HomeMy WebLinkAboutLAKE RIDGE TERRACE BLK 5 LT 5Onsite File
Lake Ridge
Terrace
Block 5
Lot 5
#051-313-22
Municipality of Anchorage
On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP211310 PID Number: 051-313-22
Dwelling: ❑t Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑■ New ❑ Upgrade
Name
HOME RENEWAL COMPANY
ABSORPTION FIELD
❑ Deep Trench ❑ Wide Trench >•❑ Bed ❑ Mound
Site Address
14935 TARRACE LN, EAGLE RIVER, AK
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
0.5 GPD/SFJ
2.5 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
2.0 Ft.
Gravel depth beneath pipe
O.5 Ft.
Subdivision Block Lot
LAKE RIDGE TERRACE BLK 5 ,LOT 5
Fill added above original grade
1'+ Ft.
Gravel length
55 Ft.
Township Range Section
Gravel width
15.4 Ft.
Beds: Number of Lines
4
Distance between lines
3.33 Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
902 Ft2
Ft.
Well
00'+
100'+
50'
TANK ❑ Septic ® S.T_E.P. [__1 Holding -❑ Other
Manufacturer
Manufacturer Capacity
Surface Water
100'+
100'+
Gal.
Material
Number of compartments
Lot Line
10'+
10'+
NA
Foundation
j 101'I-
101+
LIFT. STATIONManufacturerCapacity
AnntI Talk
1500 Gal.
Remarks
Alarm location
Electrical installed by
NORTH SIDE OF HOUSE
CONTRACTOR
PIPE MATERIAL House to tank 3034 Tank to 3034
drainfield
Installer
RED DOG MASONRY
Drainfield 3034 C0/MT3034
Inspector MIKE N ANDERSON, P.E.
BENCH MARK (Assumed elevation) 98.5 ft
Inspection 2"°n 1st 1/21/22 1/24/22
Location and description
dates:
TOP OF TANK MH
3`tl 4+"
ON-SITE WATER AND WASTEWATER SECTION APPROVALo
.?tramp
4
Conditional Approval: Date
'U� a.•' ; I-" ° -
.: 4911-1
.J
t,.:'-;
. • •
�
F
r�
e.i
o o • o • •'... eeo<.
.
AMCHAEL N.
'`
S
i z
g
.9.cSeptic
ApprovDate t;
2•i�.>x40
0t•
• rl
•�� t ,
Note: this approval does not include well permit requirements.
U.: L
(Rev 05102118)
Permit No. OSP211310 Page 2 of 2
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: LAKE RIDGE TERRACE BLK 5 LT 5
PID No.: 051-313-22
MARK
A
B�
" IC
C01
20
78—
Tcol
22
23
TCO2
26
27
MT1
65
44
MT2
MT3
75
55
60
60
I MT4
141
147
WELL 0
I
i /
/
7
MT
MT
100
WELL RADIUSOWEH
TICQ2
TC
CO1
N
N TOP OF
A
HOUSE
WFL
I!
IELL LOCATION
WELL
ly
ASBUILI
SCALE: 1"=y8o'
COI TCOI TC01OF
MTI&2 MT3&4
tx .............
4V
#
%
i
gumMM
-1-0
— OR
NAF
I 49-TH
0
FILTER FAB= & INSULATION
0
Id R, 0
NEW 1.500 GALON
PLASTIC STEP TLANK
GM
?_�"'.MICHAEL N. ANDERSON.- ALT
AV
No. CE AV
9469 4�
X1-12-22 AV
87_
........
SERC SECnoN
N.T.S.
