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LAKE RIDGE TERRACE BLK 11 LT 13 REM
MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page I of 3 ONSITE WASTEWATER INSPECTION REPORT Permit Number: OSP2013L9 PID Number. 051-323-24 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New [11 Upgrade Name ABSORPTION FIELD Car Van Dyke ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 99577 14632 Don Circle Ea le River, AK ❑ Other Phone Number of Bedrooms 1Rating Total depth from original grade 3 GPMF Ft LEGAL DESCRIPTION depth to pipe in from odginaI gradeGravel F,. depth beneath pipe Ft Subdivision Block Lot Lake Ridge Terrace 11 13 Fill added above original grade Gravel length Ft Tovmship Range Section Gravel widthBeds. Ft. Number of Li Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. be Tenches From Tarlo Field Lift Station Tank Line Ftp well 001+ NA NA NA NA TANK ❑ Septic ❑ S.T.EP. ❑ Holding ❑ Other Manufacturer Greer Tank capacity 1000 Gal. Surface Water 00' NA NA NA NA Material Plastic Number of compartments 2 Lot Line 10'+ NA NA i NA NA Foundation 10ft NA NA NA LIFT STATION Ter Capacity Gat Remarks Original tank pumped, removed. and taken off site for disposal Pion C installed by by contractor. PIPEMATERIAL House to tank D3034 Tankto drainfiedD3034 installer JRs Septic — — Drainfield COUTD3031 Inspector Pinard Engineering BENCH MARK (Assumed elevation) 100.0 ft Inspeciondates: is 9/17/20 2'" 9/17/20 LocaBar and description Top of Flashing at Bottom of Siding 3'd 9/17/20 4'^ 8' East from Corner "A". ONSITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date OFlts�' i4�P� °*'.* '49th*' ........... a... ^- �-...........--..... �•, Paul E. Pinard ; i Septic S to Approved t.. �� Date q-zo CE - 4793 .°S°° F��f •_., .• h�' P it gr Note: this approval does not include well permit requirements_�f+r�rf'�l (Rev 85102118) 1 1 Zt I7 -O in � � o N w N W s a_ ra•, d s 4) ❑. CK �e� "�" Q/1 Z pL[ ; �• m aUiMSM + Oq LL V U i�La w i� cz cc 9 RR c=.0 mVE r_i J�J O�f Q CO f, I uy i m CL Ll3 'rj ^ V Z O- 0 RE dao, n w �0 _m N fim N a-+ Q. G iz a�Is t rs AA y O a it !£Pi's . m uro ".S O m d s u L E i O a i m E.L. j.F •� �` e.ReYeeE£o�v 94 R. � d S� . cm n-yL O k e..£ +' O O— w w u c u •rl � e $e L 0.0 O 6 'Utility to d o E , U] Nv `• �/ GY law 0,4 O CID Ao e c ` m oar = oo 4-) E H m 3 0 ` O m c w aOz m •� w o� m- W n p a O w m 40 PL gOrF a. � g 400L__ s g m1-4 = a W F 6 KVMRDIH MID clgo cn M U 00� m mho TL w m o cv .D of rn T N N N N N -. — a 0� o cv .o co j rn a o,L W`' CVT N M; F4 O O F E Oi O 6 U U Co Wei U U! U 1n0 N 4310 �! _ 31anaQ S m C6 O p+ U .ono F—NV310 NNdl N E 1n0 NV310 ANbl I r N E O 0 U 1nO NV310 NOIIVC] NnO4 Z P N N a o,L W`' � �j Q Z O N iL ca CL 1n0 N 4310 �! _ 31anaQ S m C6 O p+ U .ono F—NV310 NNdl N E 1n0 NV310 ANbl I r N E O 0 U 1nO NV310 NOIIVC] NnO4 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196654 4700 Elmore Road f� Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http:l1www.murti.or91onsite r DeI)artincnt On -Site Wastewater Disposal System Permit Permit Number: OSP201349 Effective Date: 9!212020 Work Type: SepticTank Upgrade Expiration Date: 9/2/2021 Tax Code Number: 05132324000 Site Legal Address: LAKE RIDGE TERRACE BLK 11 LT 13 REM G_0553 Site Mailing Address: 14632 DON CIR, Eagle River Owner: VANDYKE CARY R Lot Size in Sq Ft: 25482 Design Engineer: PINARD ENGINEERING Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field Q 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 (2417). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either. a. Opener! and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing a ` Received By: �- Issued By: Date: cj�- I Z9Q Date: f MUNICIPALITY OF ANCHORAGE Development Services Department .u,� Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTICM/ELL PERMIT APPLICATION r Parcel I.D. 051-323-24 Property owner(s) Cary Van Dyke Day phone Mailing address 14632 Don Circle, Eagle River, Alaska 99577 Site address 14632 Don Circle, Eagle River, Alaska 99577 Legal description (Sub'd., Block & Lot) Lake Ridge Terrace, Bk 11 , Lot 13 REM Legal description (Township, Range & Section) Lot Size 28,724 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) If (w/wo ADU) Septic Tank ® Upgrade ® Duplex (D) ❑ Holding Tank ❑ Renewal ❑ 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: PE 6- 7-5 COVIN f Waiver Fees 2� 1 - Date of Payment: _01Z_e5U ��t�Zc�zo Date of Payment: Receipt Number: -OiXOS Receipt Number: Permit No. 05P2.0 1; qq Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc PINARD ENGINEERING Paul E. Pinard Registered Engineer/AK & ID P.O. Box 871347, Wasilla, Ak 99687 (907) 357-ENGR(3647) Becca Carroll Municipality of Anchorage Onsite Water & Wastewater PO Box 196550 Anchorage, Alaska 99519 RE: Lot 13, Block 11, Lake Ridge Terrace; Septic Tank Replacement Dear Ms. Carroll: 1�1 September 1, 2020 The scope of the job on the referenced property is to remove the existing 1000 gallon septic tank after pumping it and then disposing of the tank at an approved site. This tank is 38 years old and appears to be leaking, necessitating its replacement with