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Home My WebLink AboutLAKE RIDGE TERRACE BLK 11 LT 3Lake Ridge Terrace Block I I Lot 3 #051-323-34 �. wx vvrvu �vl Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231373 PID Number: 051-323-34 Dwelling: H Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New O Upgrade Name JEREMY TOU ABSORPTION FIELD ❑ Deep Trench ❑® Wide Trench ❑ Bed ❑ Mound Site Address 14523 DON CIRCLE, EAGLE RIVER, AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 832-594-5581 3 1.2 GPD/SF SEE DWG. Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade SEE DWG. Ft. Gravel depth beneath pipe 2.03 Ft. Subdivision Block Lot LAKE RIDGE TERRACE 11 3 Fill added above original grade Gravel length Township Range Section SEE DWG. Ft. 55+ Ft. - Gravel width 6-7 Beds: Number of - Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 392+ Ftz Ft. Well EXIST. 100'+ EXIST. - 25'+ T Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water EXIST. 100'+ EXIST. - Gal. Material Lot Line EXIST. 10'+ EXIST. - NA �ccom_pa_ Foundation EXIST. 10'+ EXIST. - ATION Manufacturer Capacity Remarks THIS IS A REBUILD OF AN EXISTING Gal. DRAINFIELD. Alarm location Elec�b, Installer PIPE MATERIAL House to tank EXIST. Tank to EXIST. drainfield JR'S EXCAVATION Drainfield D1785 CO/MTD3034 Inspector GEG CONSULTANT, JODY MAUS BENCH MARK (Assumed elevation) 100.00 ft Inspection 1st 11/20/2023 2�d 11/20/2023 dates: Location and description 3rd 11/20/2023 41h 11/21/2023 DOOR SILL (FINISH FLOOR) AT BACK DOOR ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp o600p o��F AL°pop Conditional Approval: Date 49 ....... .................. 11�� f - __ _ 0 Septic Syste Qp re arness:' Approved Date // Q Z Q 9 CE 795 a -91 d ' f %% rQo Note: this approva oes not include well permit requirements. OfessW' oma #AECC684 ��OOpo�o �. wx vvrvu �vl PERMIT NUMBER: OSP231373 PARCEL ID NUMBER: RECORD D RAW I N G 051-323-34 / \ I I 100' WELL n y 1 00'WELL i RADIUS \ Y RADIUS / �� QO GENERAL �• GENERAL j LOCATION ''e '� �� \\ LOCATION EXISTING I •4: ' 3 -BEDROOM EXISTING 1250 -GALLON STEP HOUSE I TANK. APPEARS TO BE INSTALLED ON 12/14!2012 BASED B ( UPON ELECTRICIAN'S REPORT. r APPROXIMATE LOCATION OF STEVE PANNONE, P.E ♦\ F� / 12/7/2009 TEST HOLE #1 100' WELL \\\ GS ' / • ' /% )`�� RADIUS \ GENERAL \ / o EXISTING \\ DOUBLE LOCATION \\ CLEANOUTS / j REBUILT DRAINFIELD. NEW \ / DIMNESIONS ARE 55+ FEET LONG BY 6-7 FEET WIDE ��\ iln_l__l 101.1 1 75.5 63.9 _ --------" �' MT2 89.8 78.9 82.13 N �' NOTE: PIPE LOCATIONS ARE �'' ' SHOWN PER GEG SHOTS I TAKEN WITH LEICA DISTO S910 LASER DISTANCE SCALE: j METER. SWING -TIES TO i HOUSE CORNERS WERE � 1"= 30' r GENERATED IN AUTOCAD. ENGINEERING - SALES 3. CONSULTING 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, ALASKA -PHONE (907) 337-6179 " WEBSITE: www.gamessengineering.ecm PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JEREMY TOU 832-594-5581 2 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: LAKE RIDGE TERRACE S/D; BLOCK 11, LOT 3 J.L.M. TYPE OF WORK: DATE: RECORD DRAWING OF SEPTIC UPGRADE 11/27/2023 poj a ♦i+�pROFE'7 Alp SS�60 ��•` LICENSE �141`t,� #AECC884 i PERMIT NUMBER: PARCEL ID NUMBER: OSP231373 RECORD D RAW I N G 051-323-34 NOTE: THIS IS A REBUILD OF AN EXISTING DRAINFIELD. W 1I12g! 23 KENNE-FH-M-DI}FFU6, P.E. TEST HOLE #1-1 INVERT OF PRESSURIZED DISTRIBUTION LINE = 111.30. PER THE CONTRACTOR, THE DISTRIBUTION LINE IS 1.25" SCH. 40 PVC LATERAL LENGTH 52 FEET, WITH 3/16" DIA. HOLES, SPACED 1.75' ON CENTER, 30 HOLES TOTAL— BOTTOM OF NEW DRAINROCK (TOP OF LEVELING SAND) = 109.. 0.9'- 1.5' OF MOA LEVELING SAND ADDED 6-7 RELATIVE ELEVATION OF BOTTOM OF PANNONE TEST HOLE BASED UPON HIS ORIGINAL GRADE = 102.20. TEST HOLE DRY TO 12 FEET ON 4/26/2010 PER DUFFUS DESIGN NARRATIVE DATE 4/28/2010. GARNESS ENGINEERING GROUP, Ltd ENGINEERING SALES CONSULTING 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, ALASKA • PHONE (907) 337-5179 • WEBSITE: w .gamessengineering.wm PREPARED FOR: ONE NUMBER: PAGE NUMBER: JEREMY TOU 7832-594-5581 3 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: LAKE RIDGE TERRACE S/D; BLOCK 11, LOT 3 J.L.M. TYPE OF WORK: DATE: RECORD DRAWING OF DRAINFIELD REBUILD 11/27/2023 TUBE (TYP.) GRADE = 116.01-117.75 RIGINAL GRADE PER DUFFUS RECORD DRAWING = 114.20 FILTER FABRIC 2.03' OF EFFECTIVE i EXCAVATED ALL CONTAMINATED DRAINROCK AND SOIL FROM SIDES AND BOTTOM OF EXITING DRAINFIELD. LIMITS OF EXCAVATION DEPTH = 107.77-108.37 4yq .... ................. . ................... �1#1'I� �f CE -7953 � 2-1 PROESS LICENSE ICEN#AECC6E4,t 11yAIk ` ). -7 2 3 SQL flc�hJlotir orj 11/2A J22 0 '1 200 0 0- 00 00'- b ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: LAKE RIDGE TERRACE SUBDIVISION LOT 3BLK11 PLAT P-549 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shouh any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. IEXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat I 0 = FND I" IRON PIPE 0 = FND 5/8" REBAR 01% rA IN 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax MUNICIPALITY OF ANCHORAGE Vent On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite �I Depar till ell t On -Site Wastewater Disposal System Permit Permit Number: OSP231373 Effective Date: 11/6/2023 Work Type: Septic Upgrade Expiration Date: 11/5/2024 Tax Code Number: 05132334000 Site Legal Address: LAKE RIDGE TERRACE BLK 11 LT 3 G:0553 Site Mailing Address: 14523 DON CIR, Eagle River Owner: TOU JEREMY Lot Size in Sq Ft: 25851 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 3 This permit is for the construction of: Q Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: I, • Monitor tubes for a pressurized trench are to be located within a foot of each end. � fo G 6-4-' Issued By: / Date: Date:/ ,� MUNUPALITY OF ANCHORAGE Q O 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. 