HomeMy WebLinkAboutPREUSS #3 BLK 6 LT 5Preuss #3
Block 6
Lot 5
#050-571-24
a
Municipality of Anchorage Page 1 of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 3434744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number. SW000462 PID Number: 050-571-24
Name:
Wastewater System: 0 New 12 Upgrade
Troy Buse
Address:
ABSORPTION FIELD
Louis Place Eagle River AK
:
Anon9'9
�96-2673
No. of Bedrooms:
Three
O Deep Trench hallow Trench O Bed O Mound O Other
^
LEGAL DESCRIPTION
soil Rating:
1.2
Total Depth from original grade:
8
GPD Ft.
Subdivision'
Lot: Block: u d S si n'
3
Depth to pipe bottom loinoriginal grade:
Gravel depth beneath pipe
5 6 P .
4 Ft.
Fl.
Township:
Range:
Section:
Fill added above original grade:
Gravel length: ,
44
2 Ft.
Ft.
WELL: ❑ New 0 Upgrade
Gravelwidth: 5
Numberines: Datarce mem lines
�o�fl/ Ft.
FI
ckssiticahon (Private. ABA):
Total peptn:
Cased To:
Total absorption area:
440
Pipe material:
ASTM D3034 PVC
Existin
Ft.
Ft.
so. Ft.
Driller.
Date Drilled:
Staticwale Level:
Installer.
CCC Construction
Date 1tall�d'
11/3/00
Ft.
Yield:
Pump Set at:
easing Hmgtlt Above Ground:
TANK
GPM
Ft.
FL
SEPARATION
DISTANCES
WSeptic E3 Holding 0S.T.E.P. '
To
Septic
ADaonption
Lift
HoldiMblc/Private
Manufacturer..
Shafer
Capacity in gallons:
1,000
From
Tank
Field
station
Tank
Sower urwa
Welt
>100'
>100'
N/A
N/A
>25
Material:
t{DPE
paents:
Number of Comrtm
Two
Surface
rf re
>100'
>100'
N/A
N/A
N/A
LIFT STATION- N/A
Lot
>51
>10,
N /A
N/A
N/A
size In gallons.
Manufacturer.
Line
"Pump on' level at
'Pump ott' keel at
High water alarm at
Foundation
>51
>10' I
N/A
N/A
N/A
Curtain
-
—on Joted
Pump Make d ModN
rfored Dy:
Electrical Inspections pem
Drain
NA
n To
BENCH MARK
Remarks: Existing Trench Abandoned
Location and Description: Bottom Step From Upper
in Place.
Deck in Rear.
Assumed Elevation:
100.0
�+. fir" �F�• �1�
a
Inspections performed by: MFA Dates:lsf 1113 100 `J�•�
' �� ���
2nd 11/i/no '
1�.did�Yx`S;�`j
Department of Health and Human Servic s approval
iE` ,.e �r .;,f� •.'%
Reviewed and approved by: Date: -3o-OD
i�
fit'
72-013 (Rev. fMt) MOA 25
Municipality of Anchorage Page 2 of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION .
P.O. Box 196650 - Anchorage, AK 99519-6650 - 343.4744
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number SW000462 PID No. 050-571-24 _
PLAN AS -BUILT
SCALE 1" = 30'
A
B
S7
14.5
11.8
S2
17.5
12.2
64
37.1
47.1
V1--
32.5
35.2
C5
37.5
24.6
PLAN AS -BUILT
SCALE 1" = 30'
2;
Municipality of Anchorage Page 3 of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 -Anchorage, AK 99519-6650 - 343.4744
Onsite Wastewater Disposal System or Well Inspection Report
Permit Number SW000462 PID No. 050-571-24
99.2 Nr -j rn
rn ri ri
- _
MUNICIPALITY OFANCHORAGE
Department of Health and Human Services
On-Site Services Program /� Sn
825 L Street, Room 502 ` n i
P.O. Sox 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Oct 31, 2000
Expiration Date: Oct 31, 2001
Permit Number: SW000462 Parcel ID: 050-571-24
Legal Description: PREUSS #3 BLK 6 LT 5
Design Engineer: 0014 Anderson Engineering Site Address: 010115 LOUIS PL
Owner Name: Troy Buse Lot Size: 22922 SQ. FT.
Owner Address: 10115 Louis Place Total Bedrooms: 3 Permit Bedrooms: 3
Eagle River , AK 99577 -
This permit is for the construction of:
Vj 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 ( 1BAAC72 ) and Drinking Water Regulations (18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-4744 (24 hours). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date:
(D
Date: 10-31-00
October 25, 2000
AND RS NGINEERIN
_e . of o 3''
t N
A-NCHOgG
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
Anchorage,'AK 99502-0650
Subject: Lot 5, Block 6, Preuss Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer.
{ The existing septic system on Lot 5, Block .6, Preuss Subdivision has failed and must
nt is currently backing into the house. We: are
be replaced immediately as efflue.
therefore applying for a permit to construct a new septic system on the lot to serve the
three bedroom home. The attached Site Plan and backup documentation identify the
1 location and configuration of the new septic system and the parameters used in the
design..It also shows the location of the existing well on the lot and the 100' protective
eptic tank will be
radius. The existing sremoved from the project and properly disposed..
The existing absorption trench will be abandoned in place. .
A test hole was placed on the.lot at the location shown which indicated silty gravel with
some cobbles to a depth of 18'. No groundwater or bedrock.was encountered in the .:
test hole not was any found during the monitoring period. We are therefore proposing
to place a 5',wide shallow absorption trench system with 4' of drainfied rock beneath
the distribution pipe. The pipe will be placed at 4.0' below the existing ground surface
and the total depth of the trench will be 8.0'. The length of the trench will be 40. A
minimum of 3' of cover will be placed over the trench to prevent frost penetration and
possible freezing..
The ground surface on the lot slopes as shown on the attached Site Plan. The area for
is fairly flat. The new trench will be constructed
the new absorption trench, however,
parallel to the contours of the surface in conformance with Municipal requirements.
Grading will be accomplished to assure surface drainage is away from the new trench.'
If the system is constructed in accordance with our, design the foliowing statements
aPIY:
1 The system, if constructed as designed, will have no adverse impact on the wells ..
in the area or those to be constructed in the future.,: The subdivision is currently'
served by a community water system
2. The system, if constructed as designed, will have no adverse impact on existing
tructed in the future.
septic systems iii the area or those to be cons
Lot 5, Block 6, Preuss Subdivision
October 25, 2000
Page Two
3. The system, if constructed as designed, will have no adverse impact on reserve,
space, either surface or subsurface, on any lots located in the area.
4. The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely, G_�S��i � • . �,�,,,�.�+'a@�,,
Michael E. Anderson, P.E.