a new septic tank that meets all of the MOA's current requirements. The new tank will be installed at the same location as the existing tank, sited to meet the minimum 10' separation requirement from the house foundation. At this location, the new tank will meet all minimum separation requirements from water supply wells on this property and the adjacent properties. There would be no adverse impacts to any of these properties by this project, ie installing a new septic tank at the same location where the current tank has existed for 38 years. Sincerely, Paul E. Pinard, P.E. OFA S� c Paul E. Pinard CE -4793 9(t j7r2 OLD GLENN HIGHWAY � t� c l m N � Sv N w x_700 r < -Radius �. m S � c l CD � Sv N w 90 o 0o D m -4_ �u A9 v _ N cnn ' v Q c V V m m Z � d� CA � -0 l m () X= Z 0 fC 1 Ay m•v ; '^ •_e.' C y m •T' A\ Z .n � g \ j CCD co 'sl9flx� ..... O k r w P. N' Z0 pm c+ £ C+ R. H P. Qq � 7 O (D o �d b �t o C+ M w m � w� ,a o '* a asE� �zTt�R OR caa c 90 a cm.,����r�+� _ O G it F 3 =�,Q, e,.,��•3� q CD n a c •_e.' C y m •T' w .n � g j 'sl9flx� ..... k ooya y.__t 7 A e c ��Ii°IT9T rn ir L,c:x?. i.,.,e:,g a :l. :: !ih.,~,b ,:::I ~, v :i. ~.~ :i c:~ n ~ I.,,.A~:::[E R :[ Z)(bE "FE:I::,:F~:ACE: [..cit. = Lc)'l:. ~ :i, ;('. (.:.:.? ~;:~.(iil'?'.L:,i!4. (s~::i. {"L,, Qr' · SCALE !~ 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 ~ H 0 N~-O-~Z~ MAILING ADDRESS ~ LEGAL DESCRIPTION LOCATION '-- 0 NO. OF BEDROOMS ~ ~ Manufacturer ~ Material ~ ~o. of com~artmonts kiq. capacitg in ~aHons ~nside length Width Eiquid depth ~00 IF HOME.DE: ... ., ~ ~ Well Dwelling PERMIT NO. DISTANCE TO: ~ ~ ~ Manufacturer Material Liquid capacity in gallons Q Well Foundation Nearest lot line PERM IT NO.~ i~e ~~ inches Distance between lines No. of lines Length Total length o[I s Trench widt I ~ ~ ~ Top of tile to finish grade._ ~.,~' ~ Material beneath tile ~ ' inches Total effecti~s:r~on~,, area Length Width Depth PERMIT NO. ~ N Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ ~ C~ 0 ~ De~ ~ Dr~ller ~~ Distance t° I°t line ~~ PERMIT NO' ~ DISTANCE TO: Sui~~~~. Sewer ~oline r Septic tan k ~/.OO"~ ~ Absorption~area(s) OTHER PIPE MATERIALS SOIL TEST RATING REMARKS APPROVED DATE LEGAL FiPF:'L. i i L 0 CI~ T I !iliH L E "3 :: L ( 82E14'P'F [>ON CiRCL.,E Li3 E::I.J.. LFtKE R]i)GE TERR 'T'YPE 'iii:'-" 'SO I L. FiE:SOF.:PT ]l 'iff. l.:,"~' ~"-'rr:'H:,, ,_. _T S:, ' _. I-]; ::i~: II il . , r:;;: MFIN!h!Uhi NtJi"IE~E:R f]F THE L. EHGTH DZI',!'ENS.i:ON IS THE LENlr-'iiTH ,:lIN FEET) OF' THE 'F,q'.ENCH OR DRF~.INFIELD. 'T'HE: [:,EF'TH OF F.:l TRENCH OR PIT i'S 'T'HE [:,iSTFI:.,",!CE E:ETHEE]",I THE '.:5i. JRF'RCE O1::: 'THE GROL!ND .¢':ll",!E:, THE BOTTOt"! OF' THE E::-.:CRVFFF Z ON ,:: ~ N FEET ). THERE: iS NO SET !,.!ID'T'H FOF.: 'TRENIi:HEE;. THE GF:RYE:L DEPTH IS THE MIN..-'[MUM [:,EF'T!4 OF GRFI",,,'EL E:ETFtEEN 'T'HE f3U]"F"FILL PIPE FIND THE E',OTTOH OF THE EXCR'v'RTII:]F,! -'::ZN F'EET). F'EI:-:.:H):'T' RPPL I CRNf' k!RS THE F.:ESPOI",!SiB ILi TY 'TO iNFORM "FI'.!IS DEPFIRTMEI',iT DLiRi NG THE INS]"Ri_L. RT!Oi'q INSF'ECTIONE; OF FINY I.,.!EL. LS RDJRCEN]" TO THIS !:::'R(]PERTY FIND THE NUHE~E:R OF RESIDENCES THFIT THE: HELL HILL. SER'v'E. ....................... "]- ~....~ E/Z? ,:1:;;EL7 2, ~1 P-.~ lee F' EEl El: -~'" lE ~l~ ~"~ 91] ~=~ F: ~ ~:~: EEE ,1;::~ ~......~ % LF;E: EE: E:RCKF iLLl['~",!G OF FINY SYSTE]"! 14:!:THOUT F'INFIL I NSPEE:TiON RND, 8F:'F'RO'¢RL. E',Y THIS DEF'F:IRTMENT H]:LL BE: :SUB.TECT TO F'ROSECUT:[ON. i'"i i N i MIjM D ! STF!I'.,iCE E:E'T'HEEN FI I,.iEt...L.. FINE:, PiNY ON-S i TE SE!4RGE D i S.I.':'OSF!L. SYSTEM :l: 9'.'; :!.E}9 FEET F:O,q: R F:'R!',,,'F!TE I,.!EL..L OR :tSEi 'T'O ;;:.'{-.'~E~ F'EET FROM Ft F'UBL. ZC HELL [:,EPEI'.,![;,]:HEi ijF'Effq THE TYPE OF' PUBLIC HEL_L. PiiNIMf...iM [:, ]: 'iE;TF'P~CE FROM 8 F'R!YF!TE HELL 'i'O F! I::'RiVFi"FE SEHER LINE iS 25 FEET !:lIND 'T'O R COMHLi!'-4!TY SE!qER LiNE IE; '.F."D F:EE:T. O'i"P;EF;'. REE:K.i I REP'iEHT:~-2; MF:!'?' FIF'PL'?'. SPEC i F I CRT i ON:'_E; FIND CONSTRLICT I (.!N D !. FE!iRFIMS F:IF~'.E !::!VR.T.L.fiBLE TO INSURE F'ROPER ZNSTF:~L!.~F:ITI 'r 2f:'F'T l Fy "I'HRT .... · ............... 4 t F:!i"! FFiMIL 'i:F,F: t,.IlTH THF:' fi'F~NI'[RE.'"!ENTS - -'p '"[.l-,::;T~b. ':I::k!ERS F!J'-,i!} I,.tEiL.L.S FIE] F 'iiFTTId F: Y THE h'!lJ?.~ I ti:: I PFIL I TY OF f: "J l '"t 'i fi'F:If:iE 2 ' 'r ................. !.,.IZ~ I xN';:;TFtl t ..... ~f.~b '~' '":' : T.:.T:'-'"'t Z~',! F f":f":- ~;'":,i~FJCE. .... ,..,.h 't"r'~,, THI:. ,~ ........ .... f"ll],F';; 3: Z .Ji',iE:,E::F":ST~N[:' 'T'HF~'T' ""'~"-~ ,'~= ¢'~N-SZ"r!{... EP4gt;'., ...... c,.p::TEEh'! !"tRY N'.E(;:~LIIRE ENLFIRCEEHENT IF THE PF"::;. .T [:,ENCE I S REM(][:,ELE[:, TO _T ........ '-,iF:I I i":,F:' ',I '",~'~:,,., F PP~ T f":~h~F~ .... Y ¢ DY ............... .......... ~/ ................................................ -; --.7 ......................... EN(~'i'NEERING & DEVELG. MENT Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 CO, RusSell Oyster 694-2774 Performed for: Legal Description: Earl Eilio SOIL LOG 688-2280 . No.