HomeMy WebLinkAboutLAKE RIDGE TERRACE BLK 6 LT 1
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
PermitNumber: "5"WzC~70,.~ (~..~' PIDNumber: 0~}-~1~-~
Name: /~ y ~ U ~ ~ ~ ~ ~ ~ w ~ Wastewater System: ~ New ~ Upgrade
Address: P.O. 80~ 77/; oa ABSORPTION FIELD
Phone: ~¢~ -~3~ IN°'°fB%cms: ~ Deep Trench ~ Shallow Trench OBed ~Mound ~Other
LEGAL DESCRIPTI ON so, Rating: O. ~ GPD/Sq. Ft. Total Depth fromToriginal/grade:
Subdiv~ion: )epth to pipe bosom from original grade: Gravel depth beneath pipe
Township:~I~ Range: ~ Section: -- Fill added above__original grade: Ft. Gravel~ ~length:~¢f ~/~ ¢~4) Ft.
I Number of lines: Distance baleen lines:
WELL: ~ New ~ Upgrade Gravel width: ~. Ft. ~ /~ ~ Ft.
Classification (Private, A,B,C): Total Depth: Cased To: !Total absorption area: ~ Pi~e material' --
Driller: Date Drilled: Static Water Level: Installer: Date installed:
Yield: Pump Set at: Casing Height Above Ground:
~ ~.~ ¢~.~*/ ,t. ¢ ,~. TANK
SEPARATION DISTANCES ~s.,t~c u Ho~din, ~ S.T.E.,.
To Septic Absorption Lift Holding ~ublic/Private Manufacturer: Capacity in gallons:
Fro~ Tank Field Station Tank Sewer Lines ~C~ ~ ~ ~
/ Material: Number of Compa~ments:
S~ace ? ~ ~ LIFT STATION
Water /dO /~O +
Lot /
Size in gallons: Manufacturer:
Line
0
Foundation ~/ ~ "Pump on" leve~off"~ level at: High water alsrm at:
Cu~ain ~ode[ Electrical Inspections pedormed by:
Drain ~ ~ ~g~
Remarks: ~ ~,~ ~-~ ~~ BENCH MARK
Location and Description:
/Oo
lnspecbons pe~ormed by ..... er Ala~ka~57~ ~a~es: 1st ~';~ Cg ?, .................................
Department of Health and Human Se.ices a~prova, '" ........
Rewewed and approved by: / .~Date.
72-013 (Rev. 9/91) MOA 25
PERMIT No. SW970565 PAGE 2 OF, 3
Mumicip. o.[i-I: of' Ar~chor'c~c~e
DEPARTMENT OF HEALTHAND HuIvrAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 eAnchor~.ge, Ato.$ko. 99519-6650®Tetephone, 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEH AND/OR WELL INSPECTION REPORT
LEGAL LOT 1, BLOCK 6, LAKE RIDGE TERRACE P.].D. NO. 051--.315-25
LOT 143/~3V~0c~,,/~.hO?E7
SEC.25, T15N, R2W
UTILITY EASEMENT NEW 1000 GAL. co~
- 002 MTn, ~
~ SEPTIC TANKI ~] ,~,~
........... ~ ........... in -T f f~-
/ ~c~/NEW ~ ~E ,i~NEW
~ ~3'k~RM ,, , ,~ , TRENCHES
~ / u~lVF., TH~
II
~ ~ ~ ,o~,~ c. COW*N ~ ¢ ~
/ ~::., .... , ......
/ ,~ ~o :.,::%
PERMIT NO. SW970565 PAGE 5 OF 5
Municip~Li~cv o~ Anchor~oe
DEPARTMENT OF HEALTH AND HUNTAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
p,F1, Box 196650 mAnchoro, ge, A[~sk~ 99519-6650m Telephone: :34:3-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LF..GAL LOT 1, BLOCK 6, LAKE RIDGE TERRACE
P.I.D. NO. 051-513-23
ST1 ST2
n/98.~' n
NEW ~ INSULATION
A B
FCO 1.5' 30.5'
ST1 6.5' 52.0'
ST2 12.5' 5,5.5'
DBL1 16.5' 55.5'
DBL2 lg.O' 37.0'
CO1 27.0' 52.5'
MT1 28.0' 55.0'
C02 50.5' 31.0'
MT2 50.0' 29.5'
C05 46.5' 65.0'
v~T5 47.5' 65.5'
C04 65.0' 46.5'
MT4 61.0' 45.0'
CO1 = 98.2', rC03 = 98.41
Tco,,%z co4 =
C01 = 93.9 C03 = 94.0',._/
C02 = 93.~"--//,/~ C04 =
M?i = 91.~'~ ~T8 = 91.1'~
MT2 = 91.1' MT4 = 91.3'
&86.8'
WATER FOUND
80.1' B.0.H.
