HomeMy WebLinkAboutPREUSS #3 BLK 11 LT 7Preuss #3
Block I I
Lot 7
#050-572-28
Municipality of Anchorage
(a Development Services Department''`'}'
Building Safety Division
On -Site Water and Wastewater Program, 4700 S. Bragaw SI.
P.O. Box 196650 Anchorage, AK 99519-6650 Page 013
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. S)01021l�� PID Number: 02-57, —c�&
Name S! eVe ijCjrrr
Wastewater System: ❑New Upgrade
pp
Address: LIMA Lc4c Ea `r_nl v@✓ & 7
-'96aa ABSORPTION FIELD
Number of Bedrooms:
Phone: 6q'4—
✓/J_ QI" 16
❑Deep Trench VLShallow Trench [] Bed ❑Mound ❑Other:
LEGAL DESCRIPTION
Sed Rating:
Total Depth from original grade:
3
.�GPofFf
Pt.
Block' 1 Lot: i{ Subdivisio¢PreuL/�
J�
Depth to pipe bottom from original grafi: Ft.
Gravel depth beneath pipe:
FI.
Township' Range: Section `
Fill added above original rade:
m g
Gravel Length:
1 0s' 8()
FLaQ
Ft.
Well: ❑ New ❑ Upgrade
GrwlwWth!
Numberaf lines:
Distance between lines:
19
Ft.
lals/sfig<at i rivale, A, B. C':� Total Depth: cased lo:
1
Total absorpllon area: 571
pFt.
pip.
La�t/f ''��{
-
D303'/ PO'O
' F Ft
Ft'
7�Material
/ t
DOW Data or Static Water Level:
Instelier: L k
CCC C0Y15`Yyc�-10n
Date Installed:
�('—`T'Q�
Ft.
Yield:
ump Set at
i ht Above Ground'
TANK
GPM
FI.
Ft.
SEPARATION DISTANCES
)A Septic ❑ Holding ❑ S.T.E.P. ❑ other:
To
Septic
Absorption
Lift
Holding
PublidPrivatE
Manufacturer : I
�1
capacity:
From
Tank
Field
Station
Tank
Sewer Line
G V i
Q00 Gal.
Well
�+
//'
'
Malarial
Ly
��I
Number of compartments:
SudaceWater
1001+
[D0/-
1004-
LIFT STATION
Lot Lina
ao`
%%
A ►
V
a$ 1
Size: ^�
p` d� Gal.
Manulacturer
QY Y%%;Pi% 1 I Ci S G
Foundation
11 T
�-
�`
�'
on'Ie el at
49
'Pump off level el
�'.
High water alarm /a[k c
W-
1
in.
in.
in.
chrism Drain
Ivor?e
11600
Make& Madel
ElBlasfel ERX
Electrical Inspections performed by:
'Mf Kd- )-A v 414
Remarks: 11f
Of fn5uIa�-fog fn5'f'aI led
BENCH MARK
andel- dr;veWa .
LOc3110n and DaSGlpllen:
Top o co✓itlete
'
�^1 (rj,r vaAssumed Eletion:
0, uJtoo Ft.
E
q, qs�
y7f
*j
S&SEiNGINEERING
Loop River Road, No. 204
17034 Eagle at
Inspections performed by: Dates: 1 �
Q
Rivers Masks 995- -
gagle C�
2nd 6
`•p •ROBERT C. COWAN�C
,.�
DevelopmeltServices Department Approval
CE -8801 ?�
Reviewed and approved by: Date: AD _2A.0/
1te('e „"L "'C
Sr, 12100)
PERMIT NO. SWO 10275
PAGE L OF
MunicipaUtof Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.0. Box 196650 *Anchorage, Alaska 99519-6650 • Telephone 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 7, BLOCK 11, PREUSS #3 P.I.D. NO. 050-572-28
---------------------------------------------
10' UTILITY EASEMENT
NOTE: THIS PROPERTY SERVED
BY PUBLIC WATER. NO WELLS
SEPTIC
F WITHIN 200' OF SYSTEM
c AREA
00F°o 2
�l
�
sF o
y ,
FCO
EXISTING 1000
GALLON
CONCRETE SEPTIC TANK . STI A
GARAGE C
(VERIFIED 8/28/01)
DBL1 & DBL21
DV (DIVERTER
I`
VALVE) LIFT
STATION B
I MT1� TBM
CO7 MH
LOT 6
i
LOT 8 4
MT2
(- co — — — M MT3
NEW TRENCHES -
H I
I TH MT4
o.
Mr co I L\
SEPTIC
L-----� £
Q AREA
KEYBOX
SCALE: t" =-40'
LUCAS AVENUE
-0. ROBERT C. COWAN.....
tj , •� CE -8801
PERMIT NO. SWO 10275
PAGE 3 OF 3
MunicipaUt of Anchora e
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P 11. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 7, BLOCK 11, PREUSS #3 P.I.D. NO. 050-572-28
FINAL GRADE
EXISTING
PRESSURE DISTRIBUTION DATA: 1000 GALLON
CONCRETE
30 GPM PUMP / 30 HOLES TOTAL = 1 GPM/HOLE SEPTIC TANK
(2) 38' LONG LATERALS ^-15 GPM/LATERAL
(15) 3/16"0 HOLES/LATERAL ® 2.7' SPACING
1.25"0 LATERALS
2"0 MANIFOLD
97.8'
98.9' 97.4' 96.0
FINAL GRADE
,2" INSULATION-
qq;6,------m SR DISTRIBUTION PIPE
MTI - 92.5 'MT2 = 92.6
MT3 91.2
WATER FOUND @ 80.7'
78.2' B.O.H.
4.3' '
suurEo
1oER
LUM OUTLET
\-91.7'
S MT4
95.6'
S R
MT4 = 91.4
N. T. S.
A
B C
ST1
46.5
68.5' -
DBL1
47.0
68.0'-
DBL2
47.5'
68.0' -
DV
47.5
67.0' -
001
48.5'
60.6' -
MH
48.5
59.0 -
MT 1
24.'5_1_2
_CC-
MT2
-
32.5 43.0'
MT3
54.5'
39.0' -
MT4
76.5
- 66.5
WATER FOUND @ 80.7'
78.2' B.O.H.
4.3' '
suurEo
1oER
LUM OUTLET
\-91.7'
S MT4
95.6'
S R
MT4 = 91.4
N. T. S.
To whom it may concern;
This letter is notify you that the new sewage system controls at lot 7
Block_ in Eagle River are wired per manufactures instruction and to meet local
and national electrical codes. An Alaska state journeyman electrician #113941 did the
work. /�� U r 5 S S u j7j�
�a�a9 ltivc s s't-.
Thankydi Mike Lauer
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
Date Issued: Jul 30, 2001
Expiration Date: Jul 30, 2002
Permit Number: SWO10275 Parcel ID: 050-572-28
Legal Description:1111FARION;,,f
Design Engineer: 0003 S & S Engineering Site Address: 020629 LUCAS AVE
Owner Name: Steve Harrison Lot Size: 22485 SQ. FT.
Owner Address: 20629 LUCAS Total Bedrooms: 3 Permit Bedrooms: 3
EAGLE RIVER , AK 99577-8622
This permit is for the construction of:
❑✓ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify 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.
Issued By:
-Y(GfZ 4 --
Date:
'7-3o- O(
r Date: 7-30-01
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.cl.anchorage.ak.us
(907)343-7904
ON-SITE SEWERMELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 0 S-0 _ 7 b —3 js Permit Number SW610 2 % S
Property owner(s) S T If,v C H A R4e sa d Day phone
Mailing address (1) ;)0 (oa-0) L.icA} AVk-, P -4-(,t- _ n?IvI/,L 14K
Mailing address (2)
Legal description (Lot, Block & Sub'd.) �-O t
Legal description (Section, Township & Range)
Lot Size a a'i Ff57 Acres Ft.l
THIS APPLICATION IS FOR:
Zip Code �2� S 7
iar"c II I�rL ✓S1 3SIO
Number of Bedrooms
3
Sewer Only ❑ Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade N
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.