-4ftnrhmpntS'•T-
. _
.cit.
...
. s.. a..,
LOT 5, BLOCK y6, PREUSS SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Three Bedroom Home 5' Wide Trench System
Perc. Rate: 1.5 Min.flnch 1:wo Gallon Septic Tank
Application Rate: 1.2 GPD/SF 4' Draintield Rock.
IL
Municipality of Anchorage
Department of Health & Human Services jo
825 L Street, Anchorage, AK 99502-0650+ •��; �+
SOILS LOG - PERCOLATION TEST • �Q7..:''
Performed For: TIDY Buse Date Performed:
Legal Description: ' of 5 Block a are,,« Subdivision
SLOPE SITE PLAN
1 OG/OL
2
3
TFSTHOLE NO, Tract A -B
q
5
6
i
.71
Hole '
Perc. Rate: 1.5 MinAnch Perc. Hole Diameter. 6"
200 Test Run Between 5 Fl. and 6 Ft.
Comments: Percolation Cavity Presoaked Prior to Testing.'
Performed By: Mike Anderson_ I, Michael F Anderson Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 1025100 -
Was Groundwater -
9
Encountered? No S
,1
m0®
If Yet, What Depth? L
10
GM Depth to Water O .
After Monitoring None P
11
Date: 1024100 E
Hole '
Perc. Rate: 1.5 MinAnch Perc. Hole Diameter. 6"
200 Test Run Between 5 Fl. and 6 Ft.
Comments: Percolation Cavity Presoaked Prior to Testing.'
Performed By: Mike Anderson_ I, Michael F Anderson Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 1025100 -
os
,1
m0®
®sem®®®
�s■oo®®
Hole '
Perc. Rate: 1.5 MinAnch Perc. Hole Diameter. 6"
200 Test Run Between 5 Fl. and 6 Ft.
Comments: Percolation Cavity Presoaked Prior to Testing.'
Performed By: Mike Anderson_ I, Michael F Anderson Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 1025100 -
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 5, BLOCK 6, PREUSS SUBDIVISION
GENERAL:
1. The scope of this project includes the removal and disposal of the
existing 1,000 gallon septic tank and the procurement and placement
of a new 1,000 gallon septic tank at the. location shown on the site
plan: Work also includes the construction of a new 40'. long X 5' wide '
X 4' effective depth absorption trench at the location shown.: The
distribution line in the trench will be placed at 4.0' below the existing
ground surface. Total. depth of the trench will be 8.0' below the
existing ground surface. All components of the septic system must be
placed outside the 100' protective radius of the existing well on the lot.
2. Construction shall be in accordance with the approved 'site plan
design drawings, Municipal Permit with any special provisions -or
conditions, and all applicable State and Municipal Wastewater
Disposal Regulations.
3. The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of the septic system and verification of the
location of all lot lines.
4.. Unless specifically agreed otherwise, the contractor . shall be
responsible for final grading areas subsequently depressed from soil
settling. Property owner shall be responsible for'revegetation of
affected areas unless specifically agreed otherwise.
5. Contractors installing wastewater disposal systems must be' certified
by the Municipal. Department of Health, and Human, Services for
s
system installation. Owners installing their own systems must receive
prior approval from D.H.H.S. before beginning system installation:
SEPTIC TANK INSTALLATION
1. A new 1,000 gallon septic tank must be be procured from an approved
source and installed at the location shown:
2. A septic: tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access. .
3. The septic tank shall tie sufficiently bedded_ to prevent settling or.
shifting of the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct
burial insulation.
1. ...,_, I
Lot 5, Block 6, Preuss
October 24, 2000
Page 2 of 3
6. A foundation cleanout shall be installed one to four feet from the
building foundation. Two cleanouts are required between the tank and
the drainfield.
7. Final grading over the tank shall be such that a positive slope exists
away from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the
design. The bottom of the trench shall be within 2" of level.
2. Distribution piping must be placed level with perforations down atop a
level bed of drainfield rock. Rock should then be placed over the pipe
to provide a minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between the drainfield
rock and the natural soil backfill:
.4. Monitor tubes must be 4" in diameter'and installed. at the locations
shown on the design. The portion below ground must be perforated.
5. Contractor shall .verify the septic tank and drainfield "are a minimum
100' away from any private water wells in the area,. 150' from a Class ,
i "C" Well or 200' from any community well.
6. Directbury insulation must be pace over the' distribution system if
less than 3' of backfill depth is available. Finish grade over the trench
must be mounded to prevent settlement or depressions.
7. Grade area surrounding the absorption trenches to drain away.
8. A minimum 2' of accepting soil is required below the drainfield "rock for
a 5' wide trench. Contractor shall verify this condition" prior to
v placement of the rock. All pockets of unacceptable materials must be
• removed and replaced. .
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a municipally. approved septic
tank manufacturer.
2. The following pipe materials are approved.for use in septic system
installations in the Municipality of Anchorage:"
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated
and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and
ASTM D2662 or,A.B.S. (perforated and solid).
3. Insulation shall be at ,least 2" thick extruded direct burial polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Femco, or equal).
Lot 5, Block 6, Preuss
October 24, 2000
Page 3 of 3
GREA1` R ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME � O e_ll z� MAILING ADDRESS t55�-yU/r ,OE' PHONE
LOCATION S ��/ V� LEGAL DESCRIPTION
SEPTIC TANK:
DISTA�FFE/a �^ NUMBER OF
FROM `WELL !6� tt MANUFACTURERC� r��e,< MATERIAL "� COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY a -t! GALLONS.
SEEPAGE PIT: %
NUMBER OF PITS ` DIAMETER OR WIDTH m , LENGTHa_� DEPTH ,
LINING MAT ERIAt4�2 d CRIB SIZE: DIAMETER —DEPTH � DISTANCE FROM: WELL l�
TOTAL
TIVE
BUILDING FOUNDATION_, NEAREST LOT LINE_" ABSORPTIONAREA(WALL AREA) 3VL1Y/ SQ. FT.
ADDITIONAL ABSORPTION
` r
WELL:s
TYPE
CONSTRUCTION
BUILDING NEAREST
FOUNDATION , ' LOT LINE
CESSPOOL OTHERSOURCES
APPROVED DISAPPROVED
DISTANCES:
INSTALLED BY: � S
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
NEAREST
SEWER LINE
REMA
DEPTH
SEPTIC
TANK_
DIAGRAM OF SYSTEM
DISTANCE FROM:
SEEPAGE
SYSTEM
by
A & L DRILLING COMPANY
BOX 97, EAGLE RIVER, ALASKA 99577 • TELEPHONE 694-2588
OWNER OF LAND 4''� l._.I_ l ��'r-`^�'>/�^� DEPTH OF WELL 3 U �
STATIC LEVEL OF WATER FT. 4jc� l
ADDRESS nn
LEGAL DESCRIPTION 4 U.t jC fir-; rJS S SJ O90 DRAW DOWN FT.
