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HomeMy WebLinkAboutLAKE RIDGE TERRACE BLK 2 LT 26 ?. Municipality of Anchorage Page ~ . DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O, Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~l,'vc/qd..?~/~ PID Number: Q,<,'/.~'/~4/ . Name: ~ Wastewater System: [] New ,~Upgrade ^ddr.s~ ABSORPTION FIELD 14~I~ ~, ~ ~wo~ iD~. "~=;; I NO. of Bedrooms: E~' ~W~, ~ ~77t ~ ~ Deep Trench ~ Shallow Trench ~'Bed ~aound. ~Other LEGAL D ESCRIPTIO N so, Reting~;n~hc~' Total Depthz.~from original grade: Lot: Block: Subdiv~ion: Depth to p ps boEom from original grade Gr~vel depth beneath pipe ~ ~ ~ ~/~0~ ~~ /,~ Ft. ~,~ Ft. Township: ~ Range: ~ Section: Fill added above original grade: Gravel length: WELL: D New ~ Upgrade Gravel width: Number of lines: Bis~n~ ~n lin~: t7 - /~t. Z ~/, ~ F~. Classification (Private, A,B,C): E~/~ Total Dept~: Cased To: Total ~bsorption area: ~ Pipe material: ~IV~ Ft. Ft. ~Z,3 SO. Ft. ~Zm D20E4 Driller: Date Drilled: Static Water Level: Installer: ~G~g~ ~G, Date installS: ~. ~ ~c~y~r/~e ~ /o//~/~ ~ I Yield: Pump S~t at: [ c~i.g H~ight Above Ground: ~ TAN K GPM Ft.~ Ft. SEPARATION DISTANCES a Septic ~ Holding ~ S.T.E.P, To ~/~ Ab~rpflon [IO~ Hold[rig Public/Private Manufacture~ Capaci~in gall~s: Material: Number of C~paAments: Water /0~ ' /0 ~ ~ /0 ~ ~ ' Lot ~Siza i~ gallons: ~anufacturer: /~ L Line ~' /d' ~4' !./~ I - Om~4o/~/~/~cy , , "Pu~ on' level at: ~ "Pump off" lev~ at: ~High w~er~ala[m~/at: Foundation 17~ Z / / 7 ~ -- Z ~ '~ I ~" Cu~ainDrain ~ ~ /~ ~Pump Make & Model~ Electrical~ Inspections~ p~o/m ed~/~.by: Remarks:~~ /~ ~/~/E~ ~/~/~ BENCH MARK / Location and Description: I Inspections pedormed by: ~..~. m..,. ~.~, 9~7 Dates: 1st ~/(//2 ~/ .. .-j · . 2nd 'd//~q~ ~~;r~ Department of Hea~and Hum~Se~lces appro~a'l~ ~' e ,ewe a. ,0w Permit No.SW940544 Page 2 of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Descriptio~.AKE RIDGE TERRACE, BLOCK 2, LOT 26 PIDNo.: 05151501 --100.2' (M~) i "8 5' ' . 99.~ I~ ........................................................................................................................... i---\-~-.I.ll ~ ...................... ~ .......... % t ....F'"'~ .......................................... ~ (MT1& ~L-DIST. PIPES ~ WITHIN SEFER ROCK, 6' UNDER MT2) ~ OVER DIST. PL°ES WELL A B ~01 i17.0 30.0 BIO ~24-.0 29.5 WI'I' f77:U' "'50:0 ~,iT2 {79.0 60.5 ~[T3 39.0 52.0 ~T4 24.0 41.0 PRESSURE DISTRIBUTION BED : BIOCYCLE UNiT SAND 3'"'BDRM HOUSE WELL ABANDONED PACKAGE LIFT LINE SCALE t' = 40' CONCRETE RETAINING WALL WELL 25 Ne. 1457-J 72-013 A (1/93) ' Municlpalily of Anchora;e DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street Anchorage, Alaska 99502-0650 Township, Range, Section: 1 2 3 4 5, 6 7 8 9 10 11 12 13 14 15 16- 17- 18- 19- SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED.;' IF YES, AT WHAT Depth to Water Alter:.// Moniloring? /'"j//"~"' Date: /"2'tr''~ Gross Net Depth to Net Reading Date Time Time Water Drop 20 ' PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER ~· _ 17034 Eagle River Loop R~d I~o. 20~ /~ / ' Ea~le Ri~er, Alaska 99577 /~//~RTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BY ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINI~II~EFF/E'CT ON THIS DATE. DATE: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 2 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT N73MBER:SW940344 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:SKALA TIMOTHY W & MARIE E 0WNER ADDRESS:14615 W LAKE RIDGE DR EAGLE RIVER, AK 99577 DATE ISSUED: 9/16/94 EXPIRATION DATE: 9/16/95 P~a_RCEL ID:05131501 LEGAL DESCRIPTION: LAKE RIDGE TERRACE BLK 26 2 LT LOT SIZE: 27700 (SQ. FT.) NUI~BER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: THE ATTACHED APPROVED DESIGN. ALL REQUIREN_ENTS 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). THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: A CONFIRMING PERC TEST MUST BE TAKEN DURING CONSTRUCT- OF THE DRAINFIELD. WATER MONITORING TUBES MUST BE INSTALLED ON BOTH SIDES OF THE BED. IF THE GROUNDWATER IN EITHER TUBE IS LESS THAN PAGE 2 OF 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 TWO FEET BELOW THE BOTTOM OF THE BED, THE BOI UNIT MUST BE COm~RTEO TO A HO~DIN~ TAN~ m~IL THE ~ROUNWATER 3.