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Home My WebLink AboutPREUSS #2 BLK 1 LT 13Municipality of Anchorage`- On-Site Water and Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP141370 PID Number: 050-571-15 Dwelling: 0 Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑■ Upgrade Name: Larry & Rina Landaal ABSORPTION FIELD ❑ Deep Trench ❑■ Shallow Trench ❑ Bed ❑ Mound Address 20232 David Avenue Eagle River, AK 99557 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 $ GPD/SF 7.9 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.9 Ft. Gravel depth beneath pipe 4.0 Ft. Subdivision Block Lot Preuss No. 2 1 13 Fill added above original grade O Ft. Gravel length Ft. Township Range Section78* Gravel width 5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 780 Ft z 1 Ft. Well >100' >100' NA NA >25' TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 11,250 Gal. Surface Water >100' >100' NA NA Material Number of compartments Lot Line >5' >10' NA NANA Steel Two Foundation >5' >10' NA NA LIFT STATION Manufacturer Capacity Curtain Drain None Noted Gal. RemarksExisting Septic Tank Decommissioned Pump on level at in. Pump off level at in. High water alarm at in. in Accordance with Municipal Code. Existing Absorption Trench Abandoned Pump make and model Electrical Inspections performed by in Place. PIPE MATERIAL House to tank D3034 Tank to drainfield D3034 Installer Stuart Gilbert Drainfield D3034 CO/MT Inspector W. Roberts BENCHMARK (Assumed elevation) 100.0 ft Inspeection 9/10/14 10/24/14 Location and description 2n 3`d 10/27/14 4"' Top of Gas Meter. COMMUNITY DEVELOPMENT DEPARTMENT APPROVALAW ' ,® Conditional Approval: Date AV .'� •� AV* : 4.9TH� � d e e.o`e/_•�.:� j ee.• 00... .e... ...00 ...e 10 90 v0- MICHAEL E. ANDERSON - ♦®� Jam.,• CE - 4381 �••��`�AV oJt�'9` C9-�&Date /bbolq �,1m®�e®a\ Approved em'' +s inspection Fteport_a-i-iz.doc *Center Line Length of Trench. Municipality of Anchorage Page 2 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904 PID No.: 050-571-15 Permit Num4r: OSP141370 11 DAVID AVENUE 1 1 1 1 1 I I 134.30 I I I I ®Existing Well PREUSS SUBDIVISION NO. 2 I LOT 13, BLOCK 1 C) i A I B C S1 15.0' 56.8' i ' : • / S2 13.3' 66.0' o .' �� C5 14.7' 38.6' i 0 C6 53.1' 23.4' /' 20232 M1 13.4' 36.4' DAVID AVENUE �� C7 58.0 1 36.9 i !' a .a Four �' Ln MI 53.2'128.4'1 ` Bedroom ' Home Co LOT 14 '��,, LOT 12 ,'�' 2CO '------------- O S1 Septic S2 2Co / Area C6 TH 1 M1 Septic I LEGEND 1� M2 ,, I Area S1 — Septic Vent I CO — Clean Out 1 I I I M1 — Monitor Tube I TH — Test Hole C7---------J I FCO — Foundation Cleanout Existing Absorption Trench. I 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 10' UTILITY EASEMENT — — — — — 1 1 NOTE: .��.►�rrr�, OF ,qi .�� Drawing Not Completed with C,ft A�••1,� Surveyed As Built. NOTE: . 1♦ Locations Are Not Exact. Existing 1,000 & 500 Gallon Septic Tanks Decommissioned in 'W_ ♦ Accordance 49th �••••............. • ••••••••• •••••• with Municipal Code. 1-�.-� PLAN AS-BUILT p • • 0 MICHAEL E. ANDERSON'] ♦1 �,' ti i SCALE 1" = 30' No. CE-4381 ;' Aw • �FESSL•' LOT 6 Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT 4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number: OSP141370 2.7 96.4 UUcli UU [�mshed Ground 2" Insulation 1,250 Gallon Septic Tank 92.5 Page 3 of 3 PID No. 050-571-15 10-17-14 m U U 26' (Trench Length) PROFILE AS -BUILT No Scale 91.3 91.3 T"'"~ MUNICIPALITY OF ANCHORAGE DE...RTMENT OF HEALTH AND HUMAN SER..,ES Environmental Health Division ~, ..... 