HomeMy WebLinkAboutPREUSS #4 BLK 8 LT 2Preuss #4
Block 8
Lot 2
#050-572-48
r-ao ire iy 1111:04a �wicnorage vveezA rump mei 'au1L4�Jau/4L p.�
Well Drilling Permit Nuuiber. SW --
Parcel Identification hhiniber: 056-57,2 — q E
.Legal Description - — --- —
%lreuss F y 6 g L2 -
Pump Instan3 ltion Data, <';
Pump intake Depth Belovi "fon of Wel[ Casing: feet
Pump -Manufacturer's Name:
Pump -Model: 8 S I (452
Pump size -�1
�' hp
Pitless Adapter Burial Depth:
PMess Adapter Alanufacrur•e,-::ti"anie:
Pittess Adapter Tnstalier:
Well Disinfected Upon Compledon? ` ❑ No
`vl:ethod ofDisinfeenon-
Comments: � e
Pump Installer Name:
V� ')o i
Date o1 Issue:
Property Owner Name & Address:
Attention; The pump histuller shall pr vide• apurap installation log m the DSD wi-hin 30 days of pump irstallatic:n,
Development Services Department
Building Sao) ety Division
On -Site 'anter ,& Waastewataar Progrura
4700 Err,ore 'Mood
P.O. Box 196650
!Vrerk@egich.
Anchorage: AK 9950;3
Maycr
vo+nr.n_ni ora/orsiYa
(907) 343.7904
Pump Installation Log
Well Drilling Permit Nuuiber. SW --
Parcel Identification hhiniber: 056-57,2 — q E
.Legal Description - — --- —
%lreuss F y 6 g L2 -
Pump Instan3 ltion Data, <';
Pump intake Depth Belovi "fon of Wel[ Casing: feet
Pump -Manufacturer's Name:
Pump -Model: 8 S I (452
Pump size -�1
�' hp
Pitless Adapter Burial Depth:
PMess Adapter Alanufacrur•e,-::ti"anie:
Pittess Adapter Tnstalier:
Well Disinfected Upon Compledon? ` ❑ No
`vl:ethod ofDisinfeenon-
Comments: � e
Pump Installer Name:
V� ')o i
Date o1 Issue:
Property Owner Name & Address:
Attention; The pump histuller shall pr vide• apurap installation log m the DSD wi-hin 30 days of pump irstallatic:n,
Municipality of Anchorage Page 1 of 3
Development Services Department
OnSite Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW020196 PID Number: 050-572-48
Wee Land Builders
Wastewater System: New
Address:
1101 W. Fireweed Lane Anch., AK 99503
ABSORPTION FIELD
Phona: N°mbar°`Bear°oma:
727-3878 Four 4
Advantex Treatment System AX20 Mode 1A with Pod
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade:
6 GPD/Ft'
4 Ft.
Block: Lot: Subdivision:
8
Depth to pipe bottom from original grade:
Gravel depth beneath pipe:
2 Preuss No. 4
1 Ft.
.5 Ft.
Township: Range: Section:
Fill added above original grade:
Gravel Length:
4.5 FL
20 Ft.
Well: New
Gravel width:
Number of lines:
Distance between lines:
10 Ft.
3
3 Ft.
Classification (Private, A, B. Q.
Total Depth:
Cased to:
Total absorption area:
Pipe Material:
Private
18/10102
423 Ft.
385 Ft.
200 W
ASTM D3034 PVC
Driller:
Date Drilled
Static Water Level:
Installer:
Date Installed:
AI ine Driliin
69 Ft.
Acreage Systems
7/29-30/02
Yield: Pump Set at Casing Height Above Ground:
2 >2
TANK
GPM Ft. Ft.
SEPARATION DISTANCES
STEP Tank (Advantex)
To
Septic
Absorption
Lift
Holding
DublictPdvate
Manufacturer:
Capecky in Gallons:
From
Tank
Field
Station
Tank
Sewer Line
Anchorage Tank
1,500
Well
>100'
>100'
>100'
N/A
>25'
Material:
Steel
Number of Compartments:
Three 3
Surface Water
>100'
>100'
>100'
N/A
LIFT STATION
Lot Line
>5'
>10'
>10'
N/A
Sae:
500 Get.
Manufacturer:
Anchorage Tank
Foundation
>5s
>10
>10,
N/A
'Pump on' level at:
"Pump of level at:
High water alarm at
28 in.
28 in.
34in.
Curtain Drain
None
Noted
Pump Make 8 Model
Orenco
Electrical Inspections performed by:
Brick's Electric
Remarks:
Gravity Flow From C06 to Absorption Bed.
BENCH MARK
Location and Description:
Garage Slab
Assumed Elevation:
100.0 Pt.
Engineer's Stamp
•pouy1
OF.....
•.•�E
Inspections performed by: MEADates: 1a` 7/29/02
i,,,,;� .49th A.
