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HomeMy WebLinkAboutPREUSS #3 BLK 10 LT 4Preuss Block :1,0 Lot 4 #050-571-52  MUNICIPALITY OF ANCHORAGE DEPARTIV~ENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION " 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 . ON-SITE sEWAGE DISPOSAL SYSTEM AND/oR WELL INSPECTION REPORT N AM~, ~-,- PHONE [] NEW M:AI~LI NG'AD DR ESs ~/ L~GAb' DESCRIPTION LO~dA~ION NO. OF ~EDROOMS IWel, / Absorption area . - D~e[ling PERMITNO. DISTANCE TO: ~ Z Manufacturer Material No. of compartments '?~ Liq. capacity in gallons inside length Width Liquid depth IF HOMEMADE: ~ ~ DISTANCETO: Well ~/ Dwelling PERMITNO. ~ ~ ~ M~aufac~urer ....... Material ' Liquid capacity in gallons ¢ Well / Foundation ,+ ~ ~) / Nearest lot line ~ PERMIT NO. i ~ DISTANCE TO: '~ /~ -- - /,~/ ~, ~, ~ .i Trench width Distance between lines ~"~ ~Z No. of lines ~ Length ofeach~,~_line ~ Total length~lines ~ ~) inches ~ ~ Top of tile to finish grade I Material beneath tile Total effective absorption a~ea i ~ 7~ i.~,.s 3~o ~ Length Width .] / Depth PERMIT NO. ~N ~ Type of crib Crib diameter Crib depth ~'otal effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth~ .~ ) ~ /~ ~ri~r~ Distance to lot line PERMIT NO. Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PiPE MATERIALS N , .~__~t.. ~ '- REMARKS W ~] ., /?_~/ ~~~;~ ~r,* ...... , ........ ~, .',' ~X~5, Tj/V(s.~X~'~ / DATE LEGAL ~,; ?~ ¢~ ~ ~ ¢. *' 72-d !Rev. 3178) Department .~i%~-~a ~vl~6~ ~Protection 825 ~J Street, Anchorage, AK. ~9501 ~ 264-4720 " * * * HANDWRITTEN PERMIT * * * Permit ~~_ WELL AND/OR 0N-SITE SEWER PERMIT Applicant: ~L~ ~/~ Mailing Address: Location: Z~ ',~ /~ /~.-'¢~ ~g~ Phone Nuraber: Legal Description: ~r ~/O ~ ~ Type of Soil~rption System Is: Trench: Drainfield: Seepage Bed: Lot Size: Holding Tank: Maximum Number of Bedrooms: ~-- Soil Rating (sq. ft/br) ~//~ The Required Size of the Soil Absorption System Is: ' DEPTH /(9 LENGTH ,~ ./I~'~GRAVEL DEPTH ~ ' WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a con~munity sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER ~1~ 1 9 8 3 * * * I certify that: (!) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may r~equire enlargement if the residence is remodeled to include more th~ bedrooms./~ Signe : ss ed Applicant ~A /X3 Date: Location: Legal Description: Type of Soil Absorption System Is: Trench: ~ Drainfield: Department f Health and Environments, 'Protection 825 '~'~ Street, Anchorage, AK. "9~9501 264-4720 * * * HANDWRITTEN PERMIT * * * W~E,L---A~EbZ~H~ ON-SITE SEWER PERMIT ~x/~.,f~z9L ~, Phone Number: ~ $ ~- YE/~ ~B~ -~/~ LOt Size: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: ~__/ Soil Rating(sq.ft/br) /~O The ~equired Size of the Soil Absorption System Is: ' , DEPTH /O LENGTH ~' GRAVEL DEPTH ~' WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall ~ipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC('MSt-B4-NG) TANK SIZE = " GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days Of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * * I certify that: (!) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if _ the residence is remodeled to include more t~/t 3 bedroom~./~ Applicant _ _ p~%GRE~, iR ANCHORAGE AREA BOk., JGH ~(;~:,~ .,/.¢,., ~ ~'~:'~, ,~/ Department of Environmental Quality ~'~ 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER -- INSIDE WIDTH ~- '~g~'-/~* MATE RIAL LIQUID DEPTH NUMBER OF COMPARTMENTS '~'~ ~"~'""--~ LIQUID CAPACITY~'~[~ GALLONS. DISTANCE FROM WELL /~ / FOUNDATION ¢;~/ /' NUMBER OF LINES / DISTANCE BETWEEN LINES DEPTH: TOP OF TILE TO FINISH GRADE WELL: BUILDING FOUNDATION _NEAREST LOT LINE /~ ~' TOTAL OF LINES LENGTHen-. ~,- TRENCH WIDTH }~/-,~ IN. TOTAL EFFECTIVE FT. LENGTH OF EACH LINE · ,__~DEPTH OF FILTER ~/'~ ~ MATERIAL BENEATH TILE 7~- IN. ABOVE TILE ~/ IN. Z~CONST RUCTION __~,~f //f-(-~ ~-/¢--='J- DEPTH NEAREST NEAREST ~' SEPTIC f' SEEPAGE LOT LINE SEWER LINE '"i~l~!