// f ? 7 GALS. PER HR
DATE -Started ri" 4 /7l Ended
PERMIT NUMBER 7 (Sy KIND OF CASING
KIND OF FORMATION:
From t Ft. to Ft.
From <i Ft. to�/2 Ft.
, �
YGY�j llv+�t ! d 600401
From
�-fFrom
Ft. to
Ft. to
Ft.
Ft.
From %/=% Ft. to / 3 Ft.
fir f� �`✓�'
From
Ft. to
Ft.
From /'�Ft. to /> —5– Ft.
f %
From
Ft. to -
Ft
From •�Ft. toll l i Ft.
5``%�� Fas.�%✓� G
From
Ft. to
Ft
From ;I / Ft. to—L17 17`A Ft.
� jai, ` G ✓hr
From
Ft. to
Ft.
From1 % ? Ft. to ?13 Ft.
All�. vy C �iy'✓�'r
From
Ft. to
Ft.
From - / i Ft. to Ft.
�aF/SH Serjv�
From
Ft. to
Ft.
From 1 L Ft. to c7y' Ft.
�i'/ °� a ���`dr"
From
Ft. to
Ft.
From ��Ft. to ��� Ft.
�t���1 t,' FrJ.�' C_
From
Ft. to
Ft.
From A', Ft. to .3 d Y- Ft.
T/ PHIL
From
Ft. to
Ft.
From Ft. to?C Ft.
From
Ft. to
Ft.
From ;"," 3 G Ft. to C' Ft.
j ,:Q Ft. to 36 2 Ft.i'q
From —_:—
r�Y '. �16I✓�= G From
From
Ft. to
Ft. to
Ft.
Ft.
From Ft. to Ft.
From -
Ft. to
Ft.
From Ft. to Ft
From
Ft. to
Ft.
From Ft. to Ft.
From
Ft. to
Ft
MISCL. INFORMATION:
r
DRILLER'S NAME
C��ett�ed Briffing:4,Kfilig
b9
A & L DRILLING COMPANY' _
BOX 97, EAGLE RIVER, ALASKA 99577 • TELEPHONE 694-2568
OWNER OF LAND &44 l=J4422/7-1
ADDRESS n
LEGAL DESCRIPTIO. aGl� >°CFJtS SJRO
DATE -Started T V27 Ended
PERMIT NUMBER % % � f
DEPTH OF WELL 3 5/ E
STATIC LEVEL OF WATER FT. 3-
,27
DRAW DOWN FT. Q
GALS. PER FIR 40
KIND OF CASING r t °'V
KIND OF FORMATION:
From O Ft. to F Ft. �t' From Ft.
From F Ft. to11/� Ft. 1�4,f% a &✓«'•dJFrom Ft. to Ft.
From //) Ft. to /d _3Ft. 5_4,.0 t 04` dWa 4
From 03 Ft. to -115 --Ft. (edi �6P/✓-�
From / Ft. to /4 1 Ft.
From 1 4 / Ft. to 17-1 Ft. eL t91_
From / 7,� Ft. to -�/ Ft. S,9^/10 6 Q'OJsen
From :) / Ft. to -2 36 Ft. �aAfSf' S.4N O
From 4a(- Ft. to )3f Ft tr6a'r�ac-
From d3�_Ft. to it Ft. *
Fromz"?V Ft. to_321- Ft. 7/40Y7 -S -4.d0
From -)Ft.to?X Ft. T'04&-,0 1- ( 1921 11LE'
From
Ft. to
Ft.
From
Ft. to
Ft,
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From d 3 G Ft. to T S� Ft. t; cR i 't- 6 QA✓r ` From FL
From i rJ Ft. to3 562 Ft. S/RTr/R' _d D CG..oS From Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft. RECEIVED
From Ft. to Ft. From Ft. to Ft
mv 36 20H
NIISCL. INFORMATION:
r zi 17 7-0 4'r
DRILLER'S NAME
Municipality of Anchorage
Aept. Health & Human Services
' ���M��������
STREET, HNCHORno�/ nx� ��o�,^
DISTHNCE BETWEEN H
�* �
`/�14� {J-
279�2511 �
SEWHGE
����~~yHv X Way! G, W WRAE�
100
FEET FOR H PRIVHTE WELL
PER�lT F -4,O < 77297 )
200 FEET FOR
H PUBLIC
MMI. ICANT GEN DEL E.
SYSTEM
694-9G56
LGCHTION LOIS & DAVID
MUST
BE
LEGHL L5 B6 PREUSS LOT 'o;
22922
SQUGRE FEET
TYPE OF 5OIL HBSORBTION SYSTEM IS� TRENCH
MAXIMUM NUMBER OF SOIL RHTING (SQ
FT/BR)�
100
THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS:
HND CONSTRUCTIGN
�����
HVHILHBLE
THE LENGTH DIMENSION IS THE LENGTH (IP4 FEET) OF THE TRENCH
OR
DRHIMFIELD
THE DEPTH OF 8 TRENCH OR PIT IS THE DISTHNCE BETWEEN
THE SL�FHCE
OF THE
GROUND HND THE BOTTOM OF THEEXCHVHTION (IN FEET)
THERE IS NO SET WIDTH FOR TRENCHES
THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRHYEL BETWEEN
THE OUTFHLL
FIPE
HND THE BOTTOM OF THE EXCHYHTIGN (IN FEET)
lot WH Q 1 .1 1: No! FEE Q A3 NEE 1:0lFX C: -T- WZI 14U it": �N: �R,�r�
-H- WO K3 Q oil 0.,- �Rol, EE CTT 1 !!-r-E-, too �is- G,,L, H.J,����
BHCKFILLING OF HNY SYSTEM WITHOUT FINHL INSPECTION HND HPPROVHL BY THIS
DEPHRTMENT WILL TG PROSECUTION
MINIMUM
DISTHNCE BETWEEN H
WELL
HND HNY ON—SITE
FORTH BY THE MUNICIPHLITY OF HNCHORAGE
SEWHGE
DISPOSHL SYSTEM IS
100
FEET FOR H PRIVHTE WELL
OR
200 FEET FOR
H PUBLIC
WELL
SYSTEM
WELL
LOGS HRE REQUIRED 8111)
MUST
BE
TO THE
WITHIN ]G DHYS
OF
THE WELL CGMPLETION
5IGNE
.~~
SPECIFlCHTIONS
HND CONSTRUCTIGN
DIHGRHMS ARE
HVHILHBLE
TO INSURE PROPER
�NSTHLLHTIO14.
