HomeMy WebLinkAboutPREUSS #3 BLK 5 LT 5Preuss #3
Block 5
Lot 5
#050-571-34
Municipality of Anchorage
On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP211291 PID Number: 050-571-34
Dwelling: H Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade
Name
MCKNIGHT BRIAN & JACQUELINE
A%ORPTION FIELD
Tp rench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
20137 David Avenue Eagle River AK 99577
�❑ Other
Phone
Number of Bedrooms
Soil RatingTotal
depth from original grade
4
DISF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original Fd Ftp
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
PREUSS #3 5 5
Fill added above original grade
Ft.
Gr 'I length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Dista a between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between tr ches
From
Tank
Field
Tank
Line
Fl?.
Well
>100'
NA
NA
NA
NA
TANK ❑ Septic ®❑ S.T.E.P. ❑ Holding El Other
Manufacturer
greer
Capacity
1500 Gal.
Surface Water
>100'
NA
NA
NA
Material
Number of compartments
Lot Line
>10'
NA
NA
NA
NA
PLASTIC
2
Foundation
>10'
NA
NA
NA
LIFT STATION
Manufacturer
Capacity
Remarks
G RE E R
1500 Gal.
Alarm location
in garage
Electrical installed by
existing panel
Installer
PIPE MATERIAL House to tank 3034 drainfield Tank to
3034
JRs Septic
Drainfield Co/MT3034
Inspector Curtis Townsend
BENCH MARK (Assumed elevation) 100 ft
Inspection 1�ectio' 8/12/2021 8/17/2021
Location and description
2�a
3`d 41h
BOTTOM OF SIDING, POINT B
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
_ A���.
Conditional Approval: Date
' • �l�,���
�����
TH
............
r�.
... ' '
sxtis L. jbevns d ° �J
!rate
Septic System—��¢
Approved..__ - I eVz Date 12
'
.
c No. CE 11904 • \��
Ilk N?'". •
�
PROFESSION .�;,�
Note: this approval does not include well permit requirements.
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UTILITY
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LOI
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http:tfwww.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP211291
Work Type: SepticTank Upgrade
Tax Code Number: 05057134000
Site Legal Address: PREUSS #3 BLK 5 LT 5 G:0056
Site Mailing Address: 20137 DAVID AVE, Eagle River
Owner: MCKNIGHT BRIAN A &
Design Engineer: EKLUTNA ENGINEERING, LLC"
This permit is for the construction of:
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
Effective Date
Expiration Date:
Lot Size in Sq Ft
�SItCI](-
W 11
v
De parrmell t
Total Bedrooms:
7127/2021
7/27/2022
22890
❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2_ Alf 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 wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (2417).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received B7
Issued By:
Date:
Date:
4
MUNICIPALITY.OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 050-571-34-000
Property owner(s) MCKNIGHT BRIAN & JACQUELINE
Mailing address 20137 David Avenue Eagle River AK 99577
Site address 20137 David Avenue Eagle River AK 99577
Legal description (Sub'd., Block & Lot) PREUSS #3 BLK
Legal description (Township, Range & Section)
Lot Size 22,890 Sq. Ft. Number of Bedrooms 4
Day phone
5 LT 5
APPLICATION IS FOR:
(N all that apply)
Absorption Field ❑
Septic Tank
0
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
APPLICATION IS AN:
-Initial -
Upgrade F-1
Renewal ❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
TYPE OF DWELLING:
Single_Family (SF) El
(w/wo AD U)
Duplex (D) ❑
Multiple Dwellings ❑
(SF and/or D)
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Munic;Tal Codes.
U —� / j _�")
(Signature of property owner orUauthorized agent)
Permit/Rush Fees: *Z25 Waiver Fees:
Date of Payment: 711aAl Date of Payment:
Receipt Number: 01 Receipt Number:
Permit No. DSPZ l2a Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewatefforms\Client FormsTermit Application.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211291, Rebecca Carroll, 07/27/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211291, Rebecca Carroll, 07/27/21
FILE NAMESHEET NUMBERSURVEY DATESTAMP:SCALECOMPANYNMICHAEL KELLER
Jul Oe 12 11:28a Sullivan Water `Hells
907 688 2759 p.1
erttfteb Drdfing In
by
DOC CO. dba
SULLIVAN WATER 'WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 -TELEPHONE 66&2759
OWNER OF'. -AND: /3jZ!d '� BORE HOLE DATA
i DEPTH
ADDRESS:
e
LEGAL DESCRIPTION: txca�SS� i3EK �s l
DATE: > O ----
PERMIT NUMBER: mZ/ PO Date of issue! -L1.-L
TAX iDENT.FICATION NUMBER: -- ----
Is well located at approved permit location? a No
Method of Dril ing: aerr rotary ::i cat,le tool
Depth of well: J 13
Casing Type1='eLWakThickness a5
inches
Diameter __4ainches, depth
feet
Liner Type:—!12O^ro— —
CasingStickupAboveGround:
—tet
Static Water Level:. �
feet
Recover Rate: _ is- m
Ag
Method of Testing --4—d
well Intake Opening Type: U open end cj-6pen hole
UScreened; Start__feet Stopped
feet
U Perforations Start f; t stopped
Grout Type:13xdrou1rc C, urr.e
feet
Depth:from _ '0-9feet
Well Disinfected Upon Completion % Wes u No
Method of Disinfection: C Kt. a w'4r• S—O i/ice
WATER QUALITY TESTING
Coliform C0000mL
Nitrates mg/L
Arsenic ug/L
Driller's Name
ATTENTION: It is the responsibility o` the property owner to submit a Copy of the well log to the proper authority. Municipality
of Anchorage: Department of Health 8 Human Services and/or Department of Environmental Conservaticn. Matsu Borough:
Department of Environmental Conservation.
J
I �
I
I
—
Driller's Name
ATTENTION: It is the responsibility o` the property owner to submit a Copy of the well log to the proper authority. Municipality
of Anchorage: Department of Health 8 Human Services and/or Department of Environmental Conservaticn. Matsu Borough:
Department of Environmental Conservation.
