MUNICIPALITY OF ANCHORAGE DE RTMENT OF HEALTH AND HUMAN SER ES 7 / Environmenta~ Hea~th Division /'~..~(~ 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 -- ON~SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name Phone(s) Permd No No el Bedrooms LEGAL DESCRIPTION TowtlShlp, Range, Section ITANKS /~ S£;PTIC [] HOLDING TYPE OF SYSTEM ~TRENCH [] BED [] W. DRAIN J~ OTHER o.g,nal grade ~'~0 FT ~, C) FI ;Ill added above original grade Number of lines so,, ~,~¢~so r:T DISTANCES SEPTIC ~ TANK WELL \\"5 ~ LOT LINE --.,,~ ~.f FOUNDATION L~5i ABSORPTION ,.- , FIELD., WELL WELLS ~t~ PRIVA'I'E [] OTHER fldentitv) Classdmatmn I^.B.Ci 1 lota~ DopUi Case0 to REMARKS: by: $ & S ENGINEERING 17034 Eagle Ri~er Loop Road No. 204 I . ~-a~-I~l'~ -A,!~-sk~-,,q~)5~7 ~ certify thai U)is Jnspeciion was pedormed accordinD lo all ,/JLlflJcipaJ ,,d Sial8 ouJdeJJheS J, ,JIBe[ on Ibis IJate: __ ~' //~//~-~/~ 72-013 (3/85) Afl AJ')I!:]I,,!t.J~]()Y Ik:!:~l ,, 7 Municipality of Anchorage DEPARTMENT OF FIEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION 1'EST LEGAL DESCRIPTION: 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS Township, Range, Section: '~"~ 2~,..\ SLOPE SlJFE PLAN WAS GROUND WATER ENCOUNTERED? I~ (7 IF YES, AT WHAT DEPTH? Depth to Waler After Monitoring? Reading Date Gross Net Depth to Net -rime Time Water Drop PERCOLATION RATE __ TEST RUN BETWEEN . (minutes/inch) PERC HOLE DIAMETER ___ FTANDFT PERFORMED BY:E w~517034 Eagle Rl~er Lo~p Road No, 2~_~.~/8, ~ I-'NGINE_ERING '"~ ~ ¢~ CERTIFYIF%~ T~T TH TEST WAS PERFORMED C C ~.~~AL GUIDE~E~FFECT ON THIS DATE. 72-008 (Rev. 4/85) QGREA/ER ANCttORAGE AREA BOROUGH Depar[ment of ['-nvironmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME J~/(/ ,'~"~'(~'/*~-/J MAILING ADDRESS ~'?~"' 0L~//- Z~,~.,,f'/'~( ,~J~/~'"',"~ PHONE '~'~.~" ~,~ LOCATION ~)~t//~J/"l"~r~'~ ~"~;'~"~/)'¥u"C' L_EGALDESCRIPTION"~°2'~'/~'~"~'~'""~e{,',~'$' ,-'~',~ ~' I SEPTIC TANK: D I ST Ar~C~,,, ,P FROM/WELL t INSIDE LENGTH · MANUFACTURER C[~-"~Jk~~ ~e /'C MATERIAL ___~_'~'~¢"~' / NUMBER OF ___ COMPARTMENTS "~ INSIDE WIDTH__ __LIQUID DEPTH .LIQUID CAPACITY //~"7¢'"~) GALLONS. SEEPAGE NUMBER OF PITS t DIAMETER LINING MATERIA ~",5' CRIB SIZE: BUILDING FOUNDATION OR WIDTH '""~, DIAMETER NEAREST LOT LINE J.~)' . ADDITIONAL ABSORPTION DEPTN_ V DISTANCE FROM: WELL TOTAL EFFECTIVE ~,/,~ ABSORPTION AREA (WALL AREA) SQ. FT. TYPE BUILDING FOUNDATION _ CESSPOOL APPROVED CONSTRUCTION_ NEAREST _, LOT LINE OTHER SOURCES _ DISAPPROVED DEPTH NEAREST SEPTIC SEWER LINE ....... TANK --, REMARKS DISTANCE FROM: SEEPAGE SYSTEM DISTANCES: PIPE MATERIAL' LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM APPROVED -- ~ " ~:::fi:~:i!.~. ,,,.ii!ii:iiiiii! 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I::ll",!E:' I::: :::'i:::' :;' I:~:I::IC!'::;F i;i I );i",li;!i i;tl::: I::d',h" ' · 1'~1:: :::q:}i:;i' i' ,' : ", I,I I i I ii:i:; ':: I::'l ~ :' I0 ;t;OH. t"i;ii"tli'iltl'i I::,Ci;il:::li",lC:/ i!i',h!:iPtl:i:li3',! I:l kill;i!. I::IH!;:' I::lt",l"~' 'l",l~'":;;'': ,I:.H" ~1 ::i ::::::i ~::li;l'::'i !::.'l;ll:;;' /;:;I i::'i:;:;I;~',"i::ltli; i,ll!;I i OI;;: ;;;i:l;.;li:'t Ff:i;i:! i:OR I::t I'1_.1,t MI:Il I.i')l';~i:~:~; I'::!i:% I;;'[:~;:;¢.1!1;;:13;;:' I:::fi",E:' I'~l.l~:;t' I~=1; i:;I::' ~;:hll::~Y:' 'FEi lI'll~: I;:,E:l:::q::ll:~fli'tl:d",F~" Ii:: '' ~- I~'l,:: !4i:i J 'i'i::' I::'t' ;H :::PI' I:::" :: 'I "1'1", ; I::lN!!::' E:Ot",l~;'~ R~ icl" 'l'i~ll';l:;~' i:;'lTM I'l;':::i' :"," ; Hl:'f'¢ ¢::f,/i:::lll I:::l(',i i: il;) ~;i",l:;;ll!;;:!:: i:::'~-~'l;;ll:::'~ :;;' ;i;i",i:~;'l t::l! 