DRY AUG 2021
E
Q)
U)
O
w
0
W
C,
I
N
M "00,0Z•00 S
a UU7 a a u., jcgLL
U
Cn
/� C) a, v ai
2 cD a W� cr
D m
•� ; _
E
SL
cD
`"U` s
V Q / V 0. O
O
u
v- O o
y Y N i
o (� 0 0 c
3
U1 — --0p z � � m -� ro C)- c
v z ca L o N o
c
rVrJ`` Z Q � � v � u 0)
V Q N >+ o 3 o ami
ow Y Q
Y n�n c� > 'vi o aoi E mo
0
Y v� > L L L ` Y s E. fl
30:� m n. `° 5
• opo
Z U N N N C Y
O V Y @ O='F
N
CT J Qr = ate, m o o ��
@ v z v m (u Y
Q� -oo zcQc
JLY V Z Quo N m Ns
a, a — Q N a E ctf)L axi o E Y
L
L)0
0 /�tL ,^ OU Y Q. W Y -O U O
3 J Q l7
o w
2 m N
L) o Z p z °m om
U YCfl v o m
U Y w O \.. A `; czlu
N ti
1 C vi �/f W 4.� U 4Y O
3 O u C "_ M— w 11 Z O
u O- O' L� .bl)
u s p
Y
4
U
O Q N
u -0G� X98 oN
u �`� .W w a CCS ,C�3ro
N Z m
x" :°tr ^'� C
j o 0 f • ^ � w@ U
Fi z � h
Y v o
00 0 > z
In
v v� �43s O- m �4 �.
°±'-o 18 �Lr'd O
.� Lt Y O
N ¢ V� W 2 C\2
0
6 SloM
0 9f
N z
,SOI
Q
(v ,0'll
u
v- O o
y Y N i
o (� 0 0 c
3
U1 — --0p z � � m -� ro C)- c
v z ca L o N o
c
rVrJ`` Z Q � � v � u 0)
V Q N >+ o 3 o ami
ow Y Q
Y n�n c� > 'vi o aoi E mo
0
Y v� > L L L ` Y s E. fl
30:� m n. `° 5
• opo
Z U N N N C Y
O V Y @ O='F
N
CT J Qr = ate, m o o ��
@ v z v m (u Y
Q� -oo zcQc
JLY V Z Quo N m Ns
a, a — Q N a E ctf)L axi o E Y
L
L)0
0 /�tL ,^ OU Y Q. W Y -O U O
3 J Q l7
o w
2 m N
L) o Z p z °m om
U YCfl v o m
U Y w O \.. A `; czlu
N ti
1 C vi �/f W 4.� U 4Y O
3 O u C "_ M— w 11 Z O
u O- O' L� .bl)
u s p
Y
4
U
O Q N
u -0G� X98 oN
u �`� .W w a CCS ,C�3ro
N Z m
x" :°tr ^'� C
j o 0 f • ^ � w@ U
Fi z � h
Y v o
00 0 > z
In
v v� �43s O- m �4 �.
°±'-o 18 �Lr'd O
.� Lt Y O
N ¢ V� W 2 C\2
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:/Awww.muni.org/onsite
On -Site Water & Wastewater System Permit
Permit Number: OSP211310
Work Type: WellSeptic Initial
Tax Code Number: 05131322000
Site Legal Address: LAKE RIDGE TERRACE BLK 5 LT 5 G:0653
Site Mailing Address: 14935 TERRACE LN, Eagle River
Owner: SIMMONS SANDRA F
Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING
This permit is for the construction of:
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
9/7/2021
9/7/2022
0 Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy 0 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
Special Provisions: The 100 ft radii of the wells to the east and west of the proposed drainfield shall be staked
by a registered land surveyor prior to installation of the field to ensure 100 ft separation can be met, as indicated
'R on the permit site plan.
