HomeMy WebLinkAboutPREUSS #4 BLK 9 LT 4Preuss #4 Lot 4 Block 9 #050-572-56 3 Municipality of Anchorage Page of 3 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 I i Permit Number: SW0001 26 PID Number: OSO-522-56 Name: Wastewater System: ❑ New 91 Upgrade Curt Dahl Atldre10133 ABSORPTION FIELD Donald Place Ea le River-~ A Phone: 694-1262 No. of Bedrooms: Four (4) M Deep Trench ❑Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: 1 . 2 Total Depth from original grade: % GPD/So. Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe 4 9 Preuss 1 Ft. 1 6 Ft. Township: Range: Section: Fill added above original grade: Gravel length: - 2. 5 ' Ft. 42' Ft. Gravel width: Number of lines:.. Distance obggtween lines: WELL: ❑ New ❑ Upgrade 3' Ft 1 N/A FL Classification (Private, A,B,C): - Total Depth: I Cased To: Total absorption area: Pipe material: Existing Ft. Ft. 504 so -Ft- ASTM T)3034 PVC Date Drilled: Static Water Level: Installer:.rjtf31ta116/2/OO Ft. CCC Construction Yield: Pump Set at: _ I Casing Height Above Ground: - TANK- - GPM I Ft. Ft. SEPARATION DISTANCES X)Septic ❑Holding ❑S.T_EP. - To Septic - Absorption I Lift Holding ublic/Private Manufacturer.- - - - Capacity in gallons: . From - Tank Field Sta[ion Tank. -Sewer Lines Anchorage Tank 1,250 Material: Number of Compartments: welt x100' >100' N/A N/A 25' Steel Two 2 Surface >100 >100' N/A N/A N/A LIFT STATION — N/A Water Lot - j 5' Y1 �' N/A N/A. N -/A Size in gallons: Manufacturer. - Line I >'5 r >10 - N/A N/A N/A "Pump on" level at- "Pump off' level at: - High water alarm at: - Foundation Curtain _ Pump Make & Model Electrical inspections performed by: None ote.d n Lo Drain BENCH MARK Remarks: 21' Insulation Over Septic Tank. Location and Description: - Garage Slab Old Tank Removed From Site. - - Assumed Elevation: - 100.0 Ft ENG�INEFi';$4SEAL - AY Inspections performed by: MFA Dates: 1st 5/31/00 r I . 2nd 6/1/00 r. Department of Health and Human Services approvaly"_� r. 15�i T IS' 0 D yt� Reviewed and approved by: Date: 72-013 (Rev. 9/91) MOA 25 - - - - Municipality of Anchorage Page 2 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744 On -Site Wastewater Disposal System or Well Inspection Report Permit Number SW000126 PID No. 050-572-56 4Well Four Well Bedroom House C4 66.561.3 M1 57:0 60.0 PLAN AS -BUILT SCALE 1" = 30' 0 U W Municipality of Anchorage Page 3 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 -Anchorage, AK 99519-6650 - 343-4744 On -Site Wastewater Disposal System or Well Inspection Report Permit Number SW000126 PID No. 050-572-56 N �N oa n ul UU 2" 11 Insulation �II 1 , 250 Gal ep. Tank 94.16 1 194.0 24.8' 7' 1' M '3..' U � H 19' 3 35' PROFILE AS -BUILT 1"=10' PROFILE qa; tY RWi T8 i\�i _ 'p n 'kis _ oftt. I f I ki MUNICIPALITY OFANCHORAGE 5/31 loo 4 -/pry-) Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: May 25, 2000 Expiration Date: May 25, 2001 Permit Number: SW000126 Parcel ID: 050-572-56 Legal Description: PREUSS #4 BLK 9 LT 4 Design Engineer: 0014 Anderson Engineering Site Address: 010133 DONALD PL Owner Name: CCC Construction Lot Size: 19600 SQ. FT. Owner Address: PO Box 770647 Total Bedrooms: 3 Permit Bedrooms: 4 Eagle River, AK 99577 - This permit is for the construction of: FDisposal Field 7Septic Tank ❑ Holding Tank ❑ Privy ❑Private Well ❑Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Date: Issued By: �ir/`/ / Z'�v • ��"'( Date: �'� ✓�' O O May 21, 2000 Municipality of Anchorage Department of Health and Human Services 825 „L„ Street Anchorage, AK 99502-0650 Subject: Lot 4, Block 9, Preuss Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The existing absorption trench on Lot 4, Block 9, Preuss Subdivision has failed with effluent currently found on the ground surface. We are therefore requesting an emergency permit be issued to construct a new absorption trench to dispose of the effluent generated in the four bedroom home. The system was originally constructed in 1979 and has completed its. useful life. The existing septic tank will be exposed and inspected and, if necessary, replaced. The new tank would be placed outside the 100' protective radius of the well on the lot. A test hole was placed on the lot in early May which revealed well graded sand and gravel with a percolation rate of 1 minute per inch. No groundwater was encountered in the test hole, but water was noted at 11' during the ensuing monitoring period. We are therefore proposing a deep trench system with a maximum depth of 7' from original ground to, insure the 4' separation from groundwater is maintained. The lengthof the trench will be 42' with an effective depth of, 6'. A flow diverter valve will be placed: outside the septic tank and the old absorption trench tie in to the system for future use if the trench should dry out and rejuvenate itself. All effluent flow will be directed to the new trench after construction: The existing drainage on the lot is primarily from north to south at varying grades with some slope from east to west. The absorption. trench will be placed parallel to the slope on a grade ,of approximately 4% to 6%. Grading will be accomplished so drainage is away from the trench but in the direction of the current drainage pattern. If the system is constructed in accordance with our design the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if.constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed: in the future. I Lot 4, Block 9, Preuss Subdivision May 20, 2000 Page Two 3. The, system, if constructed as designed, will have no adverse impact on reserved 'space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage " patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. r,3 �s it Attachments'r q 5' .a."�`�?-`ate i S89'59'004 _1160.00 .67 X63.31 63.36 I I 1 C 51 i F � o fiI ,I s 2 I J o i l i I I 1 �I lil I II 4 ii 9 0 0 1 I o Q0 .',In.3 11- - d Avenue 25-' 2 212 �_._-�--- 5 51 1 ,I - l i I I 1 o Q0 a m it I a n. slit m p IIID .. III J O o :III W >r Ifs Avenue - 381.67. 72-1 — AREA MAP — -- _ SCALE 1" - 100' Exi A'eT Valve O� TH1 Four Bedroom House .ing 1 250 LC Tank O� n 4Effect X DipWA'de Grp ion Tre tt SCOPE OF WORK: Well 1. Expose and Verify Integrity of Existing Septic Tank. 2. Replace Tank if Unsuitable Outside Well Radius. 3. If Suitable, Place Second Chamber Cleanout. 4. Place Two Post Tank Cleanouts. 5. Place Zabel Flow Diveiter Valve. 