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Home My WebLink AboutPREUSS #3 BLK 10 LT 10Preuss Block lO Lo1' 10 #050-571-58 Municipality of Anchorage Development Services Department ::'_--'*! ::-=-'",..,. Bulk:ling Safety DIv~ .'~ ~[~1' On-Site Water & Wastewater Program, 4700 Sauth Bragaw SL P.O. Box 196650 Anchorage, AK g9519-6650 www.d.anchorage.ak.u= (907) 343-7904 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SW010361 PlO Number. 050-§71-58 Neme:MICHIAL HUBBARD Wastewater$¥etem: [] New · Upgrade 20319 LUCKS ^VENUE* EX0L~ R~R. ~X 99577 ABSORPTION FIELD Ph°n':(907) 351-9117 ,3 ,Deep Trench DSh=llo~. Trench DB~d OUound rlot~er LEGAL DESCRIPTION 0.8 ~ ,, ?.5-9.0 10 10 PRUESS --~-~.::}2.41 -`3.91 r. 5.09 - - - SEE DWG. ~ 60 (2 WELL: r~ New [] Up,rode 2.5 ,, 2 ~ ~t n 610 s=.~ D 3034/ F-810 r: RPC CONSTRUCTION ~/28-~0/1/200~ ~ ~ ~ TANK SEPAR~TIONDISTANCES ,~.~uo n~o,a~ ,$.~.~. 'i'o s~pt~c ~.omuo. uft Hold~.g ~/P'~ ANCHORAGE TANK 1000 wen N/^ N/A - - 25'+ STEEL 2 s~rto:, woto, ~oo'+ ~oo'+ - - - LIFT STATION ,.+,o.+- - - '-'--I FoundoUon 5'+10'+ -- Curtain Droln ,= NONE KNOW I Remarks: -EXISTING WELL ABANDONED PER UPC. BENCH MARK -EXISTING SEPTIC TANK ABANDONED PER UPC. TOP OF HOSE BIB :"-'~ ~'~*"'" 100.00 Inspections performed by: AWWC, INC. Dates:lst ,/~/~001 r'cO/q[q I~~ ' ''-'*'~''''''' 2nd 9/28/2001 : ...... 'J ';/"/[ ~'~ :; ..... ~..'~,.,.,.,.,.,.,.-~....J..V.I... 4- ......... =...., 3rd 10/1/2001 [ :.,J/~ey,< Dopartm~nt o! It~alth and Ituman $,~i¢~ approYal ~h:~ot ......~ ... ..--. ---- - rr ---.~~gv~ew'~anrlannmvndhv~D°te:~-/?-0~ ' '~ ~ ~ AS BUILT DRAWING SW010361 - 050-571-58 \ ! _ ~/ - w~ W ~DONED /~. __ ,o, ~ ~ __~ I I ~ I I- ~ ,-' ~ ~'~ W~--- x I APPROXI~T~ s~2~.4s ~ I DBL1 18,36 7 W ~ 2o.~5 ~ I C01 37.94 63.20 ~ ~n ~N~ 1000 ~LO~ MT~ 39.20 60,81 ~.~ / S~IC T~K ~ C02 44.89 56.45~~BL1 I ~ ES 43.22 66.57 =~ I Wi c03 52,39 78.59 ~ I X~IN~D ~OW MT2 50.12 71,87 ~ ~ ~ D~ER (FD) -~I~NG D~NRE~ C04 53.69 69.84 ~~ ~ BEINGUSE~A o ~ ~ ~ RESE~E O ,~~IN~I'~O ~O~ J J/ ~ 8 S~[R (~) N~ D~NRE~S~ - j J W ~ LUCAS AVENUE ------ w- ........................................ C.J.G. ~ FOR: ~ONE NUMB~ P~ NUMB~ MICHIAL HUBBARD (907) 35~-9117 2 OF 3 '~p~r~/A. PRUESS SUBDIVISION; LOT 10, BLOCK 10, AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE SWO10361 050-571-58 R~ 1000 ~ oF eu~o SEP~C T~K ' I~ OF BUNO AT INORTHI ISOUTHI MICHIAL HUBBARD (907) 551-9117 3 OF PRUESS SUBDIVISION; LOT 10, BLOCK 10, PROFILE AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 190650, Anchorage, AK 99519-6650 (907) 343-7004 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Sep 10, 2001 Expiration Date: Sep 10, 2002 Permit Number: SW010361 · "Legal Description: PREUSS #3 BLK 10 LT 10 Design Engineer: 0041 AK Water & Wastewater Consultant Owner Name: Michial Hubbard Owner Address: 349 South Park St. Anchorage, AK 99516-0000 Parcel ID: 050-571-58 Site Address: 020319 LUCAS AVE Lot Size: 22107 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Pdvate Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. Ail requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Ddnking 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. Municipality of Anchorage Development Services Depar ent Building Sefety DMslon On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 vnvw.d.anchorage.ak.us (~?) 