HomeMy WebLinkAboutLAKE RIDGE TERRACE BLK 4A LT 6Onsite File
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e Municipality of Anchorage -�► ',`
Development Services Department
Building Safety Division s • • r
On -Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page of
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: C106 11)01 5 'a PID Number: a 5 '` - '— 06'
Name: P IG, Jia Y- Gap /� (�, t
G [�
Wastewater System: ❑ New Upgrade
Address: '
3
all?ABSORPTION FIELD
Phone: °�-1 LVA j %'� �•`, Number of Bedrooms:
�V_/l QVC
1%,Deep Trench [I Shallow Trench ❑Bed El Mound El Other:
LEGAL DESCRIPTION
Soil Rating: 4
). 6
Total Depth from original grade:
GPDrFI'
Ft.
Block:44, f !{ Lot: Subdivision: �. �,
CI�°�li LCt C G�l Ie1�1rG?%�
Depth to pipe bottom from original grade:
eft FL
Gravel depth beneath pipe: i �l
Il/// Fl.
Township: Range: Section:
Fill added above original grade:
C��
Gravel Length: [—
0
Ft.
Fl.
Well: El New New ❑ Upgrade
Gravel width:
Number of lines:
Distance between lines:
Ft.
Ft.
Classification (Private, A, B,j,)C):-�^
Total Depth:
Cased to: ,-
/
Total absorption area: Jj'��
I O
Pipe Material:
�J (�` �+-�
�y! D�031l ei}
X r s �' T -1 n f
tel•
Ft.
V Fly
T4s, W
Driller.
Date rilletl.
Static Water Level:
Inslalle,>; �JQ
Dale Installed:
vue&
V
Yield:
Pump Set at: j_Ca—s!Ffg-HeigbjAbov
Ground:
TANK
GPM
Fl.
` FL
SEPARATION DISTANCES
MSeptic ❑ Holding ❑ S.T.E.P. ❑ Other:
To
Septic
Absorption
Lift
Holding
PubliclPrivat
Manufacturer. ` ff
�! �lLL %
Capacity.
3�ii
From
Tank
Field
Station
Tank
Sewer Line
e1'n 1 e 5 IG 5
Gal.
Well
Cf'
i "1 `
5-31
I
Q5 1
Material: /n) �(/kyr—
H' B 4.
Nu b of Compartments:
Surface Water
)00`-f-
100A
LIFT STATION
Lot Line
a
`
IV
Size:
_____G.L
Manufacturer.
Foundation
If 6
575
'Pump on' level at:
"Pump off' lev
High water alarm at:
j
in.
_ in.
Curtain Drain
_
Pump Maka & del
Electrical Inspections performed by:
Remarks: �;, �� 1 S 1 (iJ i.• S i�CO ! t N h�
J
BENCH MARK
Location and Description:
/�
J7
Ajssumed Elevation:
(J () Fl.
`E r sFSfA,rk
q
............1''`'�S�.�yA
s -I :f cf '.
5 & S ENGINEERING
17034 Eagle {diver Loop Road, No. ates:
Inspections performed by:
E -angle. River, Alaska 99577
r _
nd
Development Services Department Approval
ROBERT C. COWAN
CE -8801
n �' ZuI�Z,
Reviewed bDate:
003
Qt�Fc:�''° ...:..,...• ''�t�a
and approved y:
(Rev. I2/00)
`J
PERMIT NO. SW0201 52 PAGE 2 OF 3
MunicipaUt of Anchora e
DEPARTMENT OF HEATH AND HUM'A'N SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 6, BLOCK 4A, LAKE RIDGE TERRACE P.I.D. NO. 051-321-06
I
I
I
I
I
I
I
I
I
100' WELL RADIUS
LOT 5
DIVERTER
VALVE (DV)
O B
TBM ST1
ST2 \
0 01 ��\O
W
w I
FCO MT1
NEW 1300 o\O
_
EXISTING
GALLON HDPE Z\�
SEPTIC TANK
4 BDRM
TH\�
I
o
HOUSE
DBL1 & DBL2
o
I
�I
A \Z
W
I
s \ N
I
MT2CO2
I
'" SCALE: 1 = 40 /
I
/
r i
LOT 7
I�.A•�
I• 1.0 NM./ •Op•M�•N••
0 ROBERT C. COWAN�Q
I
•.` r ='
CE-8801AV
����J
4
I
PERMIT NO. SW0201 52 PAGE 3 OF 3
MunicipaUt of Anchora e
DEPARTMENT OF HEATH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 i Telephone; 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 6, BLOCK 4A, LAKE RIDGE TERRACE
FINAL GRADE
FINAL GRA.