5 & 5 ENGINEERING
17034 Eagle River Loop Road No. 204
Eagle River, Alaska 99577
(Signature of property owner or authorized agent)
u u 7 J S7 ) O
Permit Fees: 3 --O. Waiver Fees: I 1
Date of Payment:
/1 X o f Date of Payment: —� // a /a
Receipt Number. 0 7) 3 9 A 1^A_ Receipt Number:
0o'7IZg4
(Rev. 12/00)
S&S
ROBERT C. COWAN,
(907)694-2979
FAX (907) 694-1211
June 28, 2001
HEALTHAUTHORITY
APPROVALS
MUNICIPALITY OF ANCHORAGE
Development Services Department
P.O. Box 196650
SEWER&WATER
g� Anchora e AK. 99519
MAIN IXTENSIONS
REFERENCE: Lot 7, Block 11, Preuss Subdivision 413
SEWER&WATER
INSPECTION
It is requested that you issue a permit to upgrade a septic system to serve the existing
three bedroom dwelling on the referenced property. A 5 foot waiver from the
proposed septic system to the east property line is also requested.
ENGINEERINGSTUDIES
ANDREPORTS
A test hole was excavated and a percolation test performed on 6/22/01. The approximate
location of the test hole is located on the attached site plan. Ground water was monitored
and after seven days water was found at 13.5 feet as shown on the attached soils logs.
WELCTION
This design is based on the high ground water (7.8 feet) found 5/17/93 while designing the
OWTESTEST
8 FLOW
system currently in use.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
SITE PLANS
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
properties.
ROAD DESIGN
If you require additional information, please contact us.
Sincerely,
soaresr
PERCOLATION
Robert C. Cowan, P.E.
TEST
RCC/bjj
Enclosure
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
ON
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TEST RUN BETWEEN J— FT AND S FT
COMMENTS
PERFORMED BY: 17034 Eagie Rivekir Leppeggn77RR�ued No X04 "4& &fA— CERTIFY THAT/ THIS
TEST WAS PERFORMED IN
EauACCORDANCE WITH An I STATE ANID MUN91 AL GUIDELINES IN EFFECT ON THIS DATE. DATE: %/ ` E?
72-008 (Rev. 4/85)
Municipality of Anchorage
Development Services Department
• Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci. anchorage. ak. us
(907)343-7904
Waiver Review Worksheet
WR#: WRO10052 PID#: 05057228 HAM Permit#:
Date Received: 7/12/01
Legal Description: Preuss #3 Blk l l Lot 7
Engineer: Bob Cowan P.E. - S&S Engineering
17034 Eagle River Loop Rd. #204 Eagle River, AK 99577
Applicant: Steve Harrison
Waiver Requested: 5 feet from septic to lot line
Criteria: Geology Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
...............................................................................
Waiver is Granted: Waiver is not Granted:
List Conditions or Reasons for above: S,tE 19EAC/-6612 L JE 7/X_ ►2 0A u S 7-
�fj
Fit um E& G- j9* nEi;a 6 - 2 P, _p/.
Date: 7-24-01 By : P/
Name of Reviewer
...............................................................................
Rec#: 7139 Amount: $115.00 Date Paid: 7/12/01
7/30/2001
Municipality of Anchorage
George P. Wuerch, Mayor
Building Safety Division
P.O. Box 196650 • 4700 S. Bragaw Street
Anchorage, Alaska 99519-6650 • (907) 343-8301
http://www.ci.anchorage.ak.us
Robert C. Cowan, PE
17034 Eagle River Loop Road Number 204
Eagle River, Alaska 99577
Subject: Waiver Request for Preuss #3 Subdivision Block 11 Lot 7
Waiver Request #WR010052
Parcel ID #050-572-28
Permit Number SWO10275
Dear Mr. Cowan:
Department of
Public Works
Your request for a waiver of the required 10 feet horizontal separation from the
absorption field to property line has been approved. The approved separation distance is
5.0 feet.
This waiver approval applies to the existing absorption field 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 343-7904.
Sincerely,
Daniel
J
Civil Engineer
On -Site Water & Wastewater Program
li
Municipality of Anchorage Page __L of
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: PIDNumber: Ol✓O�—✓-228
Name:
Wastewater System: ❑ New Upgrade
Address: Co
ABSORPTION FIELD
Phone:
No. of Bedrooms:
❑ Deep Trench ❑Shallow Trench ed ❑Mound ❑Other
LEGAL DESCRIPTION
Soil Rating:&1)1
otal Depth from origina?:
lgrad
GPD/SFt.
Lot: Block: I Subdivision: , ;
�P.
Depth to pipe bottom from ori final gra (:
Gravel depth beneath pipe /
D.dj
Ft.
Ft.
Township:
Range:
Section:
Fill added above original grade:'
Gravel length: %6/
Ft.
Ft.
WELL: ❑ New ❑ Upgrade
Gravel width: A
Number of s: Distance belw/en lines:
I (P
Ft.
Ft.
sification (Private, A,B,C):
Total Depth:
Cased To: -
Total absorptio9n,(@�rea�:p,,-
Pipe material: IDS
�j
Fl.
Ft.
1 p "-�C7</ SQ. Ft.
Driller.
Date Drilled:
Static Water Level:
Installer: OI$
%i
Date installetl?r {�
"Y
Ft.
Yield:
Pump Set at:
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION
DISTANCES
eptic CE7VST Holding ❑ S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Mpnufacturc. Capacity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
1 000
WellSurfac
,ptlr.F-(
Material:
Number of Compartments:
�j
�OrJG.�
1
frZt7
t6tit't"
LIFT STATIO
Water
LotZo
/
t �/
Size in gallons:
Manufacturer:
Line
V
Foundation
..Pump on" level at:
"Pump off" level at:
High water alarm at:
Curtain
O
`
N
O
PurnpWk1fM.dsI
I Electrical Inspections performed by:
Drain
BENCH MARK
Remarks:
Location and Description:
Assumed Elevation:
tvv—Ft
ENGINEER'S SEAL
IUV
S & S ENGINEERING
Inspections performed by: 77034 EagleRyer Lo" Road,1111 1st { �O R�
f s°°°'
ag e River, Alaska 99577 2nd 1114�7"°•..
° • •....°'
-:;14
Abbas A. Si1wfia•
Department of Healt nd Hum ervices aper va
r °�° No. 11,07-E°°•; x>
Reviewed and approved 0y: Date:
h
72-013 (Rev. 9/91) MOA 25
Zm
n
Permit No. SW920364 Page 2 of 2
Municipality of 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
PRUESS SUBDIVISION, BLOCK 11, LOT 7 05057228
Legal Description: PID No.:
MTI CO3
90.0
' I PLL98R PABRIC
84.2'
84.8,,..'
wsr. PD'a9 IADP Wf111O1 ',. '..
79.6' WATER FOUND 5/17/93 A M wn. PWM
N.T.S.
---
------------------ UTIL.ESMP
A B',
_..._.. FCO
col 19.5 52.0
CO2 65.9 95.0
CO3 90.9 12710
3 BDRM WELL ABANDONED MTl 64.6 101:5
---- HOUSE - - - BELOff GRADE MT2
N Rc
ST. 1000 100 GAL
II - TANK ETE EP C GARAGE
W , co 1
DBL CO
DRIVE
C0z _.._
ENGINEER'S SEAL
MTz CO3 E ED �'`(�'. s• !t3.