Jul 06 12 11:29a Suilivan Water Wells 907 688 2759 p.2
Development Services Department
Building Safety Division
"-hod on-site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Mark Beg ch Anchorage, AK 99507
Mayar wwwmuni ow/onsite
(907)343-7904
Pump Installation Log
Well Drilling Permit Number: CfC
Date of Issue:
Legal Description Property Owner Name &Address
Pump
F3~ -t
IPump Intake Depth Below 'fop of Well Casing. q5 feet
Pump Manufacturer'sName: f �.vtnE �
Pump Model: I&AM 1
Pump sue hp
Pitless Adapter Burial Depth: / o feet
Pitless Adapter Manufacturer's Name: fYYL�it �Q
Pitless Adapter Installer. �
Well Disinfected Upon Completion? baYes [] No [
Method of Disinfection.0,100
, O
Comments:
Pump Installer Name:
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
Jul 06 12 11:30a Su liven Water Wells 907 688 2759 p.3
Municipality of Anchorage
Community Development Department
On -Site Water and Wastewater Program
4700 Elmore St • P.O. Box 196550 Anchorage, AK 995495850 • http."/Avww.muni.org/Cmile • (907) 343-7904
Well Decommissioning Log
Subdivision
LegalsBlock -'j-Lot
...._
T R Section Lot _
onsite Wateirr'& Wasteviater Program ceni5ed contractor perlorming the well oecooimiNeoning: /
Nana: J Signature: /(
Com an 1 �� Vl a 4 C �
�- Methodoewmmmiohng:AMC 15.55.0501-1 a. ❑ b. ED]c.
weir deCammi&4ionirlg Date ld
'% „�— ,r1
LocaI Use the space below to provide a drawir� of Cie property showing the rolloWng IternTy
' lJ 1i /�(fI�!�
North arrow `"\/Decolnm!ssioned well,
other water wells an the property. ` e— �iloa ff�.(ft
Two separale awinI distances for each wall shown on ,he dmwing, 1 ,.}� R. rt
Note: The swing -tie distanoes shah be meaaured from either permanent structures or the property corners.
I VG 1 ^114 V 111-1 17 :.V ...n 1 0.J
PRIOR TO ANY EXCAVATION
r•= I atzEa/ - � WORK.
Q 1 PROPOSED TRENCH Qp µ
PROPOSED 500 GALo „I !
i S.T.E.P. SYST€iA 6
TM DECk I I
IWAA z4on =0 � 00 EXISTING 3 i C
SEDROOM�i t '\
ca
HOUSE w j I' tips r/ y}y 1 y
real €FFICIENCY"i
tO7' i
j DECK ItOT 5 ;
EXISTING P000 GAL L t
CONCRETE S PTIC TANK
——__. __" — U a SEMEN —
gARiD �— EXISTING LEACHFIEL01
Ta aE r� em aualt nut It A z
I uar 9E UaED IN 1}[ NNRE�
DAVID_ A17ENUE
-- -- - .,_ «..,..r,.e..,�n wesl�raAfnrrnatCiient FormslUlell Deeormtislaning fnrm.dac
Of
On -Site Water System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP121006
Tax Code Number: 05057134000
Work Type: Well Initial
Permit Effective Dates: January 17, 2012 to January 16, 2013
Design Engineer:
Subdivision: PREUSS #3
Site Legal Address: PREUSS #3 BLK 5 LT 5 G:0056
Owner/Address: MCKNIGHT BRIAN A &
JACQUELINE M 20137 DAVID AVENUE EAGLE RIVER AK 995778751
Site Mailing Address: 20137 DAVID AVE, Eagle River Lot Size in Sq Ft: 22890
Total Bedrooms: 3
This permit is for the construction of:
N Disposal Field N Septic Tank N Holding Tank N Privy Y Private Well N Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Special Provisions: The existing well is to be decommissioned per code prior to asbuilt:appravaY'
Received
Issued By
MUNICIPALITY OF ANCHORAGE yi
Community Development Department Phone: 907-3_43_
Development Services Division 7 9
On-Sitt Water & Wastewater Program bw L
Mayor Dan Sullivan JAN ] 7 201'1.
ON-SITE SEWER/WELL PERMIT APPLICATION
V FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050 57l - 3 y
Property owner(s) Day phone rd77 ��l
Mailing address O�%/ n OqA AA -0 Fna4e 2„ de c: 4kr5kd
Site address �)y 131 C)rA UA 14-U2 ril cu 4
Legal description (Sub'd., Block & Lot) L.DTr 13 IA -,k ,f Pr,O ID 3
Legal description (Township, Range & Section) r
Lot Size YC� Sq. Ft. Number of Bedrooms Ll
THISAPPLICATION IS FOR:
THIS APPLICATION IS AN:
(® all that apply)
Initial
Ix
Absorption Field
El
Septic Tank
❑
Upgrade ❑
Holding Tank
❑
Renewal ❑
Privy
❑
Private Well
x
Water Storage
❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
I certify that the above information is correct. I further certify that this application is being made
for a Single Family Dwelling and is in accordance with applicable Municipal Codes.
property owner or
Permit/Rush Fees: 'E00 17-0
Date of Payment: 1 Z
Receipt Number: Q F,7g6 �r
Permit No. _ 0.6p t2ricoLQ
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GABuildingl0n SiteTormsOient FormsTermit App_010411.doc (Rev. 1/11)
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Municipality of Anchorage Page I of a
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: Sw9503�3 PID Number: 0505'71S4
Name: t T� T�c7F'u
� t-RTA e��
Wastewater System: ❑ New JO Upgrade
Address: EA[ L,elZIVTKj LASKA
"pAvlr� A��. �tas-7-7
ABSORPTION FIELD
ao(3�
Phone:
No. of Bedrooms:
�}
Deep Trench ❑Shallow Trench ❑Bed ❑Mound ❑Other
LEGAL DESCRIPTION
Soil Rating:
�
Total Depth from original grade:
I a f
d . GPD/Sq. . Ft.
Lot: Block: Subdivision:
�5 �2C U SS -%t 3
Depth to pipe bottom from original grade:
1
Gravel depth beneath pipe
ID
D
a Ft.
Ft.
Township:
Range:
Section:
Fill added above original grade:
Gravel length: /
C9.S - i t Ft.
3 `Z Ft.
WELL: 13 New ❑Upgrade
'
Gravel width:
Number of lines:
I
Distance between lines:
EXc STI N 1:1Ft.
oZ
Ft.
Classification (Private, A,B,C):
Total Depth:
Cased T
Total absorption area:
Pipe material: AS?v�
�(Z1VAT�
F
Ft.
7(00 SQ. Ft.
J 4G101sc4.yoPVC
Driller:
D ed:
Static Water Level:
Installer:
Date installed:
Ft.
-rvJEEY.� IXC.
Yield:
Pump Set at:
Casing Height Above Ground:.
TANK
GPM
Ft.
Ft.
SEPARATION
DISTANCES
AET-Septic£XJ-,T-tNG0 Holding 9S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer:
Capacity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
l/ 11-
(000
Well-
%(o'+f'
(0a'
10`I'
-
i
a5 +
Material:
eONc�z>ET�
Number of Compartments:
Surfac
100'+-
Imo'+
—
—
LIFT STATION
Water
[OD
Lot
1'I't
r
10
I
1(D
—
Size in gallons:
ZOO
Manufacturer:
ANc14o¢ALA9 -TANK
Line
t
I
"Pump on" level at:
"Pump off' level at:
High water alarm at:
Foundation
a *
la
Ja
aW
lig
3�i'
Curtain
—�
N O
k2.2
w
Pump Make & Model
OS(oSHK
Electrical Inspections performed by:
{I�q�etc� Lt�liTs Cvo>T.