Received By:
Issued By:
Date:2 I
Date: % % ,ZD,Z
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051-313-22
Property owner(s) TARAS ILNITSKIY Day phone _
Mailing address 1120 HUFFMAN RD STE 2, ANCH AK
Site address 14935 TERRACE LN, EAGLE RIVER AK
Legal description (Sub'd., Block & Lot) LAKE RIDGE TERRACE BLK 5 LT 5
Legal description (Township, Range & Section)
Lot Size 16800 Sq. Ft. Number of Bedrooms )� 3
APPLICATION IS FOR:
(® all that apply)
Absorption Field 0
Septic Tank 0
Holding Tank ❑
Privy
❑
Private Well
Water Storage
❑
APPLICATION IS AN: TYPE OF DWELLING:
Initial ED Single Family (SF) 0
(w/wo ADU)
Upgrade ElDuplex (D)
El
❑
Multiple Dwellings ❑
(SF and/or D)
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.
(Signature of property owner or authorized agent)
Permit/Rush Fees: It 8 20 Waiver Fees:
Date of Payment:Z 6Iz I Date of Payment:
Receipt Number: Q2697 Receipt Number:
Permit No. OSPa 1131 d Waiver No.
G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
Aug. 23, 2021
Municipalities of Anchorage
Departments of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Fax 249-7847
Re: Septic & well permit
Legal: LAKE RIDGE TERRACE BLK 5 LT 5
To Whom it may concern:
This is a request for a septic & well permit on the above referenced lot. One test hole
was excavated and found silty gravels (GM) for the entire depth with no water after
the 7 day monitoring period. The perc rate was measured at 14 minutes per inch.
The lot has no slope after the organics were removed in area of the field. This new
system will not impact any of the surrounding neighbors.
Sincerely
Michael N. Anderson, P.E.
4661 Natrona
Anch, Ak 99516
Ph 727-8864
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211310, Rebecca Carroll, 09/07/21
Project Name: OSP211310
Project Description: LAKE RIDGE TERRACE BILK 5 LT 5
Review Comments List Date: 9/7/2021
Changemark note 402, Septic2.pdf
Please state whether the slope was flattened before or after the test hole was done. If after, please
clarify where the bottom of field will be in relation to the original grade prior to flattening. Please
also note that historic test holes showed groundwater at 8 ft in November in the area of the
proposed field.
Responded by: MICHAEL ANDERSON - 9/2/215:13 PM
THE AREA IS FLAT AFTER REMOVAL OFA SMALL PILE OF STUMPS AND ORGAINIC MATT, BOTTOM OF
THE SYSTEM IS MEASURED FROM THE SURROUNDING FLATTER AREAS
Changemark note #03, Septic2.pdf
The location shown for the well on Lake Ridge Terrace Block 6 Lot 5 does not match the location
shown on the submitted plot plan. The location shown on the plot plan puts it less than 100 ft from
the proposed field. Please address.
Responded by: MICHAEL ANDERSON - 9/2/215:17 PM
THE WELL LOCAITON IS CORRECT, SURVEYOR STAKED THE RADIUS.... WE HAVE 56.5 FEET BETWEEN
THE TWO RADIUS
Changemark note #04, Septic2.pdf
The location shown for the well on Lake Ridge Terrace Block 5 Lot 2A does not match the location
shown on the submitted plot plan. The location shown on the plot plan puts it less than 100 ft from
the proposed field. Please address.
Responded by: MICHAEL ANDERSON - 9/2/215:17 PM
THE WELL LOCATION IS CORRECT, SURVEYOR STAKED THE RADIUS...
