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HomeMy WebLinkAboutLAKE RIDGE TERRACE BLK 4A LT 2 N 6 u. Li u U) S u. ami r C7 ca o o ♦♦�►raa1��1, " N A A # X31'/`+♦`1 a p _ a a a) y r, ) ��♦ V) CY ♦♦ s 3 0 m a=i 0-0 o♦ a ro ! � ♦I� © ❑ iu c 3c m ro m n O cn r 3 ma m N E u � 1 i Z o o O p T o Y eh a°'i rn f LAJ w V ❑ v c>> c a = n E n M A W `� 'a ♦♦�'d°: ♦ W r x o o v z N v a, w ♦♦ f �� a°i ami Y ro o f * G\S.s \� O W V N iri .0W N O M ~El O rn ro Z y Q ti N Z Li LL UYO o ❑ J o Cl O o a� -L m " Z a Y .Q w J a M O W > a t a a ©� H Q m 4 Q ro ro w 0 0 d 0 3 c a ca ro ro y u 0 �' = G C d N O c� Z I— a 3 @ c"=i y m m (a ° WV oz — ❑ � m ? m Z Q c ►�, ° w c E d Z wo° ca a❑s cn o - iL c� o H F- m J m ¢ d m y 3 W o E m in x 3 c kn Q U a CLE E _, N Z W — `C: N LJJ o J 3 (0 m J N_ c H a �a U ca 300 Q 7 E YQ 0 W __ LLJ� m o A a O � Y xZ 0 1 o Z a CD' �+ a � o V Z � > o o -4 UW 'n ro o a� L LU O CL •- 4 A OA as Z z Z 0 a> of �' a p, coLL 0 a¢ F- Y W O vZ U , �. a) Oy 67 w = v Q [6 O -" O C V O Z m W ;ro ro J Q, -N x �= n a m m a u, $ u� a� ro N .- } nn. 5 a r, c c9 a � a o -� o E 6 n a) cL 3 E W a I�rN r 0 � 3: W o a� c N O U) Q CL O z in a J cn F- N LLU AS—BUILT SYSTEM DETAILS/SITE PLAN Permit ❑SP241190 LAKE RIDGE TERRACE BLOCK 4A LOT 2 PID# 051-321-02 �o- Z ` 00 h'QI STIiV USF G FCO E F A -C=70.4' B -C=80.4' A-11=71.5' 8:31�aj 83.3b B-11=81.4' y A—E=73.1' B—E=83.4' f A—F=76.9' B—F=87.9' A 0 1250 GAL SEPTIC SCALE, NTS a 4d r ■ AV ��..()F4, PREPARED FOR: ELLIS F❑NGMIE . 14715 TERRACE LANE Ayr :4 * EAGLE RIVER, AK }FIELD BOOKS cOMPUTCD: vp cGE Il •- �w� BOUNDARY: N A MAWKSp N A 1 F L srAa"� aEa�o: KM❑ v • ASBUILT: DATE 6 1 i ssYao ' i — £ � owc. FILE: GRID: N WDS, AOAD "'F- 10B "0-: 24114 r� LQ I SCALD 1" = SCALE, NTS MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241190 Work Type: SepticTank Upgrade Tax Code Number: 05132102000 Site Legal Address: LAKE RIDGE TERRACE BLK 4A LT2 G:0553 Site Mailing Address: 14715 TERRACE LN, Eagle River Owner: FONGEMIE REVOCABLE TRUST Design Engineer: ARC TERRA CONSULTING INC This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft Total Bedrooms: 7/22/2024 7/22/2025 36739 ❑ Disposal Field Lf Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing I--;— -- I ysei _ y: L 55 c e. f6 % �� l �'r�i Date: Issued By: ��U 1 Date: Z ��-- ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-321-02 Property owner(s) Ellis Fongernie Day phone Mailing address 14715 Terrace Lane Eagle River, AK Site address 14715 Terrace Lane Eagle River, AK Legal description (Sub'd., Block & Lot) Lake Ridge Terrace Block 4A Lot 2 Legal description (Township, Range & Section) Lot Size 36,739 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (0 all that apply) Absorption Field F-1 Initial 0 Single Family (SF) N (w/wo AD U) Septic Tank K Upgrade RX Duplex r_1 (D) Holding Tank El Renewal Multiple Dwellings r_1 Privy ❑ (SF and/or D) Private Well F Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Dea Duffus (Signature of property owner or authorized agent) Permit/Rush Fees: 02-2-9 Date of Payment: 7/7, Receipt Number: Permit No. CeP Z 1111 G 0 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GAIDevelopment Services\Building Safety\On Site Water and WastewaterTorms\Client Forms\Permit Application.doc 100 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241190, Deb Wockenfuss, 07/22/24 Approximate trench location Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241190, Deb Wockenfuss, 07/22/24 , Municipality of Anchorage Page / of 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: ~ ~-~o 2~7~5-"' PID Number: O,..