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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 .......... 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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 "i E. 0 M V) E. 0 M 00 .1.4 $4 P3 ',3 9.4 O 4 I z 0 M 0 0 M 00 .1.4 $4 P3 ',3 9.4 rN E. z 0 0 0 0 0 a 0 0 DW W U3: w N t17 0 E. 0 I. 0 H 0 0 I. F. c E- mi. x 0 14 z 14 rN E. z 0 0 0 0 0 a 0 0 DW W lk w N 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