HomeMy WebLinkAboutPREUSS #3 BLK 6 LT 9Preuss
Block 6
Loi- 9
#050-571-22
Municipality of Anchorage Page _ / of
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
N~. ~/)~ ~ /~A~ Wastewater System: ~New ~Upgrade
Phone: No.~Bedrooms: D Deep Trench ~Shallow Trench ~ Bed ~ Mound D Other
Tole[ Depth from original grade:
Lol: Subd~ion: ~ Depth 1o pi~ bosom from original grade: Gravel depth benealh pipe
U~ Number of lines: Dislan~e~ w~n Pines:
Classi[ication (Private. A.B,C): ~th: Cased To:
Yiel~ J Pump Set at: Casing Height Above Ground:
SEPARATION DISTANCES ~s~.tic ~ Ho~.g ~ S.T.E...
To Seplic Abso~tion Lift Holding Public/Pri~te Manufacturer: Capacity in gallons:
,From Tank Field Sialion Tank ~wer Lin.
Well- /Pb/b /00~ __ ~ __ Material: ~QWI Num~rofCompa.ments: ~
Sudace
Line /~ /~ __ Size in gallons: Manufacturer:
~CudainDrain /~ 1/ /~ /p ~ ~ -- :Pum~odel J Electrical Inspeclions pedormed by:
Remarks: ~ ~a ~ ~4;n~ BENCH MARK
Lo.lion and Oescription:o /L
~NGINEER'S SEAL
Inspections pedormed by: F~Z?~,~J Dates: 1st ~r/ZO/~ ~ 49~
Department of Health and Human Se~ices app¢oval
AS-]3UILT SYSTEM DETAILS/SITE PLAN per, mi~c SW9SO065
PREUSS S/]3 #3, LET 9, BLOCK 6 PI]}a:o50-571-aa
ia · FIT
s /...
/"',,...'r/4 .... . '::'~x~'~' , ~~~~ ~~
.
''
~ ] SCAt E~ =] 50'
'
B-C:4~,6~ ~
A-K=~,4' SEWER R~CK
~. O~ A~. ~ ~ PREPARED FOR: SCALE, NTS
~ tome WREN LANE
~ ~ ~ EAGLR RIVER, AK 99577
ENGINEERING
.. '~ ~. ~ ~ SEWARD KMD
~O~ss~O~b~ ~ ASBUlL~: SEWARD ~A~E: 10/26/98 gAGLB R~VgR, A~ 995S?-aS36
~c~ ~,m 9802~.aw0 ,o~ ~.: 9802~ (907)696-6~/p~ (907)696-8~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM
PERMIT NUMBER:SW980065
DESIGN ENGINEER:KND ENGINEERING
OWNER NAME:MATTHEWS COLIN & KATHERINE A
OWNER ADDRESS:10132 WERN LN
EAGLE RIVER, ALASKA 99577
PARCEL ID:05057122
PAGE 1 OF 1
(UPGRADE) PERMIT
DATE ISSUED: 4/16/98
EXPIRATION DATE: 4/16/99
LEGAL DESCRIPTION:
PREUSS #3 BLK 6 LT
LOT SIZE: 22922 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
'~ND ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
April 5, 1998
Municipality of Anchorage
Dept. of Health & Human Services
On-Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519-6650
Subject: Preuss Subdivision #3 Lot 9, Block 6 - Septic Upgrade Permit
Gentlemen:
Following a request from the owner, we conducted an investigation of the existing septic
system for the subject property. The observations in the monitoring tube showed the
effluent at or above the lateral and in failure. The owner requested we proceed with a three
bedroom upgrade of the septic system. On March 30, 1998 we dug one testhole for the
proposed upgrade. The results of this test are attached. The lot is served by individual well
which was tested and met minimum municipal requirements.
The proposed upgrade system will be placed approximately 10' north of the existing
system. The new tank will not require a waiver and will be placed outside the existing well
radii. As indicated on the site plan the system can be served by gravity. The existing tank
will be abandoned in place, a diverter will be installed so the existing field can be utilized
in the future. Additional cover will be provided to maintain a minimum of 3' of cover.
As indicated by the site plan drainage arrows, natural drainage is away from this site and
will be maintained after construction. There is no surface water within 100' of the
proposed installation. There are no known curtain drains within 50' of the proposed
installation. No public or private wells exist within 200' of the proposed installation
excepted as noted on the drawing. This upgrade should have no adverse effect on
development of adjacent lots.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
lltbq~ Engineering
Kenneth M. Dufft~J,P.E.
attachments:
On-Site Well and Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
WASTEWATER
DISPBSAL
PREUSS
LOT a
INSTALL
LOT ~SEPt~C '"~
LOT 5
l~jr.o~, ...........
SYSTEM
S/D #3, LOT 9, BLOCK 6
LOT 7
439,04
LOT lO
David Avenue
DETAILS/SITE
30 j 30
PLAN
LnT ~
LOT 3
LOT 4
LDT 5
K
7
NO PUBLIC WELLS WITHIN 800' DF
PRBPDSED SYSTEM,
ND PRIVATE WELLS WITHIN EOB' ~F
PROPUSEB SYSTEM EXCEPT AS NOTES.
NO SEPTIC SYSTEM~ WITNIN E00' OF
PROPDSEB WELL EXCEPT AS NOTED,
DESIGN DETAILS
3 BDRH X 150 GPO = 450 GPO
450 GPO/l,2 GPO PER SQ, FT, = 375 SQ, FT
375/(5')> X O,64(RF) (~,5' GRAVEL) = 48,0 FT, TRENCH
Total depth oF system is 3,0' FrOM original grade,
Total depth oF eFFective gravel belo~ distribution pipe Is 8.5' .
NOTES:
1. USE 1000 GALLON SEPTIC TANK. INSULATE TANK IF <4' COVER.
2. INSULATE TRENCHES WITH 8' HD BURIAL FOAM.,
3, CONTRACTOR WILL ENSURE MAXIMUM 8% SLOPE INTO SEPTIC TANK,
4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TD ACHIEVE
MIN. 3' COVER IF REQUIRED,
5. CONTRACTOR TD ABANDON TANK IN PLACE,
PREPARED FOR:
COLIN MATTHEWS
iOI3P WREN LANE
EAGLR RIVER, AK 99577
FIELD BOOKS
COMPUTED:
I]OUNDARY: -- DRAWN: KMD
ST^XIN~: SEWARD CHECKED: KMD
ADSUILT: SEWARD
ACA~ rile 98023.DW6
4/4/98
NW056
98023
SHEET 1/~
~-~ ~F~ D ENGINEERING
204.41 PTARMIGAN BLVD.
EAGLE RIVER, AK 995?7-8736
.jWASTEWATER ]3ISPE1SAL SYSTEM DETAILS/SITE PLAN
· i PREUSS S/D #3, LOT 9, ]}LOCK 6 \ /
PRFI TiXARY SYS
~ ~2.S .... ~ ""~ ~ 10132 WREN LANE
~ ~ ~1~ ~ ": ~ ~a EABLR RIVER, AK 99577
~ "'.. - ..-'""~ '" : - : KMD
*c*o .m 98023.DWG .~,,o.: 98023 (907)696-6111/F~ (907)696-6111
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6--
7
8
9
10
11
12
13
14
15
16
17
20-
COMMENTS
Municipality o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
WAS GROUND WATER A//,.
ENCOUNTERED?