~'/'~ 2~/o N~: ~G~ ~ ~ ~ l~ Wastewater System: ~ New ~pgrade Address: ~ /~/~ ~~ ~~ ABSORPTION FIELD Phone: No. or. rooms: ~ Deep Trench ~Shallow Trench ~ Bed ~ Mound ~ Other Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION ~,~ GPD/Sq. Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township: ~¢~ Range: ~/¢~ Section: ~ ¢ Fill added above original grade: Gravel length: WELL: ~ New ~ Upgrade Gravelwidth: Number of lines: Distance be~een lines: ~ ~,, / ~ ~. Pipe material: Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area:._ ~t. Driller: Date Odlled: Slatic Water Level:Ft. Installer:~ ~ ~~ Date installed: Yield: GPM Pump Set at: Ft. Casing Height Above Ground:Ft. TAN K SEPARATION DISTANCES ~eptic ~ Holding ~ S.T.E.P. TO Septic Absorption Lilt Holding =ubNc/Private Manufacturer: Capscity in gallons: From Tank Field Station Tank Sewer Lines ~ ~ ~ ~ ~ ) ~ Material: Number of Compartments: Surface LIFT STATION Water ~ ~ I O~ ~ Lot ~ ~ Size in gallons: Manufacturer: "Pump on" level at: "Pump off" level at: High water alarm a~: Foundation , ~ ~ CurtainDrain ~_ ~ ~ ~ ~ ~ Pum~ Make & Model Electrical inspections pedormed by: Remarks: BENCH MARK Location and Description: ENGINEER'S SEAL Department of Hea~ and Human Services approval -~¢~;,..,_ 72-013 (Rev. 9/91) MOA 25 Permit No. ~--~l/(J' ~ ~ ~ ~ _Page ~' 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 Description: /,,~r ~ /~w-v., ~A-~ LAr-c-~.~z)~,~- 7'~--~4¢_¢¢.~ c-~.~5 PID No.: ENGINEER'S SEAL 72-013 A (2/91) MOA 25 Permit No. .~ ¢1.~O Z~¢5'' Page ~ 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 Description: ~'~' Z. 1~ 4-,4-~ 'b~¢ ~ 72-013 A (2/91) MOA 25 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 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930245 DESIGN ENGINEER:DAVID R. DAYTON, P.E. OWNER NAME:HICKEY ROBERT E & MARY JANE OWNER ADDRESS:14715 TERRACE LN EAGLE RIVER, AK 99577 DATE ISSUED: 7/23/93 EXPIRATION DATE: 7/23/94 PARCEL ID:05132102 LEGAL DESCRIPTION: LAKE RIDGE TERRACE BLK 2 4A LT LOT SIZE: 37000 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. 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 Bo COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: 1. SYSTEM TOTAL DEPTH MUST NOT EXCEED 7.5 FT. 2. SYSTEM MUST HAVE 2.5 F%. OF GRAVEL MINIMUM BELOW THE TO FROM David R. Dayton P.E. 20~10 Donalar St. Chugiak, Alaska 99567 SUBJECT DATE RF4~.~O~__. 4S 468 I~vld P. hyt6fl P.E. ~K)210 Doflshr St. Chuglek, David R. Dayton P.E. 20210 Donalar St. Chugiak, Alaska g9567 0,~ D~vid R. Dayton p~c. :20210 Dona]ar St. ~.hugiak, Alaska 99567 PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN sERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG m PERCOLATION TEST 10 12 13 14] 15- 16- 17 18 19- 20- DATE PERFORI ~,~, '~ Township, Rang~, Section: <~ SLOPE SITE PLAN WAS GROUND WATER Al ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? P E Depth to Water After '~"~ Monitoring? 