~, TANK /'g~"J, SYSTEM DISTANCE FROM: CESSPOOL APPROVED OTHER SOURCES DISAPPROVED REMARKS SEWER LINE DEPTH: PIPE MATERIAL: ~'= LOT.SLOPE: ~ ~ ~'~-P 7='"~'T'~) ' REMARKS: Form EQ-032 DIAGRAM OF SYSTEM · ~ G.A.A.B. :L ,. ,~ .," ,~:L GreATEr ANCHOrAge AREA BorOugh~/- /bo u,... ,., SEWAGE ~ISPOSAL SYSTEM -- APPLICATION AND PERMIT NAMe OF APPLICANT. INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK / TYPE AND SIZE Of FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS COMPLETION DATE ANTICIPATED SEEPAGE PIT. DRAIN FIELD · OTHER TE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WiLL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE / ' ~.~! . TYPE MiNiM~ DISTANCES, REQUIREMENTS SEEPAGE AREA SIZE tYPE f /DIAGRAM OF SYSTEM FOUNDATION TO SEPTIC TANK ~ FOUNDATION TO SEEPAGE PIT . . DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK . , SEEPAGE PIT . TO NEABEST LOT LINE. WELL TO SEPTIC TANK / DBAIN PIELD '~o / , DRAIN FIELD ALSO CONSIDER AREA WELLS· WATER MAIN TO SEPTIC TANK . . SEEPAGE PIT _ DRAIN FIELD BEPTIC TANK, ? °~O/. SEEPAGE P*T. / ~ / · 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. CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. O Et E GED", ,CHNICAL 6' DEVEL~, ~MENT CO, Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 Soils ~' Foundations Eerl Ellis SOIL LOG ~8-22ao - Land Development \T ~% ~'~ Tel. NO. - Sell Characteristics Perfomed for: Legal Description: ~epth (feet) 2 '3 7 t 15 G~-ound Water Encountered: P)-oposed Installation: Comments: P~fo~med by: Yes~No If yes, what depth Seepage Pit ~ Orain Fie~d "/ -' ( erlifie rilliug by A & L DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONES94-2588 OWNER OF LAND ADDRESS ~ ) LEGAL DESCRIPTION ~/~ ~'~ DATE- Started PERMIT NUMBER Ended DEPTH OF WELL STATIC LEVEL OF WATER DRAW DOWN ET GALS. PER HR ~ '/ KIND OF CASING KIND OF FORMATION: From ' ' Ft. to . Ft. O t2/_~ /~6~d./~,~t From Ft. to Ft. - :.::,-.., >...; , .?---~,:,-,' ; ... , . :.. ... . . From [;:',.'o~¢Ft:'.'~O-~~'~ / ~' F*m''. Fi. to Ft '¢'-¢ ~' >' -' .,o '_'/ "' - ,r~ojz,.-: ? From Ft. From ~':/?? Ft. to / ~, ,.)d Ft. -.; From Ft. to Ft. F~om: -.., .t. t ..... From J'),;; Ft. to e'~ d' E~ Ft. ~)Z~:~_~ From Ft. to Ft From · ") ~-: Ft. to .$'r> / _Et. (~Z ~F ~O~& ~ ~W~'~m Ft. to_ Ft From~;~ ;'> / Ft. to .3 ,¢D Ft. ~, /~'/~'} 0 ~;' ~)/~e~ "- ~flOde' ~ t-- From Ft. to .... , 7¢ ¢J¢'~ Ft. to · From Ft. to. From Ft. to Ft, From Ft. to Ft From __ Ft. to Ft. From Ft. to .Ft From Ft. to Ft. From Ft. to Ft. From. Ft. to Ft. From Fr. to Ft. MISCL INFORMATION: , ,.,:-, ~. 7'~. /.'>2-: /.)r; DRILLER'S NAME Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 w,,w~.cLanchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAHILY DWELLING Parcel I.D. 050-571-52 1. GENERAL INFORMATION Expiration Date: /- ,~. - O ~ Completelegaldescription PREUSS SUBDMSION ~3 LOT 4, BLOCK 10 Location (site address or directions) 20153 LUCAS AVE * EAGLE RIVER, AK Current Property owner(s) PHILUP WOLANSKY Mailing address 20153 LUCAS AVE. * EAGLE RIVER, AK Lending agency Mailing address Real Estate Agent Mailing address MARK I.rI'TL[ w/ ASSIST TO SELL Day phone 964-9656 Day phone Day phone 727-1819 Un~sso~erwise ~ques~ HAAwillbehe~byDSDforpick~, 2. NUMBER OFBEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Cedificates of Health Authority Approval (I IAA) based only upon the representations given in paragraph 4 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ to closing for the engineering services provided. 