IF YES, AT WHAT ~ 1~
DEPTH?' pO
Reading Date Gross Net Depth to Net
Time Time Water Drop
3 ~ ~,'~ _-~" _
7 ~ ~;~- -- ~"
PERCOLATION RATE ,2., '~//_ im,nule~mch) PERC HOLE DIAMETER
TESTRUNBETWEEN ---..~FTAND
,- , .. ,
~,/' , / / WAS PERFORMED IN
^OCORDANOE w,.H ALL ~..~E',,.O MD~IC,PALVD,oE.NE~ ,. ~. o...,~ ~..~: ~/~/e~
72-~ Inev. 4/~) / /
Municipality ol Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
2
3
4
5
6
7--
8
9
10
11
12
14
15
16
17
18
19
20
COMMENTS
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT ,/~ OL
DEPTH? p
Monilorin§?
Reading Date Gross Net Depth to Net
Time Time Water Drop
Z 7¢;// /0~,',~ /,,',/'/' ~/¢ '
_ ,~ ~; z~ IO~,', /~ Yz" ',/¥"
7' ~' ~ z ./O ~,,, ;~ ~, iz' '/¢"
~ t~, ~z /D ,-,,,;-~ ~'~,/'e,~ !/2/',
PERCOLATION RATE ¢~) [minutes/tach) PERC HOLE DIAMETER .
TEST RUNBETWEEN ~:~ FTAND 7 F~
72-008 (Rev. 4/65)
~,, ~ ~ MUNICIPALITY OF ANCHORAGE ~ i L~
~r~ ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROT~E~:TION [/ LL) ~/,
ENVIRONMENTAL ENGINEERING DIVISION
~~ 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ~
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
~ 0~ ~ UPGRADE
MAI LING ADDRESS ~
LOCATION ~ ~ NO, OF BEDROOMS
~d6'l , Absorption area PERMIT NO.
~ DISTANCE TO: I ~~ Dwelling
~ Z Manufacturer Material No. of compartments
~ ~ Liq. capacity in gallons IF HOME.DE: Inside length Width Liquid depth
~ ~ Well Dwelling PERMIT NO.
DISTANCE
TO:
~ ~ ~ Manufacturer ~ Material Liquid capacity in gallons
~ DISTA~C. TO: ~ell .~ ~ Foundation ~earest lot Hne
~ ~o. of linos ~enflth o[ each line Total lan~th of lines Trench ~Mth Distance between Hnes
~ inches
~ -- Top of tile to finish grade Material beneath tile Total effective absorption area
Q inches
Length Width Depth 'PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class ¢' , ; " Depth Driller Distance to~lgt lin~ PERMIT NO.
Building foundation ~,. ~ Sewer line Septi~ tank Absorption area(s)
~ DISTANCE TO: ~%~.. ~."", ' ~* ~ /:~. C~ .~.~- ~' ~/, ~
OTHER
PIPE MATE. IAL8 W ~ E ~
SOIL TEST RATING i~~. ;
INSTAELER
REMARKS ~[)~ R ~
APPROVED ~ DATE LEGAL
72-013 (Rev. 3/78}
PFRMIT biO.
FIPPLICF~NT .)'FIf'dES O'"HFIRFI 22Et5 13Cff.~IF'F~CE: F'KP.I"P
I_OC:RT I ON HREI",I
LEGEfL L9 86 .F'RLIES;S ':];,.'"[) ~l$]: LOT SIZE
T'T'PE OF 5;C~II... FflE:E;ORE:-I"IOiq '.S"r"_-V, TEM IS: TREiqF':H
i'dl::t',qIMUM I'.,IUME:ER OF E:EE:~ROOMS = 4 SOIL RFITING (SQ FT,.."E:R)=
THE F.:EL::!IJIRE:[;', SIZE OF TPIE '.'SOIL iRE:':SORPTION SY'S'TE:M IS:;,:
I}E'i::'FIF;[i]"ME]'~I" 0F HEF:IL.-f'FI FIN[:, EN'v'IRONME:NTt':IL F'RCFI"EX:::TiCIN ~,} ~ ~
......... 264- 47;.:.-:e~ -',/~ d/C¢
,' 7'9C~4'})5 ::' ' ~-'~-'
'.2::i..TE:E:~ '-Sf;!I...IF~F;'E FEE'T'
THE LENG-['H [.',II'dENSICIN I:F.'; THE LENGTH (IN FEET) OF THE TRENCH OR DRFIINFIELD.
THE [:,EPTH OF FI -['RENCH OR PIT I'}-'; THE [:,ISTRNCE 8ETHEEN THE SI..IF.'.FRCE Cfi:: '!'HE
GROLIN[:' F:IN[:, THE BOTTOM OF: THE: EXCFIVRTZON (IN FEET).
THEP:'.E IS, NO E;ET HIDTH FOR -['RENCHEE;.
THE GRI::I'v'EL E:,EF'TH tS:; THE MINIMLIf4 r:,EPTH OF GRWv'EL. DETHEEN TIqE OLITFRLL. PZF'E
RI',I[:, TPIE E:OT'FOM OF' THE EXC:R'v'FITION (IN FEET).
PERMIT FfF'PLIC:FINT fIRS THE RESPONSIE:IL.I'TM -['0 INFORM THIS [:,EPF:fRTMENT DUI;:ING "f'HE.'
INSTRLLFITION INS;PECTIONE; OF RN'¢ WELL"S, RDJFIC:ENT TO ]"HIS PROPERT"r' RN[." TPtE
NUME',ER OF RESIDENCES'; TI-IRT THE HELL I.,.tILL. SER'v'E.
................ T IL,..~ C~ .:] ~-~ ::. ~. b',§ ~.'; tF:" IS C: 'T]E C~ f-,~ ".C:-_'~; Ftl IfiL' EE F~: EE E&~ L[ ~:: fi:~: EE lC..::, ....................
E:F:ICKF'IL. LINC'~ OF FflN"r' E;"r'"Z~;'FEM !.,.IITHOUT FINFIL INSPE;C:'f'I. ON fiN[:' FIPF'RO'v'FIL E:"r' '['HIL"~;
[:,EPFIR]"i'flEI"4T I.,.IIL. I_ E',[C SUE:JECT TO PROSECUTION.
MTNIMLIM D]:S'['Fli",IC:E BETHEEN FI WELl... FIND Fllq"r' ON-S]:TE SE!.,.IFIGE [:,ZSF'O'.:.;FIL
iC':IE~ FEET FOR FI PRI'v'FITE !.'.IELL.; OR
::LSE~i TO 2E~C'~ FEI:ET i::F-'.OM FI F'UBLIC I.,.IELL DEPEN[:'INC:i UF'OI',I THE T"r'PE OF PUE31_IC HELL..
t.,4ELL L. OGE; RRE REg!UIRED FIND i"IU:YT E:E RETLIRNED TO THE DEPRRTME:NT HITPIIN
OF THE WELL CC$1F'LE-['TOI',I.
OTHER F4. E..:.L.III:,.Ef'IEI'~T=, I"lR"r' RPPL"r'. '.SF'IiEC:IFICFtTIONSi F¢',ID CON:-Z,T[;.'.IJCT.TCIN B, IRGF-::I::fMS FIRE
F:t',,,'FIILRBLE l"O i'f',ISURE F'ROF'EF;: INSTRLLFITION.