'il'Ii::; {:;di;hlOI;;,l:: i I :i :' 0 8- E GEO', .CHNICAL 8' DEVELL Box 90, Davis St,, Eagle River, Alaska 99577 694-2774 or 688-2280 .)MENT CO. Earl Ellis Russell Oyster 694-2774 SOIL LO~ 688-2280 Soils ~ Foundations - Land Development Perfomed for: Name:.,, Mai 1trig Address: .... Legal Descrtption:_~Z-c~: /~..) Depth (fee~ ~J.1 Characteristics 4 16 Ground Water Encountered: Yes No~.,.-~.. If yes, what depth___.__ Proposed Installation: Seepage Pit~Drain Fteld.~ Comments: _ ~ A & L DRILLIt G COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE 694-2589 OWNER OF LAND/' ~/,' .,_,' , O,'~, ;: .;.,-! ~,~/,; DEPTH OF WELL ,, . ADDRESS STATIC LEVEl, OF WATER FT. / LEGAL DESCRIPTION ..(c,?' ~ o (;~,~;~ - [ / ~/.~ ;t, ,.~ d~t9, DRAW DOWN FT. DATE-Started /,//J// 7 Ended _ ~,//d;/ V ~ GA~. PER HR .. PERMIT NUMBER KIND OF CASING KIND OF FORMATION: From ~ ' Ft. to / Ft. d_/~, /'~r ,/,,'~7~t d.~ From.-- From / Ft. to ~/~ '? Ft / / . From ~/~ '/d,_ ~ From.~ From ; / Ft. to ~ o Ft. "~ ~:~j~'~ '~'} '~; /' ~ '" From , '~' Ft. to / / ?_Ft. (,'z,,~ t ~ ~; /~,,Z,,;~¢/,',', From From ,t; / Ft. to_/ :?O Ft. ,%:'?-, k:Y c~// c~/;~:¥d/:/. From.~ From: ~'' Ft. to Ft. ~/// /A Fron. From. /~ Ft. to_~Ft..~?/;/d; :~():;'~/d? ~'~5,~'-~-&,'~'Fron.~ From '~? Ft. to c;!'~ ?Ft. (i~.~Z~ ' ' From }: Ft. to · ;~ Ft, From ~Ft. to Ft. From From Ft. to Ft From From.__Ft. to.__Ft. From From.____Ft. to Ft. From From__Ft. to Ft From From Ft to Ft. From From Ft. to_ Ft. From From Ft. to___Ft. From Ft. to Ft. Ft. to_ Ft. Ft. to Ft. Ft. to Ft~ Ft. to_ Ft. __Ft. to Ft. Ft. to Ft. Ft. to Ft. Ft. to Ft. Ft. to Ft.. Ft. to Ft Ft. to Ft. Ft. to Ft. Ft. to Ft. Ft. to_ Ft. Ft. to Ft. Ft. to_ Ft. MISCL. INFORMATION: DRILLER'S NAME Parcel I.D. #_ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O, Box 196650 Anchorage, Alaska 99519-6650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING 050-572-64 1. GENERAL INFORMATION Complete legal description_BRgU$S SUBDIVISION #4: LOT 10. BLOCK 9. Location (site address or directions) 10126 PREUSS LANE EAGLE RIVER. AK Propertyowner CHAD CONVERSE Dayphone (907) 696-6912 Mailing address 10126 PREUSS LANE EAGLE RIVER. AK 99577-8774 Lending agency Day phone Mailing address Agent DON MCKENZIE W/ REMAX OF E.R. Address 16600 CENTERFIELD DRIVE. SUITE 201 Day phone (907) 242-1689 EAGLE RIVER. AK 99577 Unless otherwise requested, HAA will be held for pickup. 2, NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: If community well system, provide written confirmation fi'om State ADEC attest- ing to the legality and status of system. 