6. Tie" In Existing Absorption Trench for Future Use. 7. Construct New Absorption Trench According to Plan. I- g SITE PLAN a..' SCALE 1" = 30' ✓vim' ». LOT 4, BLOCK 9, PREUSS SUBDIVISION DESIGN FACTORS: Four Bedroom Home Perc. Rate: 1 Mindinch Application Rate: 1.2 GPD/SF SYSTEM REQUIREMENTS: Deep Trench System Verify Existing Septic Tank 6' Drainfield Rock 4 Bedrooms X 150 GPD / 1.2 GPD/SF = 500 SF of Absorption Area 500 SF/12 SF/ LF of Trench = 41.7 LF Trench Length Therefore: Construct a Deep Absorption Trench System With One Lateral 42' in Length with 6' of Drainfield Rock Beneath the Distribution Pipe. Distribution Pipe in Trench Placed at 1' Below the Original Ground Surface. Total Depth to be 7' From Original Ground Surface. Insulate or Mound Over Trench to Provide a Minimum of 3' of Cover. Place Zabel Flow Diverter Valve and Tie Existing Absorntion Trench In To System For Future Use. Natural Backfill 5' 5' 6.0' Geotextile Fabric 4" PVC Holes Down Drainfield Rock 3:0' TYPICAL DEEP TRENCH SECTION (NO SCALE) NOTE: Grade Area Over Trench to Drain Away. 'aF tc �) Provide 3' Cover Over Trench and 4' Over Tank or Iraf>ii)te . Maintain 10' Separation From Lot Line. � �•. ��: c Maintain 100' Separation From All Wells j Ig - auxTIO Municipality of Anchorage Department of Health & Human Services 825 L Street, Anchorage, AK 99502-0650 SOILS LOG - PERCOLATION TEST Performed For: CCC Construction Date Performed: Legal Description: I of 4 Block q Preuss Subdivision SLOPE SITE PLAN 1 2 3 11 12 13 14 15 16 17 18 OG/OL GW/SW TESTHOLE N0.1 alo I 0 ao Was Groundwater Date Gross Time - Encountered? Yes - S If Yet, What Depth? No L Becoming Depth to Water O More After Monitoring 11.5' P Dense Date: - 5118100 E Bottom of Hole 5111 See Site Plan 4% Reading Date Gross Time Net Time - Depth To Water Net Drop 1 9 -May 12:00 11.5" 2 12:10 10 1.5" 10" 3 - 1211 12" 4 12:21 10 -2" 10" 5 - 12:22 12" 6 12:32 10 2" 10" Pere. Rate: 1 Min./Inch Perc. Hole Diameter: 6" 21 Test Run Between 6 Ft. and 7 Ft. Comments: Percolation Cavity Presoaked Prior to Testing. Same Material as Test Hole 1. Performed By: Tim Kimbrouah I, Michael E Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 5120/00 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 4, BLOCK 9, PREUSS SUBDIVISION GENERAL: The scope of this project includes the exposing and inspection of an existing 1,250 gallon septic tank. If the tank is found to be defective it must be replaced with anew tank placed outside the 100' protective well radius on the lot. Work also includes the placement of post tank cleanouts and a flow diverter valve open to the new absorption trench. The old trench will be tied in to the system for future use. New absorption trench construction consists of a new 42' long x 3' wide x 6' effective depth absorption trench to be constructed at the location shown on the attached Site Plan. The total depth from original ground of the new trench will be 7' below ground surface. Mounding over the trench will be required to provide a minimum of 3' of cover to prevent freezing. Insulation board may be placed over the trench with 2' of cover in lieu of 3' of cover. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D. H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION (IF REQUIRED) The new 1,250 gallon septic tank must be procured from an approved source and installed at the location shown on the plans. 