'Y~ Dale: Gross Net Depth to Net Reading Date Time Time Water Drop ~,'11 .~ o /o ~ ~ '~ PERCOLATION RATE ~,~ tminutes/inch) PERC HOLE DIAMETER ~-~ '/ TEST RUN BETWEEN :~'4.- FT AND ~'~-- FT COMMENTS 72-008 (Rev. 4185) PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3- 4- 5 6 7 8 9 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Rang'e, Section: SLOPE SITE PLAN 10 11 12 13- 14- 15- 16- 17- 18- 19- 20- WAS GROUND WATER A/~ ENCOUNTERED? /¥~ S L IF YES, AT WHAT O DEPTH? P I}epthto WaterA/~~'rr~NlOnit~ring? nile: ?/?/~ Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ (minutes/tach) PERC HOLE DIAMETER TEST RUN BETWEEN ? FT AND ~, FT 4?, COMMENTS PERFORMED BY: '~;::~,1~ ~::)?Hd'-~ (~.,~:~ I ~"'~'~ /L~"Z'~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) D: DAYTON, P.E., R.L.S. k~xX~~ Chugiak, Alaska 99567 20210 Donalar (907) ~~ 696-2417 New Septic System for Lot 2, Blk 4A, Lakeridge Terrace Subdivision The proposed septic system is to rePlace an undersized tank and a failed seepage pit. The new system will be a 1250 gallon tank and a~.~75' x 8.5' deep trench with 5' of gravel. ~.~'J~'~Th~ench bottom will be 5.3' ab0ve the water table and ~/ 6' above the test hole bottom. /// The new system Will have no adverse impact on wells or waste- / ? water systems on adjacent lots. There will be no adverse impact [ on reserved space or drainage. QGRF" ""- R ANCHORAGE AREA Department ~ ~Enn~vir~o,.n.m~,ental Quality Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH INSIDE WIDTH MATERIAL LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY GALLONS. SEEPAGE PIT: NUMBER OF PITS J LINING MATERIAL LOb BUILDING FOUNDATION__ DIAMETER ~ OR WIDTH ~-~", LENGTH 1'7'~, DEPTH CRIB SIZE: DIAMETER'S'DEPTH ~* DISTANCE FROM: WELL TOTAL EFFECTIVE NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT. ADDITIONAL ABSORPTION WELL: BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION NEAREST LOT LINE OTHER SOURCES DISAPPROVED ¢[l~JOD 14~-D DEPTH NEAREST SEPTIC SEWER LINE TANK __ REMARKS. DISTANCE FROM: SEEPAGE SYSTEM DISTANCES: INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM APPROVE~L~ / ~')¢'"~"~ // C~.'A.'AoB, GRE,' .... ANCHORAGE AREA B0F" 'GH ~.q~/ Department of Environmental Quality , ~ 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION MAILING ADDRESS PHONE LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER INSIDE WIDTH (~ ree~ MATERIAL NUMBER OF COMPARTMENTS LIQUID DEPTH LIQUID CAPACITY. /'(~i00 GALLONS. SEEPAGE Pit: NUMBER OF PITS t DIAMETER 7Z/OR WIDTH /81 LENGTH/~ DEPTH b/ LINING MATERIAL ~ CRIB SIZE: DIAMETER ~/DEPTH ~2r DISTANCE FROM: WELL ~' BUILDING FOUNDATION ~Z?' TOTAL EFFECTIVE qZ , NEAREST LOT LINE ~7/'~ ! ABSORPTION AREA (WALL AREA) Z- SQ. FT. ADDITIONAL ABSORPTION TYPE CONSTRUCTION BUI LDI NG NEAREST NEA REST FOUNDATION LOT LINE SEWER LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK , SYSTEM DISTANCES: INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM DATE ~(~/' L~/ /f7~ APPROVED A~.A~B~//~/-~ GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street ANCHORAGE, ALASKA 99503 Case # Performed For Legal Description: l~e't This Form Reports Soils Log Soil Test Must Be Logged To 4' Below Proposed Seepage System - Depth Feet Soil Characteristics 2w 3w 4~ / lO-- 12~ 13~ 14~ Dated Perf§rmed Z-~-)~ ~ercolation Test ' LL Was Ground Water Encountered? If Yes, At What Depth? Reading Date Gross Time Net Time Depth to H20 Net Drop Percolation Rate Minute Proposed Installation: Seepage Pit Drain Field Depth of Inlet Depth to Bottom of--Pit or Trench''' COMMENTS: Test Performed BY /fFT~_~ $. ~.