4. TYPE OF WAS'rEWATER DISPOSAL: Individual on-site xxx Holding Tank Community on-site Public sewer' NOTE: If community wastewater system, provide written confirmation from State ADEG lng to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 Computer Version Note: Alaska, Water, and Wastewater Consultants, Inc,. shall be paid $1250.00 at, or prior to, c~osing for the engineering services prov/dea. 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 vedfy 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone (907) 337-6179 Address 6901 DEBARR ROAD, SUITE 2B ANCHORAGE, ALASKA 99504 Engineer's Signature Date In conducting this evaluation, AWWC, /nc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DHHS Guidelines & Regulations. The reported results described 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 soils 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 the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty for future estimate of how long the eystem will continue to meet the operational requirements of the ADEC or MOA DHHS. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DHHS SIGNATURE I./" Approved for ~ Disapproved Conditional approval for bedrooms bedrooms, with the following stipulations: Additional Comments By: O-,'.///.-~ ~-~,.-" ('~_~/, ~::~t~'~- Date ('0 o1~'-/') 0 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev, 1/91) Back MOA #21 Computer Version Health Authority Approval Checklist Legal Description:_PREUSS SUBDIVISION #4; LO'[' 10, BLOCK 9,.Parcel I.D.: A. WELL DATA Well Type PRIVATE Log present (Y/N) Totaldepth_ 235' 5-1/2" _ Sanitary seal (Y/N), Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 0 RECEIVED Date of sample: Municipality of Anchorage dUN 0 DEPAP, TMENT OF HEALTH & HUMAN SERVICES , MUNICIPALI¥¥ OF Environmental Services Divl.,,ion , ~'- 825 L" Street, Rm 702 Anchcrage, Alaska 99501 (907)343-474~.mONM~NTALSE~I~s' _Casing height (above ground)__ Wires properly protected (Y/N). A'r INSPECTION 5/2~/oo If A, B, or C, attach ADEC letter. ADEC water system number YES Date completed 9/13/77 . Cased to 235' 5-1/2" YES N/A 18"+ YES FP. OM WELL LOG 9/15/77 212' 211' 050-572-64 6.0 g.p.m. 1,9 +/- g.p.m. Nitrate 1,34 mg/L Other bacteria. 5/16/00 Coilected by: A,W,W.C,, INC. El. SEPTIC/HOLDING TANK DATA Date Installed 5/24-25/2000._Tanksize__ 1500 Foundation cleanout (Y/N). Date of Pumping NEW C, ABSORPTION FIELD DATA .NumberofCompartments__.2 Cleanouts (Y/N) YES YES Depression (Y/N) NO High water alarm (Y/N) YES Pumper. - Date installed 5/24-25/2000 _8oll rating (~.~[~or ft2/bdrm) Length _ 55' _Width 5' Effi~ctive absorption area 393 SQ,FT. Date of adequacy test NEW Results (Pass/Fail) - For. Fluid depth In absorption field before test (in.); - __ Immediately after - Fluid depth - (ins) Minutes later: - Absorption rate = Peroxide treatment (past 12 months) (Y/N) -- If yes, give date 72-~28 (Rev. 3/98)* Computer Vemlen 1.2 System type TRENCH Gravelthickness below pipe 2' _Total depth 4,7'-5,4' Monitoring Tube present (Y/N) YES__ Depression over field (Y/N) __ gal. water added (in,): ____ NO Bedrooms D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested 5/24-25/2000 Size in gallons 1500 YES "Pump on" level at* 43" "Pump off" level at* *Datum BO'FrOM OF TANK NEW E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main 