SEPTIC FIELD SECTION
DESIGN CRITERIA:
0.5' EFFECTIVE
3 BDRM X 150 = 450 GPD
SOILS = 450/0.5 = 900 GPD
900 GA/16 = 56'
16.0' WIDE, 1' WAIVER REQUESTED
56' LONG
(1) BED
2.5' DEEP
13
(TH#1)
1.0
GM
ORG
16.0'
-2.5
-2.0
FILTER FABRIC
6" SEWER ROCK
3,3(
GRADE
1"=200'
PROPERTY LINE
PROPOSED
DRAINAGE FIELD
PROPOSED HOUSE-TERRACE LANE--BLUE SPRUCE LANE-
SCALE:
DJRDRAWN:
DATE:
LAKE RIDGE TERRACE, BLOCK 5, LOT 5
Eagle River, Alaska
TARAS ILNITSKIY
8/26/2021 -GLENN HIGHWAY--WOODLAND AVE-PROPOSED WELL
100' RADIUS
DRY AUGUST 2021
& INSULATION
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211310, Rebecca Carroll, 09/07/21
NEW 1250 GALLON
PLASTIC STEP TANK,
w/ 20" RISERS
1"=50'
PROPERTY LINE
PROPOSED
HOUSE
PROPOSED WELL
100' RADIUS
WELL
SECONDARY
30X5X0.5 EFF
TRENCH,
APPLICATION OF 3.0
GPD/SF -TERRACE LANE-SCALE:
DJRDRAWN:
DATE:
LAKE RIDGE TERRACE, BLOCK 5, LOT 5
Eagle River, Alaska
TARAS ILNITSKIY
8/26/2021
WELL
WELL
WELL
WELL
MTMT
MT MT
FCO
CO
TH#1
THE LOT SLOPE IS
FLAT W/ NO SLOPES
OR CUT BANKS >25%
WITH 50' OF THE SITE.
WELL RADIUS' TO BE
STAKED BY RLS
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211310, Rebecca Carroll, 09/07/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211310, Rebecca Carroll, 09/07/21
Municipality of Anchorage
REQUEST FOR VOUCHER CHECK
FROM: Health & Human Services
(DEPARTMENT)
TO: MUNICIPAL CONTROLLER
DATE: October 9, 1995
R 37490
THIS SECTION FOR ACCOUNTS PAYABLE USE ONLY
1099 J VOUCHER NO. PAYMENT DT. V I VENDOR NO.
I
t
REFERENCE NO. INVOICE DATE INVOICE NO.
CHECK NO. CHECK DATE PREP APPR
1. REQUESTTHATAMUNICIPALITYOFANCHORAGECHECKBEISSUEDTO:
Name KND Engineering
20441 Ptarmigan Boulevard
Address
Eagle River, Alaska 99577
2. THIS PAYMENT IS FOR THE FOLLOWING (SUBSTANTIATION ATTACHED):
The applicant Dpplied for and paid fees for a sewer/well permit, however,
the property will not be developed at this time and the owner has requested
a refund. Thei~ eng_~eer applied for the permit and therefore the ~efund
is made to them.
LOt 5 Block 5 Lake Ridse Terrace Subdivision
3. DISPOSITION 'OF CHECK: AUTHORIZED USE ONLY
(1) ~XMAIL TO PAYEE (6) [] NOTIFY DEPARTMENT EMPLOYEE
(2) [] MAILTO PAYEEW/ATTACHMENT WHEN CHECK IS READYIN FINANCE
(3) [] NOTIFY PAYEETO PICK UP IN TREASURY
Name'
Name:
Phone NO.: erg. No.: Phone No.: --
4. ACCOUNTS TO BE CHARGED:
ITEM ENTER ALL POSITIONS OF ACCOUNTING DISTRIBUTION
NO. DESCRIPTION Or, ,'CC J%cCt/ot r: Task Opt Cost Ctr. WAYNe AMOUNT
1~. On-si.t-= S=-~e~:/~l~ P~r~i~ 2!i7] 91:~'6' 440.£~
440.120
5. TOTAL AMOUNT OF CHECK
6. SIGNATURES~ ~%..~(~F.~nf,~(,v~343_4744
Employee ~'hone NO. Approving Authority
7. INSTRUCTIONS
a. To be used only when payment cannot be made by purchase order, travel expense report, travel authorization or petty cash.
b. Must be approved by department head unless approval authority is delegated in accordance with Policy and Procedure 24-7.
c. Retain carbon copy for your file.