M
MT2=79.9'
Sn 1 sn2 ' 95.0'
NEW
90.6' 1300 GALLON
POLYETHYLENE
SEPTIC TANK
P.I.D. NO. 051-321-06
2" INSULATION
90.3'
C01=93.0'
=92.2'
?" INSULATION
;Ol =90.0'
;02=90.1'
NO WATER FOUND
73.9' B.O.H.
N. T. S.
A
B
FCO
35.0'
13.5'
ST 1
63.5'
53.5'
ST2
64.5'
56.5'
DBL1
66.0'
59.5'
DBL2
67.0'
60.5'
C01
75.0'
70.5'
MT1
73.0'
70.0'
CO2
57.0'
85.0'
MT2
56.5'
84.5'
DV
76.0'
70.0'
?" INSULATION
;Ol =90.0'
;02=90.1'
NO WATER FOUND
73.9' B.O.H.
N. T. S.
1. ;res/�
MUNICIPALITY OF ANCHORAGE
Development Services Department / V
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Jun 07, 2002
Expiration Date: Jun 07, 2003
Permit Number: SW020152 Parcel ID: 051-321-06
Legal Description: LAKE RIDGE TERRACE BLK 4A LT 6
Design Engineer: 0003 S & S Engineering Site Address: 014543 TERRACE LN
Owner Name: Richard Brown Lot Size: 32823 SQ. FT.
Owner Address: 14543 TERRACE LANE Total Bedrooms: 4 Permit Bedrooms: 4
EAGLE RIVER , AK 99577-9243
This permit is for the construction of:
0✓ Disposal Field ❑✓ Septic Tank Holding Tank ❑ Privy Private Well Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date:
Date: /710
2
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWERMELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. n SI--3c_� ( -1) b Permit Number SW020152
Property owner(s) R,�_ co a.r Day phone
Mailing address (1)
Mailing address (2Zip Code"�-
Legal description (Lot, Block & Sub'd.)
Legal description (Section, Township & Range)
Lot Size } Sq. Ft.
THIS APPLICATION IS FOR:
Number of Bedrooms
Sewer Only ® Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
I certify that the above info ation is correct. I further certify that this application is being made for a
Single Fa "y Dwelling d is in accordance with applicable Municipal Codes.
/ S & S ENGINEERING
17034 Eagle River Loop Road, No. 204
(Si natur o erty owner or authorized agent)
Eagle River, Alaska 99577
� j �
Permit Fees: ``--�� 60
Date of Payment: o S
Receipt Number: R -L-7 % 6 S�
(Rev. 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:
S&S
MG
May 29, 2002
ROBERT C. COWAN, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
AAPPROVALs"oRITv
MUNICIPALITY OF ANCHORAGE
Development Services Department
P.O. Box 196650
Anchorage, AK. 99519
SEWER &WATER
MAIN EXTENSIONS
REFERENCE: Lot 6, Block 4A, Lakeridge Terrace S/D
SEWER & WATER
INSPECTION
It is requested that you issue a permit to upgrade a septic system to serve the existing
four bedroom dwelling on the referenced property.
ENGINEERING
A test hole was excavated and a percolation test was performed. The approximate location
STUDIES
AND REPORTS
of the test hole is located on the attached site plan. At the time of excavation on 5/20/02 no
water was found. After seven days of ground water monitoring the test hole was still found
to be dry.
WELL INSPECTION
& FLOW TEST
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
SITE PLANS
properties.
If you require additional information, please contact us.
ROAD DESIGN
Sincer ,
L
SOIL TEST
ei A. Shafer, P.E.
hm
PERCOLATION
TEST Enclosure
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE I
WASTEWATER
DISPOSALSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
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Municipality of Anchorage
Development Services Department
Building Safety Division
y� On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Soils jLpg - Percolation Test
Performed For: fC�%/� / S��! ��–� G'� Date
Legal Description:./—'J /_7 T / -11elcC12 - e �t c� Township, Range, SecAUl .