WATER KEY BOX
-BY E -tl•If aDI.aD84iDC cV eY a'�.
y
LUCAS AVENUE ry �,a i*berl A. She
1" = 40' - •, No. 1453'-E
72-013 A (Rev. 9/91) MOA 25
lq.lto wsl7 1
MUNICIPALITY OF ANCHORAGE P
DEPARTMENT OF HEALTH AND HUMAN SERVICES _ l� `7�
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW920364
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:HARRISON HERBERT S
OWNER ADDRESS:20629 LUCAS AVE
EAGLE RIVER, AK 99577
PARCEL ID:05057228
LEGAL DESCRIPTION: PREUSS #3 BLK 11 LT 7 '
LOT SIZE: 22485 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
DATE ISSUED:10/22/92
EXPIRATION DATE:10/22/93
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.
SPECIAL PROVISIONS:
RECEIVED B
ISSUED BY:
DATE: ( C' z Z 5, 4? -z
DATE: / ( a x. l
HEALTH AUTHORITY
APPROVALS
SEWER&WATER
MAIN EXTENSIONS
SEWER&WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
V&
October 16, 1992
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
ROBERT SHAFER. P.E.
ROGER SHAFER. P.E.
CIVILENGINEERS
(907) 694-2979
FAX 694-1211
Request you issue a permit to upgrade the septic system serving the
referenced property. An adequacy test performed found the existing
system to be in a state of failure. A soils test was performed in the
area of the proposed upgrade and a design developed.
We do not anticipate any adverse effects on neighboring properties by
the installation of the proposed septic.
If you have any questions or require additional information for your
review, please contact us.
Sincerely,
\' V
ROGER J. SHAFER, P.E.
RJS/tv
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
1" = 40'
UPGRADE DESIGN
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Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR:I�fT—/'�, y DATE
LEGAL DESCRIPTION: L• 1mo/ 1b `4 Fy\ 543TOWnshlp, Range, Section:
., �E�P�T�H) SLOPE SITE PLAN
1
` N
2 O-`
=t�o'
5
4
6
i%
7
s fd
10 WAS GROUND WATER
ENCOUNTERED? D
11~� S
IF YES, AT WHAT O
12 L DEPTH? P
O � E
Depth to Water A r
13- Monitoring? Date: o -"I 7'��'
O
14 i Gross Net Depth to Net
co % Reading Date Time Time Water Drop
15-
16-
5 16 2 .2 o I'A' �✓ B a
3 2'.3S •, �i � �,
17 4 2: r{-5 5 ' 2
18-
19-
20
819
20 I
cul PERCOLATION RATE (minutes inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND b FT
COMMENTS
PERFORMED BY: S & S ENGINEERING I CERTIFY THAT THIS TEST WAS PERFORMED IN
17034 Eagle River Loop Road No, 204
ACCORDANCE WIjh0jM%jEMWAL § fjrlL GUIDELINES IN EFFECT ON THIS DATE. DATE: �b^iia qZ
72-008 (Rev. 4/85)
GR4ER ANCHORAGE AREA BO*GH
Department of Environmental Quality
3330 C Street
` Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME 2"Ve NRAKIS64 MAILING ADDRESS 30-3601 AOfC (-".y NVE PHONE 7V7_04/s-1
LOCATION CaCl_i LEGAL DESCRIPTION, tOr -% 6k -C 6/ rl'WsS aiG�.
SEPTIC TANK:
DISTANCE ,0 NUMBER OF
FROM WELL MANUFACTURER 'r19N MATERIAL GOteGCC'7F' COMPARTMENTS
INSIDE LENGTH - INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY 16190 GALLONS.
SEEPAGE PIT:
NUMBER OF PITS --I—.. DIAMETER -14f OR WIDTH_, LENGTH_, DEPTH
r I
LINING MATERIAL�eaur� CRIB SIZE: DIAMETER.�DEPTH-C DISTANCE FROM: WELL
�q f TOTAL EFFECTIVE
BUILDING FOUNDATION _X, NEAREST LOT LINE ABSORPTION AREA (WALL AREA) &&(0 SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE Cl C- EjDr
�T/DAIPRK.1)
3T 9'
CONSTRUCTION
DEPTH DISTANCE FROM:
BUILDING ,
FOUNDATION gy/
INE
NEARESTST
SEPTIC IDL SEEPAGE /.�.
,
LOT L
SEWERINE
TANK , SYSTEM
CESSPOOL
OTHER SOURCES_
APPROVED - DISAPPROVED
DISTANCES
INSTALLED BY:
f �AKumN fix.
PIPE MATERIAL:
CW �POAI
LOT SLOPE:
REMARKS:
DATE
Form No. EQ -031
DIAGRAM OF SYSTEM
G.A.A.B.
u $yam
' GREATER ANCHORAGE AR BOROUGH
II�jgII�IIIIIIIIIIII����� DEPARTMENT OF ENVIRONMENTAL QUAL P 0.
�11 JI� 8330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
,�pp SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT
NAME OF APPLICANT dTANU I!_TO0 ;MaVOL LiW, MAILING ADDRESS PHONE
INSTALLATION LOCATION �/,/(1r
LEGAL DESCRIPTION LV'} 7 8locx 11uge _s guh1
INSTALLATION OF:
TYPE AND SIZE OF FA
FINANCED THROUGH
SOIL TEST RESULTS
OTHER ,
COMPLETION DATE ANTICIPATED
WITHOUT SOIL TEST
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE
MINIMUM DISTANCES,
otacl fate
TYPE CSEEPAGE AREA SIZE ISP;� a TYPE
DIAGRAM OF SYSTEM
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT 2,P
C( ,DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL /J /
SEPTIC TANK SEEPAGE PIT 2a DRAIN FIELD
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK , SEEPAGE PIT /DO'
DRAIN FIELD ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK SEEPAGE PIT
DRAIN FIELD ,
11
SEPTIC TANK, 1lea=. SEEPAGE PIT DRAIN FIELD ,
TO RIVER, LAKE. STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
G.A.A.B.
OR
LICENSED DESIGNER
I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. j�
DATE `�' APPLICANT'S SIGNATURE
FORM N . EO- 16
• 0
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUA:L(TY
3330 "C" Street
ANCHORAGE, ALASKA 99503
Case #
Performed For HCL%ft4 1+401, EXC'g$jJ�wg_Dated Performed 6-21-7y
Legal Description: LotBlock It Subdivision_ Pr'U�SS
This Form Reports Soils Logue _Percolation'Test 1
- Soil Test must Be Logged To 4' Below Proposed Seepage System - 3
Depth
Feet Soil Characteristics
1 yddo-l'/z TopsoI' I
4M 1`/-- to
5
Shy C-r4ae ( GW: Tr
7•:
s ;'
to Sw-s/h
11 lT7
12
13
14
Was Ground Water Encountered? Ai 0
If. Yes, At What Depth?