~&~-~-- ~ Depth (feet) 0 Soil Characteristics PLOT PLAN 11__ ~12 __ !3-- 14__ 15__ 16 Ground Water Encountered: Yes Proposed Installation: Seepage Pit Comments: No /If yes, what depth Drain Field ~ '"ER ANCHORAGE AREA BOR~" ~--~ HEALTH DEPARTMENT · 327 . - .fT. ANCHORAGE, ALASKA 99501 .511 INSPECTIONS-REPORT ON-SITE SEWAGE DISPOSAL-SYSTEM NAME LOCATION ,,~/,~ SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY MAILING -~2~2~ '~'¢'~/f '~- ~'./)'z_z~'+--,~'~'/~, ADDRESS ~' ~, P HO N E~ ~ ~/~LEGAL DESCRIPTION ~ /~ ~~ NUMBER OF MATERIAL ~~~ COMPARTMENTS / DEPTH GALLONS. INSIDE LENGTH /~ INSIDE WIDTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF' PITS LINING MATERIAl .OUTSIDE DIAMETER NEAREST LOT LINE OR WIDTH /~/J'~'~:~' ' . LENGTH ~,,';~ ' , DEPTH ~' DISTANCE FROM WELL /-~'~ / BUILDING FOUNDATION'~' '~,~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~'~'~/ SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL DEPTH: TOP OF TILE TO FINISH GRADE WELL: TYPE ..~--/L-/'/-z~-'~c~ DEPTH ~/,~'/' ~' LOT LINE //~ /~,~. NEAREST ~/SEPTIC · SEWER LINE ., TANK TOTAL LENGTH /~ ,~"~UNDATION , NEAREST LOT LINE .... , OF LINES ., DISTANCE/BETWEEN LINES/ ~ ~ IN. TOTAL EFFECTIVE SQ. /T. LENGTH OF EACFJ.-E~ / .-,---' DISTANCE FROM / ' WATER ~,x'~ · BUILDING FOUNDATION. "~'~ SAMPLE _/~. , NEAREST ~ OTHER / /,..~ / SEEPAGE /~,..~-- / CESSPOOl. ~ , SOURCES "~ , SYSTEM , DISTANCES: DIAGRAM OF SYSTEM t -.. I ,\ - '~;' ' .I l~,~,,,'~ ?,J'l' I %" / ~. , / I ~,' <-./~.L_~---'~( .,.~ ~--~-I,.;~f GREATEI' "ANCHORAGE AREA 'gROUGH HEALTH DEPARTMENT SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT RESIDENCE ADDRESS ~, t~' ;~ LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH ~ e L~bT' PERCOLATION TEST RESULTS MAILING ADDRESS ~Ex;~ -/~*/',~ ~', PHONE NO.. LOCATION OF INSTALLATION //~ /, //~ ,~4'J''~'~ zoz--4:7 /-/¢~-~.-~T~ /~,~- ,z~/v_~- TO BE INSTALLED BY ANTICIPATED DATE OF COMPLETION K'~,-SEE~.AGE PIT. _~/ ,DRAIN FIELD BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT , OTHER , ,L , ~..,~? THIS IS TO'SERVE AS ~4~ ~.~ ~kq~/~l,~~ , PERMIT TO INSTALL A AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED · SEPTIC TANK SIZE J~//~)-~ .TYPE~,'~;~SEEPAGE AREA TYPE i-%' DIAGRAM OF SYSTEM DISTANCES: (~ ~ k ~" :'~ '7~- '/ ~LTH ~THORITY LICENSED DESIGNER I certify that I am familiar with th~ requirements of Greater Anchorage Area Borough Qrdinance No. 28-68 and that the above described system is in accordance with said code. ~)'}" ~/~L/L> ~'~/-)7~ r'~¢,~/a.. ~'~ . ''?'. .,?. 7/~ ~_~.~ "" ~ . . )~-. '.. DATE ' APPLICANTS Sl~ NATU R E 6~ 8~ 10 12 t "~ -. ~-.GRJ~ATER ANCHORAGE AREA BOROUGH '~. ~ HEALTH DEPARTMENT CASE # ~' 327 EAGLE STREET ~ ANCHORAGE, ALASKA 99501 Performed Fora Marvin H. ShepieK ~ , ~D~at%_i~e?~%%r~m=ed'' 8/17/70 Legal Descz. ip~~~ $ub~.>~L.~ ..... ..~., ~ .... This Form Reports a: S~Log '~-~ -Pe~4~ola'tion Te~---~_-c--,, , De )th Soil Chaz~act erist f,Jcs brown & gray silty, sandy g r ave 1 (GM) Was Ground Water, Encountered? If Yes~ A+ ~.'~,-. Location Sketch ..... l~d,.t,~n: Seepage Pit D~ain Field Depth Of Inlet~_____.._._.~Dep~--~o ~"it Or Trenc~ ................ COMMEN ~: ~c~mend usin 225 s uare feet of draina e surface er bedroom Test FeDfo~d By:~~isle ~ ~ese reco~endations are computed f~'om visual observation and based on the fled classification system, Data Ce~tifled By:National Testing Services, Inc. Date: --~ ' o rn 0) rn 'ce) m � I- r - CD 0 G) CY) W C f6 o LL V n LL O i U Z LL 01 J Q^ —.0 i..l.. C U a) cn U Q� Z p U .L /(/) o6 V) L C> E > a) C 00 O 0- Q_ Q U) N U) a) C 0 4+- 0 a) U LO N O N CO ti N C) O 0 IZIN c� MNM cy O a) v ol w H J r J m w U W H w c� W Q J C O Q U a) a io a) J ti LO 0) Q N Q) LU U Z N M V U) U) a) 0 ca a) D J 0 LU N I— w 06 LU Q LU U U) w Y a) C y0 L a) 0- 0 Q c N U mw m m C O cu N m C 0 0 a) U E O O a) A O O N C 0 E O A— Nt N C) N r 00 6 m Q) m U (D U m C 0) v O CO O d Q : — Q, a 4+ � _ m U V cm � N N c _L Q E (ni N O U E > C CL O _ Q. CL Q. E aa) _ w V V - aE) c N � Q) � c .0 m N E O = O 'Lo O > Q' N N +O+ 0 C v co O �j E LCD O U)) N t CD tN C Q P v0i Q a) L i x Iq KA L, O Q o Ln U LL a) C: Q UO a) Q tm Q ZU) 0 � LUO -0 m U Q O 2 U H H Q 0 a a a 0 U OD O ODOD W C (L O LL /A LL �Q 1.6. TO U Z 4 U. is O J �o Q C U 0- (1) E cn V � L c6 Q � W U7 U) U L U) L N E 0- 0 0 c6 U Q Q Q (a 0 L— CL CL U) a) -I.- U) a) cn C: O 0 N U Z O N Q c'7 N C'7 LL o Z J Q � W Z W O � le - W 0MM \'J J J m W Y U Q W Fr- Q l.J M U n' O LLI Y 0 QCO � C I- o •L UO U a) m CU a) a) a) a) C 0 a O U U Q) c O M 0 �I ■ LL aa)) aa)) J c a) 69. E a) c� LL O O —ca O U 0 U U � � � C L -• N O a) d a) ^� LL (DCO N a) O W N U C O -. O) O L O ❑ O (B t) CD C N _ a) U 9 u) H .Q ❑ O N C �_ O a) v O a) cn rn a- O U cp N _ a) ❑ ❑ a) O r a) v o U- > + M Q E] N ,Q N L d 0) c COVJ m m a) a) 0 v, Ocn a) L O U N A a C C -0 Elm CL ❑L- CL O C7 > > M N U O N ca O n a) O ❑■ El Nv_ *s `O ❑ ❑ .