100'+ 100'+ N/A On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Seweflseptic service line 25'+ Lift station 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Absorption fieId 5'+ Water main/service line 10'+ Surface water/drainage 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line *2' Building foundation 10'+ *REQUEST 5 FOOT LOT LINE WAIVER BE AN~ENDED TO 2 FEET. Water main/service line 10'+ Surface water 100'+ Curtaln drain F. ENGINEER'S I certify that I ~avo of Municipal (ecorc with MOA H~A gui Date lC Driveway, parking/vehicle storage area 5'+ NONE 'KNOWN n~ l~d~e f inspections and review stems are in conformance this date. JEFFREY A. GARNESS Wells on adjacent lots 100'+ HAA Fee $ ~ ~ '""'/~ Date of Payment ~ Receipt Number ~"~'~'~ ~/:~'/~,~ 72-028 (Rev. 3/96) Cornpuler Version Waiver Fee $ Date of Payment Receipt Number DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot I0~ Block 9; Preuss subdivision; ~ L/ Location (site address or directions) I0126 Pr~uss Lane Property ownerR°°¢'~t ~ Donna W~i~o~6 Mailing address 10126 Pre.uss Lane Day phone Eagle RiveA, Ak. 99577 694-1909 Lending agency Mailing address. Day phone AgentGdl Pulido PHH/HOME¢UITY Day phone Address P.0.Box 4039 Concord, California 94524-4039 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: $ '~ TYPE OF WATER SUPPLY: NOTE: (415)246~6508 ×X Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. XX TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev 1191) Front MOA #21 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 s & $ ENGINEERING Phone 17034 Eagle RiYer Loop Road No~ Address Eagle River, Alaska 99577 Engineer's signature Date' 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. 72q325 (Rev. 1/91) 6acx MOAIC21 Municipality of Anchorage ~ Department of Health & Human Services HEALTH AUTHORITY APPROVAl.. CHECKLIST Legal Description: ~.~-r"/C' ~¢. ~ ~¢_-0o-~ ~ Parcel I.D. (~ ~.~ ~' ~-'~7~ ~ A. WELL DATA Well type 1~¢.~,,j Log present (~N) Total depth Sanitary seal ~/N) If A, B, or C, attach ADEC letter. Date completed o~ ~ ~5_-)-7 Driller .Cased to '~..'¢~ L~ ' Casing height ~ properly protected Wires FROM WELl. LOG Date of test Static water level Well flow I~' Pump level SFPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot \ ~'"~ Absorption field on lot Public sewer main Sewer service line g.p.m. ADEC water system number AT INSPECTION ~ -%'5 -'~ ~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLF RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed Nitrate O '~fZ4' Collected by: Other bacteria ,,,,.Jo ,,J6 S & S ENGINEEEING 11034 Eagle River Loop Road No. 204 £af~le River, Alasl~a 99577 Tank size \ oc:~4::> Compartments ~'- Cleanouts ~-~/N) High water alarm (Y~b, Foundation cleanout (YI~ ~ Depression (Y~i) Alarm tested (Y/N) Date of pumping Pumper Well(s) on lot \ To property line Surface water/drainage SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: On adjacent lots t, c~c_~ ~ '~' Foundation _Absorption field \"~ ~ Water main/service line 72-026 (Rev. 7/91) Front ' CONTINUED ON SACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA elec~ SEPARATI~DNd~ISTANCE FROM LIFT STATION TO: ~n~lot ' On adjacent lots Manufacturer Manhole/Access (Y/N) ~ "Pump on" level at ~'"-~-~Pump off" level at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed ~" Length ~'~ /,~o Width Total absorption area · Depression,over field (Y/~ Results,/~/fail) Peroxide treatment (past 12 months) Soil rating "Z. ~'~ '¢,/~¢z- Gravelthickness ';~',///~.