343-?~O4 Parcel I.D. ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING 050-571-58 Permit Number Property owner(s) Mailing address (1) Mailing address (2) MICHIAL HUBBARD 349 SOUTH PARK STRELrl' * ANCHORAGE. AK Day phone 251-9117 7Jp Code 99516 Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size ..... Acms/Sq FL THIS APPUCATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade · pRLIESS SUBDIVISION: LOT 10. BLOCK 10. Number of Bedrooms Well Only Water Storage THIS PROPERTY COHTAJNS: Hot Tub Swimming Pool Tbempy Pool Water Softening Unit 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. ALASKA WATER &: WASTE'WATER CONSULTANTSI INC. Permit Date of Payment: Receipt Number, Waiver Fees: Date of Payment: Receipt Number:. ALASKA WATER & WASTEWATER CONSULTANTS, INC. August 22, 2001 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 Reft Septic System Upgrade for Lot 10, Block 10, Pmess Subdivision To whom it may concern: The existing 3 bedroom house is served by public water and private septic system. The septic system consists of a 1000 gallon septic tank and a undocumented crib type drainfield that is completely surcharged and must be upgraded. A test hole was excavated south/southeast of the existing septic system in the area of the proposed upgrade. The proposed system will be designed around the 30 foot radius of this test hole. We are proposing that a 1000 gallon septic tank be installed and a dual deep trench type drainfields be installed. Comments regarding the design are summarized as follows: 1. SOILS: See the attached log which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that due to the overall appearance of the soils, an application rate of0.8 gallons/day/It should be used. 2. TRENCH DESIGN: a. Percolation Rate: 5 minutes/inch b. Allowable Application Rate: 0.8 gallons/day/fl c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day 2 e. Minimum Absorption Area: 563 ft f. Total Depth: 9 feet (max.) g. Effective Depth: 5 feet h. Width: 2.5 feet i. Reduction Factor: N/A j. Minimum Length: 60 feet total le:ngth (2 i~ 30 feet long each) k. Effective absorption area = 600 ft 3. SURFACE WATERS: There are no surface waters within I00 feet of the proposed 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com upgrade. 4. TOPOGRAPHY: As can be seen on the attached design drawing, the average topography of this property is a I to 5 percent running from approximately north to south; in short, there are no slope concerns. The trench is to be installed parallel to slope contours. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. President' ness, P.E., M.S. NOTE: Attached is a site plan drawing, a design drawing, a soils log. and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com .~._ PHILADELPHIA WAY LOT 7 BLOCK 1 LOT 8 BLOCK 1 ,-'~OT 9 BLOCK 1 lOT 10 BLO~K~ PRUESS S/O PRU[SS S/D PRU~SS S/D/~' PRUESS $/O"~ · ......... -, ................. -~¥-: ...... , I~ :=~======-~e===~: ~' % I ~ /I 3 BEDROOM PRUESS S/D PRUESS $/o EXISllNG SE3~IO ,f~ ,/ -, __,~ .... w ..... ~ ...... ~~.._ .......... ~ -T- LUCAS AVENUE I S~ ~ ~ I I ,', z~ , , , , ~/2~/~oo~ ~S~ WATER & WASTEWATER ~ PRU[SS SUBDmS~O~= LOT ~0, ~LOCK ~0 SITE P~N FOR SEPTIC SYSTEM UPGRADE ~ 'IH[ '~ANK I~ ~'0 BE ~'.t. IrROM FOUNDATION 11~£ TA~K IS TO BE 5'4- F'~OM 11-1£ TAblK IS TO BE: 5'4- FROM LOT LINE YV 11-1[ DRNNFIEI. D I~ TO BE 12% I~OM EXIStiNG CRiB -- 11.