4, STATEMENT OF INSPECTION BY ENGINEER at, or pdor As certified by my sea/affixed hereto and as of the validation date shown be/ow, I vedfy that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage £~/es and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with ali applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phone 337-6179 Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE. AK 99504- Engineer's Printed Name JEFFREY A. GARNESS. P.E. Date Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results desodbed the peffon'nance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being sen/ed by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue lo meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE ~ Approved for '~ bedrooms. Disapproved. Conditional approval for Attachments: HAA Checklist Septic System Advisory Well Flow Advisory bedrooms, with the fllowing stipulations: .. .... .... Manitenance Agreements Supplemental Eng{neefs Reda Other Original Certificate Date: Municipality of Anchorage Development Services Department Building 6afety Division On-Site Water & Wsstwmter Pr~ram 4700 South B~gaw St. P.O. B~x 196650 ~e, AK 99519-6650 www.ct.anctmmge.alcus ¢9m3 ~,34,904 Legal Description: A. WELL DATA Well type .~IvAl~ ff A, B, or C provide PWSID~ N,/A Date completed 4/7/1976 Sanitmy seal (Y/N) YES Total depth ,395 It. Cased to 391 ff. HEALTH ~,UTHORITY APPROVAL CHECKLIST PRE:USS SUBDMSION ~3, LOT 4. BLOCK 10 Percel ID: FROM WELL LOG Date of test 4/7/1976 Static water level 355 ff. Well prm:luctlon 4.0 g.p.m. · , WATER SAMPLE RESULTS: Well Log (Y/N) Wires properly protected (Y/N) Casing height (above gmum:t) AT INSPECTION 9/16/2002 350 ft. 4.7 g.p.m. 050-571-52 24+ in. Collfoml 0 colonies/100 mi. Arsenic: N/A mgJL. SEPTIC/HOLDING TANK DATA Nitrate 0.206 mgJL. Date of sample: 9/17/2002 Tank Tyba/Matedal STEEL Tanksiz~ 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping 9/15/2002 ABSORPTION FIELD DATA Pumper ~*SELOW EXb-'I1NG CRADEI Other bacteria 0 colonies/100 mi. Collected by: AKWWC, INC. Date installed 9/9/1976 Cleanouts (Y/N) YES High water alarm (Y/N) N/A JR'S PUMPING NOTE: TESTED 1983 TRENCH ONLY Date installed ~/17/1983 Soil rating ~or ft~edrm) 14.2/150 Length 36/25+ ff. Width 3/2.5 ft. 426/ ~ *Total clepthg.o4/~7.aft. Eft. absorpti~ ama 300 ff Monitoring tube ,YES Depression over field NO Date of adequacy test 9/16/2002 Results (Pass/Fall) PASS For 3 bedrooms Fluid depth in absorption field before test P in. Weteredded1056gal. Newdepth 1.7 in. Elapsed Time: .9..90 min. Final fluid deplh 0.. in. Absorption rote >= 4504- g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE: KNOWN If yes, give date - *eMT ONLY EXTENDS 5,17 FEET IN THE DRAIN ROCK System type DEEP TRENCH ' Gravel below pipe **6 · fl. D. LIFT STATION Eo Date installed "Pump on" ~evel at ' in. Datum SEPARATION DISTANCES Size in gallons "Pump off' ~,91 at Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: In. Manhole/Acc~<; (Y/I~ High water alarm level at Meets alarm & circuit requimmente? in. Septic tan~ift station on lot '90'+ Absorption field on lot 100'+ Public sewer main N/A Sewer/septic sen. ice line 25'4. On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/deanout Holding tank N//A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Pmberty line 5'+ Water main 10'+ Water service line 10'+ Wells on adjacent lots - 100'+ Absorption field SurPace water ,5'4. 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water service line 10'+ Sudace water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ Water main 10'+ Driveway, parklngNehlcle storage F. COMMENTS *//WRg50044 G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems ere in conformance with MOA HAA guidelines in effecf on this date. Engineer's Printed Name. J~.r~KEY A. GARNESS 3/5--- Date of Payment ~ /~2.'"'