- ~ RECEIVED BY: ISSUED BY: DATE: HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER iNSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SiTE PLANS ROAO DESIGN SO[LTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERTSHAFER, P.E. September 5, 1994 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human S~rvices Attn: Jim Cross P.O. Box 196650 ~' Anchorage, AK 99519 REFERENCE: Lot 26; Block 2; Lakeridge T~rrace Subdivision Mr. Cross, As I have previously discussed with you the attached site plans are for the installation of a second Biocycle Wastewater Treatment System to be installed on the referenced property. The d~sign criteria for the Biocycle Wast~water Treatment is the same as that submitted to you in our l~tt~r requesting a p~rmit for Lot 6; Bor~alis Subdivision on August 22, 1994 We are working with Mr. Andres, ~.E. of Pegasus Engineering on this s yst~m also. The site which has been s~lected in this case do~s not require any waivers and the installation of this system should not have any impa~ on adjoining properties. We will attach a property owners agreement for the Biocycle Wastewater Treatment System. The system is to be used to upgrade an existing system which is undocumented. A permit was issued in 1981 to upgrade the existing system, however as near as we can d~termine this work was never accomplished. Request you issue a permit for the installation of the Biocycle unit and the construction of a pressurized bed distribution system for the final effluent from the Biocy~e unit. If we may be of further service, please contact us. kA. SHAFER, P.E. I~/ENCLOSURES J 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 ~ o "o J::: 0 2>, IJJ ~ E ..J Z PROPERTY OWNER AGREEMENT BIOCYCLE WASTEWATER TREATMENT SYSTEM This agre6mcnt, dated AUgust 24~1994 is made between the Municipality of Anchorage Department of Health and Human S6rvic6s (DHHS) and the property LOT 26~ BLOCK 2~ LAKERIDGE TERRACE SUBDIVISION This agreement is made for the p~rpos¢ of d~sig~ng, constructing and testing a BIOCYCLE TREATMENT on-site wastewater disposal system on the subject property. The property owners(s) agree to the following: Thc property owner(s) will allow DHHS and its rcpr6sentatives access to the subject property as required during the design, construction and testing of the wastewater system. The Engineer agrees to bear all costs involved in a testing program which will sample the effluent from this wastewat6r system ~or a p~iod of one year. This testing program will involve the engine6r on this project sampling the efflue~ for 12 consecutive months for: total s~pended solids, BOD5, fecal coliform, nitrates and total kjeldahl ~X~ogen. The property owners will pay all engine6ring and laboratory costs involved· All data will be furnished to DHHS. The property owner(s) furth6r agrees to purchase the Biocycle Treatment Unit at the end of the first year if the unit performs satisfactorily. The cost of the unit purchase shall be $4000.00 Payment is to be made to BIOCYCLE PTY Ltd. e The property owner further agrees to pay a portion of the cost to install the complete facility including the final effluent and subsurface disposal at a participating cost of $8000.00. TIMOTHY SKA~! · ~ARIA SKAEA STATE OF ALASKA 3rd JUDICIAL DISTRICT Onthis ~dayof ~r~d.~ ,inthis year )~?~ ~ before me p~rsona~y p~ · '-~I~IzI~'~IV ~(~2d~ ~ , . whose identity was proved to me'~n ~h~basis of s~'fa~tory evidence to be the person whose name is subscribed to this instrument and acknowledged that he/sh executed.  and official seal. ~e~tar y Public My Commission Expires: ~5~ ,oi ,gl '11¥.1.30/NC" ')3S-~ 'S'I'N I NO! 35-X 'S'I'N MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Strfl. t, Anch~e, Abs~# ~9S01 264.4120 SOILS LOG - PERCOLATION TEST ~.EGA, DESC.IPT,ON~ ~ .~ / r'l SOILS LOG PEflCOI..~TION TEST SITE P~.AN ! 