� W J � L E N a a) 0 ❑ -a Q a) ,.. U) U U) m —i N d >, W W ❑ WFL y a) ca Q LS n a)0 cn mu W U- U- H a c4) I_- 0 0 U LU a L nn W / W O H to Q Q Q > c� N M ui CD W m *1 LL aa)) aa)) J c a) 69. E a) c� LL O O —ca O U 0 U COSA Checklist Legal Description: LAKE RIDGE TERRACE BLK 11 LT 13 REM Parcel ID: 051-323-24 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 10/10/89 Total depth 345 ft Cased to 41 ft 9 Sanitary seal is functioning correctly Q Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 7/16/24 Well production at time of test `0.15 gpm Water storage tank volume 400+ gallons Well disinfected for coliform test? ❑ Yes 1101 No 9 Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic 6.11 ug/L ❑ Arsenic less than MRL (ND) Collected by Static water level at beginning of test 38 ft. Date 7/16/24 Comments ; WELL FLOW BUY SULLIVAN SEE LETTER, WELL CASING NOT COUNTED IN WATER STORAGE MNA B. TANK DATA Measured operating fluid level in septic tank 48 Date of pumping 7/16/24 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 7/13/82 Al ALL standpipes present per record drawing Total measured depth from grade 14.8 ft (max) Measured depth to pipe invert from grade 6.8 ft (min) ❑ N/A —pressurized field. ❑ Per record drawings, field is insulated. ❑ 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) If yes, enter date C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 7/16/24 Results 0 Pass Fluid depth prior to test 52 Water added 450+ gal New fluid depth 64 in Elapsed time 1440 min Final fluid depth 52 in Absorption rate 450+ gpd in FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 96 in Effective depth used 52 in Effective depth remaining 44 in Comments/Deficiencies: MT HAS 12" OF SOLIDS IN THE TUBE. COSA Checklist—June 2022 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' Q Yes if No _ ft Neighboring Tank > 100' Q Yes if No _ ft Absorption Field on Lot > 100' [E Yes if No ft Community Sewer Manhole/Cleanout > 100' 0 Yes if No _ ft Private Sewer/Septic Line > 25' Q Yes if No _ ft Holding Tank > 100'❑ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' g Yes if No _ ft Fi Yes if No _ ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑N Yes if No _ ft [i Yes if No _ ft ❑ N/A— Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑o Yes if No _ ft Surface Water > 100' R Yes if No _ ft Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' Water Service Line > 10' F. ENGINEER'S COMMENTS MOA WAIVER Fi Yes if No _ ft QYes if No 7" ft E Yes if No _ ft 2 Yes if No _ ft Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' 111 Yes if No _ ft Q Yes if No _ ft If tank or field is under driveway comment below 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 Finn Ml h t f4 /4't � Tv`'tr''t Phone 727-8864 Engineer's Printed Name S *w Cr Date V// r f h ••..• .. ... 0� MICHAEL N. ANDERSCN •�'�'4 COSA Checklist June 2022 COSA Checklist June 2022 Date: 5/23/24 P.O. Box 670269 Chugiak, AK 99567 P: (907) 688-2759 F: (907) 688-2259 TO: Tori & Dane Kreischer 14632 Don Circle Eagle River, AK 99577 Flow Test Results: Pumped water to 245’ and monitored for 3 hours. Let well sit for 24 hours and re-checked static. Well Produces: .15 GPM or 9 GPH MUNICIPALITY OF ANCHORAGE 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. 051-323-24 1. GENERAL INFORMATION Expiration Date: 12' 7-3 _ ZO Complete legal description Lot 13, Block 11 , Lake Ridge Terrace Location (site address) 14632 Don Circle, Eagle River, Alaska 99577 Current property owners) Cary Van Dyke Day phone Mailing address 14632 Don Circle, Eagle River, Alaska 99577 Real estate agent Dan Potts/Realty Simple Dayphone(907) 322-3267 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Private Well Water Storage Community Well Public Water System Waiver request for. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ Received by: Date: COSA to be released to the engineer, unless oBiervwse requested by the ergirreer. COSA Fee((Z.$0 Date of Payment _ $1 j S1aOati Receipt Number * o(Jrcj J5;J. COSA# 05C 96183& Waiver Fee $ Date of Payment Receipt Number Waiver# Distance: 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicabie Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that Onsite staff may visit the site to verify the information submitted. Name of Firm Pinard Engineering Phone (907) 232-1347 Address PO Box 871347, Wasilla, Alaska 996_87 Engineer's Printed Name Paul E. Pinard Date 8/13/20 .idflc OF,ge A+� 6. DSD SIGNATURE `..... System #1 Approved for 3 bedrooms i-:. Paull UPlnard System #2 Approved for _ bedrooms 1 l .� CE -4793 Disapproved Nei **ON. '�aa�;i1l41 Conditional approval for bedrooms, with the following stipulattoti!r "' g9 t t-• Original Certificate Date:2-2 3 - 2 CMZ 0 The Municipality of Anchorage Development Services Division (DSD) issues Certificates a On -Site Systems Approval (COSA) based only upon the representsdons given in paragraph 5 by an 'stdependent profeulonal thug engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for ernes or omissions in the professional engineefs work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory _X� Septic System Advisory Arsenic Advisory Well Flow Advisory Other coraG Mw ewe weer COSA Checklist Legal Description: Lot 13, Block 11 , Lake Ridge Terrace Parcel ID; 051-323-24 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _ A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 10/10/89 Total depth 345 ft Cased to 41 ft © Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 2/30 & 31/20 Static water level at beginning of test —35 —.