Depth
;Feet)
2-
3- <`0
4-
5-
6-
7-
8-
9-
10-
11-
12-
13-
15-
16-
17-
18 --
19-
20 -
COMMENTS 5 -6 -7 -8 -11-
12 -13-
15-
16-
17-
19-
20 -
COMMENTS
I
WAS GROUND WATER
ENCOUNTERED?
s
IF YES, AT WHAT DEPTH? 0
Depth to Water After P
Monitoring? E
Date:
r c
Site Plan
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
t
/w / h
Z
` Gr
e'
t Z 9
.Jo t1,11'u
i( e C
d 6 Z c(
7L 7—
No
MEMEMINE
�E■E■■■E■■,
■■.■■■■■■E
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
t
/w / h
Z
` Gr
e'
t Z 9
.Jo t1,11'u
i( e C
d 6 Z c(
7L 7—
PERCOLATION RATE U (minutesAnch) f EKG HULL UTAML I tK
TEST RUN BETWEENt- 4FT AND FT t
PERFORMED BY: I CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
-.IMA I ER ANCHORAGE AREA BORuJGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
✓rte Lc `2-40/ MAILING ADDRESS S ��71� PHONE t5
� �/;/J � , ,, , �yA�
LOCATION ��� LEGAL DESCRIPTION � ^ e,yr",�`z oc
SEPTIC TANK:
DISTANCE
FROM WELL MANUFACTURER—
INSIDE LENGTH INSIDE WIDTH
MATERIAL
NUMBER OF
7
COMPARTMENTS
LIQUID DEPTH LIQUID CAPACITY `fin GALLONS.
NUMBER OF-PtTS DIAMETER OR WIDTH LENGTH, DEPTH
LINING MATERIAL CRIB SIZE: DIAMETER -DEPTH DISTANCE FROM: WELL
_� (' TOTAL EFFECTIVE 6�>(
BUILDING FOUNDATION_, NEAREST LOT LINE( _. ABSORPTION AREA (WALL AREA) SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE 6 CONSTRUCTION
BUILDING NEAREST
FOUNDATION LOT LINE
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED
DISTANCES:
INSTALLED
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
NEAREST
SEWER LINE
REMARK
AA
DEPTH
SEPTIC �)
TANK
DIAGRAM OF SYSTEM
DISTANCE FROM:
SEEPAGE
SYSTEM
A aP%
���1 �������� �� ��4 ����������
^ DEPHRTMENT U|'`1EHLTH HND ENVlR8NMENTHL P'�TECTION
251HK. 99�J7
~ ^ 276�2221
�9"-. 0 L_ IF::���
HPPLlCHNT
LUCHTION HILLCREST C�RCLE
LEGAL L6 B4H LHKERI�GE SUBD
TYPE OF SOIL HBSQRBTIUN SYST�M IS
MHXIMUM
NUMBER OF BEDROOKS = 4
SR BOX 1175 CHUGIHK
�6
//],/'/""
688~�81I
LOT SIZE ]28 .... ] SQUH�E FEET
~��}6
��/��m,� �
SOIL RATING (SQ FT/BR)� 125
THE REQUIRED SIZE OF THE SOIL H8SORPTIO04 SYSTEM I5�
THE
THE
LENGTH
DEPTH
En. iF71 E� 0
Iv /
DIMENSION IS THE LENGT`� ' F EACH
OF H TRENCH OR PIT IS THE DISTANCE BETWEEN
SIDE FOR H SEEPHGE PlT
THE SURFHCE OF THE
GROUND
THE
AND
8RHVEL
THE B0TT0M OF THE EXCAVATION (IW FEET). �
DEPTH IS THE MINIMUM DEPTH 8F GRHVEL BETWEEN THE OUTFHLL PlPE
AND
lHE BOTTOM
OF, THE EXCAVATION (IN FEET).
MINIMUM DISTANCE BETWEEN 8 WELL AND ANY ON-SITE SEWAGE DlSP8SHL SYSTEM IS
100 FEET FOR H PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL
WELL LUGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ]0 DHYS
UF THE WELL COMPLETION.
SPECIFICHTIONS HND CONSTRUCTION DIAGRAM,. ARE AVAILABLE TO INSURE PROPER
INSTHLLHTION.
Y' V IF -a I--- 1 E�v P- 113 F? ��V-4 EE F1 �11-3 11
I CERTIFY THAT
1: I HN FAMILIAR WITH THE REQUIREMENTS FQR ON-SITE SEWERS HND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2 l WILL INSTHLL THE SYSTEM IN ACCORDANCE WITH THE CODES.