~ To~ ?'2 Cleanouts presentd~/N) Date of adequacy test for ~'I~R ¢-¢~-~...- (._"5') If yes, give date bedrooms SEPARATION DISTA'NCE FROM ABSORPTION FIELD TO: Wellon lot I1~ To building foundation On adjacent lots "~c:~ t ~- Cutbank Surface water Curtain drain E. ENG NEER S CERi~ F C~T ON "' I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect Property line To existing or abandoned system on lot Water main/service line Driveway, parking/vehicle storage area of this inspection. S & S ENGINEERING Signature 17034 Eagle Ri,vet Loop .... Road No, 2_0~J_ Eagle River, Alasl~a ~z,¢ Engineer's Name Date ~:~"'-'/..~ ""~t HAA Fee $ Date of Payment Receipt Number ~. 0 ~0 (~,~ ~ ) 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE (~ .~- DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMEN'rAL SERVICES CERTIFICATE OF: INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERA[. INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 10; Block 9; Preuss Subdivision ~4 July 21, 1987 Location (address or directions) 10126 Preuss Lane Property Owner John & Barbara FranklJ~lephone: Home Business Mailing Address Seller - George Perkins - 694-3594 Lending Institution First National Bank of Anchor,~phone Mailing Address Eagle River, Alaska/ATTENTION: Lira (b) (c) (d) (e) Real Estate Company and Agent SLEEPER REALTY/Bet~y Dunlap Address 800 East Dimond, Suite 3-385, Dimond Center Tower, Anchoraqe 99515 Telephone 344-2501/pager - 268-0500 Mail the HAA to the followino address: or: Check here [~, if hold for pick up. List contact person and day phone number below· S & S ENC, INEERINC~ 694-2979 ]7034 Eag]~ Riv~_r T,o~? Road~ S]]~t~ 204 TYPE OF RESIDENCE Single-Family ~ Number of Bedrooms ordered by Betty Dunlap WATER SUPPLY Individual Well r~ Community r-I Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite r~ Public [] Community [-I Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 IRev 8/861 Front leUO!SSeimd aq] u! SUOCSiLUO .lo sJo.l.le Joj alq!suodse~ lou s! 86e.loqouv to XHled!o!unlAI Sql 'panes! s! @leoU!Hao e eJojeq eiep eZ/,leUe ~o suo!loadsu! lonpuo3 lou op SHHQ jo s@e~oIdLUa 's]ueLu@.l!nba.l m,e),s pus le.lep@,t u!eHeo /~js!les ol .lap.lo u! suo!ln],iisu! 5u!pual Jieqi pus SeLUOq ¢O s.laseq3md oi XseHnoo e se s!qi seop SHHQ eq.L 'eHSel'¢ ,to elelS eLtl U! pe.lels!lSe~ .laau!Bue leUO!SSejmd luepuadepu! ue /,q @^oqe c LldeJl~e~Bd u! ue^i6 suo!lBluese.lde.l sql uodn ,~lUO peseq sele3!jqpeo IB^mdd~¢ XIpOLIInV qlleeH senss! (SHHQ) seo!^JeS UeLUnH pus qlleeH Jo iUeLUpedaQ @l~e~oqou'¢ ,to X]41ed!o!unlAI eqj. NOlinYo leAOJdd¥ leUO!l!puo0 ,to sm.lei leuo!ljpuoo pe^oJddBs!C] y pe^oJddv ~ · Y ~ I.~F '~¥AOI=Id.,-I'CSHHQ '9 @uoqdele± eiBC] ZZ¢66 e~selY "mA!~l ell~alll 'ON pBo~ doe'l ~al!