F" E ~;: ~'"'tl :]: '"IF" E: ::-:". IF:::" :]] ~--': IE :L--~-; IE:. EE C: E: li'"~ E: E:£ F.;: 2;J:
I CERTIF"r' THRT ] _ .
t: I RM FFIMILIIRF.: HI'FH THE RE:QI_IIF.:EMENT:S FCF.' LI4--:,I rE 5;EI.,.IERS; RN[:, I.,.IEL. I..S FIS SET
FORTPI E:V THE MUN[_.IFHLI [~ iF RNC:HOF.:RGE.
2 1' I.,.IILL tN=,IHLL. THE ..-.,r.:,TEM Ilxl RCI.-.':OR[:,I::INCE I.,.IITH THE
" "1' ' -' "- .... , RE:~IIIRE E]'..ILFIF.:GEMI:?.:NT ZF THE
]:: I Ui'.,IDE'RE;TFII",tD THRT -['FIE: ..N--.::,~TE L::';EI.,.IEF.: .=, ,..-.', FEi'I MFI"r' .
r '.ESZC, Z:S F.:Er, Or:,ELEC, T,:,THm,t E,
825~ 'L' STREET, RNCHORfGE, fit(. 9950&
TYPE OF SOIL RBSORBTION SYSTEM
pE~:[-1 T T
" ~ 264-472G
WELL a~r-4 ~-, Of 4 .... $ I TE
MfXIMUM NUMBER OF BEDROOMS = V SAIL RRTING <SQ ET/BR.`.'=
THE REQUIRED SIZE OF THE, SOIL flBSORPTION S'T'STEM IS: ,
THE LENGTH DIMENSION ~S THE LENGTH (IN FEET) OF THE TRENCH OR 'DR~INFIE~D.
THE DEPTH OF ~ TRENCH, OR PIT IS THE DISTANCE BETNEEN THE SURF~C:E OF THE
GROUND aND THE 8OTTOM~ OF THE EXCaVaTION (IN FEET).
THERE IS NO SET WIDTH~ FOR TRENCHES.
THE GR~VEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL 8ET[4EEN THE OUTF~LL PIPE
RND THE BOTTOM OF THE, EXC~VRT.ION (IN FEET).
REi;!LI I RED' SEF'T I '2 TRr4K S I ZE= /~¢¢
PERI'lIT fPPLICfHT HAS THE RESPONSIBILITY TO INFORM THIS DEPfRTMENT DURIN3 THE
INSTfLLfTION INSPECTIONS i OF 8N~ WELLS RDJRCENT TO THIS PROF'ERT'¢' 8HD THE
NUMBER OF RESIDENCES THRT THE NELL WILL SERVE.
T~,~ 4 ~ ~. ~ r-~P~T · ~,r-~ ~R~
E:flCKFILLING OF tiNY SYSTEM WITHOUT FINAL INSPECTION RND flF'PROVRL BY THIS
OEPRRTMENT WILE BE SUBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETWEEN'8 NELL RND RN~ ON-SITE SEWAGE DISPOSRL SYSTEM IS
~8 FEET FOR a PRIVRTE WELL~ OR
250 TO 288 FEET FROM 8 PUBLIC [.IELL DEPENDING UF'OH THE TYPE OF PUBLIC WELL.
[4ELL LOGS RRE REQUIRED aND MUST BE RET_RNED TO THE DEPRRTNENT WITHIN ~E~ DRYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS Mfl~ flF'F'L~. SPECIFICATIONS fiND CONSTRUCTION DIRGRRMS aRE
8VRILRBLE TO INSURE PROPER INSTRLLRTION.
F'ERr4IT ~XPIF;ES DECEr4E:EE: 2:i:. 1979
I CERTIFY THfT
t: I fM FSMILIfR WITH iTHE REQUIREMENTS FOR ON-SITE SEWERS fiND WELLS RS SET
FORTH BY THE MUNICIPALITY OF fNCHORfGE.
2: I WILL INSTALL THE S'¢STEM IN fCC:ORDRNCE WITH THE CODES;
~<: I UNDERSTfND THRT THE ON-SITE SEWER SYSTEM MfY REQUIRE ENLfRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THSN :3 E:EDROOMS,
O & E EN ~G~qEERING & DEVELO¥-~VIEN ~
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russel~'Oy.ster SOIL LOG
694-2774
Performed for:
Legal Description: L~ . z~)c/x ' ~' ~
Depth {teet) Soil Characteristics
Earl Ellis
688-2280
Na;~ne: ~/A// <~) [~//~/~ Tel. N0
Mailing Address: ~ ~ ~ ~ ~ ~ ~~
5_
6~
7~
8
10
11
12
13
15_
PLOT PLAN
PERC. TEST
16-
Ground Water Encountered: Yes
Proposed Installation: Seepage Pit~
. No J If yes, what depth_-
Drain Field_
Comments:.
Performed by:
Date: Y/~;~ '~/~' '
MUNICIPALITY OF ANCHORAGE
o f�
Development Services Department -1' Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 050-571-22-000
Expiration Date:
Legal description PREUSS #3 BLK 6 LT 9
Site address 10132 WREN LN Eagle River AK 99577
Current property owner(s) TROXELL DAVID D & REBEKAH HOPE
11/30/2023
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
Original Certificate Date: 8/30/2023
is Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist
Absorption Field Advisory
Tank Age Advisory
Other
X Well Flow Advisory
Nitrate Advisory
X Arsenic Advisory
►5
COSA ApprovaLJune 2022
CIUUHM U77 OF A HCHORRAGE
��t J
Development Services Department
On -Site Water & Wastewater Section
Phone: 907-343-7904
Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
5X,
Parcel I.D. 050-571-22000
Complete legal description Preuss #3 136 L9
Location (site address) 10132 Wren Ln.
Current property owner(s) David Troxell & Hope Rebekah Day phone 907-223-6341
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: ❑® Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ®❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 25 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench n Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: 0
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ b o Waiver Fee $
Date of Payment 6lz3A3 Date of Payment
COSA # 0 S C- 2 � / 3 'Z ( Waiver #
COSA Application—June 2022
COSA Checklist_June 2022
COSA Checklist
Legal Description: Parcel ID:
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled Total depth ft
Cased to ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank
Date of pumping
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed)
ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes go to bottom of effective.
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Adequacy test date
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) in
Effective depth used in
Effective depth remaining in
Comments/Deficiencies:
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100'
Fm -]Yes
if No
Community Sewer Manhole/Cleanout > 100'
■❑Yes
if No
ft
F!] Yes
if No ft
Neighboring Tank > 100' 0 Yes
if No
ft
Private Sewer/Septic Line > 25' ❑� Yes
if No ft
Absorption Field on Lot > 100' 0 Yes
if No
ft
Holding Tank > 100' Yes
if No ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' ❑■ Yes
if No ft
❑i Yes
if No
ft
ft
If tank or field is under driveway comment below
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' n Yes
if No
ft
❑i Yes
if No ft
❑ N/A — Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
Fm -]Yes
if No
ft
Surface Water > 100'
❑■ Yes if No ft
Tank to Property Line > 5'
❑i Yes
if No
ft
Wells on Adjacent Lots:
Field to Property Line > 10'
0 Yes
if No
ft
Private Wells > 100'
Eil Yes if No ft
Water Main > 10'
❑E Yes
if No
ft
Community Wells > 200'
❑■ Yes if No ft
Water Service Line > 10'
0 Yes
if No
ft
If tank or field is under driveway comment below
F. ENGINEER'S COMMENTS
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Naine of Firm ARE, LLC dba Alaska Rim Engineering Phone 907.775.2347
Engineer's Printed Name Charles A. Leet Date 8/22/2023
COSA Checklist—June 2022
qD
a �P,�,OF%�D
49TH
P...............................p
G! A. Zee
..............................�
�Q % Charles A. Leet
s'•� CE 10480 �d
�QQ d••�POFESSI�dc4c�
d00000d
Field Test Sheet
DATE:PROJECT # :
LOCATION:Preuss #3 B6 L9 INSPECTOR:Brandon's On Site Services / B. Jones
MSB Parcel ID:
# of BEDROOMS:3
Single Family
WELL STATIC LEVEL:n/a ft. PEAK LOAD CALC:450 gals.
