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HomeMy WebLinkAboutPREUSS #2 BLK 1 LT 17Preuss #2
Block 1
Lot 17
#050-571-11
5UbMITTA1
Municipality of Anchorage 0 T 2 261
5
On-Site Water and Wastewater Program • (907) 343-7904 Page / of l
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number:OSP/S/3Z 8 PID Number: 050 5 7/a/
Dwelling: $Single Family(SF) ❑ Duplex(D) ❑ Multiple (SF and/or D) Project: ❑ New Upgrade
Name: ABSORPTION FIELD
7—e371it 3gNA1/A16's
Address Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
26038 -6AV/0 AVC ❑ Other
Phone ?�— Q /3 Number of Bedrooms Soil Rating /02 Total depth from original grade
O V GPD/SF /i/ Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneat pipe
Subdivision t c Block Lot 7 Ft. 7 Ft.
P�EVSc) 2 / Fill added above original grade Gravel length p
Township Range Section /`, Q. •5 Ft. 3 8 Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES 2, 5 Ft. — — Ft.
To Septic AbsorptionHolding Sewer Total absorption area Number of trenche Dist.between trenches
Tank Field Lift Station
From Tank Line 532 Fe Z 15.--1- Ft.
_
Well i — + TANK Septic ❑S.T.E.P. ❑Holding ❑Other
/ w `/QQ f5♦Manufacturer Capacity
�1
Surface Water !' t /1A/C C (z 4c, %�1/IJP /.2 S6 Gal.
DV ���� f Material Number of compartments
Lot Line /04. . _... -NA s XE/.
Foundation ZQ '� 2c. `14- LIFT STATION
Manufacturer Capacity
Curtain Drain — — Gal.
1� �Y Pump on level at Pump off level at High water alarm at
Remarks or G L U YiC�7-eMc f/ [f4/\ii'ii r
v//41 L/f/t42-7 .v
yA� E in. in. in.
532 l2 rT 2 4' /15W -g t/JC r1 Pump make and model Electrical Inspections performed by
7RR.nJc(I WA/c/ g_
WcZ.
PIPE MATERIAL House to tank p /G,$‘
Tank to
11
Installer /'V(--, drainfield
bF AN DrainfieldD 3(, CO/MO303cp
Inspector A/o1ZTme)44 ,EA/6 BENCH MARK (Assumed elevation) /0O ft
Inspection 1 /n / /�5 Location and description
dates: D<//Z! 2nd a/1331/J�" R ,'cfr boo ie S/GL
3rd /Q/03,/l.S 4th
r
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL I Engineers
oto .4/ ,1,%r
Conditional Approval: Date A.
.r„
r tt :4QTil 1/4 J•.
•.. ............
X44 iti•.fi o/ZiI is
Approved L�'JCft. Cs
c. � J Date 5/Z3/11 a f.r•-,-••,--
GULL)dSUM
Inspection Report_9-1-12.doc
I
AS-BUILT MEASUREMENTS
A B
DC01 37.5 60.5
ST1 44 72
ST2 49 79
DCO2 51 81
Diverter Valve 53 82
CO/MT 57 86
C❑2 66 59
MT(Old Drainf ield) 72.5 32.5
David Ave
1% 1 Slope
1% 1 Slope ♦ Well
h/�P Wel l
�qy o
R100
AWWU
Utility
Bldg 1% Slope
4 Bairn
:
New 1250 Gallon °g e
Septic Tank w/DCD's Seep
Diverter Valve To DC01 03c'
Old Trench 5 r I
le.y ------- Septic
Diverter Valve
CD/MT 3F ,CO2
Diverter
1 Slope THp 10' Utility Easement
Public Sewer 1/4 Slope
Septic
�r .1:.„• •,
••,1,1�a"„r� 1" = 40'
1C . 4 PREUSS # 2
NORTHR/M * 49m *V RECORD
ENGINEERING J �1 BL❑CK 1 L❑T 17
PO Box 770724 4'ki
;.,.E.,, LAYOUT
Eagle River, Alaska 99577 ,z_32,./s). WASTEWATER RECORD
907. 694. 7028 UPGRADE SEPTIC Date
10/19/15 'SHEET:of 3
Foundation Cleanout levation = 103'
levation = 97'
Tank Cleanouts
Fin ade Opposing Cleanouts Between Septic Tank & Trench
iverter Valve (`13N" To New Trench)
6 Foot Cover Elevation = 96.5'
levation = 98'
�" r--.-To End-Point of Trench
1250 Gallon Steel Cover To Match Terrain
'Anchorage Tank'
❑r Equal Monitor Tube
Solid Pipe
leanout
levation = 96.6'
I
Final Elevation = 103'+
& Original Grade
Filter Fabric
• I V :IP I:• il
;alai. 7.seeeleeR
Elevation = 96' r! rl../,.:../. i
7` P= i=1=i=1=1=1=' 14`
PA r-.r•.:.•:..:.•-..
/� /:I:.: .�...
Elevation = 89' Drain Rock ! '=•='=• '=/
is P: .: .%IP:- ItAtiWOZW.S.'
T H @ 824. r. !_I:..I.._I.
/__ 11_1_/:1_x_
- 3,
IL
:�P4 .°F
NORTHRIM �
N TRENCH END VIEW PREUSS # 2
ENGINEERING i* - ; SEPTIC TANK PROFILE BLOCK 1 LOT 17
17237 Bear Pow Circle y F„' .
Eagle River, Alaska 995772 fis - SEPTIC SYSTEM
907.694.7028 4 A �' SE ria' 1' = 53 of 3
RECORD UPGRADE 10/23/15 1EET.
S
1
S❑ILS LOG — PERC❑LATI❑N TEST
RI M
Date Performed: 10/1/15
NIRINEERING
Performed For: Tom Jennings
Legal Description: Preuss #2 Block 1 Lot 17
DEPTH
(FEET)
T,H, Location: See Attached Design
1 - Organic T.H. Deepened To 21' @ Construction
2 - :,a,::-,;:-.:.
3 -
4 - :,o':`. : SM Silty Sand
5 - ';
On -Site Wastewater Disposal System Permit
Permit Number: OSP151328
Tax Code Number: 05057111000
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Work Type: Septic Upgrade
Permit Effective Dates: October 09, 2015 to October 08, 2016
Design Engineer: NORTH RIM ENGINEERING
Subdivision: PREUSS #2
Site Legal Address: PREUSS #2 BILK 1 LT 17 G:0056
Owner/Address: JENNINGS THOMAS W III &
GRETCHEN B 20038 DAVID AVENUE EAGLE RIVER AK 995778749
olZ/ �;- 3', 3
Site Mailing Address: 20038 DAVID AVE, Eagle River Lot Size in Sq Ft: 25181
Total Bedrooms: 4
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Special Provisions:
The exact location of the septic field is unknown. If, during construction, the field is located,
I construction of the system will stop and a design change submitted to On -Site for review and
approval.
r _
Received
Issued By:
Date:
Date:
Municipalityof Anchorage Onepartmenol
P.O. Box 196650 •4700 Elmore RoadAnchoraoe: Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997
htto:Hwww.mu nLom1Onsite
Development Services Division
On-Site Water and Wastewater Proaram
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSV151132 COSA#: - Permit#: OSP151328
PID#: 050-571-11
Legal Description: Preuss #2 Block 1 Lot 17
Engineer: North Rim Engineering
Applicant: Jenninas
Your request for a waiver of the required 14 feet horizontal separation from the absorption field
to absorption field has been approved. The approved separation distance is 6 feet.