Drain
BENCH MARK
Remarks: 'p(STAWr-5 GVAN0gATf1ERe p 'TANK
Location and Description:
'rAf_L>zO �-(9-�3
To of SONN£TJ$� S
SCK alt bC 6(
Assumed Elevation:
(oob
ENG L
OF A4gs
r ~
S & S ENGINEERING
17034 Eagle River Loop Road, No. 204
,� 31
,...�.,.«i.....
Inspections performed b gie-t'ver, Alaska Dates: 1st
aI
2nd I1-1 "q
.....
„a,
t'o : i ROBERT C. COWAN f
�?
<`a CE-8801 e���'�
Department of Health pjHuma rvices approval
ow
Reviewed and approved by: Date:
72-013 (Rev. 9/91) MOA 25
N6
21
S
Permit No.
SW950363
Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description:
LOT 5, BLOCK 5, PREUSS #3
PID No.:
05057134
72-913 A (Rev. 9191) MOA 2\
CO3
FINAL GRADE
r97.3'
MT1
01.9'
NEW
91.0'
00 GA 90
.T.EY
8'
SR
YSTE
97.8
87.
'--
83.0' NO WAT
R FOUND
10-16—)5
NEW TRENCH:
A
B
T.E.P. SYST
M
C01
28'
23'
2
'�'� EXIST
NG 1000 GAL
CO2
29
24
MT„��
CONCR
TE SEPTIC TM
q
M03
38
��o
45
D
CK
MT1
31'
49'
MH
CO3
A EXIS
ING 3
�yw
c9 ,
BED
OOM
HOUSE
w/
po
o� cozco
EFFI
IENCY
N
i
DECK
LOT
5
WEL
EXIS�TI
NG sLEATHCHFIELD
�� -4160
M
BE USED IN THE FUTU
E
A '{\ e ••' �S
^ t ..ROBERT C. COWAN !
SC
E 1” = 40.
_
%, �CJ�.,. CE -8801
72-913 A (Rev. 9191) MOA 2\
Heavenly � Li hto
Electrical Co ntra cti n g
22509 McManus • Chuglak, Alaska 99567
Phone# (907) 688-6060 • FAX# 688-6061 �� tau& �'-f �'
PAGE 1 OF 1
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 (UPGRADE) PERMIT
PERMIT NUMBER:SW950363 DATE ISSUED:10/24/95
DESIGN ENGINEERS & S ENGINEERING EXPIRATION DATE:10/24/96
OWNER NAME:COOK TIM L & ROBERTA
OWNER ADDRESS : 2 013 7 DAVID AVESL,,jG lufi195
EAGLE RIVER, AK 99577 I'
PARCEL ID:05057134
LEGAL DESCRIPTION:
PREUSS #3 BLK 5 LT 5
LOT SIZE: 22890 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
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:
RECEIVED BY:
ISSUED BY:
/� _'-
DATE:
DATE c z_ 1
S&
October 16, 1995
ROBERT C. COWAN, P.E.
ROBERTA. SHAFER, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
HEALTHAUTHORITY
APPROVALS
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
SEWER&WATER
MAINEXTENSIONS
REFERENCE: Lot 5, Block 5, Preuss S/D #3
Request you issue a permit to upgrade the septic system
SEWER&WATER
serving the three bedroom house with efficiency on the
INSPECTION
referenced property.
A test hole was excavated and a percolation test performed
in the area of the proposed upgrade. The approximate
ENGINEERING STUDIES
location of the test hole is located on the attached site
AND REPORTS
-
plan.
At the time of excavation no water was encountered in the
test hole and after seven day ground water monitoring, the
WELL INSPECTION
&FLOWTEST
monitoring tube was found to be dry.
Attached is the proposed upgrade design.
SITE PLANS
We do not anticipate any adverse effects on neighboring
wells, septic systems or drainage patterns by the
installation of the proposed septic system.
ROAD DESIGN
If you require additional information, please contact us.
Sincerely,
SOILTEST
Robert C. Cowan, P.E.
RCC/gk
PERCOLATION
TEST
Enclosure
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
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LEGAL DESCRIPTION:
Ut';;'r s 63 y— 5- Pi:.��ss �' 3 Township, Range, Section:
n�T1 SLOPE SITE PLAN
2 G�
3
4 ~ /
5
6
7
8-
9-
10-
11 910 11
12
9
13 ,
14
15 a
16
17 0 /
18
19
WAS GROUND WATER
ENCOUNTERED? i--�
S
IF YES, AT WHAT L
a O
DEPTH? p
E
Depth to Water After
Monitoring? Vq:::q Date:
==Mmm�
20 1
IL_._JI PERCOLATION RATE O (minutes/inch) PERC HOLE DIAMETER V
TEST RUN BETWEEN 4'S FT AND 2 FT
COMMENTS
PERFORMED BY: S & 5 ENGINEERINGwo �D
age • 2046-<l CERTIFY THAT THIS TEST WAS PERFORMED IN
17034 rRiver Loop Road No
ACCORDANCE WITH AE §l -b4 /WNIAIv'f�IV$i PA-7ZUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
OF 41
Municipality of Anchoragef_-
,� DEPARTMENT OF HEALTH & HUMAN SERVICES'
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
r
ld -0 4 ROBERT C. COYJAN rr-
CE -8801
` (� �---
PERFORMED FOR: �A'\ DL
w,
DATE PERFORMEf[.; t���'�.'
LEGAL DESCRIPTION:
Ut';;'r s 63 y— 5- Pi:.��ss �' 3 Township, Range, Section:
n�T1 SLOPE SITE PLAN
2 G�
3
4 ~ /
5
6
7
8-
9-
10-
11 910 11
12
9
13 ,
14
15 a
16
17 0 /
18
19
WAS GROUND WATER
ENCOUNTERED? i--�
S
IF YES, AT WHAT L
a O
DEPTH? p
E
Depth to Water After
Monitoring? Vq:::q Date:
==Mmm�
20 1
IL_._JI PERCOLATION RATE O (minutes/inch) PERC HOLE DIAMETER V
TEST RUN BETWEEN 4'S FT AND 2 FT
COMMENTS
PERFORMED BY: S & 5 ENGINEERINGwo �D
age • 2046-<l CERTIFY THAT THIS TEST WAS PERFORMED IN
17034 rRiver Loop Road No
ACCORDANCE WITH AE §l -b4 /WNIAIv'f�IV$i PA-7ZUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
20 1
IL_._JI PERCOLATION RATE O (minutes/inch) PERC HOLE DIAMETER V
TEST RUN BETWEEN 4'S FT AND 2 FT
COMMENTS
PERFORMED BY: S & 5 ENGINEERINGwo �D
age • 2046-<l CERTIFY THAT THIS TEST WAS PERFORMED IN
17034 rRiver Loop Road No
ACCORDANCE WITH AE §l -b4 /WNIAIv'f�IV$i PA-7ZUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELLINSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
401
IGENERAL:
ROBERT C. COWAN, P.E.