~ Date Certified BY: Date: 0 CD tiI-- CIO CIO It M I? r— rl- o O C) CY) W o ca o w V n d. 0 i U Z LL �\ 0� 1 Q —o U U � O _ Q W Z 0� U a� C,6 CO. c E O Z > U) a 00 A Al Lel M. o`` 0 w w L CO aa) Z) CNO N 3 a 0 3 t ~ � y ' J L J W c4 W_ c W C Of � O O z cu I` O L LL x LU N rn H _j O d¢ Y Q C 0 U) Y J m W U Q > 2 W co O � Q�LLJ wLu Z J w - CD rLL^J V W w v Z LiO CD Y C fC Q 'V i N Q J L V-- 3: > >, O o o m Cr_ o C 2- U O U) O Q O Q fA F Q NCl) C O NLL m d -1 i) U Al Lel M. N 0 0 o`` 0 0 L aa) a -0 3 a 0 3 t ~ y ' U) L c4 C Of � X O aEi U L = O O �O � C 0 U) 'a N OL 0 C fC Q 'V CL > >, O 4) ^cn m Cr_ o Q N •T 'O > � fA Q NCl) C O NLL U Q '� N 0 `' cn O 3 c m o a. .y �z< E N ; .,� CD rn p O) O) V � M C? c`7 N � 0 0 CY) 0) W c O LL 0 n a 0 V Z LL a y 1 0 = I c � a) V ,L L U a) o6 U),-. C a) E3: O � 00 C O 4- c� U Q Q Q O CL Q O U) N CL O O N t� cu U a) TMI a F a I• 7 N a) c� a) cn c O U O J W Ii] k LIZ a) a) LL 0 0 U O) a) c_ O O) N O CL a) O O N U Q. C M Q) C L O ❑ C fB V E = Eo U c 3 V L) U) ❑ N ) c O c O >�_ > V > E u © Q^. �- U c ❑ Ela`) rn t c _ � a) _0 Y� Ma) C: ❑ i (D (6 a) () � d a) c a) a c N V O E] > a) o El a) -a O a) O �, 0)> c C W o ® ❑ U m a C. 00 °) J ❑ °' rl a o icc � U O N'a ++ O ® ❑Elcn n o C �- o © Q ❑ •� w L' N in-a.� IL U) Ln cn � W ❑ O W N v LLIa) L � Q Q Y Z o 3 Q +) O R w LL "- F o a F- O O U cr w w O i' W CO (6 cV M st Lc; co 3: W m 40, k LIZ a) a) LL 0 0 U COSA Checklist Legal Description: .._ Lake Ridge Terrace Block 4A Lot 2 Parcel ID: 051-321-02 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ❑✓ Well log is filed with Onsite (or attached) Date drilled 1974 _Total depth 234 ft Cased to 115 ft 0 Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground) 32 in. Date of flow test for COSA 5/10/24 Static water level at beginning of test 114 ft. Comments B. TANK DATA Measured operating fluid level in septic tank New Date of pumping New tank installed 8/5/24 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 8/2/93 ❑✓ ALL standpipes present per record drawing Total measured depth from grade 7.5 ft (max) Measured depth to pipe invert from grade 5 ft (min) ❑ NIA — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 2.5' © Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced 2000 gallons 5/9/24 date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies COSA Checklist June 2022 Well production at time of test 2.7 qpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ❑✓ No ✓❑ Coliform bacteria is Negative Nitrate 14.0 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑✓ Arsenic less than MRL (ND) Collected by Arcterra Consulting Date 5/14/24 STATION ❑ Require - tenance completed Age of lift station rs Lift station material Comments Adequacy test date 5/10/24 Results Pass Fluid depth prior to test 7 in Water added 600 gal New fluid depth 12 in Elapsed time 1020 min Final fluid depth 7 in Absorption rate 