S�
19pe
Reading j na+.
fr"Isc Time
Net. _me_
Depth to HLO
Net oroo
Percolation Rate Minute
Proposed Installatioi: Seepage Pit Drain Field
Depth of Inlet —Depth 1?o Bottom FoPii or TrencN--i
COMMENTS:
Test Performed BY_ r�'L 4j6- _Date Certified BY:
Date:
Municipality of Anchorage` &
On -Site Water & Wastewater Program
(907)343-7904
,4 rij RM 'a r.
arP��
CERTIFICATE OF ON—SITE SYSTEMS APPROV
Parcel I.D. 050-572-28 Expiration Date: /
1. GENERAL INFORMATION
Complete legal description PREUSS SID #3; BLOCK 11, LOT 7
Location (site address) 20629 LUCAS AVENUE, EAGLE RIVER, AK, 99577
Current Property owner(s) KEVIN DONOVAN Day phone
Mailing address 20629 LUCAS AVENUE, EAGLE RIVER, AK, 99577
265-8102
Real Estate Agent HEATHER DECKER W/ CENTURY 21 Day phone 274-1475
2. TYPE OF DWELLING:
Single Family (w/wo ADU) r r e%
�J
❑ Duplex e v %s i
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
0
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
Public Sewer
❑
Wa1verNariance request for: DRAINFIELDS TO LOT LINE Distance: 2 FEET
Received by: V Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ O `f/ (`&O Waiver Fee $
Date of Paymentg!/� S _
Receipt Number JiS036
COSA # 05i 611;L T
Date of Payment '
Receipt Number
Waiver# (DSV 1511JZ6—
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm
GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 "ANCHORAGE, AK, 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineers Comments:
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the
guidelines and rogulations established by the Municipality ofAnchorage and industrypracboes. The reported results describe the
condition ofthe systems on the deters of the evaluation. Separation distances were measured to readdyidentidable features.
Hidden defects or encroachments may exist that were not identified during the evaluation. The operandnallik of all wells and septic
systems depend on a variety of variables including, but not limited to, .mil conditions, groundwater levels (that may fluctuate during
the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the systems. mese
conditions ran vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the
systems; therefore, GEG makes no warranty (express orirnplied) regarding the future performance of the well or septic system.
GEG makes no representation whether an alternative well or septic system can be installed on the property in the event edher of the
current systems fad. The content ofthis report is for the sole benefit of the persoNparty who retained GEG. Reliance upon the
information provided in this report by any otherperson or party, including but not limited to subsequent propeRypurchasers, -is not
authorized. In short, GEG disavows any legal duty to anyone other than the pemonliparty who paid for this report.
6. DSD SIGNATURE
System #1 Approved fory bedrooms.
Phone
337-6179
/
1ieA5
Date �.
u
atfreyA�GA1'ness : pcc�r=
,10E -795P
7 ✓If�• 1
pROFESSt��i��
�TAlk
System #2 Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following.;ft�t latigrls_StTC
Original Certificate Date:
The w(tyrnicipality or Anchorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTCHMENTS:
COSA Checklist _�� Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
(Rev. 10/12112)
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 S/D #3; BLOCK 11, LOT 7 Parcel ID: 050-572-28
A. WELL DATA PUBLIC WATER
Well type If A, B, or C provide PWSID# _ Well Log (YIN)
Date completed Sanitary seal (Y/N)_ Wires properly protected (Y/N
Total depth ft. Cased to ft. Casing height (abo rou: in.
FROM WELL LOG ATI CTION
Date of test
Static water level ft. ft.
Well production g.p.m. —
9 -p.m -WATER SAMPLE RES
Coliform colonies/100 ml. Nitrate mg./L. Collected by:
Arsenic: ug./L. Date of sample:
B. SEPTIC/HOLDING TANK DATA `6' FROM FOUNDATION.
Tank Type/Material SEPTIC/CONCRETE Date installed 7/1/1974
Tank size 1000 gal. Number of Compartments 1 Cleanouts (YIN) YES
Foundation cleanout(YIN) "YES Depression over tank (YIN) NO High water alarm (Y/N) YES
Date of pumping 1/21/2015 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA VBELOW EXISTING GRADE 1993 BED/2001 DRAINFIELD3
71161911993 0.4 BED
Date installed 8/2a-9/412001 Soil rating .p.d./ r ftllbdrm) o_8 System type DUAL 5 WIDE
38 0.5
Length 2@40 ft. Width 30/5 ft. Gravel below pipe 2 ft.
"a.3 1140
Total depth `43-5.215.2.5.9 ft. Eff. absorption area 571 ft� Monitoring tube YES •Depression over field NO
Date of adequacy test"`12126/2014 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test DRY in. Water added 1060 gal. New depth DRY in.
Elapsed Time: = min. Final fluid depth DRY in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date
"TESTED SOUTH TRENCH OF 2001 SYSTEM FOR ADEQUACY TEST. OTHER DRAINFIELDSWERE DRY.
*TO FLOAT TETHER CLAMPS.'"'PER MOA LETTER IN MOA RECORDS FROM MIKE LAUER
D. LIFT STATION ELEC #113941 AND LETTER DATED 3/25/2015 FROM J ELECTRIC LLC ( #34469)
Date installed 6126-914/2001 Size in gallons 200 Manhole/Access (Y/N) YES
"Pump on" level at *30.5 in. "Pump off level at *30.5 in. High water alarm level at *44.5 in.
Datum BOTTOM OF PUMP VAULT Cycles tested 3 Meets alarm & circuit requirements? **YES
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on
Public sewer main
Sewer /septic service
PUBLIC WATER
On adjacent
On adjacent lots
manhole/cleanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 51+ Property line 5'+ Absorption
Water main
10'+
5'+
Water service line *70+ Surface water 100'+
Wells on adjacent lots 100'+ PRIVATE / 200'+ PUBLIC
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 11993 BED 12001 DRAINFIELDS
Property line 10'+/**2'+ Building foundation 10'+/10'+ Water main 10'+/10'+
Water service line *10'+/*10'+ Surfacewater 1001+/1001+ Driveway; parking/vehicle storage***0'+/***0'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+ PRIVATE / 200'+ PUBLIC
F. COMMENTS
*PER 2001 ROBERT COWAN P.E. INSPECTION REPORT & H.A.A.. **SEE ATTACHED WAIVER LETTER.
***PORTION OF THE PARKING PAD WAS BLOCKED OFF TO PREVENT VEHICLE TRAVEL OVER THE DRAINFIELDS.
G. ENGINEER'S CERTIFICATION
I certify that i have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARN ESS
Date ybahr
(Rev. 10112112)
GARNESS ENGINEERING GROUP, Ltd
- CIVIL & ENVIRONMENTAL ENGINEERS
April 7, 2015
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Rd.
P.O. Box 196650,
Anchorage, Ak 99519-6650 �}�
(907)343-7904 �„wfJ6 44
Ref: Preuss #3; Block 11, Lot 7—(;aiver Request for Drainfield to Property Line, and request for
COSA approval.
To whom it may concern:
GEG, Ltd. recently completed a septic system adequacy test at the referenced property. It was discovered
while inspecting the as -built survey that the drainfields appear to be encroaching on the property line. At
this time we request that your department issue a horizontal distance waiver of 2' from the drainfields to
the East property line. Justification for the waiver includes:
• The condition has existed for over 13 -years.
• The neighboring reserve drainfield to the East has 5' of effective depth, and is over 10' from the
property line.
We do not foresee any risk to public health, should this waiver be approved. If you have any questions,
please contact Jeff Garness or Rob Campbell at (907) 337-6179.
3701 E. Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com
Municipality of Anchorage
ment S
A,paitment
*** VARIANCE/WAIVER REVIEW ***
Waiver#: OSVIS1016 COSA#:OSC151127 Permit#r
PID#: 060-672-28
Legal Description:Preuss N. Block 11. Lot 7
Engineer: Garness Engineering Group
Applicant: Kevin Donvan
Your request for a waiver of the required 10 feet horizontal separation from the absorption field
to the property line has been approved. The approved separation distance is 2.0 feet.
This. waiver approval applies to the absorption field only. Any future upgrade to the
on-site wastewater disposal system will require all separation distances be met or another
approval from this department,
❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected
adjacent property.
This waiver is a revision to an earlier waiver. It is assumed adjacent properties are already
aware of the less than minimum required separation:
...........................................................................�
Waiver is Granted: f X Waiver is not Granted,,
Date: 7 / r Approved by:
a of Reviewer
...■...................... ....................... ...............................