WELL CASING ABOVE GROUND: n/a in.
WELL CAP TYPE:SANITARY SEAL N/A Type of Test:
Time
Flow
Rate
(gpm)
Vol.**
(gal)
Cum.
Vol.
(gal)
Well
Static
Level
(ft)
ST
(inch)
ST
Liquid
Level
(inch)
S.A.S.
(inch)
MT#1
Liquid
Level
(inch)
S.A.S.
(inch)
MT#2
Liquid
Level
(inch)
S.A.S.
(inch)
MT#3
Liquid
Level
(inch)
S.A.S.
(inch)
MT#4
Liquid
Level
(inch)
10:06 x 0 0 x ∆ x ∆ 16 ∆ 17 ∆ x ∆ x
10:26 133.4 133.4 18 19.5
10:46 149.3 282.7 20 21.5
11:09 167.6 450.3 22 23.5 End flow
11:24 --22.5 23.5
10:10 --15 17
x ADEC Compliance:
Recommend Septic Tank Pumping?Yes No NA
Meter Correction Factor =1.14 Well Wire In Conduit?Yes No NA
** Vol. = Difference in Meter Readings x Correction Factor If Public Water Supply:
Is Water Supply in ADEC compliance ?Yes No NA
PWS ID#n/a
Class:n/a
Test Results Water:n/a
Leach Field:pass
*Test results are indicative of conditions at time of testing. Date:Reviewed By:
Multi-Family Commercial
WELL CAP
23-0125
Well flow Only
5057122000
Septic Field Adequacy Only
8/4/2023
CommentsMeter
Reading
569122
Gals/Min Flow Rate:
Start Test
117x1.14=133.4
131x1.14=149.3
147x1.14=167.6
Needs Recov. Check
569239
End Test
8/15/2023
569370
569517
-
8/5/2023
Adequacy test was conducted a second time with strick
instructions to minimze their day use. In addition,
during the retest the bull run valve was turned to the
other(secondary field)
Field Test Sheet
DATE:PROJECT # :
LOCATION:Preuss #3 B6 L9 INSPECTOR:Brandon's On Site Services / B. Jones
MSB Parcel ID:
# of BEDROOMS:3
Single Family
WELL STATIC LEVEL:90.9 ft. PEAK LOAD CALC:450 gals.
WELL CASING ABOVE GROUND: 33 in.
WELL CAP TYPE:SANITARY SEAL N/A Type of Test:Both
old
Time
Flow
Rate
(gpm)
Vol.**
(gal)
Cum.
Vol.
(gal)
Well
Static
Level
(ft)
ST
(inch)
ST
Liquid
Level
(inch)
S.A.S.
(inch)
MT#1
Liquid
Level
(inch)
S.A.S.
(inch)
MT#2
Liquid
Level
(inch)
S.A.S.
(inch)
MT#3
Liquid
Level
(inch)
S.A.S.
(inch)
MT#4
Liquid
Level
(inch)
10:58 0 0 0 90.9 ∆ 51 ∆ 13 ∆ 14 ∆ 52 ∆ x
11:18 4.1 82.1 82.1 98.5 52 15 15 52
11:39 6.1 127.7 209.8 98.9 52 16 16 52
12:06 6.0 163 372.8 99 52 18 18.5 52 End flow
12:24 5.4 96.9 469.7 99.5 52 19 19.5 52
12:39 ----51 19 19.5 52
12:54 ---90.9 -18 19 52
9:30 -----15.5 17 -
5.5 ADEC Compliance:
Recommend Septic Tank Pumping?Yes No NA
Meter Correction Factor =1.14 Well Wire In Conduit?Yes No NA
** Vol. = Difference in Meter Readings x Correction Factor If Public Water Supply:
Is Water Supply in ADEC compliance ?Yes No NA
PWS ID#n/a
Class:n/a
Test Results Water:
Septic:
*Test results are indicative of conditions at time of testing. Date:Reviewed By:
Gals/Min Flow Rate:
Start Test
72x1.14=82.1
112x1.14=127.7
143x1.14=163
85x1.14=96.9
Recov. Check
566438
Neesd Recov. Check
End Test
CommentsMeter
Reading
566366
566550
566693
566778
-
8/15/2023
Multi-Family Commercial
WELL CAP
23-0125
Septic Adequacy Only Well flow Only
51
8/2/2023
-
8/3/2023
**ADEQUACY DATA**
Brandon’s On-Site Services, LLC.
3924 N. Grey Wolf Dr.
Wasilla, ALASKA 99654
PHONE (907) 355-3987
brandonsonsite@gmail.com
Dwelling Occupied? Yes ☒ No ☐
Notes: I called the client prior. On site I met the client and explained the test. I walked down the
property. The inlet line cleanout at the tank is holding 3” of water. I set up and started the test. The inlet
line backed up to 5” then flushed out to 2” at full flow. I took pictures and cover checks. All separation
distances appear satisfactory. End flow. Well = passed, septic = 24 hr check on the field, pump = no, H2O
samples = delivered.
End of field co#1 (next to mt#1) 48” (to invert) – 16 =
End of field co#2 (next to mt#2) 67” (to inv.) – 0 = 67” cover
8/3/23 24 hr check on the field. See calc. sheet.
8/4/23 Leach field only retest. I spoke to the Eng. and the client. On site I set the outlet line diverter
valve to flow to the old field. I check flow by running a small amount of water and listening at the old mt
to make sure that’s where the flow was going, which it was. I set up and started the flow at the end of
field co#2. I added the splitter immediately. I took pictures. End septic flow test #2. The leach field needs
a 24hr recov. Check.
8/5/23 24hr recov. Check. See calc. sheet.
ST MT1 new MT2 new MT3 old MT4
Total Depth 119 77 98 144 0
Less Pipe Above Ground 13 11 0 40
106 66 98 104 0
Less ST Diam./ ED 58 30 30 60
Soil Cover 48 36 68 44 0
Project No: 23-125
Legal Description: Preuss #3 B6 L9
Inspector’s Name: B. Jones
Date/Time: 8/2/23
Weather: °,
Professional Consulting --- Practical Solutions
Page 1 of 2
ARE, LLC
dba ALASKA RIM ENGINEERING
CIVIL ENGINEERS – PLANNERS
1920 Kentucky Derby Dr.
Palmer, Alaska 99645
Telephone (907) 775-2347
Email: alaskarinmengineering.llc@gmail.com
August 21, 2023
Municipality of Anchorage
Onsite Water and Wastewater
P.O. Box 196550
4700 Elmore Road
Anchorage, Alaska 99519-6650
RE: Preuss #3, Block 3, Lot 9
Subject: Nitrate Investigation Report
The owner of the above lot is in the process of obtaining a loan for their home on Presuss #3, Block 3,
Lot 9. The owners purchased the property on a land contract. To comply with the MOA requirement for
land transfer they contracted ARE, LLC to assist them in obtaining a Certificate of On-Site Systems
Approval (COSA)
This letter is to provide you with the results of the COSA and address the water test results specifically
the elevated nitrates.