�01 W F=j wit F`=- 171 1=1 Rol ���11,
I CERTIFY THl
1� I HM FHMILIRR WITH THE REQUIREMENTS
FGR
ON~SITE SEWER5
HND WELLS AS SET
FORTH BY THE MUNICIPHLITY OF HNCHORAGE
2� I WILL INSTFA.L THE SYSTEM IN OCCORDRNCE
WITH THECODES
]� I UNDERSTHND TWITTHE ON�SITE SEWER
SYSTEM
MHY REQUIRE
ENLHRGE�ENT IF THE
MESIDENCE IS REMODELED TO INCLUDE MORE
THHN
] BEDRQOMS
5IGNE
.~~
U"T: I u V9 T V-1 T, P=N eon I ��T_x e-4 V- I �*,..... "
0 & E OEOT'L...; HNI CAL Et DEVELC-,;MENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2.280
Russell Oyster Earl Ellis
694-7.774 SOIL LOG 688-2280
Soils Et Foundations Land Development
Performed for: Name: %,—"Zl .r. o�;Mvv� Tel. No.
Mailing Address:_
Legal Description: -ez
Depthfeet) Soil Characteristics
0
2
6
7
8
9
10�
v., r z S a ,J jai
w
11
12
13
14
15
A
`✓
Ground Water
Encountered: Yes No
If yes, what depth
Proposed
Installation: Seepage Pit Drain
Field
Comments:
-�-- t
.� m fall 2 -.4-
[J r �-
�w �.r�i,A, 2 .
"LZaxn
Performed by: Date: "NY 7
' �{.3� L _ ..L�
i ���
. u
l _ � �
.�''
,� �
��� �� �-.
����1�'��r�,
v� t
® 1®/ imicipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 050-571-24-000
Expiration Date: / - /9—/G
1. GENERAL INFORMATION
Complete legal description Preuss #3 Block 6 Lot 5
Locatign',(site-address) 10115 Louis PI.
Currtsnt Property owngr(s;) Justin Spears Day phone
Mailing address" 8462 Metzger Ave Unit B JBER, AK 99506
2.
Real Estate Agent ;,"Candace Abrego
TYPE OF. DWELLINd
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone 312-5001
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
E
Individual
El
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver/Variance request
COSA to be released to the engineer, unless otherwise requested by the engineer
Release to Candace Abrego
COSA Fee $52 m duck Waiver Fee $
Date of Paymentyha/,e Date of Payment
Receipt Number C)IZ-2 Receipt Number
COSA# 015ca()1k��+ Waiver#
5. STATdala@E 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 Alaska Rim Engineering, Inc. Phone 745-0222
Address 9131 E Frontage Rd. Palmer, AK 99645
Engineer's Printed Name Charles Leet Date 3
6. DSD SIGNATURE
4 System #1 Approved for --rs bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for
bedrooms, with the following
By: Original Certificate Date: Z
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA bNe sheet!'- .. c
If more than 1 septic system is on the lot:
COSA Checklist # _of _
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: Preuss #3 Block 6 Lot 5 Parcel ID: 050-571-24-000
A. WELL DATA
Well type Private
If A, B, or C provide PWSID #
Date completed 8127/77 Sanitary seal (Y/N) Y
Total depth 362, ft.
Cased to 40+ ft.
FROM WELL LOG
Date of test
8/27/77
Static water level
327 ft
Well production
4.0 g.p.m.
WATER SAMPLE RESULTS
Well Log (Y/N) Y
Wires properly protected (YIN) Y
Casing height (above ground) 7 in.
AT INSPECTION
3/22/16
319.6 ft.
4.0 g.p.m.
Coliform ND colonies/100 mL Nitrate 1.02 mg/L
Arsenic ND ug/L Date of sample: 3/8/16 Collected by: Alaska Rim Engineering
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/HDPE
Date installed 11/3/00
Tank size 1000 gal. Number of Compartments 2 ; Cleanouts (WN) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 3-23-16 Pumper SR's Pumping
C., ABSORPTION FIELD DATA
Date installed 11/3/00 Soil rating (g.p.d./ft2 or'ft2/bdrm) 1.2gpd/ft2 System type shallow trench
Length 44 I Width 5 ft. Gravel below pipe 4 ft.
Total depth o trption area 440 ftz Monitoring tube Y Depression over field N
Date ofy'acy � Results (Pass/Fail) PASS For 2 bedrooms
N..:.. � ---
Fluid de%th in absorption field` beTor$aest 0 in. Water added 479' 1 gal. New depth 3.5 in.
1 �0 .... J 0 450+
Elapsed Fj�ie: m�n. �' I fluid depth in. Absorption rate >= g.p.d.
Any
4
mo.) (YIN &type) N
If yes, give date -
D. LIFT STATION
Date installed
"Pump on" level at
Datum
_ Size in gallons
in. "Pump off" level at in.
_ Cycles tested
E. SEPARATION DISTANCES
WELL ON LOT TO:
Manhole/Access (Y/N)
High water alarm level at in.
Meets alarm & circuit requirements?
Septic tank/lift station on lot 100,+ On adjacent lots 100,+
Absorption field on lot 1001+ On adjacent lots 100,+
Public sewer main 100,+ Public sewer manhole/cleanout 100,+
Sewer/septic service line 25F+ Holding tank 1001+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5+
Water main 10,+ Water service line 10,+
Wells on adjacent lots 100,+
ABSORPTION FIELD ON LOT TO:
Property line 10,+ Building foundation 10'+
Water Service line 10,+ Surface water 100,+
Curtain drain 100'+ Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems, are /n
conformance with MOA COSA guidelines in effect on this date.
Engi er's Printed a�me(,q�Chh��arllees Leet
Dat ZJ
COSA canary sheet_2-6-15.doc
Absorption field 51+
Surface water 100'+
Water main 100,+
Driveway, parkingivehicle storage, 10,+
��
�}
�§
v }� �
< , !\
; t J.
f /� \
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.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. D 5D - 5 I -a4 COSA # log IT13
Expiration Date: I / —2 - Q 7--
1. GENERAL INFORMATION
Complete legal description Lot 5 Block 6, Pr ,ss S„hdiviginn n3
Location (site address) 10115 Louis PLnrp - Faglee RivPr, Ak gU577
Current Propertyowner(s) Denine S Steve Austin Dayphone 694-6799
Mailing address same
Lending agency 1st American Title Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well 13
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 Onsite 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 Onsite 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. DSO 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 engineers work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, i verify that my Investigation,
based on procedures outlined in the Certificate of Onsite 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 S b S Engineering Phone 694-2979
Address ISS61 S- Birchwood Ln Rd - ChiiRink, Ak. 99567
Engineer's Printed Name Robert A. Shafer Date
5. DSD SIGNATURE
_Z Approved for _�3— bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
BT �� Original Certificate Date: oz
(Rev. 11*5)
Municipality of Anchorage
• "� Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: L-crS'r TJtlxl� b`� 8� Parcel ID: OSD-�����
A. WELL DATA
Well ty�VIM If A, B, or C provide PWSID If _ Well Logi) Y6�
Date completed -2,5 R'7''q'7 Sanitary sea(IDN)
Total depth ft. Cased to Nbl+ft.