.Intl 7/30/09
G
♦�^'; MICHAEL `E •'ANDERSON �"�j
Department of Health and Human Services approval
0 f :, No. CE-0381
RevDewed and approved by: Date: 7-103-
a'
♦♦i� PF •.................. ' �:•
•.•
♦♦♦11
`1k ESS\
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
Onsite Wastewater Disposal System or Well Inspection Report
Permit Number: SW020288
Legal Description: Lot 7A, Block 2, Upper Eagle River Estates Subdivision
LOT 1
25' S 89'58'57" E 163.33'
0
0
0
N
3
0
0
ro
0
0
0
Well
EXISTING
HOUSE
N 89'59'00" W163.33'
LOT 3
PLAN AS- UILT
SCALE = 30'
Page 3 of 3
PID No. 050-781-23
TH 1 Alternote
13 C5 Site
C3
i A i 8
C2 61.4 37.0
MH1 54.E 24.6
C3 68.2 37.9
C4 71.0 38.3
M1 65. 35.8
MI -12 67.9 47.4
0
0
0
N
3
0
0
ro
0
0
0
AEL E. ANDERSON
No. CE -4391 r'
Municipality of Anchorage Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number: SW020288 PID No. 050-781-23
I U 2" Insulation to Lig II Station
/— 101.3
� 100.1
Pod
2" PVC 2" Insulation to Cleanout
gg,2 1.25" PVC to Cleanout
96.5 96.35
97.4 —J L.�_J Lift Station
101.7
/ E U
20'
Sand From Quality Sand & Gravel in Wasilla Meeting Municipal Specification
PROFILE AS -BUILT
Scale: 1" = 10'
Geotextile Falor
c
fi
Grainfield
ock
2' Coors
Sand
96.2
20'
Sand From Quality Sand & Gravel in Wasilla Meeting Municipal Specification
PROFILE AS -BUILT
Scale: 1" = 10'
FROM : BRICKWELL FAMILY FAX NO. : 345-2923 Jan. 28 2003 09:00AM P1
11425 Aviora Street Anchorage, A1C 99516
State torUcenseVA624 MOA Contractor License #1976
1-28-03
To who it may concern:
Brick's Electric has performed all wiring necessary for the Orenco septic system at the foI-
lowing location:
Lot 2 Block 8
Preuss Subdivision
10225 Ronald Place
Eagle River, AK
All work performed as per current National Electrical Code
Sincerely, e44
4
William Brickwell— Owner
Phone: 907345-2923 a 1G'ax: 907-770-2933 'Cell: 440-9351
DM ALPINE DRILLING FAX N0. : 907 345 0202 Jan. 24 2003 11:21AM P1
Municipality of Anchorage
Department of Health and Human Services
825 "L' Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
Rick Mystrom http://w ,c;!.anchomge.ak.us
Mayor
Permit Number. #SW 020196 Date of Issue: 1-26-02 Parcel Identification Number: 505-724-8
Date Started: 8-4-02 Date Completed: 840 02 Is well located at approved permit location? ® Yes ® No
Legal Description: Preuss # 4 Blk 8 Lt 2
Property Owner Name & Address: Ken Jackson /Free -Land Builders
1101 W F!reweed Lane
Anchorage, Alaska 99503-1771
Borehole Data:
Depth (ft).
Method of Drilling ® air rotary ❑ cable tool
Soil Type, Thickness 8c Water Strata
From
To
Casing type: steel
Stick-up
0
2
Wall Thickness:_250 inches"
organic & silt
2
3
Diameter: 6 inches Depth: 385 feet
silly cobbly gravel w/bldrs
3
34
Liner Type:
silty sandy gravel wet
34
37
Diameter: inches Depth: feet
Casing stickup above ground: 2 feet
gravelly slit
silty cobbly gravel w/bldrs
37
42
42
70
Static water level (from ground level): 69 feet
Pumping level: 300 feet after
sandy sift wet
70
72
2 hours pumping 2 gpm
silty cobbly gravel w/bldrs
72
117
Recovery Rate: 2 gpm
gravelly sandy sift H2O
117
120
Method of Testing: air
Well Intake Opening Type:
gravelly sill 120 157
silty cobbly gravell w/bldrs moist
157
423
❑ Open End ❑ Open Hole
❑ Screened Start feet Stopped feet
® Perforations Start117feet Stopped 120 feet
Grout Type: Bentonite granular Volume: l bzs
Depth: Start 0 feet Stopped -: feet
Pump: Intake Depth feet
Pop size hp Brand Name
Well Disinfected Upon Completion? ® Yes ❑ No
Method of Disinfection: chlorine tablets
Comments: well is backfilled with native soil to inside
casing with a bentonite seahuside the casing at
appoximarely 360 feet_
Weil Driller. Alpine Drilling & Enterprises
PO Box 110496
Anchorage Alaska 99511
Attention: The well driller shall provide a well log to the property owner within 30 days of completion and the property
Received Time Jan,24. 10:12AM
MUNICIPALITY OFANCHORAGE p,14
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Date Issued: Jun 26, 2002
Expiration Date: Jun 26, 2003
Permit Number: SW020196 Parcel ID: 050-572-48
Legal Description: PREUSS #4 BILK 8 LT 2
Design Engineer: 0014 Anderson Engineering Site Address: 010225 RONALD PL
Owner Name: Ken Jackson / Free -Land Builders Lot Size: 19600 SQ. FT.
Owner Address: 1101 W FIREWEED LANE Total Bedrooms: 4 Permit Bedrooms: 4
ANCHORAGE , AK 99503-1771
This permit is for the construction of:
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 1BAAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
OMA U\ �1 �C 0 e o�
Date:
Date: 'Ooze'?
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. C)z5C)— e 7a — q ff Permit Number SWO20/96
Property owner(s) Ken Jackson/Free-Land Builders Day phone 333.6122
Mailing address (1) 3501 Hiland Drive Anchorage, AK 99504
Mailing address
Code
Legal description (Lot, Block & Sub'd.) Lot 2, Block 8, Preuss Subdivision Unit No. 4
Legal description (Section, Township & Range)
Lot Size 046c Acre S5?
THIS APPLICATION IS FOR:
Number of Bedrooms Four (4)
Sewer Only ❑ Well Only ❑
Sewer and Well ® Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
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.
(Signature of property owner or authorized agent)
Permit Fees: Waiver Fees:
Date of Payment: 6 & y16) z., Date of Payment:
Receipt Number: 2 (76 Receipt Number:
(Rev. 12/00)
June 23, 2002
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 2, Block 8, Preuss Subdivision, Unit No. 4
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 2, Block 8, Preuss Subdivision, Unit No. 4 intends to construct a four-
bedroom home on the lot. We are therefore requesting a permit be issued for the
construction of a new well and septic system to serve the proposed home. The
attached Site Plan and backup documentation identify the location and configuration of
the new well and septic system and the parameters used in the design. Also identified
on the plans are the test hole location and the locations of the wells and septic systems
in the area. Drainage arrows are also shown and current drainage patterns will be
maintained after construction. Shallow ground water and areas of surface water plague
the lot and some grading will be required to assure a minimum separation distance of
100' between any surface water and the new septic system. We are proposing use of
the new Advantex Treatment System with AX20 Mode 1A 40x94 Pod for this lot due to
the shallow groundwater and the presence of surface water.