This waiver approval applies to the proposed absorption field only. Any future upgrade to the
on-site wastewater' disposal system will require all separation distances be met or another
approval from this department:
0 The affected adjacent property owner(s) have been given a.7 day notice regarding this
waiver.
Notarized letters) of nonobjection have been received' from the owner(s) of the affected
adjacent property;
Z Adjacent properties are not affected by this waiver.
Waiver is Granted: X Waiver isnot Granted
Dater Approved by: hzt
Name of Reviewer
•:...Y.YYY.•:...YY.....Y.Ya:.....Yl....••....a..•..•►r...•••..••. •:............Y. - - -
**** VARIANCEMAIVER REVIEW ****
Community Development Department
Development Services Division
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL
Parcel I. D. (} E D — S 71- /l
Property owner(s)4:_"' nn1A1S S
Mailing address 000Sda LAV14
Site address ,¢-MF
Legal description (Sub'd., Block & Lot)
Legal description (Township,
Range & Section)
Lot Size Zsi f�y/ Sq. Ft.
APPLICATION IS FOR:
(® all that apply)
Absorption Field
TYPE OF DWELLING:
Septic Tank
Single Family (SF)
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
SEP 2 2 2015
NE
C
one: 907-343-7904
Fax: 907-343-7997
Day phone < rW O
Number of Bedrooms _4
APPLICATION IS AN:
TYPE OF DWELLING:
Initial ❑
Single Family (SF)
(w/wo ADU)
Upgrade
Duplex (D) ❑
Renewal ❑
Multiple Dwellings ❑
(SF and/or D)
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
L p j G/,v,_ a- ,61 7_We,E6 cJ T;e'SAICt"1' Distance: S i9L
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
of property owner or
Permit/Rush Fees: q
Date of Payment: gt2
Receipt Number: o (o3 h,
Permit No. o5015132 -ti?
Permit App_9-1-12.doc
f
Waiver Fees:
Date of Payment:
Receipt Number: 09 0 (4 3 D
Waiver No. t5Vi5-1132
TH I� M
ENGINEERING MEMO
Steve Eng, PE, PH
P.O. Box 770724, Eagle River AK 99577
(907) 694-7028
SteveEngPE@gmail.com
Date: 9/21/15 Number of Pages: 5
To: MOA On -Site Services
Subject: Preuss #2 Block 1 Lot 17
Septic System Upgrade
An existing trench/tank has failed on the subject lot. A previous soil test was used for design -
attached. The design calls for a 12' deep trench, and a new septic tank. A diverter valve will be
installed and connected to old trench. The entire subdivision is on private water wells and mostly
septic systems. The terrain slope at the septic system is slight. The system size is a single family
at 4 bedrooms. Due to the limited space, we are requesting a waiver between the existing trench
and new trench ,
Please review the wastewater system design for the existing 4 bedroom home. I have included
design plans & specs, design guidelines, & soil tests. If there is need for additional information or
clarification please give me a call.
Thanks -Steve s'
ENGINEERING
Preuss # 2, Block 1, Lot 17
Wastewater System Sizing: This is an exfsifng 4 -bedroom, single family home. This is a
developed subdivision. These lots are large and are served by private water wells. No
adverse impacts are expected from trench/tank upgrade. No conflicts to the other lots
will take place by this septic system construction. The easements are located on the
drawing and are not encroached upon. A new test hole was completed- An application
rate of 125 FTI/Bdrm. Trench Length = 500 FTI/7 x 2 = 1 line @ 38'. A new 1250
gallon septic tank will be installed; Decommission old tank/trench per UPC. Install
Diverter Valve To Both Old And New Trench- "ON" To New Trench. Due to the limited
available space, we are requesting a waiver to the existing trench @ 8'.
Specification Requirements: All components and work must comply with the
Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water
Regulations and Wastewater Regulations.
• Two compartment, New 1250 gallon septic tank. Install new Double Cleanouts.
• 5' minimum between the tank and trench. 10' to property lines.
• 3' of cover or insulation is required for trench; 2" Minimum thickness for insulation
can substitute for 1' cover.
• Tank & solid pipe must be set on well compacted, stable soil.
• 4 inch diameter cleanouts with airtight caps are required 1' to 4' from foundation
wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two
adjacent opposing cleanouts between the tank and the absorption field, not more than
10' from the tank positioned to provide cleanout access towards the tank and towards
the absorption field.
• All cleanouts must extend to at least ground level.
• In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.
• Trench to be placed level, minimum of 4' to groundwater, 6' to bedrock from drain -
rock.
• Drain rock to be''/I inch to 2 '/I inch screened. Drain rock to be distributed uniformly
throughout the trench.
• Perforated pipe to be installed level with perforations down.
• Silt barrier (filter fabric) to be installed above the drain rock.
• Smeared trench sides must be raked or scarified before drain rock placement.
• Backfill over drain rock must not be less than 36".
• The finish grade must be mounded to promote drainage away from trench.
• Insulation must be placed over any pipe installed under driveways or parking areas.
• Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789,
ABS ASTM D2661,
• Sewer Service Line is minimum 2% slope.
• Septic Tank to be pumped every two years or when required.
• Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal)
DESIGN NOTES:
1. Total Depth of Trench is 12'.
Match Depth To Existing Drainfield.
2. Sewer Service Line minimum 2% slope.
3. Private Water Wells In Area In Addition To Some Public Utilities.
4. Decommission Old Trench/Tank Per UPC.
5. Diverter Valve After Tank. Connect To Old Trench.
"ON" to New Trench.
6. 5' Minimum Separation Between Foundation & Septic Tank.
7. 10' Minimum Separation Between Drainfield & Property Line.
8. 8' Separation Waiver Between New Drainfield & Old Drainfield.
David Ave
1%1 Slope
1%I Slope Well
Wel l
qy o
100
AWWU
Utility
Bldg 1% Slope
4 Bdrm
co
New 1250 Gallon
Septic Tank w/DC❑ s
Decommission ❑ld 0 c 0 Q�
Septic Tank Per URC Septic
-�Diverter Valve
1Y SLoiDe co MT/CO
TH10 10' Utility Easement
Public Sewer 1%1 Slope
Septic
A-,;. OF � PREUSS # 2
_�P .......... PLAN
NORTHR/M tu��
�
ENGINEERING �+ BLOCK 1 LOT 17
r
PO Box 770724 �Cagle Rlver, Alaska 99577 ' WASTEWATER DESIGNLAY❑UT
907.694.7028 UPGRADE SEPTIC o/7/15 12o* f 3
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S❑ILS LOG — PERC❑LATI❑N TEST
THI IL -
ENGINEERING
Performed For; Tom Jennings
Date Perf ormed: 10/1/15
Legal Descriptions Preuss #2 Block 1 Lot 17
1 -
2 -
3 -
4 -
5 -
6 -
7 -
8 -
9 -
10 -
11 -
12 -
13 -
14 -
15 -
16 -
DEPTH
(FEET)
Organic
SM Silty Sand
w/ Gravel
Dense
TA Location; See Attached Design
Groundwater? No
Depth --
Water Depth/S-
After Monitorino,None Date: 15
#
Date
Gross Time
Net Time
Depth
INet Drop
1
10/1
0
--
7"
--
2
10/1
10
10 min.