40-001 (Rev. 2,'gl) MOA #15
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Services Division
Telephone: 343-4744
ON-SITE SERVICES FEE DOCUMENTATION
OS--
Date Paid:
Name of Payer: (Name on Check)
Mailing Address: (Off of check)
Legal Description(s):
Permit Number:
00820
Type of Payment: (Indicate Amount Paid) '"~{~'d~
WAIVERS~,
Well to Tank:
~-Jealth Authority:
Sewer & Well Permit:
Well Permit: /,~-~
Sewer Permit: ~'~'~) ~'
Copy Request:
72-034 (Rev, 10/87)
Excavator Permit:
Engineer Permit:
Pumper Permit:
Well Driller Permit:
Tank Manufacturer:
(Waste Treatment)
DISTRIBUTION:
Well to Field ~ [~'~' o~ ,
.C'~" \ C) ' -
Field to Surface ~/atex
Tank to Surface
WHITE--MASTER FILE CANARY--PROGRAM FILE
NOTE: Applicalion musl b~ lilled out complelely
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
On-Site Sewer/Well Permit Application
SINGLE FAMILY DWELLING
Property Owner Name Scott SJmmons c/o Y,,ND
Mailing Address
Legal Description
,- ,, = .... o r~4~ U .... Day Phone
204~3 r~-armig~_n ~l:v~- Eag]_le River, ALZipCode
Lot 5 B]k 5 Lake Ridge Te~a~e
Section Township
sr
Lot Size ....
Acres/Sq FI Inspections will be conducted by:
Number of Bedrooms: 2 X Approved Engineering Fir~
O~ ~q ~.~d Municipality (permit fee incl')
Does your house contain any of the following: Hot Tub, Swimming Pool. Therapy Pool, Jacuz~
696-6131
99577
OZ
or Water Softener Unit? ~N If yes, which one?
This application is for:. Sewer Only Sewer and Well X Sewer ~¢~a%
I certify that the above information is correct. I further certify that this application i~ be~ade
and in accordance with applicable Municipal codes. .,~ ., .~.
__ ees: '/-/'Y · ' Receipt# -- d"//~"~/'~ ) Permit#
MUNIClPALITY OF A NCHORA GE
DEPARTMENT OF HEALTH & HUMAN SERVICES
On-Site Services Transmittal Sheet
TO:
The attached paperwork has been reviewed and is being returned
for the following reason(s):
__Discrepancy in legal description and/or owner name.
__Discrepancy in number of bedrooms.
__ Signature and/or stamp missing on
Show measured distances to sewers/wells, curtain drains
and streams within 200 feet of proposed system.
__ Replacement disposal si%e not shown and/or tested.
__Calculation error in design.
Show locations of all soils, percolation or water table
tests.
__ Proposed system too deep for soil test submitted.
Topographic information missing or inadequate.
~Narrative missing or inadequate.
__ Additional soil/perc test needed.
__ Sand filter requirements not satisfied.
__Water monitoring results missing or inadequate because
Incomplete; missing.
__Well log required.
__Water sample unacceptable because
Please supply the necessary information and re-submit your
request. Your cooperation is appreciated.
Reviewer_~ ~OF~/
LEA VE THIS FORM ATTACHED TO PAPERWORK
/203-rev. 4/93
SITE PI AN
WASTEW~TER ~ISPOS~L SYSTEN
LOT 5, I~lock 5, LAKE RIDGE TERRACE SUt~I)IVSIDN
Lo~ 6 Lo~ 7
Lo'l; Size, lB, lB4,11 SF +/-
TDTAL AREA AVAIL, FDR A]~SDR]], SYSTEM~ 3,046,37 SF
PREPARE]) FDR~
SCOTT & SAN])RA SIMMONS
149D1 TERRACE LANE
EAGLE RIVER, ALASKA 99577
KN]) ENGINEERING
20441 PTARMIGAN t~LVD
EAGLE RIVER, AK, 99577
907-696-6111
I)EglGN DETAILg
WASTEWATER A]~SORPTIBN SYSTEM
LOT 5, t~lock 5, LAKE RIDGE TERRACE SUBDIVSIDN
P,I,D.