@L Comments Well production at time of test 0.34gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes] No T Conform bacteria is Negative Nitrate12.8 mglL ❑ Nitrate less than MRL (ND) Arsenic ug/L M Arsenic less than MRL (ND) Collected by Pinard Engineering Date of Sample 7/30/20 8/3/20 for Bacteria s•t- w�Ea..1...d rr+e,w.o •� '9,1�t�f� re.`t�. Mea*ured depth to pipe invert from grade 6 .7 ft (nin) - - qZo LZI 1 B. TANK DATA Age 9 t2t 715 C. LIFT STATION NA t of tank(s) �Ia'— years ❑Required maintenance completed Tank typelmaterial S1eiffV FI&5+1c Age of lift station _ years Meafured operating fluid level in septic tank ec '" Lift station material _ © Standpipesfioundation cleanout per record drawing Comments: Date of pumping . tAtu Absorption rate 450+gpd ANS{y[Ieel �t(ri(1a Any rejuvenation treatment (past 12 months) None K D. ABSORPTION FIELD DATA — Whidh system tested (date installed) 7/13 /82 Adequacy test date 7/30 & 31/20 ® At.L standpipes present per record drawing Results ®Pass For 3 bedroorr,s Total measured depth from grade 14.7ft (max) Fluid depth prior to test 63_ in Mea*ured depth to pipe invert from grade 6 .7 ft (nin) Water added 450 gal ❑ N/A- pressurized field New depth 77 in ® Monitor tubes go to bottom of effective. If not, state Elapsed time 1 305 min depth into effective — ® Code -required soil cover over field Final fluid depth 63 In ❑ System presoaked Absorption rate 450+gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) None K date of test) WKnown Gallons introduced -t •59- gallons — CominerrtslDeficiencies: COSAt 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' ® Yes if No _ ft Community Sewer Manhole/Cleanout > 100' ft Yes ffNo_ft if No _7 ft ®Yes ifNo_ It Neighboring Tank > 100' X3 Yes if No_ ft Private SewerlSeptic Line > 25'M Yes if No_ ft Absorption Field on Lot> ioo' $$ Yes if No _ ft Holding Tank > 100' ®Yes if No _ ft Neighboring Absorption Fields > 100' Animal Containment? 50' ® Yes if No—ft fl Yes ifNo__ft Community Sewer Main > 75' Yes if No ft Manure/Animal Excreta Storage> 100' _ ® Yes it No_ ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No _ft Surface Water> 100' Property Line > 5' ® Yes if No_ ft Wells on Adjacent Lots: Absgrption Field > 5' ® Yes if No — ft Private Wells > 100' Water Main > 10' Water Service Line > 10' ® Yes if No ft ® Yes if No ft Community Wells > 200' ® Yes if No_ ft ® Yes if No _ ft ®Yes if No _ ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less tnan required) Building Foundation > 10' ® Yes if No _ ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No _7 ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No _ ft Private Wells > 100' UYes if No _ It Water Service Line > 10' ® Yes if No _ ft Community Wells > 200' Yes if No _ ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS ,*Waiver previously granted by MOA for 7' separation from Absorption Field to the property Line. TL01C 4, be le."" � W he..o Le#" to -tor+, 'R . —4[ zt 12D G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review Of Municipal records that tha above systems are in conformance with MOR COSA guidelines in effect on this date. COSA Checklist yellow sheet �JP�E OF q, !t�hh& �49- c : Paul E. Pinard .,SCE • 4793 �:�RoptSStONA j VI // a ° MEMO from Anchorage Well & Pump Service, Inc s Date: 9/15/20 Via: email daniel@realtysimple.com To: Whom it May Concern From: Jana Littlewood, Anchorage Well & Pump Service Re: 14632 Don Circle, Eagle River Upon extensive review of the COSA records and MOA Nitrate Maps for the property at 14632 Don Circle, we have concluded that the first and best recommendation for mitigation to reduce nitrate levels at this property is to have the 38 year old septic tank replaced. We have consulted with an Engineer with extensive experience with septic systems and he concurred. Please note that it may take some time for this to make an measurable difference in the well Nitrate levels. Anchorage Well & Pump Service, Inc. Anchorage Phone- 243-0740 Fax.- 243-0742 Valley Phone: 745-0740 Fax: 745-0724 E-mail. awps@mtaonline.net MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT a' On -Site Water and Wastewater Section \ j www.muni.org/onsite Well Water Advisory Certificate of On -Site Systems Approval # OSC201436 Subdivision: Lake Ridge Terrace, Block: 11, Lot: 13 907-343-7904 Fax: 343-7997 This well's productivity was determined to be.34 gallons per minute. Theminimum 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. MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section l r www.muni.org/onsite --� Nitrate Advisory Certificate of On -Site Systems Approval # OSC201436 Subdivision: Lake Ridge Terrace, Block: 11 , Lot: 13 A water sample revealed a nitrate concentration of 12.8 907-343-7904 Fax: 343-7997 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. / R= 36.53' L= 45.37' �Py u Bitty Paley 6 Vett WC -11y. / N Guy w / Virro ro / _ P C (T t hO Imo' �N Grovel w Ilrive UI Enve 31 I m C Env, Overhead •�,/ Utility / i t Be Lines/#' Xt / Deck1 _ 6•X7' w. ) Frame