ZONING Duma*
fRG!!T aiwnwc SEaAac
589°49'00"VV 129.00'
me Iil{CP1C s�eA<x
TO' UTIL ESMT
rsu e..anrw sere.ca — -----------
i0
UP
e
r
0
HOUSE
GARAGE
LUCAS AVENUE o
'b
UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSIROC-11CIY OR FOR ESTASUSHING BCUNCARY CP. FENCE -NE"
THE SURVEYOR TAKES RESPONSIBIUTY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OFTHE SURVEY.
LISTED DISTANCES PREVAIL OVER SCAUNG. REPRODUCTION MAY CAUSE ERRORS IN SCALE.
LOT SURVEY SURVEY TYPE SYMBOLS
FOUNOATIaN AS -BUILT SET REBAR DRAINAGE ASPHALT
❑ FINAL STRUCTURE AS -BUILT
❑ PLOT FLAN ... AS -BUILT ... LOT SURVEY ... TOPOGRAPHY O FOUND REBAR g__9_g ,WOOD FENCE CONCRETE
CONCRETE
.....,.. .,.. — f-'1 .,,, <„o.,<e< r `r (9a>ASSUMED ELEV. �I - i ( METAL FENCE ®. WOOD DECK
IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
SURVEY CERTIFICATION +�®�[[Q► OF ���1,®
PLOT PLAN
tlw plm INE le
ma ,Chau. W 0Yn
cv. am v.
PON AS -BUILT
on an wv ut ma as a m.7.
a. ma hNmaam n dwT IIMei �'.
.,a „e .naaaa.nnes
STRUCTURE AS -BUILT
t E JC„A i, Mnay a fy Mal I
.mn.a ae A.eae ....y N
ns IM a,a neV a n.
n. aw TyarmWv, m •,o.., tnr.m
ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE -WILL BE
SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS. SIDEWALKS, DRIVEWAYS,
ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW
MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED.
ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED.
Prepared by
Robert E. Johns, Jr. & Assoc.
Professional Land Surveyors
1700 Brink Drive.
ANCHORAGE, ALASKA 99504
Scale: 1 ,o = 40, Rea. Lot S.F. Ree. Plat File No.
Date Surveyed: 10118111 Drown by. R i Checked bgy. �y�
I J e3i3f K
Date Drawn: 10/19111 Grid NVV056 I W O. 11-364
LOT 7 BLOCK 11
PREUSS #3
J ELECTRIC LLC
6732 E. 99th AVE.
ANCHORAGE, AK. 99507
March 25, 2015
To the Residence of
20629 Lucas
Eagle River, AK.
This letter is to certify thai:_J Electric completed the
inspection of'the wiring for the control panel of the
septic system at the above address According to the NEC and
MOA rules.
sin-, rely.
J e Saggs- Owner
J LECTRIC LLC
Contr. Lic: # 34469
Rob Campbell
From: Crewdson, James A. [CrewdsonJA@ci.anchorage.ak.us]
Sent: Monday, April 06, 2015 9:38 AM
To: Rob Campbell
Cc: Jeff Garness
Subject: RE: Preuss #3 B11, L7 - JRs UV coating job photos
Rob,
On -site's code requirements do not speak to insulation coatings. I felt justified to push
for UV protection because the manufacturer of the installed insulation
requires it. Dave
Mero and I came to agreement that one of the roofing products might be
a way to achieve that.
It appears from the photos that the coating does provide some level of
UV protection, and
that it's adhering well without causing any significant degradation to
the insulation. The
code doesn't speak to whether it has to look pretty or not, so as long
as the insulation is
intact (doing its job) and the UV protection isn't falling off, On-site
considers the
installation to be in accordance with the code
Thanks
Jay
James "Jay" Crewdson, P.E.
Civil and Environmental Engineer
Municipality of Anchorage - Development Services Division
On -Site Water and Wastewater Program
Location: 4700 Elmore Road
Mail: P.O. Box 196650, Anchorage, AK 99519
v. 907.343.7908 f. 907.249.7601
-----Original Message -----
From: Rob Campbell[mailto:Rob(&garnesseneineerine.com]
Sent: Monday, April 06, 2015 8:46 AM
To: Crewdson, James A.
Cc: Jeff Garness
Subject: Preuss #3 B11, L7 - JRs UV coating job photos
Hello Jay,
Let me know if this meets your satisfaction, and if this is the product that JRs discussed
with you for use on the tank riser at the subject location.
Thanks so much.
Rob Campbell
Superintendent/Engineering Consultant
Garness Engineering Group, Ltd.
3701 E. Tudor Road, Suite 101
Anchorage, AK 99507
Office: (907) 337-6179
Cell: (907) 317-9433
Fax: (907) 338-3246
http://www.garnessengineering.com/
1
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Foam Kit 200 FR - Item # 4004001200 of leftover material/containers in
200 board feet (18.6 m2 @ 25 mm) 4. TECHNICAL DATA accordance with federal, state and local
Applicable Standards regulations. See Material Safety Data Sheet
Foam Kit 600 FR - Item # 4004521600 . ASTM G21 Fungi Resistance for more information. Refer to "Foam Kit
600 board feet (55.7 m2 @ 25 mm) . ASTM E84 Surface Burning Operation Instructions" for storage of
Characteristic partially used kits.
FeaturevBeneh'ts . ASTM E96 Water Vapor Transmission
• Class 1, fire retardant foam
• Easy to transport • ASTM E283 Air Permeance
• No expensive maintenance . ASTM C518 R -Value
• No investment cost . ASTM D1621 Compressive Strength
• No deposit/No return . ASTM D1622 Density
convenience Products . ASTM D1623 Tensile Strength
_` 866 Horan Dr., Fenton, MO 63026 USA 54002-0409.Trvs
\(lltl� (800) 325-6180, (636) 349-5855 tel.
TECH DATA SHEET
5. INSTALLATION / APPLICATION
Refer to "Foam Kit Operation Instructions"
found inside the product carton or request a
faxed set of these instructions by calling
Customer Service at 800-325-6180.
Always refer to local building codes prior
to application of Touch 'n Seal® spray foam.
Touch 'n Seal spray foam can be applied to
and will adhere to almost any traditional
building material surfaces including; wood,
concrete, polystyrene, gypsum board,
fiberboard, masonry and metal.
Surfaces to be sprayed must be dry, clean
and free of dust, dirt, grease and other
substances that may inhibit proper
adhesion. For best results apply Touch 'n
Seal spray foam when surface and ambient
temperatures are between 60° - 90°F (16° —
32°C). Chemical contents must be between
70° - 90°F (21- — 32°C) before dispensing.
Use all chemical contents within 30 days of
initial dispensing.
Keep out of reach of children. Always
wear proper personal protective equipment,
including head covering, gloves, clothing,
eyewear and respirator. Use in well -
ventilated area.
6. AVAILABILITY & COST
Availability
Touch 'n Seal Two Component FR Spray
Foam Kits are available throughout the
U.S., Canada, Mexico and the world.
Contact Convenience Products Customer
Service at 800-325-6180 or FAX
636-349-5335 for distributor information.
Cost
Contact Convenience Products for local
distributors who can provide cost and
delivery information.
7. WARRANTY
Convenience Products warrants its spray
foam kits to be free of defects in
workmanship and function.
Thermal Protection 07 21 19
Foamed In Place Insulation
Convenience Products is not liable for any
incidental, consequential or any other
damages or remedies. There are no
warranties that extend beyond the
description herein, however, certain states
have specific laws regarding limitation on
incidental or consequential damages, in
which case, you may have other legal
rights.
8. MAINTENANCE
Minor— Refer to "Foam Kit Operation
Instructions."