~ IOZ R,cet..u. r 2bl 'l (Rev. 12J01) WaNer Fee $ Date of Payment Receipt Number Sent By: HP LaserJet 3100; 907 563 3494; 8ep-25-02 8:52AM; 1627 C~2eol 1~1~l~4 5L320 Page 111 $£P-24-02 0Z:52~ FROI4-CT,tE ENVII~I,ENT,~ SR'/ ~tt"K CT&E Environmental Servlcea Inc. T-T,48 P.OZ/(13 F-$12 CT&E Ref.; Client Hame i~roJett Name/; Client Sample ID Matrix Ordered By PWSLD Sample P. emnrks: 1026137001 AK. Water & WasteWnter Consultants Inc. Ptcuss S/D #3; lot 4, Block 10 'Pre,ss S/T) #3; lot 4, Block 10 Drinking Water All Dar t-,./l'lmes are Alaska Standard Time Printed Date/Time 09/20/2002 18:36 Collated Date/Time 09/17/2002 8:32 l~-eeelved Date/Time 09/17/2002 15:30 'l'echnleat Director Released By ~~ P,~I~ I~L Uni~ Med~od Aflowable Ih~ An~t'xsi~ l.imiu I~te t~te Init 0.206 0.200 mg/L EPA 300.0 {.c~10) 09118/02 IL'[ c ~'ob:l. o 1-Ogy Z.n'hora~.or,/ Total Coliform 0 col/lOOmL SMI8 9222B (<'-11 ~/1~02 KAP Parcel I.D. # DEPARTMEN'r OF HEALTH & HUMAN SERVICES - Division of Environmental Services' -' ~ ~'~./~ i-'' On-Site Services Section -. - - P.O. Box 196650 Anchorage, Alaska 99519-6650 . _ - - ' ' ' '- 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING o5o-s71-5 H^A .....' GENERAL INFORMATION Complete legal description Lot 4, Block 10, Preuss #3 Location. (site address or directions) 20133 Lucas Avenue Property owner Mailing address Lending agency · Charles~Laurie Carter · Day phone -20133 Lucas Avenue, Eagle River, AK 99577 694-2410 Day phone Mailing address Agent Les Bailey, Prudential Day phon~89-6451 Address16635 Centerfield Drive, Eaqle River, AK 99577 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well XXX Community well NOTE: Public water If community well system, provide written confirmation from State ADEC attest- ing to.the legality and status of system. XXX TYPE OF WASTEWATER DISPOSAL: Individual on-site Community on-site Public sewer If community wastewater system, provide written confirma attesting to the legality and status of system. · NOTE: 72-025 (Rev. 1/91) Front MOA#21 STATEMENT OF INSPECTION ElY 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 hum bet 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 Address Eagle Ri;~ -- DH? SIGNATURE -- Approved for '~,~.~ bedrooms. -- Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: 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 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#'21 Lege, Description: i0 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN sERVICES Environmental Services Division ,lAN 1 ! lc)c~! 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 t~LIN~QIPALI]'Y OF ANCHORAGE ~NNtI~aN~NfAL SERVICES DIVISION Health Authority Approval Ohecklint /~(..~5~ ~t/:~-~ Parcel I.D.: 0 J;-O -St ?f" ,~-,~ A. WELL DATA Well type Log present (Y/N) V~/~ Total depth .~ 75~ / Sanitary seal (Y/N) V'~ / Date of test Static water level Well production If A, B, or C, attach ADEC letter. ADEC water system number Date completed /"~ 7- 7~~ Cased to ,~ ?"~'~/ Casing height (above ground) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION g.p.m. WATER SAMPLE RESULTS: .~ Coliform © Nitrate Date of sample: / --~%' ~'~ ~- ~ - ? - cl B. SEPTIC/HOLDING TANK DATA Date installed 7~ Tank size /,~ Other bacteria 0 Foundation oleanout (Y/L~, /~Cl Depression (yc'N~ /k~.O High water alarm (Y/~ Date of Pumping ~'- ~- ?~ Pumper ,~/~ l'7"Ai~-/ ~/~/L~ ~ Collected by: 17034 Eagle River Loop Read No. 204 Eagle River, Alaska ~9577 Number of Compartments C. ABSORPTION FIELD DATA Date installed ?/~ ~"/<~2~ Soil rating (g.p.d./ft~ ~bdim~/¢,~//~'~System type ~ / / f '~ / t / / Length, &'.,/25 Width .:¢¢50 Gravel thickness below pipe ~7~ Totaldepth Effective absorption area Y~,~TL'~ Monitoring Tube present ~/N)'~ Depression over field (Y~ . Date of ade.uacy test .esu,ts Pass. Fa,, For S bedrooms Fluid depth in absorption field b'efore test (in.); Fluid depth ~ ~ (ins) Minutes later: Peroxide treatment (past 12 months) (Y~) Immediately after'~,~gal, water added (in.): Absorption rate = '~/~.,~) g.p.d. If yes, give date 1// 72-026 (Rev. 3/96)* D..LIFT STATION Manhole/Access (Y/N) ~P~on" level at* High water ala~ *Datum "Pump off" level at* E. SEPARATION DISTANCES Septic/holding tank on lot Absorption field on lot Public sewer main SEPARATION DISTANCES FROM WELL ON LOT TO: ¢(~ / LK ~' ~ '~ ~] ~ °~'~/~On adjacent lots //Z..