JAN--l~--99 WEB 11:24 AM SULLIVAN WATER WELLS 688 2?59444444444444 P. 01
,SULLIVAN WATg WELLS
!~.O. BOX 670272, CHUGIAK, ALA$1cf, A 99507 ~ ~ELEPHONE 688-27~9
LEGAL DESCRIPTION ~4~
PERMIT NUMBER ~ A '~. ~n~t.
T~ INDENTIFIOmlON NUMBER
Is well located at approved permit location? ~ ~ No
Method of Drilling: ~aW ~ cable tool
/
Casing Type ~Wall Thickness, ~.¢ inch~s
Diameter ~ ¢ inches, depth /4J feet
Liner Type:
Casing Stickup Above Ground: ~ feet -~
Static Water Level (from ground level): .. /O~ _ feet
Pumping level; feet after hrs_ pump(rig ~9pm
Recover Rate: ~ gpm
Method of Testing:. ~1~
Well Intake Opening Type: ~ Open End ~ Open Hole
[] Screened; Start
~'P'~erforations Start
Grout Type:
Depth: from__
Pump Intake Depth:
Pump Size
feet Stopped__ feet
_ __feet Stopped _~ ! ~__feet.
Volume cg~oO &, ./~ ,j
feet, to _ __feet
feet
Brand Name
Well Disinfected Upon Completion? ~ ~ NO
Method of Disinfection: ~ /¢~t'z~Y'~ ~ ~"¢~041¢~'¢~.
Comments;
8ORE HOLE DATA
FEB 2 1999
Mun c pa ~[y ~1Ai~cl'iorage
.Copt He~!th & [4.man Gerv!c.e.~.
ATTENTION: It is the respo.sibilily of the proper~y owner to submi~ a copy of the w~ll leg to tha prope~ authority Municipality
of Anchorage: Departmen~ of Health & Human Services and/or Oepadment of Environmental Conservation. MatSu Borough:
Department of Environmental CoP, servation.
OA~.I. ON voorl I:=OMPA~ti¥
NON-OB~CTION TO ~SE~:N~ ENCROAC~NT DO~F
By ~s do~e~ ~ Telephou~ ~cia~o~ ~c. ~TA) d~l~ ~ it h~ ne obj~on to ~
eu~hme~l ora septic system ~ ~e p[~ 33' U~ E~ement ~o~ Lot 1, Block 6, I,~e ~dge
Te~ce Sub--ion ~ Township 15 No~, ~uge 2 W~h S~on 25, S.M.
Please be advised thru MTA tl~ough the issuance of this document does not forl~/t any of its fights to the u~e
of the area cited, tn the exercise of these fights MTA will, ffneeded, upgrade, makltain~ repair, anddor replace
buried or aerial tel~eommurdcations facilities within the easement. Any repaks that may be required to the
encroachment ~ a result of utility construct/on ~ill be borne by the propeR, owner of record. ~ document
does not authoriz~ the placement of any additional encroachments w/thin the easement area.
Th. is document is. in no wnav. an a eement to vacate an ortiqn of the utit/tv easement mad should not be
issued for Matanuaka Telephone Association, Inc. *,his Ist day of February, I999 by,
~, Plant Operations Admi~or
II41S IS TO CERTIFY, that on this I st day of February, 1999, before me the ,undersigned, a Notary Public in and
for the State ofglsska, duly commissioned and sworn as suck, perso-~!ly appeared Carlos Ed PowelI known
to me and to me known to be the individual named in and who executed the tbregoing in~ument and
acknowledged to me that he signed and sealed the same as a volumary act and deed for the uses and purposes
therein mentioned.
IN W3[TNESS WHEREOF, I have hereunto set nay hand and offieia/seal the day and year first above v~Titten.
GRANTORS ADDRESS:
Please Return tot
Matanuska Telephone Association, Inc.
Real Estate and Propea-fies Section
P. O, Box 3550
Palmer, Alaska 99645
My comm/~ion expires:
GRANTEES ADDRESS:
P.O. Sox ~2Z202
Eag&e R±ver,.t,g 99577
~8tanuske Telephone A~$ociaficm, Inc.