The test hole placed near the location of the proposed absorption bed indicated clean
sand with varying amounts of silt and percolation rates of between 1 and 5 minutes per
inch. Groundwater was found during the placement of the test hole at approximately 4'
below the surface. The level dropped to 6' when measured on June 9, 2002. We are
therefore proposing to use the Advantex System with a 10' wide by 20' long absorption
bed on the property. The bed will be constructed 1' above the original ground surface
with coarse sand placed to insure a minimum separation distance of 4' to groundwater.
The ground surface on the lot slopes as shown on the attached Site Plan with fairly
shallow slopes from east to west. The new absorption bed will be constructed in
conformance with Municipal requirements and parallel to ground contours where
possible. All components of the new septic system will be constructed a minimum of 10'
from the water service line on the lot and 100' from all wells in the area. The system
will also be constructed a minimum of 1 00'from any surface water in the area.
If the system is constructed in accordance with our design the following statements
Lot 2, Block 8, Preuss No. 4
June 23, 2002
Page Two
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.
3. The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
4. The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
Al
Michael E. Anderson, P.E.
Attachments
49th /� •_'�
MICHAEL E ANDERSON
N., rC-ATRi
Lucas Avenue I a I PRWDSED WATER LINE 3
EL= EL=t0U.UD
BLK 81 0
WELL
L❑LOK
T 6
OT 6
BLK 7
VACANT
LOT 1 SEPTIC il j
Ji BLK 7
T 1 7.4 a -i? SEPTIC
H 1 7-1 �TOTH I
LOT 6 vR.v... PRI.Avy s—. . RESE ?VE SYSTEM
PW1t vote,
Public Vote'
PUoUC Vote,
P 1,� Voter
Pu ftc Voter
Puko, vote
SEPTI
BILK 7
BLK K
LOT 2
LOT
0
WELL
BLK It...__
BILK 11
BLK 11
BLK 11
BLK 11
BLK
LOT jA
__....._BLK
LUT E!A
LOT 3
LOT 4
LOT 5
LOT
SEPTIC
SEPTIC
....
....... .. ..
.. ......
0\\
W WE
ELL
SEPTIC
SEPTIC
SEPTIC
Lucas Avenue I a I PRWDSED WATER LINE 3
EL= EL=t0U.UD
BLK 81 0
WELL
L❑LOK
T 6
OT 6
BLK 7
VACANT
LOT 1 SEPTIC il j
Ji BLK 7
T 1 7.4 a -i? SEPTIC
H 1 7-1 �TOTH I
LOT 6 vR.v... PRI.Avy s—. . RESE ?VE SYSTEM
- - - -
AREA SYSTEM PLAN
SCALE 1" = 100' wo C-). OF 1% %
J. 49th
... ...... ....... ..... . ......
0
NOTE: No Conflicts With Wells or Septic . .. ......... .........
0# � 5 MICHAEL E. ANDERSON
Systems on Neighboring Lots. No, CE -4381 A_
—THIS P
0
C5
SEPTI
BILK 7
BLK K
LOT 2
LOT
0
WELL
BILK 7
LOT 7
0
WELI
0
LOT
0
SEP Ic WUL
L
Wo -L
LOT 7 0
I -
WELL
VDT7
BLK 7
LOT
L
BLK 7 T\�.
T 8
LOTS
L
L 8
0\\
W WE
ELL
- - - -
AREA SYSTEM PLAN
SCALE 1" = 100' wo C-). OF 1% %
J. 49th
... ...... ....... ..... . ......
0
NOTE: No Conflicts With Wells or Septic . .. ......... .........
0# � 5 MICHAEL E. ANDERSON
Systems on Neighboring Lots. No, CE -4381 A_
LOT 2, BLOCK 81
PREUSS SUBDIVISION UNIT NO.4
AdvanTexy Treatment System
'
CROSS,
p.E�HA5IMTMME
NOTE: THE BOARD N BE
INSTALLED OVER THHEI NS
OTANK& 4"
AX20 - Mode 1 a
6
ADVANTEX MANUAL
BEYOND ON ALL SIDES EXCEPT UNDER
THE ADVANTEX FILTER. THIS WILL ALLOW
40x94Pod
amass•
FOR HEAT TO ESCAPE FROM TANK &
RISE TO THE FILTER ABOVE R.
INLET
FIML
6" JIM CAP ADV/JiTFX
lrm.2j� `AX20 p0D
30 INCH
SYSTEM SECTION
NOT TO SCALE
• /*
49th A=
�0 Wit, MICHAEL E. ANDERSON
NOTE: SYSTEM MUST BE PLACED IN STRICT CONFORMANCE WITH #j�%T No. ce-436 p
MANUFACTURER'S RECOMMENDATIONS. �j n ••...__ __..••°' F
LOT 2, BLOCK 8, PREUSS SUBDIVISION NO.4
ABSORPTION BED
DESIGN FACTORS: SYSTEM REQUIREMENTS:
4 Bedroom Home Shallow Bed Disposal System
Pere. Rate: 1.5 Min./Inch 4 Bdrm. Advantex Treatment System
Application Rate: 4 GPD/SF 1' Total Drain Field Rock
4 Bedrooms X 150SF/Bedroom / 4 GPD/SF (Application Factor) = 150 Square Feet
150 SF/15 LF (Width of Bed) = 10 LF Length of Bed
Therefore: Construct an Absorption Bed Larger Than Design Requirements 20' in Length
and 10' Wide for a Total of 200 Square Feet of Absorption Area. Bottom of Distribution
Piping to be Placed 1.5' Above Original Ground Level. Peat and Organics to be Removed
to Underlying Sand. Place Clean, Coarse Sand to Raise Bed a Minimum of 4' Above
Groundwater. Bottom of Bed to be 1' Above Original Ground. Mound Over Bed to Provide
3' Minimum Cover or Provide 2' Direct Bury Insulation and 2' Minimum Cover to Prevent
Frost Penetration.
Natural Backfill
Geotextile Fabric
Monitor Tube
4
4" PVC
Schedule 4
i 2 I— 31 f' 3 --F 2'
SHALLOW BED DETAIL
(NO SCALE)
Rock
NOTE: Grade Area to Drain Away.
Maintain 6' Separation From Bedrock.
Provide 3' of Cover or 2" Insulation and 2' Cover.