051-323-34 Property owner(s) JEREMY TOU Day phone 832-594-5581 Mailing address 14523 DON CIRCLE, EAGLE RIVER, AK 99577 Site address 14523 DON CIRCLE, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) LAKE RIDGE TERRACE; BLOCK 11, LOT 3 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑ ADU) Septic Tank E] Upgrade ❑ Upgrade (D) ❑ Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: S Waiver Fees: Date of Payment: 1 0 Zo -c-3 Date of Payment: Receipt Number: ��i �l (�` Receipt Number: Permit No. ()S F Z 3 I Waiver No, GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc 7V Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231373, Deb Wockenfuss, 11/06/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231373, Deb Wockenfuss, 11/06/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231373, Deb Wockenfuss, 11/06/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231373, Deb Wockenfuss, 11/06/23 Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP101009 PID Number: 051-323-34 Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade Name: NOLAN ELLIOT ABSORPTION FIELD ❑ Deep Trench ® Shallow Trench ❑ Bed ❑ Mound Address 14523 DON CIRCLE, EAGLE RIVER, AK 99577 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 1.2 GPD/SF 5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3 Ft. Gravel depth beneath pipe 2 Ft. Subdivision Block Lot LAKE RIDGE TERRACE Y -/j 3 Fill added above original grade Var. 1.7 - 3.0 FL Gravel length 53 Ft. Township Range - Section Gravel width 5 Ft. Beds: Number of Lines 1 Distance between lines 1 Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 378 Ftp 1 Ft. Well 100'+ 100'+ 100'+ _ 25'+ TANK ® Septic ® S.T.E.P. ❑ Holding ❑ Other ManufacturerCapacity Anchorage Tank 1250 Gal. Surface Water 100'+ 100'+ 100'+ -- Material Steel Number of compartments 2 Lot Line 5'+ 10'+ 5'+ __ NA Foundation 5'+ 10'+ 5'+ LIFT STATION Manufacturer Anchorage Tank Capacity 1250 Gal. Curtain Drain NA *50'+ 1 NA t-- Remarks Field insulated. STEP connected to Pump on level at 44 in. Pump off level at 42 in. High water alarm at 48 in. existing electrical box / alarm. Old septic system decommissioned. Pump make and model Franklin 2445040117 Electrical Inspections performed by PIPE MATERIAL House to tank D3034 Installer MIKE ANDERSON drainfied D3034 Dralnfield D3034 CaMT D3034 Inspector ARCTERRA BENCHMARK (Assumed elevation) 100 ft Inspection1"5/21110 5/22/10 Location and description zed 3" 6/4/10 4" 12/14/12 DOOR SILL — finished floor COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL 'a�ft"w0k OF Conditional Approval: Date 9THS' N f�KESSYo� Approved Date/;Z -2 g —/ "A� Inspection Report.doc ' AS—BUILT 01.00 SYSTEM DETAILS/SITE PLAN Permit OSP101009 A—C=62 LAKE RIDGE TERRACE LOT .3, BLOCK 11 PID# 051-323-34 SCALE, 1' = 50' law A OF AL4 ,1 0, KE OF / CE-711kXk 6 s�lyj //lvti� \ lk '33IO�= 53' PREPARED FOR: NOLAN ELLIOT 4444 W DELAWARE ST SPIRIT LAKE, ID 83869 208-277-7328 FIELD BOOKS c PUTED: 01.00 101.1 STANING. STAKING >� A—C=62 DATE: 12/10/12 DWG ALE DRi°: NW553 B—C=62' Tj g A—D=62'n! 117.2 FINAL GRADE 11519 B—D=96' & A—E=76' A NIAIA @ F FILTER N , MSW R B—E=87' 1ST250 ti EPGAL 111.20 111.20 v TANK SEWER ROCK law A OF AL4 ,1 0, KE OF / CE-711kXk 6 s�lyj //lvti� \ lk '33IO�= 53' PREPARED FOR: NOLAN ELLIOT 4444 W DELAWARE ST SPIRIT LAKE, ID 83869 208-277-7328 FIELD BOOKS c PUTED: e No` BOUNDARY DRAft BMW STANING. STAKING CHECKED: KMD A%ulLr. JLS DATE: 12/10/12 DWG ALE DRi°: NW553 " No.:10-110 SCALE, NTS 4 v C CD N fD N 3 m 0 0 c m CD m r n c m f/1 O 7 N O 1 n O 3 3 CD 7 N W, N D CL CL CD 0 ra o co Q A d N (D W; r °D 0 r_ N �C `° Z 0 O �W �. a Fn, �" — Z o < W _O C� m On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP101009 Tax Code Number: 05132334000 Work Type: Septic Upgrade Permit Effective Dates: May 14, 2010 to May 14, 2011 Design Engineer: ARC TERRA CONSULTING INC Subdivision: LAKE RIDGE TERRACE Site Legal Address: LAKE RIDGE TERRACE BLK 11 LT 3 G:0553 Owner/Address: ELLIOTT NOLAN R 4444 W DELAWARE ST SPIRIT LAKE ID 838690000 Site Mailing Address: 14523 DON CIR, Eagle River This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank All construction must be in accordance with Lot Size in Sq Ft: 25851 Total Bedrooms: 3 N Privy N Private Well N Water Storage 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 must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either. A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By Municipality of Anchorage C• ..1 Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.org/onsite (907)343-7904 ON-SITE SEWERMELL PERMIT APPLICATION 05P/0 /00q FOR A SINGLE FAMILY DWELLING Parcel I.D. PS -1— 323' V Property owner(s) Ea 017' Day phone Mailing address yyyq W Pwww- S7 . spi2rr LA!LCt Zb Zip Code '3Z?6q Siteaddress IY529 Do)o Gff- fAhE Rl✓tyfAK Zip Code 9957-) Legal description (Sub'd., Block & Lot) LAKE 9166 ?iWeC !Ruck. U, Lar 3 Legal description (Township, Range & Section) Lot Size 25 QST Sq, Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms 3 THIS APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. property owner or authorized agent) Permit/RushFees: 753D., Waiver Fees: _ Date of Payment: b C/ 30/�0 Date of Payment: �Receipt Number: �/1 Receipt Number: (Rev. 11105) t.RCTERRq `.'k.ARCTrRrrA CONSULTING, INC F 212 E. 51" Ave, Anchorage, AK. 99503 �-"� �rOfrce (907) 868-3791, Fax (907) 868-3793 April 28, 2010 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Upgrade Sewer Permit - Lake Ridge Terrace Lot 3, Block 11 Gentlemen: The owner has requested we proceed forward to obtain a septic permit to upgrade the failed leachfield on the subject lot. The general slope of this lot is from east to west at various grades of approximately 5-29% over the septic area. The steeper slopes are due to surface subsidence and a cut, therefore, additional fill will be added and vegetated to maintain a grade of less than 25% over the area. On December 7, 2009 Steven R. Pannone, P.E. to investigate soils and groundwater, performed a testhole. The results of this test are attached for your review. We conducted additional groundwater monitoring on April 26, 2010 and found the testhole to be dry. The proposed upgrade will serve the existing 3 -bedroom house. We propose to install one 5' wide pressurized trench. The property and adjacent lots are served by private wells as noted. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 868-3792/FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. Kenneth M. us, P.E. Attachments: On -Site Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test Owner/Contractor Specs 20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577.8736 • PH (907) 868-3791 • FAX (907) 868-3793 (WELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLA LAKE RIDGE S a • ' QY t� W FLAG PROPERTY LINES WELL RADII & EASEMENTS PRIOR TO C❑NSTRUCTI❑N NO PUBLIC YELLS WITHIN YW OF PROPOSED SYSTEH NO PRIVATE YELLS WITHIN 2W OF PROPOSED SYSTEM EXCEPT AS NOTE& NO SEPTIC SYSTEMS WITHIN ROW Q PROPOSED WELL EXCEPT AS NOTE& OF AZ�4 *4 %nsslo'o Av Ilk -dw LOT 3, BLOCK 11 I� Scale, 1'= 100' DESIGN DETAILS PAGE 1 OF 2 3 BDRM X 150 GPD = 450 GPD 450 GPD/1.2 GPD PER SO. FT. (40 MIN/IN.)= 375 SO. FT (375 / 5 x .70 RF (2' GRAVEL) = 52.5 FT. TRENCH USE I TRENCH - 53' (L) X 5' (W) X 2' (D) Total depth of system Is 5' max from original grade. Total depth of gravel below distribution pipe Is 2' . NOTES, 1. INSTALL 1250 GAL STEP b INSULATE TANK IF <4' COVER. 2. INSULATE TRENCH WITH 2' HD BURIAL FOAM IF < 3' OF FILL. MIN. 2' FILL WITH INSULATION, >3' COVER NO INSUL REO. 3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK. 4. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC... PREPARED FOR: NOLAN ELLIOT 4444 V DELAWARE ST SPIRIT LAKE, ID 83869 208-277-7328 FIELD BOOKS BpB,D,Nr. BOU STw,ola STAI AST' JLS Owl FEE: ACRD " FILE COMPUTED: DRAM: BMW CHECXED KMD DATE: 04/28/2010 ao: NW553 10-110 WASTEWATER DISP❑SAL SYSTEM DETAILS LAKE RIDGE TERRACE LOT 3, BLOCK 11 PRESSURIZED DISTRIBUTION SYSTEM HOLE SPACING DESIGN ' 1. RESIDUAL HEAD = 5' 2. HOLE SIZE - 3/16' = 1.00 GAL. PER HOLE 2 30 PSI 3. 30 GALS (PUMP DELIVERY)/1.00 GALS./HOLE = 30 HOLES 4. 53 LF LATERAL/30 HOLES = 1.75' SPACING PER HOLE 5. ALL HOLES SHALL HAVE CAPS INSTALLED PER MANUFACTURES SPECS. s 9F.AL9s 1 PREPARED FOR, ��Q`.. •'.'�91+ NOLAN ELLIOT 4444 W DELAWARE ST * SPIRIT LAKE, ID 83869 208-277-7328 . Rarvna, •r. NyF r.,.a. / �resstDO�� FIELD BOOKS WUNDu -BOLINC SyA STAKR Asm At JLS Dm. ns ACO "`E' FILE col lm aur+: BMW aca®: KMD DAIS: 04/28/: mo.. NW553 Joe w>:10-110 le Scaler 1'= 30' PAGE 2 OF 2 SOI( SLOPE X TEST HOLE DG - PERCOLATION TEST EXISTING —/ 7 (STING 1 SEPTIC WAS GROUND WATER ENCOUNTERED? N IF YES. AT WHAT DEPTH? -0-' DEPTH TO WATER AFTER MONITORING? -Dry - DATE: 2-12-10 EXISTING 3 BR HOUSE SLOPE TH 1 READING DATE TEST HOLE 1 NET TIME WATER LEVEL READING NET DROP OR TOPSOIL 1 s.lr 0• 2 2 SM BROWNSILTY 8.64• 3.4r 2Y GRAVEL 3- 5.1r 0• 4 4- 45 10 MIN 8.43 ' 328' 3.1 5 11:47s.lr 01 8 8 11: 57 10 MIN SAP 3.24• 3.1 GRAY GRAVEL T GP POORLY 8 1207 GRADED B 323• 3.1 s 10 11 12 BOH SOI( SLOPE X TEST HOLE DG - PERCOLATION TEST EXISTING —/ 7 (STING 1 SEPTIC WAS GROUND WATER ENCOUNTERED? N IF YES. AT WHAT DEPTH? -0-' DEPTH TO WATER AFTER MONITORING? -Dry - DATE: 2-12-10 EXISTING 3 BR HOUSE SLOPE TH 1 READING DATE CLOCK TIME NET TIME WATER LEVEL READING NET DROP �� RAPE 1 12-7-08 11:27 s.lr 0• 2 11:37 10MIN 8.64• 3.4r 2Y 3 11:37 5.1r 0• 4 11:47 10 MIN 8.43 ' 328' 3.1 6 11:47s.lr 01 8 11: 57 10 MIN SAP 3.24• 3.1 7 11:57 6.17- 0• 8 1207 10 MIN 8.40• 323• 3.1 PEROLATION RATE 3.1 (min/Inch) PERC HOLE DIAMETER 6Inches TEST RUN BETWEEN 4 FT AND 5 FT DATE PERFORMED: 12178009 COMMENTS: Test hole excavated by FLINTSTONE CONSTRUCTION. Test dole was presoaked before pert test. PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. ENG � U01e N TES: PAMO E ANCHORAGE, VC, LLC 4� �F ACgsli' 12/9/09 p'' Sc01e Ef PHONE (907) 272-8218 FAX (907) 272-8211 NTS ..:.. P.I.D. NO LAKE RIDGE TERRACE BLK 11 LOT NOLAN ELLIOTT Leve , 'R. on o e 'RMIT NO. 14523 DON CIRCLE �l� cs Joe 8Z/z9 • ' �i SW...... SOILS LOG EAGLE RIVER, AK 99577 (\\; \A2pjf` sheet 5 MUNICIPALITY OF ANCHORAGE �• DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE EW 4- VV\-, S ❑ UPGRADE MAILING ADDRESt., LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS c Well I �?� Absorptiprea % 1� Dwelling �J J � PERMIT NO. C, 12, Uy DISTANCE TO: (91 _n L5 h Z N F Manufacturer (y/� / , _ / / 7V C- �_7 0lig � � � (yX Mae l ST - 6-- No. of compartments Liq. a city in gallons .�a yj IF HOMEMADE: Inside,lengt_-.. -Width �s Liquid depth z DISTANCE TO: Well Dwelling PERMIT NO. 02< zF Manufacturer IMaterial Liquid capacity in gallons 0 W Foundation Nearest lot line PERMIT NO. LU DISTANCE TO: JLL Z No. of lines Length of each Total length of lines Trench width Distance between lines Z w I- - inches oc � F Top of the to finish grade Material beneath the Total effective absorption area inches J LengtL�a Width Depth ( U (j PERMIT NO. A - W s-� u r nT Type of crib Crib _diameter Crib d-�- eptt Total effective abs tiu��acea Lu 1J rob DISTANCE TO: Well "t ! Build fo al v Nearest lot ILme _j Class Depth Driller Distance to lot line PERMIT NO. n w uildi f un atio Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALS p VC, SOIL TEST RATING INSTA�LER Cil'- VIA -t-1 REMARKS I PIT -3-Twr 0 htc L- GI 1 iyfii j It .L4 'A' J r. i•+. 9_- AP.O ED DATE LEGAL a li 9 SJ �CI,, 20K -T A M !N 5 MUNICIPALITY OF ANCHORAGE Department"f Health and Environmenta'e,Protection 825 Street, Anchorage, AK. .9501 264-4720 # # # HANDWRITTEN PERMIT # # # Permit # C, F, WELL AND/OR ON-SITE SEWER PERMIT Applicant: 6E'mis Mailing Address: �-RAV3 Location: Phone Number: (ORf--- 3SS3 Legal Description: 10T- /� // �,��,elc Lot Size: Type of Soil Absorption System Is: "74CMG4 Trench: Drainfield: _ Seepage Bed: �� Holding Tank: Maximum Number of Bedrooms: 23 Soil Rating (sq. ft/br) The Required Size of the Soil Absorption System Is: DEPTH, LENGTH _��_ GRAVEL DEPTH'S WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC (4&La -P&) TANK SIZE _ /OOU GALLONS # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * # * TWO M INSPECTIONS ARE REQUIRED # # # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. # # PERMIT EXPIRES DECEMBER 31, 1 9 3 3 # I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the idence is remodeled to include more that 3 bedrqojns. Signed: Issued by: v r� Applicant Date: SWP/024 (1/81) ('611wd -110JR � �� -0 R -SOILS LOG MUNICIPALITY OF ANCHORAGE ❑ PERCOLATION ' • +.e\ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 825 L. Street, Anchorage, Alaska 99501 2644720 SOILS LOG — PERCOLATION TEST PERFORMED FC LEGAL DESCRIF DEPTH (FEET) 1 r t` 2- 3 �5P'� 4- 56 5- 6- 7 8- 91011 9- 10- 11 12- 13- 14- 15- 16- 17- 18- 19- 20 21314151617181910 COMMENTS L C_ l D 4(5-6tV r>^11S�e ��%vh� No. 4286-E 'o n,''ROFESS1��a PERCOLATION RATE TEST RUN BETWEEN DATE PERFORMED:/ SLOPE WAS GROUND WATER S ENCOUNTERED? L Depth to Watzr O P IF YES, AT WHAT/ E DEPTH? 7 cliff SITE PLAN 7w Reading Date Gross Time Net Time Depth to Watzr Net Drop d t2 C7 1 3. (minuteshnc�il r t�'� �F '' FT AND FT PEiFORMEb BY: � re-_�1y A�1r6 �e CERTIFIED BY: DATE: C"UGIAK, ALASKA; KCAL ?Q- T3B1S_ K 1, AL; A m .� 68-3t a.' SITE tD$s-asze Y E 44 M:E'/$LL ALASKA =_ T p [ cis POST OFFICE BOX 42l 1UGIAK ALASKA 895567 a V OWNER OF LAND .w.,. ru. .... . PEP OF WELL 24 ft , Coat .. . ........ ...... 2 _. .. OOft. Z 'n hole ADDMSS-.Hox..363...EagLe...Rimez,.:.Alaska...... 9.5.7..7...... STATIC LEVEL: OF WATER ...... WELL - SITE . 3 •• B 1 I Lak-e.. e.:.:Te a�.3C.�.• DRAW ... ............................ . ... s.d9 DOWN FT. I00% _ DATE STARTED ................... 5=9-a3............ .............................. - GALS. PER HR... 3Q..9S14%............................................................. DATE - ENDED .......................5..10..8 3 ... ......................... KIND OF CASING 611 t Sch #40 .... ............. ...... FIND OF FORMATION: 0 2 5 Sand & ;Gravel 1 �' FT. TO ._...214 FTBedrock FROM ...................... FT. TO ...... FT....................... .. FROM ....................... ... .... 25 42 Clay & Gravel 214 w 217 Fractured rock FROM...................... FT. TO.................... FT.................................... FROM .......... ...... FT. TO .. FT. y� 3yS �1 B6draek 214 24314y edrock s- FROM .................... FT. TO ..... .......... FT................................. FROM ........ ... FT. TO ....................... FTB................................ `33C►2f 7 FROM ......... 