dye c House N<l stairs 33' B to J�4 r,%, ►� 4, I, j 1 i f / ` F�S9_ / / p ® rseptk / `CN VP4tt \ e/ / R= 113.63' See 2007-064498-0 /� L= 94.23' LEIT 13 ARD. BLOCK 11 / �gC NOTE: / Qocr New lot dimensions detailing a Right of Way take by Alaska / /arc GtiQ nepartment of Trampnrtatinn are from •/ �, i Plat 2013-106, Anchorage Recording District(A.R.D.). rS PF / 5� PqE OF AL,gsi+e, / 5 I hereby certify that I have surveyed the following described *' 9TH property: Lot 13, Block 11, Lake Ridge Terrace. Plat No. P-549% & Plat 2013-106, Anchorage Recording District, and that no ; .. .. . • r An on encroachments exist except as indicated hereon. This .As -built � � �, y P. 8oneta will only show the easements that appear on the recorded circumstances LS -10393 S —sJL s10393/ subdivision s'rAnchorage eDtrieundeno should this data rn be used . for the construction or establishing of boundary or fence lines. 't 1P 3 Lake Ridge Terrace ASBUILT SURVEY APB Land Surveying anxrr w n2r Lot 13 Block t t 1 • = 30• As Depleted on: 2013-106 REM 12204 East Prince W Peace DAve Anchorage Recording District Eagle River, Alaska 99577 Sumeyed: SepL 23, 2020 GRID: NW0553 a w aaaan (907) 227-1361 '•QxL';r7 Y ':aTiff" h - it-c tage t: "S":, .:9 .0 .-. - '.t:'i t 3 it,14`tit Y3jFin'f • • L 80 Municipality of Anchorage On-Site Water and Wastewater Program rs:11'4 _. (907) 343-7904 s A CTY CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-323-24 Expiration Date: 1. GENERAL INFORMATION Complete legal description LAKE RIDGE TERRACE BLOCK 11, LOT 13 REM Location (site address) 14632 DON CIRCLE, EAGLE RIVER,AK 99577 Current Property owner(s) TRISTAN C. RABER Day phone Mailing address 14632 DON CIRCLE, EAGLE RIVER, AK 99577 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 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ® Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class Well ❑ Public Sewer ❑ Public Water System ❑ WaiverNariance request for: Distance: Received by: Date: /0 -3 -/`) COSA to be released to th®-e r, unless otherwise requested by the engineer. COSAFee $ 54 Waiver Fee $ Date of Payment � �' - Date of Payment Receipt Number Qat 6D Receipt Number COSA# Q5C/7 /451 Waiver# d� ,•ir ia; ;?t'1 ii ,i,.1 '.i• 'i ...�_ nt`aL•1�3+"'-itEt1"", .. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. 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 8/8/2017 THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen em`►\ encroachments,deficiencies or discrepancies exist. ....--C. of AL's 1 49 1 . Tr-i -\ , * T 6. DSD IGNATURE I VIIP r� System #1 Approved for '3 bedrooms. KENNETH 7�! System #2 Approved for bedrooms. + S> ? iG ,�.w\/ Disapproved. • 1 \�' 4,• ,• ;10��""�� \'_-46f Conditional approval for bedrooms, with the following stipulations: _ gb ��F.tfcfrrrfr T--n—i -s t c 1� 33 � s �r'`f • Alr�V �'.P i xt, .CD 1PAA4. ., `_ ...g. � ��-SITE ,, /��•iTY , z WATER AND o WASTEWATER o rROGRAM ' F!�T S+ER`1 — By �`�t'% Original Certificate Date: t 0 - a t 7 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph S by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheer 10-10-12.doc ' ,'"_t#Wtlao 10,,,1010•!i►ii:.-40ty '. :,aa' `}P.Lt_,r.' }' ' • • • • 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 13 REM Parcel ID 051-323-24 A. WELL DATA Well type PRVT If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 1011011989 Sanitary seal (YIN)Y Wires properly protected (Y/N) Y Total depth 345 ft. Cased to 41 ft. (INTO BEDROCK) Casing height (above ground) 18 in. FROM WELL LOG AT INSPECTION Date of test 10110/1989 61712017 Static water level 40 ft. 44 ft. Well production 7 g.p.m. 2.81 g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate `� 22- mg/L N o3 — Agefv. Pump 916111 Arsenic. ND ug/L Date of sample: 7/19/2017 4 Collected by: ARCTERRA B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC I STEEL Date installed 7/13/1982 Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (YIN) N Date of pumping 6/2912017 Pumper SANITARY C. ABSORPTION FIELD DATA - `MT EXTENDS APPROX.79" BELOW INVERT Date installed 7/13/1982 Soil rating (g.p.d./ft2 or ft2/bdrm) 198 System type DEEP TRENCH Length 39 ft. Width 3 _ _ ft. Gravel below pipe 8 ft. Total depth *14.8 ft. (Measured 6/7/17) Eff. absorption area 624 ft2 Monitoring tube Y Depression over field N Date of adequacy test 6/7/2017 _ Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 46 in. Water added 450 gal. New depth 61 in. Elapsed Time: 1440 min. Final fluid depth 45 in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) _ N If yes, give date c,^ gkl7 ' .. 1,04 rz",t 1'#a3�" `.I •:4iA.>!":4,`.t' hrrr'" D. LIFT STATION Date installed Size in gallons Manhole/Access(Y/N) "Pump on" level at in. "Pump off" level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 1001+ Sewer/septic service line 25'+ Holding tank 100'+ Animal containment areas 50'+ Manure/animal excrete storage areas 1004 SEPTIC/HOLDING TANK ON LOT TO: 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 7'+1-(WAIVER) 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 I 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. OF t4' Engineer's Printed Name KENNETH M.DUFFUS Date 8181.20179 * �T 1\ COSA canary sheet_2-6-15.doc , r KENNET �fL: ' 1›. 