3 4 5 6 7 8', 9 10 11 12 13 14, 15- 16 17 18- 19- 2O COMMENTS PERFORMED BY:__ WATER ../// CERTIFIED BY: LEGAL DESCRIPTION:Z 2 ~ '~--~ Z~C~'~[~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ~ // Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13~ 14 15 16 17 18 19- 20- COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? PERFORMED BY: ACCORDANCE WITH ALL STATE AND MUNI( IF YES, AT WHAT OEPTH? Depth to Water Alter,// Monitoring? /"//or- Date: Gross Net Depth to Net Reading Date Time Time Water Drop q ~ ~. ~o ~ ~ ~. / '/~" ~ ~/ '-- . PERCOLATION RATE g ~ ~"/ (minutes/inch) PERC HOLE DIAMETER ~.~ · TEST RUN BETWEEN ~'.~.~ND ~__~ FT Eagle River, Alaska ~$77 ~R --~__ _ TIFY THAT THIS TEST WAS PERFORMED IN 31PAL GUIDELINE~,-A'q EFF/E'CT ON THIS DATE. DATE: POUCH 6-650 ANOHORAGE. ALASI</x,r~, (907) 2(},1-411 I MA YOR DEPART~viENT OF HEALTH AND ENVIRONMENT/\L PROTEC¥1ON January 4, 1982 Timothy Skala c/o S&S Engineering 5610 Silverado Way Anchorage, AK 99502 Permit ~ 810917 Subject:.Lot 26 Blk 2 Lakeridge Terrace A permit issued by this department for a well and/or sewer system has expired as of December 31, 1981. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please call this office at 264-4720. Sincerely, Sewer and Water Program Enclosure: Copy of Permit /-NUNICIPALITY OF ANCHORAGE ,~'x Department ', Health and Environmental' ~rotectio~ · ~ ~, 825 L Street, 264-4720 Anchorage, AK~ 99501 ~t~"~ * * * HANDWRITTEN PERMIT * * * ,~ , ~/ELL AND/OR ON-SITE SEWER PERMIT Location: ~~ ~_~ , PhOne ~umber: __ Legal Descr~p~ion: ~ ~ ~/~ ~ .'~~.~o~ Size: ' ' Type of Soil Absorption System Is: Trench: Drainfield: ~._ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: ,.~ Soil Rating(sq.ft/br) DEPTH The Required Size of the Soil Absorption ~System Is: LENGTH ,/"_/~ ~' _ GRAVEL DEPTH ,~-~' WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). ~Z~/~,/~,"~~ ~ ~ * REQUIRED SEPTIC(HOLDING) TANK SIZE = GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. · * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER i 9 8 1 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I undg~stand tha~ t~e on-site sewer system may require enlargement if ~~~o/- deled to inslude more~~thatx3 bedro~ Signe~: F//~ Issued by: ~jlicant Date: SWP/024 (1/81) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST LEGAL DESCR,PT,ON: /L 2 1 SOILS LOG ~ 2 PERCOLATION TEST SLOPE DATE PERFORMED: ~-'/ /~'/'~ 6/ SITE PLAN 10- 12 14 18 17 R~t~ert A, 19 20 WASGROUNDWATER /~'.~ ENCOUNTERED? O P E IF YES, AT WHAT // / DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE J~ (minutes/inch) / COMMENTS PERFORMED BY: ' ~._~I~1[ S EagiaeeH~,? CERTIFIED BY: DATE: ~'/ //~'~'~"' OC~ / P E f:d"C[ ",r' ?40. B" E P Fff':': 'l"J"i E N T" HEFiL, TH 825 FIPPL I C F~,f.,iT I...OCFI:T I ON LEGFtL E;:[L..L"? W. MRRT:[N I,]. L.I:!F.:[~.'F;..' i 1.'.:,lie I_":t[..:.:'. L26 E~.:.'2 LRf.':.'ER!DGE TERRRCE PO .80::.:; 89]i: L.OT SIZE ,hl I N I MUM D I STF~.f',iCE BEi"I.4EEN R !.,,!EL.L, F:!!'.~[) RN"r' O!",!"'"~; ! TE :!,:;!E~4!::IGE :J..OI-3 FEET FOR F! PR):',,,'RTE i,4ELL.; OR ....... . F ':LSEt "t .... :::,;~17~ FF'ET F[~'C;M. .. R PUE&..:£C I.qELL DEF'ENE:'ZNG UP!jif.,! THE IqELL LOG"2 RRE F-:'.E6!UIREB' F:!N[:' MUST E~E RETUR?'4ED "FO THE [;:,EPF:IRTMENT !,.!Z'T'HIN OF TH.E WELL COMF'L. ETION. OTHER RE6:!UIREMENT'.E; l"iFt'¢ FIPPLY, S;PECZFZCRTZON'.E; FIt",![:' CON:E;TRUC'!"ZON I;::,IFiGI;.:F:d"iE; FIRE Ft'v'R:[LRBLE TO ZNSURE PROPER IN:E;TRLL, FiTION i E:ERTI F:'"r' '¥1"I[~'F ::L: i RM F:'~qt"ilLIPiR 1.4ITH THE RE'..';:!UIREMEN-F~¢ FOR ON-SITE :F;EP.!ERS FIN[:, I...!ELI....:B R~; SET F:OF~'.TH E:'?' THE MUNICIPFIL. I T'?' OF' F!NCHORRGE. 2: I k!!L.L INSTF!LL THE 2%.'STEM IN FIE:CORDRNCE k!]:"!"H THE ~; ): G f.,i~>:~.. ...