Maintain 4' Separation From Groundwater.
Maintain 100' Separation From Private Well and Surface Water.
Ground
49th
MICHAEL E. ANDER`.
Nom CE -43W-
0
Coarse
. 00
. . 0i
i 2 I— 31 f' 3 --F 2'
SHALLOW BED DETAIL
(NO SCALE)
Rock
NOTE: Grade Area to Drain Away.
Maintain 6' Separation From Bedrock.
Provide 3' of Cover or 2" Insulation and 2' Cover.
Maintain 4' Separation From Groundwater.
Maintain 100' Separation From Private Well and Surface Water.
Ground
49th
MICHAEL E. ANDER`.
Nom CE -43W-
0
Municipality of Anchorage
Development Services Department/On-Site Water and Wastewater Program
4700 South Bragaw Street, Anchorage, AK 99516-6650
SOILS LOG - PERCOLATION TEST
Performed For: Ken Jackson/Free Land Builders - Date Performed: 5/26/02
Legal Description: Lot 2. Block 8. Preuss Subdivision No. 4
SLOPE SITE PLAN
1
10
11
12
13
14
OG/OL
SM
TESTHOLE Na 1
Some
Cobbles
South
Was Groundwater
Encountered?
Yes
If Yes, What Depth?
4'
Bottom of Depth to Water
Hole After Monitoring
6'
Date:
619102
See Site Plan
49th
VICHAEL --. ANDERSON
!'R0; -S510N�i
Perc. Rate: 1.5 Min./Inch Perc. Hole Diameter: 6"
21 Test Run Between 2.5 Ft. and 3.5 Ft.
Comments: Test Hole Presoaked Prior to Percolation Test.
Performed By: Mike Anderson. I, Michael E. Anderson Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 6123102
E
825 "L" STREET
ANCHORAGE, ALASKA 99501
(907) 264-4111
GEORGE M. SULLIVAN,
MAYOR
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
December 31, 1979
Don Gabbert
no mailing address
Permit # 790605
Subject: Lot 2 Block 8 Preuss Subdivision
A permit issued by this department for well and/or sewer
system has expired.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal ordinance.
if you have drilled the well, a well log should be sent
to this department to document the installation date.
If an engineer has inspected the installation of the
on-site sewer system, please have them send us the as-builts
for our files.
If there are any further questions, please contact this
office at 264-4720.
Sincerely,
r 4V kA, 6�
Les N. Buchholz,R..S.
Senior Environmental Spec' st
LNB/ljw
enc: Copy of Permit
n
too KITY KIZ1
I CERTIFY THRT
jI R|i FHMIL]HR WITH THE REQUIREMENTS FOR ON~SITE SEWERS HN� HELLS HS SET
FORTH BY THE MUNICIPHLITY OF HNCHORHGE
2 I WILL IMST8LL THE SYSTEM IN HCCORDHNCE WITH THE CODES
]' l UNDERSTAND THHT THE ON~SITE SEWER SYSTEM MGY REQUIRE ENL8RGEMENT IF THE
R�SIDENCE IS REMODELED TQ IOCLUDE MORE THHN ] BEDROOM&
HPPLICHNT DUN GHGBERT
��
DRTE ��-]�� V!"2
/
����J~���~Y������������
DEPHRTMEMT OF HE`,'!LTH HtsD ENVlRO�MENTHL PROTECTION
5TREET. HHCHORHGE, HK_ 99501
120
^
tip
2�4~47
ph 1 R J 1=1 10
PKI Y 7�
PERMIT
HPPLlCHNT DON
G@BGERT
LCIA? 7ION PRESS
& It R RD LOT
SIZE 20000 SQUHRE FEFT
LEGHL LT
2 BLK G PRUESS :E, -D
TYPE GF SOIL
HBSOR8TION SYSTEM IS� TRENCH
1110:110011110:110011110:11001NUMBE�
OF BEDROOMS - ] SOI| - R�TING
THE REQUIRED
SIZE! OF THE SOIL HBSORPTION 5YSTEM IS:
K.. IKE7 10 K0 -F 1-!- 012 50 0.1
T" 0FF 1� �
i±E IT`
11.121
THE LI&A NQTH
DIMENSION IS THE LETNGTH (IN FEET) OF THE
TRENCH OR D�HINFIEL�
THE DEPTH
OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN
THE SURFHCE OF THE
GROUND HND
[HE' BOTTOM OF THE EXCHVHTIO�
THERE IS NO
SET WIDTH FOR TRENCHES:.
THE GRHVEL
DEPTH lS THE MINIMU� yt' TH OF GR8yEL BETWEEN
THE OUTFHLL PIpE
HND THE BOTTOM
OF THE EXCHVHTION (lN FEET)
HHS THE RESPONSIBILITY T8 INFORM THIS
DEPHRTMENT DURING THE
PERMIT HPPLICHNT
INSTHLLHTION
INSPECTION5 OF RNY WELLS HDJRCENT TO THIS
PROPERTY HND THE
NUMBER OF RES]DENCES
THHT THE WELL NILL SERYE.