9. TECHNICAL SERVICE
Technical assistance, including detailed
information, product literature, test results,
assistance with preparing project
specifications and application training is
available by contacting Convenience
Products.
10. FILING SYSTEMS
Additional information is available from the
manufacturer upon request.
TVPIQAI PRnPFRTIFfi nF TnIICH 'N SEAL FR SPRAY POLYURETHANE FOAM 1.75 PCF (28.03 kalm3l
------------------ -- ------ -- -
Shelf Life
1 year; unopened container
Output
Foam Kit 200 FIR
Foam Kit 600 FR
200 board feet (18.6 m2 @ 25 mm)
600 board feet 55.7 m2 @ 25 mm
Dry time/Tack Free Time
30 — 60 seconds
Fully Cured
Approximately 1 hour
Cuttable
2 — 5 minutes
STM G21 Fungi Resistance
Does not support growth
STM E84 Surface Burning Characteristics @ 2" (51 mm)
Flame Spread
Smoke Development
15
250
STM E96 Water Vapor Transmission
2.80 perms @ 1 in. (25 mm)
STM E 283 Air Permeance
< 0.01 ft3/sec/ft2 (< 0.05 Us/m2)
STM C518 R -Value — Initial
7.121 in. (25 mm)
STM D1621 Compressive Strength
13.1 psi (0.92 kgf /Cm2)
STM D1622 Density
1.75 t .1 pcf (28.03 t 1.60 kg/m3)
STM D1623 Tensile Strength
38.23 psi (2.69 kgf/cm2)
STM D2126 Thermal and Humid Aging — Dimensional Stability
-40°F (-40°C) 2 weeks
158°F (70°C) 2 weeks
Combined -40°F (-40°C) 2 weeks & 158°F (70°C) 2 weeks
Linear
Mass
+0.05%
+1,g0%
+1,85%
+0.10%
-2.95%
-2.85%
STM D6226 Closed Cell Content
> 90%
International Residential Code
Compliant
California Bureau of Home Furnishings and Insulation
Filed
Convenience Products
866 Haran Dr., Fenton, MO 63026 USA
54002 -0409 -TNS
(800)326-6180,(636) 3493855 tel.
USES:
WART
ATCO 0870 is a premium, heavy-duty, alkyd resin and
If.,._,...
aluminum based coating used for covering roofs and siderwallis
N uailers.R.V..'s. mobile homes, truck bodies and other types
of metal roofing. Silver Seal farms a tough, bright decorative
coafing Which reflects both heat and ubra-violet radiationaway
Crus=-
uomthesurface. Its use will seal small holes and seam openings
;1110;,•:
a -i' on metal and other surfaces, including corrugated galvanized
SUM—
steel, or aluminum, masonry and concrete.
ardss�`
DIRECTIONS
laf.r_:
T`�e amain he coated should he clean and dry. Large hales
gaps or separations
should hep atched with lass fabric
-eemeoled beb."en two heave applications of Silver Seal
ALPbj hp brush,
spray or roller. Seams, vents, and Omer
"= tonneclions
should receive a heavier application for
F, aurum Protect ion. One gallon covers 5O-75 sq. ft. Use
t ner
or mineral spirits clean-up Maximum
is 425
oramsrlitec Donot thinor dilut.
F
M,.
Wkir ;
-
x`
Municipality of Anchorage
N• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON—SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-572-28
1. GENERAL INFORMATION
Complete legal description Preuss #s S/D, Block 11, Lot 7
Location (site address) 20629 Lucas Avenue, Eagle River, Alaska
Current Property owner(s) Tod and Tricia Miller
Mailing address
Lending agency
Mailing address
COSA # Ot)C, m 3V9
Expiration Date: / 0 / L — oZ
Day phone 696-7696/11, 529-7692/c
Day phone
Real Estate Agent Audrey Mason of ReMax of Eagle River Day phone 622-3344
Mailing Address 11525 Old Glenn Hwy., Eagle River, AK 99577
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
❑
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑✓
TYPE OF WASTEWATER DISPOSAL:
Individual On-site ✓❑
Individual Holding Tank ❑
Community On-site ❑
Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, l 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. 1 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.
7 M ri
Douglas T. Kenley, P.E.
Address 9606 E. Nonhstar Circle, Palmer, AK 99645
Engineer's Printed Name Douglas T. Kenley
5. DSD SIGNATURE
Approved for _ bedrooms.
Disapproved.
Phone (907)746-1073
Date b qU
Conditional approval for bedrooms, with the followil
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date: /0
(Re¢ 1IM5)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Preuss ria s/D, Block 11, Lot 7 Parcel ID: 050-572-28
A. WELL DATA
Well type Public
Date completed _
Total depth ft.
Date of test
Static water level
Well production
WATER SAMPLE
Coliform
If A, B, or C provide PWSID # _
Sanitary seal (Y/N)
Cased to ft.
FROM WELL LOG
40211.12
Well Log (Y/N) _
Wires properly protected
Casing height (abo rc
AT IN TION
mL Nitrate mg/L Collected by:
ft.
in.
nic: _ ug/L date of sample: _
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Concrete Date installed 1974
Tank size 1000 gal. Number of Compartments t Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y
Date of pumping 10/13/2011 Pumper J R's Pumping
C. ABSORPTION FIELD DATA
Date installed 9/4/01 Soil rating (g.p.d./ft3 or ft2/bdrm) 0.8 System type 5' Wide Trench
Length 40+40=80 ft. Width 5 ft. Gravel below pipe 2 ft.
Total depth 3 ft. Eff. absorption area 571 ftz Monitoring tube Y Depression over field N
Date of adequacy test 10/4/11 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 1/1/8 in. Water added 603 gal. New depth 6, in.
Elapsed Time:120 min. Final fluid depth ""'� 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 914/01 Size in gallons 200 Manhole/Access (YIN) Y
"Pump on" levet at 48 in. "Pump off' level at 51.5 in. High water alarm level at 44.5
Datum bottom of basin Cycles tested 3 Meets alarm & circuit requirements? _
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankilift station on lot On adjacent lots
Absorption field on lot On adjacent I
Public sewer main Public sewer manhole/cleanout
Sewertseptic service line Holding tank
Animal containment areas 50+ ft. Manure/animal excrete storage areas 100+ ft.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ ft. Property line 5+ ft. Absorption field 5+ ft.
Water main 10+ ft. Water service line 10+ ft. Surface water 100+ ft.
Wells on adjacent lots 200+ ft.
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line eft• Building foundation 10 ft. Water main 10+ ft.
Water Service line 10+ ft. Surface water 100+ ft. Driveway, parking/vehicle storage 2+R
Curtain drain None known Wells on adjacent lots 200+ ft.
F. COMMENTS
R
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are In
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed !Name Douglas T. Kenley P.E.
//
Date 10 I r5I N
COSA Fee $ eAc1O
Date of Payment UU
Receipt Number x`714 U
(Rev. 4110)
Waiver Fee $ _
Date of Payment
Receipt Number
!V.
in.
, . ra
* V,
Pereh. 0 FlNISYEa FUCCR
as, (,h..EO)
PROPasEO WIMNG CORNER
EtTv.(ASSNMEO)
IIXIING DISTRICT
FRONT KIWING SZMACI(
S89h 49'00"W 129.00'
9DE BULDING sETBAO,
10' UTIL ESMT
REM EGWIhG GF%ACR
_
--
n,
C,
Z
EXISTING
HOUSE
9� 10
N
S
io
O,
0
ryo 13.6'
o
GARAGE
....
z 8
g
C.OS...
a
w
0
0
M. H. ---'
o
�
r
129,00' S891 59' 00"E
LUCAS AVENUE o
UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES.