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NameDISTANCES ^..,ess TANK FIELD WELL AS-BUILT DIAGRAM (Show I~at~on ol ~ell. septic system, prope~y hnes, loundahon. TYPE OF SYSTEM ~ ~ ' ' "~ RENCH ~ BED ~ W. DRAIN Q OTHER I WELLS--1 I ~ PRIVATE ~ OTHER (Identify1 ) REMARKS: 7'2-013 (3/85) HUNICIF'ALI'FY OF AIgCHORAGF- DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 ON--SITE "SEWER PERMIt- ' PERMIT NO: DATE ISSUED: 850645 10/01/85 APPLICANT: ADDRESS: CONTACT PHONE: LEGAL DESCRIP: LOT SIZE: MAX'BEDROOMS: KEN TRAVERS 5555 DENALI ST. ANCHORAGE, AK 99503' 274-7557 SUBDIVISION: PREUSS SECTION: 8 TOWNSHIP: 14N 0.5A (SO. FT. OR ACRES) 4 LOT: 15 BLOCK: 1 RANGE: 1W Listed below are the options available to you in designing your septic system. Choose the option that best fits your site. TRENCI-I BED DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0 GRAVEL DEPTH (FT.) 6.0 0.5 TOTAL DEPTH (FT.) 10.0 4.5 GRAVEL WIDTH (FT.) 2.5 22.0 GRAVEL LENGTH (FT.) 50.0 41.0 · GRAVEL VOLUME (CU.YDS.> 50.1 55.5 TANK SIZE (GALS) 1,250.0 **' 1,250.0 ** SOIL RATING (SQ. FT. /BR) 150 150 W.'DRAIN 4.0 5.5 7.5 5.0 65.0 48.2 1,250.0 ** 150 ** TANK MUST HAVE.AT LEAST TWO COMPARTMENTS I certify that: 1. I am familiar with the pequirement~ for on-site sewers and wells as set' forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. 'I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 5. I will adher~ to all MOA and State'of Alaska requirements ~or the set.bac~ distances from any existing well, wastewater disposal system or public 'sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 4 bedrooms and any enlargement will require an additional~permit. ' 'IF: A LIFT STATION IS INSTALLED~IN AN AREA COVERED BY MOA BUILDING CODES,' .THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST-BE OBTAINED; (2) AS-BUILTS 'WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (5) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED . _~~~.~ ' '. DATE: i AF'PLICANT: KEN TRA~ERS "ISSUED DY ~~_._~. ' ~/~-~ DATE: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST SOILS LOG PERCOLATION TEST LEGAL DESCRIPTION: 1 4 9 10 11 12 13 14 15- 16- 17- 18- 19- 2O DATE PERFORMED: COMMENTS SLOPE SITE PLAN 1 ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE ~/j~t (minutes/inch) TEST RUN BETWEEN FT AND , FT ,SR~ I~C,X, PERFORMED BY: .-- '~!,E ]~ ~/ER. AL~S~f~. ~'~*~'-'~ 72-008 (6/79) CERTIFIED BY: DATE: ~ '" MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION [[~.~ [~'. ~) ,- ENVIRONMENTAL ENGINEERING DIVISION ~ ~1." ~ 825 L Street- Anchorage, Alaska 99501 Telephone 264~720 ~~ oN-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~ UPGRADE u,. ~ DISTANCE 'O: IWell /~/ I Abs°rpt'°n area~ ' D--lling ~ Liq. ca~allons IF HOME.DE: Inside length Width Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. ~ ~ ~ Manufacturer Material Liquid capacity in gallons ~ · ~ No. of lines ~ ~ TOp of ti/e to finish grade q ~ Material ben,ath til~q ~ inche, Lengt~ Width Depth PERMIT NO. ~ ~ Ty~e of crib Crib diameter Crib depth Total effecti~ absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTH E R PiPE M~TERiALS REMARKS t . APPR~ DATE LEGAL 72-01 ev. 3178) MUNICIPAUTY,P~.