51.....,.. FT. TO ......... ?.:.... Fr. Ei gAgtiZed... Vock FROM ....................... FT. TO ....................... FT................................. FROM ........ 6.... FT. TO ........ .64 ....... F,.Bedrock ................ FROM........................ FT. TO FT: FROM .......t4........ FT: TO .........�? ..:... FT.F ? lea... 4ek FROM ........................ FT. TO ........................ FT-- ......................::.... FROM ........65.....:.. FT. TO ....;....1 U ..--- FTBedrock .............. FROM ....................... FT. TO ........................ FT ..........................:.. --M ......... Q9..... FT. TO ..........FTF:7 . t1ArRa...X:4ek FROM ....................... FT.-TO . FT. FROM .--------112 FT. TO ......... .3 ... FTBedrock . ... FROM .....................:. FT. TO ........................ FT.........................,....... 131135 Fractured rock FROM...................... FT. TO ...................... FT. ........ .,.......................... FROM ....................... FT. TO ........:............... FT................................. FROM ......135..... FT. TO .........157..:.. FT.Bedrock.... FROM ....................... FT. TO ....................... FT.................................. . FROM ......... 1-5.7...... FT. TO ......... L62.... FT.F.rarctured... rack FROM ....................... FT. TO ........................ FT................................. MISCLANFORMI ATION: - No warranty or no warranties implied. MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 051-323-34 Certificate of On -Site Systems Approval Expiration Date: 9/14/2024 Legal description LAKE RIDGE TERRACE BLK 11 LT 3 Site address 14523 DON CIR Current property owner(s) TOU JEREMY XThe On-site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: Original Certificate Date: 11/29/2023 This Certificafe of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory X Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 U IUPAU Y OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051-323-34 Complete legal description LAKE RIDGE TERRACE; BLOCK 11, LOT 3 Location (site address) 14523 DON CIRCLE, EAGLE RIVER, AK 99577 Current property owner(s) JEREMY TOU Day phone 832-594-5581 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: 0 Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 13 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑® Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: 0 Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Waiver Fee $ Date of Payment // �2��Zzi Date of Payment COSA # 05G 23l _13 8 Waiver # COSA Applicakn June 2022 COSA Checklist Legal Description: LAKE RIDGE TERRACE; BLOCK 11, LOT 3 Parcel ID: 051-323-34 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 A. WELL DATA W Well log is filed with Onsite (or attached) Date drilled 8/10/1983 Total depth 243 ft Cased to *40+ ft n Sanitary seal is functioning correctly X Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 9/14/2023 Static water level at beginning of test 14.7 ft. Comments *PER PREVIOUS COSA'S AND HAA'S B. TANK DATA Measured operating fluid level in septic tank Date of pumping 9/18/2023 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 11/20/2023 ❑■ ALL standpipes present per record drawing Total measured depth from grade 8.5 ft (max) Measured depth to pipe invert from grade ft (min) ❑E N/A —pressurized field. ❑ Per record drawings, field is insulated. 0 Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced _gallons date Any rejuvenation treatment (past 12 months) N/A If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 Well production at time of test 1.0+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ® Nc X Coliform bacteria is Negative Nitrate 0.334 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by GEG, LTD. Date 9/14/2023 C. LIFT STATION FE Required maintenance completed Age of lift station 13 years Lift station material STEEL Comments: Adequacy test date NEW Results Q Pass Fluid depth prior to test NEW in Water added NEW gal New fluid depth NEW in Elapsed time NEW min Final fluid depth NEW in Absorption rate 450+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 24 in Effective depth used 0 in Effective depth remaining 24 in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' FC Yes if No ft FN_1 Yes if No Neighboring Tank > 100' ❑■ Yes if No ft Private Sewer/Septic Line > 25' Q■ Yes if No Absorption Field on Lot > 100' E Yes if No ft Holding Tank > 100' QYes if No Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ❑i Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' MN Yes if No ft Q Yes if No ❑ N/A — Served by Community Well (not on lot) or Public Water ft ft ft ft ft From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q Yes if No ft Surface Water > 100' 0 Yes if No ft Tank to Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑■ Yes if No ft Private Wells > 100' M Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' g Yes if No ft Water Service Line > 10' Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS 1983 WELL LOG INDICATED PRODUCTION OF 0.5 GPM. 1996 HAA INDICATED WELL FLOW OF 0.75 GPM. THE 2021 COSA INDICATED WELL FLOW OF 0.77 GPM. WELL FLOW ADVISORY RECOMMENDED. G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Gamess Engineering Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Garness Date In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an attemative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. COSA Checklist June 2022 r A' fer ss: CE -795 -Aa.�� 3�0 LICENSE 4�d Pr o f e s siottoQa #AECC884 Well Water Advisory Certificate of On -Site Systems Approval # OSC231458 Subdivision: Lake Ridge Terrace, Block: 11, Lot: 3 This well's productivity was determined to be 1 gallons per minute. The minimum well productivity required under (AMC 15.55) for a 450 -bedroom residence is 0.31 gallons per minute or 150 gallons per day per bedroom. Although the subject well currently exceeds this minimum requirement, the production capacity can fluctuate and may be insufficient to meet your needs. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Mailing Address P O Box 196650:* Anchorage, Alaska 99519 6650 *www mum org MUNICIPALITY OF ANCHORAGE Development Se6kes Department �r Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Lift Station/Pump Vault Maintenance• • Owner_ Street AddressI ` ., Septic Tank: Sludge leve inches •Pumpin+ Lift station: •Pump basket cleanee no *Control floats cleaned e no ,Operation satisfactory djj no Afartn System: 1: required es no -Pumping complete es no -Effluent filter cleaned(Xe� nb -Proper float settings confirme esu) no •Dedicated electrical alarm circui es` no -Audible and visual alarm inside dwellin e � no *Alarm system operation satisfacto notsatisfactory Manhole Risek : MumaPAUTY OF ANCHORAGE: i� Development Services Department,/� Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-323-34 1. GENERAL INFORMATION Expiration Date: 12-AkI Complete legal description Lake Ridge Terrace Block 11 Lot 3 L t; •t 14A 14523 Don Circle OCU V" (sl e a ress) Current property owner(s) Denise Ray Mailing address Real estate agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic R 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 Fee $ 550 Waiver Fee $ Date of Payment 03 1201? I Date of Payment Receipt Number 0o (o % 66 Receipt Number COSA # QS (-;?,11 5 3 � 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 Illy 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MCA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name 6. DSD SIGNATURE Steven R. Pannone P.E. Date 0..k�q r� System #1 Approved for y pp 3 bedrooms �� Jt`vVBll PC11110rc System #2 Approved for rl':. bedrooms`�� ;, Disapproved ^ Conditional approval for bedrooms, with the following stipulat ns: �(C6i/i 0F A \N M JJJJI J)))AfT SF -F,\ - By: LOriginal Certificate Date: C, /g( A I The Municipality of AnchorreDevelopment 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 X Other COSA Checklist blue sheet Legal Description: Lake Ridge Terrace Block 11 Lot 3 Parcel ID: 051-323-34 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth 243 ft Cased to 40+ ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA °'`°'20-' Static water level at beginning of test 36.2 ft. Comments B. TANK DATA Age of tank(s) 11 years Tank type/material Measured operating fluid level in septic tank 55 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 8/27/21 D. ABSORPTION FIELD DATA Shallow Trench Well production at time of test 0.77 gpm Water storage tank volume NIA gallons Well disinfected for coliform test? ❑ Yes ®✓ No ❑ Coliform bacteria is Negative Nitrate •284 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L On Arsenic less than MRL (ND) Collected by PES Date of Sample 8/23/21 C. LIFT STATION OR Required maintenance completed Age of lift station 11 years Lift station material Steel Comments: Which system tested (date installed) 052212010 Adequacy test date 0712012021 ❑ ALL standpipes present per record drawing Results [Z)Pass For 3 bedrooms Total measured depth from grade 8.0 ft (max) Fluid depth prior to test 6 in Measured depth to pipe invert from grade ft (min) Water added 450 gal ❑ N/A — pressurized field 29 New depth in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 256 min depth into effective WECode-requiredsoil cover over field Final fluid depth 6 in On System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced 1900 gallons If yes, enter date Comments/Deficiencies: FIELD FLOODED AT 1900gal . ADDED ADDITONAL WATER TO TEST SYSTEM. COSA Checklist yellow sheet 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' ✓0 Yes Community Sewer Manhole/Cleanout > 100' 0✓ Yes if No ft 0 Yes if No ft Neighboring Tank > 100' M Yes if No ft Private Sewer/Septic Line > 25' F,71 Yes if No ft Absorption Field on Lot > 100' F-71 Yes if No ft Holding Tank > 100' F/� Yes if No ft Neighboring Absorption Fields > 100' Yes if No. Water Main > 10'✓0 Animal Containment > 50' El Yes if No ft ✓0 Yes if No ft ✓V Yes if No. Water Service Line > 10' Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' 0✓ Yes if No ft FVJ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ✓0 Yes if No ft Surface Water > 100' Yes if No. Property Line > 5' ✓0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' if No Yes if No ft Private Wells > 100'✓� Yes if No. Water Main > 10'✓0 ft Yes if No ft Community Wells > 200' ✓V Yes if No. 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' 0✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' U✓ Yes if No Water Service Line > 10' 0✓ Yes if No ft Community Wells > 200' 0✓ Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION -0--OF AL -'A I certify that l have determined through field inspections and review cjP �-y�i of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. i ®® _ Steven R. Pannone CE 8149) COSA Checklist yellow sheet ft ft ft ft ft www.muni.org/onsite Well Water Advisory Certificate of On -Site Systems Approval # OSC211537 Subdivision: Lake Ridge Terrace, Block: 11, Lot: 3 This well's productivity was determined to be .77 gallons per minute. The minimum well productivity required under (AMC 15.55) for a 3 -bedroom residence is .31 gallons per minute or 150 gallons per day per bedroom. Although the subject well currently exceeds this minimum requirement, the production capacity can fluctuate and may be insufficient to meet your needs. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. *�e`tg nMa�6ng Atldress P� Box 196650 Ancf�orage, Alaska 99519 B650 *www muni org ,f 1- ?r3:,.,,.L%i';S�^.. 8 Poi '-° Municipality of Anchorage On -Site Water and Wastewater Program � (907)343-7904 R U 1 • S Err CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-323-34 1. GENERAL INFORMATION Expiration Date: _ `2 0 -_13 13 Complete legal description LAKE RIDGE TERRACE BLOCK 11, LOT 3 Location (site address) tl4523 DON CIRCLE EAGLE RIVER AK 99577 Current Property owner(s) NOLAN R. ELLIOTT Day phone Mailing address 4444 W DELAWARE ST. SPIRIT LAKE ID 83869 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Received by: Date: ` COSA to be released to the engineer, unless otf� i requested by the engineer. COSA Fee $ OCD d 1�� c �h Waiver Fee $ _ Date of Payment o� Date of Payment Receipt Number OJ��J�� Receipt Number COSA# 0 1 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by myal algxled hereto and as of the validation date shown below, I verify that my investigation, based on procedufds�ogflned ithe Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site wate'rsuply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS , Date 12/27112 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future+�tE occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist.'` 7 _� E3 6. DSD SIGNATURE: $ System #1 Approved for. bedrooms. .V System #2 Approved for _ bedrooms.i Disapproved. Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: I a " T. uni par ynchorage 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory _ Arsenic Advisory Vveli Flov✓Advisory Ofne, If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: LAKE RIDGE TERRACE BLOCK 11, LOT 3 Parcel ID: 051-323-34 A. WELL DATA Well type PRVT If A, B, or C provide PWSID # Date completed 5-10-1983 Sanitary seal (Y/N) Y Total depth 243 ft. Cased to 40+ ft. FROM WELL LOG Date of test 5-10-1983 Static water level 10 ft. Well production 1.2 9 - p.m - Well Log (Y/N) Wires properly protected (Y/N) Y Casing height (above ground) 24+ in. WATER SAMPLE RESULTS: Coliform /zrY__colonies/100 mL Nitrate 3�q mg/L AT INSPECTION 12-14-12 28 ft. 0.98 9 - p.m - Arsenic: /Vu ug/L Date of sample: 12/14/12 & 12/26/12 Collected by: ARCTERRA B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC STEP / STEEL Tank size 1 250 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping 12/11/12 Pumper JRs C. ABSORPTION FIELD DATA Date installed 5/22/10 Cleanouts (Y/N) High water alarm (Y/N) Y Date installed 5/22/2010 Soil rating (g.p.d./ftZ or ftZ/bdrm) 1.2 System type SHALLOW TRENCH Length 53 ft. Width 5 ft. Gravel below pipe 2 ft. Total depth 8 ft. (Measured 12114/12) Eff. absorption area 378 ftz Monitoring tube Y Depression over field N Date of adequacy test 12/14/2012 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 3.6 in. Water added 600 gal. New depth 15.6 in. Elapsed Time: 90 min. Final fluid depth 6 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N _ ___ If yes, give date ___ D. LIFT STATION Date installed 5/22/10 Size in gallons 1 250 Manhole/Access (Y/N) Y "Pump on" level at 44 in. "Pump off' level at 42 in. High water alarm level at 48 in. Datum Bottom of Tank Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main 75'+ Sewer/septic service line 25'+ Animal containment areas 50'+ SEPTIC/HOLDING TANK ON LOT TO: Meets alarm & circuit requirements? Y On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout 100'+ Holding tank 100'+ Manure/animal excrete storage areas 100'+ Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 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. Engineer's Printed Name KENNETH M. DUFFUS Date 12/27/12 COSI+ brown shec-t_3-1-12.doc Municipality of Anchorage sy Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # 121583 During a recent COSA on-site inspection and test of the potable water supply well on Block 11, Lot 3 of Lake Ridge Terrace subdivision, the well's productivity was determined to be 0.98 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. 9 W F— F— 0 — F-0 i— DON CIRCLE S47°26'00"W 125.05' (125.00' RE ED �' SH rn A U GRAVEL D/W w 0 CA 0 Z z N N Cj F— C, f 0 C cONCRE�" C O 12.2' SA O 2 n p 35 LOT 3 BLK 11 ANCHORAGE RECORDING DISTRICT • M SEPTIC VENTS (NP) 30.1 NEIGHBORS SHED ENCROACHES --r 10' UTILITY EASEMENT S47°16'51 "W 125.05' (S47°26'00"W 125.00' REC) ASBUILT OF: LAKE RIDGE TERRACE SUBDIVISION LOT 3 BLK 11 PLAT P-549 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 10-005 MAVM BY: CHECK D BY MID nUNB- B-- PI JLS NW553 100118 LOT 5 BILK 11 !li 0 =END 1" IRON PIPE O = END 518" REBAR OF'kA'�II 49TH :JOHN L. SCHULLER.� o LS -10408 a �� fessionol �"� w4 5 ; LAft Cc) � �i� xa �r � a r 1851 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I. D. # 0 5-1 - 3 a 3 ~ 3 y HAA.# A a s` o 1. GENERAL INFORMATION Complete legal description Lot 3• Block 11° Lakeridge Terrace Location (site address or directions) 14523 Don Circle Eaqle River, AK Property owner Virgil Howell Day phone (503) 255-4100 Mailing address C/O Remax of Eagle River 16600 Centerfield Drive Eagle River, AK Lending agency Day phone Mailing address Agent _ Address Kathi Olmstead Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water _ Day phone 694-4200 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 XYX 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/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. S & S ENGINEERING //R r q 7rj Name of Firm 17034 E,gtP Rivers Loop Road No. 204 Phone (� Address Eagle River, Alaska 99577 j Engineer's signature Date 3/ y �% 7 �s3:tSir .' , .,. •,fid . }5`f ,1 I)1' ROBERT C. COWAN C,C-11 —: At 6. DHHS SIGNATURES .,,", Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: �� /� Date 3) \ 1-011 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ..72-M (Rev.1/91) Back MOA #21 MUNICIPALITY OF ANCHORAGE jjjjjk • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services VIMM On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D. # C)4� 1 -Sad, -2-A HAA # 0 R' In ) '�.C)Q 1. GENERAL INFORMATION Complete legal description Lot 3• Block 11• Lakeridge Terrace Location (site address or directions) 14523 Don Circle Eagle River, AK Property owner Virgil Howell Day phone 696-8834 Mailing address 14523 Dons Circle Eagle River, AK 99577 Lending agency Mailing address. Day phone Agent Kathi Olmstead/ Remax Eagle River Day phone Ariririm. cc _ 694-4200 Unless otherwise requested, HAA will be held for pickup.e MUNICIPALITY of ANCjjC)MA ENVIRONMENTAL SERVICES DIE VISION 2. NUMBER OF BEDROOMS: ? NOV 15 7996 3. TYPE OF WATER SUPPLY: Individual well XXX RECEIVED Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of systemF 4. 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.W21 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/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. S & S ENGINEERING Name of Firm 17034 Eagle River Loop Road No 204 Phone Eagle River, Alaska 99577 Address , Engineer's signature 6. DHHS SIGNATURE Approved for bedrooms. C_-8801 Disapproved. Conditional approval for 3 bedrooms, with the following stipulations: /MONEY .S1119LL DE PLACED /N ESCYOW 1N T -/-/,e 19r10uNT Or lk1900 TO 11A51P.9P rYE Wg5rF_W#)- R 5Y5TEr1 SERVING iN1s RROOERry 1,V THE EyEA/i THE h/,9STf- WF?rE/'{ mam 00/S ivo7- /'ASS lglwHER 190EcJua Y FEST m/ ¢ MONTHS -/To y Additional Comments OCr0ae1? MDNPY /Av r-sclFow SpAL1 NOT lir: 1?ELER5E0 C(NTIL iH/S OFF/Ef //flS G/yEAI By: �/ ��O'/.� Date// —,2 CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto 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.1/81) Back MOAk21 Date 11 C_-8801 Disapproved. Conditional approval for 3 bedrooms, with the following stipulations: /MONEY .S1119LL DE PLACED /N ESCYOW 1N T -/-/,e 19r10uNT Or lk1900 TO 11A51P.9P rYE Wg5rF_W#)- R 5Y5TEr1 SERVING iN1s RROOERry 1,V THE EyEA/i THE h/,9STf- WF?rE/'{ mam 00/S ivo7- /'ASS lglwHER 190EcJua Y FEST m/ ¢ MONTHS -/To y Additional Comments OCr0ae1? MDNPY /Av r-sclFow SpAL1 NOT lir: 1?ELER5E0 C(NTIL iH/S OFF/Ef //flS G/yEAI By: �/ ��O'/.� Date// —,2 CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto 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.1/81) Back MOAk21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES i Environmental Services Division .,;N'`✓F;� 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744"a,, y4'TY01p Health Authority Approval Checklist N�tl , �cSeR eco` c� s, Legal Description: LEYT- 3 i? )L- -- 1 S �ih(��r Parcel I.D.: r' rz v 199 ` p` A. WELL DATA 1I Well type 62-wl wz�-� If A, B, or C, attach ADEC letter. ADEC water system number Log present Y/) Date completed �� (z�:, i3 "�5 Total depth �' �� Cased to �r� I Casing height (above ground) Sanitary seal f i) ' 4 Wires properly protectedON) Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform D FROM WELL LOG AT INSPECTION g.p.m. 1�i g.p.m. Nitrate ca 11& % Other bacteria 0 Date of sample: l L) `/ Collected by: S, 4g, S ENGINEERING ;y34 Eagle River LOOP KVUQNd- 204 B. SEPTIC/HOLDING TANK DATA <i1F 4ioer, Alaska 99577 Date installed Tank size l ocy Number of Compartments Cleanouts Y/ )-q--- e Foundation cleanouti�N) I Depression &k -1L— High water alarm (Y/N) rl Date of Pumping � I - Z -q to Pumper S , C. ABSORPTION FIELD DATA I l Date installed r) - 2-D (a'5 Soil rating (g.p.d./ft2 or ft2/bdrm) 1�5l� System type Length 5) Width % r Gravel thickness below pipe Ca Total depth Effective absorption area L� �� Monitoring Tube presentow)*- Depression over field (Y6)3 �' Date of adequacy test I > 9 Resultsq Fail) F'^sS For 5 bedrooms Fluid depth in absorption field before test (in.); �%� Immediately after3 dD gal. water added (in.): a Fluid depth Q (ins) Minutes later: Absorption rate = 4�;-D g.p.d. Peroxide treatment (past 12 months) ) If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access •(Y/N) /9 CIJW F P- "Pump on" level at' /-/J- "Pump off' level at' /8 High water alarm level at' `I `Datum of -r- 0,) -mm Cycles tested S4 It 4,-4—A- - E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot in)I I On adjacent lots Absorption field on lot 1 p� t k On adjacent lots Public sewer main r�I Public sewer manhole/cleanout Sewer /septic service line 1,75' t Lift station ,C�-)ik U SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: �1 Foundation 2-5- Property line 1 k Absorption field Water main/service line�fl t`� Surface water/drainage 1CO1k Wells on adjacent lots ' lC-)o SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line a t ` Building foundation ZS Water main/service line 1 Surface water Curtain drain vlU,� (-- k Driveway, parking/vehicle storage area F. ENGINEER'S CERTIFICATION �.s a Wells on adjacent lots \�r I certify that 1 have determined thru field inspections and review of Municipal records that tit+ in conformance with MOHAuides in effect on this date. C')�. Signature ?ej /C O�4_/Z p (JA 1 .. Engineer's Name Date HAA Fee $ i Date of Payment Receipt Number 72-026 (Rev. 3/96)` Waiver Fee $ Date of Payment Receipt Number e5 D I 1 N ERT C. COWAN F CE -8801 pyfle S&S 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 DISPOSALSYSTEM DESIGN ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. March 3, 1997 CIVIL ENGINEERS (907) 694-2979 FAX(907)694-1211 MAR ) 1997 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services Municipality of Anchorage P.O. Box 196650 Dept. Health & Human Services Anchorage, AK 99519 REFERENCE: Lot 3; Block 11; Lakerdge Terrace Subdivision A Conditional -Health Authority Approval was issued on 11/21/96 for the referenced property. A septic adequacy test was performed on 2/28/97 which is the allotted four months from when it was peroxided. Water was added to the system while water level measurements were taken from the monitoring tube located in the leachfield. From this test it was concluded the septic system is currently functioning adequately for a three bedroom house. We request you issue a Final Health Authority Approval at this time. If you have any questions or require any additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/gk 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES}1 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # L){l — SaS— Zq HAA # V -M' It a 'I 1 z 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision,.section, township, range) Lot 3• Block 11• Lake Ride Terrace Subdivision Location (address or directions) NHN Don Circle, Eagle Riverr Alaska (b) Property owner Mailing Address Paul VanHoek Telephone: (home) 696-5271 Business 373-8669 P.C. Box 771696, Eagle River, Alaska 99577 (c) Lending Institution Mailing Address Commonwealth Western (d) Real Estate Company and Agent Address Telephone Telephone (e) Mail the HAA to the following address: (or check here 2S, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING/694-2979 17034 Eagle River Loop Road, Suite 204 Eagle River,. Alaska 99577 2. TYPE OF RESIDENCE Single -Family IN Number of bedrooms 3 3. WATER SUPPLY Individual Welles Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site IN Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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 &s ENGINEERING Telephone 17034 Eagle River Loop Road No. 204 Address ragle River, Alaska 99577 Date !t/.Z & DHHS APPROVAL Approved forte—bedrooms by .��l��,f/�i�� Date U�� Approved Disapproved Conditional Terms of Conditional Approval =CAUTION a' -V14 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72025 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) • Health Authority Approval (HAA) ` CHECKLIST - FEBRUARY 1984 i MUNICIPALITY OF ANCHt W4744 ENVIRONMENTAL SERVICES DIVISION Qp r 1 Legal Description: .40t 3�. APR 2 7 IZ990 /--iq �_7_Ed4igca A. WELL DATA RECEIVED Well Classification 6r N (� r- M (14If A, B, C, D.E.C. Approved (Y/N, Well Log Present (Y/N) Il Date Completed 5 — / O 83 Yield z AO Total Depth -3_ ._.Cased to AO Depth of Grouting Static Water Level / a r Pump Set At� rt Casing Height Above Ground 5U Sanitary Seal on Casing (Y/N) i— Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) dJ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot / C)/ r ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot �� f ; On Adjoining Lots /00 r f To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole —d1,/A rt To Nearest Sewer Service Line on Lot � S Water Sample Collected by fes;Date—A4 1 r Water Sample Test Results fActee)61 - A AC tC4 8 -+ AJi�-,aAfe-S Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size No. of Compartments Standpipes (Y/N) i—Air-tight Caps (Y/N) T_Foundation Cleanout (Y/N) Depression over Tank (Y/N) A/ Date Last Pumped • - 3 —10 Pumping/Maintenance Contact on File (Y/N) 1A ; for Holding Tank High -Water Alarm (Y/N)—IJ�-Temporary Holding Tank Permit (Y/N)� SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well ( DC7' -t To Building Foundation Z S r To Property Line �C) rfi To Disposal Field 3 , r. To Water Main/Service Line 1 0 7" To Stream, Pond, Lake or Major Drainage Course N D Comments !GWrc- PyMied 64 )(yrs 72-026 (Rev. 7/8B) Front Page 1.of 2. C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata�R, 1�7 Type of System Design +' Date Installed P� - 2 c) ` F33 Length of Field r Width of Field Depth of Field 3 Gravel Bed Thickness Square Feet of Absortion Area 14 3E Statndpipes Present (Y/N) k Depression over Field (Y/N) N I Date of Last Adequacy Test Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well �f To Property Line (D t To Building Foundation S To Existing or Abandoned System on Lot A)0tNe ; On Adjoining Lots 30 'f" i To Water Main/Service Line (0 f To Cutback (if present) t%G ti To Stream, Pond, Lake, or Major Drainage Course tipN� To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed e -Zo - 83 Dimensions SOD c/Pct AW_ ( d n1K Size in Gallons Oo Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at r+ High Water Alarm Level at Vent (Y/N) /J Tested forL /�% .' S ?- } �� ; , , Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) u e S Comments *`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, insnPntinn Signed S & S RNGINFERING 17034 Fa910 Company Eggin River,Alaska 99577 Date ;,5,0 MOA No. Glzj Receipt No. Receipt No. — �� Date of Payment / / ;2-- Waiver Fee: $ Amount: $ ,x %�- a�) Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 cF LAIORATORIES CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET • ANCHORAGE, ALASKA 99518 • TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order # 21214 Date Report Printed: APR 23 90 @ 16:40 Client Sample ID:L3, Ell LAKE RIDGE TERRACE S/D PWSID :UA Collected APR 19 90 @ 14:50 hxs. Received APR 20 90 @ 12:45 his. Preserved with :AS REQUIRED Analysis Completed :APR 20 90 Laboratory Supervisor :STEPHEN C. EDE Released By : A-,/ Special Instruct: Chemlab Ref #: 901001 Lab Smpl ID: 1 Parameter Tested ------------------- NITRATE-N Sample ROUTINE SAMPLE. Remarks: SAMPLE COLLECTED BY RDJ Matrix: WATER Result Units -------------------- 0.22 mg/l Client Name S & S ENGR Client Acct SNSENGP P.O.# NONE RECEIVED Req # Ordered By : ROBERT SHAFER Send Reports to: 1)S & S ENGR 2) Method EPA 353.2 Allowable Limits --------------------- 10 ===1 Tests Performed= _ =See =Special Instructions Above UA=Unavailable ND- None Detected See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Greater Than \NOfc(ry�f 0 p 0 A gy yR G n 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 1. GENERAL INFORMATION (a) Legal Description (include lot, block, -3 "r5// zG. Application Date (G 9 section, township, range) Location (address or directions) r— (b) Applicant Name S Telephone: Home S 3 Business 20 Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/buildeX Buyer ❑ ; Other ❑ (explain); (d) Lending Institution OyL9 Telephone Address (e) Real Estate Company and Agent N j:7 - Address Address Te ephone LO (f) �� he HAA to the following address: ) mei�a y ". 1.G p�tiV Iply ALAS€ .A PA. n e J`t-N 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms _3 3. WATER SUPPLY Individual Well`I,� Community El Public 11Note: If commu'nity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL OnsitXe 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. 72-025 (11,84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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 Addre Date DHEP APPROVAL Approved for J bedrooms by _ Approved Disapproved Terms of Conditional Approval lyz ` / ct Date Conditional CAUTION -S: o�av,Tka•K.sa� e�a ae 8sbart A. Shafor r° No. 1457-E >•9 �`'� °e 6* 00 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. MUNICIPALITY OF ANCHORAG, DEPT. OF HEALTH & ' MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 OR 9. 9 9985 264-47720 Legal Pesc r%io r C E' V L Q A. WELL DATA Well ClassificationO(Y �/ 6_114e_If A, B, C, D.E.C. Approve (Y N) Well Log PresentN)Date Completed � !6183 Yield Total Depth JY3 r Cased to Depth of Grouting - Static Water Level .200, Pump Set At Casing Height Above Groun C) Sanitary Seal on Casing Lr (Y/ ) Electrical Wiring in Condu (Y/ ) Depression Around Wellhead ('4"N) Separation Distances from Well: To Septicbf,Tank on Lot / ; On Adjoining Lots G"o To Nearest Edge of Absorption Field on L/ot l ; On Adjoining Lots /U To Nearest Public Sewer Line IF I To Nearest Public Sewer Sewer Service Line on Lot Z'_ :r y ; Date 161 -5 Cleanout/Manhole '"h- To Neares Water Sample Collected by S z z2 / Water Sample Test Results /=} -7-t S �� cl�`P Comments /y-l.q '-'J 17 B. SEPTIC/1,18EE44Q TANK DATA Date Installed 20 Y -3Size / 00 Q No. of Compartments 2_� Standpipes(Y N) Air -tight Cap(Y N) Foundation Cleano (Y N) Depression over Tank (Y('Ny Date Last Pumped , 5; �- �� Pumping/Maintenance Contract on File (Y/N)r1 ; for Holding Tank High -Water Alarm (Y/N) /J`� Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/#eWkig-Tank: C '1 L"z' To Water -Supply Well �Ut% —I To Building Foundation �— C To Property Line f� `� To Disposal Field To Water Main/Service Line �� f To Stream, Pond, Lake, or Major Drainage Course /I.J » zi e Comments Page 1 of 2 /u 0 ,oj5' C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �Type of System Design Date Installed Z zoo Length of Field 2- f Width of Field '16Depth of Field 3 Gravel Bed Thickness ae C/ r Square Feet of Absorption Area Standpipes Present(Y N) fJ Depression over Field (YO J Date of Last Adequacy Test d Results of Last Adequacy Test O`er - %A Separation Distance from Absorption Field: To Water -Supply Well /00 -,(- To Property Line To Building Foundation Lot z� F On Adjoining Lots 0 To Existing or Abandoned System on To Water Main/Service Line ,fib To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course oxi /`1 0 To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION 1v L-) /�J- IF Date Installed v Dimensions C 14 Size in Gallons SZ Manhole/Access (Y/N) ` �C" lcle"- 7/ Cr" "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) A) Tested for A,�- Electrical Codes (Y/N) Comments N "' Check Permitted Bedroom Rating Against HAA Request `" Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all M A and HAA guidelines in effect on the date of this inspection. Signed f& .'"ff iFi = Rih' = Date Z SRO 196X Company:!'" Ssc IVE-1, ALASKA M,577 MOA No. Receipt No. 3 (0 (,, f�,3q- Date of Payment el e c, Amount: $ _�/' / 1 ` S15— Page Page 2 of 2 72-026 (11/84) /`,�.v9i u� i APPLIf- \NT FILLS OUT UPPER HAr 'ONLY Property Owner //>> / / "i. - 'l �./ Phone Mailing Address - (' -, / Zip Code— Buyer DateDate Address Zip Code Lending Institution � ��:'� . �-l ✓� �,:�/C Phone Address �. /''i f- �i:-.�� Zip Code Inspector ,Ff ,/'+. Field Notes: S j, .. / Phone Realty Co. & Agent DEPT. OF HEALTH O; ENVIRONMENTAL PROTECTION Address Zip Code ... � Legal Description W (,o Street Location / -,i �-- / �'Z� Type of Residence `CONDITIONS OF APPROVAL - ,54 Single Family ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. BY: For wells drilled prior to that date, give well depth (attach log if available). ❑ Community Date Sewer Installed ❑ Public Utility - Well Log Received ry Sewer Disposal - - Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. L- I,/\ n t-ri /- t\ pip 1P (-) , 1 , Time Time Time Time - Date DateDate Date (7 Inspector Inspector Inspector Inspector Field Notes: S j, .. / MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH O; ENVIRONMENTAL PROTECTION SFP 16 ... � RECEIVED W (,o ( ) APPROVED BEDROOMS `CONDITIONS OF APPROVAL - (✓ ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE BY: Soils Rating Date Sewer Installed Well To Absorption Area v Well Log Received Well to Tank Septic Tank Size