// On adjacent lots / ./- Sewer/septic service line Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: / Foundation '1~'' ~-~ Property line -Y~ /O Water main/service line. '7~/~~ / Surface water/drainage SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: / Property line -I/- t/~ Building foundation_ "/:'-/LO Sudace water ~,/~ Curtain drain ENGINEER'S CERTIFICATION Absorption field .,~ Wells on adjacent lots / Water main/service line '7L'/'~ Driveway, parking/vehicle storage area Wells on adjacent lots I certify that I have determined thru field inspections and review of Munic,pal record.~"~-.~.~o~.~s ara ~,,--~ .....' ;"...;.:o,~ in conformance with MOA HAA guidelines in effect on this date. ~.. Sig aturen ' HAAFee $ (2~"'~' ~;'() Date of Payment Receipt Number o/-- Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* ,~ iZT&E ~nvironmen~! Sea{cern Inc. Cli~t porn Printed D~a/Tlme 01/11199 13:18 Coilo~e~t 01105/~ 14:30 R~eiv~~ 01106199 14;15 T~h~{ D~o~ $1eph~n C, ~d~ Parcel I.D. # 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 GENERAL INFORMATION Complete legal description Preuss #3 Lot 4, Block 10 Location (site add ress'or directions) ,~' "~"'" 20133 I~ucas Avenue, Eagle River Property'owner .-patrick ~lanigan & Mary Morgan Day phone 563-1072 Mailing address 20133 Lucas Avenue. Eagle River, Ak 99577 ke6dli,nQ agency City Mort§age/Jeanie Mee Day phone 696-0701 Mailing~,d~dress--ll901-Business Blvd., Suite 8, Eagle Rive,r AK 99577 Agent Don Hcw~nzim RE/Les Bailey Day phone" 694-9035 Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: NOTE: x Individual well Community well Public water ., If community well system, provide written confirmation from StateiADEC azte lng 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 MOA #21 5. STATEMENT: OF INSPECTION BY ENGINEER AS certified b¢'m~'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 ~agle River Ez~g.~neer~ng Se~-qices Phone 694-5195 Address P.O. Box 773294, Eagle River, AK 99577 ~- Engineer's signature ~ Date ,. .... : '._ · DHHS SIGNATURE ~ Approvod for' ~ bodrooms. Disapproved. Conditional approval for 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 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. 724TzS(Rev. 1/91) Back MOA#21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744 Legal Description: A. WELL DATA Health Authority Approval Checklist ~3 /--¢'P /~/¢7 Parcel I.D.: Well type .,QZ'////¢V-~ Log present (Y/N) y~ Total depth .~5 ' Sanitary seal (Y,q'q) )/~"~ Date of test Static water level Well production Date completed Cased to .~ ~ 5" IfA, B, or C, attach ADEC letter. ADEC water system number Casing height (above ground) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION WATER SAMPLE RESULTS: Coliform ~ Nitrate t52,/ff ,~6~//- Other bacteria Date of sample: 0 ~ 0(?/~ ~ Collected by: ~'/P~--~ B. SEPTICfHOLE'~,~qG TANK DATA Date installed [~ cj/.~{~ Tank size //~f) () Number of Compartments /~ Cleanouts (Y/N)__ Foundation cleanout fi/N) ,fro Depression (Y/N) /9/D High water alarm (y/N) /V/~ Date of pumping O~/t~//~ Pumper ..fi/~ ~ Co ABSORPTION FIELD DATA 'Date installed ~?/'7U//7'5/o¢~ Soilrating (g.p.d./ft2o[~/~/~/~) Systemtype z'(" L" ' ' ' / ' /~0 Gravel thickness below pipe .f{~¢ //P Totaldepth /0 //4:9 / Effective absorption area ':'~.2 49 Monitoring Tube present(Y/N) Y' Depression over field (y/N) Date of adequacy test 69 ~Y//L~' / 5/¢- Results(Pass/Fail) p/¢~ For ~ bedrooms Fluid depth in absorption field before test (in.); Fluid depth l~/q 0 Minutes later: ~b Peroxide treatment (past 12 months) (Y/N) Inunediately after qSv gal. water added (in.): (in.) Absorption rate = qff~3 .g.p.d. fi///~ If yes, give date /V/?'Z] Do LIFT STATION Date installed Manhole/Access (Y/N) ~level at* High ,vater ~ev. y3~ *Datuin "Pump off' level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holdmg tank on lot 52L) ' 3(- Absorption field on lot ///"/ / Public sewer main P-/{.)