~£ DRNNFIE1.D ~ TO BE 5' FROM LOT UNE --V/DJ. NOT IN USE.. 1HIS V/DJ. 1HE DRNNFi[.LD iS TO gE 10'+ FROM WATER UNES IS TO BE COMPL-r11:q Y 15.55.060 I __ _L .~ -- -- -' I ~ " t NO?£: IH£ ¢ONI~CI'OR /~ . SHALL .AVZ mr SOUm LOT /~ ~ m:.'no.). I LJNE FLAGGED BY A / ~/ I I I I REGi:5~ERED LAND SURVEYOR / ~ ~ i PRIOR TO CONSTRUCTION. / _~<. ~ '_t I ~ EX~-I~NG SEP~C ?ANK ~ & _ / ~INSTN. L FOUNDA~ON~:'.. PROPOSED --W- --[_U CAS AVF U£ ..... W To BE -i-- ~ A RF..SERV[ SITE ALASKA WATER & WASTEWATER ~ ?..~{. CONSULTANTS, lNG .... (go7) 351-9117 2 OF 2 MICHIAL HUBBARD DESIGN FOR SEPTIC SYSTEM UPGRADE CONSULTANTS, INC. JSOIL LOG - PERCOLATION TESTI -.~.~.~t.t~r.r,~' ..... '.:--4 PERmRMEO FOR: .ICH~ HUB~D OA~: 8/15/2001 (f OR~CS FEST HOLE ~lJ 2 II ~ I~Hll LO~ UlX~ ~ ~ / P~ S/D GH ~CL ~_ I GC OL ~I~NO ~ J / ~, , SW HH ~ BEDROOM . I HOUSE~ _U / " SP CH I DEPTH TO DATE L----- ~ ----i" I 9~ltilllll~Nflllll Sw~LS~ ~0 ~ 14.5' 8/22/2001 i . SEP~C /~ ..... ~{~Jlllll w/ SOaR I J ~M~ ~10~ J ~itilllll~ POCK~ ~liilllll OF CL DATE RE. lNG CLOCK NET TIHE WATER LEVEL NET DROP B/16/2001 1 2:35 - 6- - 13 3 2:45 - 6' - 4 2:55 10 3 3/4' 2 1/4' 1 5 2:55 - 6' - 6 3:05 10 4" 2' I ~ 3 7 3:05 - 6' - 9 5:15 - 6' - " - - 1 12 3:35 lO 19~ J ~ PERCO~TION ~TE 5.0 (HIN./INCH) PERC. H~ DIA. 6" (INCHES) 2D~j J ~ TEST R~ BET~EN 5,0 ~. ~D 5,5 COHHENTS: PERC HOLE W~ PRE-SOAKED 4+ HOURS, PER ~ W~ P~FOR~ED ~ ~EB ~LL, PERFORMED BY A~ WA~R · W~ATER I, ~E~ ~ ~N~S, CER~ ~T ~IS W~ P~FORMED IN ACCORD~CE W~ ~ ~A~ ~D MUNIClP~ GUIDE~N~ IN EFFLCT ON ~IS DA~: ~1Ol DEPTH TO DATE GROUNDWATER DRY 8/15/2001 O~ 8/~8/200~ aJ~ 14.5' 8/22/2001 ~ .... ~-VV DRILLING, Inc. P.O. Box4-1224 · 1310C International Airport Road (907) 274-461! ANCHORAGE, ALASKA 99509 DRILLING LOG Well Owner_ j3ickm~l J:~11'J 1 t~_~ Use of Well Location (address of: Township, Range, Section, if known; or distance main road LlO, B10, Preuss Subdiv,, B_~9-1--e--Rj-ve~ -- -~ - ---- 300 feet 6" Size of casing~ ___Depth of Hole~5 ___fee~ Cased to~5-~feet 4" ABS plastic Static water level 3~0 _ft. ~) (below) land surface. Finish of well (cheek one) open end ( X ); Screen ( ); Perforated ( X ). Describe screen or perfora~onLiner is slotted from 405 to 425~ w/ 4" siots~ 2/ft. Well pumping test aL 1 gallons per (~) (minute) for_ ]- hours with 10~ ft. of drawdown from static level. Date of completion _ 20 Dec 74 WELL LOG Depth in feet from ground surface Give deta~ils of formations penetrated, size of material, color and hardness 3 O .TO_ 75 3 _TO 120 75 __TO_ 120 .TO_ 125 125 _TO_ 165 165 TO 175 175_TO- 280 280 .TO 309 .309 TO_ 425 TO_ ~TO TO_ ~TO_ TO Organics Silty Gravel: small Gravelly Hardpan Cobbles G~ayel__ly.__Hardpan Cobbles Hardpan: occasional cobbles __anj qravel streaks Small Gravel: sRmi.cons__olida!ed, conqlomeratic Bedrock: waterb__e_B~n~_fraGtBreM around 406 1 -- CUSTOMER MuniciPality'0 A chorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 A~chorage, AK 99519-6650 vA,,*,v.