'HE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY.
LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE.
❑ LOT SURVEY SURVEY TYPE
SYMBOLS
❑ FOUNDATON AS -BUILT
❑ FINAL STRUCTURE AS -BUILT
SET REBAR E1]snxc PR°P°sED D ASPHALT
° <= ♦ DRAINAGE
❑ PLOT PLAN ... LE SURVEY . TOPOGRAPHY
O FOUND REBAR gag WOOD FENCE CONCRETE
CONCRETE
O CORNERS SE C
10 AS -BUILT ... NO CORNERS SEi RECERTIflCATON AS -BUILT ... NO CORNERS SET
00 a. ASSUMED ELEV.
� I( )( X" METAL FENCE ® Wp00 DECK
PLOT PLANS & LOT SURVEYS
NOTE:
IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO
ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE
SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS,
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW
THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS
MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED,
WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED.
SURVEY CERTIFICATION
�.•�E OF q<y
Prepared by
Robert E. Johns, Jr. & Assoc.
PLOT PLAN
'b°byownaddrthatemnhow ^°andar.nmet1
lot -hewn and ee°mnm nefem, and mat
:• •1 ♦j♦
Professional Land Surveyors
nom
he a established of me eanere
•
swcDlb
1700 Brink Drive.
o"A
mown °,� ma PIm am to me met or my
an t at
Nnowleaye one bungee, ai almmelm° now be.
: 'ee ♦♦
ANCHORAGE, ALASKA 99504
Scale: 1 II _ 40,
Per. Lot SE
Rea Plat File No.
,reasoned'"° and `" "
a 49 , ♦
AV
FOUNDATION AS -BUILT
••• •.•••• ••••• ....
• •••�
-
h wbe E. gonna. as b.m�o.rury not
mw venh t an t rwy or the
rw"aam" this lot that m°
/
•• ••• •�••
•,
Y p
Date Surveyed: 1 0/1 8111
Drawn by. REJ
Checked byn A
of and
on hm
an all
a. nuona no mmrmheoo as mown neleon
♦ OB JR.
ROBERT . JOH
J I VI K
Date Drawn: 10/19/11
Grid:
NW056
W.O.
11-364
t
mownw <rve here "o mcroo hmnb ..let u°I.°z
om.wioe.
♦ G A W
♦ p a
♦♦9', •••
FINAL STRUCTURE AS -BUILT
I, Robert E. Johns. dr., hereby mot I
4121—S :• a°'A�
01. •'• .' •y4t.1
Legal Description:
wrify
how performed a Aw-B°at rwy e, me
edmt
is
e ........... •
hW°mre ao no mot hw me
d d
p an .•
LOT 7 BLOCK 11
almenolo and' mr.mmlca oh mown name.
I �o fessionol ��
�����.w`..••
sh.-mhna.e hrhham.nlw aLtunle.e
PREUSS #3
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-Z8
1. GENERAL INFORMATION
HAA # zf-I�Q/C Ll
Expiration Date: In •2.'t -0 �
Complete legal description 4ot 7, Block 11, Pruess 163 Subdivision
Location (site address or directions) 20629 Luca
Current Property owners) (Herbert) Steve Harrison Dayphone 694-2416
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
20629 Lucas Avenue, Eagle River, AK 99577
Day phone
Day phone
Unless otherwise requested, HAA will be held by DSD for pickup. 7avzZ _' ",,,,,` /04),-7/00
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
®
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewater disposal 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 less than 30 days old. (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, 1 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.
5 & 5 ENGINEERING
Name of Firm 17034 Eagle River Loop Road No. 204
Eagle River, Alaska 99577
Address
Engineer's Printed Name Robert C. Cowan, P.E
Phone 6 Ot 41 — 3LI 7 2
Date %0//T/0/
y9aLz\V.t
tOFgZ•
<kROBERT C. COWAN t C-
5. DSD SIGNATURE 1 s.,t cE-8801 ;i
Approved for _ bedrooms. �� l c `• .........•
Disapproved.
t,,i�a�aaaza4'`'
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: ay /� Original Certificate Date: ID ",2
(Rev. 12/00)
Municipality of Anchorage a �E
Development Services Department
Building Safety Division
a SA ETT
On -Site Water & Wastewater Program
4700 South Bragaw St
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: (�T �� oC/L , �i�L( SS 3 S� Parcel ID: j!?60 -5:4 z -z.8
A. WELL DATA (711
Well type _ If A, B, or C provi a PWSID #
Date completed _ Sanit seal (YIN)
Total depth ft. asedto ft.
WELL LOG
Well Log (YIN)
Wires property protected (Y/N)
Casing height (above ground) in.
AT INSPECTION
Date of test % _ ---
Static water levet,, ft. __ ft.
i
Well production g.p.m. 9.p -m.
WATER S PLE RESULTS:
Colifor colonies/100 ml. Nitrate mg./I. Other bacteria colonies/100 ml.
Date sample: Collected by:
B. SEPTIC/H. GG TANK DATA �1
Tank Type/Material l ii L / XNC11 Date installed / 9
Tank size Lo gal. / Number of Compartments f Cleanouts (YIN) `lis
Foundation cleanout (Y/N) 7 Depression over tank (Y/N) .-LL High water alarm (Y/N)
Date of pumping Ki I Pumper _�J?G i S _
C. ABSORPTION FIELD DATA
Date installed r%
Length & _ft.
Soil rating (g.p.d./ft2 or ft2/bdrm) -6
Width
ft.
Total depth 3 ft. E,ffabsorption area '5;?/'5;?/ ft' Monitoring tube
/
Date of adequacy test / V C� Results (Pass/Fail) P4 -15
System type : gg7 7 ®Z¢ � CH
Gravel below pipe Z ft.
'7 Depression over field �Ni
For 3 bedrooms
Fluid depth in absorption field before test _ in.ter added_ gal. New depth_ in.
Elapsed Time: _ min. Final fluid depth in.Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/ type) If yes, give date
D. LIFT STATION `' �nl
Date installed `� 01 Size in gallons 1 v
"Pump on" level at J118 in. "Pump off' level at 9. Stein.
Datum & 773m ! 045 fA/ Cycles tested Z,
Manhole/Access (Y/N)
High water alarm level at 44• L iinn.
Meets alarm & circuit requirements? _� 5
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer /septic servie6 line
On adjacent lots
On adjacent lots _
Public sewer manholelclea ut
Holding tank
SEPARATION DISTANCES FROM SEPTIC/1-191,0 G TANK ON LOT TO:
Building foundation 5 fi Property line 5 f Absorption field
Water main % F Water service line r� Surface water / oo
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /o Building foundation /0 Water main
Water Service line Surface water /(�� 9r- Driveway, parking/vehicle storage Z
Curtain drain 10WE- //1rkN Wells on adjacent lots -NIA
F. COMMENTS
G. ENGINEER'S CERTIFICATION 'a'•^
I certify that 1 have determined through field inspections and J
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date. NEER amu".
ROB@ ������ggWAN f ?
Engineer's Printed Name I�oa�a7 Cpclgd s+�C£��E01
Date/ /17 0 /\h�PF,BFe551'
HAA Fee $ 3 00.