ROBERTA. SHAFER, P.E.
ON-SITE WASTEWATER DISPOSAL SYSTEM CIVIL ENGINEERS
(907) 694-2979
CONSTRUCTION PRACTICES FAX(907)694-1211
and
MATERIAL SPECIFICATIONS
Lot 5, Block 5, Preuss SID #3
October 16, 1995
1. The scope of this project includes the installation of
a 500 gallon wastewater S.T.E.P. system (septic tank)
and a pressurized leachfield trench to serve the three
bedroom residence with efficiency located on the
referenced property. The existing leachfield is to be
abandoned such that it may be used in the future.
2. Construction shall be in accordance with the approved
site plan and 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 any
necessary underground utility locates.
4. Unless specifically agreed otherwise, the property
owner shall be responsible for final grading areas
subsequently depressed from soil settling.
5. Contractors installing wastewater disposal systems
must be certified by the Municipal Health Department
for system installations. Owners installing their own
systems must also receive prior approval from the
Municipal Health Department.
IC TANK INSTALLATION:
1. A septic tank is to be constructed by a certified
septic tank manufacturer. Construction shall include
two 4" cleanouts for pumping access.
2. The septic tank shall be sufficiently bedded to
prevent settling or shifting of the tank.
3. All standpipes on the septic tank shall extend a
minimum of 12 inches above final grade.
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
Page Two
Lot 5, Block 5, Preuss S/D #3
October 16, 1995
4. Septic tanks installed with less than 4 ft. of cover shall
be insulated.
5. A foundation cleanout shall be installed one to four feet
from the building foundation. In the line between the tank
and the leachfield there shall be two adjacent cleanouts
(unless an effluent pumping system exists within the septic
tank). These cleanouts shall be located on undisturbed
soil not more than 10 ft. from the tank. The first
cleanout, in line, shall be to clean toward the leachfield.
The second cleanout shall be to clean toward the septic
tank.
6. Final grading over the septic tank shall be such that a
positive slope exists away from the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
1. Excavate the proposed trench to the dimensions shown on the
design. The bottom of the excavation shall be within 2
inches of level. If the sidewalls of the excavation become
smeared, they must be raked or scratched (ruffed -up) before
gravel (sewer rock) placement.
2. Once the gravel is installed, the distribution pipe is to
be installed level with the holes faced downward. The
distribution piping is to be of PVC (ASTM D3034 or equal).
All joints are to be solvent cemented. Gravel is then to
be placed over the distribution pipe to provide a minimum
of 2 inches of cover over the pipe.
3. A silt barrier must be installed between the final gravel
layer and the native soil backfill. Ensure the silt
barrier covers the entire gravel surface before placing
backfill.
4. Monitor tubes shall be of four (4) inch diameter,
installed approximately in the locations shown on the
design, and extend a minimum of 12 inches above final
grade. The portion of the monitoring tube extending
through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This is
equivalent to the effective depth of the gravel as noted on
the design.
Page Three
Lot 5, Block 5, Preuss S/D #3
October 16, 1995
5. Backfill over the final gravel layer must not be less than
twenty-four (24) inches. Insulation must be installed when
the backfill depth is less than thirty-six (36) inches.
The finish grade over the trench must be mounded to prevent
the formation of a depression after settling.
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation 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:
Type of Pipe Perforated Solid
Cast
Iron
Yes
Yes
ASTM
D3034
(PVC)
Yes
Yes
ASTM
F810
(HDPE)
Yes
No
ASTM
D2662
(ABS)
Yes
Yes
Use of a type of pipe other than listed above must be
approved by the inspecting engineer.
3. Insulation shall be at least 2" thick extruded direct
burial polystyrene (Dow Chemical Company Styrofoam HI or
equal).
4. Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N,
or equal) must be installed between the final leachfield
gravel layer and the native soil backfill.
6. All leachfield gravel (sewer rock) shall be 0.5"-2.5"
screened gravel with less than 3% passing the #200 sieve.
7. When sand is being used as a filter material, its gradation
specifications must conform to current M.O.A. or D.E.C.
requirements.
Page Four
Lot 5, Block 5, Preuss S/D #3
October 16, 1995
INSPECTIONS:
Typically there will be a minimum of three (3) inspections
required during the installation of the wastewater disposal
system. These inspections will occur as follows:
1. The first inspection must be conducted after the
excavation of ditches, pits, trenches, or beds and
before the installation of any gravel. A septic tank
may be set in place, but may not be backfilled before
this inspection.
2. The second inspection must be conducted after the
placement of the silt barrier, gravel, distribution
lines, standpipes, cleanouts, and insulation, but
before the placement of any other backfill.
3. The final inspection is to occur upon final grading of
the property.
Often there will be more than these 3 inspections required.
Especially with the installation of multiple trenches, sand
filters, pressurized distribution systems, etc. Thus, the
inspecting engineer is to be contacted at least 24 hours prior
to the start of construction. If necessary, a pre -construction
meeting will take place on-site. The inspecting engineer will
not coordinate, direct or control in any way the contractors
activities.
The owner shall contract with the contractor to perform the work
outlined in these specifications and plans and, in accordance
with the attached M.O.A. permit. There will be no contractual
arrangement existing between the contractor and S & S
Engineering. S & S Engineering shall be the owner's
representative and will inspect the work as stated above to
document the contractors activities. Final acceptance of the
contractors work rests with the owner and the M.O.A.
Page Five
Lot 5, Block 5, Preuss S/D #3
October 16, 1995
S & S Engineering shall have no liability to the owner or to
others for acts or omissions of the contractor or any other
persons performing work on this project or the failure of the
contractor to carry out the work in accordance with these
construction documents. S & S Engineering's inspecting engineer
will not be responsible for the construction means, methods,
techniques, sequence, procedures or the safety precautions
incident to this project.
CONTRACTOR/INSTALLER
S&
October 9, 1995
ROBERTC. COWAN, P.E.
ROBERTA. SHAFER, P.E.