%NCHORAGE STATE 0t ALASr~ RETURN'TO:' 'Ol~lslon of Oeologlcal end ~ '\yslcaJ Surveys (DGGS~ DEPT. 0~r L~LTH & DEPARTMENT OF NATU~L RESOURCES 3~1 Porcupine Drive (Tel~, .ne: 277-661S) E~/RO~ENT~c F~OTE~ION Anc~rage, Alaska ~501 ~ ~ ~ ~AT E R ~E L L RECORD -- Orllllng Permit No, ta. Borough Subdivision Lot Block ' lb. Fraction Section No. I lc, Distance and Direction fr~ Road Intersections ]. O~ER Or ~LL:~jCr~ Address: ~:~ · ~ e ~O:~ Street Address and Area of ~ell Location ~&t~ ~Y~I ~L~'Le 2. ~LL LOG Feet 8el~ ~. ~LL DEPTH: (c~leted) Surface Elevation 0ate C~letlon Su,9~. 128 ft. -- ~ ~terlat Type Top ~tt~ ~[VL Cs ~C' 5. ~Czble t~l ~,~Rotary ~Orlven ~Oug ~ ~:.t ~C' '/'/ ~ Auger ~ Jetted ~red ~Ot~r: J Clear ~Cd ~V!' Q~ loc, ~lrrlgatlon ~Rec~rge ~C~rclal Til~ ,~O~ ] P? ~Tesc Well ~Other: Grvl 1 P7 ] ~O In. to ft. Oepth 8. FINISH OF WELL: :. $1ot/~esh Size: Length: ., . . 1. Set bet~en ft. and Fittings: S. STATIC WATER LEVEL: C~q Ty~ o~ lO. PUMPING LEVEL bel~ land surface':~ ~ ft. after ~hrs' pu~lng r~ g.p.m. fi, after ~hrs' pumping ~ 11. ~LL H~0 COMPLETION: ~ In App~ved Pit ~Pltless Adapce~ inches a~ve grade 12. GROUTING: Veil G~uted: ~ Yes ~terlil: ~Neat Ce~nt ~ Other: I~. PUMP: (If avill/ble) HP 1/% Length of O~p PIpe ~ ~ ~ ft. ca.city ~ g.p.n Perforations at lO?-llO ]~. WATER WELL C0NTRACTOR~S C~RTIFICATION: Thls well ~s drilled under ~ ~urlsdlctlon and this re.ri Is true to the best of my kn~ledge and bellef: Reglstere~ Business Na~ Contract License Number Address: P.O. ~O~: ~O~F '~,~].4: ~ivez',~..~'~. "' ' .... 10. 1979 '' Authorized Representative Form 02-~ Copy,OJstrlbut'lon: ~HITE - State DOGS,. PINK -Orlller, :A~RY - Custo~r ; .. DEF'RRT£'IENT OF'"HERLTH AND Er,r,,~IRONr.£N,TRL PROTECTION · ; ' ' ' E:25 "L" STREET, RNCH~RRGE, r4 LL ON-- X TE P Rr.l[ APPLICANT DON ZII,lr,IERMRN .TR. BO 596 LOCATION DRVID LEGAL LOT 1~< BI F'RLIESS LOT SIZE 21~00 SQUARE FE TYF'E OF SOIL RE:SORBTION SYSTEH IS: TRENCH MRXIMLIM NUMBER OF E:EDROOHS = Z SOIL RFITING (SO FT/BR)= THE REO. LIIRED SIZE OF THE SOIL ABSORPTION S'T'STEI"I IS: [-:'EF'TH= ::1.1 L E r-,i G T I-I = -19 G F-' R'...' E L I::, E F' T I---I -~'-~, THE LENGTH DIMENSION IS THE LENGTH (IH FEET..`' OF THE TREr.,IC:H OR DRRINFIELD. THE DEPTH OF FI TRENCH OR PIT IS THE DISTRHCE BETHEEN THE SURFFIC. E OF THE GROUND FIND THE BOTTOH OF THE EXCRVFITION (IH FEET..`'. THERE IS IqO SE]' [4IDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE HINII',IUM DEPTH OF GRAVEL BETHEEN THE OUTFRLL PIPE · FIND THE BOTTOM OF THE EXCRVRTION (IN FEET..`'. F'ERHIT RPPLICRNT HAS THE RESPONSIBILITY TO INFORI'I THIS DEF'RRTMENT DI_IRING THE INSTR_LFITION II",ISPECTIONS OF ANY HELLS RDJRCEHT TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THAT THE I.,[ELL 14ILL SERVE. TI-..I~3 < 2 > 1' I'-.1'---"'; F' EIDT ! ~al"-.l$ RF-:E F.'E _¢-!LI 'r BRCKFILLIt,,IG OF AN':' S%"STEM [4ITHOUT FII'-,IRL INSPECTION RND APPROVAL BY THIS DEPFtRTI'IENT HILL BE SLIE:.TECT TEl F'ROSECLTION r'lll'.lll.lUH DISTANCE E:ETI4EErl R HELL AND FINY OrJ-SITE SEHRGE DISPOSRL SYSTEi,1 IS · 1DA FEET FOR R PRIVRTE I,]ELL~ OR ::L50 TO 200 FEET FROM FI PUBLIC [.]ELL DEF'ENDING UPON THE TYPE OF PUBLIC I..]ELL. HELL LOGS FIRE REQUIRED RiND MUST BE RETURNED TO THE [:,EF'RRTMEHT HITHIH ~0 DRYS OF THE 14ELL COMPLETION. OTHER REOUIREMENTS MR':-' RPPLY. SF'EC:IFICRTIONS AND CONSTRUCTION DIRGRRHS ARE AVAILABLE TO INSURE PROPER IHSTRLLRTION. F'EF-'r.11 T E.?--:: F' X RES DE~gEr. IBFF-' 3-1 .. -1'=,-79 I CERTIF°'r' THAT l: ] RH FRHILIRR HITH THE REQUIREMEHTS FOR ON-SITE SEHERS FIND [.]ELLS RS SET FORTH BY THE MUNICIPRLIT',' OF ANCHORAGE. 