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Lot 4, Block 9, Preuss Subdivision May 20, 2000 Page 2 of 3 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be:such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trenches to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). Lot 4, Block 9, Preuss Subdivision " May 20, 2000 Page 3 of 3 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5 in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. Hey ,,h andEnvironmentalProte,` ./ion Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 -- INSPECTION ioFPORC ON-SITE SEWAGE DISPOSAL SYSTEM_._______ NAME-_- Ll. 7r_. .. -.. . r,il, ING ADDRLSS-140".BMX._ LOCATION DG?.UAt--- SEPTIC TANK: DISTANCE NUMBER OF FROM WELL (viAl'dUF CTURER _.__---- TERI: I- -- f_ �J _� .4----COF:4PARTPAENI'S _-_ --- INSIDE LENGTH_,.__-_-__ INSIDE WIDTH------ -"__-_ _ LIQUIO DEPTH LIQUID CAPACITY, � A,LLOhIS. T11 nl�nlnl F j:j D• TOTAL LENGTHlr ` DISTANCE FROM WELL _��� _FOUNDAIION__�QNEAR[ ST LOT LINE OF LINE LINE / # Of Lines -__--______ DISTANCE BETWEEN LINES -____ 1 I �_.__-TRFNCH V/IDTH y _ IN. TO FAL EFFECT-IVE ABSORPTION AREA _30-o. SQ. FT. LENGTH OF EACH LINE _ r DEPTH OF FILTER �J DEP11: TOP OF TILL T -O F INISII GRADE _ (. - AIATERIAt HENEATII TIL F _(_-_ _'f?J- ABOVF fILF IN. SEEPAGE PIT: ---- -- DIAMETER ---_-__ OR WIDTH ------- LENGTIH_ DEPTH Log Crib _Rings_ Crib Size: DIAMLTEf2DEPni_ DISTANCE FROM: TOTAL_ EFFECTIVE BUILDING FOUNDATION , NEAREST LOT LINE . ABSORPTION AREA (WALL AREA) Well Jl ;'Iel Class: rk)AV, Depth i 1 j i I –r - Well Distance To: Lot Line I Bldg: Sewer Line: :_ f- iU1Pi Pipe Materials:- # of Bedrooms: ——_ Installer:P1�CAhJj Remarkkqs: I l!0 0 DATE I -3 11Z_ APPROVE WELL I 1 I T I I SQ. FT. MHX THE REQi]IRED SIZE OF THE SOIL HBSORPTION SYSTFM IS: �R:-;::, * j; * 1; � :11.: li . K_���il, j�' " �' :;; �son 001 W 07 0 .. ��NO, ��=: � THE LENGTH 0JMFNSION IS THE LENGTH (IN FEET) OF THE TRENCH OR VRHINFIELD, THE DEPTH OF H TRFNCH OR PIT IS THE DISTHNCE BETWEEN THE SURFACE OF THE GROUND HND THE BOTTOH OF THE FXCHVHTION (IN FEET), THFRE IS NO SET WIDTH F0R TRE�CHES, THE GRHVF| DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFHLL PIPE HND THE BOTTOill OF THE EXCHVHTION (IN FEET) owl J: ir �::;! )l i; limur"! 11... ��ji­:.f� A To wv�-- f 1 1100 tot U.. 1. . VIA 140 tb; 1- AM "D J! � 041 YIN 00" 19- 90 T- 1: 171141 YK low To! No! HR WE 10 1 .1 1 FAV WE Cy BHCKFI|1'ING OF MY SYSTFM WITHOUT F7NHL INSPECTION HND HPPROVHL FRY THIS � DEPHRTMENT WILL BE SUBJECT TO PROSECUTIOW MINIMUM DISTENCH BETWEEN H WELL HND MY ON-SITE SEWHGE DISPOSHL SYSTEM IS FEET F0R H PRlVHTEWEL} OR 200 FEET FOR H PUBLIC WELL � ~ � � OTHER RFQUIREMENTS MHY HPPLY, SPECIFICRT IONS HND CONSTRUCTION DIHGRHMS HRE � HVHILow LE TO TNSURE PROPER INSTHLLHTION. �1; �' jj j! ' 11' Al P D P[R 17 � WIT M psi Ev OR A To -1 ��WT 2: I CERTIFY THHT iI HM FHMILIHR 147TH THE REQUIREMENTS FOR ON-SITE SEWERS HND WELLS AS SET FORTH BY THE MISIICJPHL7TY OF HNCHORHGE 2: I WILi INSTHLL THE SYSTEM IN HCCORDHNCE WITH THE CODES ]: I UNDERSTHND THHT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLHRGEMENT IF THE RESIDENCE IS RFMODELFD TO INCLUDE M0RE THHN 4 BEDROOMS. Ail ISSUED BY�. 7 �....... ..... ....... ....... ~DHTE...~~. .... ...... .... ^_-�_..