9,5"
2,5"
3
10/1
12
--
7"
--
4
10/1
22
10 min,
9,5"
2,5"
5
10/1
25
--
7"
--
6
10/1
35
10 min,
9,5"
2,5"
7
10/1
37
--
7"
--
8
10/1
47
10 min,
9,5"
2,5"
9
10/1
50
--
7°
--
10
10/1
60 11
10 min.
1 9.5"
2,5"
21 Percolation Rate 4 min,/inch Perc Hole Diameter 6"
Test Run Between 5' and 6'
Comments; Presnaked Measured to ne qt 1/16th inch.
Performed By NorthRim Eng, I CERTIFY THAT THIS TEST WAS
Performed in Accordance with All State/Municipal Guidelines in Effect
ON THIS DATE, DATE: 10/1/15
----------------
P�,•,.. axe,
NOR THRIM Vewo
ENGINEERING
PO Box 770724Eagle Rhw. Alaska 99577902694.7028 ' 6 i
TESTH❑LE LOG
GE❑TECHNICAL
TH1
rz
GRESER ANCHORAGE AREA BOGUGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME VJA-L ='2
&MA FF
MAILING ADDRESS(O42C E ICK 6-C40iA6f_
PHONE
LOCATIONI&VIJ
A05—LEGAL
DESCRIPTION to
f7 etccuc I py"s5
//��
�UD.
SEPTIC TANK: ULA` 201904
DISTANCE - Q NUMBER OF
FROM WELL MANUFACTURER vK�e2 MATERIAL VTee �- COMPARTMENTS Z
INSIDE LENGTH INSIDE WIDTHLIQUID DEPTH LIQUID CAPACITY �22 GALLONS.
SEEPAGE PIT: 04LSo 63' mlr Seefey /Y4mcI4 i' ell�!cftu-I deti4.
NUMBER OF PITS i DIAMETER Sbr OR WIDTH/&'�' LENGTH©©20� DEPTH fZ
LINING MATERIAL ' CRIB SIZE: DIAMETER�DEPTH� DISTANCE FROM: WELL 90'
TOTAL EFFECTIVE �.3L
BUILDING FOUNDATION_, NEAREST LOT LINE ABSORPTION AREA (WALL AREA) g SQ. FT.
jj
ADDITIONAL ABSORPTION �3o D` 1h S 4 ly?MC
fD7$
WELL:
TYPE L[CCC� CONSTRUCTION Jrftkn DEPTH
BUILDING 3S -r NEAREST
FOUNDATION -,LOT LINE
CESSPOOL -,OTHER SOURCES
APPROVED DISAPPROVED
DISTANCES:
All
INSTALLED BY:
PIPE MATERIAL:
(A ILAf mWWL" �.
LOT SLOPE:
REMARKS:
Form No. EQ -031
DISTANCE FROM:
NEAREST SEPTIC r SEEPAGE
SEWER LINE -,TANK I� SYSTEM ��
DATE 6
DIAGRAM OF SYSTEM
N
fe� a ♦♦♦
ak' P
E
14
w�
Y
GREATER ANCHORAGE AREA BOROUGH
Sy DEPARTMENT OF ENVIRONMENTAL QUALITY
PERMIT NO.
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT c� ySU f
NAME OF APPLICANT W�fJ'/I� ��`�L IC 6; RAF MAILING ADDRESS641 ,5 �` / 6 "' PHONE
INSTALLATION LOCATION [::_/) l/ t_ I1� X1,00. (J
LEGAL DESCRIPTION 6_n�J-7 i+ ( pfL" Coil
INSTALLATION OF: SEPTIC TANK 1/ SEEPAGE PIT
TYPE AND SIZE OF FACILITY TO BE SERVED�J�
FINANCED THROUGH
SOIL TEST RESULTS
COMPLETION DATE ANTICIPATED
TO BE INSTALLED BY
DRAIN FIELD , OTHER
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE /✓o—wi
TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT.—J= DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK , SEEPAGE PIT , DRAIN FIELD
TO NEAREST LOT LINE.
SEEPAGE AREA SIZE
WELL TO SEPTIC TANK /v v , SEEPAGE PIT
DRAIN FIELD ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK , SEEPAGE PIT
DRAIN FIELD
SEPTIC TANK, V/f 0 SEEPAGE PIT /D-" / DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGHH REGULATIONS REGARDING INSTALLATION. /
G.A.A.S.
OR
I LICENSED DESIGNER
TYPE
DIAGRAM OF SYSTEM
1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THEABOVE
^ESCRIIBED SYSTEM
IS IN ACCORDANCE WITH SAID CODE.
ITE '�.2 ` APPLICANT'S SIGNATURE V`� A
_I,RM NO: EQ -016
0 Et
E GEOTECHNICAL & DEVELOPMENT CO.
_
Box 90, Davis St.,. Eagle River, Alaska 99577 -
694-2774 or 688-2280
Russell Oysfer
694-2774
- - -. Earl Ellis
688-2280
'Soils Et Foundations
- - - Land Development
SOIL LOG
Performed for:
f
Name: KIA-roe 64F Tel. No.
Mailing Address: %S`Vr 6. /6'`—y /ode,, /g-VChFFQ410,6
Legal Description:
GoT 17, gcx /, P,QU��S rlf3.
Depth (feet)
Soil Characteristics
0
2
3
4
-
5
6
GO t1 5 /ITY S,*VVY
8
k®j r 510C of p7T
g
/q2 G.�u� c 7
to
11
12
Ground Water Encountered:
Yes No If yes, what depth
Proposed Installation:
,Seepage Pit ''�` Drain Field
Comments:Nb
I;X,9V6A 14/*7-,ciL Dom` /�ED20Gf< L�XPECTi�A fV/T�/i�!
lAr GlM7�
pit J EOTlC` .� k 0 1 ! SeZ46A66i 4 dEc. &--o tel ' rIA61
Performed by:
Date:-- Q �
•'�%iT�rr?�-
/�! D /TchC Irr!�ct 3AnlL� f/ ��IrIEG aJ� /DCI.,i'1��,,�,
I
z
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0
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0
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00
.1.4
$4 P3
',3 9.4
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4
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0
0
M
00
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$4 P3
',3 9.4
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0
0
0
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a
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DW
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0
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Municipality of Anchorage •
��
�� On-Site Water and Wastewater Program
�_, (907) 343-7904
S c r r
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050-571-11 Expiration Date: 1 — LS)
1. GENERAL INFORMATION '
Complete legal description Preuss #2 Block 1 Lot 17
Location (site address) 20038 David Ave
Current Property owner(s) Jennings Day phone 230-3650
Mailing address Same
Real Estate Agent Olmstead Day ph ne 244-8020
,\,,b,;.%.t3-! ' .„:
2. TYPE OF DWELLING: ~ SE
re
® Single Family (w/wo ADU)
❑ Duplex �e
❑ Multiple Dwellings (Single Family and/or Duplex) N - -- -
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class C Well El Community ❑
Public Water System ❑ Public Sewer ❑
Received by Date: /C7(7( 7
COSA to be released to the engineer,unless oth rwise requested by the engineer.