CIVIL ENGINEERS
(907) 694-2979
(907) 694-1211
ICEIVE
OCT 10 1995
RSRORITrAPOVALMunicipality of Anchorage �� ;y ,; Anchora
DEPARTMENT OF HEALTH AND HUMAN SERVICES eP1 eartFr& Human Service
c
825 L Street
P.O. Box 196650
SEWER&WATER Anchorage, Alaska 99519-6650
MAINEXTENSIONS
REFERENCE: Single Family Dwellings with Efficiency
SEWER & WATER
INSPECTION
Dear Mr. Cross,
ENGINEERING STUDIES We are presently working on a 3 bedroom single family
AND REPORTS residence with an efficiency that does not have a bedroom but
does have a kitchenette and must be accessed from the garage
or from the exterior of the home.
WELCTION
&FLOW An Engineer Bulletin 92-11 from August 26 1992 clarifies
OWTESTEST g () g
the jurisdiction of DHHS and ADEC. However, this bulletin
(attached) makes no reference to single family dwellings with
an efficiency.
SITE PLANS
On September 29, 1994, The DHHS issued a septic permit for a
2 bedroom house with an efficiency on Lot 55H-1, Secticri 33,
Township 13 North, Range 3 West. This property also received
ROAD DESIGN a HAA on December 6, 1994. We propose to use the same
approach for the property we are currently addressing.
Would you please explain the course of action(s) we should
SOILTEST take in this situation so we may better serve our clients.
Sincerelyr
PERCOLATION
TEST zzle
Raymond L. Shafer
Engineering Technician
STRUCTURAL&
&YL /�/-v
/Iz�
MECHANICAL
INSPECTIONS
Robert C. Cowan
Professional Engineer
ONSITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
Municipality of Anchorage }
Department of Health and Human Services dhhS
825 "L" Street
Tom Fink, P.O, Box 196650 Anchorage, Alaska 99519-6650
Mayor
ENGINEER BULLETIN 92-11
August 26, 1992
To: All Engineers Submitting Permit and/or Health Authority
Approval Applications
Subject: System Classification
Single Family or Multi-family/Commercial
The DHHS has regulatory jurisdiction over single family on-site
water and wastewater disposal systems. The Alaska Department of
Environmental Conservation (ADEC) has jurisdiction over
multi -family and commercial systems. In situations where the
classification of a system(s) is in question, this office will
use the following criteria in determining whether a structure
and associated on-site system(s) are single family or
multi-family/commercial:
l.. If the municipal property appraisal records indicate
that the property is commercial or multi -family, the
on-site systems will be considered under ADEC
jurisdiction.
2. If it is evident that the general public is being
served by the on-site systems, such as in the case of a
beauty parlor, barber shop or bed and breakfast, the
on-site systems will be considered under ADEC,
jurisdiction.
3. If it is evident that a commercial, office or in home
occupation activity is subordinate to a single family
house, the on-site systems will be considered under
DHHS jurisdiction.
If you have any
classification
systems, please
Sincerely,
Jo
h,
Pan
questions regarding the determination and
of single family, multi -family or commercial
contact our office at 343-4744.
ger, On-site Services
cc: Lee Browning, P.E.,
Bill Lamoreaux, P•E
Office, ADEC
Manager Environmental Services
, Manager, Anchorage District
�--. GRE,; ER ANCNORAR ARtA BW 'UbM
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME 7162fJS /?41,, L! 43 MAILING ADDRESS .99 jZoYJ20-3 PHONE
LOCATION �i�!l�La �n/, LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE rNUMBER OF
FROM WELL 26 MANUFACTURER `� L MATERIAL ? COMPARTMENTS /
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH '— LIQUID CAPACITY /000 GALLONS.
SEEPAGE PIT:
NUMBER OF PITS--/—. DIAMETER OR WIDTH g LENGTH_y DEPTH r
LINING MATERIAL ' CRIB SIZE: DIAMETER—DEPTH 0 • DISTANCE FROM: WELL
TOTAL EFFECTIVE
BUILDING FOUNDATION_,, NEAREST LOT LINE ABSORPTION AREA (WALL AREA) 60,VY SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE 0AJ//EIJ CONSTRUCTION DEPTH DISTANCE FROM:
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION LOT LINE SEWER LINE -,TANK -,SYSTEM
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED REMAR
DISTANCES:
INSTALLED BY: (al AIIIX4:-601)1's f
PIPE MATERIAL: 4/I 614S1 zy0
LOT SLOPE: 7
REMARKS:
Form No. EQ -031
DIAGRAM OF SYSTEM
DATE �%KZ23 APPROVED
�..o<
GREATER ANCHORAGE AREA BOROUGH
6° �"` •9OPERMIT NO.
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
o p51 TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM — APPLICATION AND PE ol
L�i� x
NAME OF APPLICANT/����`S 1� MAILING ADDRESS /Y 1'� ` PHONE
INSTALLATION LOCATION'-�~�
LEGAL DESCRIPTION
L PIT DRAIN FIELD OTHER SEEPAGE
INSTALLATION OF: SEPTIC TANK - (
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH TO BE INSTALLED BY
SOIL TEST RESULTS NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED '
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE / O C TYPF�-f�0 �SEEPAGE AREA SIZE TYPE
MINIMUM DISTANCES, REQUIREMENTS
Y /
FOUNDATION TO SEPTIC TANK
�U
FOUNDATION TO SEEPAGE PIT DRAIN FIELD =U-6
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK SEEPAGE PIT �� / DRAIN FIELD
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK SEEPAGE PIT
DRAIN FIELD ( / ALSO CONSIDER AREA /WELLS.
WATER MAIN TO SEPTIC T I K
�L/ / SEEPAGE PIT 49 /
DRAIN FIELD /U
SEPTIC TANK, e) SEEPAGE PIT DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL SACKFILL
CONFORM TO BOROUGH EGULATIONS RE/]GL/AA/RDING INSTALLATION.
G.A.A.B.
OR
LICENSED DESIGNER
DIAGRAM OF SYSTEM
I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE___ ^ N-.
;7
DAT�l APPLICANT'S
FORM NO. EQ -016
Y 0 & E EivGI NEERI NG & DEVEL Oi-MENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 333-5240
Russell Oyster
Earl Ellis
694-2774
333-5240
Civil Engineering
Surveying
Soils Et Foundations
Land Development
SOIL LOG
Performed for: Name:Tel. No.
Mailing Address:�v�S
Legal Description:
Depth (feet) Soil Characteristics...