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAHILY DWELLING Parcel I.D. 050-571-58 HAA~ 1. GENERAL INFORMATION Expiration Date: Complete legaldescription PRUESS SUBDIVISION; LOT 10~ BLOCK 10~ Location (site address or directions) 20319 LUCAS AVENUE * EAGLE RIVER, AK 99577 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address MICHIAL HUBBARD Day phone 351-9117 349 SOUTH PARK STREET * ANCHORAGE, AK 99516 Day phone AINSUEY PHILLIPS w/ PRUDENTIAL VISTA Day phone 4241 'B' STREET * ANCHORAGE, AK 99503 696-6814 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 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 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. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, or prior to closing for the engineering services provided. 4. STATEMENT. OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation data shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal SYStem is(are) safe, functlonal 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. NameofFirm ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phone 337-6179 Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE. AK 99504. Engineer's Printed Name JEFFREY A. CARNESS. P.E. Date Engineer's Comments: In conducting this eva/ua#on, AKWWC, Inc. attempted to provide a thorough, conscientious engineerng analysis of the system in accordance with ADEC and MOA DSD 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 ali wefts and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions ara outside the control of the eva/uator of the system. Satisfactory test results do not guarantee future performance of the system, nor de they guarantee that . there are no hidden defects or encroachment$. AKWWC, Inc. can therefore not provide any wamanty or future esb'mate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. 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 percon or pady is not authorized, nor wi//it confer any legal rght whatsoever. 5. DSD SIGNATURE Approved for ~' Disapproved. Conditional approval for Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: "~ Municipality of Anchorage Development Services Department On-6~e Wirer & Ws~w~r Program 4700 Seth Bmgaw 8~ P.O. Box 196650 AncO, ,NC 99519-6650 HEALTH AUTHORITY APPROVAL CHECKLIST PRUESS SUBDIVISION; LOT 10~ BLOCK 10~ A. WI~LLDATA PUBLIC WATER wen type IfA, B, orC provide PWSlD~ Wen L~g (Y/N) Parcel ID: 050-571-58 in. FROM WEU. LOG WATER SAMPLE RESULTS: AT INSPECTION B. SEPTiC/HOLDING TANK DATA Date of pumping ~ NEW Pumper C. ABSORPTION FIELD DATA eE*L Date Installed e/2B:1o/1/2ool ~ ~ ~/or ~) Leng~ SO (20 30)lt. Width Installed 9/28/Ol C~eanoute (Y/N) YES High water amnn (Y/N) N/A Fluid depth In absorption field before test in. Elapsed Time: min. Final fluid depth Any rejuvenation treatment (past 12 mo.) (Y/N & type) System type TRENCH Gravel below plpe 5.09 ft. Totaldepth*~-~-g. Olt. Elf. absorpflonama 610 ft* MoNlorlngtube Y~S Dapresslonoverfleld NO Date of adequacy test NEW Resulbl(Pas~Fall) PASS For 3 bedrooms Water added gal. in. In. g.p.d. Now dep~ At--on rate >= ff yes, give date D. UFT STATION 'Pump on' level at ~ Hlgh water atsnn level at cy ee ta ,d E. 8EPARATIOH DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Meets alarm & circuit requirements? PUBLIC WATER AbeorpUon field on lot ~ Public sewer main ~ Publtc eewer manhole/cleanout ~ Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building fonndallon 5'+ Property lire 5% A~on field. 