P.O. ~ox 3550 · P~lmer~ Alaska 9~=:~46-3550
1 .~00.746,~510 · 907_?~1,2510 ~ Fax 907.761.2646
ENSTAR Natural Gas Company
A DIVISION OF SEAGULL ENERGY CORPORATION
3000 Spenard Road
P.O. Box 190288
Anchorage, Alaska 99519-0288
(907) 277-5551
February 1, 1999
To Whom It May Concern:
ENSTAR Natural Gas Company has no objection to the 4 inch PVC septic stand pipes
encroaching into the 33' utility easement located along the North side of Lot 1, Block 6 Lake
Ridge Terrace Subdivision provided that the following conditions are met:
1. "ENSTAR" will be held harmless, now and forever, for any damages or injury to
any person or property as a result of this encroachment.
2. Any costs incurred by "ENSTAR" for special construction necessitated by this
encroachment will borne by the property owner.
3. This letter of non-objection will in no way preclude "ENSTAR" from full use and
enjoyment of its rights within any portion of the right-of-way.
If you have any questions please call me at 264-3712.
Very Truly Yours,
ENSTAR Natural Gas Company
Ken Gibson
Engineer
cc: File
February 1, 1999
Raymond Mulholland
P.O. Box 771202
Eagle River, Alaska 99577
Dear Mr. Mulholland,
Subject to your agreement to indemnify the company as set forth below, GCI Cable Inc.
of Alaska has no objection to the septic stand pipes encroaching into the section line
utility easement on the north property line of Lot 1 Block 6, Lake Ridge Terrace
Subdivision. Kno~vn as 15138 Terrace Lane in city grid NW 653.
This letter of non-objection in no way precludes GCI Cable from full use and enjoyment
of any rights it may have within any portion of the utility easement and or the right-of-
way, including unlimited access for servicing its facilities. Also any additional and
extraordinary costs incurred during any future required construction, repair or
reconstruction of GCI's facilities to accommodate any or all of the encroachments shall
be paid by the property owner.
By signing below, you agree to indemnify and hold GCI Cable harmless, now and
forever, for auy damage, costs, expense (including reasonable attorney's fees), liabilities
and iujury to any person or property occurring as a result of the encroachment.
Please indicate your acceptance by signing and retp~ing this letter to [nyself~tt~the
address below.
Sincerely,
Rebecca Colton
OSP Design Engineer
Date
5151 Fairbanks Street · Anchorage, Alaska 99503 · 907/786-9260
t~ohl,: ~,~n,i~,,=e nrm/irtnrt h~/ ~1~.1 ~..~hlo Inn
STATEMENT OF NON-OBJECTION FOR ENCROACHMENT
WITHIN UTILITY EASEMENT
Matanuska Electric Association, Inc. (MEA) has no objection with the location of two
septic system standpipes within the utility easement along the north boundary of the
following property;
Lot 1, Block 6, LAKE RIDGE TERRACE SUBDIVISION, according to the official plat
thereof, filed under Plat No. 549, records of the Anchorage Recording District, Third
Judicial District, State of Alaska.
Situated in Sec. 25, Township 15 North, Range 2 West, Seward Meridian.
This non-objection is conditioned by the stipulation that MEA will be held harmless from
any and all damages to the encroachment that may result from the existing and future
use of said easement.
Matanuska Electric Association, Inc.
t~eneral Manager or ms p
February 1, 1999
Date
MEA ACKNOWLEDGMENT
STATE OF ALASKA )
) SS.
THIRD JUDICIAL DISTRICT )
The foregoing agreement was acknOwledged before me this 1st day of
~iary Public for (he State of Alaska
My commission expires:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW970365
DESIGN ENGINEER:S & S ENGINEERING
OWNER NANE:MULHOLLAND, RAY
OWNER ADDRESS:P.O. BOX 771202
EAGLE RIVER, ALASKA 99577
PARCEL ID:05131323
PAGE 1 OF 1
DATE ISSUED: 10/14/97
EXPIRATION DATE: 10/14/98
LEGAL DESCRIPTION:
LAKE RIDGE TERRACE BLK
6 LT 1
LOT SIZE: 32200 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL 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 343-4744 ( 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:
RECEIVED BY:
ISSUED BY:
DATE:
DATE:
ROBERT C. COWAN, P.E.