~.. � ✓ by A & L DRILLING COMPANY 1 BOX 97, EAGLE RIVER, ALASKA 99577 • TELEPHONE 694-2588 ! I7 OWNER OF LANDC,, a/o -lam t". raj Vz' DEPTH OF WELL Or 3 1' ADDRESS STATIC LEVEL OF WATER FT LEGAL DESCRIPTION -6—/—k— -IL-1-0- --I--"p DRAW DOWN FT. DATE - Started 146ri Ended / GALS. PER HR �0 PERMIT NUMBER 17 143 KIND OF CASING KIND OF FORMATION: From r'' Ft. to '^ Ft. Q G' ri 61) 4151V From Ft. to Ft, From Ft. to—Lt' Ft. �� �� From Ft. to Ft, From I LFt. to-11—Ft. ! (s(YrC,�/iUL� From Ft. to Ft. From 34Ft. to S ! Ft. f7` r K"i/ U I' E' From - Ft. to Ft. From !! Ft. to l Ft. `�` x ( r?" 62-4• From Ft. to Ft. From i 1 Ft. to (Li,) Ft. (/1 )/ uG'G t -6-01W& - From Ft. to Ft. From i :: / Ft. to le") Ft. 4 Aj `I' -9 From Ft. to - Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From - Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From—Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. MISCL. INFORMATION: DRILLER'S NAME MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ]0 DAYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE T8 INSURE PROPER INSTHLLHTIQV-k ���--1 1 "T- ���T 0---x F= r- F� ���� ���� I CERTIFY THAT I HM FHMILIHR WITH THE REQUIREMENTS FOR ON-SITE SEWERS HND WB -LS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTAL -1 THE SY'STEM IN ACCC)RDANCE WITH THE CONE"'S. SI ISSUED BY __~DHTE~ _^~ DEPARTMENT ` HEALTH AND ENVIRONMENTHL `�?OTECTlON � 825 ��� STREET/ HN�HORHGE, AK. 9L_�1 ^ 279~25�J. �4 F---- 9-_K�-EFF."M I PERMIT 77167 > �� ,\ APPLICANT LEE SUI LIVHW P Cl BOX 197 E. R. 694-2588 LOCATION DONHLD/DHVID LEGAL L4 B9 PREUSS SUBD LOT SIZE 0 SQUARE FEET MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ]0 DAYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE T8 INSURE PROPER INSTHLLHTIQV-k ���--1 1 "T- ���T 0---x F= r- F� ���� ���� I CERTIFY THAT I HM FHMILIHR WITH THE REQUIREMENTS FOR ON-SITE SEWERS HND WB -LS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTAL -1 THE SY'STEM IN ACCC)RDANCE WITH THE CONE"'S. SI ISSUED BY __~DHTE~ _^~ Ckarles 6a(zal+\tA1 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us S (907) 343-7904 ffERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. �SD`57z- �j6 HAA# 09uyso •'+, Expiration Date: 1. GENERAL INFORMATION Complete legal description-1-RENS5 "y Loi ZI 131 OCk 9 Location (site address or directions) 10133 bomJLD Ip"L•4Cc Current Property owner(s) _3-4SOAJ OMEN t�ANEIP Day phone _622-39$1 Mailing address . 10133 bo,yALD n! .4CAZ 944LC RRItle Ak IYS77 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well [� Individual On-site [� Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional 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. 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. Eagle River Engineering SerAM Name of Firm 10421 VFW Rd Suirn om Phone 1941-5115-- Address `941'511S Address Eagle River, AK 99577 Engineer's Printed Name GHRTSTOPHA2 r? ttkoll1 Date 7%2f/4.