2: I HILL INSTALL THE SYSTEM IN ACCORDANCE HITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE 5EHER SYSTEM r,lRY REQUIRE ENLRRGEHENT I~ THE April 18, 1979 R&MNo. 951111 Mr. Don Zimmerman, Jr. P.O. Box 396 Eagle River, Alaska 99557 Subject: Soil Investigation for Sanitary Sewer System, Lot 13, Block Pruess Subdivision, Eagle River, Alaska Dear fir. Zimmerman: At your request of April 17, 1979, we conducted a subsurface soils investi- gation at the proposed location of the sanitary sewer system on the subject lot. The investigation complied with those procedures required by the Municipality of Anchorage Department of ~ealth and Environmental Protection. This investigation, which was accomplished on April 17, 1979, consisted of a test pit excavated to a depth of 15 feet below the existing ground surface. The test pit was sited according to your instructions and its location is shown in attached Drawing A-01. Excavation was accomplished with a backhoe. All material excavated was continuously monitored by an experienced engi- neering geologist. The topography at the excavation site is generally horizontal. At the time of the investigation the site had original vegetation consisting of aspen and birch trees. The top of the test hole was located at original ground surface. The soils encountered in the excavation are shown in the test hole log in Drawing A-01. This log displays specific conditions encountered at the test location. ~owever, subsurface conditions may vary in other parts of the lot without any apparent surficial evidence of the change. Groundwater was not encountered and bedrock was not encountered. At the time the hole was excavated seasonal frost was not present andpermafrost was not encountered. We appreciated this opportunity to be of service to you. Please contact us if you have any questions concerning this letter or if we can be of addi- tional service. Very truly yours, R&MCONSULTANTS, INC. Ernest R. Rahaim Staff Geologist GS/rm/12-U BORING NUMBER Date Completed: 4-17-79 SOIL D£SCRIPTION ORGANIC MATERIAL .5' SILT W/TRACE ORGANICS ,, I .5' SANDY GRAVEL, GW Numerous Cobbles 15'T.D LOCATION SKETCH David 60! Test Pit 1'~--'--12' 10' No Scale NOTE; DISTANCES SHOWN ARE APPROXIMATE AND HAVE NOT BEEN MEASURED BY SURVEYING METHODS, EXPLANATION '. ~'~ ~ ORGANIC MATERIAL ~o - Little Visible Ice 0~10' Vx =-.o ~Ss 72,5Z1°/o 85.9~cf ~0 ~5- I I ~WA~FR ~ ~ SAMPLg~ ~ BEDROCK ~F,eOZ£N 6ROUND TYPICAL SOILS LOG ~ S~ Z 4 " SP£1T SPO~I Wff~ 140 ~ H~MME~ S~ 1.4" $PL~ S~ON W/T~ 340 ~. HAMM~ A ~UGF~ ~MPLF SAMPEER TYPE SYMB~S ~ SOIL SYMBOLS IDWN. E.R.R. CKD. DATE. 4-17-79 SCALE. 5 5%u. H SOILS LOG }J Lot 13, Block l, Pruess Subdivision Eagle River, Alaska 951111 GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot. block, subdivision, section, township, range) Lng' 137 B,~n~,~ I? Location (address or directions) 20~32 David (b) Prope~ Owner De~ COX Telephone: Home (c) ~ending Institutioq ,. K~,~ Ba~k Telephone Mailing Address A~ION~ (d) Real Estate Company and Agent CEleRY Address. 2518 Telephone ' .~' Mail the HAA to the followin~ address: or: Check here List contact pemon and day phone number below. S ~ S E~GI~EERING/694-~979 ......... (e) o5' 5-7/ MUNIClPALI~ OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES *CERTIFICATE OF INSPECTION FOR HEALTH AUTHORI~ APPROVAL . '~ Applicatioq Date Business 17034 Eag[~ RZv~ Loop Road, Sult~ 204 Eagle Rlue~, A~6ka 99577 TYPE OF RESIDENCE Single-FamilyY~ Number of Bedrooms WATER SUPPLY Individual Well~ Community [] Public1-1 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~ Public [] , Community [] Holding Tank r'l Note: If community'well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and siatus. 