CIVIL ENGINEERS
October 6, 1997
(907) 694-2979
FAX (907) 694-1211
HEALTH AUTHORI~'
APPROVALS
SEWER&WATER
MAIN EXTENSIONS
SEWER&WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOWTEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
wP,STEWATER
DISPOSALSYSTEM
DESIGN
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 1, Block 6, Lake Ridge Terrace Subdivision
Request you issue a permit to drill a well and install a septic system to serve the
proposed three bedroom house on the referenced property.
Test holes were excavated and percolation tests performed. The approximate location
of the test holes are located on the attached site plan.
At the time of excavation water was encountered at 17 feet in test hole #1, and was dry
in test hole #2. After seven day ground water monitoring water was found at 12 feet in
test hole #1, and 15.5 feet in test hole #2.
This property has enough area for a future septic upgrade ~vhich can be seen on the
attached site plan.
We do not anticipate any adverse effects on neighboring wells, septic systems or
drainage patterns by the installation of the proposed septic system.
If you require additional information, please contact us.
Sincerely,
RCC/mg
,MUNIL, iI-'ALITY 01: ANc...HOy,~r~z:
ENVIRONMENTAL SERVICES DIVISION
OCT 0 7 1997
RECEIVED
Enclosure
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
10' UTILITY EASEMENT
TERRACE
LANE
r-~>
PROPOSED
3 BDRM
HOUSE
--I "~
--m-o
Z'-D
O0
Try)
mm
C~ .._1 m
C')O~ --'~m
O~Oz C')
~.lZ
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
DATE PERFORME¢~
~lTownship, Range, Section: ~ "
SLOPE SITE PLAN
10-
11
12
13
14
15
16
17
18
19
2O
WASGROUNDWATER
ENCOUNTERED?
DEPTH?
Depth to Water A,er !~
Monitoring?
Gross Net Depth to Net
Reading Date Time Time Water Drop
i I,. o .:
~ ' ' ~ ,;~o I0 ~,~. 5V2~ ~q"
PERCOLATION RATE J'~(~ {minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FT AND ~ FT
COMMENTS
PERFORMED BY: $ & $ ENGINEERING I ~-~/-~'~-~'=~-.--- CERTIFY THAT THIS TEST WAS PERFORMED IN
17034 Eagle River Loop Road No. 204 ~ ' /'7 /
ACCORDANCE WtTI~Ij~e~F'i~,~SI~J~I~I- GUIDELINES IN EFFECT ON THIS DATE. DATE: ~O c~ '~
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
COMMENTS
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
~..~.t.~, :;,..,~..;
DATE
Township, Range, Section: · ""
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT ~ OL
DEPTH? I L~ '~ /O / '~. J ~l '7 Pr-
neplh Io Waler Alter
Monitoring? .
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE I~[~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~" FT AND & FT
PERFORMED BY: 17034 Eagle River L~p ~oad ~, ~ ' CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WIT~;~r~,~B~ GUIDELINES IN EFFECT ON THIS DATE. DATE: ~ O/7 ~ ~ 7
72-008 (Rev. 4/85)
C, AAB-HD- ]
G [ '~,TER ANCHORAGE AREA BOROr
b~r'AFITMENT OF EBIVIFIOBII~IENTAL 0. UALll ,'
3§00 TUDOR ROAD ANCHORAG£, ,ALASKA gg§07 27g-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
MAILING ~(~.,.~,,,~
ADDRESS
LEGAL DESCRIPTION
DISTANCE FROM WELl
LIQUID CAPACIrY ~./4:x; ,:~ GALLONS.