/9 / On adjacent lots On adjacent lots Public sewer manbole/cleanout /-/00 / ?700 /-I00 Sewor-/septic service line Lift station ,A///q SEPARATION DISTANCES FROM SEPTIC/H'OL-DiNG TANK ON LOT TO: / Foundation 7z ~ Property line 'P / D ~ Absorption field 7~. Water,maitqservice line. ~)L't}/,) } Surface water/drainage fi,///] Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ~--/L7 ' Water main/service line Surface water Curtain drain ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area Wells on adjacent lots L/-;7 I certify that I have determined thrufield inspections and review of Jglunicipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. ,/ /~/¢/~ ~~/ ff~7~P/~ Engineer'sName ~Y/5' ~1~5t7 ~'- ~.::~<~,,_~ ~~2~°~'~' ....2~h Date ~.2~:..S- ~ ~ · . -- ~- .2S' - 95- -~ ~, Lores A. Butera e,~ ~i~, CE- 6736 ,'~' .................................................................. ~t*rn~ [~ ~z &%%~; HAA Fee $ WCg Waiver Fee $ ff~ ,ff~X~ Date of Payment Receipt Number Rev. 8/95 OSS: baa.wk.doc Date of Payment Receipt Number ~.~-'~ Laboratory Analysis Report WATER Techni~&l pl~ec~or ST~PH~ C. QC A~lowable ~x~. A~al Nturate-~ 0,10 ~ ~J/L E~A ~S~.2 10, 08/1X/95 C~ '- 2~ W. P~ter Dr~e, A~cho~e, AK 99518-160E -- Tel: (907J 562-2343 Fax: (~7) 561-5301 ~_NVIRONMENTAh FACILIIIE$ IN At. ASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND. MIC}-II~iAN. MIB~OI-IRI. ~E~N .IEil~lf¥,. OHIO. WEST V~RGINIA Rick Mystrom, Mayor MuniC p W of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 September 28, 1995 Lou Butera, P.E. Eagle River Engineering Services PO Box 773294 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 4 Block 10 Preuss #3 Waiver Request ~WR950044, PID ~050-571-52, HA950384 Dear Mr. Butera: Your request for waiver(s) of the required 100 foot horizontal separation of a septic system to a private well has been approved. The approved separation distance(s) are a septic tank to the private well on property is 90 feet. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. ~incere~, ! ames P. Williams ivil Engineer On-site Services JPW/ljm '~.,,,MUNICIPALITY OF ANCHORAGE~'~ ..... Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR#[3_~~ PID% ~.~-~\-~ HA% '.~qi~L/ Permit Date Received: August 31, 1995 Legal Description Lot ,~Block : -~Preuss Subdivision Engineer: Lou Butera, P.E., Eagle River Engineering Services PO Box 773294 Eagle River, Alaska 99577' Applicant: Patrick Flanigan Waiver Requested: well to the septic tnk of 90 feet Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: ~,' Waiver is NOT Granted: List Conditions or Reasons for above: Date: Rec %: %01263/2727 Amount: $625.00 Date Paid: 8-31-95 Louis Butera, P.E. Registered Civil Engineer August 25, 1995 Jim Cross, P.E. Municipality of Anchorage On-Site Services 825 L Street Anchorage, AK 99504 Re: Preuss//3 Lot 4, Block 10 Waiver Request Dear Mr. Cross: On behalf of our client, Mr. Patrick Flanigan, we are submitting a request for determination of waiver of horizontal separation distance for the above referenced three bedroom private residence. The request is for a waiver of well to septic tank distance to 90' separation. There is a site plan attached. The septic system and well were installed in 1976 and appear to have a previous Health Authority Approval issued by MOA in 1976 and reissued in 1983. The system was inspected in 1976 by the Municipality with the tank shown at 100' distance. The septic leachfield was upgraded in 1983, retaining the existing septic tank. Soil characteristics in the area are well documented. The immediate subsurface soil is a sandy gravel (GP-SP) down to the typical test hole depths of 12'. Soil logs are attached for lots directly