~t ~ISB~! i¢0Zt ssempv 'UO!lOadsu! s!ql ,to @iBp eH1 uo ),oelle u! suo!leinl~eJ pub 'seoueufpJo 'sepoo elelS pub Iedlolun[~ lie HHM eoue!ldmo3 ul s! ~alsXs lesods!p JeiBMelBBM Jo/pus Xlddns JeleM e~!s-uo eq] 'uo!ioedsui pus uo!~e6!~eaAu! X~ ~oJJ pus eel!j aeeJoqguv ~o XHled!o!un~ sql peu!~lqo uo!l~Jolul sql uo paseq leq) XI!JeA Jeqpn~ I 'u!aJaq paleolpu~ eJnlonJls jo adXl pus s~ooJpaq jo ~eq~nu sql eienbape pus leUOllounj'ales si ~81sXs lesods!p JeleMelSeM Jo/pus Xlddns JeiBM ells-uo aql 1eH1SMOHB leAoJddv Xlpoqlnv qileaH slqj ~o uo!iee!iseAu! ~ leq] ~JpeA I 'MOleq UMOqS a~ep UoRBp!IBA sql Jo se pus o]eJaq pax!jiB lees X~ Xq Pe!H~ao sV .g ,k~,C¥,,-,,d"C~'~pJICIPALITY OF ANCHORAGE (MO~-,~ ~,~ ~ ~1 264-4720 WELL DATA Well Classification Well Log Present ~'~N) Total Depth ~-~ Static Water Level Casing Height Above Ground __ Electrical Wiring in Conduit(~N) Separation Distances from Well: ~-~ ~ If A, B, C, D.E.C. Approved (Y/N) I"--~//~ Date Completed '¢111~ )'~'~ Yield - '"~,/¢:' ~"¢1~ ~ Cased to ~__ Depth of Grouting ~"---- Sanitary Seal on Casingd~N) Depression Around Wellhead To Septic/Meld nl'h'~Tank on Lot \ \ ~ ' ; On Adjoining Lots To Nearest Edge of Absorption Field oo Lot ~"¢--~ '"' ; On Adjoining Lots ~ ~ To Nearest Public Sewer Line , //~' To Nearest Public Sewer Cleanout/Manhole I~//~ To Nearest Sewer Service Line on Lot Water Sample Collected by ,~ ~ '~'~'-~ ~";:~:;=¢L4~,, ; Date Water Sample Test Results ~A'~¢'/¢:>~----'~"7::~ -~ '"' 1:~,¢:>¢-~F, '~ ~ I'"'[~.~--''~-'~ B. SEPTIC~H~)EDtN~'TANK DATA Date Installed_ ~>~'~,~;~""~ Size Standpipes ~¢;~N) Air-tight Caps Depression over Tank Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holdm~ Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course No, of Compartments _ ~ Foundation Cleanout (Y,~'~ Date Last Pumped / //'~ ; for ~--- Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata "~.'Z.~ '~/I~.~/.~- Date Installed ~ ~:~/,""/--/ ~'~ Width of Field ~ '~'~" ' Square Feet of Absorption Area Depression over Field (Y//~;P Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot !"~ ~ .~z..tc-.¢1~l~, To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field ¢¢.~'"""~ ' ' // ,..~ ~ r Depth of Field . ~ /, /7' ..~ Gravel Be,.d Thickness ~(~ '~5//'/ZZO'~Standpipes Present4i~)N),~ ~ / / , Date of Last Adequacy Test To Properly Line To Existing or Abandoned System on ; On Adjoining Lots TO Cqtbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (V/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, or conformed to all M CA and HAA guidelines in effect on the date of this inspection. Sigr~. ~ ENGINEERING Date 17034 Eagle River Loop Road No. 204 Co · · ,- m~E~wr, ...,,.~,... ~9577 MOA NO. Receipt No. //(~) Date of Payment Amount: $ -- Page 2 of 2 72 026 (11/84) L MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTI4 & ENVIRONMENTAL PROTE~t~)~01PALITY OF ANCHORAGE 825 L Street - Anchorage, Alaska 99501 DfiPT, OF I:-',LT;I & ENVIRONMEI41,:: ;:, r~CTION ENVIRONMENTAL ENGINEERING DIVISION Telephone 264.4720 j~,i)R r~ lg~0 DIRECTIONS: Complete all perts on pe§e 1. Incomplete requests will not be processed. Please ollow ten {10) days for pmcessin§. 