MATERIAL /.:~,:-,~-~? ,~,/¢,z:j-'/ .f~.?.ef/~K~-:b-~..~(-_ COMPARTMENTsNUMBER OF /
,/., / .;.. ,/.4.x- .~ LIQUID
INSIDE LENGTH ~'~TNSIDE WIDTH /-~---~ DEPTH__
SEEPAGE SYSTEM:
NUMBER OF PITS. /' OUTSIDE DIAMETER
LINING MATERIAL ..~'~-~.~[.>c~
NEAREST LOT LiNE
S E E P A G E P IT: ~"2~"'~'-'"~/'~ ~'
~ OR WIDTH
DISTANCE FROM WELL
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
, LENGTH '-~'~ , DEPTH ~
BUILDING FOUNDATION'''~ ~'~ ~
'~'-~' ~' ~ SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL ~, FOUNDATION
NUMBER OF~'ff~ES DISTANCE BETWEEN LINES
ABSORPTION AREA
, NEAREST LOT LINE~
~. TRENCH WIDTH
SQ. FT. LENGTH OF EACH LINE
TOTAL LENGTH
, OF LINES
IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE__
,./~.~-6-~/~'~/.~-'~'~ ~'~'~'~-~'~"~-~ DISTANCE ~:ROM
WELL: TYPE~~, DEPTH '~ ,BUILDING =OUNDATION.~
~ NEAREST ~ SEPTIC ~ SEEPAGE
LOT LINE SEWER LINE , TANK , SYSTEM___
WATER
SAMPLE
· CESSPOOL
, NEAREST
OTHER ~'
SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
,., ~' GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6-6§0
ANCHORAGE, ALASKA 99502
TELEPHONE 279-8686
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
FINANCED THROUGH TO Bg INSTALLED BY
SOIL TEST RESULTS
FINAL INSPECTION.' 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE TYPE SEEPAGE AREA SIZE TYPE
MINIMUM DISTANCES, REQUIREMENTS DIAGRAM OF SYSTEM
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT. ,DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK , SEEPAGE PIT
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK
DRAIN FIELD
WATER MAIN TO SEPTIC TANK .
DRAIN FIELD
SEPTIC TANK, . SEEPAGE PIT
TO RIVER, LAKE. STREAM.
CAST IRON INTO AND OUT Of SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION S FEET INTO UNDISTURBED SOIL,
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION,
HEALTH AUTHORITY ~
or
LICENSED DESIGNER
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
., DRAIN FIELD
· SEEPAGE Pit
ALSO CONSIDER AREA WELLS.
., SEEPAGE PIT
,, DRAIN FIELD .
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE Area BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN. ACCORDANCE WITH SAID CODE.
DATE APPLICANT'S SIGNATURE
?er'for, med For Palmer
............. . ~ ................... e t er.re.meal · 7/30/71
Th ,- "r-*-- p ........... 7_~TM ..... ~*- * .... /La~e R~dge Terrace)
Depth
6--4
8--~
10--
12~
14'~
16~
Gray silty sand with poorly
graded sand seams and fine
gravel~~
Proposed - - ' ..... -~,
.... i l e4.0
,e~.,tl~ To ~ottom Of Pit F;r '?Pe~ch
240 s~ fleet of drainage area zs rea~a~~6~
Test Pemfommed By: R. E. Carlisle
Data Certified By:National Testing Services, I~c,
Date: ...... ~ .......... ~ ....
Readlng Date ~ 'Ti me
Location Sketch
i~e'x ',,7.~r;,e Depth To H20
Net Drop
De~:,t?, Of .;Znlet Z/' De:)tb 'Jo Bottom Of Pit Or
COMSENTg: ~ ~ -_-, .
Test Performed B:,,;_~~,
1. GENERAL INFORMATION ..... :"" ";" .... ; '"
Lot 1, Block 6, Lakerldge-Terrace
Corn plete legal description
DEPARTMENT OF HEALTH & HUMAN SERVICES -..
Division of Environmental Services' ~ ·
P.O. Box196650 Anchorage, Alaska 99519-6650 ' ' · 343-4744 - - ' '
CERTIFICATE OF HEALTH AUTHORITY
.APPROVAL FOR A SINGLE FAMILY DWELLING
Location (site address or directions)
15138 Terrace Lane
Property owner
Mailing address
Ray Mulholland Day phone 696-6365
PO Box 771202, Eagle River, AK 99577
Lending agency
Mailing address
Premier Mortgage/Margie Day phone 696-0701
11901 Business Blvd.,/Building B, Eagle River, AK 99577
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3 ~
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. -
4. TYPE OF WASTEWATER DISPOSAL: '~' ' ~'
Individual on-site .- - ...- '- .--~--'~
· , communityon-site ' - ' ' ' ' ~ '~'-
/ ,-'NOTE: 'if c~mmSnity ~v[~t~w~"te~; S~/gteni;'b~.~)~db Written] ~,o~fi~m~ti~' from $(a~e.,
.'" ' : -' -. atteSting".td:ihe'lega!it'y.~,d'~t~'~g:'bis~/bte"m~.i'~' -. il "'.:i"i",..' '.-, '::.'.: _-.,i:.::, ,.,: :.,i:,:!,:..:::.ii:.i:_'.,,,~,:
STATEMENT OF INSPECTION BY ENGINEER
As certified by niy seal affiXe~l j~eret° af~d a~ ~of the validation date shown below, I verify that my.
investigation of this i~lealth AuthOritY APprOVal applicat on shows:that the on-site Water supply
and/or wastewater dispOsal system is SafeI 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 regulati0~is in effeCt on the date of this inspection,
Name of Firm' :' ' i S & S ENGiNEERiNG
1703,4 F~.U;~ ~iver Loop Road No 204
Address ' Eagle River, Alask?9577
Engineer,S.signature ' .~,~,/
Phone
DHHS SIGNATURE
'// Approved for
Disapproved.