Water samples were collected August 2, 2023, and brought to Mat-Su Test Lab, LLC for an analysis.
The sampling results are provided on the COSA Check List. The sample results for Nitrates
concentrations in the water well were 13mg/L greater than recommended maximum concentration of 10
mg/L.
The following outlined the steps taken to determine the cause if any for the elevated nitrates. The
Anchorage Municipal Code (AMC) 15.55.055H. The COSA Guidelines provide steps to investigate
elevated Nitrates.
On August 19, 2023, Jim Sullivan of Arctic Pump & Well and I conduct a visual inspection of the well
hole and casing. The well is located in the front lawn with positive drainage away from or around the
well.
A camera was lowered into the annulus of the well casing to visually inspect the casing, joints(welds)
and pitless adapter. The pitless adapter was inspected for weld failures and signs of corrosion and leak
ON-SITE WASTEWATER
NITRATE INVESTIGATION REPORT
PREUSS #3, BLOCK 3, LOT 9 Page 2 of 2
Professional Consulting --- Practical Solutions
Page 2 of 2
there were none of these to be found. The casing segments were inspected. All welds made to connect
the segments were visually inspected and found to be in good condition with no perforation or leaks.
Welds were noted at 6, 26, 46, 66, and 86 feet below the top of the casing (BTC).
The camera was lowered to 89 feet the static water leveled. There is no perforation or screens in the
well casing above the 89 foot depth.
The camera was lowered to the bottom of the well again no perforation or screens were seen; therefore,
the only way water can enter the casing is at the bottom of the casing at 108 BTC. Therefore, there are
no points along the casing for cross connections.
A review of the Nitrate map indicated this area has significate elevated nitrates.
Based on the well investigation the source of contamination seems to be in the ground water.
The property does not have any animal containment operation on the property or within 50-feet of the
well.
The owners have installed a reverse osmosis (RO) in the kitchen. Reportedly, manufactures of RO
systems claim to reduce a high percentage of Nitrates as well as other contaminate in the water.
If there are any questions, please contact me.
Sincerely,
ARE, LLC.
Charles A. Leet, PE
Principle
CC: ARE File No. 2023011.1.4
ENCL: COSA Checklist
Water Quality Test Results
Well Flow and Adequacy Test Data
DEVELOPMENT SERVICES DEPARTMENT
On -Site water and wastewater Section
www.muni.org/onsite
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC231321
Subdivision: Preuss #3, Block: 6, Lot: 9
907-343-7904
Fax: 343-7997
A water sample revealed a nitrate concentration of 13 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for
important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
z
Mailing Address P O` uBox 196650 *Anchorage, Alaska 99519 6650 *www muni arg ;',
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
Mailing Address P �tO Boxr196�50 *rAnchorage, Alaska 99519 6650 *www muni arg '`
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT of
On -Site Water and Wastewater Section
www.muni.org/onsite
Septic Tank Advisory
Certificate of On -Site Systems Approval # OSC231321
Subdivision: Preuss #3 Block:6, Lot: 9
907-343-7904
Fax: 343-7997
The septic tank for this property is 25 years old. The average life of an asphalt
coated steel septic tank is 20 years. Typical replacement costs are $10,000 or more,
not including engineering, surveying or MOA permitting fees.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
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. ~5'0 - ,9-7'/- ,~.2 HAA# ,/f~O/O~/.~'~:~'
Expiration Date: ff -
1. OENERAL INFORMATION
Complete legal description Z~,," ,~. ~.~¢'~"~, ~,'~',','~ ~," A',,~/;.',;~./~/7
Location (site address or directions) /,~/~..? Z/M,-¢,,~ ,Z,,e,~., .z',,,,~,/~ /¢:~}'~, ,,¢,e' ¢~.~'??.
Current Property owner(s) /~/,'- 7z' .5'~,~.,-- r',-)¢/' Day phone
Mailing address /~/~.~ /~/~-~, X-~,~, ~-~?/~ /~'~/~, '¢'~'
Lending agency Day phone
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise requested, HAA 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 Deve!opment Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations 9ivan in paragraph 5 by an independent professional civil
engineer registered in the State of AJaska. 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 end/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
ne,,'/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 MunicipalibJ of /~,chorage is not responsible for errors or omissions in the professional
engineer's work.
4. * ................ '~": '~'~ ::"~
STATEMENT OF INSPECTION BY ENG NEER *
' ~ ce~fied by my seal affixed hereto and ~s of ~'~ v~lidation date shown below, I veri~ that my'investigation,
· b'a~ed oh procedures outlined In ~e Heal~'~u~6ri~'~roval Guidelines for ~is applimtion, sh6ws ~at ~e
on-site ~*ter supply andlor wastewater disposal ~st~ Is(are) ~afe, ~nctiona and adequate for ~e number of
bedrooms and ~e of st~cture Indicted he~eifi.:'l ~er ~eri~ ~at based ~n ~e Info~a~on obtained from the
Municipality of ~chorage files and from my'~ve~tigation and inspection, the on-site water supply and/or
wastewater disposal system Is(are) In ~mpli~nce wi~ all ~pplicable Municipal and State codes, ordinances,
and regulations In effect at ~e time of installation.
NameofFi~, ~u? ~ ' - . ~.'Ph e*
Enginee¢~Pdni~dN~me:,,Owt~/~x, ~ ~e~/d~ Date
DSD SIGNATURE
~ Approved for ~ bedrooms. ' '
Disapproved.
Conditional approval for i. ' be'dmOrns, with'the following stipulation.~
Additional Comments
...:WATER AND'~.
· .~.~,~.,IATER :
'.- PROGRAM ;
..'Z' ·
...... ,
Note: The well for this property meets existiag State and Municipal Codes. There are aitrates
Current nitrate concentration is 7.62 mg~. EPA maximum concentration is 10.0 m~. More
infori-atio, ua llliratcs Is available from lbe On-Site Services l'rogram, at 343-7904.
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: ,~'-. Z/~- O /
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewatar Program
4700 South Bragaw St.
P.O. Box 196650 Anchomga, AK 99519-6650
www.ci~nchoraga.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal DescHptton: .~,~/f~,/5~//~-,~'~ /~,-5'$ /;'.,-//'~/~;,<' ~..F Parcel ID: 0-~'g)- ,~' 2/-,~
A~ WELL DATA
Dam completed ~'~/~
Total depth /~.5' lt.
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
If A, B, ~. C provide PWSID #
Sanitary seal (Y/N) y
Cased to ~',P" It.
FROM WELL LOG
~¢~.~/2~ /¢7¢
¢./- It.
Coliform '~ colonies/100ml. Nitrate ~.~,,~ mg./I.
Date of sample: /f'f,~F/-Y. ,,~d~,/ . Collected by:
SEPTIC/HOLDING TANK DATA
TankType/Material ,:r ~,,,~ /.. 5~r~''C
Tank size /,~4 d gal. Number of Compartments ~
Foundation cleanest (Y/N) y Depression over tank (Y/N) ..
Well Log (Y/N)
Wires property protected (Y/N) .7'
Casing height (above ground) o~. 'Y'/"Y,i~.
AT INSPECTION
.~. ~ g.p.m.
Other bacteria .--~'
Date installed
c~eanouta (Y/N)
colonies/100 mi.