600+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 34.8 in Effective depth used 11.8 in Effective depth remaining 23 in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' ✓❑ Yes if No Community Sewer Manhole/Cleanout > 100' ❑ Yes if No 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 ft Holding Tank > 100'✓❑ Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' Q Yes if No ft Yes if No ft ft If tank or field is under driveway comment below 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 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 ft Water Main > 10' v Yes if No ft Community Wells > 200' © Yes if No ft Water Service Line > 10'✓❑ Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Arcterra Consulting Phone (907)-696-6111 Engineer's Printed Name Kenneth Duffus Date d Z 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 encroachments, deficiencies or discrepancies exist COSA Checklist June 2022 LL cr r- 0 am rn rn � n m m M M X 0 rn Li r= w� 'u U H N � N Q y LU m N w 41 V aj w O N O r n z i Cw 4, O G E CL :3 O 41 � LU ui 0 0 Ln 00 J E Q-0 m t]A — 4- X m -0 Q) an N fD a) +j V) a) mn3 > bn c i2 L t1A Ln v a) m a) cu _0 CON a--+ N a) 4� co m Q) > m+� v � W '� a)bn F N a) 3 a� U a O O 4- +� °) Ln U m U - a) z a) V � 4-J cn C O O cv `~ U U v a) C ; N U,F; N O CL Q E � N l/7 C O 4-J O aJ L U N O J O m a; L N a) Wa) O s Ln O w 4 N C uQ a) c cp (3)d v cB N Q Q d w v a) o V v � — ateJC c a) C a) I— -Q Q O _j \ o 4_ O U O > °J a -J C: Ov LU i O 75 bD N O u v -0 N aJ N N ,> Q O -� N Z Q) O 4_ a) v }' _0w O E O C cB 4 a1 N - l/) N v > aJ L O v ate- W N N d f0 '-' a) =30- (1) J L- i O m E _o C }, c O N v o U — O U Va f0 N i ON Is— a m MW C: 4J N v GJ 0 t Vf o U to m S� N a T L C) i ZI E 0 LL 0 a p Vi _ . 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O oA L p u a CL E O pq ++ 7 a u C a c � c Y -C �' a 4 J E M t a/ O 0 T L W i O U r6 x M +- c -C O c r6 a 3 6a c L awl +L,, > U O c ro c t O ro ° c s bA ''- �, 3 � O— 'c N N @ N o `n a E +� c 4 v '- r6 3 c d4 ° E O L ai +1 > `+ y 3 t 3 W — t C r6 r6 O N a c L > � a p a 3 rLo T> ai E u E U N - Q LE o +' al o a E c ,n rn °� ° x L t6 3 Q y L +_� N ' L N V r6 '}, c U c a 0 N E (L6 +-' c r6 a c > y L c Q C N T E L a 6A a +� E ° �' v- O +' a c O LJ c 0 L al O 4„ E `° C C 3 a a--� Vf 4 0 L O N m + a p ,� by 3 C l6 r6 L a +� o N a r6 N v c"o +' L c> 4 N c > y a `�° 3 a 6A a o c-0 � r6 c 4- N v a +� :+� a r6 � a y tca v r6 L Q" rL° c a L ° `^ O c a E }, u p L a-, ,� L E c ca +_+ z +_+ 3 a L t +� c ° - L Q N i z O +- ° Q o cel a a z o -° a — H o ,� w r6 L O v c Q a .N 4 U �O CU L EJ C CU L Q > a ..0 "M O L o °N' ° E H 0 a)� N a o� L� o = E V Cj m y y� Eo L 0 ,E C p p X 0 ° a C W o Cl) a C N a a a O ON 0 ° n 0° H 3 E� 4- H E r�6 M 4- rn6 .- 0� +�, FA_ I r1A _r I ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: LAKE RIDGE TERRACE LOT 2 BLOCK 4A PLAT 71-293 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shout( any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. I EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE: SCAU: E-MAIL AUG 11, 2024 1 "=30' schullerakOgmail.com 24-093 DRAWN BY. ICHECKED ByGRID NUMBS: 9-0-0KAAGF- JLS NW0553 240275 NOTE: 1. DIRECT ACCESS TO GLENN HWY IS PROHIBITED. * = FND 5/8" REBAR A*2 2�1%1129 SUR W Am O.F L A N,�) 4 X 0�1 AW 0 10, A00 00 01' 49TH ?, ......... ......... F m j6,HN L. SCHULLER.