~~_ 'l:~~: E, IL.L'¢ l.,.l. MFIRT I N Parcel I.D. 051-315-01 Certificate of On -Site Systems Approval Expiration Date: 1-28-2023 Legal description Lake Ridge Terrace Block 2 Lot Z (, Site address 14615 West Lake Ridge Dr. Eagle River, AK Current property owner(s) Jeanson X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: Z bedrooms, with the following stipulations: Original Certificate Date: / 0— This— This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA ApprovaIjune 2022 MUNICIPALITY OF QHCG> O , GE Development Services Department t Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051-315-01 Complete legal description LAKE RIDGE TERRACE B2, L26 Location (site address) 14615 WEST LAKE RIDGE DRIVE, EAGLE RIVER, AK 99577 Current property owner(s) HERVE & LISA JEANSON Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ® Fiberglass Age 28 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ® AWWTS ® Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property -is -subject to inspection -by -municipal On-site staff to verify the accuracy of the information provided. COSA Fee $5� // Waiver Fee $ Date of Payment `U zj I g_� Date of Payment COSA # 11SC a pigq L1 Waiver # � a / COSA Application 2022.doc Legal Description: LAKE RIDGE TERRACE B2 L26 Parcel ID: 051-315-01 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ® Well log is filed with Onsite (or attached) Water storage tank volume NA gallons Date drilled 9/27/79 Total depth 220 ft Well disinfected for coliform test? ® Yes ❑ No Cased to 60.5 ft ® Coliform bacteria is Negative ® Sanitary seal is functioning correctly Nitrate mg/L ® Nitrate less than MRL (ND) ® Wires are properly protected Arsenic ug/L ® Arsenic less than MRL (ND) Casing height (above ground) 36+ in. FWH Date of flow test for COSA 9/26/22 Collected by > & SULLIVAN Static water level at beginning of test 29 ft. Date 9/26/22 & 10/18/22 Well production at time of test 4.2 gpm Comments WATER SYSTEM CHLORINATED BY SULLIVAN — SEE COLI SAMPLE. B. TANK DATA Measured operating fluid level in septic tank Date of pumping *8/22/21 ® Required maintenance completed, if AWWTS Comments: *SEE BIOCYCLE MAINTENACE D. ABSORPTION FIELD DATA Which system tested (date installed) 10/12/1994 ® ALL standpipes present per record drawing Total measured depth from grade 4.3 ft (max) Measured depth to pipe invert from grade ft (min) ® N/A — pressurized field. ® Per record drawings, field is insulated. ® Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date C. LIFT STATION ® Required maintenance completed Age of lift station 28 years Lift station material FIBERGLASS Comments: *FLOATS SEE MAINT REPORT Adequacy test date 9/26/22 Results E Pass Fluid depth prior to test 0 in (NE MT MOIST) Water added 450 gal New fluid depth 3 in Elapsed time 1300 min Final fluid depth 0 in Absorption rate 450 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used 0 in Effective depth remaining 6 in Comments/Deficiencies: MT AT EXISTING GRADE. NO KNOWN FROST ISSUES. FW S COSA Checklist 2022.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ❑ Yes if No *50+ ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No *50+ ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ❑ Yes if No *50+ ft Tank to Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ® Yes if No ft Private Wells > 100' ❑ Yes if No *50+ ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ❑ Yes if No *50+ ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *MAY MEET CONVENTIOANL SEPARATIONS BUT SYSTEM MEETS CATII SEPARATION DISTANCE REQUIREMENTS. SEE MOA ON SITE FILE IF NEEDED. G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Finn FIRST WATER CONSULTING Phone 907-350-9566 Engineer's Printed Name CURTIS HUFFMAN, PE Date 10/28/22 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 1 wi S COSA Checklist 2022.docx AJ ,mom,..,• � •.V %_.. TH ..... ......... �.• urtisuffman CE 128991 l��••1Q/28/2�.•'c�� �k �' �PROFESSI4NA .� \���,����. MUNICIPALITY Or ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this / 2- Day of of 20 2, , by and between herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as AN BIOCYCLE located at (legal description) LAKE RIDGE TERRACE B2, L26 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS sei vice and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This }y t includes an annual maintenance fee (typically $400 to $600). j� Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Pagel of 3 RN Owner acluiowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. ,00 Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER: //,A, By: /�yh� (signature) Date: /2 Oer Z,22- 1�*^l In"" "W (print name) STATE OF ALASKA } ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this day of beef , 20, bY_�Qr�ITZ�Fqq�i�//i NOTARY PUBLIC F R A�LASKA �: ma ` My Commission expires: - J :NOTARY -a O (p .