7 2 MG.��/ Y SLI/ .. \rioEsSIOt.a. • • Municipality of Anchorage Ati ,, I Development Services Department r - 167 Building Safety Division s.� T On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On-Site Systems Approval # OSC 171458 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 11, Lot 13REM of Lake Ridge Terrage subdivision. This inspection revealed a nitrate concentration of 9.22 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On- S ite Systems Approval. AAROW PUMP & WEtl SERviu, LLC P.a- B0X 110496 Andiorage, AK 99511 Office: (907) 346-9355 - Fay (907) 3,33-8976 Eagle River. (907) 622-9335 P.1 &,,,ncsS 33$"-&�q6 Oaf WE J1 r{ 4-ll,:Z CUSTOMER I 5�4A��1 n���� P.1 &,,,ncsS 33$"-&�q6 Oaf WE J1 r{ 4-ll,:Z Thank You 1 • a .i. •J 4 i t' L. �i 1311 • �. � � � �r R� � sa 'L � 1 � 1 �. aI, i ,,tr � • _ Isar i I- I QUALITYMOM - Thank You 1 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel i.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) LOT I$; Block Ill Lakeridge Terrace (c) Location (address or directions) 14632 Don Circle, Eagle River, Alaska Richard '0~lke and Mailing Address 14~3¢ Lending InstitutiOn.: Mailing Address Telephone:(home) 696-3791 E~g2~ RJu~_~: AE. 99577 Telephone Business (d) (e) Real Estate Company and~,gent Tr~b w~¢¢ Pnmpany/ ~R~rba~?_ PrZ~_¢¢nde~ Address ~0928 Eagle River Road~ Eagle Riv~_r, Ak. 99577 Telephone 694-5500 Mail the HAA to the following address: (or check here ~,if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family [i~ Number of bedrooms 3 WATER SUPPLY Individual Well~ Community [] Public [] Note: If community wel! system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. SEWAGE DISPOSAL On-~ite [~X 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 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 flies and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGtNEEKmiG Add ress 17034 Ea9te RWe_r.L_o~.,P.,~oad No. 204 Eag|e RWer, Alas~-a ~w, · Date Telephone 6. DHHS APPROVAL /~,pk)rov~ed,, r for ~-J- bedrooms by Approved Disapproved Terms of Conditional Approval Note: Conditional The well for this property meets existing State and Municipal Codes. There are nitrates present, however, it is suggested that periodic testing be performed to insure the wells continued suitability. Nitrate concentration is 7.5 mg/1. EPA maximum concentration is 10.0 mg/1. 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. 72q325 (Rev. 7/88) Back Page 2 of 2 ~ MUNICIPALITY OF ANCHORAGE (MOA) ' (,*_,tTj~/"'~,l Health Au~h0.rity Approval (HAA) kkma~,~,/NicI?/''LIT/~-,~I~i~,FEBRUARY 1984 ~:ON q~NTAL S~LV[O:~ DD/~744 I~ ~q Legal Description: Well Classificatio, Well Log Present (Y/N) ~ Date completed /~-/~ -- ~ Total Depth~Cased to 5~ Depth of Grouting Static Water Level ./-/~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ,/DO To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line ~ '?'-~-'-'~ To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments I1 If A, B, C, D.E.C. Approved (Y/N) Yield 'qc~ Pump Set At U I.,~' Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Y 4- ; On Adjoining Lots / I Or2 ~' ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole B. SEPTIC/HOLDING TANK DATA Date Installed ~ -/'~-,'~. Size ~ No. of Compartments Standpipes (Y/N) [/ Air-tight CaPs (Y/N) ? Depression over Tank (Y/N) ~0 Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) /~d///'~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/Service Line Foundation Cleanout (Y/N) Date Last Pumped ~- ~/~ ; for -- -- Temporary Holding Tank Permit (Y/N) To Building Foundation '_/. (O To Disposal Field To Stream, Pond, Lake or Major Drainage Course Comments -~ ~"~ ~--,~ .5.5,~e o / - / 1,~/ 72-026 (Rev. 7/88) Fronl Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Width of Field Type of System Design Length of Field Depth of Field I Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ! O~ /-~ To Building Foundation Lot To Water Main/Service Line / To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line ! To Existing or Abandoned System on ; On Adjoining Lots To Cutback (if present) ~/~ ~O Comments LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. 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 inspection. Signed $ & S F_NGINEERING Company Date // ,/ -,, MOA NO. Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date z'7'/~ '~' ~' GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, to. wn~ship, range) Location {adt_dress or directions) C (b) Applicant Name %'C'~AA;'t""r~ ~¥-r~ Telephone:Home ./¢~.¢.--.~q~LJ Business Applicant Address ~ (..,. c~ -~'.'.)4.~r~-4 (4~¢_~ ~---~---¢~. {'~tk/¢-¢/-~ [ j~,r.._. ~!,q, ~ ~ ~'~ (c) Applicant is (check one): Lending Institution [-I'; Owner/builder~[~'; Buyer []; Other [] (explain); (d) Lending Institution ¢',,.