FROM WELL LOG
Date of test a
Static water level -7, a � ft.
Well production y, Z% g.p.m.
WATER SAMPLE RESULTS:
Coliform �colonies/100 mL Nitrate Lb%mg1L
Arsenic:, 0 ug/L date of sample: L�i q'D 9
B. SEPTICINCUZWTANK DATA
Tank Type/Material a3ErriL tiP
Tank size 16Q2gal. Number of Compartments
Wires properly protectec(15k
rr
Casing height (above ground) 1 Z in.
AT INSPECTION
I
� ft.
3-S g.p.m.
Other bacteria (D colonies/100 mL
Collected by: Sa f"� Rf6rx96ft�I�G
Date installed I l
Cleanoutqgq F�
Foundation cleanout®!) *'LS Depression over tank Qfl3)AjT High water alarm (Yd) Q�
Date of pumping to 1 LOb PumperT2rS r'Jry1Pr�(�
C. ABSORPTION FI LD DATA
Date installed 1l Soil rating p.d./ r ftZlbdrm) • 02 System type '3H*t(Cxt) T"-AXff
I I I
Length u�_ft. - Width s ft. Gravel below pipe �_ ft.
r
Total depth ft. Eff. absorption area L1g0 ft2 Monitorin tube � Depression over field -Lb
Date of adequacy test 6 I Result as ail iS For _ .1_ bedrooms
Fluid depth in absorption field before test z in. Water added gal. New depth$rin.
'` N50 -t d.
Elapsed Time: Amin. Final fluid depth � in. Absorption rate >= g.p.
Any rejuvenation treatment (past 12 mo.) (type) /9C) If yes, give date
D. LIFT STATION J1 11'
Date installed ll
"Pump on" level at _ in.
Datum
E. SEPARATION DISTANCES
Size in gallons
level at _ in.
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100,+
Absorption field on lot IM I4 -
Public sewer main U
Sewer/septic service line o2G +
Animal containment areas 504
High water alarm level at
Meets alarm & circuit requirements?
/
On adjacent lots (004-
r
On adjacent lots (-)0 1"
Public sewer manhole/cleanout OLA
in.
Holding tank
I
Manure/animal excrete storage areas�-
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5 r t Propertyline 9 I4- Absorption field 5 t+
I
Water main A.) hq Water service line 104- Surface water
r
Wells on adjacent lots 100 =
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
r I
Property line / 0 f Building foundation / Water main 1,4
/ 1 r
Water Service line /� F Surface water /00 'L Driveway. parking/vehicle storage �D
r -t
Curtain drain AV",KX-'CYt1(I Wells on adjacent Tots 1
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal record"t the above systems are in
conformance with MOA CO g aline in OffTois da
Engineer's Printed Name //1
Date d
COSA Fee $ 3v — Waiver Fee $ _
Date of Payment Date of Payment
Receipt Number 00617 2F) Receipt Number
(Rev. 11105)
N'
z -17
G. h u
r0�
tetra i
/ v
1/'
(tp l s7� �ftVl0 f�tV�, 1
AS -BUILT
I hereby certify that I have surveyed the following
described
property: ;k0e
.zG6Jl fl aj-yhl_* NOr 3r Sl /tf .
Ste. %an &a %/ S�,cJ t iQ / w, -" M ;
Anchorage Recording Precinct, Alaska, and that -the'
improvements situated thereon are within the property
lines and do not overlap or encroach on theproperty -
lying adjacent thereto, that no improvements on prop- _
erty lying adjacent thereto encroach on the premises in
question and that there are no roadways, tnnaaaladon
lines or other visible easements on said property except
ns indicated hereon. -
Dated at F.ayle River, Ala�s�ka'� -
thisl0 nft day oc� _U C
ROBERT C. JOHNSON •�'�'�jL
SCALE: Registered Land Surveyor NO. SBttiL6
I'= g 60' Dox 4%, Eagle River, ,M=
Phone OW2543
ANALYTICA
GROUP
S&S Engineering
Attn: Taml / Yoshi
17034 Eagle River Loop Rd.
Eagle River, AK 99577
907-694-2979
Fax: 907-694-1211
Client Sample ID:
Sampling Location: L5 B6 Preuss 3
Client Project: none
Samplc Matrix: Aqueous
COC #: 60498
PWS#:
Residual Chlorine:
Comments:
Lab#: A0707298-OIA
Analytica International, Inc.
4307 Arctic Blvd.
Anchorage, AK 99503
Phone: 907-258-2155
Fax: 907-258-6634
Report Date: 8/2/2007
Receipt Date: 7/2412007
Sample Date: 7124/2007
Sample Time: 2:15:OOPM
Collected By: YN
Flap Definitions:
MRL - Method Reporting Limit
MCL - Maximum Contaminant Limit
B e Present also in Method Blank
H s Exceeds Regulatory Limit
M Matrix Interference
J e Estimated Value
D Lost to Dilution
•• RL higher than MCL; target not detected
TNC - Too Numerous to Count - result rejected
CF a Confluent Growth - result rejected
TCNG - Turbid Culture No Growth - rejected
Analysis Method Prep Prep Analysis
Parameter Result Units Flags MRL MCL Method Date Date Analyst
_:....,_ ..,.,.. Test was conducted by: Analyrica - Thornton
Arsenic
e ?&-d-
Reported by: Krissy Plett,
Laboratory Project Manager
0.817 ug/L 0.15 Jo 200.8 7/31/2007 7/31/2007 KS
Page I of 1
SCS ReLN
1072761001
Client Name
S B. S Engineering
Project Name/N
L5 D6 Preuss No 3
Client Sample ID
L5 D6 Preuss No 3
Matrix
Drinking Water
PRBID
All Dstes/fimes are Alaska Standard Time
Printed Date/time
06/19/2007 12:22
Collected Datc/fime
06/14/2007 18:00
Received Date fime
06/15/2007 16:45
Technical Director
Stephen C. Ede
Sarnple Remarks:
4500-NO3 - Total Nitrate/Nitrite - The matrix spike recovered below the QC criteria. The batch LCS is within QC limits.