��������������� ����
1�14���������� ~~_
BHCKFlLLING OF
HNY SYSTEM NITHOUT FINAL. INSPECTION HND
HPPR8YHL BY THIS
DEPRRTMENT WILL
BE SUBJECT TO PROS�CUTION
|1INIhUM DIST8NCE
BETWEEN R WELL SENHGE
DISPOSHL SYSTEM IS
100 FEET FOR
H PRIVHTE WELL/ OR
�50 TO 200 FEET
FROM H PUBLIC NELL DEPENDING UPON THE
TYPE OF PUBLIC WELL
�THER
MHY HPPLY� SPECIFICHTIONS HND CONSTRUCTION
DIHGRHMS HRE
REQUIREMENTS
HVHILRBLE TO
INSUR� PROPE� INSTHLLRTION
too KITY KIZ1
I CERTIFY THRT
jI R|i FHMIL]HR WITH THE REQUIREMENTS FOR ON~SITE SEWERS HN� HELLS HS SET
FORTH BY THE MUNICIPHLITY OF HNCHORHGE
2 I WILL IMST8LL THE SYSTEM IN HCCORDHNCE WITH THE CODES
]' l UNDERSTAND THHT THE ON~SITE SEWER SYSTEM MGY REQUIRE ENL8RGEMENT IF THE
R�SIDENCE IS REMODELED TQ IOCLUDE MORE THHN ] BEDROOM&
HPPLICHNT DUN GHGBERT
��
DRTE ��-]�� V!"2
/ F-1 k -A" 1 I L 1••~"L_ 1 I -•r -• r n n ._• r-, n •� c
DEPART ,1-,. J' OF HEALTH AND ENV I RONMENA AL , PROTECTION
825' 'L' STREET, ANCHORAGE, AK.99503
264-4720
WELL n,r-aCa 0r-4 =•ELaEF= PEF=::t•7 I T
PERMIT NO. C
APPLICANT aUN G/i/S T Ups
LOCATION p2ves5 �1
LEGAL At, a I3/k 8' plz4ves5 S/c LOT _ I LE Xvo o-% , SQUARE FEET
TYPE OF =OIL ABSORBTION SYSTEM IS:
MAXIMUM NUMBER. OF BEDROOMS =3 SOIL RATING C S 0 FT w E -R
THE REQUIRED SIZE OF THE:SOIL ABSORPTION SYSTEM IS:
E e9d Ta ,(�JTOnn o F E�Ys7�iyU j�:T , l of[na x,
E7A EF:5_r /Q LEr-IlaTH= RC1 ��F---F1EL_ CHEF='TF4 5' .
THE LENGTH DIMENSION IS 71HE L, MOTH CIN FEET? OF THE TRENCH OR, DR•.AINFIELD.
THE DEPTH OF A TRENCH,OR PIT .15 THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM,OF THE EXCAVATION CIN FEET).
THERE I5 NO SET WIDTH, FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIP£
AND THE BOTTOM OF THE;EXCAVATION CIN FEET?.
Ft: E L,1 t1 I F E G• =• E F• T I c- -r n _- I � E = F 9��S�ieo-. r t� IL L_ C1 t -J
PERPIIT 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.
— — — T W t --i C 2 >, 'I t•a F~ E 0 T I I_+ r-4:5 H FRI E F=: E CA L_1 I F=.• E G8 — BACKFILLING OF ANY SYSTEM W I THO! iT FINAL INSPECTION AND APPROVAL BY THIS
I DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
I
aMINIMUM DISTANCE BETWEEN A WELL AND ANY Ota -SITE SEWAGE DISPOSAL SYSTEM IS
,,100 FEET FOR A PRIVATE WELL, OR
4150 TO 200 FEET FROM A PUBLIC WELL DEPENDING CAPON THE TYPE OF PUBLIC: WELL.
'WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN <<+ DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F='EFty I T E>4F• I F, E: GmE�Et-tE.EF�' 2::JL � _+
I CERTIFY THAT
is I API FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS _,ET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RES I DE14CE IS REMODELED TO INCLUDE MORE THAN r BEDROOMS.
_SIGNED
Applicant
ISSUED
V3. .
•
• E
•- 7.-r— Municipality of Anchorage
On-Site Water and Wastewater Program o;p�
(907)343-7904 SA ET1
Certificate of On-Site Systems Approval
Parcel I.D. 050-572-48 Expiration Date: t)i,Ai
1. GENERAL INFORMATION
Complete legal description Preuss #4, Block 8, Lot 2
hoc anon (site address) 10225 Ronald Place, Eagle River, Alaska 99577
Current Property tiwrier(s) Robert Springhill Day phone 907-205-7856
Mailing address
3239 Eastgage Place #25
Real Estate Agent ,� FSBO Day phone
•
•
2. TYPE OF DWELLING:
0 .:."Single`Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Q Individual El
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer El
/4
WaiverNariance request for':' Distance:
Received b ' Date: - 3 1 J
COSA to be releasifl tf/the engineer,unless otherwise requested by the engineer.
COSA Fee $ 5 ✓ Waiver Fee $ •
Date of Payment S/1?- ) 11 Date of Payment
Receipt Number 016/406) Receipt Number
COSA# C6(,11 1380 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.
Name of Firm Crewdson Engineering, LLC Phone 907-280-9493
Address PO Box 671389, Chugiak, AK 99567
Engineer's Printed Name James Crewdson Date 8-15-2017
Note: as engineer of record,the information I have provided on this form satisfies MOA CaOtb. Cin-Site
.i
Systems Approval requirements only, and does not include any statements or guaranlrt 's ge`k1, re
life and serviceability of the subject systems. 'C j ''• •. 1
6. DSD SIGNATURE % �! . rr�
�•.'4g ► , !�.: • , /
J System#1 Approved for 14 bedrooms / • ..
lSystem#2 Approved for bedrooms aes A. Crewdson
Disapproved /11' � 011527
. �•• .•v2�i
Conditional approval for bedrooms, with the following stif4680 SSIONP��
/+LIC, !lc 0
,0 OF AA A/
ON-SITE G'�`•;
WATER
AN
WASTEWATER O
•<2. PROGRAM
L;GR\y •
By: I\',��`-C„0.0 CA.X.USI Original Certificate Date: �1 /20 l
The Municipality of Anchorage Development Services Department(DSD) issues a Certificate 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 blue sheet j '- c
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: Preuss#4, Block 8, Lot 2 Parcel ID: 050-572-48
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Yes
Date completed 8-10-02 Sanitary seal (Y/N) Yes Wires properly protected (Y/N) Yes
Total depth 423 ft. Cased to 385 ft. Casing height (above ground) 24+ in.
FROM WELL LOG AT INSPECTION
Date of test 8-10-2002 8-14-2017
Static water level 69 ft. 99 ft.
Well production 2 g.p.m. 2.8 g.p.m.
WATER SAMPLE RESULTS:
Coliform ted colonies/100 mL Nitrate H. (oC1 mg/L
Arsenic N13 ug/L Date of sample: 44-2017 Collected by: Crewdson Engineering LLC
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Advantex/Steel Date installed 7-30-2002
Tank size 1500 gal. Number of Compartments 3 Cleanouts(Y/N) Yes
Foundation cleanout(Y/N) Yes Depression over tank (Y/N) No High water alarm (Y/N) Yes
Date of pumping Pumper * See attached Advantex maintenance report
C. ABSORPTION FIELD DATA
Date installed 7-30-2002 Soil rating (g.p.d./ft2 or ft2/bdrm) 6 gpd/sf System type Bed
Length 20 �� ft«� Width 10 ft. Gravel below pipe 0.5 ft.