]' I UND R H THHT THE ON~SITE SEWER SYSTEM MAY REQUIRE ENL�lRGEMENT IF THE
RESIDENC THAN 4 BEDROOMS
MHCKEY
ISSUED B DHTE-_�������L��/
(`'^//'
�~
/ /\|
8HCKFILLING OF ANY
SYSTEM
WITHOUT FINAL INSPECTION HND
APPROVAL
BY THIS
MINIMUM DISTANCE BETWEEN 8 WELL AND ANY ON-SITE SEWAGE DlSP8SHL SYSTEM IS
100 FEET FOR H PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL
WELL LUGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ]0 DHYS
UF THE WELL COMPLETION.
SPECIFICHTIONS HND CONSTRUCTION DIAGRAM,. ARE AVAILABLE TO INSURE PROPER
INSTHLLHTION.
Y' V IF -a I--- 1 E�v P- 113 F? ��V-4 EE F1 �11-3 11
I CERTIFY THAT
1: I HN FAMILIAR WITH THE REQUIREMENTS FQR ON-SITE SEWERS HND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2 l WILL INSTHLL THE SYSTEM IN ACCORDANCE WITH THE CODES.
]' I UND R H THHT THE ON~SITE SEWER SYSTEM MAY REQUIRE ENL�lRGEMENT IF THE
RESIDENC THAN 4 BEDROOMS
MHCKEY
ISSUED B DHTE-_�������L��/
(`'^//'
�~
/ /\|
Lonstzueilon Srest 1'caL7
"Ons test is worth a thousand npinions"
2204 Cleveland Anchorage, Alaska 99503
Performed For Harry Mackey. Date Performed 6/25/76
Lenal nescrintion: Lot 6 Bloc4: 4A Subdivision Lake Ridge
This Form Renorts Soils Lon yes Percolation Test_
Eagle River
Det) th
Feet Soil Characteristics
Topsoil _
2 =
4Silty Gravelly Sands (SP - SM)
—
6 —
Coarse Gravel (GP)
8 -
Sands (SP - SM)
10
Gravel (GP)
12
Silty Sand (SM)
14-
16-
18-
20—
Was Ground Water Encountered? No
If Yes, At what Denth?
Readinq Date Gross Time Net Time Depth to H2O Net Dron'
i—
r--
Percolation Rate Minute
Prnrosed Installation: Seenaae Pit Drain Field _
Depth of Inlet Depth To Bottom Of Pit Or Trench
ComMENTS: 125 Square Feet drainage area required per bedroom.
ncount
No ground water or bedrock eered.
Test Performed By
I
Data Certified By: CONSTRUCTION TEST
naro• 6/28/76 LAB
GREATER ANCHORAGE AREA BOROUGH
_,Dep m�o�EtNyronmental Quality
Street, Anchorage, Ai-a�ska 99503 274-4561
Mailing Address:
Eagle River
Date Received November 30, 1976
Time of Inspection 9:30 a.m.
Date of Inspection 12-1-76 Wednesday
Pratt
QU APPROVAL OF
I I WER & WATER FACILITIES
FOR
Conv.
)y: Alaska Bank of the North
Phone:
2. Property Owner: Harry A. Mackey Phone: 688-2813
Mailing Address: Star Route Box 1175
3. Legal Description: Lot 6 Block 4A Lake Ridge Terrace
4. Location:
5. Type of facility to be inspected Single Family No. of bedrooms 3
6. Well Data:
A. Type Individual B. Depth 297'
C. Construction D. Bacterial Analysis
7. Sewage Disposal System: On-site system, Permit #76445
A. Installed 1976 B. Installer
C. Septic Tank: 1. Size 2. Manufacturer
D. Seepage Pit: 1. Absorption Area 2. Material
E. Disposal Field: Total length of lines
8. Distances:
hf
A. Well to: Septic tank , Absorption area Sewer Lines ,
Nearest lot line Other contamination
B. Foundation to septic tank , Absorption area
C. Absorption area to nearest lot line
Fo-n2a 11/7x\ Dnnn 1 nF Fran nnnnc
`n
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1.
Type of Inspection: CMRO
VA
FNA CONV �
2.
LL/fit
11/
Property Owner: �r y �
yy�
MAC, �1E-1
Mailing Address: 7�"� �Ou� , UC4 1 I % S
Day Phone: (0 S g a YJ
3.
Name of Buyer: v I LA4- a
ioo �1 �
Mailing Address:
Day Phone:
4.