Allowable Prep Analysis
Parameter Results POL Units Method Container ID Limits Date Date Init
Waters Department
Total Nitrate/Nitritc-N 0.656 0.100 mg/L SM20 450ONO3-F B (<10) 06/16/07 JDS
microbiology Laboratory
TotalColirorm 0 coV100mL SM209222D A (<I) 06/15/07 DLC
Municipality of Anchorage
'ea se
,.. Development Services Department
Building Safety Division
On -Site Water and Wastewater Program , e
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ek.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING' '�10,�/
Parcel I.D. 05-0 - S-71 - 7 `i HAA # & D 7
Expiration Date:
1. NERAL INFORMATION
.Complete legalde'scription Lot 5 Block 6 Preuss #3 S/D
:-Lo . cation (site addreis or directions) 10115 Louis Place Eagle River, AK 99577
-..Current Propertyowner(s) Troy & Julie Ruse' Dayphone 696-2873
Mailing address P 0 Box 770693 Eagle River AK 99577
• Lending agency Vista Mortgage Dayphone273-7326
Mailing address
Real Estate Agent David
Wrigift
Day phone
Mailing Address
be
held by DSD for
/
-� Z L)'1�
unless otherwise requested, HAA will pickup.
2. NUMBER OF BEDROOMS:
3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑X
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, I verify that my investigation,
based on procedures outlined in the HealttlAuthority Approval Guidelines for this application, shows that the
on-site water supplyand/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 disposalsystem is(are) in compliance with all applicable Municipal and State'codes, ordinances,
and regulations In effect at the time of installation.
Name of Firm - S & S ENGINEERING : Phone G q H _ a9 79
Address Eagle River, Alaska 99577
Engineer's Printed Name BLf/R 7• C. COWA Date Y/}.s,�p/
" t ISO
GINEE.PA Fq�q
Id
5. DSD SIGNATURE ROBERT G COWAN
_� Approved for _ bedrooms. +r4 v•;�, �= 8801
Disapproved. +t'i ,I ."^�
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
tttltt t f ffffliii�,��
ONSITE • �;
WATER D—; rn-
WASTEWATER
X Maintenance Agreements
Supplemental Engineer's Report
Other
By: �-- Z Original Certificate Date: 1? -.2-7-0/
of
(Rev. 114101
Municipality of Anchorage
• Development Services Department
Building Safety Division
On-Ske Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.d.anchorage.ek.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: I �U5�3 5 I7 Parcel ID: PSD' !I;-? ( - Z¢
A. WELL DATA
Well typeQ4.I AO -L -
Date completed 4714+
Total depth �Z ft.
if A, B, or C provide PWSID #
Sanitary seal(Y/N)
A
Cased to a fl.
FROM WELL LOG
Date of test
static water level 3 Z'a- ft.
Well production 4 9•p•m-
WATER SAMPLE RESULTS:
Well Log (YIN) '46:!L—
Wires
properly protected (Y/N)
Casing height (above ground) Ti +in.
AT INSPECTION
8tLo1
3 2-2 ft.
x O.3 + g.p.m.
^L�^'rte dY P,.wA 4 PL✓MAJJ c
Coliform O colonies/100 ml. Nitrate (2• -5'-mg.A. Other bacteria O colonies/100 ml.
Data of sample: Collected by: ?1
B. SEPTICIHOLDIN__G TANK DATA
Tank ,Type/Materiel S I.r T c N D p E Date installed yl 3 o A
Tank size ) V OO gal. Number of Compartments a Cieanouts ®N) Y C 1
Foundation cleanout (Y/A) _ Depression over tank (Ye ^ o High water alarm (Y/0 X O
Date of pumping ° o Pumper /L 's
C. ABSORPTION FIELD DATA
Date installed ; /n Soil rating g.p.d./ft r fe/bdrm) I_a System type TR N
Length`~y ft. wrath $"- ft. Gravel below pipe ft.
Total depth ) C ft. Elf. absorption area yM0 112 Monhoring lube YCS Depression over field NO
Date of adequacy test MIA — PJ"J Results (Pass/Fail) For bedrooms
Fluid depth in absorption field before test -12� in. Water added= gal. New depth= in.
Elapsed Time: = min. Final fluid depth 0 in. Absorption rate >= g-p.d.
Any rejuvenation treatment (past 12 mo.) (YM 8 type) ""4 { K N 4 ✓ ,i If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
'Pump on" level at in. 'Pump off" level at _ In. High water alarm level at in.
Datum Cycles tested Meets alarm & circult requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAlft station on lot lu � ''— On adjacent lots
Absorption field on lot /00, -#--
Public
0or+Public sewer main N 1A
Sewer /septic service line
On adjacent lots /00 � 4
Public sewer manhole/deanout ^'1A
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
r
Building foundation S t r Property line S Absorption field r t4
Water main P/4 Water service line �+ Surface water /00 �4
Wells on adjacent lots / 0 J �4
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line J C + Building foundation / J 4 Water main
N /A
Water Service line / 0 r Surface water 106 �'0 r
Driveway. paftVivehide storage 30 F
Curtain drain N a N,t, Kivo NN Walls on adjacent lots / 0 d 't
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field lnspecODns and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines In effect on this date.
Engineer's Printed Name Rae« C. CowA.r
Date %/ Zh /0
HAA Fee 3 300.01
Date of Payment } 3 /o I
Receipt Number o I t o)
(Rev. 120e)
Waiver Fee $
Date of Payment
Receipt Number
40►MW cowrrr
CE -8801
.tla�
ME Environmental Services Inc.
CT&E ReEM
1015576001
Client POM
Client Name
S & S Engineering
Printed Date/time 08242001 16:54
Project Name/#
L5, B6, Preuss #3 SID
Collected Date/time 08222001 17:30
Client Sample ID
L5, B6, Preuss #3 SID
Received Date/time 08232001 10:26
Matrix
Drinking Water
Technical Director Stephen C. Ede
Ordered By
PWSID
-
0
Releasedy0O A /f
/) _//_
A C]LY7
Allowable Prep Analysis
Parameter Results PQL Units Method Limits Date Date Intt
ram
W&t:&r■ D*yartM2=
Nitrate -N 0.500 U 0.500 mg/L EPA 300.0 (<10) 0823/01 SCL
uNerobiolotay Laboratory
Total Coliform 0
0 coVI00mL SMI89222B
0823/01 SKW
$1
Municipality, of Anchorage
! ,i Department of Health and Muman Services
Division of Environmental Services
On -Site Services Section 825 •L' Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOFi A SINGLE FAMILY DWELLING
_6 k
Parcel LD. 050757.1-24
HAA#y1aYX0i(6()S
Expiration Date:
1. GENERAL�INFORMATION'
Complete'legal description
Lot 5, Block.:6,
Preuss Subdivision No.