- 0 LS -10408 1831 Talkeetna Street �• ... a AUV Anchorage, Alaska 99508 `�►of essionc AW (907) 227-1455 office v�l (907) 274-4992 fax MUNICIPALITY OF ANCHORAGE 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. # O.~'1 .--~7~-I o2.~- 1. GENERAL INFORMATION Complete legal description HAA # Location (site address or directions) Property owner Mailing address Lending agency Mailing address Day phone Day phone Agent '~WZ~,~ :r~v Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: Day phone 2.3z/ TYPE OF WATER SUPPLY: Individual well Community well NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewbr NOTE: Public water If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system; 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 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 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 flies 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 re~t.n~f~.on the date of this inspection. 20210 Donalar St. /~ Name of Firm ChuCak,--Al~ska~7 Phone Address /,, ,~ /"~} / Engineer's signature DHHS SIGNATURE Approved for ¢ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additiona'l Comments 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. 72~)25 (Rev, 1/91) Back MOA#21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A, Well Data Log present (Y/N) Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed ! ~ '~ ~ Driller Total depth ~,2:~ ~//~ Cased to //~' Sanitary seal (Y/N) ~ Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test /z~, ~, /~?~ ~~ Static water level / ~ ~ ~ ~ Well flow ~ Pump level1 '& · SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot / Z, ~" Absorption field on lot Public sewer main Sewer service line 5"o Casing height g.p.m, g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhoie/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform 4:> ('~ C~ ~) Nitrate Date of sample: ~/(~ (~/~/¢ ~ /, ~-5 d~' Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~/z.-/'~ ~ ~ / Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size / 2~-'~ Compartments Foundation cleanout (Y/N) y' 'i D~preSsi0n'(Y/N) A~,///'~ Alarm test:ed (~/N) '' '/~ ~(-~ ~¥5; ,f~/~ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot i To property line Surface water/drainage On adjacent lots Absorption field Foundation Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D, ABSORPTION FIELD DATA Date installed Length /~'¢' Width Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/FF) O, ES System type ¢ Gravel thickness 2~, ~ / Total depth Cleanout present (Y/N) '7' Depression over field (Y/N) X,/ ~/',~/"~-f~ Results (pass/fail) for O After test ,,~ If yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water ./oc~ +- On adjacent lots .,¢'"~ ',~ Property line ~ To existing or abandoned system on lot Cutbank ,¢¢~,,z~ Water main/service ~ine Curtain drain Driveway, parking/vehicle storage area t~"~ ~- E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to afl MOA and HAA guidelines in effect on the date of this inspection. David R. Dayton P.E. 20'210 Donalar St. Chugiak, Alaska 99567 Signature Engineer's Name Date HA,& Fee $ / Date of Payment Receipt Number ~,'~ %. David tL D(wton ~ .,u~/-.