~p~'T/.AL- [~,~ OP' ~C_ Telephone Address ~¢''1'~¢'¢' P¢'~ ¢'' ~ /~'t~-'~ (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: S & S ENGINEERING SRB 196X EAGLE RIVER~ AK 99577 TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms 3 Other WATER SUPPLY Wel~] Community [] Public [] Individual Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite"~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As cedifi, ed by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health · AuthorityApproval shows that the on-site water supply and/or wastewater disposal system is safe, functiona~ 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 ~f Firm S g', S ENGINEERING Telephone ~' ~"~'"~-----~ S~B 196X - ' Address EAGLE RIVER, AK 99577 Approved for-'"/'/g¢~.'~, bedrooms b Approved j% Disapproved Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates ha§ed solely upon the representations given in paragraph 5 above by an independent professional engineer registered Jn 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 befor~'a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional, engii~eer's work. Page 2 of 2 ~-~ MUNICIPALITY OF ANCHORAGE (MC,~) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 IViUNICIPALITY OF ANCHORAGe. DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MAY 0 2 lg8 LegalDescription: ill% RECEIVED WELL DATA Well Classification Well Log Present Total Depth Static Water Level Cased to Casing Height Above Ground Electrical Wiring in Conduit ~)-N') Separation Distances from Well: To Septic/Holding Tank on Lot If A, B, C, D.E.C. Approved (Y/N) Date Completed '-'~..io~ I°l~Z Yield Iq Depth of Grouting Pump Set At Sanitary Seal on Casing ~ Depression Around Wellhead To Nearest Edge of Absorption Field on Lot j ¢,.~ I ~- To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ~( S ~ P--r~ r/,.f'~'CZ~.//'V'G ; Date /-'/~ /~8 ~ Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~ ~' j-'2.~._ ~)'~ Size I ~ ¢~ No. of Compartments ~ Standpipes~C)',N~ Air-tight Caps~/,N~ Foundation Cleanout4~'Y~ Depression over Tank,¢~) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~ Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Mei,~Service Line Course Date Last Pumped 'for Temporary Holding Tank Permit (Y/N) ~ To Building Foundation To Disposal Field / "-/! To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date installed Width of Field Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To BtJilding Foundation Type of System Design Length of Field ;-%¢1 Depth of Field "~- /~' Gravel Bed Thickness ~ Standpipes Pr ese nt~CYJ'~) Date of Last Adequacy Test Lot To Water M"~'n/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area .. Comments To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~'~ To Cutbank i present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Dimensions ,~/~/Man hole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify t ~t~¥~(~:~:~, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed 5['~ G I~ Date Compan~E~. ~ ~t~'l=~ AE' qq~7~' MOA No. ReceiptNo. ~ ~ Z '3 ~* ~ Date of Payment ,~-- 2_ ~ ~ Amount: $ ~ ~ d~ O Page 2 of 2 72-026 (11/84) I',' DATE RECEIVED INSPECTION APPOINTMENTS DATE DATE DATE ~UNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~RONMENTAL 825 L Street - Anchorage, Alaska 99501 APR 0 1,981 ENVI RON~ENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed. Please allow ten (10) days for processing. 1, PROPERTY OWNER IPHONE PROPERTY RESIDENT Hf different from above~ PHQNE 2. BUYER PHONE MAIM~GAD~fiSS 3. LENDING INSTITUTION / PHONE 4. REALTO~/~{NT I PHONE. / / , BAILI~6 A~RESS / /' 5, LEGAL DESCRIPTION 6. TYPE OF RESIDENCE ~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four j~ Two [] Five [] Three [~] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY *ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM [~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, THIS SIDE FOR OFFICIAL USE ONLY '1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER ~]Septic Tank or []Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: I Absorption Area to nearest Lot Line 5, COMMENTS [] APPROVED FOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [~"~61SAPP R OV E D 826 "L" S'FF'~E ET /\NCHORAGF.:, ALASKA 99501 (907) 264-4111 GEORGE M, SULLIV,, MAYOF1 DEPAFF~7',4Et',IT OF HSALTH AND ENVIRONMENTAL PROTECTION May 19, 1981 Alaska USA Federal Credit Union % Fred Smith 2600 De Barr Road Anchorage, Alaska 99504 Subject: Lot 13 Block 11 Lake Ridge Terrace Subdivision Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: (1) The water analysis report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. (2) The standpipe to the septic tank needs to be raised above ground level. (3) The well that is approXimately thirty(30) feet from the standpipe of the seepage pit needs to be abandoned. (4) Locate all wells on neighboring propert]~es so that measurements can be made to determine proper distance between the sewer system and-the wells. (5) The adequacy test failed and an upgrade will be necessary. Prior to the upgrade, a soils test must be performed so that a permit may be issued by this department. A permit fee is requied of $20.00. If there are any further questions, please call this office a't 264-4720. Sincerely, F. obert C. Pratt~ R.S. As~oc].at Specialist RCP/ljw