I :~' I ~ ~' ]IDTTDH DF ]tEl) 1,0' /
M,T,
C,[
15' M.T.
C,D.
~4' SDLID MANIFOLD
C C [0 o~e
ENllS DF LATERALS WILL nE CAPPEI)
DESIGN CRITERIA,
E ]~EI]RDDNS X 150 F,P))/I~EI]RBDN = 300
SDIL RATINGm EO MIN/IN = USE 0.4 GPI)/SF
300 GP]) / I).4 GP])/SF = 750 SF AI~S. AREA
I~E]) I)ESIGN WITH 750 SF, MAXIMUM 15' WII)E
750 SF / 15'WI]IR = 50' LDNG
0.5' MAXIMUM ]]EPTH nF GRAVEL
INSTALL ~' HI) INSULATION DVER ENTIRE FIEL])
INSTALL 1000 GAL. STEEL TANK, INSULATION
REQUIRE]) IF ]~URIAL ])EPTH <4'.
ALL SnLI]l PIPING WILL ]lE 93034 DR EQUIVALENT,
PREPARED FOR,
SCDTT & SANI)RA SIMMDNS
14901 TERRACE LANE
EAGLE RIVE~ ALASKA 99577
KND ENGINEERING
PPO41 PTARMIGAN DR
EAGLE RIVER, AK, 99577
69G-6111/FAX 696-8111
"nAT£, .4-1&-95. ]]R/~VIN6
~OT TO SCALE
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: KNB
LEGAL DESCRIPTION: Lo~5, B1 k5
iorganic
2
perc hole
3 ~" -- SM Med
4
5
6
7
8
9
10
11
12 Irregul ar rock
at bottom
13
14
15
16-
17
18
19
2O
COMMENTS ,P e-:r S o a k e d
Engineerinq
LakeRidge
terrace
dense
?~GM
increasing density
& mci'st w/depth
OF 4
DATE PER FOR~~
Township, Range, Section:
SLOPE SITE PLAN
WAS GROUND WATER N 0
ENCOUNTERED?
s
L
IF YES, AT WHAT O
DEPTH? ~
neplh to Water Ai~er
Monitoring? 9 . 2 ' Dale: 1 '1 / 7 [ 9 4
Reading Date Gross Net Depth to Net
· Time Time Water Drop
1 10/27 12:28 - 3 3/4"
2 12:33 5min 4" 1/4"
3 '12:38 5min 4 3/5" ~/$"
4 12:43 5min 4 1/2" 1/8"
5 12~:44 ~dd!w:at~ 3 5IR"
6 1 2:49, 5mi'n 3/7/8" 1 /4"
Y 12:54 5mTn 4 1/R" 1/4"
8 12;59 Hmin' 4 3/~" 1/4"
PERCOLATION RATE 2 0 (m~nutesnnch) PERC HOLE DIAMETER __
TEST RUN BETWEEN . 2 FT AND 3 FT
hole.. Sand caving in during perc-test,.
PERFORMED BY: S~)~K~) I KPnn~th r]llffll~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE· DATE: 4 / 1 7 / 9 5
72-008 (Rev. 4/85)
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3--
4
5
6
7
8
9
10
11
12
13
14,
15
16
17
18
19,
20-
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
En9 ~neem i~ng ~
B1 k5 Lake
Te')-'r a c e
o-y'g a n i,]c
SI~GM reddish
.Perc hole
,seepi]ng
w/rocks
.s:eepi'ng
COMMENTS ,1~,0'[, e prege~ked
OF
Scott S ~mm~n s D AT E P E R F O R ~ ~'~ ~ ~%;
~ J;d g e Township, Range, Section:
SLOPE SITE PLAN
WAS GRouND WATER
ENCOUNTERED? ,y e s
s
L
IF YES, AT WHAT 8 t O
DEPTH? . p
E
Depth to Water After 8 '
11 / 7 / 94
Monitoring?