- Waiver Fee $ Date of Payment Receipt Number .- ~, ~ ~ .- ' ~ .~,." ·' .' '-- -',r "~ ' ' J' .~ ':J .... ~'~' , j' . ..; .... '. . . .. ~' :' . .. . ~ ~ -['~ , ..~. ..i ...~. . ., . .,. · ~ ': ... ~ ~.'~.~') ...... . ~ .... ; .- ,. ..1.~ ~, .... · . '.." ~ , ' .. ~:': ' :' -r ~.~ ~-[~'., ~-~... ' . . ~"~'~/',.~~'' ' ,.., ¥ ','~' I : [ .... :.:~- . ]~ . [ ~. .~ · . . ~ · ~.: .., ~-,.= *' ., - ~ .~. J ~.,' ',','..: .'~ .... .". ~ '"'~ .t.~ ~ · ' ,~' '.1.~ '."~ ' .: '": ' : ' J. · ..,- ,.., :. ,. ., :',...,.,. ..~.~, ... , ..~ · · .. ~c, '~ , I" I ' · I , ' ': 'J ..'.: I ., ~. , . .. ,J , . ~ :' . . . . . .,~ i ..t., ., }' [ '"'~,~'~" ..... ~.,. j..' ," ,.,. ~ - ~ · ~. *'.: ,t"~""~"F"~'X" -.¥' ....... ..- ~,. .... ..~ . , , . J ~ ' I ~4 .1 ,, D. R. AYTON, P.E., R.L.S. ~'~~1~ Chugiak, Alaska 99567 20210 Donalar August 7, 1993 WELL FLOW TEST Legal Description: Lot 2, Block 4A, Lakeridge Terrace Subd. Date of Test: August 6, 1993 Well Depth: 234' - from well log Casing Depth: 115' - from well log Static Water Level: 130' Requirements: 4 Bedrooms - 600 gallons per day (907) ~7~ ~ ~i~]~ ~ 696-2417 Test: The well was tested with the existing pump through an outside hose bib. The flow was varied through the test to determine the rate at which the drawdown would remain constant. Results: The well produced 600 gallons in 257 minutes of pumping at an average flow rate of 2.33 gallons per minute. The flow rate at which the drawdown remained constant was 2.0 gpm. The well is currently producing adequately for a 4 BR home. ONMENTAL LABORATORY SERVICES ......... REPORT of ANALYSIS Chemlab Ref.~ :93.2770-5 Client Sample ID :L2 B4A LAKE RIDGE TERRACE Matrix :WATE~ 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 Client Name :DAVID DAYTON, P.E. WORK Order :67165 Ordered By :DAVID R. DAYTON Report Completed :06/17/93 Project Name : Collected :06/14/93 @ 14:00 hrs. Project# : Received :06/15/93 @ 10:15 hrs. PWSID :UA Technical Director:STEPHEN C. EDE Released By : ~. ~/~ / Sample Remarks: ROUTINE SAMPLE COLLECTED BY: D. DAYTON. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate-N 1.93 mg/L EPA 353.2/300.0 i0 06/16 LLH * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than Member of the SGS Group (Soci~t~,G~n~rale de Surveillance) ENVIRONMENTAL LABORATORY SERVICES ........ 8 REPORT of ANALYSIS Chemlab Ref.~ :93.3828-5 Client Sample ID :L2 B4A LAKERIDGE TERRACE Matrix :WATER 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 Client Name :DAVID DAYTON, P.E. WORK Order :69071 Ordered By :DAVID DAYTON Report Completed :08/09/93 Project Name : Collected :08/03/93 @ i1:00 hrs. Project~ : Received :08/03/93 @ 15:15 hrs. PWSID :UA Technical Director:STEPHEN.C. EDE Released By : ~. ~ Sample Remarks: ROUTINE SAMPLE COLLECTED BY: DRD. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate-N 0.90 mg/L EPA 353.2/300.0 10 08/06 LLH * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than ~SG-~ Member of the SGS Group (Soc!~t(~ G~n~rale de Surveillance) MUNICIPALITY O[,ANCHORAGh-~ ~ AND EDVIRONMEN' '. PROTECTION Date Rec. eived: Dat_e_L n s P ~_~h~ .u_r sd ay Mailing Address: Phone: 2~ Proper~y Owner ~ R. ob__er_t__S.._am_~p_s._°__n- ............................... Phone: 688-3117 HaiJing Address: 3. Lethal Descrip+Jon: Lot 2 Block 4A Lake Ridge Terrace Subdivision ~.,.: &-',]_nqle Fam_=5' Residence: ( x} Number of Bedrooms: Fou~ P~illl. tp.~,-. . .......... PqmJqy. Residence: (, ,1 Number of b~d..oom,_ . 5~ Well Syskem: individual We]-]- (x) Comxnunity/PublJ_c System ( ) Pd;rmit 4~ Depth of Well 234' Well l,og on File ( ) Construction Bacterial Analysis Sewage Disposal System: On-site System (x) Public Utility ( ) Permi't # Installed .__!_9_~4_ ...... Instal]_e~ Septic Tank Size Manufacturer Absorption Area Soils Rate Material Distances: Well to Septic Tank "co Sewer Line Nearest Lot line to 'Nearest: Lot Line to AbsorptJ.on Area ............. Absorption Area i¥1UNICIPALITY OF ANCHORAGE .~,,U''' ...... ' DEPARTMENT OF ENVIRONMENTAL QUALITY ~'~it~, Anchorage, Alaska ~- ~t ...... :" ........... REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: 1~l~ ~ VA ~~/ 2. Property Owner: FHA Name of Lending Institution: ~~ ~ Mailing Address: .,~¢ ?~~ ~~ ~ Phone Name0f Real~ororAgent:~~ ~. ~~/~o Mailing Address; ~)9 /~~~~ ~ Phone Legal Description: ...~.',~ ' /~z~ Location:. ~-'¢~ /~~__ - Type of Facility to be inspected: .~..<z.~-~.~.~ Water Supply Type of Supply; Public Utility If Individual, number of dwellings presently served If Individual, depth of well ~5//_1__ No. Bdrms. Individual 4 Sewage Disposal System Type of System: Public Utility il If Individual, date of installation '?__~'/~ NOTE: EQ-037 (1/74) Individual (on-site) As of May 27, 1977 the fee schedule went into effect. All requests for inspection must with them a $25.00 fee attached with the reques~ before we can set up inspection.s Any questions, please call me at 279-2511, extension 224 or 224 Thank you. Laura Department of Heal-th and Environme:~.tal Protecticm Reg. uest for Approval of Individual Sewer and Water Fac:Llities Legal Description: Lot 2 Block 4A Lake Rid.g~_Terrace Subdivision CoiRments: Affadavit Attached: ( ) Approved: (' Disapproved: Letter Attached: ( ) Date: Department Worksheet: ! ) Date Received 10/31/74 Time of Inspection Date ~ ut Inspection 10/31/74 INDIVIDUAL SE*~R & ... ~R ,~.~I~S FOR Conventional l, Approval requested.by: Mailing Address: 2. Property Owner: Mailing Address: Alaska Mutual Savings Bank P.O. Box 1120 Anchorage Harry Mackey SR Box 1175 Chugiak AK 99567 Phone: 274-3561 Phone: 688-2813 3. Legal Description: Lot 2, Block 4A [.akeridg~ ~errace Subdivis'~,, 4. Location Eagle River 5. Single No. of bedrooms 4 6. Type of facility to be insmected Well Data: A. Type Drilled C. Construction Standard Sewage Disposal System: A. Installed ~x 1973 C. Septic Tank: t. Size D. Seepage P~t: E. Disposal Field: Distances: A. Well to: Septic tank 291 Nearest lot line B. Foundation to septic tank C. Absorption area to neares~ lot lime B. Depth D. Bacterial Analysis Satisfactory B. Installer rtarry Mackey 1000 gal 2. ~',~ ~-- Greet ~ ~a nu'~ o.:~u rem I. Absorption Area 18xl8x6 2. Material Log Total length of lines , Absorption area , Other contami',mtio,q 10' , Absorption area 40 ' , Sewer Lines 48' Page 1 of two pages P~a_.ge] 2_of two pages - Rec' -~'t for Approval of Individual .~ ' & Water Facilities Comments Approved Disapproved Date Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74)