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Pa^oJdd'es)a .~" paAoJdd¥ ,~q suJooJpaq ~ JOJ pa^oJddV 'WAOI:IddV SHHa '9. //g66 I~S.lV 'Je.q'8 ell~'~ aleO euoqdaleJ. ,')NI~gNION3 $ '~ S mJL-I jo amen · uo!loadsu! s!qt lo elep UO loalla u! suo!leln§aJ pue 'saoueu!pJo 'sapoo alelS pue ledp!un~ lie LII!M aoUe!ldtUo3 u! s! uJaisXs lesods!p JaleMalseM Jo/pue Xlddns JaleM el~s-uo cut 'uo~loadsu~ pue uo~ieS~Isa,u~ X~ moji pue saul aOeJoqouv lo Xl~ledp~un~ aql moji peu~elqo UO~le~JOlU~ eql uo paseq leql XjpaA JaqUn; I 'u~aJaq paleo~pu~ eJnlonJls lo edX1 pue s~ooJpaq jo Jaq~nu eq~ JO; elenbape pue leUO]iounj 'ales s~ ~alsXs lesOds~p JeleMeiSeM Jo/pue Xlddns JOleM al~S-UO aql leqJ SMOUS leAoJddV ~lpouinv qlleaH s~ql jo uotleS~lsaAu! ~m leql XjpaA I 'MOlaq UMOUS elep uo!lep~leA aU1 lo se pue olaJeq pax~lle leas ~m ~q pa~j~peo sv NOIlV~MO3NI ~NV V~VO 'HO~V3S gql~ 'S~Sg~ 'SNOI~OgdSNI ONIQIAO~d ~MI~ ONIMggNION3 ,c~O~.M~itNICIPALITY OF ANCHORAGE (MOA) O~H AUTHORI~ APPROVAL (HAA) CHECKLIST - FEBRUARY 19~ 2~744 Legal Des~iption' ~' Well Classification Well Log Present~/N) Total Depth ~'~ ~ Static Water Level Casing Height Above Ground Electrical Wiring in Condt~it~/N) Separation Distances from Well: tb~Ol ]~:)L1.~,,1.. If A, B, C, D.E.C. Approved (Y/N) ~f Date Completed ~ - \0--"~ Yield Cased to/ ! 'Z--t~! Depth of Grouting ('P~:~' Pump Set At t ~;'" Sanitary Seal on Casing(:[.~/N) "-/ "/' Depression Around Wellhead (Y~13::, r''-~' To Septic/H~dL,'~j Tank on Lot ~, c::~I''~ ; On Adjoining Lots To Nearest Edge of Absorption Field on.Lot [ C;~'''?'4- ; On Adjoining Lots To Nearest Public Sewer Line , r'3/-/L, To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by ~ ~" ; Date Water Sample Test Results SEPTIC~fl'I~N,13tN.G TANK DATA Date installed {~'/"7~ ~ t?~'Size ~,~---~ "~"C~_No. of Compartments '~ "~c::~"~ Standpipes~:~/N) . y Air-tight Caps~N) ~f Foundation Cleanout(~)N)... Depression over Tank (Y/~ r~ . Date Last Pumped '~- pumping/Maintenance Contract on File (Y/N) i t'~/}~ ; for - Holding Tank High-Water Alarm (Y/N) I'~/~; Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Ptold+~Tank: To Water-Supply Well ! C~C:, ~ To Property~lne... .... ~ c> ~. Course' · ..., To Building Foundation .... ~" ! ......... To Disposal l~ield '"' ~:; ~' ~' '~ To Stream, Pond, Lake, or Major Drainage 72-026 (Rev 8/861 Froml ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ c:p --*'Z.. ~'~" Width of Field Square Feet of Absorption Area Depression over Field (Y/~J:) Type of System Design ~-~-~-~ ,~ Length of Field ~ I Depth of Field ~ ~ Gravel Bed Thickness ' Standpipes Presen~N) '~" Date of Last Adequacy Test "~'-'~ ~"~ ~ Results of Last Adequacy Test ~ ~ - ~ Separation Distance from Absorption Field: To Water-Supply Well ~ C::>~ ~ To Property Line ! To Building Foundation ~ ~ To Existing or Abandoned System on Lot ~ C::~ , On Adjoining Lots ~ To Water Main/Service Line ~. ~ I.J¢. To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course ~ ~;~----~ To Driveway, Parking Area, or Vehicle Storage Area ~'~'~'{~:) ~ '42- Comments ~)aLeJ. D. stalled Dimensions Size in Gallons~~' Manhole/Access (Y/N) "Pump On" Level at ~'~.~.,.