COSA Fee $ 0,30 30 Date:
Date of Payment q/?2/( ? Date of Payment
Receipt Number QO5 O-O Receipt Number
COSA# 056 /q/4c? 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 NorthRim Engineering Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng Date 9/22/2017
, ,„ 44s
A
.,. •
6. DSD SIGNATURE "
System #1 Approved for I/ bedrooms. - ...
?<-
System #2 Approved for bedrooms. •�w,�^
Disapproved. 712/fig •".<'C`'-
Conditional approval for bedrooms, with the following stipulti..olis:, r
ccY r r
02,
ON-RITE
WATER AND rn
rn WASTtWATER
PROGRAM
CJ �J`•_
By: � Original Certificate Date: Q —(y—/ 7
The Municipality of Anchorage Devlopment Services Division(DSD)Issues Certificates of On-Site Systems Approval(COSA)based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 9-1.12 doc
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate 4f On-Site Systems Approval Checklist
Legal Description: f'EV.s_s• #2 5 ( ` / 7 Parcel I D:0 50 57 t (
A. WELL DATA
Well type P
If A, B, or C provide PWSID# Well Log (YIN) \-/
Date completed ill(677-- Sanitary seal (Y/N) 7' Wires properly protected (Y/N) XTotal depth 337 ft. Cased to 33 f ft. Casing height (above ground) /Z in.
FROM WELL LOG AT INSPECTION
Date of test. y///6175 91/2/// 7
Static water level 2.-?d' ft. 2 f_5. 3 ft.
Well production g.p.rn. S f'" g.p.m.
WATER SAMPLE RESULTS: ,I
Coliform Jcolonies/100 mL Nitrate /v 6 mg/L
Arsenic , A/!5 ug/L Date of sample: -///2. // 7 Collected by: /Vie//`/ (.ti.,/ .ti,
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material 5777—e"3/ I7/S7- l�L Date installed /Q //3/is
Tank size /Z5 gal. Number of Compartments Cleanouts (Y/N)
/V i
Foundation cleanout (Y/N) y Depression over tank (Y/N) A/ High water alarm (Y/N) Aii
Date of pumpingiti . Pumper
C. ABSORPTION FIELD DATA
0eeo
Date installed /5-Soil rating (g.p.d./ft2 or ft2/bdrm) / c System type T re,,,c.h
Length ft. Width 2. 5 ft. Gravel below pipe 7 ft.
Total depth /4/ ft. Eff. absorption area 5-3 2-ft2 Monitoring tube Depression over field Ni
S S/4= S
Date of adequacy test/VS S 7 a., 2 'F�esults (Pass/Fail) For Zi bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN &type) If yes, give date
D. LIFT STATION Am.
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot ifj i "r On adjacent lots /6‘..."/ r
Absorption field on lot /00 `# On adjacent lots /06 (4-
Public sewer main /CJO r-4- Public sewer manhole/cleanout - /ad-("I—
Sewer/septic service line 2 S -F Holding tank /00 /4-
r
Animal containment areas 50 f Manure/animal excrete storage areas /0 Cr
SEPTIC/HOLDING TANK ON LOT TO:
l f
Building foundation ..�/'t�" Property line /0 Absorption field Jr '�
Water main / 14- Water service line /0 r't Surface water /60 r*
Wells on adjacent lots lug (-
ABSORPTION FIELD ON LOT TO:
Property line /fl r'.. Building foundation la r'r" Water main ( a
t
Water Service line �U ('� Surface water /06 -f- Driveway, parking/vehicle storage Z0 ,it-
Curtain drain 5 6 '4" Wells on adjacent lots MO ''f"
F. COMMENTS
77;74/ (C f . Q 3 rr_CI or* "------/_0,÷7--4.4c
G. ENGINEER'S CERTIFICATION •' At
, \
/ certify that l have determined through field inspections and -
review of Municipal records that the above systems are in , e.:,_: ;; .
conformance with MOA COSA guidelines in effect on this date.
Ai Engineer's Fri
tedmem ��( �c/� C -"- --�� � � "
7 /Date5r!f 7.,.
Lw.
COSA yellow sheet_2-6-15.doc
DAVID AVENUE
Mal �`; r`
S 89'59'00"E 134.30'
13
17_ \
VI
Lot 17 :: -
0_. 25,181 s.f. 1
/
1
v °'•
�� l
f a> WELL CT
PROTEC VE plus .N.
cry N
5..2iii'x:12,2'• DECK a
10,2'x12.2'(SHED 4
2.0'x24.1' CANT col
ASP a
Lot 181 z �,�;i ........,., • p ii.
m Lot 16
ao 0 68.0 30.0'
\ o cv TRI-LEVEL v
0 32 7' RESIDENCE s c /
\ a 68.0• N
\ ~' CONCR E. I
_.\
PAT10 .. �..
11.0'x15.8' CONCRETE PAD w/
co \ TWO CHAIN-LINK DOG RUNS
in-.4 /
SEPTIC
10' UTILITY PIPES
EASEMENTS
1—.. —.. —,. —n —u —.. —I. —+. —
N 89'59'00"W 134.30'
WOODEN FENCE I
Lot 1 Lot 2 Lot 3
I �
PLOT PLAN AS BUILT X SCALE 1- = 40_ GRID NW 0056 Project No. 17-340/A1
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates , inc . (907) 522-6476 Phone oopdp
(907) 522-4625 Fax 4O F A L Q%p
Professional Land Surveyors kenOlangsurvey.com ,`CL •• 9 �a�
JonathanOlangsurvey.com ( ^
I hereby certify that I have surveyed the following described property: Y
LOT 17, BLOCK 1. PREUSS SUBDIVISION UNIT No. 2 (PLAT 70-42) * 4�Z �� •�,�
Anchorage Recording District, Alaska, and that the improvements situated thereon are / D
within the property lines and do not encroach onto the property adjacent thereto, that V # ,( Q
no Improvements on the property lying adjacent thereto encroach on the surveyed c KENN . LANG : 4
premises and that there are no roadways, transmission lines or other visible c, p ,�� -i 0
easements on said property except as indicated hereon. • 1 ��
04 •. s-5202.••' env
Dated this the Day of , , at Anchorage, Alaska ,o '•'•' a
404Ru sioNM-�a
It is the responsibility of the owner to determine the existence of any easements, QdOoo�d
covenants, or restrictions which do not appear on the recorded subdivision plot. AECC963
O MUNICIPALITYANCHORAGE
• DEPARTMENT OFFHEALTH
&8 HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650 �}
343-4744 vG 'tf� F
CERTIFICATE OF HEALTH AUTHORITY l �OsooPy
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # Dso -S7/- / / HAA #
1. GENERAL INFORMATION
Complete legal description -'0;' i 7 4'-a c
Location (site address or directions) Zoo3e�a��o HJE. Eas�E UER
Property owner Day phone 96 - 876
Mailing address -4-1038-o-ez2a
Lending agency
Mailing
Day phone
Agent Dayphone 69y-5z�
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
-41 v
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site ✓
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1191) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm
777�Y
Phone —',0 yy
Address H
Lr) I f3 o,c
(60 3-4
9C-2(a,y ;-
Engineer's signature
6. DLIIIS SIGNATURE
IV
Approved for t(C bedrooms.