<— 5. DSD SIGNATURE _1z Approved for Lf— bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments �`; WATER AND :R'= Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: 7-2-2,-0-6-- (Rev -2-2,-0.S (Rev 01002) Municipality of Anchorage .,r; Development Services Department ...; Building Safety Division " On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: IOREN s 01 Lei 4 $Loci 9 Parcel ID: O SO-C7Z-56 A. WELL DATA Well type J,/ATE If A, B. or C provide PWSID # _ Date completed y /9/77 Sanitary seal (9N) Total depth 73-.5—ft. Cased to 4—n. FROM WELL LOG Date of test (41101,177 Static water level uNit: ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate q -4Y mg.A. Arsenic: AI� mg.A. Date of sample: —lky/o y B. SEPTIC/Met tt#G TANK DATA Well Log ON) _ Yt'r, Wires properly protected 6)N) /t5 Casing height (above ground) _0in. AT INSPECTION 7/1y 6r g.p.m. Other bacteria 0 colonies/100 ml. Collected by: C li01473 84LZ4rLAO ' Tank Type/Material$d/�TiG�s%fit L Date installed hIL01 1610 Tank size 12 $ O gal. Number of Compartments Z Cleanouts (Y/N) 1/E: S Foundation cleanout aa%IN) Y'S Depression over tank (Y/M ND High water alarm (Y/)) N D Date of pumping _tP&_1D9_ Pumper 1:11e f C. ABSORPTION FIELD DATA Date installed 610_11120 Soil rating (g.p.d./ft2 orft;tdwn) _2 System type beV TREX161 Length Y Z n. Width 3 ft. Gravel below pipe Total depth ft. Eff. absorption areaYftZ_So Monitoring tubes Depression over field NO Date of adequacy test _7//J6 Result (Pas Itdl) PASS For A bedrooms Fluid depth in absorption field before test J in. Water added gal. New depth in. Elapsed Time: 3-5—min. Final fluid depth Q in. Any rejuvenation treatment (past 12 mo.) (Y& type) Absorption rate >= 6*0 g.p.d. /fit'% If yes, give date VIA- D. LIFT STATION Date installed Size in gallons 'Pump on" level at_ in. `Pump_Qtglevej'al�n. Datum yclesllttested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: r Septic tankilittstatien on lot 'f Ivo , Absorption field on lot fI� Public sewer main t 7T r Sewer /septic service line 125 _ Manhole/Acces S f AHigh water alarm level at in. Meets alarm & circuit requirements? . r On adjacent lots r /� On adjacent lots + 1`00 Public sewer manholelcleanout 1F 100 r Holding tank t-1&0 r SEPARATION DISTANCES FROM SEPTIC/H9e5M TANK ON LOT TO: Building foundation + s r Property line —5r Absorption fiel r , Water main + ry Water service line i-10 Surface water Wells on adjacent lots 'f 100 r r d I- S + 1&0 r SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r r Property line 10 Building foundation f, t Or Water main Water Service line rlV r Surface water 'r -loo f Driveway, parking/vehicle storage 4 r Curtain drain i Sd Wells on adjacent lots '*/00 F. COMMENTS SYR&i D6'SL4iutb+7-43iM rcA 4 BQ- QcunRDS PvWr ITE S aQ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineers Printed Name 489XV~ Date �.&.I S— HAA Fee $ 3° a' 13% &S H Waiver Fee $ _ Date of Payment ,1�lloS Date of Payment Receipt Number ( 7b Receipt Number (Rev._ 12/01) UVU 8 h 9 Yr µ.rc zo � • i� �vey'.f3' sw /�J rr Q ti ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 694-0829 1 HEREBY CERTIFY -THAT I HAVE SURVEYED THE SCALE: FOLLOWING DESCRIBED PROPERTY:~��• .fpFq*��% �Ey11rU��.r�/Typ fi�oTS�eP� i DATE:......�•1 1 AND THAT NO FNCROACHMEfNTS EX(ST EXCEPT AS i`Q ' `r¢ 4 INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: / .�J •d EASEMENTS, COVENANTS, OR RESTRICTIONS Nws6 fi/L WHICH DO NOT APPEAR ON THE RECORDED SUBDIDuey Me rk SewerA VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB- I••. 