0
7 `
5
6
8
9 r5e.c5m `�r
10
11
LJ .S �S
1�2
(Ground Water Encountered: Yes No N 61 If yes, what depth
Proposed Installation: Seepage Pit ✓ Drain Field
Comments:r A ;szn.nr4 \ >
p
Performed by: Date: 7
MUNICIPALITY OF ANCHORAGE
Development Services Departments Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 050-571-34
1. GENERAL INFORMATION
Expiration Date:
Complete legal description PREUSS #3 BLK 5 LT 5
Location (site address) 20137 David Avenue
Eagle River AK 99577
Current property owner(s) MCKNIGHT BRIAN & JACQUELINE
Mailing address
Real estate agent
Day phone
20137 David Avenue Eagle River AK 99577
2. TYPE OF DWELLING:
0 Single Family (w)No ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
E
Private Septic
0
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distan
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 550
Date of Payment g 1Z5-
Receipt Number C)"2 D r)
COSA # 05 C Z l l 5 1 l
Date:
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Eklutna Engineering, LLC Phone 907.406.1058
Address 19162 Mountain Rd Chugiak AK 99567
Engineer's Printed Name Curtis Townsend, PE
6. DSD SIGNATURE
—4— System #1 Approved for S_ bedrooms
System #2 Approved for bedrooms
Disapproved
Date
® ,q4��� i
Col..
THeJ� . ........
L
Conditional approval for bedrooms, with the following stipulations:
O
q' F
rn �. V
ro pR �' � A rn _
o
M ,1
1 •}
Original Certificate Date:
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 Checklist blue sheet
1#1040136 �T AN ME �Ml
Legal Description: PREUSS #3 BLK 5 LT 5
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
0 Well log is filed with Onsite (or attached)
Date drilled ' 2012
Total depth 115 ft
Cased to 115 ft
0 Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) + 24 in.
Date of flow test for COSA 4/282021
Static water level at beginning of test 78 ft.
Comments
B. TANK DATA
Age of tank(s) 1 years _
Tank type/material STEP pjS�j
Measured operating fluid level in septic tank
0 Standpipes/foundation cleanout per record drawing
Date of pumping INSTALLED Aug 2021
D. ABSORPTION FIELD DATA
Which system tested (date installed) 1995
0 ALL standpipes present per record drawing
Total measured depth from grade 14.25 ft (max)
Measured depth to pipe invert from grade ft (min)
0 N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
0 Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 050-571-34
Structure served by this system
Well production at time of test 5.6 gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes 0 No
0 Coliform bacteria is Negative
Nitrate 4.03 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by CURTIS TOWNSEND
Date of Sample 81172021
C. LIFT STATION
❑ Required maintenance completed
Age of lift station < 1 years
Lift station material PLASTIC
Comments: INSTALLED Aug 2021
Adequacy test date 4129202'
Results ❑✓ Pass For 4 bedrooms
Fluid depth prior to test 0 in
Water added 657 gal
New depth 23/26 in
Elapsed time 1440 min
Final fluid depth 7 in
Absorption rate ' 600 gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
Rim
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
p✓
Yes
Community Sewer Manhole/Cleanout > 100'
f7v Yes
if No
ft
✓[ ] Yes
if No ft
Neighboring Tank > 100' Q✓ Yes
if No
ft
Private Sewer/Septic Line > 25' F/I Yes
if No ft
Absorption Field on Lot > 100' [71 Yes
if No
ft
Holding Tank > 100' 0 Yes
if No ft
Neighboring Absorption Fields > 100'
Q Yes if No ft
Water Main > 10'
Animal Containment > 50' Fv� Yes
if No ft
F✓ Yes
if No
ft
F-71 Yes if No ft
Water Service Line > 10'
M
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway
Community Sewer Main > 75' FV -]Yes
if No
ft
P/1 Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
p✓
Yes
if No
ft
Surface Water > 100'
Q Yes if No ft
Property Line > 5'✓0
Yes
Yes
if No
ft
Wells on Adjacent Lots:
0
Absorption Field > 5'
M
Yes
if No
ft
Private Wells > 100'
Q Yes if No ft
Water Main > 10'
0
Yes
if No
ft
Community Wells > 200'
F-71 Yes if No ft
Water Service Line > 10'
M
Yes
if No
ft
If septic tank is under driveway
comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
0
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
0
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
0
Yes
if No
ft
Private Wells > 100' Q Yes if No ft
Water Service Line > 10'
Yes
if No
ft
Community Wells > 200' R Yes if No ft t
Surface Water > 100'✓0
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
l certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
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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.ok.us
(907) 3434904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
�: ` 1� — —_-
Parcel I.D.050-571-34
.
ParcelI.D050-571-34 HAA# r, ',P- 0 5-7q
r Expiration Dale: .2 -/5-03
1. GENERAL INFORMATION
Complete legal description Lot 5; Block 5; Prr+rngq Unit- # 4
Location (site address or directions) 20137 David Ave., Eaole River, AK
Current Property owner(s) Mr Bud Amadon
Mailing address Same
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
Day phone
Day phone
Day phone
2. NUMBER OF BEDROOMS:
4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representatlons 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.) Certifidates 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 Health Authority Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system Is(are) safe, functional and adequate for the number of
bedrooms and type of structure Indicated herein. 1 further verify that based on the Information obtained from the
Municipality of Anchorage files and from my Investigation and Inspection, the on-site water supply and/or
wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm S & S Engineerinp
Phone 694 - 2979
Address 17034 N. Eazle River LD. Rd. E.aZle R!vPr, AK
Engineer's Printed NameRobert C. Cowan Date P/1'f/02-
5. DSD SIGNATURE
i/• Approved for bedrooms.
�0
V ROBERT C. COWAN
C:-8801
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
`��P�\11 OF ANcyo
�,
v
ON SITE �=
Additional Comments z: WATER AND
WAS I Eq% ER
PROGRAM
IEMSE%4 11)�
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: (, , / C�
IRN. Ib001
Original Certificate Date: / /- /,S-- O - —
Municipality of Anchorage °
1E� 0N.
a s
Development Services Department
Building Safety Division
On -Site Water S Wastewater Program
4700 South Bragaw St.
P.O. Box 198650 Anchorage, AK 995198650
www.ci.enchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: 1,ar5t lIeLDerr4; Q&/!"';% Z/WIT J Parcel ID:Ow-5;i-34
A. WELL DATA
Well type -4f-- If A, B, or C provide PWSID # = Well Loo (Y/N) _e
Date completed _a -J k. Sanitary seal (YIN) Wires property protected (Y/N) _-
Total depth SL fL Cased to 2 R Casing height (above ground) . la" in
FROM WELL LOG
Date of test
Static water level
Well production _
WATER SAMPLE RESULTS:
AT INSPECTION
10/23/01, BY
fL �1�0�l ft. A W w c
g.p.m. g.p.m
Coliform O colonies/100 ml. Nitrate �• 62mg.r. Other bacteria colonies/100 ml.