below (Lots 1, 2 & 6, Block 5 Preuss) and adjacent (Lots 3 & 6, Block 10 Preuss) to the subject lot. No ground water was shown on the on-lot test hole log which is attached for your review. The well logs for our subject lot and nearby properties (Lots 6 & 7, Block 10; Lot 6, Block 5; and Lots 3 & 6, Block 10 Preuss), are attached, well depth is 395' with overlying clay gravel at 19- 38', 208-280' and 330-392'. This is consistent with adjacent well logs of 380' 375' 395' and 500' depths for lots adjacent and south. Our well flow test shows a static water level of 355' with a total drawdown of 25' pumping at 3 GPM. This would indicate a large semi-confined aquifer. Soil layers from surface to bedrock level for adjacent well logs indicate multiple clay and/or hardpan layers which would act as a barrier. The ground surface gradient provides a positive evidence in support of waiver. Slope between up-gradient well head location and down-gradient tank shows a average gradient of 2-4 % in a direction downhill from our water source. The gradient would ensure that any possible surface contaminate from the septic components located at less than 100' would definitely travel down gradient to the South, and away from the well. O:\WPDOCS\ 1995\95-079A.LTR P.O. Box 773294 · Eagle Rim; Alaska 99577 · Telephone (907) 694-5195 · Fax (907) 694-3297 There are other mitigating physical characteristics that .should be taken into consideration in the evaluation: The house is located directly between well and septic components providing a physical barrier. The area has a low population density and public sewer is available on lots to the north. Water samples of the on-site well show no evidence of coliform, and no background Nitrate levels (< MDL of 0.1 mg/L). The system has been in place for 19 years. Please review the attached data and if you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. fc: D.McKinzie RE, L.Bailey pc: Owner, P.Flanigan G:\WPDOCS\1995\95-079A.LTR - APPLIr- iT FILLS OUT UPPER HA' - ONLY P~'opertyOwner Dale & Carol Bicher ' Mailing J~ddress ]~OX 5222 I~/oas Avenue - ~gle Riv~/' ~s~ zip Code 99577 Phone 694-9615 Buyer Patrick B. & Mary A. F. lanigin AddreSs" 2804 Wesleyan Drive - Anchorage, Alaska ' zip Code 99504 Lending institution First National Bank Address 36th & C - Anchorage, Alaska Zip Code Phone 276-6300 Realty Co. a Agent '~:)t~9~. Co~mo~l~ Nancy Mcx3:~9 & AtZ:~'ey MasOn Phone Address t~OX 92 --' Ea~e River, klaska ..... zip Code 99577 694--9494 Legal Description Street Location Lot 4 Block 10 Preuss SYfodivision ~3 5222 Lucam A~enue Eaqle River~AAaska Type of Residence ~ Single Family [] Multiple Family No. of Bedrooms ' ~ [] Other Water Supply ~] Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. [] Community For wells drilled prior to that date, give well depth (attach log if available). ~ Public Utility Sewer Disposal ~ Individual Year Individual Installed: 1976 [] Public Utility When Connected to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Date Date Inspector Inspector Date Insp Field Notes: j ( ~CONDITIONAL APPROVAL* Soils Rating Date Sewer Installed APR 04 83 *CONDITIONS OF APPROVAL / Well To Absorption Area ' Well Log ReCeived Well to Tank Septic Tank Size 72-023 (31~) P.O. BOX 754 EAGLE RIVER, ALASKA 99577 (907) 694-2131 IONYKNOWI ES, MA YOn DL=PARTMENT OF HEAL'rH AND ENVIRONMENTAL PROTECTION April 14, 1983 Dale And Carol Bicher Box 5222 Lucas Avenue Eagle River, Alaska 99577 Subject: Lot 4 Block 10 Preuss Subd. Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: Exposed electrical wires to the well head are in violation of the Municipality of Anchorage codes and must be encased in conduit. An adequacy test needs to be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this office for ou~ review. The septic tank pumped with a receipt submitted to this department. Please notify this department for a reinspection when the noted descrepancies have been corrected. If there are any further questions, please call this office at 694-2131. Environmental Division Eagle River Office EXCAVATION ROBERT A. SHAFER WORK April 10, 1983 CIVIL ENGINEER 694-2979 Totem Realty ATTENTION: Nancy Moore P.O. Box 911 Eagle River, Alaska 99577 Dear Ms. Moore, Reference: Lot 4: Block 10: Pruess Subdivision A sewer system adequacy test was performed on the system located on the referenced property, as you requested. The septic tank was pumped and verified to have a capacity of 1000 gallons. The absorption trench was tested by a continuous flow of water over a. period of 48 hours however at the conclusion of the test water had backed up into the septic tank and the trench was completely saturated. A period of 48 hours was allowed to pass and the test was re-started and approximately 340 gallons of water was placed in the system over a period of 24 hours and again the system backed up. It can be concluded from this test that the waste water disposal system serving the three bedroom residence located on this property is not currently functioning adequately. It is estimated that the absorption trench is percolating a sufficient amount of water for between one and two bedrooms. It will be necessary to have the system upgraded for a minimum of two bedrooms before it can be considered adequate. If we may be of further service, please do not hesitate to contact US. cc: Municipality of Anchorage Department of Health and Environmental Protection SR8 196X EAGLE RIVER, ALASKA GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received August ll, 1976 REQUEST FOR APPROVAL OF INDIVIDUAL SE ER & ATER FACILI*IES Cony. '-, 1. Approval requested by: Mailing Address: Property Owner: Mailing Address: Legal Description: Location: Lucas Avenue o 4. 5. 6. First National Bank of Anchorage Post Office Box 720 Gordon W. Webber/W.L. Foreman FOR 279-4481 X 2:8 / Phone: Phone: 333-5~69/69~-9056 7529 Old Harbor Road Lot 4 Block 10 Preuss Subdivision Type of facility to be inspected Well Data: Individual A.. Type Single Family NO. of-bedrooms 3 C. Construction Sewage Disposal System: A. Installed /~9~oi C. Septic Tank: 1. D. Seepage Pit: 1. E. Disposal Field: Total length of lines B. Depth D. Bacterial Analysis On-site system B. Instal]er Size 2. Manufacturer Absorption Area 2. Material Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank , Absorption area , Other contamination , Absorption area C. Absorption area to nearest lot line 39~' , Sewer Lines , EQ-034 (1/74) Page 1 of two pages _Page 2 of two ~ages - Req 't for Approval of Individual S Le§a~ ~)~s~ripti0n Lot 4 Block 10 Preuss Subdivision r & Water Facilities Comments ~x~l-'~'~7~pproval ,[~alid for one ~/r from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) L.~/MUNIClPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA FHA 2. Property Owner: Gordon W. Webber & W. L. Foreman ~LIJ~(~IPAUTY OF ANCHORAGE. DEPT. OF HEALTH & '~q~/IRONMENTAL PROTECTION AUG 1. t 1976 RECEIVED CONV × Mailing Address: 7529 Old Harbor Rd. Anchorage Name of Buyer: PO¥~ELL, Billy L. and Nancy K. Day Phone 333-5469 694-9056 Mailing Address: 4. Name of Lending Institution: Mailing Address: ?, O, Bo× 720 5. Name of Realtor or Agent: None Mailing Address: 735 Birch St. Anchorage, Ak. 9950~ay Phone 274-3828 862-2108 The First National Bank of Anchorage Anchorage, Ak. 99510 Phone Phone 279-4481 x288 6. Legal Description: Lot 4, Blk 10 Preuss S/D Location: Lucas Avenue, --Eagle River, Ak. 7, Type of Facility to be inspected: 8. Water Supply Type of Supply: Single Familv Residnece No. Bdrms. 3 Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well 394' Sewage Disposal System Type of System: Public Utility If Individual, date of installation Individual (on-site) Septic EQ-037 (1/74) Mary Ann Dodge 8/5/76