A`�1 yl
Total depth 4.5 ft. Eff. absorption area 200 ft2 Monitoring tube Yes Depression over field No
Date of adequacy test 8-1i4-2.017 Results(Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorptior�,fpId before test 0 in. Water added 600+ gal. New depth 0 in.
Elapsed Time: min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N &type) None known If yes, give date
D. LIFT STATION
Date installed 7-30-2002 Size in gallons 500 Manhole/Access (YIN) Yes
"Pump on" level at 30 in. "Pump off' level at 28 in. High water alarm level at 34 in.
Datum Bottom of Tank Cycles tested 3 Meets alarm &circuit requirements? **Yes
**Alarm is in the Advantex Treatment System
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot '+ On adjacent lots 95'
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
Sewer/septic service line 25'+ Holding tank 75+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 6+ Property line 5+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain None Known Wells on adjacent lots 100'+
F. COMMENTS
"' See waiver OSP121159
G. ENGINEER'S CERTIFICATION r"t. OF A4gI'
�.kQ'•• fS' I
I certify that I have determined through field inspections and 1'y .' ��� .. li
review of Municipal records that the above systems are in % T f J.
�� ,//
conformance with MOA COSA guidelines in effect on this date. ? 9 a . /
'D 6 / • w r 5..
Engineer's Printed Name Z vv, S Cr WCLsd-m 3a es A. Crewdson .
/� 11527
Date 3.--14-1-/7 Vpz.'•K y,,,,•� _
Note: as the engineer of record, I haveprovided information on P?'
g �kVIOFESSION�
this form intended to satisfy MOA COSA requirements only, and \�.�:�
it does not include any statements or guarantee regarding the AL`C i ,as r
future life and serviceability of the subject systems.
COSA canary sheet_2-6-15_CE.pdf
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Annual Inspection 907-272-3543
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10726 Ronald PIS, Eagle River AK 9cts.*t I (5X97)612-810/P.
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nn ttxdio zr+cel:, ... Pep sboad Ulf Mimit
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ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
BETWEEN MUNICIPALITY OF ANCHORAGE
AND o+17 (t) . LZI H
15e-r
THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this
3 O Day of -Ap� Mz
, � of 20 (3 , by and between w„at/
1 J
herein the "OWNER,"and the Municipality of Anchorage, herein the
"MUNICIPALITY." In consideration of the mutual covenants contained herein, the
parties to this Maintenance and Repair Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. Municipality grants permission to
Owner to utilize and operate an Advanced Wastewater Treatment System
(AWWTS), described as
A van--Lx
located at(legal description).
Pre,A5s 9 &B La
2. Definitions.
Alteration. Any change to the design or function of an AWWTS that
includes the installation or removal of any parts,components or pieces not
included in the original construction permit and design.
Certificate of On-Site Systems Approval(COSA). An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with Anchorage
Municipal Code(hereinafter, "AMC") 15.65. These approvals certify that
the systems are adequate for the homes that they support and meet the
codes that were in place at the time of system construction.
Damage. Any man-made or natural change in a system that would inhibit
the system from performing as designed.
Maintenance and Repair. The scheduled and as needed replacement of
existing parts, components and pieces of an AWWTS that were included
in the original design which would allow the AWWTS to continue to
perform as designed.
Permit. An On-Site Wastewater Disposal Permit as required by AMC
15.65 to construct and operate an AWWTS.
3. Term. The term of this Maintenance and Repair Agreement shall begin on the
date of approval by the Municipality to operate the installed system or issuance of a
COSA, and shall continue while the AWWTS is in use or is operational or until the
property is sold or title is transferred by the owner and a new COSA is issued to the
new owner or transferee of the property.
4. Alterations, Installation and Removal of Additional Equipment. Prior to
performing any alterations to an AWWTS,the owner agrees to obtain an On-site
Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65.
5. Maintenance and Repairs.
A. Throughout the term of this Maintenance and Repair Agreement, the Owner shall
maintain their AWWTS in a satisfactory condition capable of producing treated
septic effluent in accordance with the equipment's approval for operation in the
Municipality. The owner shall enter into a service agreement with an AWWTS
service and maintenance provider approved by the municipality and the
manufacturer of the AWWTS for the entire term of the AWWTS. In addition, it
shall be the responsibility of the Owner during the term of this Maintenance and
Repair Agreement, and any renewals thereof,at the owner's sole expense,to pay
for any and all: (1)repair(s), (2) maintenance, (3)adjustment(s), (4) replacement
costs, and(5) inspection costs.
B. Owner agrees to comply with all applicable ordinance, laws, regulations,rules
and orders for the AWWTS.
C. Upon request by the Municipality,the owner agrees to provide the Municipality a
written schedule of routine maintenance and repairs which have been performed
on the system. When a record of maintenance is documented and maintained by
the system vendor,the owner agrees to allow the Municipality access to this
information.
D. Owner acknowledges that the fine for failing to maintain and repair an AWWTS
may be assessed in accordance with AMC 14.60 for improper discharge.
E. Owner agrees that only maintenance and repair personnel approved by the
Municipality will inspect and make any necessary maintenance,repairs or
permitted alterations to the system.
F. Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS upon 24 hours written notice.
G. Owner agrees that any sale or transfer of title of the property will not occur
without a new Certificate of On-Site Systems Approval.
H. Owner agrees that the AWWTS installation and maintenance requirements as
provided by the AWWTS vendor/installer and approved by the Municipality are
the governing guidelines for the construction,maintenance and repair of the
Owner's AWWTS.
I. Owner agrees to provide and maintain a telephone connection to the AWWTS as
required by the AWWTS approval.