Arsenic: mg.A. Date of sample:&#O �i Collected by:.���
B. SEPTICIHOLDING TANK DATA
Tank Type/MaterialIL /kr
;0-
t�iDate installedTank size /Q?� gpl : :`Compartments /� Cleanouts (Y/N)
Foundation le�ut (Y/NDepression
over tank (YM) ( High water alarm (Y/N�
Date of pumping/a a Ax�P'AJ l
C. ABSORPTION FIELD DATA . .-�
Data installed 7 / Still ra0n9 (g.p.d.Alz or IIZAbdrm) System type / CE+t/Gzy
Length Width 2" 5 ft. Gravel below pipe _10 ft.
Total depth 1_ R Eft. absorption area -fe
Monitoring tube _�
/ 'J
Depression over
V
Date of adequacy test /O/Z$VdL Results (PasslFail)
tfield
For 7 bedrooms
RFluid
depth in absorption field before test 3� in.
Water addedmgal.
N/ew, depth in.
Elapsed Time: min. Final fluid depth IL in.
Absorption
rate >= g.p.d.
1,
m
rejuvenation treatment ast 12 mo. YIN 8
Y(p ) ( type)
If es, give date —
Y 9
I
D. LIFT STATION
Date installed P///
S Size in gallons S7M Manhole/Access (Y/N)
"Pump on" level at It in. -Pump ofr level at fiL in. High water alarm level at
Datum ,609107 At AWX Cycles tested 2 Meets alarm E Circuit requ'uemenfs? Y
E. SEPARATION DISTANCES
SEPARATION DISTANCES
FROM WELL ON LOT TO:
Septic tank/lift station on lot 7�/� r'- On adjacent lots
Absorption field on lot 700,4- On adjacent lots
Public sewer main IV/ Public sewer manhole/cleanout A,11,+�
S/septic service One ; r !f' Holding tank N%ff
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line_1:�- Absorption field 5 t
Water main �%/A Water service One /O �* Surface water /001 -
Wells
t01"Wells on adjacent kris /LO
/r--
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: /
Property line /O r' Building foundation Water main
Water Service line /0 t Surface water AV /� Ddvmw. parking/vehide storage
e
Curtain drain /✓DR/6' AKW009W Wegs on adjacent lots
F. COMMENTS
�C�/D/f�J ^rn'TlALf GYM/G //V/}t.t.Y /NST7
G. ENGINEER'S CERTIFICATION :-
.` i
I cedH/y that I have determined through field inspections and
review of Municipal records that the above systems are in �.
conformance with MOA HAAU,qidelines in effect on this date.
Engineer's Printed Name
Date
HAA Fee $ 37.r- °I4 '- l S�. �� R �rN� Waiver Fee $
Date of Payment 1(/ m,0 /0 Date of Payment
Receipt Number ° a g / t 6 Receipt Number
(Rev. 12101)
F
MG COWAN
a - 8801
NOV-01-02 04:49PM FROII••RESIDENTIAL MAIN T-165 P.02/02 F-282
ft
.' • ' X90 7�• ., .
ILI
ge
�
IV 5Y Z
ILI
4Y� sfaaks-
14
IL to . fX140
-' :AS -BUILT . .
I hereby certify ,that.l have surveyed the followir p deicYrbed
property:
Anchorage Recording 1'ieeinct, Alaska, and that'the bnprout,-
�.��y�Y t mens situated thereon are 11 within the.pwperty lines and do not overlap or encroach on the property lying adjacent.the veto, that
�`P4� �. �•;42 no improvements on property lyingg -ad'titthereto.enrn,ach
a.�C .`"a s s�}�• on the promises in. questum and that.dure are. no vo4dways.. -
e� ._ transmission lines or other visile easements on said property
except as9ndicated hereon.
k 'Dated att'Enee River, Alaska
�1i�eer! thrs2 dayof 19���
C, )o / ROB I C. JOHNSON � 684
I r �, No:Bpp-5 a • Z°o> SCALE: Regtstered Land Surveyor.. o. 6841$
,'�'p •4 '�r "'
I" . 3 PBox hone 4 . Eq;Ie River, Alaska 99577
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
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 0.5-61 S 1 - 3
1. GENERAL INFORMATION
HAA# ��r1"1'•'.1;
Complete legal description Lot 5; B.I?ock 5; Plc�3h Subdiv.i3.ion #3
Location (site address or directions) 20137 David
Property owner
Mailing address
Lending agency
Eagle R.iveA, AK
Tim 9 RobeAta Cook
20137 David Stxeet
Day phone 694-1521
R.ivek, AK 99577
Day phone
Mailing address
Agent Cindy W esonl JACKWHITE CO. E.R. Day phone 694-5500
Address 11823 Old Glenn Hwy. Eagte Riven, AK 99577
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: I �1
3. TYPE OF WATER SUPPLY:
Individual well XXX
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XXX
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Re . 1/91) front 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 S & S ENGINEERING
Phone
age River Loop Road No. 204
Address Eagle River, Alaska 99577
Engineer's signature
6. DHHS SIGNATURE
x Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments
i
wTic
0
Date >1 /7 5`
A!• ROBERT C. COWAN �.
'c'•''.� CE - 8801 r:
'............`. .v
t�1�. r'VFC�`t���9y'-v'
bedrooms, with the following stipulations:
/�
Date %
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in orderto 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@3 -Rev ':911 3� UCw n'
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Health Authority Approval Checklist
Legal Description: LOT S1 fjtocK Parcel I.D.:
A. WELL DATA
Well type If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Ye Qo Date completed V%K- (�Erzt0t-75-)
Total depth 7 Loa Cased to q O fi Casing height (above ground)
Sanitary seal &N) JES Wires properly protected &N) y£S
Date of test
Static water level
FROM WELL LOG
v / ae
,v / K
Well production tr
WATER SAMPLE RESULTS:
Coliform 0 Nitrate
g.p.m.
0, q
AT INSPECTION
II -3-95
sa
G. -7 9 -
p.m -Other bacteria 0
Date of sample: Jo ( -3 / 5S- Collected bv: S & S ENGINEERING
17034 Eagle River Loop Road No. 204
B PTIC OLDING TANK DATA Eagle River, Alaska 99577
Date installed 9 -6-13 Tank size I000 Number of Compartments Cleanouts OM t��S
Foundation cleanout (Y/@ Q c) Depression (Y/Q iJ c High water alarm (YA@ 00
Date of Pumping " cy 9 S Pumper _�7_R• s pjMe,,w
C. ABSORPTION FIELD DATA
Date installed I I- I -tel 5 Soil rating(Gp.d./ Z r ftz/bdrm) 0'2' System type
I
Length 3 c3
Width a S Gravel thickness below pipe 10 Total depth I�{
Effective absorption area _ OD Monitoring Tube present(�N) yEs Depression over field (Y/� IJo
Nom-")
Date of adequacy test N A a s Results (Pass/Fail) For
Fluid depth in absorption field before test (in.); Immediately after= gal. water added (in.):
Fluid depth " (ins.) Minutes later: Absorption rate = g.p.d.