5% Water main lO'+ Water eervlce llne 10'+ Surface water. 100'+ Wells on adjacent lots 1 oo'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Pmpegy fine 10'+ Bulidtng roundel]on 10'+ Water main 10'+ ~ I , Water eervlce fine 10'+ Surface water 100'+ Driveway, perffingNehlcle Morage ~5'+ Curtain drain NONE KNOWN . Wells on adjacent lots 100°+ F, COMMENTS H Fon$ 3'75' Date of Payment ?~.~_~ Waiver Fee $ Date of Payment. Receipt Number _ .... ~ u'rt LJ.'r¥ · ,t .08' I hereby cerU~' th~ I h~,e furV~Tect the followinf described ~o~le ~in~ ~ctnc~ AtasLa. ~ that. 't~ ITi~ adjacent ~e~. ~i[ no im~royemen~ en prop- ~ ly~g adjacent ~ere~ en~oa~n ~ the qU~ e~d that ~ a~ ~ r~d~ys. ~an~ton 2nii or o~ visible e~em~ ~ ea~d p~p~y except ~ ~icated ~r~n. DaSd at ~le ~ver, ~ska 20SE~T C ~O~NSON ~ S~E: ~ Reg~tered L~d Su~or No.~O-~ l' = ~0 ~x 4~. ~le ~ver, P~ne 69~25t3 ' MUNICIPALITY OF ANCHORAGE ~ ~'~) ' '~ ''~/-- ~ DEPARTMENT OF HEALTH & HUMAN SERVICES' DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL J~ ~- ~! C~ I ~ OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date -~'--//~ ~7~/~ d° GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property Owner ,~.~_z~.¢~.-,. ~-/~r~--r,~ Telephone: Home ~ ¢¢ ~-¢¢~ Business (c) Lending Institution ~ *~/v~ R ~ Telephone. Mailing Address ~J / ~¢~- ' . " Address /~ ~ ~ ~/~~Z~ ~Y~ ~ ~ ~. ~e~--:2 Telephone ' ~ ~ ~- ¢~ / ' (e) Mail the HAA to the followine address: or: Check here~, if hold for pick up. List contact person and day phone number below. S & S ENGINEERING 17034 Eardl~ Ri.vet L~,op Roac~ NO. 204 Eagle Rivert Alaska 99577 TYPE OF RESIDENCE Single-Family,0~ Number of Bedrooms WATER SUPPLY Individual Well [] Community [] 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,,[~ 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 I of 2 72-025 (Rev 8/861 Fron! ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown be[ow, 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. Name of Firm ~ & $ ENGINEERING 17034 Eagle Rid'er Loop Road No. 204. Address ~.agie ~;vur~ ,'---~-- ,, z-,,, Date Telephone DHHS APPROVAL Approved for ~,~d~ edrooms by Approved X Disapproved Terms of Conditional Approval Conditional CAUTION 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. Page 2 of 2 72 025 fRev 8/86) Back [3, WELL DATA ~UNICIPALITY OF ANCHORAGE (MOA) AUTHORITY APPROVAL (HAA) ~ECKLIST - FEBRUARY i984 264-4744 ~'¢ Legal Descrip~ ~ Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level 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 ~ *- C~'~/~, SEPTIC/~ TANK B'ATA If A, B, C, D.E.C. Approved(~N) Date Completed Yield th of Grouting ,~, Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ~ !4- ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Date Installed ~~,1¢~'~'' Size Standpipes ~'~'4) y ~ Air-tight Caps (~N) Depression over Tank (Y~) Pumping/Maintenance Contract on File (Y/N) / Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/F'Itrfdm~ Tank: To Water-Supply Well To Property Line \ ~--"~ :Fo Water Main/Service'Line course No. of Compartments "/ Foundation Cleanout ¢t~) Date Last Pumped ~ / ~/~ ;for /. Temporary Holding Tank Permit (Y/N) To Building Foundation \~--~ I'~r~ T~ Disposal Field .