1, PROPERTY OWNER Bernard & Margaret Stalmann MAILING ADDRESS 5710 David Ave~ Eagle River~ AK. PROPERTY RESIDENT (If different from above) 99577 PHONE 694-3612 2. BUYER PHONE John & Barbara Franklin MAILING ADDRESS __ P. O. Box 144~ Chugiak, AK. 3, LENDING INSTITUTION Security National Bank MAILING ADDRESS 880 H. Street, Anchorage, AK. 4. REALTOR/AGENT Margaret Stalmann MAILING ADDRESS 99567 PHeNE 276-68~0_____ PHONE _ AREA~ Inc., Realtors, Box 249~ Eagle River~ AK_~._9957_~ 5. LEGAL DESCRIPTION Preuss ti4, Blk 9 Lot 10 STREET LOCATION 5710 David Ave., Eagle River, AK. 99577 (corner of Preuss & David' 6. TYPE OF RESIDENCE NUMBER OF BEDROOM[; ------ [] One [] Four [] Other I~ SINGLE FAMILY [] Two E] Five MULTIPLE FAMILY ~ Three L~ Six WATER SUPPLY ~ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) 8, SEWAGE DISPOSALSYSTEM E~ INDIVIDUAL/ON-SITE** **If individuel/on-site, give installation date_]._gj,%;L_~p~,ox. If system is over two (2) years oJd an adequacy test is required [] PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SiDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME [)ATE ~-ATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS F~ SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR F~J SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEl'TH OF WELL E3 COMMUNITY DATE DRILLED [] PUBLIC UTILITY 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER E]INDiVIDUAL/ON -SITE DATE INSTALLED C]PUBLIC UTILITY Connection Verified INSTALLER E]Septicl-ankor E]HoldingTank Size: ~/(~)0 _ If Tan[< is homemade SOILS RATING give dimensions: TOTAt_ ABSORPTION AREA MATERIAL. 4, DISTANCESwELL TO: Septic/Holding ' Absorption Area to nearest Lot Line 5. COMMENTS [/~/"-APPROVED FOR ~i~ __ BEDROOMS [] CONDITIONAL APPRO~any certificate) ~'I~ISAPPROVED LEGAL DESCRIPTION 72-010 (Rev. 3~78) CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. FEDEFIAL TAX lO # 92'0040440 -e #1: Time Date Insp 'UNICIPALITY OF ANCHORAGE DEPARTMENT .F HEALTH AND ENVIRONMENTAl ROTECTION 825 L Street, Anchorage. Alaska 99501 264-4720 Date Received: October 17, 1977 1:30 p.m. #2: Time ti3: Time 10-18-77 Tuesday Date Date Willis Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Institution Request: Alaska Pacific Bank Mailing Address: Post Office Box 420 99510 Phone: 276-3110 694-9056 2. Property Owner: Bill Foreman Mailing Address: General Delivery 99577 Phone: 3. Legal Description: Lot 10 Block 9 Preuss SubdJ_vision 4: Single Family Residence: (x) Multiple Family Residence: ( Number of Bedrooms: Number of Bedrooms: Three Well System: Individual well (x) Community/Public System ( Permit # 773 L Depth of Well 235' Well Log on ]Pile Construction ~. Bacterial Analysis Sewage Disposal System: Permit # ~7~& Septzc Tank Size Absorption Area On-site System (x) Public Utility _ Installed _~/~/~7 Installer / Od>O Manufacturer ~3z~k So~l~ Rate I ~ Material Distances: Well to Septic Tank to Sewer Line to Nearest Lot Line to Absorption Area Nearest Lot line _/~ Absorption Area Pag9 Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 10 Block 9 Preuss Subdivision Comments: Affadavit Attached: ( ) Approved: Disapproved Letter Attached: ( ) Date: Date: Department Worksheet: