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LAKE RIDGE TERRACE BLK 4A LT 10
, 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: ~.,)~ ~ ~"~¢~ PID Number: ~ ~i ~ *~ Name: ~O~ ~ ~L~i~ Wastewater System: ~ New ~ Upgrade Address: ~q ~-T7 ~fft~ 'Tz~ Lf~ E~ ~ Al( ABSORPTION FIELD Phone: C~ ~ ~ ~ NO. of Bedrooms: · ~ ~ ~ Deep Trench '~ Shallow Trench ~ Bed ~ Mound ~ Other Total Depth from ori~inal grade: LEGAL DESCRIPTION Soil Rati.g: O.~ GPD/Sq. Ft. '7- LOt: Block: Subdiv~ion: Depth to pipe boltom from original grade: Gravel depth beneath pipe Township: Range: Section: Fill added sbove original grad~: Gravel length: , i~ ,7~ ~ ~ ~ O'-- ~ ~" ~t. (~ ~ :{~,. i~ ~O) ' ~t. WELL: ~tSTi~N ew O Up~/ Gravel width: ~ Number of lines: Ois,ance between lines: . ~ Ft. '~ ¢ 0 Ft. Classification (Private, A,B,C): ~th: Cased To: Total absorption area: Pipe material: ~'~ Driller: ~ Date Drilled: Static Water Level:Ft. Installer:~ ~ Date installed: ~ GPM PumpSeta,: Ft. CasingHeightAboveGrou;~: TANK SEPARATION DISTANCES ~eptic D Holding D S.T.E.P. To Septic Absorption Lift Holding Public/PrivateManufacturer: Capscity in gallons: ~ ~ .... From Tank Field Station Tank Sewer Lines ~O¢~ ~ ~ ~ Number of Compa~ments: W~H- iO~.~ ¢~i~ ~ .~i~ M"~"r~a~: ~T~ Surface Water iO~t+ ,~14 ~ -- ~'~ LIFT STATION LineL°t jOl~ ~el ~ ~ ~ Size in gallons: ~ Ma.ufacturor: Foundation '~ ~ ~O ~ ~ ~ .~ "Pump on" level at: ~el at: High water alarm at: '-- ~o,,'~ JL ~,j "~ ~ J~ctri~ct~nspe,ormedby: Cudain Drain Remarks: L~,s~/~ /~o G-4~, ~,,c. BENCHMARK Location and Description: Inspections performed by: S&SENG,NEERIN",.,,- - ~[d~X EaSe River, Alaska 9~577 2nd_ lO "H"~ ~t,(~5,~'~5 ROBERTcE. ~801C' COWAN el Heallh and ~a~Services approval '~,~>.,, ,, .,.. ..., Department Reviewed and approved by~/~Ju ,:b,~ Date ~/?/ "tt~27'~.~ I/ 72-013 (Rev. 9/91) MOA 25 Permit No. SW960519 2 2 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 LOT 10, BLOCK 4A, LAKE RIDGE TERRACE 051-.321-10 Legal Description: PID No.: ST] ST2 /97.4' ~ ~INAL GRADE CLASS 7 ~ cot = 98.~ 03 = 97.4' WELL / ~.~5o c~ 92.?' C02 L ' ~ fi2 = 87.3~ -EXISTING ;RIB I ~ ~0' UTIL / ~ ST1 O' 55.0' /~ ~ X ~0~ ~ ~~ CO, ~INST~L[E ELOW ST2 m j42.5, 65,0' ~~ ~l ..... A co 72-013 A (Rev. 9/9t') MOA 25 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT NUMBER:SW960319 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:MELCHERT ROBERT J & MARY E OWNER ADDRESS:14417 TERRACE LN EAGLE RIVER AK 99577 PARCEL ID:05132110 PAGE 1 OF 1 PERMIT ~_a\~q~ DATE ISSUED: 9/26/96 EXPIRATION DATE: 9/26/97 LEGAL DESCRIPTION: LAKE RIDGE TERRACE BLK 4A LT 10 LOT SIZE: 22878 (SQ. FT. NUMBER OF BEDROOMS: 4 THIS PERMIT: THIS PERMIT IS FOR THE CONSTRUCTION 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 (18AACS0) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 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 B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ~HE EXISTING TRENCH MUST BE ABANDONED AND ITS USE,~_ D~SCONTINUED. FUTURE USE OF THE EXISTING ABANDONED TRENCH WILL NOT BE PERMITTED UNTIL THE PROBLEM OF!WELL TO ABSORPTION .FIELD ENCROACHMENT HAS BEEN SATISFACTORILTf RECEIVED BY: ~ . DATE: DATE: ROBERT C, COWAN, RE. ROBERTA. SHAFER, RE. HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENS]ONS SEWER&WATER INSPECT[ON ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN September 4, 1996 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 10, Block 4-A, Lake Ridge Terrace S/D Request you issue a permit to upgrade the septic system serving the existing ~ovm. bedroom house on the referenced property. Also, request you issue a 35 foot waiver from the proposed trench to a slope that is greater th~n 25 percent. A test hole was excavated and percolation test performed in the area of the proposed upgrade. The approximate location of the test hole is located on the attached site plan. At the time of excavation no water was encountered and after seven day ground water monitoring, the monitoring tube was found to be dry. Attached is the proposed upgrade design. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. The proposed 1250 gallon septic tank is to be placed outside the well protective radius. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. aCC/gk Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 SCALE © SITE PLAN Lid mo ~ n~LLCREST ¢~CLE (PLAT) TE17RACE LANE {POSTED) IOUE _<- 0 PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION:~/°7'' /~ / SLOPE ,~/,d,4z..~._'1-ownship, Range, Section: 1 0~,~ ~~ 2 3 4 5 6 SITE PI. AN 10- 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH;' Depth to Water After _ Monitoring? ~ ~ Y' Oa,e: ~-2~-~1 I I I .I I I I I I I Reading Date PERCOLATION RATE TEST RUN BETWEEN Gross Net I ,.~pth to Net Time Time Water Drop .'0[ :o2- _ (minutes/inch) PERC HOLE DI,HvlETER ~ FI AND FT COMMENTS PERFORMED BY: i/0a~! i~lgie Rlyel' L~0p R~lld No. 204 ' ~ ACCORDANCE W~a~LI~'I~I~"JPAL GUIDELINES/~IN EFFECT ON THIS DATE. DATE: ~ /':~ '/~ (~ 72-008 (Rev. 4/85) PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION:~/o,~' / SLOPE 10 11 12 13 14 15 16 17 18 19 2O DATE PERFORMED: ~r;A/ ~.~.4..~-_ Township, Range, Section: ./'z-/, ,~. SITE PLAN WAS GROUND WATER ENCOUNTERED? L IF YES, AT WHAT /4./, ,~ pO DEPTH? ' E Depth to Water After MonitorinD? ~ ,~E/,-' Date: j i Gross Net Depth to Net Reading Date Time Time Water Drop / J ¢-zz-~' ;'oo : co '~" Z, // ' O/ .' ~'/ 7 '/"~," //,-/ "' ~ " .' oZ " 7~/~'' '/~" 5' /' .' ,~/ " '7,.c/Z'''' ( " .. ~,f- ,, 7.~,'v ,, ,, PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) PERC HOLE DIAMETER __ FTAND__~/' FT COMMENTS / S & S ENGINEERING PERFORMED BY: 170~4 Eagle RiVer Loop Road No. 204/----' ~ ACCORDANCE W~t.I~I~/i~;rlA~IIN~EM~PAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ROBERT C. COWAN, P.E. ROBERTA. SHAFER, RE. HEALTH AUTHORITY APPROVALS SEWER&WATER MAiN EXTENSIONS SEWER&WATER iNSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 REFERENCE: Lot 10, Block 4-A, Lake Ridge Terrace S/D September 4, 1996 GENERAL: 1. e The scope of this project includes the installation of a five foot wide drainfield to serve the existing four bedroom residence on the referenced property. The existing septic tank is to be excavated, pumped, crushed and abandoned. The existing leachfield is to be abandoned as such that it may be used in the future. ~,v~r-~u~ ~ I~o ~,~ ~r,c .r~ Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations~ The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems~ the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access° The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Page Two Lot 10, Block 4-A, Lake Ridge Terrace S/D September 4, 1996 4e Se Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Se e Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (roughed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. e Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page Three Lot 10, Block 4-A, Lake Ridge Terrace S/D September 4, 1996 De Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches° The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2° 0 ° The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron ASTM D3034 (PVC) ASTM F810 (HDPE) ASTM D2662 (ABS) Yes Yes Yes Yes Yes No Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the ~200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.0.A. or D.E.C. requirements. Page Four Lot 10, Block 4-A, Lake Ridge Terrace S/D September 4, 1996 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal ~ystem. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2e The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. Page Five Lot 10, Block 4-A, Lake Ridge Terrace S/D September 4, 1996 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER Municipality of Anchorage Department of Hea~th and Human Services 825 "L" Street RickMystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor December 9, 1996 Robert C. Cowan, P. E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 subject: Waiver Request or Lot 10 Block 4A Lake Ridge Terrace Subdivision Waiver Request #WR960065, PID #051-321-10, HA960470 Dear Mr. Cowan: Your request for waivers of the required 100 foot horizontals separation of an on-site wastewater disposal system to a private a well has been approved. The approved distances are a private well and the 1986 trench serving this property of 95 feet; a private well and the 1996'trench serving this property of 95 feet. This waiver approval applies to the existing on-site wastewater disposal system (trenches) to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, Please call our office at 343-4744. ai~cerely' /Q P. Williams kJCivil Engineer On-site Services JPW/ljm:Melchert MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR~ WR960065 PID# 051-321~10 HA# HA960470 Permit Date Received: November 13. 1996 Legal Description: Lot 10 Block 4A Lake Ridge Terrace Subdivision Engineer: Robert C. Cowan, P.E., S & S Engineering 17034 Eagle River Loop Road, Suite 204, Eagle River, Alaska 99577 Applicant: Robert J. Melchert Waiver Requested: Private well and 1986 trench serving this property at 95 feet Private well and the 1996 trench serving this property at 95 feet. Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: Points: 3. Other: Waiver is Granted: ~ Waiver is NOT Granted: List Conditions or Reasons for above: ~ ~~% Rec #: #02299/2386 Amount: $ 920.00 ?~e of Reviewer Date Paid: Nov 13, 1996 nqtneeetnq HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SiTE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN t~ovember lz, 1996 O_5\- ROBERTC. COWAN, P.E. ROBERT A. SHAFER, EE. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 10 Block 4-A Lake Ridge Terrace Subdivision Request you issue a Health Authority Approval on the referenced property and grant a waiver for the horizontal separation distance between the following: 1. Well and the 1986 trench serving this property at 95 ft. 2. Well and the 1996 trench serving this property at 95 ft. The mitigating factors involved which support the issuance of the waivers are as follows: 1. Reference to the site plan/topo, surface effluent would not flow toward the well. 2. The house is located between the well and septic on the referenced property. 3. Nitrate sample taken from the well located on the referenced property indicated "none detected". In our opinion, the separation distance requirement prescribed by iSAAC.021 is not necessary in this case. If we may be of further service please contact us. Robert C. Cowan, P.E. ATTACHED: well logs, site plan/topo MUNIC~VALITY OF ANCHORAGE ~NVIRONMENTAL SERVICES DI~JI$1ON NOV lb 199 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 ,SCALE SITE PLAN WAIVER REQUEST HILLCREST,~Q~,_RCLE (PLAT) TERRACE LANE (POSTED) 10' UTIL. £SMT. CD rq Z co .~ ,.': ' ., ,,..~:, · ~ ,~ '/, z~7 '~ 'V,~M ......... ,/.' ~'- .~' ~' ~' /~' 7' ~7 " '~' ~.' .... ' _ , ..., ~ .?~. ~ ~ '~ ,~ ~ ~ ............. _..~ ~'-~ ~...~ ~-~- ..... - ~ :., , ,~ ~. 3~~ ~ ~: ~ t ~ . . , .../~.~. ~?? .z,-~ ...... '¥. · : ,~, .~,. ~ ~; ~, 7~ ~ .,~..~ ~..,, ..~, .~ ~,~. _ '/~.~ _~. ~.~ . ..~ '-~:,~. ~ zez' ~ '.- ,.. ' .[7 ~ ~ . ~/.~,~' ~ ~?~ ~,.':- . ...... ~: .. ~., ~.' .~'.,'1 ~ .~',' '/~ ~ Y~ '~'~'~ ~7~'/~ ~'~' ~'~':'7~ 7 -'"" ~'~ ~ 11~ · ,.,.. ...... ..r. ..... ~,~,'~ · '.I..L · ~ .'. ' ~ ,'~ ~' I , .,, ~..~ ~,,'~,~ ~ ~ - . '-,.',~,. :~. ,'~ · :~...~., /: ~ ,~/~ ~ ~ ~ . t; ~ /.. . ~ .. . I · i ! - . ~.j~,-' .i : ~... :'. : ~: '!'::""t.~i'.'~ ~.~-t .,' ~ ~.,..,';. , , ,. :.~... ~ ,~ '-... ~... ~:.~;.. .,.z~..'~' · . '~ , ~ . .: . ~. - . ~ ' .....~ ...~ ,, ,. ., " '. ,.'.i I,~ ~..~ I ~ .. .. ..,.. '" ~ .I ~. ' : '..!?,. ,,~. ~ / 2 RECEi.V. ED ;i WELL LOG Lot 11, blk. 4a, Lake Ridge Texaco Subdivision, ~Lillcl'~st Circla '.Builder: Har~y A. Mackay .'.Driller: Har~ A. Mackay O%mers : William and Paula K~nt 0-5 ft. - Topsoil 5-95 ft. - H~DJ p~n nixed with gravol, clay ~nd boulders 95-1~O ft. - Brow~ shale changing to &-~ay 1~O-151 ft. - gray, sandy shale 15~-178 ft. - More shale changin~ to sandstone ~?8-~go ft. - Sanstone 180 ft. - Small vein of coal with ~atar - sandstone also produces some ~rater. 181-202 ft. - Gray shale Production: 4 gal. per min. Static Level: 102 ft. Cased to: 101 ft. 10 in. X /~ /6r ~ ,'----., MUNICIPALITY OF ANCHORAGE ~ DE. ATMENT OF HEALTH AND HUMAN SER,..,,ES Environmental Health Division ~ 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name ~_~ ~ ~__~ DISTANCES ~ SEPTIC ABSORPTION Address ~ / ~ ~¢, ,/~ ~~. ~~ TANK FIELD WELL Phone{s) WELL / ] Permit NO. NO. Gl Bed ..... LEGAL DESCRIPTION LOT LINE Township, Range, Section ~% ~ ) ~ J ~ ~¢ ~~ivewsy'AS-BU~LTD~AGRAM~Sh~w~~cau~r~~fwe~~~septicsystem~pr~pertyhnes~~~un~ah~n~waterb~~~~s~e~c) TANKS Manufacturer Capacity ~n gallons Material NO. of Compa~ments TYPE OF SYSTEM ~- TRENCH ~ BED ~ W. DRAIN ~ OTHER Depth to pipe boltom from Total depth from original grade / Fdl added above original 9rade Gravel depth beneath pipe Gravel lengHi ~ Gravel w~dth ~,O FT ~ ET T°talabs°rpt'°narea ~ ~8Q FT Dis' .... be,ween,ines ~/~ FT WELLS ~ PRIVATE ~ OTHER (ldentifv) CJ~ss~Ucahon (A,B,C~ ~ Total Deplh Cased to DaJe Installed: I S~ J¢6X Gadfly that Ibis JnspsclJo~ was psdormBd aGsording lo all ()7 lC)C? KEV:IN EARl::' L-:/L' S & S ENG'G EAGL..E. J:;'. ....... 'r VE'I:: .... ..... 9gP ..... 77 d c2 Zl.-'29'79 GUBDZVZ - -' " ..... ;" '" SION. LAKE RIDGE ]ERRACE I:i]T: 10 SEC i" i uN: ..::,~:;~ ........ ,...:,r, 1 '* ,, '..',= N RANGE: 2W :2q' ~ ~ ~) (SQ ,, !::"1' ,, (]l::;~ ACRES ) :5 BLOCK: 4A t..~., :i. on tha'L best £its 'y'c, ui ...... . DEF)Tlhl 'l"C] F:' :i: F'E: BO'T']"[)M (!::"I- ,, ) Ed:LAVE]... :OEF:"I H TcT'r',,.'%L. DEPTH (I:::"]'~) E~F:~AVEL.. WI; DTFi GRAVE:L L.ENG]'H (FT,) E~RAVEL VOL.UME (E:U, YDS,, ) TANK SIZE (GALS) SOIL RATIN(:~ (Si:;),, !:::'t", /BI:R} · ,~',~' -.I,h-.. I"iL.P.:i!~]" r ?...RE. Fl] ~ F:'AF~T TbJ() COMPAF:~TMEiJN'r's .]: c:E..n"lt.J, fy 'Lhat; :L,, ]: am f'ami].J, ar' kx~:L'LI"'~ 'LhE:, pequipemerrLs f'or' on-site sewei"s and b~eJ.:Ls as set. For. th by thee Hunic:i. paI:Lty o¢ Ai'lc:hopatgE;, (I'i[)A) ,~d"id the State of Alaska, 2. :[ ~/,~:L] i :Lnst. a!l the system in accor'dance wi1:.!"i all MOA codes and r'egulat:Lc, ns, and in compiia, nc~.:¢ b~i'Lh the des:Lgn cr':i.'LeP:La oF th:i.s pePmit,, :?;,, Z w:L].], adheH".e ~:.o a].i !fiC)A and State c)f Aias!.::a r',);.)C:lU:Lpemc-:,r'vLs {c:)p the set back d:i. star'Jces {pc)m any exis1:.:[ng welt, wast. e~!a1:.er' disposal system c,r' pub].ic :[ under, st. ar'~cl that th:i.s per'mi'L is vat:i.d ¢c)p a max:i, mum of' 3 bedpooms and any er'ilap,g(amc:,FYL bJJ.].], r'.(.:.:.)quir'~ an addit:i, oila], pepm:i:t,, £J::' A L.:[F::'T S'I'A'F:[ON IS INS'I'ALL. ED IN AN AREA COVERE:D BY HOA BL..,'-ILDING CC)DES, ]"FiiEN (:L) AN !EL. ECTF~ICAL. F:'E:RMIT AND IIqSPECT]:ON F!UST BE OB]"A]:NED~ C2) AS-.BLJILTS t4ILL NO]' BE AF:'PROVED W:['r'HOUT AN E:L. ECTi::;::[C:A[~ ]:NSI::'EC]"I[)N REI:::'C]RT; AND (:5) 'T'HiE IEI...ECTIRZCAI_.. WORK F'ILIST BE DC)NE: BY A I...ICENSE:D EL. EC]'RIC]:AN,, ........ ............................................................................. ......... ......... AF:'PL iE:AN'f~ I<EV]:Iq EAI::d::' C:I[:) S & S E:NG'G :[ ,: ~: dE.o ¥:,w DA'T'E: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: ~ ~ ~.~ ~ LJC/~ DATE PERFORMI Township, Range, Section: "~'~---~t'~ t~-?~'v~ i ~-~' '~(~ SLOPE SITE PLAN 10- 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water ,~lter Moniloring? I'5C, ~ Date: ~ Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER COMMENTS 5 & S ENGINEERING /-"-) /.~ .~:-./,~_~ ~ c~ ~ ~ ~GLE RIVER,AK 99577 HAT THI TE T F ACCORDANCE WITH ALL STATEAND MUNICIPAL GUIDELI~ECT~ THIS DATE. DATE: JU~ ~ ~S~ SCALE QGREAII::R ANCHORAGE AREA BORUJGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE /C~ FROM WELL INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH .__.LIQUID CAPACITY / g:~ GALLONS. SEEPAGE PiT: ( NUMBER OF PITS i . DIAMETER ?~ OR WIDTH LENGTH LINING MATERIAL ~/~ '/) <~} CRIB SIZE: DIAMETER ~' D~PTH g DISTANCE FROM: WELL / BUILDING FOUNDATION NEAREST LOT LINE . ABSORPTION AREA (WALL AREA) ,SQ. FT. ADDITIONAL ABSORPTION WELL: BUILDING FOUNDATION -- CESSPOOL APPROVED CONSTRUCTION NEAREST NEAREST LOT LINE SEWER LINE OTHER SOURCES DISAPPROVED DEPTH / ~ .~ DISTANCE FROM: SEPTIC/.~ SEEPAGE / ~// (~ TANK iv- O SYSTEM REMARKS DISTANCES: INSTALLED BY:///( //~/7~/~'~// PIPE MATERIAL: LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM i....~E(JFIt .... HI::tRf;.iY t]1- ...['..E '~ ~ I-1' :[ L _. ~. E=, C: :[ 14iE:!....IE L.::LO Bq-R LF:ii.(E [iiZI.::,GE '~LIE~[':, L::i;F.: E:r' ::.:: .LJ ..... 'J:HLIG if L01" _ I ,= E. 'I-YI.,;'E Ett;' :~,.;i]l't'[,,. Fl[-.':2:,;OF~:E:l":[Oi'.l, 2;"r'E;1EI"I 12'%: F']:t" HFIX]:HLIH I'.I.LtHBER OF BEI::,Fi:OOHE; = 2.: 'IHE RE[::!LJ].'I'~:E[:, :E;iZE OF THE 5OIL FtE:25ORF'TZON '.5"r'ff:;'fEl'"l 122;: ~ L:~, I~Z'j IF:' '-ii ~ ~4 ='-'= :::!L ¢E.~ it _~ [~7 tP-.it ~.-Z~ "'~,'" Nii == d_~!; it;2~ tF~: R %~," E: L_ E:, E; F" '"~" ii"-~ 'f'HE:: L..E1"I.G'YH DIHEN.'E;:[Oi",I IS THE LENGTH '::IN F'EET.'.', OF EFICH S12DE F'OIR FI :~;EEf:'I::IGb: F':t:"i'. THE L':,EPTH OF FI TRENCH O1:4: F"IT IS 7'HE D]:E;TFfNCE BE'I"P-IEEN "['HE'( E;L.II~:l:;:'FIE:[£ (~iROUN£:, FIN, I::, THE BO t"TOH OF' 1'HE E',=',,'C:FI'v'FIT 12 ON ,.'.' 12 N FEET ::,. '/HE GRFiVEL DEPTH 125 THE P'i:[NZHUH DEPTH OP' ORF,I'v'EL 8ETHE:EN THE OUTF'F. ILL FIN[:~ 'THE bOl"TCff'l Ot:: I'HE l:E:~.:',C'l::l'v'laTlOl"l. ,::ZN FEET). E',FtCKF 12 L..L. :[ I'.,IG OF F:INY :SY2:;"1"E:H H :f. TlaOIJT F'): NFII.... 12 NE;PECT J: ON RI'I,D Ri:::'I::'R. EI',,,'F'IL EFt' TH E:,D:F'FI~'.'f'HE1"I.I' !.4 :[ I...L BE ~;L.IE,'5'EC:T 1'O F'IRO.'SEC'.'U'.I"Z O1",!. Ft:[1"~1"tLIH [:'i:S'f'I::INCE E~ET.HEEN FI HELL FIND RN"r' ON-L:;:[TE E;EH'I::IGE D)J2.;PO%FIL %Y::::;'TE::H :ZOo:'.'* F:EE"i" F'Oli: FI PR:[","laTE 1.4EI._L OR 200 IcE:ET FOl.': R F'UB[_:[E: HELL.. HELL. I..OI3% FII;?.E RE(:qU]:F.'ED RND 1'FlU~;T DE RETUR1",IED 'f'O THE [':'EPF:IR"I'HENT .t412 'TH ]: N ::i:O t.'."F:IY:i:; OF' THE: HELL E:OHF'LET:[ E;F:'!:EC :[ F :i: CFIT :[ ON'2~; R1"I'D COhtS"I'[4:LICT:[ ON D 12 FIGRI:tl'IS RRE FI',,"R 12 LFIE;LE "1"O T NSURE F'ROF'Ei:::: :[ FI.2;TF~LI...FI'I" J: ON. ;I.' C:EI';;:'1":.t: FY THFI"t" :i..: 12 FiH !::'F:IH12LZRF~'. HZ'TH THE REQU12REf"IEN'I.'2; F;OF.: ON'~'~';]:TE ::.::;EHER:E; FIND HELLE; FI2; i:;Ot'4: i'H E~"r' 'THE HUN 12 E: :,[ F'FtL :[ T"r' OF' ;-2: Z H:[LL :[N:STFtLL THE '_:.;"r".E;TEH :IN FICC:ORDFINCE HZ'1"H THE :.ii:: Z LtNDEP::::-2TRi".ID THFIT TlalE 6)t'4-5:["1'['.-.'.' ~;[EI.4ER SY."STEH HI;:IY ,ri::EQLI12RE ENLFIRGEHEN.I" :[F' THE I~:E2;];E:,ENCE:/C('Li'~Fi::F.2HOL:'EL['LI::' rO :[t'-~'TL--~E:,E 1','i~::~[:_~:~'f'F.If:11'.,I ..:.q. E,E[::,fi. OOH~.';. F:IF'F'L 12 CFIN'T' HFIP::t~:Y FtRCI-::: E"r' 4 6 8 10 £2 16 18 20 2204 CleVeland Anchorage, Alaska 99503 Performed For Harry Mackey Date Performed Leaa] ~escriotton: Lot 10 Block 4A Subdivision Lake Ridgo This Form Renort$ Soils Lo~ yes nenth Feet Soil Characteristics ToPsoil Interbedded Sandy Gravels & Silty Sandy Gravels (GP - GM) Gravelly ~Silty Sands (SM) Bottom of Test Hole Was Ground Water Encountered? I~ Yes, At what Denth? No 6/25/76 Percolation Test Eagel River I Readinq Date Gross Time Net Time ii Depth to H20 Net Dron I '' I : Percolation Rate Hinute Proposed Installation: Seenaae Pit Drain Field Deoth of Inlet Depth To Bottom Of Pit Or Trench CASemENTS: 125 Square Beet dra±nage area required per bedroom, £rom -2 to -? ~eet. No ground water o~ bedrock encountered Test Performed By /,/~/~0 /(~' "~~ Data Certi fi ed BY :CONSTRUCTION TEST ~:f.. ~/9R/7~ LAB MUNICIPALITY OF ANCHoRA(~E DEPT. OF HEALTH & ~NVIRONMENTAL PROTECTION~ OP, T 9 1976 RECEI.VED ~'~LL LOG Lot 10, Blk. 4a, Lake Ridge Terrace Subdivision, Hillcrest Circle Builder: Harry A. Mackey Driller: Harry A. Mackey Owners : Speculation House 0-5 ft. - Top Soil 6-83 ft. - Hardpan with boulders and some gravel seams 84 ft. - Gravel with water 84.6 ft. - Back to hardpan 84.6- 98 - Gravel, Sand and bou~ders 98-130 ft. Brown shale 130-152 - Sandy shale and sandstone 152-180 ft. - Sandstone 180-182 ft. - Coal seam with water 182-198 ft. - Back into shale ?roduction: 3½ gal per min. Static Level: 98 ft. Cased to: 44.6 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 Parcel I.D. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING - ]~l -/o HAA# GENERAL INFORMATION Complete legal description Lot 10; Block 4A; Lake Ridge Terrace Location (site address or directions) Property owner Mailing address Robert Melchert C/O Perkins Realty 14417 Terrace Lane Eaqle River, AK Day phone 25801 Imperial Drive Eagle River, AK · Lending agency Mailing address Agent George Perkins/ Perkins Realty Address Day phone Day phone 694-3594 J Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well ××× Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX 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 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 Address Engineer's signature $ & S ENGINEERING 17034 Eagle River Loop ~'~,! No. 204 Phone G ¢/'~/- ~ el 7 ¢7 D_~ SIGNATURE ' Approved for~'~-~,,J/L . Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional 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 DH HS 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 (Rev. 1/91) Back MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: A. WELL DATA Well type Log present (~N) Total depth Sanitary seal (~N) Date of test Static water level Well production Health Authority Approval Checklist ¢>;~6~ i.~,,~ ~ LA'[.~ioc-r~- Parcel I.D.: If A, B, or C, attach ADEC letter. ADEC water system number ..... Date completed ~ ~'~:~' Cased to '~, (~ Casing height (above ground) Wires properly protected ~N) FROM WELL LOG AT INSPECTION i -%o WATER SAMPLE RESULTS: Coliform O Nitrate Date of sample: ~C i I~/ c~f¢ B. O'DINO TAN DATA Date installed io~'~'-~i'& Tanksize Foundation cleanout (~/N) ~¢5;, Date of Pumping ~ ~ Pumper ~' ' J Other bacteria cD Collected by'. ,r~~ ~ '~ '-- ~ ' '" ~ 'ZS,~O Number of Compartments ~Z Cleanouts (~N). ~ Depression (Y/~) ~O High water alarm (Y/~) ~ o C. ABSORPTION FIELD DATA Date installed io :-~ Length ~, i ~_ ~.,~/'7¢~ Width Effective absorption area Date of adequacy test Soil rating (g.p.d./fForfF/bdrm) ~P,~ ~/~y~sstem type Gravel thickness below pipe Total depth Monitoring Tube present f~N")?~--~' DepresSion over field (Y(~ Results (Pass/Fail) For Fluid depth in absorption field before test (in.); Immediately after gal. water added (in.): Fluid depth .... (ins) Minutes later: -- Absorption rate = .g.p.d. Peroxide treatment (past 12 months) (Y/N) ~---'~'~ If yes, give date bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION Date installed ~ Size in gallons __..~,, Manhole/Access (Y/N) ~~~a'~~~'Pump off level at* ~i~h wa~ *D at um E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: L~olding tank on lot Absorption field on lot Public sewer main I~/,tN Sewer/septic service line te'o if. On adjacent lots ¢5") On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM/~HOLDING TANK ON LOTTO: Foundation ~:~ i Property line ~"Z, ~ Absorption field Water main/service line I c,l ~' Surface water/drainage iool"t' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I f~ Building foundation ~ ~'* Water main/service line Surface water ] ~ OI 4- Driveway, parking/vehicle storage area Curtain drain ~ /i~, Wells on adjacent lots i O~i 4- HAA Fee $. ,~ Date of Payment Receipt Number ENGINEER'S CERTIFICATION .... I certify that I have determined thru field inspections and rev/ew of Municipal records_t/~..(,.i~a~b~ ~'~ms are in conformance with.MOA HAA g~delines in effect on this date. Signatur ~ Date /O /~/ / ¢G Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev, 3/96)* Parcel I.D. # 1. 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 GENERAL INFORMATION Complete legal description Lot 10: Block 4A: Lakeridge Terrace Eagle River Location (site address or directions) 14417 Terrace Lane, Eagle River Property owner Mailing address Lending agency Mailing address Walter Leffeck and Dianne Rogers 14417 Terrace Lane, Eaqle River, FHA Day phone 696-5074 Alaska 99577 Day phone Agent Clayton Halverson/RCI Properties Address Day phone 266-4200 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 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. 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/orwastewater 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 Address Engineer's signature DHHS SIGNATURE ~'/'~_ Approved for Disapproved. Conditional approval for 5 Z4 S ENGINEERING 17034 Eagle River Loop Road No. 204 Phone Date 0 7'~/-,¢2~. '¢.,) b e d r o o m s. bedrooms, with the following stipulations: Additional Comments I The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Oertificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does th is a8 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 certifioate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72 025 fray 1191) Back MOA ~21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lo T-/o /~.,/,( ,~ L-~A~E t~t(.N_.~ Parcel I.D. A. WELL DATA Well type P/~((/R ~--¢~- If A, B, or C, attach ADEC letter. Log present(~N) Totaldepth Sanitary seal ~N) ~'~'~' ADEC water system number Date completed Iff?& /~/'-7~ Driller Casedto 44. ' Casing height. Wires properly protected (_'~N) Date of test. Static water level Well flow Pump level FROM WELL LOG AT INSPECTION '~'¢' g.p.m. ~, O SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /(~ f Absorption field on lot /~°¢ Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots /00 Public sewer manhole/cleanout /'L////~ Petroleum tank ~-'_C /OO ~- ' 0 Z coo WATER SAMPLE RESULTS: Coliform ~) C Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed / //~/r~r'/ Nitrate Tank size /000 Other bacteria ,/,4'a/,J ~- Collected by: '~ ~ c~NEERING 37034 Eagle River Loop Road No. 204 Eagle River, Alaska 9{7577 Compartments ~- Cleanouts(~N) ' /u'¢'--C · Foundation cleanout~)/N) ~/~ '" Depression (Y~ ,/JO High water alarm (YN~ /kJ 0 Alarm tested (Y/N) ~/~ Date of pumping _.~ / ~ C~ / ~ ~-- ~ Pumper ~"]"~ ~5/'~ooL SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /00 ~ On adjacent lots ! go/~. Topropertyline /(-P/4- ~.C.)" Surface water/drainage Absorption field /'f' Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE '"'"""C~F T STATION Da~ Manufacturer Size in gallons~,,,-"'""~ ~ ,, Manhole/Access (Y/N) .~7,, ~ ~::: (wY:~e)r alarm level Pump ~e~°ff" level a~ Meets MOA eiectric~ ../..~.LP~n lot On adjacent lots ' Surface water '"--..~ D. ABSORPTION FIELD DATA Date installed System typo ¢~ Length ~ ,~'¢ Width ~"~' ' Total depth ~ ¢¢ ?60 ¢ yes Total absorption area Depression over field (Y/~ .,*JO /(2 /z. 2./~. Results ~)fail) P/45_~ J bedrooms Peroxide treatment (past 12 months) (Y/N) /~OzJ~' /L) '~INFORhl~TIOI,,I IS ~'RO/~UpG&APE O/dcy. SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot [00 / On adjacent lots /00/+ Property line ~.O / To building foundation 5~~ To existing or abandoned system on lot ~.5" ¢ To On adjacent lots ~_..)~k Cutbank --,~" Water main/service line Surface water /OO~+ Driveway, parking/vehicle storage area ~'0 % Curtain drain ~/)~ ' Soil rating Gravel thickness Cleanouts present ~_Y)N) Date of adequacy test for 1,(~O p.) ~J If yes, give date ENGINEER'S CERTIFICATibN I certify that I havechecked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ;5 ~*, $ ENGINEERING 'i 707,4 Ea,cOe River Loop Read Nee Signature ¢~ :%:~ ~w~r, Ai~k~ ~9577 Engineer's Name Date ~ -- HAA Fee $ I '? 0, Date of Payment .t t( Receipt Number Waiver Fee: $ ,.I Date of Payment Receipt Number 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 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision; section, township, range) Location (address or directions) (b) Applicant Name ~-v'J~J ~ Telephone: Home Business Applicant Address ~-~ ~..//~t/¢~ -~ ~ ~"L-~of'~ ~;)'~E.- (c) Applicant is (check one): Lending Institution []; Owner/builder,~ Buyer []; Other [] (explain); (d) Lending lnstitution //~'K, I~OqF'O,C','~'~,,~-.~V--- Telephone Address ~ ~ ~ ~~ (e) Reap Estate Company and Agent ~ ~ ~ Address ~~ ~*~ ~ - / (f) Telephone Mail the. HAA to the following address: ~ ~ ~ ~J~,~-~ ..... S~ 196X ~G[E R~V~7 TYPE OF RESIDENCE Single-Family'-_ Multi-Family [] Number of Bedrooms '~ Other WATER SUPPLY Individual Wel.~ Community [] Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL 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) ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FILE SEARCH, DAi'A AND li~IFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation o~ this Health Authority Approval 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 investigatior~ and inspection, the on-site water supply and/or wastewater disposal system is in compliance with ail Municipal and State codes, ordinances, and regulations in effect on the date of this inspecti(~J~8t S ENGINEERING Name of Firm c= n, ~v Telephone Address Date JUL II 1986 DHEP APPROVAL Approved for ,/~'~Z'~_.~ <~__~ bedrooms by Approved ~/~ Disapproved Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOAI HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Des~ WELL DATA Well Classification Well Log Present. N) Total Depth ]~ ~ ~ Static Water Level Casing Height Above Ground Electrical Wiring in Conduit~.~N) Separation Distances from Well: To Septic/M~dtrf'C-Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole If A, B, C, D.E.C. Approved (Y/N) Date Completed ~'1. ~' Yield Cased to gJf4J¢~ (,¢,/ Depth of Grouting ~ ~;~ / Pump Set At ['~-' '~ Sanitary Seal on CasinC__OYN) Depression Around Wellhead (Y~ ; On Adjoining Lots ! I. ~::~ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ~ ~-~ B. SEPTIC/H~G TANK DATA Date Installed I-~, ~'-)~. Size I ~ No. of Compartments Standpipes~N) Air-tight Caps ~N) Foundation Cleanout (Y~) Date Last Pumped [-¢~"Z~4 ~'~)~ Depression over Tank (Y~:) ttj~ Pumping/Maintenance Contract on File (Y/N) ~4 / 'for, ~/~ Holding Tank High-Water Alarm (Y/N) ~,t~ Temporary Holding Tank Permit (Y/N) . Separation Distances from Septic/-Nofd~ Tank: I To Water-Supply Well ~ ~ To Property Line '~ ¢2 To Water Main/Service Line ~ (~ To Building Foundation To Disposal Field Course To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed "~ ~ ~ ~ -~ Width of Field Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /¢&~c~'- Type of System Design Length of Field Depth of Field Gravel Bed Thickness L "~"['~(~'~ / Standpipes Present~/N) Date of Last Adequacy Test To Property Line To Building Foundation Lot ?,---'~ ' ¢ ,¢¢~------=,rO4Y~ ¢---¢4r~ To Water Main/Service Line \c:;, [~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ~ ~7/ ; On Adjoining Lots '~c;~ To Cutbank (if present) To Existing or Abandoned System on Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Commehts ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S & S ENGINEERING JUL } Signed_ .= Date _ _ ~R I~ 196X MOA No. c°r~r~LE RIVER. AK 99577 Receipt No. ,~c;t,,L/~ Date of Payment ~- ~ ~\ Amount: $ (o%, ~ Page 2 of 2 72-026 (11/84) --r. ,t ' DATE ~ECEIVED , INSPECTION APPOINTMENTS I NSPECTOR~/ INSPECTOR I NSPECTO.~, DFPI. OF IlEAl. IH & MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROIECTION OEPARTMENT Or .EA,TR & ENVIRONMENTAL PROTECTION 825 L Street- Anchorage, Alaska 99501 S E P 1 5 1980 i~.' ~') ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 R E C E I V E D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1, PROPERTY OWNER PHONE Paul V. and Doreen B. Harris 688-2278 MAILING ADDRESS Box 1715 Blue Spruce Eaqle River, Alaska 99577 PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PRONE KevJn N. and Shala K, Earp 333-2059 MAI LING ADDRESS 51:[ S. Braqaw Unit #6 Anchoraqe, Alaska 99504 3. LENDING INSTITUTION PHONE Alaska PacifJc Bank 274-966~ MAILING ADDRESS 601 N. 5th Avenue Anchoraae, ^laska 9950[ 4. REALTOR/AGENT PHONE Richard N. Brown 688-2850 MAILING ADDRESS 1715 Blue S~)ruce Eaale River, Alaska 99577 15. LEGAL DESCRIPTION Lot 10, Block 4A, Lakeridge Terrace Subdivision STREET LOCATI ON NHN Hillcrest Circle TYPE OF RESIDENCE E~ SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY NUMBER OF~BEDROOMS ~ Four [] Other One r--I Two [] Five ~ Three [] Six *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.) 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-O10 (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 E~] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] IN DIVI DUAL/ON -SITE DATE iNSTALLED []PUBLIC UTILITY Connection Verified iNSTALLER ' []Septic Tank or []Holding Tank Size: ~ ¢~Oc.) If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: Septic/Holdin§ Tank Absorption Area Sevvor Line Nearest Lot Line Absorption Aroa to nearest Lot Line 5. COMMENTS ~-'~PPRoVED FOR [~O¢J'~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY DETACH AND RETAIN THIS STATEMENT 9-15-80 T-#304 Harris/Earp Lot 10, Block 4A, Lakeridge Terrace Water and Sewer inspection Subdivision $25.00 8:00 8:30 9:00 9:30 10:00 11:00 11:30 12:00 1:00 3:30 4:00 4:30 $:00 5:30 Received From "7~',---.~,~E Address /~/ ~z?~ ~ ACCOU HOW PA~D , 2 ' ~T. O~I J I CASH ,c~o~ ! I 4 / ~u~ ~ / , , , ' ' .~~ Eagle River Area GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received February 25, 1977 Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: 3201 2. Spokane Mortgage C Street, Suite 250 Property Owner: Harry & Madeline Mackay Mailing Address: % Dick Dohlman Phone: Phone: 277-0543 Legal Description: Lot 10 Block 4A Lake Ridge Location: Hillcrest Subdivision Type of facility to be inspected Single Family No. of bedrooms 3 Well Data: A. Type Individual ~-) B. Depth C. Construction D. Bacterial Analysis // Sewage Disposal System: On-site system, Permit ~ 76442 198' A. Installed 1977 B. Installer Harry Mackey C. Septic Tank: l. Size 1.000 qals. 2. Manufacturer Gree~.- D. Seepage Pit: l. Absorption Area 432 sq. ' 2. Material Steel E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank J~c¢( , Absorption area / TO , S wer Lines / B. Foundation to septic tank ~__t _~ , Absorption area / C. Absorption area to nearest lot line /0 ' EQ-034 (1/74) Paae 1 of two Daaes MUNiCIPALlY( OF ANCHORAGE DEPT. OF II~ALYN MUNICIPALITY OF ANCHORAGE EN¥1RONMEN~AL PI.:OT~CTION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 FEB 2, 5 1,977 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES- 1. Type of Inspection: CMRO 2. Property Owner: Harry Mackey VA FHA CONV Mailing Address: 3. Name of Buyer: Day Phone: Mailing Address: 4. Name of Lending Institution: Mailing Address: 3201 §. Name of Realtor or Agent: Mailing Address: 6. Legal Description: Lot 10 Location: Spokane Mortgage, % C Street, Suite 250 Block 4A Lake Hillcrest Circle DayPhone: Dick Dohlman Phone: '277-0543 Phone: Ridge Subdivision 7. Type of Facility to be Inspected: 8. Water Supply Type of Supply: Single Family No. Bdrms. Public Utility ,Individual xx If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of Svstem: If Individual, date of installation 198' Public Utility Individual(on-site) xx 1977 Permit #76442 72-003(3/76) P~ge 2 of two pages - RE ~st for Approval of Individual ler & Water Facilities ~'egal Description Lot 10 Block 4A Lake Ridge Subdivision Comments Approved ~//~'~._~ Di sapproved ~proval.Valid for one year from date signed Greater An~i~orage 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 E0-034 (1/741