~_~:, 1,.¥._~- .~ . To Stream, Pond, Lake, or Major Drainage Pag~:l of 2:; ": · 72-026 (Rev 8/861 Front ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~1'"~"¢~'~ ~ Width of Field ~.)~.~ Square Feet of Absorption Area Depression over Field (Y.~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well '~....-~¢:' To BuildingLot Foundation Type of System Design Length of Field ~' Depth of Field Gravel Bed Thickness Standpipes Present Date of Last Adequacy Test To Water Main/Service Line To Property Line ; On Adjoining Lots To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~ ~'"~\ ~.~1,,~ . .' To Existin~l or Abandoned System on To Cutbank (if p{esent) · ,.T Date Installed Dimensions Siz~ Manhole/Access (Y/N) "Pump On" Level at %~ "Pump Off" Level at High Water Alarm Level at ~ Vent (Y/N) Tested for ~...~Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Sign.<:& $ ,NGINEERING Date ~ 17034 Eagle RNer Loop Road No. 204 uom ,a y . ~-~ MOA ~e River, Ai~*a · .... Date of Payment ~-~3 ~¢ Amou.t: ¢ / 2 Page 2 of 2 72-026 (Rev 8/861 Back /LS-BUILT I hereby certify that I have surveyed thc f~,ilowin~ described property: ~ehorage ~cording Preein~, Alaska. and tha~ the improvements situated th~eon ~e within the ~ro~erty l~e5 and do no~ overl3p or encroach on the pvo~m.tv lying adJacenL thereto, tha~ no improvements m~ pro~2 erty lyin~ adjac~nL thereto en~o~cn on the premise~ in lines or other visible easements on said property cxcopt as indicated hereon. Dated at Eagle River. Alaska thm__~- z~.. day ROBERT C. JOltNSON ~' SCALE: ~ Re~istercd Land Surveyor N- 1": ~O BOX 45~{. Eagle River. Phone t;~4-2513 % ~ ¢ DA~, ~RECEIVED ~, "~TIME' 't-, ~,,! . INSPECTION-APPOINTMENTST~ME T~2'~ ' : ' DATE DATE DATE ' INSPECTOR ~ / INSPECTOR INSPECTO~* (W~ ANCHORAGE % ~ MUNIC ~UNIClPALITY OF ANCHORAGE ~NVIRONMENTAL fiF, OTECTION ( ENVIRONMENTAL SANITATION DIVISION RECEI2EB Telephone 264-4720 ..... REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1, PROPERTY OWNE~ PHONE ~ MAILING ADDRESS PROPERTY RESIDENT (If different from abovel , [ PHONE 2. BUYER , PHONE ~AI LING ADDRESS 3. LENDING INSTITUTION ) I MAILING ADDRESS 4, REALTOR/A~ENT I PHONE I MAI LING ADDRESS 5. LEGAL DESCRIPTION ~UMBER OF BEDROOMS 6. TYPE OF RESIDENCE [] One [] Four ~ SINGLE FAMILY E~ Two [] Five · [] MULTIPLE FAMILY [~ Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975, For wells drilled prior to that date, give well depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [~] PUBLIC UTILITY /9 9 Z.~YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) . THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified _ INSTALLER []Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank IAbsorption Area Sewer Line I Nearest Lot Line I I WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS [] CONDITIONAL APP~-~L Ilette~"~ust accompany certificate) GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received June 1, 1976 Time of Inspection c~,,~ ~ Date of Inspection ~-/~-~/m REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Conv. 1. Approval requested by: Mailing Address: 535 D Street 2. Property Owner: James W. Bickman Mailing Address: 3. Legal Description: 4. Location: Home Federal Savings & Loan Association Phone: Phone: 272-1451 277-3587 Lot 10 Block 10 Preuss Subdivision See back for instructions. 