0
Disapproved.
Date % - `3 • (,o
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
auric
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The D HHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025(R.v.1/91) 81Ck MOAl121
Municipality of Anchorage SLI
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825"L" Street, Room 502 • Anchorage, Alaska 995010 (907) 33471 &,pq
�pP o
Health Authority Approval Checklist rP4
Legal Description: G 79e / �66utS �p °/� Parcel l.D.:Ds O- s -7/-
A. WELL DATA
Well type D2id 4TE If A, B. or C, attach ADEC letter. ADEC water system number
Log present (YM) y Date completed
.l%rG�ACT
Total depth Cased to 7//Casing height (above ground) /6"
Sanitary seal (Y/N) Y Wires properly protected (YIN) y
FROM WELL LOG AT INSPECTION
Date of test `���4/7� ✓U� y / / 99�
-1�
Static water level X 9 8
Well production 6 g.p.m.m
g•p
WATER SAMPLE RESULTS:
Coliform Nitrate le Other bacteria _60 -
Date of sample: e 8 , 9 916 Collected bv: /�ZL 0 G!J �c tJG6 y
B. SEPTIC/HOLDING TANK DATA
Date installed �� 3�7e' Tank size iz 5""D Number of Compartments Z Cleanouts (Y/N) y
Foundation cleanout (Y/N) .il Depression (Y/N) A-) High water alarm (Y/N) "�I) I9
Date of Pumping,/u u� '/ i99�umper c/.ia.'s Se 1 -Tae- "i A,6r11JL
C. ABSORPTION FIELD DATA
Date installed 629.3@�
e � Sail rating (g.p.d./ftZ or ft'/bdrm) Zr-Z 5- System type 91 c'.ez�
7Le5g"t1' 6 3 Width .9 Gravel thickness below pipe S' Total depth 1.7
.yX2 s 6d0
Effective absorption area iab z -/i "Sionitoring Tube present(Y" )/ Depression over field (Y/N) t/
/ r. 6/iJ/46
Date of adequacy test Z— %l fla Results (Pass/Fail) i'o-r s For bedrooms
Fluid depth in absorption field before test (in -);-0'S% Immediately after/090_ gal. water added (in.): 5/6
� SSE Ff�7.4a�
Fluid depth `! (ins.) Minutes later: / 2 70 Absorption rate = _ a O g P r
Peroxide treatment (past 12 months) (YIN) /t% If yes, give date
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
Size in gallons
"Pump on" level at* off' level at*
High water alarm level at* *Datum
sted
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot /3 On adjacent lots
Absorption field on lot Tem ve y ims ' ; On adjacent lots
Public sewer main
/,049 '�71
.-GG tF:
Public sewer manhole/cleanout I�-g
Sewer /septic service line -/a Lift station Als9
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 117,1 Property line Z `% l Absorption
Water maintservice line Ziff/Surface water/drainage VIAle Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation
Gott
i0 F71
100 `"f7'
Water main/service line ZStF-
Surface water A la-uE Driveway, parking/vehicle storage area
Curtain drain AI&o ,C
F. ENGINEER'S CERTIFICATION
.s'S'ft
zsfs-
Wells on adjacent lots Property line '
I certifv that I have determined thru field inspections and review of Municipal records that the above systems are
in conformance with MOA HAA guidelines in effect on this date.
Signature to - • • /t ° • ° 3� I�
Engineer's Name Od4/GGAS T, =tJG6y S I Here
Date 7 . 3 •9 w A.. . • • • .. ...
HAA Fee $
Date of Payment
Receipt Number calx
Rev. 8/95 OSS: haa.wk.doc
Waiver Fee $
Date of Payment
Receipt Number
ZZBH7�
a� yi%y
Douglas T. Kenley Civil Engineer State of Alaska C.E. 8176
WELL & SEPTIC SYSTEM ADEQUACY TEST
Legal Description Lor
_ Zao
Applicant Eo�y %P� orb
Date of Test _✓�/v i�9G a�arE T.� s �r eE>Err�eoy
System Data
e.e w ley
Tank Volume i2S0 y.pc.S'. Absorption System
Number of Bedrooms Absorption required (1,11daily flow)o
TIME
VOL.
al
DIFF.
FLOW
m
TEST DATA
TANK
LEVEL
TUBE
LEVEL
DIFF.
WELL DIFF.
LEVEL
y
11x- z
11,6
!.
;447
//
G ZO
Zz9
A� 37
0J4 0-7
r.Z S'.—
zo
"16,75P
81j�
moi.
,lE �
i.5"o G.ae
u/�.� ,4006a
m �O a
E��/J
Hesur6
.�s-s' O PN vie�,rJ
System Passed
Comments ,2.076 �aG�i4a
( r 4 c)- L7,9,/ 7 S
System Failed
(moo 90 -f �,Ia ) — ,.J
p
Jr. .
ENtl t 1 Zb� CAG _ "JG
MUNICIPALITY OF ANCHORAGE Q—Zk
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage. Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. #yCG' S7 l t ! HAA #
1. GENERAL INFORMATION
Complete legal description L-�•f' I�, (iLn_ t %Let, -�s z --
Location
Location (site address or directions) 2003� L74,0, o t5�7-_
Property owner (OLL'I 10
� SbMU,6'1 /
&!Xr5AI
Day phone
Mailing address cX L9y'3A
04-110 I
6�6Lg
/2)°✓,zr 1c 5`1:5 17
Lending agency
Day phone
Mailing address
Agent 12G'Mit MA<Z)AJ Day phone Lo ref u�v
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4-
3. TYPE OF WATER SUPPLY:
Individual well X
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm David R. Dayton P.E. Phone 6o0165; _�2�417
20210 Donalar St.
Address
Engineer's signature
6. DFIS SIGNATURE
Approved for `' T/ bedrooms.
Disapproved.