• Pj -BLIC *\ ��� �1I0►IIIII\\\\\`\\ MUNICIPALITY: 1339— — (signature) Date: 169 (print name) Title: (rev. 05/18/2018) Page 3 of 3 JJaC ET Anchorage AK 99503 Email: crbioak@gmail.com (907) 274-0314 • Quarter Inspection -•r , Homeowner Info Customer Name: Herve and Lisa Jeanson Address: 14615 W. Lake Ridge Tank#: 2 Install Date: Oct. 1994 Initial Inspection: Area Eagle River Alarms Tested: Air [;4 High Water [�J Battery Tested: Yes 0 No ❑ N/A ❑ (Please make sure alarm is on "normal", not °`haute°`) Does system have a septic tank ? No A Yes ❑ (Recommend pumping tank every 2 years) Is System Lid Locked? Lid hardware in working order? Is there any noticeable odor? Yes 0 Repaired F] Yes 0 Repaired ❑ Strong ❑ Mild ❑ None A Inlet plumbing in working order? Yes 0 Replaced ❑ Are all aerators functioning? Yes 0 Replaced ❑ Clarification return system operating? Yes [VJ Adjusted ❑ System Inspection Solids pillow normal? Yes [V] Requires Pumping ❑ Any buildup of solids? Yes ❑ N o [V] Any buildup of solids? Yes ❑ No 0 pH Reading: Dissolved Oxygen PPM Turbidity of discharge (in FTU) (pH of 6-8 is ideal) (2-5 is ideal) (Under 35 FTU is considered compliant.) 7.5 3.5 6.22 Pump float operating? Yes 0 Replaced ❑ Filter cleaned? Yes F 1 N/A ❑ Comments: Inspected By: Chris Alarm float functioning? Yes 1� Replaced ❑ Any buildup of solids? Yes ❑ No V Discharge line condition: Good ® Replaced ❑ Date: 05/29/2022 Has emailing or mailing of form been requested? YesNo (contact office to request...) • • •� '`° Municipality of Anchorage PGE 7 On-Site Water and Wastewater Program z:-"``1 (907) 343-7904 ei SA A ETV T T V y CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-315-01 Expiration Date: 2- Zq- �g 1. GENERAL INFORMATION Complete legal description LAKE RIDGE TERRACE BLOCK 2, LOT 26 Location (site address) 14615 W LAKE RIDGE DRIVE, EAGLE RIVER,AK 99577 Current Property owner(s) TIMOTHY SKALA Day phone Mailing address 11940 BUSINESS BLVD. 102, EAGLE RIVER,AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well Holding Tank ❑ Individual Water Storage ❑ Community 0 Community Class Well ❑ 0 Public Sewer Public Water System ❑ WaiverNariance request for: Distance: Received by: /Air/ Date: f (/2 9//7 COSA to be released to the engineer, unless of a e requested by the engineer. COSA Fee $ 59t. Waiver Fee $ Date of Payment WOO'WOO19 Date of Payment Receipt Number 31$361D Receipt Number COSA# (bLi?-157 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 ARCTERRA CONSULTING,INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD.,EAGLE RIVER,AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 11/09/2017 THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface,changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen �.b.." .\ NIL encroachments,deficiencies or discrepancies exist. r'4 , OF Az _7 *14_• TH , r 6. DSD SIGNATURE 1. ar _� �j�V K System#1 Approved for _.j bedrooms. + s KENT-E, �! la-, Al 'tf 7116 4w/ 1� ,� System#2 Approved for bedrooms. <r›, r'�FEss1•`N`" i !ov ale Disapproved. \``,!41P- Conditional approval for bedrooms, with the following stipulations: ,,�kttttrrri, •,,,y `J`� \�V OF,q41 , , \ ON-SITE .. :',.. WATER AND m;. PROGRAM o By: IA.., /`. Original Certificate Date:• j - I The Municipality of Anchorage Development 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_10-10-12.doc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: LAKE RIDGE TERRACE BLOCK 2, LOT 26 Parcel ID: 051.315.01 A. WELL DATA Well type PRVT If A, B, or C provide PWSID# Well Log (Y/N) Y 9-2-t-7Q Date completed.t91$ Sanitary seal (YIN)Y Wires properly protected (Y/N) Y Total depth 220 ft. Cased to for Aiti. Casing height(above ground) 36+ in. FROM WELL LOG AT INSPECTION Date of test q"23- 7q 10-26-2017 Static water level (0 ft. 25 ft. Well production 3 g.p.m. 51 g p m WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate ND mg/L Arsenic: ND ug/L Date of sample: 10/26/2017 Collected by: ARCTERRA B. SEPTIC/HOLDING TANK DATA Tank Type/Material BIOCYCLE I FIBERGLASS Date installed 10/12/1994 Tank size 1373 gal. Number of Compartments 4 Cleanouts(Y/N) Y Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) Y Date of pumping Pumper 'Y 1p.