High water alarm (Y/N)
Oate of pumping ~/~.~~ Pumper ~.~,'~,~
C. ABSORPTION FIELD DATA ~Or/2/~'~/sg~/:"'~'
~ r/~ ~/~
Da~lns~ll~ ///~'/~ ~ilraflng (~~) /'~ Syst~pe~
Leng~ ~-~ fl. W~ ~ fl. Grovel below pipe
Total depth ~/ ¢' It. Eft. absorption area ~37 ~ Monitoring tube
Date of adequacy test /~'/;'~/~'~ ~'-~/ Results (Pass/Fail) /2d-<-~
Fluid depth in absorption field before tas[ ~ in. Water added ,~z/'~gal.
Elapsed Time: ~ min. Final fluid depth ~'-;r*~in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) ,,~
Depression over field
For ~. bedrooms
New depth ,'
Absorption rate >= "//~'-~ g.p.d.
If yes, give date ~ --
D. LIFT STATION
Data installed
Size in gallons
'Pump on' level at in. 'Pump off' level et
Datum tested
Cyctas
Manhole/Access (Y/N)
[p.______-Htgh w=~=~
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tanldliff station on lot
Absorption field on lot
Public sewer main
Sewer/septic sew/ce line · .-~..<-,,'
On adjacent lots
On adjacent lots
Public sewer manhole/ctaanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation /~-~ / Propen'y line 7,~ -~ /
Water main .~/~ · Water service line ~,~x-/~
Wells on adjacent lots /~' 4 ~' ·
Absorption field
Surface water
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /~ ' Building foundation // /
Water Service line ,,.?..,~'Y- ' Surface water /~, ~- /
Curtain drain /-~ ~,~ Wells on adJacent lots /~/~
Water main
Driveway, parking/vehicie storage
F. COMMENTS
O. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems ere/n
conformance with MOA HAA guidelines in effect on this date.
HAA Fee $ ~q~d.
Data of Payment
Receipt Number
(Rev. 12/00)
Waiver Fee $
Date of Payment
Receipt Number
I~Y-18-01 08:26 FR0tA-
,~1~_,.~ e CT&E Environmental Servlceu thc.
T-796
P.OZ/03 F°118
C~&E Ref.# 1012496001
Client Name Douglas Kenlcy P.E.
Project l~ame/~ ~t 9, B~ 6. P~s ~3
Client Sample ID ~t 9, Bk 6, p~s ~3
Order~ By
~WSID 0
Sample R~narks:
NitTatc-N
7.62
printed Dare. line
Collected Date/rime
~t~dved Date2~lme
Ttthnkal Director
Retched By
05/18/2001 8:09
05/13/2001 16:00
05/14/2001 10:45
Stephen C. £de
PQL Units Meth~
Allowable Pr~ Anal~is
LimilS Dale Dale
0.500 mg/L EPA 300.0
(<10)
05114/01
Init
SCL
M:Lc~:ob:Lo~.ogy Labo~atocY
Total Coliform 0
0 col/lOOmL SM1892ZlB
05/14/01
KAP
PRELIMINARY -
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
~"~ I - '.'~"7_.- '"" HAA # ~
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address.
Agent
Address
Day phone
Day phone
Day phone
Unless otherwise requested, HAA
NUMBER OF BEDROOMS:
~vill be held for pickup.
TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev. 1/91) Front MOAN21
Phone
Address
Engineer's signature · Date
STATEMENT OF INSPECTION BY ENGINEER
As cer-[ified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm //<~/~//-) ~ ~'~"~,~)~
DHHS SIGNATURE
Approved for -~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulatic,-:'
Note: The well for this property meets existing State and Municipal Codes.
T¼~r~ nr~ n~trn~ present, It ~ s,,gg~sted that periodic testing be
performed to insure the wells continued suitability. Current nitrate
8~ .............. um conc~nLzation" ' i~ 10.0 rog/1.
~,...~M°re information~,. ,~,, on nitrates is available from the On-site Services Program,
Additional Comments
Date/,2. --./- F~
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 DH HS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72q325 (Rev. 1/91) Back MOA ¢21
Municipality of Anchorage :~¥-~fl0~'~rf~L ~F.W~CE.~;~,~_'"~--
DEPARTMENT OF HEALTH & HUMAN SERVICES NOV 19 1998
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 3~-4~4,
Health Authority Approval Checklist
LegalDescription: ?/~eN;~':~:~ ~/J~ '~t}~' (P! b'{- ~ ParcelI.D.: (~'b~ ~"7l- ~-'~
A. WELL DATA
Well type
Log present
Total depth
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ~) ~/ 2.~
Cased to Y~height (above ground) ,,2
Sanitary seal (Y/N) ,.~--'-~ ~ Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
Date of test 0~/Z~ /')~ // ~,//~[~
Static water level ~,~.t ~ ~7,~1 ~/
Well production/ ~ -~ g.p.m. ~J
WATER SAMPLE RESULTS:
Coliform ~) Nitrate ~', G'L ~,~/~ Other bacteria
g,p.m.
Date of. sample: ~/I ~/~¢-4J/ ///q/~]~' ~' ~.~/Co,lected by: //~/x/~//~
SEPTIC/HOLDING TANK DATA
Date installed ~//~Zo/'~ Tanksize //~ Number of Compartments ~
Foundation cleanout (Y/N) ~ Depression (Y/N)
~- Cleanouts (Y/N) Y
High water alarm (Y/N) ~
Date of Pumping Pumper
ABSORPTION FIELD DATA
Date installed 0~//~ 5>/~'~
/
Length ~' ~ / Width. ~' Gravel thickness below pipe
Effective absorption area ~ g ~' Monitoring Tube present (Y/N) "~
Date of adequacy test ,/~esults (Pass/Fail)
Peroxide tre~st 12 months) (Y/N)
72-026 (Rev. 3/96)*
Soil rating (g.p.d./ft~ or ff~/bdrm) /- ~-~ System type -~/~///~'~-~
~. 5~ / Total depth '"~.' ~; ¢ /
· Depression over field (Y/N) /V
For /'
Immediately after ,~gal. water added (in.):
Ab~ = ~.p.d.
/' If yes, give date
bedrooms
D. LIFT STATION
Date installed
Manhole/Access (Y/N).
High water alarm level at*
Cycles tested.~-~----
Size in gallons ~
"Pump on" level at* .~~ump off" level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
/'0 D/'-/- On adjacent lots //'¢ z, / -/-
,/~ ~ r ./ On adjacent lots ,/'0 z~ ' v-
~,//~ Public sewer manhole/cleanout /b//''~
.~ .~ / ~ Lift station //V//~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation /~/~ ProPerty line /~) / 9- Absorption fie d. /D/'-¢.
Water main/service line /0/4- Surface water/drainage /0~/4' Wells on adjacent lots /¢~/Y'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /E~/4-
Surface water /~D / l-
Curtain drain / DC [ /
F. ENGINEER'S CERTIFICATION
Building foundation lb/~ Water main/service line
Driveway. parking/vehicle storage area
Wells on adjacent lots /¢¢
I certify that I have determined thru field inspections and rewew of Mumc/pal records,4~a~~stems are
in conformance with MOA HAA guidelines in effect on this date. ~-~,,~.,~ .... o,Lo0.~_?'~;~ _~
HAA Fee $ ~-~ ~¢) '
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
NORTHERN TESTING LABORATORIES, NC.