3
Location (siteaddressordirections) 10115
Louis Place Eagle River.,..AK
..
Current Property owner(s)
Troy Buse
Day phone 696=2873, '
Mailing address .10115 Louis Place
Eagle River, AK 99577
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DHHS
for pickup. HAA picked up by:
2. '-NUMBER'OF BEDROOMS:
Three (3 )
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual On-site
g]
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class
Well ❑
Community On-site
❑ .
Public Water System
❑•
Public Sewer
El,
The Municipality of Anchorage'Department of Health and Human Services`(DHHS) issues Certificates of•
Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent'
professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are
required for the transfer,of title (except between spouses) on properties served by a single family on-site
wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners.
Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by
a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates
are valid for one year for properties served by Class A or B wells or a public water system. The Municipality
of Anchorage is not responsible for errors or omissions In the professional engineer's work.
72-M (Rev. 01/00)•
P
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 Health Authority Approval Guidelines for the Health Authority Approval
'application show that the on-site water supply and/or wastewater disposal system is safe, functional and
;:adequate for the number of bedrooms and type of structure Indicated herein. I further verity that based on the
Information obtained from the Municipality of Anchorage files and from my Investigation and Inspection, the on-
site water supply and/or wastewater disposal system is In compliance with all applicable Municipal and State
codes, ordinances, and regulations In effect at the time of installation.
Name of Firm ' -.'Anderson' Engineering 1 Phone 522-7773
Address P.O. Box!' 240773 Anchorage, AK99524
Engineer's Printed Name Michael E. Anderson, P.E. • Date 11/30/00
Eg
TAMP.
6. DHHS SIGNATURE' ' ' •:
'Approved for _ bedrooms. l'Eol
Disapproved.
`Conditional approval for bedrooms, with the fogowing s3i 21o11S" ,
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory.
Well Flow Advisory.
Maintenance Agreements
Supplemental Engineer's Report
Other
By..��/ l/%, / —a- Original Certificate Date:
Expiration Date: 2 ' %-fib "0 n Reissue Date:
75-025(R".01/00)• - -
^ECEIVED
"'Municipality of Anchorage
Department of Health and Human ServicesNOV 3 0 2000
Division of Environmental Services
On-Sfte Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-666WNICIPALITY OF ANCHORAGE
www.ci.anchorage.ak.us ENVIRONMENTAL SERVICES DIVISION
(907)343-4744
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 5 Block 6 Preuss No. 3 Parcel I.D.:
050-571-24
A. WELL DATA
Well type Private if A, B, or C provide PWSID #
Date completed -8/27 7 7Sanitary seat Y
Total depth 362' it Cased to >40' It
FROM WELL LOG
Date of test 8/27/77
Static water level 327 ft
4
Well production 9 -P -m
WATER SAMPLE RESULTS:
Coliform 0
colonies/100 ml
Nitrate . 5
mg/l
Dateofsamplw
11/28/00
Coilectedby:
MEA
B. SEPTIC/HOLDING TANK DATA
TankType/Material Septic/HDPE
Well Log
Wires properly protected Y—
Casing height (above ground) 24 in.
AT INSPECTION
11/29/00
326 It
4.3 g.p.m
Other bacteria 0 colonies/100 mi
Date installed 11/3/00 Tank size 1 , 000 gal Number of Compartments 2
Cleanouts Y Foundation cleanout Y Depression over tank N High water alarm N
Date of pumping New Construction Pumper
C. ABSORPTION FIELD DATA
Date installed 11/3/00 Soil rating (g.p.d./fI2 or ft2/bdrm) 1.2 System type 5' Wide Trench
Length 44 ft Width _L—ft Gravel below pipe 4 ft
Total depth 10 h Effective absorption area 440 tt2 Monitoring tube Y Depression over field N
Date of adequacy test New Const. Results (Pass/Fail) For bedrooms
Fluid depth in absorption field before test in Water added gal. New depth in.
Elapsed Time: min Final fluid depth in Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date N A
72026 (Pw. 01100)'
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 HAA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date_ 11/30/00
HAA Fee $ d2f • Waiver Fee $ _
Date of Payment Date of Payment
Receipt Number Receipt Number.
72.026 (Rev. 011001'
D. LIFT STATION - N/A
Date installed
Size in gallons Manhole/Access
"Pump on" level at in "Pump off" level at in High water alarm level at in
Datum
Cycles tested Meets alarm & circuit requirements
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tanMIft station on lot
> 100On adjacent lots >100'
Absorption field on lot
>100, On adjacent lots >100'
Public sewer main
N/A Public sewer manhole/cleanout N /A
Sewer /septic service line
>251 Holding tank _ N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5'
Property line > s Absorption field __j5 .
Water main _ N/A
Water service line > i n , Surface water
?1001
Drainage > t on'
Wells on adjacent lots > , nn
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >101
Building foundation > i n' Water main _ NIA
Water Service line >10'
Surface water > 100' Driveway, parking/vehicle storage >20
Curtain drain None Noted Wells on adjacent lots __LLOO,
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date_ 11/30/00
HAA Fee $ d2f • Waiver Fee $ _
Date of Payment Date of Payment
Receipt Number Receipt Number.
72.026 (Rev. 011001'
I■M 11-24-00 18:04 FROM -CTE ENVIRON1fNTAL 5615301
Ass
Mo ■
ME Environmental Services Inc.
Laboratory Division
200 W. Potter Drive
Anchorage, AK 99518
Tel: (907) 562-2343
Fax: (907) 561-5301
CTBE Ref tt:
1007377001
Client Name:
Anderson Engineering
Project Name:
n/a
Client Sample ID:
Lot 5, Block 6, Preuss
Matrix:
Drinking Water
PWSID n/a
T-005 ' P.01/02 F-551
Client PO#:
n/a
Printed Dateff'me:
1129/00 17:50
Collected Daterrime:
1128/00 10:30
Received Date/Time:
1128/00 11:00
Technical Director.
Stephen Ede
Released By:
Sample Remarks:
Allowable Prep Analysis
Parameter Results PCIL Units Method Limits Date Date Init
Total Coliform (MF) 0 coU100 ml SM9222D 1128/00 KAP
Nitrate 0.5 U 0.5 mg/L
Received Time Nov -29. 6:01PM
EPA 300 10.0 1128/00 SCL
-
DATE RECEIVED
INSPECTION APPOINTMENTS
STREET LOCATION "
�y c c� ✓= c Z.