Dale:
Reading Date Gross Net Depth to Net
Time Time Water Drop
1 10/28 1:05 - 4 3/4"
2 1:10 5 min 5" 1/4"
3 1:15 5 min 5 3/8" 3/8"
4 1:20 5 min 5 5/8" 1/4"
5 1:25 add water 4 5/8 -
6 1:30 5 min 4 7/8" 1/4"
7 1:35 5 min 5 1/8" 1/4"
8 1:40 5 min 5 3/8" 1/4"
PERCOLATIONRATE ~0 (mmutes/mch}PERCHOLEDIAMETER ~"
TESTRUNBETWEEN 3 FTAND 4 FT
test
PERFORMED BY: ,V.~ I Kenneth Duffus CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THiS DATE. DATE: 4 / 1 7 / 9 5
72-008 (Rev. 4/8.5)
MUNICIPALITY OF ANCHORAGE
t.
Development Services Department �,.- _ 4�' Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-313-22 Expiration Date: Q
1. GENERAL INFORMATION
Complete legal description LAKE RIDGE TERRACE BLK 5 LT 5
Location (site address) 14935 TERRACE LN, EAGLE RIVER AK
Current property owner(s) HOME RENEWAL COMPANY LLC Day phone
Mailing address
Real estate agent
1120 HUFFMAN RD STE 24-797, ANCH AK 99515
2. TYPE OF DWELLING:
I] Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone.
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
I]
Private Septic
El
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for:
Distance. -
Received by:
Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fees 7.5
Date of Payment / Receipt Number Number d2 1 0-
COSA # 0 -SC Z 2 1020
Waiver Fee $
Date of Payment
Receipt Number
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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864
Address 4661 NATRONA AVE ANCH AK
Engineer's Printed Name
MIKE N ANDERSON, P.E.
6. DSD gGNATURE
System #1 Approved for 3
Date 1/22/22
,te r • 49L, � •�: t.
•
...............
bedrooms ,�•�•`
• MICHAEL N. ANDS RSCN ;
System #2 Approved for_ bedrooms - 9
Disapproved "�tit� • • ((•' . L�' ="y
Conditional approval for bedrooms, with the following stipulation'���'`�
�,�tt(ttt(fr/i�.4,
OF AA(,
�
nN-SITE n
WATER AND
By: Original Certificate Date:
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 ChecMist blue sheet
' lb
Legal Description: LAKE RIDGE TERRACE BLK 5 LT 5
Parcel ID: 051-313-22
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 9110'21
Total depth 145 ft
Cased to 145 ft
IN Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 24 in.
Date of flow test for COSA NEW
Static water level at beginning of test 112 ft.
Comments
B. TANK DATA
Age of tank(s) NEW years
Tank type/material SEPTICP n5
Measured operating fluid level in septic tank new
❑ Standpipes/foundation cleanout per record drawing
Date of pumping_
D. ABSORPTION FIELD DATA new 3 bedroom SYSTEM
Which system tested (date installed) 1/21/22
❑ ALL standpipes present per record drawing
Total measured depth from grade 3.5 ft (max)
Measured depth to pipe invert from grade ft (min)
On N/A — pressurized field
HE Monitor tubes go to bottom of effective. If not, state
depth into effective
❑ Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced 0 gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Well production at time of test 4+ gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes ❑ No
HE Coliform bacteria is Negative
Nitrate 2.57 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by SULLIVAN
Date of Sample 1/18122
C. LIFT STATION
❑ Required maintenance completed
Age of lift station NEW years
Lift station material PLASITc
Comments_ NEW 1500 GALLON STEP
Adequacy test date NEW
Results ❑✓ Pass For 3 bedrooms