�/
Name of Lending Institution: Ac
f ,', le 47-14
Mailing Address:
Phone:
5.
Name of Realtor or Agent:
Mailing Address:
Phone:
1
/-b �i
/
� �G�
ZA1r,5Irl d c—t 722/c*ce
6.
Legal Description: 7
Location:
7. Type of Facility to be Inspected: Si`� No. Bdrms.
8. Water Supply
Type of Supply: Public Utility Individual
If Individual, number of dwellings presently served IW07c_�
If Individual, depth of well 12�q q
9. Sewage Disposal System
72-003(3/76)
Type of System: Public Utility
Individual (on-site)X—
If Individual, date of installation /��5®
Page 2 of two pages - Req ,t for Approval of Individual S 'r & Water Facilities
Legal Description Lot 6 Block 4A Lake Ridge Terrace
Comments
Approved SSG �"
Disapproved
DateL 6
Approval,Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
EQ -034 (1/74)
Date
F_'�) L.LQ l C RFs C_� to.c— -
GREATER ANCHORAGE AREA BOROUGH
wmoO'
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
�+ Date Received October 15, 1976
� Time of Inspection
Date of Inspectionrp
- -
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Conv.
1. Approval requested by: Alaska Mutual Savings Bank % Chris
Mailing Address: Post Office Box 1120 Phone: 274-3561 x 235
2. Property Owner: Harry and Madeliene Mackey Phone: 688-2813
Mailing Address:
3. Legal Description: Lot 6 Block 4A Lakeridge Terrace
4. Location: See directions on back
5. Type of facility to be inspected Single Family No. of bedrooms 4
6. Well Data: Individual
A. Type B. Depth
C. Construction D. Bacterial Analysis
7. Sewage Disposal System: On-site system (permit #76445)
A. Installed 1976 B. Installer
C. Septic Tank: 1. Size 2. Manufacturer
D. Seepage Pit: 1. Absorption Area 2. Material
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank , Absorption area Sewer Lines ,
Nearest lot line Other contamination
B. Foundation to septic tank , Absorption area
C. Absorption area to nearest lot line
Po_nza L1/7al PAnn 1 of +wn nanoc
El
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
9`--1.0--76
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO VA FHA CONV : a
2. Property Owner: Marry mid "ladeleine, :1ac.1,ey
Mailing Address: Day Phone:---
3.
hone:
3. Name of Buyer: Pichard :en(' Tot -i ')roe.,n
Mailing Address: 2.31.0 Success Drive Day Phone: 279--409l
4. Name of Lending Institution: Alaska `tutual Savin s 'lank. --Chris
Mailing Address: P.O. 'lox 11.20 Anchora a Phone: 274-3561 R 235
5. Name of Realtor or Agent: 'Vile
Mailing Address: Phone:
6. Legal Description: 1 r / n LqI.Lg
U
Location: Turn left off NcT i Glenn Jli�rh- ny onto front• fge Id onposite
Fire Like. Turn left ou Blue Spruce Lane. Take first left,
o past ilillerest Dr., on left limed side.
7. Type of Facility to be Inspected: ST' No. Bdrms. /
8. Water Supply
Type of Supply: Public Utility Individual V Y
If Individual, number of dwellings presently served One
If Individual, depth of well
9. Sewage Disposal System
Type of System: Public Utility Individual (on-site) v :•
If Individual, date of installation
72-003(3/76)
Page 2 of two pages - Re st for Approval of Individual er & Water Facilities
l.egal'"Description Lot 6 Block 4A Lakeridge Terrace
Approved Disapproved Date
Approval., Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true ana
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
EQ -034 (1/74)
Date
LOT 5
LOT 7
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Lot 6, Block 4A
Lake Ridge Terrace Subdivision
32,823 Sq. Ft. +/-
14543 Terrace Lane
2 Story Wood Frame House w/Daylight Basement
and Attached 2 Car Garage
SHED
ED
G
E
P
A
V
E
M
E
N
T
PROFESSIONAL SEAL
Date:Frontier Surveys, LLC Project No:
650 W. 58th Ave. Suite E Anchorage, Alaska 99518
As-Built Survey of:
www.frontiersurveys.com
Frontier Surveys, LLC
I, Pierre Stragier, hereby certify that this Mortgage Inspection Survey was performed by me, or
under my direct supervision on
Plat:Grid:Ordered By:
907.460.1686 - info@frontiersurveys.com
This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and
conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any
inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the
existence of any easements, covenants, or restriction which do no appear on the record plat. Under no circumstances
should this document be used for construction or for establishing a boundary or fence line.