Date of Payment /0 /1? ? / o /
Receipt Number a) r s 6 Y 'LA
(Rev. 12100)
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE •
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date APRTT, 23, 19137
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
20629 T,TTCIAS, FAC=i F. RTVFR, PK
(b) Applicant Name STEVE RARRTSON Telephone: Home —Ll/a Business 786-3327
Applicant Address _20629 TTTCAS, FACT,F. RTVFR, ALASKA 995177
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builderXI ; Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution C. M A C, Telephone _562-2181
Address 701 E =)DR, SUTTF 107, ANCRORAGE, AT ASKA 99503
(e) Real Estate Company and Agent n/,
Address n/a
Telephone n/a
(f) Mail the HAA to the following address:
FOR PTCKULRYRj(`.I RI'R ENGINEERING SERVICES
2. TYPE OF RESIDENCE
Single -Family NK Multi -Family ❑ Other
Number of Bedrooms R
3. WATER SUPPLY
Individual Well ❑' Community ❑ Public D=
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite MC Public ❑ Community ❑ 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 (11/84)
5. ENGINEERING FIRM PROVIDI*NSPECTIONS, TESTS, FILE SEARCH, Do AND INFORMATION
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 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, LOT LINE AND DRIVEWAY SEPARATION DISTANCE PRIOR TO 1986 ORDINANCE.
Name of Firm EAGLE RIVER EtdGIN1=, NG SERVICE'S Telephone 694-5195
Address P.O. BOX 773294, EAGLE RIVER, AR 99577
Date _��4 7
Louis A. Sutere
CE -6736
6. DHEP APPROVAL �7
Approved for - bedrooms by d� Date 5-7
Approved X Disapproved Conditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
MUNICIPALITY OF ANCHORAGIR
ENVIRONMENTAL, SERVICES DIVISION
-
APR 2 31987
RECEIVED
A. WELL DATA
MUNICIPALITY OF ANCHORAGE (MIR
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: �rs rf 7
Well Classification If A, B, C, D.E.C. Approved (Y/N) y
Well Log Present (Y/N) Date Completed
Total Depth
Static Water Level
Cased to
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Depth of Grouting —
Pump Set At
Yield
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
On Adjoining Lots
On Adjoining Lots
— To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
Date
Date Installed 1275/ Size h,60-54/ No. of Compartments /
Standpipes (Y/N) y Air -tight Caps (Y/N) y Foundation Cleanout (Y/N)
Depression over Tank (Y/N) IV Date Last Pumped �7, /Zfd'7
Pumping/Maintenance Contract on File (Y/N)
1/14
for
Holding Tank High -Water Alarm (Y/N) /✓-4 Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well To Building Foundation A%
To Property Line i� To Disposal Field 13 ?a
To Water Main/Service Line
Course 10<
Comments
Page 1 of 2
72-026(11/84)
1/0,
To Stream, Pond, Lake, or Major Drainage
0 0
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata __�� �� Type of System Design
Date Installed Length of Field
Width of Field l X15; Depth of Field
Gravel Bed Thickness 5 -
Square
Square Feet of Absorption Area `4--+§� tStandpipes Present (Y/N) _Y
Depression over Field (Y/N) N Date of Last Adequacy Test
Results of Last Adequacy Test .Sts >!�, ��a-x 4�S" -6-7 " C.le '`� • � '�^ uJ� .
Separation Distance from Absorption Field:
To Water -Supply Well
To Building Foundation a S /
Lot Nle
/
To Water Main/Service Line
k- /
To Property Line
To Existing or Abandoned System on
On Adjoining Lots 3,91
To Cutbank (if present)
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Areaf 14�ew�
Comments - SeroS ati-iso.. UiJ7%.✓ceJ /O�, or 7�a /SFsEy>'wo••�,
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 (Y/N)
"Pump Off" Level at
" Check Permitted Bedroom Rating Against HAA Request "
Vent(Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
I certify that I have chec ced, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed/ Date % /--
Company z.,'/c S MOA No. S7-
-e2, -s -
Receipt No. —/� aDOj �—
Date of Payment `a 3 —,F 7
�a
Amount: $ �� �J � r '�. Engineer's Seal
Eagle River Engineering Services
Page 2 of 2 P. 0. Box 773294
Eagle River, AK 99577
C ;„
694.5195
72-026(11/84)
(r (
Time
APPLI90T FILLS
OUT UPPER HA ONLY
Property Ownerrj�;Q_ ���c �j/5�
Time
Md'ling Address /
% -� Cn -^` Sr `;
��_F % Zip Code
/Phone
i_
Inspector
Inspector
Buyer
Inspector
Address
Zip Code
Lending Institution
Phone
Field Notes: '^^� rt.. ,wv -Tp+�^
�-
�" �-
MUNICIPALITY OF ANCHORAGE
tF/�� C� ,
Aul- l'
Addressi-'
-G
Zip Code
�� ///�G �/Y�
Realty Co. 8 Agent
A, tem �
`��� ,f�L. �61U x'!� >-�..i
Phone
Address 'fit/-
� .�,`Lz/
Zip Code ��r 7
V
Legal Description
i
Street Location
'CONDITIONS
OF APPROVAL
Type of Residence
[3e -'Single Family
❑ Multiple Family
No. of Bedrooms
❑ Other
Water Supply
Date Sewer
Well To Absorption Area 41
LpUDdividual
Well Log Received
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
❑ Community
Well to Tank
For wells drilled prior to that date, give well depth (attach log if available).
❑ Public Utility
Septic Tank Size Q
-
Sewer Disposal
7�
[kindividual
Year Individual Installed: 17
❑ Public Utility
When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
(r (
Time
Time
Time
Time
Date -
Date
Date
Date
Inspector
Inspector
Inspector
Inspect
`�I(Je
Field Notes: '^^� rt.. ,wv -Tp+�^
�-
MUNICIPALITY OF ANCHORAGE
tF/�� C� ,
Aul- l'
DEPT. OF H`ALTH F:
ENVIRO,',kALypj4TAL
�.
I�'�/ G��ry4y�M
�� ///�G �/Y�
ez
� �d��G�y�'/��
�� Vim'"S�, V�
'tel i
!/PROT/EECTION
�b�l V )JY.s
Ne C.0'r
RECEIVED
Ngo
( ) APPROVED BEDROOMS
'CONDITIONS
OF APPROVAL
(3) DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE i 7 '-q 3
BY:
Soils Rating
Date Sewer
Well To Absorption Area 41
Well Log Received
1
-7 -7q
Well to Tank
"�qq �+
(V� n
Septic Tank Size Q
72 U3 (WM)
�ALLu 1Ca��� Fc2�
t � MUN AL
ICIPALIIi OF ANCHORAG
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825- L Street, Anchorage, Alaska 99501
279-2511, ext. 224, 225
C1 Date Received: March 10, 1977
1st Inspection: Time ►�,C� an. 2nd Inspection: Time
Date _ �_Ij�_)'I_�A;'J Date
Inspector yc Inspector
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. Lending Institution Request: Alaska Statebank
Mailing Address: 310 East Northern Lights Blvd Phone. 279-7637
2. Property Owner: Herbert S/Rachel Ann Harrison
Mailing Address; Star Route Box 5624 Eagle River,
Ln�P�
Phone: 277-1561 x 235
99577
3. Legal Description: Lot 7 Block 11 Preuss Subdivision
4. Single Family Residence: XXX Number of Bedrooms:
Multiple Family Residence: ( ) Number of Bedrooms:
5. Well Data: Type Individual
Construction
Depth 425'
Bacterial Analysis
3
Well Log Filed ( )
o'. Sewage Disposal System: On-site system $X$ Public Utility
Permit # Installed 1975 Installer
Septic Tank Size
Absorption Area
Manufacturer
Soils Rate
7. Distances: Well to Septic Tank
to Sewer Lines Nearest Lot Line
Absorption Area to Nearest Lot Line
Material
to Absorption Area
Page -Two 0 0
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and relater Facilities
Legal Description: Lot 7 Block 11 Preuss Subdivision
Comments:
Affadavit Attached: ( )
Approved:
Letter Attached: ( )
Date: 3 1l l
Disapproved: Date:
Department Worksheet:
y
r)t-( Y`X-- S ` /u u