~ "Pump Off" Level at High Water Alarm Level at~ Vent (Y/N) Tested for Electrical Codes (Y/N) Comments dequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all M OAand HAA guidelines in effect on the date of this inspection. Signed S & S ENGINEERING Date ~"-//~' CompanYr~,~-..ti ~v~r. A'''~'' ~'~''~. ......... ~'OA NO. ~' ~ ~O~ ' Page 2 of 2 72-026 fRev. 8'~61 Back MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Dat~ 1. GENERAL INFORMATION (a) Legal Description (include lot. block, subdivision, section, township, range) Location (address or directions) __ ~ _ , ~ __ . / . {~) ~pplicant Uame~~ ~ lelephone: .ome~-~7 {c) ~pplicant i~ {chec[ one): [endin~ Institution ~; Owner/~; ~uyer ~; Other (d) Lending Institution Telephone Address (e) Real Estate Companyand Agent Address .~one (f) ~-MeTt~he HAA to the following a. ddres~: .. SRB 196X · .. TYPE OF RESIDENCE Single-Family,S' Multi-Family[] Other .Number of Bedrooms ~ WATER SUPPLY Individual Well~ Community[] Public[] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL , Onsile~. ' Public [] Community I-I Holding Tank [] ' Note:if community well system, must have Written confirmation from the State Department of Environmental Conservation attesting to the I~ality and status. Page 1 of 2 72.025 (11,64) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 shows that the on-site water supply and/or wastewater disposal System is safe. functional and adequa',e for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtaine~ 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. Address ~.:, ,~L~ ~uV~ A~S~ ~. Date PH. ~9~g Telephone 6., DHEP APPF " f' " , Approved or : _ bedroon'~ f Approved '~. ~,,': Disapprove~ -Terms of Conditional Approval '~/llfljI t~ CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional .engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions In order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 WELL DATA Well Classification '-?~.t'~ ~ Well Log Present Total Depth [. ~i~ [ Cased to Static Water Level ~:~ Casing Height Above Ground Electrical Wiring in Conduit Separation Distances from Well: MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) ~ - [- ] ~[ ~5 CHECKLIST - FEBRUARY 1984 Legal Description: If A, B, C, D.E.C. Approved (Y/N) Date Completed ~'- t O - ~'-~ct ' Yield L.[c)l ~' Depth of Grouting ~ Pump Set At ~---- ~,~ 4-- Sanitary Seal on Casing~/l~ Depression Around Wellhead ~ To Septic/Holding Tank on Lot [~:3(~t ~ ; On Adjoining Lots To Nea,rest~g~of Absorption Field on Lot Icao I~' '~'~; On Adjoining Lots To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by ,5,{[$ 'E.~,.~l,,.t~_~::C~..~,~ ~ Water Sample Test Results Comments H,/td~.. ~ To Nearest Public Sewer __ To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ~'o~O'~e[ Size Standpipes ~ Air-tight Caps Depression over Tank,,(,~"/~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course Comments · · No. of Compartments Foundation Cleanout ~/~ly Date Last Pumped /'~'-5'''*~'' ~J/'('- ;for ~'~/~ Temporary Holding Tank Permit (Y/N) To Building Foundation ~ '/ To Disposal Field ~"'! 'To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~;~ ~ o - ~ $, Width of Field Square Feet of Absorption Area Depression over Field ~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation /,3 ~ ~'' Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field Depth of Field ~,~" Gravel Bed Thickness Standpipes Present~/N)-' Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~ ' /- To Cutbank (if pre,sent) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) M/oimensi°ns le/Access (Y/N) //"Pump Oft' Level at '//~//.4 Vent(Y/N). //~ Pumping Cycles during Adequacy Test. Meets MOA Comments *' Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed "~'& ~.