January 3rd, 2024.
Legend:
Scale 1" = 50'
Gas Meter
Electric Meter/Outside Power
Septic
Fence
Overhead Utility
Lot 6, Block 4A Lake Ridge Terrace Subdivision
General Notes:
1. This document is created for the purpose of a single property transaction and is subject to Federal Copyright Laws.
2. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey.
3. All measurements/setbacks are to the visual/apparent building footprint.
4. All dimensions to property lines are plus/minus 0.1ft.
Jennifer Bohannon
23-510 1/5/2024
71-293 NW553
E Elec. Pedestal
Water Well Tel. Pedestal
ConcreteG
E
S
[
TW
Jan 12, 2024
R
E
GISTEREDPROFESSIO N A L L A N D S URVEYORPierre M. Stragier
No. L.S. - 9812
NOTE: SOME FEATURES OF THIS
SURVEY MAY NOT BE SHOWN
DUE TO ICE/SNOW CONDITIONS.
NO EVIDENCE
OF OLD
CLEANOUT OR
TANK 6" SUMP w/ CO
POINTING TO
THE NW
APPROX
TRENCH
DIRECTION
www.sullivanwaterwells.com
Pump Installation Log
Well Drilling Permit Number: SW Date of Issue
Parcel Identification Number:
Legal Description Property Owner Name & Address
LAKE RIDGE TERRACE BLK 4A LT6 Steve Bohannon
14543 Terrace Lane Eagle River, AK 99577
Pump Installation Date:
1-25-24
Pump Intake Depth Below Top of Well Casing:
280 feet
Pump manufacturer’s Name:
Franklin
Pump Model:
10FRD1P4-3W230
Pump Size:
1 hp
Pitless Adapter Burial Depth:
10 feet
Pitless Adapter Installer:
Unknown
Disinfected Upon Completion?
yes no
Method of Disinfection:
Chlorine 50 PPM
Comments:
Pitless Manufacturer: Unknown
Pump Installers Name:
Sullivan Water Wells
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Parcel I.D. 051-321-06
Certificate of On -Site Systems Approval
Expiration Date: 11 /6/2024
Legal description LAKE RIDGE TERRACE BLK 4A LT6
Site address 14543 TERRACE LN Eagle River AK 99577
Current property owner(s) Fenoseff
X The On -site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
Original Certificate Date: 2/1 /2024
This Certificate 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
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA Approval June 2022
MUNICIPALITY OF ANCHORAGE
Development Services Department P p 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. 051-321-06
Complete legal description Lake Ridge Terrace Block 4A Lot 6
Location (Site address) 14543 Terrace Lane, Eagle River, AK 99577
Current property owner(s) Thomas & Laura FenOSeff Day phone
2. ON -SITE SYSTEMS SIZED FOR 4 BEDROOMS
3. TYPE OF WATER SUPPLY: X 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: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel X Plastic ❑ Concrete ❑ Fiberglass
Age 21 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed N Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
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 $ 55'(� Waiver Fee $
Date of Payment I210-15Y1z3 Date of Payment
COSA # 05C Z:�2 l 473 Waiver #
COSA Application —June 2022
Lake Ridge Terrace Block 4A Lot 6 051-321-06
0
140 12/6/23
48"
6/18/2002
*12.8
*2.9
1/11/24
N/A
1/12/24
43
600
59
42
120
42
78
* Slight grade difference between trench pipes. Full effective depth justified.
(907) 522-7773
Benjamin Schiller, P.E.1/15/2024
• g'1 8 •E ti.
Municipality of Anchorage ti ; /y4,— J�,A�
On-Site Water and Wastewater Program <
(907) 343-7904
Certificate of On-Site Systems Approval c>
CJ
cu
Parcel I.D.
051-321-06 a 6 8; 9��
Expiration Date: � 2--
1. GENERAL INFORMATION
Complete legal description Lake Ridge Terrace Block 4A Lot 6
Location (site address) 14543 Terrace Lane
Current Property owner(s) Berry Vaughan & Heather Lee Day phone
Mailing address 14543 Terrace Lane 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: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well El Individual 0
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by. a t 1`♦ Date: 311
3
COSA to be released to the engineer,unless otherwise requesilty the engineer.