‘t^h 4t vtc. Aa k‘c yi.„6 k C. ABSORPTION FIELD DATA Date installed 10/12/1994 Soil rating (g.p.d./ft2 or ft2/bdrm) 1 System type BED Length 53.5-61.5 ft. Width 15.17 ft. Gravel below pipe 0.5 ft. Total depth 3_5 ft. (Measured 10/26/17) Eff. absorption area 862.5 ft2 Monitoring tube Y Depression over field N Date of adequacy test 10-26-17 Results(Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 5 in. Water added 460 gal. New depth 6 in. Elapsed Time: 1430 min. Final fluid depth 4.5 in. Absorption rate >=450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) N If yes, give date D. LIFT STATION —Biocycle 4t Compartment L.S. Date installed 10/12/1994 Size in gallons 132 Manhole/Access (Y/N) Y "Pump on" level at 24 in. "Pump off' level at 6 _in. High water alarm level at 30 in. Datum BOTTOM OF TANK Cycles tested 2 Meets alarm&circuit requirements? Y E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 100'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway,parking/vehicle storage 5'+ Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 100'+ F. COMMENTS Absorption bed life expectancy is at 80-90%based on observations. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance _Nob, with MOA COSA guidelines in effect on this date. OF A i�� j,Ni 1 Engineer's Printed Name KENNETH M.DUFFUS Av 7 � Date 11/10/2017 4• TH Amp COSA canary sheet_2-6-15.doc $, KENNETH7 Mxtr�c \.P/o,:So1O1`a� Air ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT BETWEEN MUNICIPALITYIOF ANCHORAGE AND (Buyer) t4 EE,(Z1it', Jt t3S) N THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this 20 Day of 1;0 v IL-.kki of 20 H,by and between t:.lL\iG ;_i\ N N herein the"OWNER,"and the Municipality of Anchorage,herein the "MUNICIPALITY." hi consideration of the mutual covenants contained herein, the parties to this Maintenance and Repair Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as Bio-cycle located at(legal description). 14615 Lakeridge Dr.Eat River- LAKE RIDGE TERRACE BLK 2 LOT 26 2. Definitions. Alteration. Any change to the design or function of an AWWTS that includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Certificate of On-Site Systems Approval (COSA).An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with Anchorage Municipal Code (hereinafter, "AMC") 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. Permit. An On-Site Wastewater Disposal Permit as required by AMC 15.65 to construct and operate an AWWTS. 3. Term. The term of this Maintenance and Repair Agreement shall begin on the date of approval by the Municipality to operate the installed system or issuance of a COSA, and shall continue while the AWWTS is in use or is operational or until 1 the governing guidelines for the construction,maintenance and repair of the Owner's AWWTS. I. Owner agrees to provide and maintain a telephone connection to the AWWTS as required by the AWWTS approval. 6. Nonwaiver.The failure of either party at any time to enforce a provision of this Maintenance and Repair Agreement shall in no way constitute a waiver of the provisions,nor in any way affect the validity of the Maintenance and Repair Agreement or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 7. Amendment. A. This Maintenance and Repair Agreement shall only be amended,modified or changed by a writing, executed by authorized representatives of the parties, with the same formality that this Maintenance and Repair Agreement was executed with,and such writing shall be attached to this Maintenance and Repair Agreement as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this agreement, the only authorized representatives of the parties are: a. Owner: (Buyer) +r2Ve -A c N Sc) b. Municipality: Director, Community Development or designated authority C. Any attempt to amend,modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance and Repair Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Maintenance and Repair Agreement. 