Conditional approval for
Additional Comments
ra,
=:2e
Date
bedrooms, with the following stipulations:
By: m P Date 9, .)_ � _ 9-25
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
7MM (Rev. 1/91) Back MOA 021
Municipality of Anchorage
Department of Health and Human Services 46
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: %v g Parcel I.D. ¢�
A. Well Data
Well type P�'i 04F If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) li Date completed -f/ & % 7) Driller 421 L Dzi ci t a'<
Total depth _3 _) Cased to 3'2�,`? Casing height I Z''
Sanitary seal (Y/N) ii Wires properly protected (Y/N)
Sewer service line 4o r Petroleum tank ��✓�
WATER SAMPLE RESULTS:
Coliform Nitrate Other bacteria
Date of sample: -10-3.0-3 Collected by: :Z>.n
B. SEPTIC/HOLDING TANK DATA
Date installed w/t3/7� Tanksize IZ-Sz% Compartments
�_j
Cleanouts (Y/N) f Foundation cleanout (Y/N) A) Depression (Y/N) N
High water alarm (Y/N) /U /lt Alarm tested (Y/N) A111-
Date
1//Date of pumping ` /j - Pumper SP ,-7� d� t. wi2, n;c;
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot / 4` On adjacent lots L v r Foundation
To property line Z -e:, Absorption field 67, Water main/service line
Surface water/drainage
SZ% y
72-026(3/93)"Front CONTINUED ON BACK PAGE
FROM WELL LOG
AT INSPECTION
Date of test
C
Static water level
Z i
3 4/
56
oz
Well flow'
g.p.m.• % g•p•m.
cn
n
z
imi
Pump levell
4 k�_
< >
SEPARATION DISTANCES FROM WELL TO:
r�r-Iw
N
C
Septic/holding tank on lot
1
On adjacent lots j' Y<_
O m.
Absorption field on lot
`fc>
; On adjacent lots
z
Public sewer main
n
Public sewer manhole/cleanout ti/h
Sewer service line 4o r Petroleum tank ��✓�
WATER SAMPLE RESULTS:
Coliform Nitrate Other bacteria
Date of sample: -10-3.0-3 Collected by: :Z>.n
B. SEPTIC/HOLDING TANK DATA
Date installed w/t3/7� Tanksize IZ-Sz% Compartments
�_j
Cleanouts (Y/N) f Foundation cleanout (Y/N) A) Depression (Y/N) N
High water alarm (Y/N) /U /lt Alarm tested (Y/N) A111-
Date
1//Date of pumping ` /j - Pumper SP ,-7� d� t. wi2, n;c;
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot / 4` On adjacent lots L v r Foundation
To property line Z -e:, Absorption field 67, Water main/service line
Surface water/drainage
SZ% y
72-026(3/93)"Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed �iT Manufacturer
Size in gallons
Vent(Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
D. ABSORPTION FIELD DATA
Manhole/Access (Y/N)
"Pump off" Level at
tested
Surface water
- yZ T-/�;vucJt
Date installed ��) Soil rating (GPD/Ft2) ��� /`Z System type
Length zv `Width �� Gravel thickness c• Total depth i 2.
W
I&E 10 �i�1f"i
Total absorption area 44f -N Cleanout present (Y/N) Y' Depression over field (Y/N) A/
Date of adequacy test � / 0 / G'3 Results (pass/fail) Y'iKy for Bedrooms
Water level in absorption field before test ;� 3 , After test 13"
Peroxide treatment (past 12 months) (Y/N) A/ If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot C?,, C,4 On adjacent lots i i Property line
.54
To building foundation -74;' To existing or abandoned system on lot •: s
On adjacent lots 1 cam' = Cutbank Ac c,;) a Water main/service line
Surface water [ Jc}
Curtain drainoN
E. ENGINEER'S CERTIFICATION
Driveway, parking/vehicle storage area -2 7
I certify that l have checked, verified, or conformed to all MOA and HAA guidelines in
David R. Dayton P.E.
20210 Donalar St.
Chugiak, Alaska 99567 s3
Signature r „
Engineer's Name
Date
HAA Fee $
.)e0 4
Date of Payment
Receipt Number
72-026 (3/93)" Back
01
Waiver Fee $
Date of Payment
Receipt Number
SC, r -
of this inspection.
Davx! R. C ..
NO. =S
D. R. DAYTON, P.E., R.L.S.
WKWUWOW Chugiak, Alaska 99567 (9071 99MPY
20210 Donalar 696-2417
September 15, 1993
ADEQUACY TEST
Legal Description: Lot 17, Blk 1, Preuss Subd. Unit #2
Date of Test: September 11, 1993
Septic Tank: 1250 gallon, 2 compartment, steel tank
Absorption System: 20' x 16' x 6' seepage pit & 63' x 5' trench
Soils Rating: 225 sf. per BR
Requirements: 4 BR - 600 gallons per day
Test:
water was pumped into the absorption system while measuring
volume, time and water level rise. After pumping was stopped, the
water level drop was measured at timed intervals.
Results:
The system accepted 610 gallons with a 1" rise in the liquid
level. The water level returned to the original level within 1 hr.
after pumping was stopped.
The system is currently functioning adequately for a 4 BR home.
q,%sOF A4g'hj
e !
s
'� •°,N P.4 TM :tip _, ! 94
David R. DcYiac
NO. 2205•E
D. R. DAYTON, P.E., R.L.S.
Chugiak, Alaska 99567
20210 Donalar
September 15, 1993
WELL FLOW TEST
Legal Description: Lot 17, Block 1, Preuss Subd. Unit #2
Date of Test: September 11, 1993
Well Septh: 339'
Static Water Level: 301'
Requirements: 4 Bedroom - 600 gallons per day
(907) M
696-2417
Test:
The well was tested with the existing pump through a hose bib
with the valves fully open. Volume and drawdown were measured at
timed intervals.
Results:
The well produced 610 gallons in 14 hrs. at a flow rate of
0.73 gallons per minute.The maximum drawdown was 6'.
The well is currently producing adequately for a 4 BR home.
a.
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 Date Z �r
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, I wnship, range)
! % R
Location (address or
(b) Applicant Name CSU✓ lC Gly / Telephone: Home "Eusiness
Applicant Address %0 3 2a o,, . CZ E <2 77
(c) Aoplicant is (check one): Lending Institution ❑ ; Owner/buildert'i'�Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution N O 1 - Telephone
Address
(e) Real Estate Company and Agent inz-'t JC
Address />7 6) .4701-5, % 70 epAE-ii _ 5�c5_%Z_
Tel ph I 7y-- !74z 0 0
f) HAA to the following address:
2. TYPE OF RESIDENCE
Single -Family Multi -Family ❑ Other
Number of Bedrooms 44/
3. WATER SUPPLY
Individual WelX1Community ❑ 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
Onsite Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (11. 84)
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
19
Ascertified by my sea] affixed heretoand as of thevaliclation dateshown below, I verifythat my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
forthe number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm 8 im C, 1571off Telephone
Address qp 196X
Date
DHEP APPRO
,VAL
Approved for C' bedrooms by
Approved Disapprove
Terms of Conditt tp��al Approval —
CAUTION
The Municipality 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 enginee!'s work.