3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456 3116 - FAX 456-3125
8005 SCHOON STREET ANCHORAGE, ALASKA 99518 (907) 349 1000 ~' FAX 349-1016
KND Engineering
20441 Ptarmigan Blvd.
Eagle River, AK 99577-3736
Attn: Ken Dufus
Client ID:
Client Project #:
Source:
NTL Lab#:
Sample Matrix:
Comments:
Preuss SubdivisionL9, B6
HoseBib, N. Side ofHouse
A154578
Water
{Method Parameter Units Result
Report Date: 3/30/98
Date Arrived: 3/18/98
Sample Date: 3/18/98
Sample Time: 10:30
Collected By: Ken
** Legend **
MILL = Method Report Level
MCL = Max. Contaminant Level
B = Present In Method Blank
E = Estimated Value
M = Matrix Interference
H ~ Above MOL
D = Lost To Dilution
Date Date
MRL Prepared Analyzed
SM 4500 E
Nitrate-N mg/L 5.32
2.50 3/26/98
Repo¢ By:'J'o~a t~ kuu~i~tro/
Chmnistry Supervisor
RECEIVED
NOV 19 1998
Mumc~palit¥ of Anchorage
Oept. Nea/th & Human Service,.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
Location (site address or ~lirections)
Property owner
Mailing address
Lending agency
Mailing address.
Day phone
Day phone
Agent ~,/m^~ o~
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
NOTE:
Individual well 7--
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
NOTE:
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) F~ont MOA#21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm David R. Dayton P.E. Phone
-.,u-2iO Dona]ar ST.
Address Chugiak, Alaska 99567
Engineer's signature & ,,~'~'-~/~/~---' Date
DHHS SIGNATURE
/~ Approved for
bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comt~e~t~: mba we] ] for this property meets existinq
State and Municipal Codes. There are nitrates present. It is
suggestcd ~ ° periodi-c testing ~ .... ~ ~ 4~,~,~¢, ~h ..... ~]~
continued suitability. Nitrate concentration is 7.5 mg/1. EPA
The Municipality of Anohorage Department of Health and Human Se~ices (DHH$) issues Health Authority
Approval Oertificates based only upon the representations given in paragraph 6 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a oourtesy to purohasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHH$ do not
conduct inspections or analyze dat~ before a ¢ertificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineers work.
72-O25 (Rev. 1/91) Back MOA fY21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. Well Data
Well type ~1 t/~-~7.~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump level1
Cased to
FROM WELL LOG
Y
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ,Z~t~ ~ z.~ Driller
~/ Casing height
Wires properly protected (Y/N)
AT INSPECTION
g.p.m.
RECEIVED
g.p.r~.U J~ ~ 1994
Municipality of t, .,~o~ age
Dept, Health & Human Services
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot /¢¢
Public sewer main
Sewer service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
~ Nitrate
Coliform
Date of sample:
Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed '~/¢ ~
Cleanouts (Y/N) ¥
High water alarm (Y/N)
Date of pumping
Tank'size ! 2_~'-o Compartments
Foundation cleanout (Y/N) t/ Depression (Y/N)
/'~,//t Alarm tested (Y/N)
~//[/¢t~ Pumper '~-~'~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot
To property line '~-
Surface water/drainage
On adjacent lots
Absorption field
O, Foundation
Water main/service line
72-026 (3~93)* Front
CONTINUED ON BACK PAGE
C, LIFT STATION
Date installed
Size in gallons
Vent (Y/N) "Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
D. ABSORPTION FIELD DATA
?~ / / Manufacturer
Manhole/Access (Y/N)
Date installed
Length ~/
Total absorption area
Date of adequacy test
"Pump off" Level at
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Cycles tested
Surface water
¢/;~4~,/ '7¢ Soil rating (GPD/FF) t¢5"' System type
Width '~ Gravel thickness ~ .Total depth
~/o 5.~ Cleanout present (Y/N) Y' Depression over field (Y/N)
~5~"-/5'~/9~ Results (pass/fail) ,,,~2¢5 ~ for ,75
After test
Bedrooms
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on
To building foundation
On adjacent lots
Surface water /
Curtain drain
On adjacent lots / oo .4- Property line /~,-
To existing or abandoned system on lot
Cutbank /,-J_//¢)-- Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on.the-date of this inspection.
, .' ,~
David R. Dayton P.E. ~ ,' .... , '- -' ~--
Signature
Engineer's Name
Date
20210 DonaJar St.
Chugiak, Alaska ~9567
HAA Fee $
Date of Payment
Receipt Number
72-026 (3/93)* Back
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Day phone
Agent _t~~ Z ~~~F ~ ~'~ -- ~ ~ Day phone
Address ' ~ ~
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
NOTE:
Individual well
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
NOTE:
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of theval[dation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structureindJcated herein. I furtherverifythat based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations ir] effect on the date of this inspection.
David R. Dayton P.E.
Name of Firm 20210 Dona]ar St. Phone
Chugiak, Alaska 99567
Address /n, ~ ') /~,
Engineer's signature ,//,-z-~/)~,, ,/~'~//~'~-'~ Date ~,'/Z~/'~/_.
DHHS SIGNATURE
~- Approved for ._~ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
By:
AdditionaIComments Note: The well for this property meets existing
State and Municipal Codes. There are nitrates present. It is
suggested that a periodic testing be performed to insure the wells
continued suitability. Nitrate concentration is 7.3 mg/1. EPA
m~Um c~ncentration is !0.0. mg/!.
' k~ ~ ~r~~'/~-'P Date ~/~/L?
/ ,
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 DH HS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev 1/91) Back MOA 1~21
Legal Description:
A. WELL DATA
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
/Z_.,,/- ~ 6/.~..~4C ~ Parcel I.D.
If A, B, or C, attach ADEC letter. ADEC water system number
~/ Date completed ~ 2."i , ~. - Driller
j O ~' Cased to Casing height
Y Wires properly protected (Y/N) Y
FROM WELL LOG
Date of test
Static water level ~_,5t ~ ~,,,~ L~v¢-~-
Well flow ~ g.p.m.
Pump level
SEPARATION DISTANCES FROM WELL TO:
Septic/he,!nO tank on lot
Absorption field on lot
Public sewer main
Sewer service line
WATER SAMPLE RESULTS:
Coliform c~ Nitrate
Date of sample: A~,/ IV ,}t_
AT INSPECTION
,~/~.~//,~- -z_
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
~7, -~ Other bacteria
Collected by:
B. SEPTIC/H(H,-BIN~ TANK DATA
Date installed
Cleanouts (Y/N)
High water alarm (Y/N)
Date of pumping
Tank size i~~"~::;~ Compartments
Foundation Cleanout (Y/N) ~ Depression (Y/N)
~ Alarm tested (Y/N)
,¢/).-,/'~ z.~ Pumper .~, :,-.,-//z-y/
SEPARATION DISTANCES FROM SEPTIC/H~---EH4N'~T-ANK TO:
., ~ 5¢¢/.~j~/¢CcZ /://.P/ZC&, *-~.~ ,. t
Well(s) on lot [.C~ ~:'-' Onadjacentlots cI.~
To property line '-~"~ Absorption field I O ~
Surface water/drainage '2- gO "~m
Foundation
Water main/service line
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
Manufacturer
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed
Length /~J Width
Total absorption area · 4[
Depression over field (Y/N)
Results (pass/fail)
Peroxide treatment (past 12 months)
Soil rating ! '3 ;5-- System type -'-r--~?-~'~-'-~,~/¢
Gravel thickness ~ Total depth ¢
Cleanouts present (Y/N) V
Date of adequacy test ¢$-o/¢/-_
for ~ bedrooms
/~ If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot t 2.~.0~
To building foundation
On adjacent lots
Surface water
Curtain drain
On adjacent lots /' oO ~ -I-- Property line
To existing or abandoned system on lot
Cutbank /~J~ Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that
Signature
Engineer's Name ' ~'~"~. ~1¢-~
Date ¢'/'~///1/' ~
have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of thi¢ inspection.