Peroxide treatment (past 12 months) (YIN) If yes, give date
bedrooms
V
D. LIFT STATION
Date installed 11- (-9G
Manhole/Access (DN) Yk S
High water alarm level at*
Cycles tested ;J
E. SEPARATION DISTANCES
-- Zin
Size in gallons 7500
"Pump on" level at* a S "Pump off' level at* 1,511
*Datum 611' "^ d1' rA"K-
SEPARATION DISTANCES FROM WELL ON LOT TO:
Se ti olding tank on lot On adjacent lots
Absorption field on lot 1 o a ; On adjacent lots
Public sewer main -7S r -r
)Do 1
foo `d -
Public sewer manhole/cleanout 100'-k
r ,
Sewer /septic service line a 5 Lift station 1o`I
-Y- (N5%Ai.IC4 11/6 /-73
SEPARATION DISTANCES FROM EPTI OLDING TANK ON LOT TO:
Building foundation 2 Property line q9 Absorption field
Water main/service line ly r-1- Surface water/drainage ioo � Wells on adjacent lots /yo r�
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation IQ' Water main/service line to .r
t
Surface water I co •r
r
as
Curtain drain woNL-- KNoL j J
F. ENGINEER'S CERTIFICATION
Driveway, parking/vehicle storage area
Sot
Wells on adjacent lots loci t*- Property line to '
I certifv that I have determined thru field inspections and review of Municipal
in conjbrmance with A1IOA H.14 guidelines in effect on this date.
Signature _YW4�`
Engineer's Name /` o.6`e,X-i C o r✓ q
Date / I / 7 / q S`
HAA Fee $ I(r, 6q1 Waiver Fee $
Date of Payment Date of Payment
Receipt Number Receipt Number
Rev. 8/95 OSS: haa.wk.doc
p;•...............
A el
�J
-QVC! AH�1�
x ..:..............:.•...............
ROBERT C. COWAN f,^'
CE -8801 r? ,
JC.1y'4. .�•'''`�J�y.F
are
MUNICIPALITY OF ANCHORAGE
• Department of Health & Human Services M� j
(` DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. f# (-) 2,n " �� 1- 22 L' HAA It OiDd8 , n t
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
L47—> C'C i�,26uSS't3 T�.J �/� SELF
Location. (address or diretiins)
n tr �gT�S 40, EzA
(b) Property owner '�1L��'
° Telephone : (home)
Mailing Address
(c) Lending Institution , -
Telephone
Business 2_�3— /98?
9303
Mailing Address
(d) Real Estate Company and Agent
Address 7, `SY_ �u. AlAe %7� d3
Telephone
(e) Mail the HAA to the following address: (or check her0i(if hold for pickup.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE 3
Single -Family`( Number of bedrooms
3. WATER SUPPLY
Individual Well)l Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site)d Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legaiity and status.
72-025 (Rev. 7/88) Page 1 of 2
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MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA) r
�7 CHECKLIST -FEBRUARY 1984
343-4744
Legal Description:°mssGK� j��Z�a5S
-f-114J
A. WELL DATA
Well Classification ���// If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Yo Date Completed ���°`) l �97f Yield Ui�9
Total Depth > &Z! Cased to d i -,t Depth of Grouting /J/h
i /
Static Water Level S � Pump Set At .�/w
Casing Height Above Ground
Electrical Wiring in Conduit ON)
SEPARATION DISTANCES FROM WELL:
Sanitary Seal on CasingON) —
Depression Around Wellhead (Y�
To Septic/Holding Tank on Lot 77'rT/0—;�
771.5, - On Adjoining Lots
To Nearest Edge of Absorption Field on Lot /66 / T '1p ; On Adjoining Lots fay rt
To Nearest Public Sewer Line �J/A To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot 25
Water Sample Collected by he_S A Date 7-
Water Sample Test Results 3,+e- T --&— J/7`k#-701� /.O
Comments dcvz' F� -",7— 1,7- 7-84'
,
B. SEPTIC/HOLDING TANK DATA
Date Installed "Size /0-aV No. of Compartments 1
Standpipesl&N) Air -tight Caps ON) Foundation Cleanout (Yo
Depression over Tank (YoV Date Last Pumped 7-/tO lyhh'"
; 4/4
Pumping/Maintenance Contact on File (Y/N) /t4 ,
for x
Holding Tank4High-'V�1ater Aj<al' rW4/N) Temporary Holding Tank Permit (Y/N)
i
SEPARATION DISTANCE..ggS. FROM :S PTI C/HOLDING TANK:
To Water -Supply Well '77e f,Nef9> 7° To Building Foundation /O
To Property Line• �'/e"'`' To Disposal Field
To Water MaPn/Service'Line,
To Stream, Pond, Lake.or.Majo'r,Drainage Course %Oa T"
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA dP4 A�
��
Soils Rating in Absorption Strata _', Type of System �Design y�
Date Installed 91_6 .7j Length of Field 1`
0 /
Width of Field Depth of Field
� Gravel Bed Thickness
Square Feet of Absortion Area
Depression over Field (Y/®
Z
Statndpipes Present &N)
Date of Last Adequacy Test
Results of Last Adequacy Test A "4f 4'Tir
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well /06, G'Pam To Property Line
To Building Foundation To Existing or Abandoned System on
Lot � ; On Adjoining Lots
To Water Main/Service Line /6 ��`' To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course It -
To Driveway, Parking Area, or Vehicle Storage Area /0 /
Comments /6/u, Ah" 70� BY16b NP Y/1kh . DEP* or Fial-D A -r s?rWaPA - /� � 3f I-
D.
D. LIFT STATION
Date Installed
Size in s
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Check Permitted Bedroom Rating Against HAA Request"
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
I certify that I havee checked, verified, or conformed to all MOA and HAA g (���iT f �p�on the date of this
inspection. A.ZC_- G'l/G/ �1`'oVo�,o[••opiloe"0 4
Signed +'! � C
�' o00
Company �G Gf a.* 4 4
•� �••. ee e.•
Date /—/j�pineer's Seal
MOA No 0'a-
Receipt No. % (2 3
Date of Payment
Amount:
Receipt No.
Waiver Fee: $
Date of Payment
72-026 (Rev. 7/88) sack Page 2 of 2
ROY C. REID, JR.
R• CE - 2251 .°