Fluid depth prior to test in
Water added gal
New depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
P1 Yes
Neighboring Tank > 100' [] Yes
if No
if No
Community Sewer Manhole/Cleanout>
ft M Yes
ft Private Sewer/Septic Line > 25'M Yes
100'
if No
if No
ft
ft
Absorption Field on Lot > 100' C/ Yes
if No
ft Holding Tank > 100' ❑✓ Yes
if No
ft
Neighboring Absorption Fields > 100'
❑✓ Yes
if No
Animal Containment > 50
ft — ' ❑Yes
if No
ft
Community Sewer Main > 75' M✓ Yes
if No
ft Manure/Animal Excreta Storage > 100'
[]✓ Yes
if No
ft
From Septic/Holding Tank on Lot to:
(Please enter distances if less than required)
Building Foundations > 10' ❑ Yes
if No
ft Surface Water > 100' ❑✓ Yes
if No
ft
Property Line > 5' ✓❑ Yes
if No
ft Wells on Adjacent Lots:
Absorption Field > 5' Q✓ Yes
if No
ft Private Wells > 100'✓Q Yes
if No
ft
Water Main > 10' Q Yes
if No
ft Community Wells > 200' Yes
if No
ft
Water Service Line > 10' ❑✓ Yes
if No
ft If septic tank is under driveway comment
below
From Absorption Field on Lot to: (Please enter distances
if less than required)
Building Foundation > 10' [✓ Yes
if No
ft If absorption field is under driveway comment below
Property Line > 10'✓[] Yes
if No
ft Wells on Adjacent Lots:
Water Main >10' ✓
_ ❑ Yes
if No
ft__ Private Wells > 100, El Yes
if No
ft
Water Service Line? 10' Yes
if No
ft Community Wells > 200' ✓Q Yes
_
if No
ft
Surface Water > 100' Q Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
l certify that l have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
Well Drilling Permit Number: SW
Parcel Identification Number:
® DOC CO dba
BILL 8& DOLE
ULLIVAN WATER WELLS
P.O. Box 670269, Chugiak, AK 99567 688-2759
www.sullivanwaterwells.com
Pump Installation Log
OSP211310 Date of Issue 9-7-21
05131322000
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
Certified Drilling log
DOC CO dba
BILL 8c COLE
��► ULLIVAN WATER WELLS
ef—P.O. Box 670269, Chugiak, AK 99567 688-2759
OWNER OF LAND: Home Renewal Company - Taras
ADDRESS: 14935 Terrace Lane Eagle River, AK 99577
Bore Hole
Data
Depth
From
To
LEGAL DESCRIPTION Lake Ridge Terrace Block 5 Lot 5
DATE: 9-10-21
0
2
PERMIT NUMBER: OSP211310 DATE OF ISSUE: 9-7-21
TAX IDENTIFICATION NUMBER 05131322000
Is well located at approved permit location: ®Yes ❑No
Method of Drilling: ®air rotary ❑cable tool
Depth of Well: 145
Casing Type: Steel Wall thickness .250 inches
Diameter: 6 inches, depth 145 feet
Liner type
Static Water Level: 112 feet
Recovery Rate 5 ® gpm ❑ gph
Method of Testing Air
Well Intake Opening Type: ® open end- ❑open, hole
❑ Screened Startfeet Stopped .
® Perforations Start 105 feet Stopped 110
Grout Type: Bentonite Volume: 50 lbs
Depth: from 2 feet, to 42 feet
Well Disinfected Upon Completion: ®yes ❑ no
Method of Disinfection: Chlorine 50 PPM
Comments:
Perforations at 120' to 130'.
2
4
4
10
10
42
42
83
83
103
103
108
108
123
123
129
129
135
135
140
140
145
Casing Stickup
Overburden
Silty Sand & Gravel w/ Clay
Tight Silty Sand & Gravel
Hardpan
Tight Silty Sand & Gravel
Loose Sand & Gravel Damp
Hardpan
Tight Sand & Gravel Water
Hardpan w/ Clay
Shale
Coal
Coliform
nitrates Z. /L
Arsenic �9
i
Drillers Name: Cole Sullivan
ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority.
Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation.
Matsu Borough: Department of Environmental Conservation.