3 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 Ot4fi+4400ti£010£01U4 0:000MNSOA 4f 14f £Si£Mt'i}; fOMk394 SBItratit Moff£iC£i 4s€4EI02084i'F�Y?1�#E k :434iFt.`:t 4MAgAfrtF';l 4141+404 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of California 1 County of_Nevada )r On 20 2011 ._ before me. .- Jamie-hrtigo...[`lotaty_P�rt�l.i _______.------ , Date Here Insert Name and Title of the Officer personally appeared ._ CVG _ '►54.1 ------__ Narrri?(s.,`f Signer. who proved to me on the basis of satisfactory evidence to be the persoN§1 whose nam'+(s),is • subscribed to the within instrument and acknowledged to me that heialielthey executed the same in his/ 'r. authorized capac0(ie. and that by his/14c414air signaturd($.ctn the instrument the person or the entity upon behalf of which the persoritskctecl, executed the instrument. 1 I certify under PENALTY OF PERJURY under the — I JAMIE ARKhG) t laws of the State of California that the foregoing P':4 ' COMM_A21MO4 paragraph is true and correct. ii t!!ea NOTAAYPi a ir.tA'IFr A \ia�. MyCamm:6x,�.Grp.1121WITN_ Si sand • nd • ` it I seal. IN I Sig+alive tollw _._. Place Notary Seal and/or Stamp Above Si• attire of No Public __._..__... OPTIONAL Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: ---...___..._.__._._...-..._. ._.._..._ — Capacity(ies) Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: __. • ' . _.--- ❑ Corporate Officer–Title(s): 0 Corporate Officer–Title(s): ❑ Partner-- 0 Limited 0 General 0 Partner– 0 Limited 0 General ❑ Individual 0 Attorney in Fact ❑ Individual 0 Attorney in Fact O Trustee o Guardian of Conservator ❑ Trustee 0 Guardian of Conservator O Other: ❑ Other: Signer is Representing: _- Signer is Representing: ©2017 National Notary Association N11.05•07„ ��„� �N729•00,, 15742, — s /55.80, • i 'OWER FI RE BICE 1 EXISTING /' I SHORE INE •k- 00 0 00 O b / o Quo to o e•o• N 5 � LOT 26 Q / BLK 2 / / . WELL '7' to •Doi ' oFCk e O MONITOR WELL 01 oFCks O O h moi• O / / Seo• 9w A N StCANT Att,t,FH T / 0 -NIo. Ft / 46.OOD O m QZ wo OO o Jr. 16 '8• o / so, NN /(f) SEPTIC 80, SYSTEM o, / • Ssitc,/ • rye. ?63• / / / 14.3, / ' / PAVED 20 D/W 20 N-4 OD • E--1 � /10' T&E ESM T S00'06'00"W 90.51' (90.49' R) LAKE RIDGE DRIVEN .Q ANCHORAGE RECORDING'D� C� _ i N ASBUILT OF: LAKE RIDGE TERRACE LOT 26 BLOCK 2 PLAT P-549 ��.D S j� SURVEY CERTIFICATION: I,John L. Schuller,have conducted a �������\ \ ��Z' LANE v..� physical survey of this property as shown on this drawing and that the s��, . F•.A���' ��y ��O ��' � improvements situated thereon are within the property lines and no / �• `9tS� `� w �' enchroachments exist other that noted. ( 49TH • �) 1� � EXCLUSION NOTES: It is the owners responsibility to determine the / U a existence of any easements,covenants,or restrictions which do not 4 t� c .. appear on the recorded subdivision plat. Under no circumstance should �,t /6%-( . SCHULLER. �°, ;,any information on this drawing be used for construction of fences, �'�'/ -10408 .• i/ • . structures, improvements,or for establishing boundary lines. a ,Co- � • 5,i w►�• ••� ' % ,o "' r?„a 1831 Talkeetna Street WORK ORDER NUMBER: DATE: SCALE: E-MAIL: �Ofessiono' ��' Anchorage, OCT 28, 2017 1"=20' \���`� Alaska 99508 17-055 DRAWN BY: CHECKED BY GRID NUMBER: BOOK/PAGE: (907) 227-1455 office JLS NW0553 170170 (907) 274-4992 fax APPLIC'NT FILLS OUT UPPER HAl" ONLY -' Properiy Owner ~7 . . : . ., ' ~ - ¥ Phone Mailing Address . ~ ,' . ~- ' ~. -'- '~ t~ · '"; }- - Zip Code .... ," ? -;z "" ,' Buyer - _ ... ( , .: : ' Zip Code Address -.; -'~7-;. ~ -1--. Phone Lending institution ;.,~ .~ .:- " · . - !~ : .~ , Zip Code Realty Co. & Agent -.J Phone · i ; :...~-~ Zip Code Address Legal Description : · ~- :', · ~/% ; ?. Street Locatioa . ! / .~ ~ , , , .[.