Conditional 'approval for
· 'bedrooms.
bedrooms, with the following stipulations:
Additional Comments
v~he M.L~nl~ip~a, lity of A~le,~o:.rage Department of Health and Humap Services (DHHS) issues Hea th Authority
~App.roval;,Ceftlficates 'based only upon the representations given in paragraph 5 above by an independent
professional engineer r~gistered In the State of Alaska, The DHHS does th s as a courtesy to purchasers of homes
and'their le~ding in~'tl~tl0~s In order:t0 satisfy certain federal and state requirements. Employees of DHHS do not
c'ond~u~;t, lnspec[i~s~'~.ranalyZe-data before a cedlflcate,ls Issued., The MuniclPall~ of Anchorage Is not
~'es~ible'fer'e~ 0r 0missiOns In the pr0fe~slon~l eng neecs work '
72~5 (R~, 1~1), ~ck ~1
- ~
RECEIVED
Municipality of Anchorage FEB 02 19c),~'.~\
DEPARTMENT OF HEALTH & HUMAN SERVICES~uNiaP^Urr oF ^NC
Environmental Services Division ENVIRON,MENTAL SERVICE~
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744'
Legal Description: Zo ?" /
Health Authority Approval Checklist
~£0~-/~ ~/ '/"~,,e,E,~c~' Parcel I.D.:
A. WELL DATA
oS/- 3 / 3 -,~,~
Well type J~ 1 VA ~"E' If A, B, or C, attach ADEC letter. ADEC water system number
Casing height (above ground)
Log present ~'N) )/E'~' Date completed
/
Total depth / 5/ ~ / Cased to / ~//
Wires properly protected (~N)
Sanitary seal L~/N) ;Y'E'~
FROM WELL LOG
/00 /
g.p.m.
AT INSPECTION
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Other bacteria
Collected by: e ~ e ~- .............
17034 Eagle P, iver Loop Road No.
Eagle River, Alaska 99572
Number of Compartments
Depression (Y/~ /,/~ High water alarm (Y/N) .~/~
Coliform O Nitrate
Date of sample: I I .). '3 / ¢1cl
B. SEPTIC/HOLDING TANK DATA
Date installed '7 -c~ 3 -~ Tank size /~o o
Foundation cleanout (~/N) Y'E'_~
Date of Pumping ////~ /./.~'~J Pumper
C. ABSORPTION FIELD DATA
Date installed "/-c3 3 -¢ ~
Length /~' ' ¢~¢'~- Width
Effective absorption area
.~-//
Soil rating (g.p.d./ft2 or f¢/bdrm) (g, ~-,.5~ System type
.5' ~ Gravel thickness below pipe ~, _5- Total depth
Monitoring Tube present (~/N) Y'E'-~' Depression over field (Y~)) ,~/~
Results (Pass/Fail) For ~_ ~ bedrooms
Date of adequacy test
Fluid depth in absorption field before test (in.);_ ~mediately after gal. water added (in.):
Fluid depth ~er: Absorption rate = _g.p.d.
P~m3~'T~e treatment (past 12 months) (Y/N) If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High wate~
Cy~les~ested
~' level at*
*Datum
E. SEPARATION DISTANCES
"Pump off" level at*
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot ,/dO ~
Absorption field on lot /~ o "~
Public sewer main ///~
Sewer/septic service line ~.5" /7
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station /ch
,/¢0 "/
/OO / ¢-
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation Property line z/'O" Absorption field
Water main/service line /O/¢- Surface water/drainage /PO ~ Wells on adjacent lots
/
/0o
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Surface water
Curtain drain
Building foundation ¢.~' ''2 Water main/service line
Driveway, parking/vehicle storage area
~,, ~, Wells on adjacent lots /~0
ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal recor?~;t.l~a.,~.?thb~b'b¥4~sj/~'~,s are
in conformance with M, OA ];:IAA guidefines in effect on this date.
Engineer's Name ~8~*,¢,~- ~- E ¢w~
Date - ·
~., ',~. ~
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number