5. Type of facility to be inspected 6. Well Data: Individual A. Type Single Family No. of bedrooms 3 C. Construction Sewage Disposal System: A. Installed C. Septic Tank: 1. D. Seepage Pit: 1. On-site system B. Depth D. Bacterial Analysis B. Installer Size 2. Manufacturer Absorption Area 2. Material Total length of lines jOO , Absorption area , Other contamination E. Disposal Field: Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank C. Absorption area to nearest lot line , Absorption area EQ-034 (1/74) ? /d~2 ~- , Sewer Lines Page 1 of two pages Page 2 of two pages - Re~ st for Approval of Individual ~ ar & Water Facilities L e~a'l Description Lot 10 Block 10 Preuss Subdivision Comments Approved< XI~(~m~[]~'"/~/~,~.]L~/(') Disapproved Date Approval ~Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating~/~$factorilc~]~- Z / SIGNED .,~/4.~<~'-- ~ ~~~/q' m/ Date ~/~/~3/~ EQ-034 (1/74) DAVID A, SLENKAMP ROBERT A. SHAFER MECHANICAL ENGINEER 694-9055 A~gnst 70, 1981' CIVIL ENGINEER 694-2979 MUNICIPALITY OF ANCHORAGE DEPT. OF I IEALTiI & ENVIRONMENTAL PkOTECTION Jim Bickman SR Box 5422 Fagle River, Alaska 99'577 Dear Mr. Bickman, Reference:- Lot 10; Block 10; Pruess Subdivision Simp 2 I981 RECEIVED A sewer system adequacy test was performed on the system located on the referenced property as you Mequested. The septic tank was pumped and verified to have a capacity of 1000 gallons. The seepage pit ~as charged with 1000 gallons of fresh wate~ and after a period of 24 hours all the water which had been added to the crib had percolated out. It can be concluded from this test that the waste water disposal system serving the three bedroom residence located on this property is currently functioning adequately. However, the system cannot be guaranteed against subsequent failures. If we may be of further assistance, Blease do not hesitate to call. SRB 196X EAGLE RIVER, ALASKA 0 . 1, Type of Inspection: 2. Property Owner: Mailing Address: 3. Name of Buyer: n/a Mailing Address: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES CMRO VA. FHA BIC~MAN, James W., Jr. & Susan M. 4. Name of Lending Institution: Mailing Address: 535 D Street, ANC 99501 5. Name of Realtor or Agent: n/a Mailing Address: DEPT. OF HEALTH & ENVIRONMENTAl PROTECTION RECEIVED CONY ~ Day Phone 277-3587 (Dow Insuranc( Day Phone H(~ 2~.nW~AL SAVI~C-~ & LOAN ASSN. Phone 272-145] Phone Legal Description: L10¢ B10. Pruess SubdivJ.~ion Location: Traveling ~01]fh mn V,-3g"l~ Rioter R~; Nlm lmff nn T~T~e~_ L~ne aft~ ~at ~t~sec~on. No. Bdrms. Type of Facility to be inspected: ~i~l~ f~m4~y Water Supply Type of Supply: Public Utility If individual, number of dwellings presently served If Individual, depth of well Individual Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation May 26, 1976 EQ-037 (1/74) N PLATAPPROVAI- NOTARYACYNOWLEDGE24ENT DTI001333 1984-7405