1
COSA Fee $ NO Waiver Fee $
Date of Payment 3l Q 112 Date of Payment
Receipt Number 00q36 Receipt Number
COSA# 06(.17/0-7-9" Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined
in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater
disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply
and/or wastewater disposal system is(are)in compliance with all applicable Municipal and State codes, ordinances,and regulations in effect at
the time of installation. •
In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA 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.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 3/8/2018
•Xxv
OF Akgskl
14
6. DSD SIGNATURE /
System#1 Approved for L bedrooms • Steven�2.� Oannane
r -Os% CE-8149 //
System#2 Approved for bedrooms �� gs'
Disapproved 'k 1.�OFESSION +
Conditional approval for bedrooms, with the following stipulations:
ON-SITE 9-
WATER AND tT
r3 W •
6ASTEWATER
o PROGRAM
y'
Original Certificate Date: 2 - t
The Municipality of Anchorage Development Services Division (GSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet .' c
If more than 1 septic system is on the lot:
COSA Checklist# 2 of 2
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: Lake Ridge Terrace Block 4A Lot 6 Parcel ID: 051-321-06
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (Y/N) N
Date completed 1976 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 280+ft. Cased to 40+ ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test UNK 11/2/2017
Static water level UNK ft155.6 ft.
Well production UNK gpm 3.5 g p m
WATER SAMPLE RESULTS:
Coliform NEC' colonies/100 mL Nitrate ND mg/L
Arsenic ND ug/L Date of sample: 3/2/2018 Collected by: PES
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/HDPE Date installed 6/18/2002
Tank size 1300 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N/A
Date of pumping 10/5/2017 Pumper JR's Pumping
C. ABSORPTION FIELD DATA •
Date installed 10/7/1976 Soil ratin i z 125 SF/BDRM Dee Trench
g (g.p.d./ft or ft /bdrm) System type p
Length 50 ft. Width 3 ft. Gravel below pipe 6 ft.
Total depth 10 ft. Eff. absorption area 600 ft2 Monitoring tube Y* Depression over field N
Date of adequacy test 2/8/2018 ResultsPASS
(Pass/Fail) 4
For bedrooms
Fluid depth in absorption field before test DRY in. Water added 600 gal. New depth DRY in.
Elapsed Time: 180 min. Final fluid depth DRY in. Absorption rate >= 600+ d.
9.P.
N
Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date
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:
100+ On adjacent lots 100+
Septic tank/lift station on lot
100+ On ad scent lots 100+
Absorption field on lot 1
75
Public sewer main
75+ Public sewer manhole/cleanout 100+
25+ Holdingtank 100+
Sewer/septic service line
Manure/animal excrete stora a areas 100+
Animal containment areas 50+ 9
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+ Absorption field
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+
10+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage
Curtain drain 50+ Wells on adjacent lots 10
0+
F. COMMENTS
Survey on file.
G. ENGINEER'S CERTIFICATION m'"'*OF A&q�ki
I certify that / have determined through field inspections and , ' S �)— .y
review of Municipal records that the above systems are in 0*: l` -.*ry
conformance with MOA COSA guidelines in effect on this date. `_�
Engineer's Printed Name Steven Pannone .:S�everi i..15orinorie:
3/8/2018 Iv ei;*.. CE-8149 1
Date gik%ROFESSI .,* ':
r
tl,A�
COSA canary sheet_2-6-15.doc
41-2 _A Municipality of Anchorage 4,----4.."709
On-Site Water and Wastewater Program E Nov f I i °1
(907) 343-7904 " �'!' `i Siad.r T, . j
Q. i V
Vall fl1
Certificate of On-Site Systems Approval `` �li 61' ssc �o c'n
Parcel I.D. 051-321-06 Expiration Date: 2 6
1. GENERAL INFORMATION
Complete legal description Lake Ridge Terrace Block 4A Lot 6
Location (site address) 14543 Terrace Lane
Current Property owner(s) Berry Vaughan & Heather Lee Day phone
Mailing address 14543 Terrace Lane Eagle River, AK 99577
Real Estate Agent Day phone
2. TYPE OF DWELLING:
0 Single Family (wlwo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 74
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well 0 Individual 0.
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: !JLs Ci
Date: ///27/4 7
COSA to be released to the engineer,unless otherwise reques by the engineer.