Page 2 of 2
MUNICIPALITY OF ANCHORAGE ( �IPALITY Of ANCHORAGE "
HEALTH AUTHORITY APPROVAL (vn`�I � iEPT. OF HEALTH &
ONMENTAL PROTECTION
CHECKLIST - FEBRUARY 1984 MAY
Legal Description: r%
A. WELL DATA
Well Classification W keAT 05 If A, B, or C, D.E.C. Approved)
Well Log Present Date Colleted &/G�%J` Yield
Total Depth civ l Cased to d/D f Depth of Grouting
Static Water Level Pump Set At Z_C
Casing Height Above Ground /o) Sanitary Seal on Casing -`L u#
Electrical Wiring in Conduit (iYW Depression Around Wellhead (!F40
Separation Distances from Well:
To Septic/Holding Tank on Lot �/p On Adjoining Lots bop'
To Nearest Edge of Absorption Field on Lot �D, ; On Adjoining Lots !yD 'r
To Nearest Public Sewer Line IX///¢ • To Nearest Public Sewer
Cleanout/Manhole /To Nearest Sewer Service Line on Lot
Water Sample Collected By S Date S/-y-£d(S
Water Sample Test Results tv/zy
Comments 3)EC AtaaVs2 1;cfECzu(62tiz'rcc �97T�KN��
B. SEPTIC/HOLDING TANK DATA
Date Installed -75- Size /._),1--z1 No. of Compartments -2
Standpipes W"X) Air -tight Caps (2 N Foundation Cleanout ) �d
Depression over Tank W4Date Last Pumped .3 - S ,-
Pumping/Maintenance Contract on File (Y/N) • for 'C/ 1-7
Holding Tank High -Water Alarm (Y/N) /V 1% Temporary Holding Tank Permit (Y/N) 04-14
Separation Distances from Septic/Holding Tank:
To Water -Supply Well loo r To Building Foundation
To Property Line //j /�` To Disposal Field f
To Water Main/Service Line � To Stream, Pond, Lake, or Major Drainage -
Course )j//✓f
Comments B(/(2 ^✓ r' `
Receipt # i� I
Date Paid:S-
Amount: �-IS.cg
[Page 1 of 21
2-15-84
0
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata �?oZ S ¢fes Type of System Design
Date Installed w -/c3 '~%rr Length of Field 3 -'
Width of 94e+d- /6 ' X do K,1 A' Depth of Field 8'
���QF Gravel Bed Thickness If -
Square Feet of Absorption Area /O %8 fxl( Standpipes Present ((N)
Depression over Field OWG Date -of --Last Adequacy Test li 8 3
Results of Last Adequacy Test SA; i s
Separation Distance from Absorption Field:
To Water -Supply Well gD ' To Property Line /b /71
To Building Foundation ! o To Existing or Abandoned System cn
Lot .N l,4' On Adjoining Lots /0 0/ -e-
To
To Water Main/Service Line A-/ To Cutbank(i£ present)
To Stream/Pond/Lake/cr Major Drainage Course✓!
To Driveway, Parking Area, or Vehicle Storage Area ,rb
Comments,± 09Z --r- <.E77,1 -le- "V7Ts3cAl! a
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Ccdes(Y/N)
Commnts
(YM)
i1 at
v Vent (Y/IN) _
during Adequacy Test. Meets MSA
** Check Permitted Bedroan Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MCA HAA Guidelines in effect
on the date of this inspection.
Signed S & EAIGIPIMR 4 Date '41- G - gs
Cc npany-:,aLE R1,1,W, ALpSK0. 'V577 MOA No.S,S 00 3
RBI/d5/s
[Page 2 of 21
"- 2-15-84
�rTit�,t/tp ' •
N
ROBERTA. SHAFER
CIVIL ENGINEER
e 6942979
1 s:
April 7, 1.985
HEALTH AUTHORITY
APPRO,A,, State of Alaska
Department O'er r;nvirnnme:7tal con,Sc'rvat. io n
437 E Street
Anchnr"age, -Alaska 99501
R & WATER ?Jt
MAIN
EXTENSIONS dHF17i �tCc"c 7Pruess 5uhdivlsion F
Reque,�,t, a waiver be 1.``'..,kjO`[ accep':.ing rA 9Q foot hori ZOntal
separation di. stance 'betl.reon the private well and the
on-site wast,-, water system located on the .referenced
SEWER &WATER property. The on -sit,_ w.ste water d7.
INSPECTION 5 pOsal system and
well were installed in June 1975 under municipal permit.
UL201904 and inspected and approved by the r^unicipality
at the above prescribed horizontal. eparation.
SYSTEM DESIGN Based upon sail strata anal the depth of the existing well
and upon the soil analysis provided at the time the septic
system was installed it is our ol:>inion that the horizpontal
separation distances prescribed by ISAAC72 are not required
WELL INSPECTION in this, cast?.
8 FLOW TEST
:Chis system was determined to be adequate under an adequacy
test performed in march 1.981 and :in November 1982 and
again in April 1985. Coliform bacteria -analysis of the
SITE PLANS water from the well perfti:i_med in 1902 rind again In 1984
provided satisfactory rc-,sults.
I'snclosed for your revie=w ore colli c,i of the following
ROAD DESIGN documents.
A. .nchor,age= area bo:rougYL ora -site sewage dispnsal
inspection .repos"t-
SOILTEST
B. A .pquacy test rt-oor.11s,
C. Soil Tog
PERCOLATIONTEST D. 4vell log
E. Coliform bacteria wat_r analysit,; reports
STRUCTURAL Sincerely,
MECHANICAL.
INSPECTIONS
ROBERT A. SFIA '^R, ..F..
RAS/s.-
ON
2AS/ssON SITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
SHB 196X EAGLE RIVER, ALASKA 99577
,
�fj
ILI"N't i��S17�MM.�iJ�
f) r�
iy
>r6;iI
"u, � yn., ,:iia- i;_{{. ., _,. -..:.
... r � '�i '• °
lrpi.
J
k
!'f A
IIS
i I
t'
r
,r
APPLI T FILLS OUT UPPER HA ONLY
Property Owner
�
Phone
WatlingAddrees V - Zip Code
O ��
Buyer
Address Zip Code
Lending Institution �-...� (3 p -(c. (.. Cs�
Phone
Address v\�- _ w � �5`.��V_ Zip Code "
Date
Realty Co. & Agent �1.�.�cc. cQ2---k .. v.�,
�h , .�
1
Phone
Address '� 0� Zip Code
X
t Ln�
Legal Description LcA �-., 4 Pt -e
Street Location V ��
Type of Residence
Single Family LI
Multiple Family No. of Bedrooms
❑ Other
Water Supply
�, Individual W �.�,
❑ Community
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).
Public Utility
191 DFnr cT:.
Sewer Disposal
Q Individual Sxp Year Individual Installed
�Y When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
- Y1 C- CLS" -51 &A
Time
Time
Time
Time
r_1 a o
Date
Date
Date
Data
Inspector
Inspector
Inspector
Inspector
Field Notes:
dna.Jtilh
MUNICIPALITY OF ANCHORAGE
Z('�hm�s
191 DFnr cT:.
ENVIR A!—r, -TION
C" 12 1989-
982RECEIVED
RECEIVED
( ) APPROVED BEDROOMS
'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIO�INAL gPPROVAL-
DATE 1I —I Iz} C/
-
��')J
BY:
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well Log Received
-
Well to Tank
Septic Tank Size ) Sa
S
Ll
EXCAVATION
WORK
ROBERT A. SHAFER
CIVIL ENGINEER
694-2979
November 12, 1982
MUNICIPALITY OF_ANCHORIGE
DF°T Or ;
ENVIR•.7_ L`, _t_ . A.... -_U � --TION
Chugach Realty ;, 'J 6 1982
ATTENTION: Shell Hensley
1806 Dowdoin Circle RECEIVEDAnchorage, Alaska 99504
Dear Ms. Hensley,
Reference: Lot 17; Block 1; Pruess Subdivision 412
A sewer system adequacy test was performed on the system
located on the referenced property, as you requested.