~ Type, of Residence ) [~Single Family ~1 Multiple Family No. o[ Bedrooms [] Other Water Supply '~ndividual ATTACH WELL LOG. A we~l log is required for all wells drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach log if available). [] Public Utility Sewer Disposal ,~ Individual Year Individual Installed: Public Utility When Connected to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE iNITIATED. Time Time Time Time inspector Inspector Inspector Inspector ( ) CONDITIONAL APP~* ~ Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received Well to Tank Septic T~k Size TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR MUlqlCir~U~ ~ ur aa,~,unD^[~_F~T. OF HEAUH & MUNICIPALITY OF  DEPARTMENT OF HEALTH & ENVIRONM~~TEcTION 825 L Street - Anchorage, Alaska 99501  ENVIRONMENTAL SANITATION DIVISION ' Telephone 264-4720 ~ ~ ~ ~ I REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be proce~ed. Please allow te~ (10) days for processing. PHONE PROPERTY OWNER MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION / [ PHONE I MAILING ADDRESS 4. REALTOR/AGENT / ~ PHONE I MAILING ADDRESS 5. LEGAL DESCRIPTION / o 7 ,.~.~ A z/'d ~ x4x.-~' .~//_~--m' 7~'.d/.~c'~' -';/~'¢P STREET LOCATION J '- t~'/:/?d ~o~,';7 ,4.4,'<~' ~/_~;~ c°4~Z~' ,~/uP£, /~,4,,0~;/--~ 6. TYPE OF RESIDENCE NUMBER OF~BEDF~OOMS ~/ SINGLE FAMILY [] MULTIPLE FAMILY [] One [] Four  Two [] Five Three [] Six [] Other 7. WATER SUPPLY JLa' INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY *ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM '~]' INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] iNDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER E~]INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER [~]Septic Tank or []HoldingTank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TQTAL ABSORPTION AREA MATERIAL 4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line J Nearest Lot Line 1 WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS [] APPROVED FOR BEDROQMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY ALASKA eI1UIROIlmeI1TAL CONTROL SeRUICeS, I11C. J~l~§Jneer'Jll(j ~ J~nuJromentol StucJJes MUNICIPALITY OF ANCHORAGE DEPT. OF HEAL]-H & ENVIRONMENTAL PROTECTION MAR 1 1_ 1981 RECEIVED 3.-1 0..-~ :L F'EOPLES E:ANK & TRUST F'OUCH 7007 8TH 8, (2,.' STREET ANCHORAGE AK 99510 SELLER -- MARTIN SUE:DIVISION--LAKE RIDGE TERRACE E:LOCK-2 LOT-26 THE TYPE OF: AE:SORPTION SYSTEM iES A DRAIN FIELD W."£TFI AN UNKNOWN AREA. THE SYSTEM IS CAF'ABLE OF ACCEPTING 450 GAl_CONS OF WATER PER DAY, E:ASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABI-E FOR A 3 BEDROOM HOME+ THE SEPTIC TANK ~AS PUMPED ON 10-13'-8:L The Septic tank ~ize is 1500 gallons. , o ~ C. Reid, Jr. ,? .~. ~ ALASKA ENVIRONMENTAL CONTROL SERVICE,r~-"NC. 1220 West 25th Avenue ANCHORAGE, ALASKA 99503 Phone 276-1361 SHEET NO. CALCULATED BY CHECKED BY SCALE /'~¢~/'~ OF¸ D~TE DATE CHEMICAL GEOLOGICAL LABORAT, RIES OF ALASKA, INC. TELEPHONE (907)279-4014 P.O. BOX 4-1276 4649 BUSINESS PARK BLVD. ANCHORAGE, ALASKA 99509 ANALYTICAL REPORT Water Analysis(Facility) Sound Construction Company Date Collected: 11-24-76 Time Collected: --- By: .... Source of Sample: Well Water Physical.Observations, Remarks: Clear, colorless [] mg/1 Aluminum [] 380 mmhos [] mg/1 Arsenic ~] 9.1 units [] mg/~l Barium [] mg/1. [] m9/l Boron []__ mg/1 [] mg/1 Cadmium [] mg/1 [3 0.4 mg/1 Calcium [] [] mg/lCopper E] []_ mg/l Chromium-Total [] mg/1 []___ mjg_~]_Chromium-Tri [] mg/1 [] ~g/1 Chromium-Hex [] 5 [] mg/1 Iron-Total [] mg/1 []_ _mg/1 Iron-Dissolved [] mg~ [] mg/~ Lead []_ ~ ~g/1 [~__0~2 _ m~/1. Magnesium [] mg~ [] ~/1 Manganese [] mg/1 []_ mg/1 Mercury [] m9_/1 [] mg/l~ Nickel [] mg/1. [~ 1 mg/l_ Potassium ~] 348 [] n~Selenium [] m~/1 [~]84 mg/1 Sodium [] mg_~/~ [] mg/1 Silver [] mg/1 [] mg/1 Zinc [] JTU Conductivity pH Ammonia. Nitrogen-N Kjedahl Nitrogen-N Organic Nitrogen-N Nitrate(N) Nitrite(N) Phosphorus (Ortho)-P Phosphorus (Total)~P Chloride Fluoride Cyanide Sulfate Phenol MBSA BOD COD TD Solids TV Solids Suspended Solids SV Solids Turbidity ~] 2 mg/1 Hardness as CaCO3 ~] 270 mg/]_Alkalinity as CaCOB [] mg./1Acid~ty-T as CaCO3 []_ _ mg/1 Acidity Free as CaCO~ [] /lOOml Colifor~-T [X]_ <l /lOOml Col iform-F [] /lOOml Strep-F [] units Color ~__2J~_ mg/1 CO3 [] Transported by: Received by: Transported by: Received by: FOR LAB USE ONLY Lab# 5080 Rec'd by: Se Date sample rec'd: 11-24-76 Date analysis completed: 12-3-76 Date results reported: 12-3-76 Date: December 3, 1976