HAA Fee $ /'7° ' ~
Date of Payment ~r' - ~.¢ ~-- ~7 ~
Receipt Number ~' ~c/~-~/ ~ ~ ~ ~.// ,)
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
D.' R. DAYTON, P.E., R.L.S.
~.~~7~' ~ugiak, Alaska 99567
20210 Donalar Street
696-2417
August 22, 1992
WELL FLOW TEST
Legal Description: Lot 9, Blk 6, Preuss Subd. #3
Date of Test: Aug6st 20, 1992
Depth of Well: 105' (per well log)
Static Water Level: 95' below top of casing.
Test:
The well was pumped for 2 hr. 20 min. producing 463 gallons.
Results:
*The average flow pumped was 3.3 gallons per minute.
Conclusion:
The well is currently functioning adequately for a 3 bedroom home.
*The well was not pumped to full capacity of the pump. A previous
flow test on March 14, 1984 showed the well capable of 5+ gallons
per minute. The drawdown during the 8/20/92 test indicates the well
will still producein excess of the 3.3 gpm pumped.
D.'R. DAYTON, P.E., R.L.S.
~xX~]~]~r~ Chugiak, Alaska 99567
20210 Donalar Street
(907) ~~
696-2417
August 22, 1992
ADEQUACY TEST
Legal Description: Lot 9, Blk 6, Preuss Subd. ~3
Date of Test: August 20, 1992
Septic Tank: 1250 gallon
Absorbtion System: 413 t~ench
soils Rating:135 sq. ft. per bedroom
Daily Design Flow: 3 bedroom - 450 gallons per day
Test:
643 gallons were injected into the absorbtion system in 2 hr. 20 min.
Results:
The absorbtion system accepted 143% of the daily design flow
with a 1.10 ft. rise in the monitor tube liquid level. The
absorbtion rate was constant at 0.13 ft. per minute or 55 gal
~ per minute.
Conclusion:
The absorbtion system is currently functioning adequately
for a 3 bedroom home.
/ Xunicipality
of
Anchorage
P.O. BOX 6650
ANCHORAGE, ALASKA 99502-0650
(907} 264-4111
MAYOR
Di~PA~ITM~NT OF H[ALTH · J,~t, AN SF..NVICE$
Oc~oker 9, ~986
Lou Dute~a, P.E.
KaSle RiVer, Alaska 99577
:....-: ·Dear
· .: :'..:..::.i:.~'be~voen ~ho well on the s'jbJeet property and septic tanks
· '-..- :~ ~.=':~- loeaCnd.on ~he ~ubleaC propor~y and on Lo~ 9 ~o ~he no~C~ has
'....' :':;;' This w~i~er is valid ~or the existing ~hreo bedroou single
APPLIC FILLS OUT UPPEH rIAL
Phone
Property Owner~ Jim O ' [{ara
MailingAddre~ Star Route Box 5412 Eagle River ZipC0de 99577
Buyer
Zip Code
~,ddress Phone
Lending Institution
Zip Code
Address Phone
Realty Co. & Agent Audrey Mason
· ~ 99577
Pos% Office Box 911 Eagle River ZipCode
Address
Legal Description Lot 9 Block 6 Preuss Subdivision
Street Locati~
Type of Residence
1'~ Single Family
[] Multiple Family No. of Bedrooms three
~] Other
Water Supply ATTACH WELL LOG. A well Io9 is required for all wells drilled since June 1975.
~:/x~lndividual For wells drilled prior to that date, give well depth (attach Icg if available).
[] Community
[] Public Utility
Sewer DisposaJ Year Individual Installed:
l~].[IndividuaJ When Connected to Public Utility:
[] Public Utility '
[] Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
( ~ ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received
Weft to Tank Septic T~k Size
72-023 (3182)
October 7, 1983
j idl /'~ ~ !tara
nagle i.',iveu, AK 99577
Subject: Loy 9~ block 6~ -o -~,~-.,~ Subdivision
Approval Lot the individual sewer and water ~:ac~i~c.~ -
be qranted until the ioilowing items have been completed;
~ . .. ~ .~. '. ...... to this
'"'~e depression o~' pit around the well casin9 needs to be
'i~. ' · · : .... ,,~)~, soil sO that it slopes away
~ilied with ifi~peL'Vi~}tl~ ~.Y~ ~
The septic tank pumped with a recczpt submit~eo co this
~bOb~ department-
.- ' test v;ill detern~ine
leachin9 area. ~nis ..
adequate accordinq to National Standards. A listing of
i~ .... '-- the test ts enclo,~u. Th~s report
,,, private ~irms oer~o~:.,,ing '
~ . ~ . -'~'-'~? to this o[fice ~Or our
Please ~otify this De~artu.'~ent ]:or ~ - ,' ,. ~ . ., .. ,
~. corrected. XZ there are
............ '~,~: have been '64 ,1720.
llOteO dlsC~ ~'i)allCl~° '
further questions~ please call th~s office at 2e -
~;nc los u re
Cory Wtiiis,
Acting3 Server & Water
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
iNSPECTOR INSPECTOR INSPECTOR
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION
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.
PROPERTY OWNEP~, HONE
PROPEF~TYRES DENT (If differenttroma ve PHONE
PHONE
L2. BUYER
MAILING ADDRESS
3. LENDING INSTITUTION-~ I PHONE
MAILING ADDRESS '~ ~'"~ ~ F
, 4. REALTOR/AGENT/~ ~/ PHONE
MAILING ADDRESS , _
6. TYPE OF RESIDENCE
[~r_~-SING LE FAMILY
[] MULTIPLE FAMILY
~/~2t~'~NUM~EROF~'~E~'~"O~S ~/~--~ ~::~"'~ ~/~'- i I
[] One [] Four [] Other__
[] TWo [] Five
[~j- Three [] Six
7. WATER SUPPLY ~ INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTI LITY
*ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
[~ INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
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 ~1 ONE ~ THREE E~ FiVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
2. WATER SUPPLY PERMIT NUMBER
~'/INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[~I~NDIVIDUAL/ON -SITE DATE INSTALLED
I~1PU BLIC UTILITY
Connection Verified
INSTALLER
[~eptic Tank or ~ Holding Tank
Size: & Z~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line
WELL TO:
I
Absorption Area to nearest Lot Line
5.
COMMENTS
~ CO~DITIO~Ak A~BOVAk (letter must accompang certificate)
~- DISAPPROVED
DATE BY
72-010 (Rev. 6/79)
S & S Engineering
SRB 196X
Eagle River, Alaska
October 3, 1983
99577
Totem Realty
ATTENTION: Audrey Mason
P.O. Box 911
Eagle River, Alaska 99577
Dear Audrey,
Reference: Lot 9: 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_~as
pum_q~Ox~z3~nd verified to have a capacity in excess ~f 1250 gallons.
The absorption trench was tested by a continuous flow of water
over a period of 48 hours without any adverse effect on the
system..
It can be concluded from this test that the waste water disposal.
system serving this residence appears to be adequate for four
bedrooms. However, the system cannot be guaranteed against
'subsequent failure.
If we may be of further service, please do not hesitate to contact
cc: Municipality of Anchorage
Department of Health and. Environmental Protection