The absorption trench and seepage pit combination was
tested by a continuous flow of water over a period of
72 hours. During each 24 hour period the flow into the
system exceeded normal requirements for a four bedroom
residence. At the conclusion of the test there was no
adverse effect on the system. The septic tank had been
pumped by Sanitary Pumpers of Eagle River prior to
commencing this test. In accordance with the volume
removed by the pumper, the Municipality's records and
our adequacy test in March of 1981, the septic tank is
verified to have a capacity of 1250 gallons.
It can be concluded from this test that the waste water
disposal system serving the four bedroom residence located
on this property is currently functioning adequately.
In our letter reporting the adequacy test in March 1981,
it was noted that the owners had agreed to remove the
obstruction and repair the clean-out in the crib. This
had not been done; however, it was accomplished just
prior to performing the present adequacy test.
If we may be of further service, please do not hesitate
to call
P. E.
cc: Municipality of Anchorage
Department of Health and Environmental Protection
SAB 196X EAGLE RIVER. ALASKA
•
F
5. LEGAL DESCRIPTION
/
DATE RECEIVED
INSPECTION APPOINTMENTS
-
TIME
TIME
TIME
DATE
DATE
DATE
INSPECTOR
INSPECTOR
INSPECTO
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI?N DEPT. OF HEALTH &
825 L Street - Anchorage, Alaska 99501 C'`�VIRCNMENTAL PROTECTION
•
ENVIRONMENTAL SANITATION DIVISION MAR 3 1981
Telephone 264-4720
((�� FF
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER �)U1l1,,//E@PD
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTYOWNER
/y/,Cie �1— ao41Z �,v
PHONE
�y�-����
MAILING ADDRESS
PROPERTY RESIDENT (If different from above)
PHONE
7 YEAR ON-SITE SYSTEM WAS INSTALLED.
kgs/- 3a art
2. BUYER
PHONE
MAILING ADDRESS
3. LENDING INSTITUTION
MAILING ADDRESS / /
Is f -/r, L1+2 tt Ile Pr .6.0 d Y Ti I�
4. REA OR/AGENT
PHONE
�—
MAILI AD KESS
6X Cde Ae�) 7,7
5. LEGAL DESCRIPTION
/
U 7'/ 7
STREET LOCATION
V S7- Gc-_7Z
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS
Zr SINGLE FAMILY
❑ One D5, Four ❑ Other
❑ Two ❑ Five
❑ MULTIPLE FAMILY
❑ Three ❑ Six
7. WATER SUPPLY
DK INDIVIDUAL*
* ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
9 INDIVIDUAL/ON-SITE**
7 YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLICUTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79) Vt_�����,,
0
P
Greatland Realty
ATTENTIONr Dolores
P.O. Box 633
Eagle River, Alaska 99577
Dear Dolores,
DAVID A. SLENKAMP
MECHANICAL ENGINEER
694-9055
March 17, 1981
Reference: Lot 17; Pruess Subdivision #2
�J
ROBERT A. SHAFER
CIVIL ENGINEER
694-2979
MUN'C'PALI ry
ENVIRNOF AtVC
pL� �OGFMENAy �,
MAR 9 19t9'
RECEI QED
A sewer system adequacy test was performed on the system located
on the referenced property from March 12 through March 16, 1981.
The test was performed at your request and included the pumping
of the septic tank. The septic tank was verified to have a capacity
of 1.250 gallons and the absorption trench and seepage pit were
filled full of water. Approximately 700 gallons of water was then
added to the absorption area by continuous flow over a, period
of 24 hours.
It can be concluded from this test that the septic system is
currently functioning adequately for the four bedroom residence
located on this property.
The clean out in the crib located in the seepage pit has an
obstruction which prevents access to the crib. It is my understanding
that the present owner has agreed to repair this.
If we may be of further assistance, please do not hesitate to call.
Sincerely,
cc: First National Bank
South Center Branch
Municipality of Anchorage
Department of Health and Enviornmental Protection
SRB 196X EAGLE RIVER, ALASKA
kle River Area
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received November 18, 1976
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Conv.
1. Approval requested by: Alaska Bank of Commerce % c
Mailing Address: Pouch 7-012 Phone: 279-5631 x 314
2. Property Owner: Walter Graf Phone: Ol�DCr
Mailing Address: 6425 East 16th Avenue -OIL t xusr�n�l.
3. Legal Description: Lot 17 Block 1 Preuss Subdivision #2
4. Location: NHN David Avenue
5. Type of facility to be inspected Single Family No. of bedrooms 4
6. Well -,Data:
A. Type Individual B. Depth
C. Construction D. Bacterial Analysis
7. Sewage Disposal System: On-site system
A. Installed B. Installer
^C. Septic Tank: 1. Size 2. Manufacturer
D. Seepage Pit: 1. Absorption Area 2. Material
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank , Absorption area Sewer Lines
Nearest lot line Other contamination
B. Foundation to septic tank , Absorption area
C. Absorption area to nearest lot line
EQ -034 (1/74) Page 1 of two pages
Page 2 of two pages - Rest for Appro4al o'F Individual #r & Water Facilities
�* LegeYl bescription Lot 17 Block 1 Preuss Subdivison #2
Comments
Approved Disapproved Date/A=I- Zd
ApproP 1,Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I
cprtifv that the infnrmatinn rnntainpd in thic rpnupct fnr annrnval to ha a trop ane
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED ;:'" Date
A;
EQ -034 (1/74)
b 0
GREATER ANCHORAGE ARL, BOROUGH
Department of Environmental Quality
3330 "C" St., Anchorage, Alaska 99503 - 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
1. Type of Inspection: CMRO VA FNA CONY 1xx
2. Property Owner: Walter Graf
Mailing Address 6425 East 16th Avenue Day Phone 691-908
3. Name of Buyer: HOLLI11GERy H chael J. & Judith A.
Mailing Address: S.R. Box 5103 Eagle River Dav Phone 69h-SOB8
4. Name of Lending Institution:
of
Mailing Address: Pouch 7012, Anchorage 99510 Phone 279-5641 x314
5. Name of Realtor or Agent: NONE
Mailing Address:
0
6. Legal Description, Lot 17. Block 1 Preuss Subdivision Addition #2
Location. NHN David Avenue, Eagle River, Alaska 99577
7. Type of Facility to be s`nspected:. single family No. Bdrms. 4
Adwelling
Water Supply
Type of Supply: Public Utility Individual xxx
If Individual, number of dwellings presently served 1
If Individual, depth of well
9. Sewage Disposal System
Type,of System: Public Utility Individual (on-site) xx
If Individual, date of installation