15-G918 � ANY DATA HEREON BE USED FOR CONSTRUCTION 9� �`r ttrO�' •. '3�i OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. DRAWN:^747ew .vis 07-19-05;09:36 ; witt'Is-:41 I SCS Ret.0 Client Name Project Name/if Client Sampla lD h1stria Sample Remarks: 1054105001 Eagle River Engineering Preuss 04 Lot 4 Block 9 Preuss 94 Lot 4 Block 9 Drinking Water ;907 561 5301 All DalesMimes are Alaska Standard Time Printed Datt/Time 07/15/2005 11:37 Collected DatdTime 07/08/2005 12:40 Received Datt/Time 07/08/2005 14:47 TechnicalDircelur Stephen QEde # 2/ Miozobiology Laboratory TotalCol;rorsn 0 coV100mL SM2092220 A (<-1) 071005 TLP Allowsbto Prep Analysis Parameter Results PQL Units Medal Container ID Limits Date Dole Init Nitratc-N 4.84 0.100 mr/L EPA 3532 B ("10) 07/08/05 ?LW Miozobiology Laboratory TotalCol;rorsn 0 coV100mL SM2092220 A (<-1) 071005 TLP -� Alunicipality of Anchorage oso _ • Development Services Department �( Building Safely Division On -Site Water and W,aslewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AR 99519.6650 www.ei.anchorage.ok.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D. 050-572-56 HAA# f -{A ('):Z ©�,Q_� Expiration Dale: 2- a O- 6 Z 1. GENERAL INFORMATION Complete legal description Lot 4; Block 9; Preuss Subdivision #4 Location (site address or directions) 10133 Donald Place, Engle River Current Property owner(s) Dennis Jorgensen Day phone 696-2209 Mailing address PO Box 566 Soldotna, AK 99669 Lending agency Mailing address Real Estate Agent Mailing Address Kathi Olmstead Unless ofhenvise requested, HAA will he held by DSD for pickup. 2. NUMBER OF BEDROOh1S: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone 696-2209 TYPE OF WASTEWATER DISPOSAL: Individual On-site lu Individual Holding lank ❑ Community On-site ❑ Public Sewer ❑ 16 - .-_---- ------ - -. H .. The Municipality of Anchorage Development Services Department (DSD) Issues Certificates or Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal ehdlor water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date or 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 or up to one year with valid water samples.) Certificrales 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, 1 verify that my Investigation, based on procedures outlined in the Health Authority Approval Guldelines 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 Ilial based on the information obtained from the Municipalily of Anchorage riles and from my Investigation and Inspection, the on-site water supply and/or wastewater disposal system Is(are) in compliance Willi ail applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S h S Enoineerinp Phone 694-2979 Addressl7034 N. Eagle River Loop Earle River, AK 99577 Engineer's Printed Name Robert C. Cowan Dale U %/ k/ o 7 - MM MM r1 �� R09ERT C COWAN S. DSDSIGNATURE J CE -8-01 Approved for L bedrooms. t Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments WATER AND WASTE`"f,1TE4t--: PROGRAM Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report ',Veli Flow Advisory Other By: mIt 7 w Original Certificate Date: / ✓' - Lam% Me, R•MI I Municipality of Anchorage °.. ' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw, St P.O. Box 196650 Anchorage, AK 99519.6850 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LoT N 13"c y pe i PI # Parcel ID: O S'v -s 7 X -S- A. WELL DATA Well type/°RN#Ti It A, B, or C provide PWSID # = Well Log &N) y. J Date completed y�i1/77 Sanitary seal ®TI) J Wires properly protected ()Y N) J Total depth 21p fL Cased t0L3 /01r R Casing height (above ground) IS f- in. . FROM WELL LOG AT INSPECTION Date of test JY %1-7 % 11113107 - Static water level tl 1A( ft a 9 ft Well production Q g.p.m. 7.9g.p.m. Pin X- PwM,4,, ,- WATER SAMPLE RESULTS: e 4,4-r*0 6Y Coliform colonies/100 ml. Nitrate -4. y3 mg.A. Other bacteria colonies/100 ml. Arsenic: Date of sample: b /i 3 Ia 2 B. SEPTICIHOLDING TANK DATA Tank Type/Material 'St AT. - / d T t'i L - Tank size a Se gal. Number of Compartments Foundation cleanout&)Yil Depression over tank (YQ r ou Date of pumping // //6 A Z Pumper C. ABSORPTION FIELD DATA Date installed 4/2 /00 Soil rating g.p.d. r ft /bdrm) Length a ft. Width D • J- ft. Collected 4A 3 ENGINEERING 17034 Eagle Rlwr Leap Read Na 404 Eapto Rlwr, Alaska 99577 Date installed 6 /i / a o Cleanoutst%) YE J High water alarm (YAO N 0 System type 7114 f' c - W Gravel below pipe G R Total depth ff L ft. Eff. absorption area 1!!y fe Monitoring tube Ydl Depression over field N 0 Date of adequacy test It /13/e Z Results ail) /34 SJ For Jt bedrooms Fluid depth in absorption field before testA,�L in. Water added 6 a 11 gal. New depth Lly in. Elapsed Time: N/4 min. Final fluid depth M/* in. Absorption rate >= 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Nv,+d K,r o.r,— If yes, give date — D. LIFT STATION Date installed Size in gallons 'Pump on" level at_ in. 'Pump otr level at in Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: I ManholefAcces+ (r/tl) Fligh water alarm level at Meets alarm b circuit requirements? I Septic tankllift station on lot loo 4 On adjacent lots ) o o t Absorption field on lot /00 iL On adjacent lots /00 Public sewer main N /A Public sewer manhole/deanout N 1.4 Sewer /septic service line 3L S' r Holding tank N 1A SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: � � r Building foundation 40 t Property lineao •% Absorption field a a � Water main N 1A Water service line /0 f Surface water /06 Wells on adjacent lots /00 �+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /D Building foundation 3o i Water main N 1A r Water Service line 10 -f• Surface water / c o �t Driveway, parkinglveNcle storage O Curtain drainf''iN4 KNvOwr' Wellson adjacent lots, JOI F. COMMENTS ,�F of 3 S>,4 i G. ENGINEER'S CERTIFICATION y� I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in .F]l conformance with MOA HAA guidelines in effect on this date. µ l Engineer's Printed Name /� 0 B EAT C • Cd wA.✓ v�sr,, Ot . ,1�i2w Date !r / ! /0 7 - HAA HAA Fee $ 3 '?s-. r Waiver Fee $ hDate of Payment it If 06 2- Date of Payment Receipt Number o a g a'l 3 Receipt Number (Rev. 12JOI ) li} a a CUE Environmental Services Inc. AE" �.tt Cr&E Rct# 1027822001 Client Name S & S Engineering Project Name/# Lot 4 Block 9 Preuss #4 Client Sample ID Lot 4 Block 9 Preuss #4 Matrix Drinking Water PWSID 0 Sample Remarks: Parameter Remits All Dates/Times are Alaska Standard Time Printed DateJTlme 11/15/2002 15:15 Collected Date/time 11/13/2002 15:30 Received DateMme 11/13/2002 16:15 Technical Direct Stepb Ede Released By� Allowable Prep Analysis PQL Units MOW Limits Date Date Init Waters Department Nitrate -N 4.43 0.600 mg/L EPA 300.0 (<=10) Microbiology Laboratory Total Coliform 0 coU100mL SM189222B (<=I) 11/14/02 Is 11/13/02 KAP