TIME
6. TYPE OF RESIDENCE
TIME
/ -_ ,L,�
'J
TIME
�` !/mac- `�'✓/1/di
DATE
❑ Two ❑ Five
DATE
DATE IL /
INSPECTOR
* ATTACH WELL LOG. A well log is required for all wells drilled
INSPECTOR
INSPECTOR -
qacn
❑ PUBLIC UTILITY
MUNICIPALITY OF ANCHORAGE DEPT 'F & JN
2
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECfILHNP0NMr
8. SEWAGE DISSPP SAL SYSTEM
825 LStreet -Anchorage, Alaska 99501
•
APR 2 r
❑ PUBLIC UTILITY
ENVIRONMENTAL SANITATION DIVISION
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Telephone 264-4720
RECEI
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. PR PERTY O
NER
PHONE
MAILI G ADDRES
ROPERTY RESIDENT (If different r m above)
PHONE
PHONE
My AJ LINA%DDR
e
Liter (/C ` �)
1-L !
3. E DING INS IT I N ,-
E
PHONE
LING ADDRj 17 S /`-6I
/ENT
'9
4. REALTO((,,/
PHONE
j
(J/_�D,
~i
MAILING ADD S
/
5. tLEGAL PESULIPTIO 751
c �.0/3/
STREET LOCATION "
�y c c� ✓= c Z.
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS
❑ One ❑ Four ❑ Other
INGLE FAMILY
❑ Two ❑ Five
❑ MULTIPLE FAMILYhree
❑ Six
7. WATER SUPPL -
INDIVIDUAL*
* ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISSPP SAL SYSTEM
•�
L5" INDIVIDUAL/ON-SITE**
YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
1
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON -SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATE INSTALLED
rqf
INSTALLER
❑Septic Tank or ❑ Holding Tank
Size: If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL TO:
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
t
b--APPROVEDFORBEDROOMS
❑ CONDITIONAL APPROVAL (letter st accompany certificate)
®� DISAPPROVED
DATE
BY
72-010 (Rev. 6/79)
�j DAVID A. SLENKAMP ROBERT A. SHAFER
MECHANICAL ENGINEER CIVIL ENGINEER
694-9055 694-2979
` May 52 1981 MUNICIPALITY OF ANCHORAGE
eq� DEPT. OF HEALTH &
RIVER, Ps�P
ENVIRONMENTAL PROTECTION
MIA
Jack White Realty
ATTENTION: Clyde Lower RECEIVED
3201 C. Street
Anchorage, Alaska 99503
Dear III-. Lower,
Reference:' Lot 5; Block 6; Pruess Subdivision
A`sewer system adequacy test was performed on the system located
on the referenced property as you requested. The septic tank was
pumped and verified to have a capacity in excess of 1000 gallons.
The absorption trench was tested by a continuous flow of 584 gallons
of water over a period of 24 hours with no measurable increase in
the water level in the sump at the end of the trench.
It is concluded from this test that the septic system is currently
functioning adequately for the three bedroom home located on this
property.
If we may be of further assistance, please do not hesitate to call.
Ci nncr cltr
ccs Alaska Pacific Bank
ATTENTION: Patty Harp
Municipality of Anchorage
Department of Health and Enviornmental Protection
SRB 196X EAGLE RIVER, ALASKA
yYc�
♦. r h u 11 ��.
j`
' X41 �4 Fk Lv z..PU-
, i i
825 "L" ST REE
ANCHORAGE, ALASKA 995-01
(907) 264-4111
GEOPMF NI. SULLIVAN',
MAYOR
D%:.F'ARThPiENj"OF HEALTH AND ENVIRONA ENTIA.L. t'FimEcriON
April 30, 1981:
Mark Lower
% Clyde Lower
Tack White Company
3201 C Street - Suite 101
Anchorage, Alask-a 99503
Subject: Lot 5 Block 6 Preuss Subdivision #3
Approval for the individual sewer and water facilities
cannot be granted until the following items have been
completed:.
(1) The wa.te.r. 'analysis report needs to be delivered
to this off.-i-ce from the Chem Lab; 56)33 B Street,
for our review.
(2) The septic tank pumped with a receipt submitted
`SCJ to this office.
If there are any further questions, please call this
office at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
cc: Alaska Pacific Bank
Post Office Box 420
99 510
#1: Time
Date
'UNICIPALITY OF ANCHORAGE
DEPARTMENT` . -r HEALTH AND ENVIRONMENTAL,)ROTEC ION
825 L Stree , Anchoraap. Alaska
264-4720
a>t - Date Received: October 17, 1977
9:30 a.m. #2: Time #3: Time
10-21-77 Friday Date Date
Insp Willis
Insp
Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. Lending Institution Request:
Mailing Address:
2. Property Owner:
91
Mailing Address:
Bill Foreman
General Delivery 99577
Phone:
Phone: 694-9056
Legal Description: Lot 5 Block 6 Preuss Subdivision
4: Single Family Residence: (x) Number of Bedrooms: Three
Multiple Family Residence: ( ) Number of Bedrooms:
5. Well System: Individual Well (Y) Community/Public System ( )
Permit # = Depth of Well 361' Well Log on Files )/U.
Construction Bacterial Analysis
6. Sewage Disposal System: On-site System (X) Public Utility ( )
C,�
Permit # Installed 00l8 -77 Installer 60 c)s
� � /
Septic Tank Size 1000 Manufacturer
Absorption Area 2(4 6 Soils Rate 00 Material "tAal^eA
1 (J
7. Distances: Well to Septic Tank 100 to Absorption Area ZJC�
t
to Sewer Line Nearest Lot line 11 6 Absorption Area
f
to Nearest Lot Line D-0
,Page Two \
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 5 Block 6 Preuss Subdivision
Comments:
Affadavit Attached: ( )
Approved:
Disapproved:
Department Worksheet:
Letter Attached: ( )
Date:
Date:
`JJNICIPALITY OF ANCHORAGE ,`� �v R�_
" Department of Health and Environmental Protection,,, I2 -e LC)
*_q
825 L Street, Anchorage, Alaska 99501264-4720
uest for Approval of Individual Sewer and Water 4acili'4ie,s
1.
2.
Property Owner:
Mailing Address:
Name of Buyer:
Mailing Address:
e : �
Phone:
3. Lending Institution:
Mailing Address: Phone:
4.
5
Realtor/Agent :`—
Mailing Address:
Legal Description
Street Location:
Phone:
�u
6. Single Family Residence: (Z-)-�-Number of Bedrooms: s�
Multiple Family Residence: ( ) Number of Bedrooms:
7. Water Supply: *Individual Well k/� Public/Community System ( )
If Individual Well, well depth J
If Community System, name of system
8. Sewage Disposal System: On-site System (/,�-�_ Public System ( )
If On-site System, date of installation:
*NOTE: A well log is required on ALL wells drilled since 6/75.
If on-site sewer system is over two(2) years old, an adequacy
.test is required by this department.
A fee of $25.00 must accompany each request before processing
can be initiated.
3/77
I