~.~ ,~I,..~..I~i~E~ N {~ Date Amount: $ ~ ~ Page 2 of 2 72-026(11/84) '"' DATE RECEIVED "' INSPECTION APPOINTMENTS ~~_~ TIME °: TIME TIME · DATE DATE DATE INSPECTOR INSPECTOR INSPECTO~ MUNICIPALITY OF ANCHORAGE MUNICIPALIW OF AN~O~GE DEPARTMENT OF HEALTH & ENVIRONMENTAL PflOTECTIO~EpT. OF I:~ALTH 825 L ENWRONM;NTAL SANiTATiON D, WS ON t AR 2 6 lg80 Telephone 2~7~ DIRECTIONS: Complete all parts o~t page 1. I~omplete r~u~ will not ~ pr~. Please allow ten (10) days for processing. 1. PROP~TY OWNER~ MAILING~DDRESS ~ PROPE~Y RESIDENT (~f different from ~)~ ' ~ 'PHONE MAILING ADDRESS 3. LENDING INS~UTION PHONE 4. REALTOR/AGE~ ~ · ~AILIN~ ADDRESS STREET LOC~TION 4) u ,'n 6. TYPE OF RESIDENCE , ~L.--SINGLE FAMILY MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four [] Two [] Five ' ~ Thre.~. [] Six [] Other 7. WATER SUPPLY ~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) S. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTI LITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY .~ 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [--I SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SiX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED PERMIT NUMBER 3. SEWAGE DISPOSAL SYSTEM []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic ]'aqk or [] Holding Tank Size: /~)0~ If Tank is homemade SOILS RATING give dimensions: ~:3,.~f ,,,, TYPE Of TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: ( ~7 t3 I ( 0 o Absorption Area to nearest Lot Line 5. COMMENTS ~ APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL {letter must accompany certificate) [] DISAPPROVED DATE BY 72.010 (Rev, 6/79) MUNICIPALITY OF ANCHORAGE Development Services Department ,.3r Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-571-15-000 Expiration Date: 1/10/2025 Legal description PREUSS #2 BLK 1 LT 13 Site address 20232 DAVID AVE Eagle River AK 99577 Current property owner(s) WILSON PARKER XThe On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 3/14/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE Development Services Department P p Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 050 571 15 Complete legal description PREUSS #2 BLOCK 1 LOT 13 Location (site address) 20232 DAVID Current property owner(s) WILSON 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: 9 Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 7 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench X Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 0 S C-2 Lf (O 3 y Waiver Fee $ Date of Payment 2 / 2 Li Date of Payment COSA # Waiver # COSA Application_ June 2022 COSA Checklist_June 2022 COSA Checklist Legal Description: Parcel ID: If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank Date of pumping Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Adequacy test date Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in Comments/Deficiencies: COSA Checklist_June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F.ENGINEER’S COMMENTS G.CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Phone Engineer’s Printed Name Date C&M ENGINEERING CHARLES BALZARINI, PE 1/23/24 3/14/24