6. Nonwaiver. The failure of either party at any time to enforce a provision of this
Maintenance and Repair Agreement shall in no way constitute a waiver of the
provisions, nor in any way affect the validity of the Maintenance and Repair
Agreement or any part hereof, or the right of such party thereafter to enforce each and
every provision hereof
7. Amendment.
A. This Maintenance and Repair Agreement shall only be amended,modified or
changed by a writing, executed by authorized representatives of the parties, with
the same formality that this Maintenance and Repair Agreement was executed
with, and such writing shall be attached to this Maintenance and Repair
Agreement as an amendment.
B. For the purposes of any amendment modification or change to the terms and
conditions of this agreement,the only authorized representatives of the parties
are:
a. Owner:
lw.o // (EvLJ( 1Ge r
b. Municipality: Director, Community Development or designated authority
C. Any attempt to amend,modify, or change this contract by either an unauthorized
representative or unauthorized means shall be void.
8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance
and Repair Agreement shall be brought in the Superior Court for the Third Judicial
District of the State of Alaska at Anchorage. The laws of the State of Alaska shall
govern the rights and obligations of the parties under this Maintenance and Repair
Agreement.
9. Severability. Any provisions of this Maintenance and Repair Agreement decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining
provisions of the Maintenance and Repair Agreement.
OWN_R:
,l
= ,„ cJ , (signature) Date: 33-6—242)/&
_A"r (print name)
STATE OF ALASKA )
) ss.
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this " day of
20/ff ,by llmorfty W. 7 u./ i-c.,G ".otim u1/4,_
3.• / ``�� ...S'''am
ARY P :LIC FOR ALASKA =S a0?AR Y
My Commission expires: /00h, PuBtG
1))))OF lAjpS`````�
MUNICIPALITY:
BY: Ig`'i(�('R CirtiteeP (signature) Date: 3/30/2 0 1
eeiDeeCk. (-ro(( (print name) Title:
If more than 1 septic system is on the lot:
COSA Checklist # _of_
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: PREUSS #4; BLOCK 8, LOT 2 Parcel ID: 050-572-48
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN)
Date completed 8/10/02 Sanitary seal (Y/N) YES
Total depth 423 ft. Cased to 385 ft.
FROM WELL LOG
Date of test 8/10/02
Static water level 69 ft.
Well production 2 g.p.m.
WATER SAMPLE RESULTS:
Coliform d colonies/100 ml.
Arsenic: 0 ug./L.
B. SEPTIC/HOLDING TANK DATA
Nitrate L-! -0 mg./L.
YES
Wires properly protected (Y/N) YES
Casing height (above ground) 24+ in.
AT INSPECTION
10/26/12
75 ft.
0.74 g.p.m.
Date of sample: 10/31/12
Tank Type/Material STEP/STEEL
Tank size 1500 gal. Number of Compartments 3
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO
Date of pumping Pumper N/A
C. ABSORPTION FIELD DATA *BELOW EXISTING GRAD
Date installed 7/29-30/02 Soil rating (g.p.d./ft or Ibdrm 6.0
Length 20
Width
Collected by: GEG. Ltd.
ADVANTEX SYSTEM
Date installed 7/29-30/02
Cleanouts(Y/N) YES
High water alarm (Y/N) YES
ADVANTEX SYSTEM
System type BED
Gravel below pipe 0.5 ft.
Total depth *4.58 ft. Eff. absorption area 200 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test **10/27/12 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added 632 gal. New depth 0 in.
Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d,
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE If yes, give date -
**DRAINFIELD WAS PRE-SOAKED WITH 1000 GALLONS ON 10/26/12 (APPROVED BY JEFF POET).
D. LIFT STATION
*SEE ATTACHED MAINTENANCE REPORT.
Date installed 7/29-30/02 Size in gallons 1500/500 Manhole/Access (Y/N) YES
"Pump on" level atTIMER 28 in. "Pump off" level atTIMER 28 in. High water alar level at 46/34 in,
BOTTOM OF TANK Cycles tested * Meets alar & circuit requirements? YES
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lob
Absorption field on lot 100'+ On adjacent lots
Public sewer main
Sewer /septic service line 25'+
Animal containment areas 50'+
100'+
i"1.7
Public sewer manhole/cleanout N/A
Holding tank N/A
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water, 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
*WR# OSP121159
G. ENGINEER'S CERTIFICATION
I certify that t have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSH guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date III,4/2
(Rev. 11105)
Municipality of Anchorage o
Development Services Department*.t,,
tLY t .a
Building Safety Division a
On -Site Water and Wastewater Program ;'
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-572.48 HAA #
Expiration Date:
1. GENERAL INFORMATION
Complete legal description Lot 2. Block 8, Preuss Subdivision No. 4
Location (site address or directions)
Current Property owner(s) Freeland Builders Day phone 727.3878
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
1101 W. Fireweed Lane Anchorage AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
Four 4
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
M
Individual On-site
M
❑
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 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the 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.
Name of Firm Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson. P.E. Date 2/512003
49th
MICHAEL E ANDERSON
No. CE -4381
5. DSD SIGNATURE
Approved for 4L bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Haartional comments— • DD'N�MA rte _
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Jam.
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date: rV
a f Z 02
(Rev. 12/00)
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
www.cl.anchorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 2. Block 8. Preuss Subdivision No. 4 Parcel ID: 050-572.48
A. WELL DATA
Well type Private If A, B, or C provide PWSID #
Date completed 811012002 Sanitary seal (Y/N) Y
Total depth 423 ft. Cased to 385 ft.
FROM WELL LOG
Date of test 8110/2002
Static water level 69 ft.
Well production 2 9 -
p.m -WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate 2.96 mg./l.
Date of sample: 111412003 Collected by: AH
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEP/Steel-Advantex
Tank size 1.500 gal. Number of Compartments 3
Foundation cleanout (YIN) Y Depression over tank (Y/N) N
Date of pumping
C. ABSORPTION FIELD DATA
Pumper
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) >24 in.
AT INSPECTION
ft.
Other bacteria 0 colonies/100 ml.
Date installed 7!2912002
Cleanouts (Y/N) v
High water alarm (Y/N) Y
Date installed 713012002 Soil rating (g.p.d./W or ft2/bdrm) 6 GPDISF System type Advantex
Length 20 ft. Width 10 ft. Gravel below pipe .5 ft.
Total depth .5 ft. Eff. absorption area 200 fP Monitoring tube Y Depression over field N
Date of adequacy test Results (Pass/Fail) For _ bedrooms
Fluid depth in absorption field before test _ in.
Elapsed Time: _ min. Final fluid depth
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
Water added_ gal. New depth_ in.
in. Absorption rate >= g.p.d.
4 If yes, give date
D. LIFT STATION
Date installed 712912002 Size in gallons 500 Manhole/Access (YIN) Y
"Pump on" level at 28 in. "Pump off' level at 28 in. High water alarm level at 34 in.
Datum Bottom of Tank Cycles tested New Const. Meets alarm & circuit requirements? Y
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot >100'
Absorption field on lot >100'
Public sewer main NIA
Sewer /septic service line >25'
On adjacent lots >100'
On adjacent lots >100'
Public sewer manhole/cleanout NIA
Holding tank NIA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line -2f Absorption field >5'
Water main NIA Water service line >10' Surface water >100'
Wells on adjacent lots >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10' Building foundation >10' Water main >10'
Water Service line >10' Surface water >100' Driveway, parking/vehicle storage >25'
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that t have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 21512003
w
HAA Fee $ 3%$ Waiver Fee $
Date of Payment 2-5--03
Receipt Number 3�0 % 3 'PJ'
(Rev. 12100)
Date of Payment
Receipt Number
MICHAEL E. ANDERSON
0
01/11/2000 19:46 9075226779 TBC / ANDERSON ENGR PAGE 02/02
25'
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LOT E, BLOCK 8 HAS
19,599.85 SQ.FT, OF AREA
LOT 1
89'58'57" £ 163.33'
EXISTING
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LOT3 GRAPWC SCALE, t &4h = 30 Feat
I 15 30 60
I
VERTICAL DATUM WAS ASSUMED
FOR: FREELAND BUILERS Date seat$ Legal Description
1-29-03 1" -- 30'
Lan Mark Grid Aa guilt Lot z Block 8
vaginvereg A m^trwn fta NW 58 2300188 PREUSS
9330 Suits M
Anohe uard Drive.
991507 Dram by Field Back SUBDIVISION
Cil 6e2-6050 - K.H. 195
I hereby certify that the property described harden bas been surveyed
by me, or at my direction, and that the improvements situated thereon
are within the property linea and do not overlap or encroach on the mW P,^ %k
property tying adjacent thereto unless otherwise shown. That no -t
istprovemente on the property lying adjacent ll a oto entrench on the '�,
premises in question and that Thera are no roadways. transmission :., rb' ' % it
lines or other easements on said property except as shown. - - --' - - - --- - -
it is the responsibility or the owner or builder, prior to construction, p CHARLES E. fORSES o
to verify proposed building grade relative to finish grade and utility m - i
connections and to determine the existence of any easements, covenants, ",.. LS -7326 z .,
or restrictions which do not appear on the recorded subdivision plat.
\Listed distances prevail over scaling, e�pP$f11 rsston$XV
Reproduction may cause distortion.
Municipality of Anchorage
P.O. Box 196650 • 4700 Elmore Road
Anchorage. Alaska 99519-6650 a (g071 343-7904 • Fax (907) 343-7997
http:llwww.m un i.org/Onsite
Development Services Division
On -Site Water and Wastewater Program
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSP121159 COSA#: Permit#:
PID#: 050-572-48
Legal Description: Preuss #4. Block 8. Lot 2
Engineer: Anderson Engineering
Applicant: Anderson Engineering
Your request for a waiver of the required 100 feet horizontal separation from the absorption field
to the private well has been approved. The approved separation distance is 95.0 feet.
This waiver approval applies to the existing absorption field and well only. Any future upgrade
to either system will require all separation distances be met or another approval from this
department.
® The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected
adjacent property.
❑ Adjacent properties are not affected by this waiver.
.................................................. a . . . . . . . . . . . . . . . . . . . . . . . 0....
Waiver is Granted: X Waiver is not Granted:Date: Cv aS� Approved b . ( `'
Name of Reviewer
......................................................... a ........... ..........
Rec#: NIA Amount: $0.00 Date Paid: NIA
**** VARIANCEIWAIVER REVIEW ****
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 '.FAX
(}SP la f) 5'01
June 24, 2012
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 2, Block 8, Preuss Subdivision No. 4
Well to Absorption Pit Waiver
Dear Onsite Services Engineer:
Oso-s?a-y9
Ko Ck rf
The existing well on Lot 2, Block 8, Preuss Subdivision No. 4 was constructed in August
of 2002. It was located by the well driller almost exactly 100' from the monitor tube in
the seepage pit on Lot 3, Block 8, Preuss Subdivision No. 4 to the south. The exact
configuration of the seepage pit is unknown and the location of the monitor tube in the
pit is also unknown. The exact distance from the edge of the seepage pit to the well is
impossible to compute, but is probably less than 100'. We are therefore requesting a
waiver allowing the well to remain 95' from the seepage pit.
The well on Lot 2 is 423' deep with casing to 385'. The pumping level is 300' below the
surface and the static water level stabilized at 69'. The well log indicates silty sandy
material nearly the entire depth of the well. Effluent from the absorption pit would
travel more than 250' through silty sandy soil before entering the aquifer feeding the
well. The possibility of contamination is remote.
The ground surface on the lot slopes to the southwest at 5%. We assume the water
table gradient flows in the same direction which is away from the well.
ADEC POINT ANALYSIS
Bottom of Absorption Pit to Highest Water Table (SWL) — 60' 5.50 Points
Soil Absorption Type — Silt or Sandy Silt 3.00 Points
Permeability — Silt with Sand 2.00 Points
Water Table Gradient - +5% 4.50 Points
Horizontal Separation — 95' 2.90 Points
TOTAL POINTS 17.90
Almost sure to be free from any form of contamination from household sewage.
Lot 2, Block 8, Preuss No. 4
June 24, 2012
Page Two
We therefore recommend a waiver be issued allowing the well to remain 95' from the
absorption seepage pit.
Sincerely,
Michael E. Anderson, P.E.
�:,e•49th �.. �5
MICHAEL E. ANDERSON