4
COSA Fee $ 2-6::. — Waiver Fee $
Date of Payment 11-2-0 - 17 Date of Payment
Receipt Number 0a 'St i G Receipt Number
COSA# 05C-1-7 I S3 Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined
in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater
disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply
and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at
the time of installation.
In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA 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.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 11/20/2017
AL'Q., k
6. DSD SIGNATURE
System #1 Approved for q bedooms I •Steven R. Pannone:
Y pp
System #2 Approved for bedrooms �� qs, CE-8149 ��
..:.,
Disapproved ����DpROFES540NA
Conditional approval for bedrooms, with the following stipulations:
11\Ise +[ Aa( ,) t�►v✓y
( o��� P� =
dr, AV
,oN
co
.
, OPME �• .
By: ( �- Original Certificate Date: ) (–Z2-
Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS: • • •
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory . - • - •
Well Flow Advisory Other
COSA blue sheer r
If more than 1 septic system is on the lot:
COSA Checklist# 1 of '
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: Lake Ridge Terrace Block 4A Lot 6 Parcel ID 051-321-06
A. WELL DATA
Well type Private If A, B, or C provide PWSID # Well Log (YIN) N
Date completed 1976 Sanitary seal (Y/N) Y Wires properly protected (YIN) Y
Total depth 280+ft. Cased to 40+ ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test UNK 11/2/2017
Static water level UNK ft155.6 ft
Well production UNK g p m 3.5 gpm
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 0.206 mg/L
Arsenic ND ug/L Date of sample: 11/2/2017 Collected by. PES
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/HDPEDate installed 6/18/2002
Tank size 1 300 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N/A
Date of pumping 10/5/2017 Pumper JR's Pumping
C. ABSORPTION FIELD DATA
Date installed 6/18/2002 Soil rating (g.p.d./ft2 orft2/bdrm) 0.6 SF/BDRM System type TRENCH
Length 50 ft. Width 3 ft. Gravel below pipe 10 ft.
Total depth 12.75 ft Eff absorption area 1000 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 11/2/2017 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 1 10 in. Water added 600 gal. New depth 120 in.
Elapsed Time: 1440 min. Final fluid depth 110 in. Absorption rate >= 600+ g.p.d
N
Any rejuvenation treatment (past 12 mo ) (Y/N & type) If yes. give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN)
"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 100+
Sewer/septic service line 25+ Holding tank 100+
Animal containment areas 50+ Manure/animal excrete storage areas 100+
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 10+ Building foundation 10+ Water main 10+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
*Survey on file.
G. ENGINEER'S CERTIFICATION OFALAI Ik
I certify that I have determined through field inspections and ',,Nark.•• ��� �y���
review of Municipal records that the above systems are in *. 49 TH /\ •.* o
j
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Steven Pannone '•:'Sems k Pannone• -
11/20/2017 1j�+4•. CE—$149 r
Date %
�1JfES'S�,�+�
COSA canary sheet_2-6-15.doc
•
• Municipality of Anchorage .?„&,
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Development Services Department
Building Safety Division
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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
Septic System Advisory
Certificate of On-Site Systems Approval # OSC 171538
During a recent adequacy test on the septic system for Block 4A, Lot 6 of
Lake Ridge Terrace subdivision, 110 inches of standing water was observed
in the absorption field. This indicates that approximately 92% of the
absorption area is inundated. Although this system passed the adequacy test,
the remaining life expectancy may be limited.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval
Municipality of Anchorage ®°
On -Site Water & Wastewater Program
(907) 343-7904 s
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-321-06
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
Expiration Date: U I
14543 TERRACE LANE *EAGLE RIVER, AK 99577
RICHARD BROWN Day phone 244-4581
14543 TERRACE LANE *EAGLE RIVER, AK 99577
N Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual On-site
0
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
i
Received by: �ir Date: —4
f
COSA to be released to the engineer, unless otherwise requested by the engineer. -
COSA Fee $ - IC/1'y[
Waiver Fee $
(
Date of Payment ` 4
I 1 3 C&
Date of Payment
Receipt Number OCII,Ot](0 G
Receipt Number
COSA # () 1,;1000
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 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 GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
in conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described 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 soils condition, groundwater 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 the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
6. DSD SIGNATURE
(, System #1 Approved for bedrooms.
System #2 Approved for bedrooms.
Disapproved.
Phone 337-6179
Date 1 t r
Conditional approval for bedrooms, with the following stipulations:
ON-SITE
WATER AND
WASTEWATER
PROGRAM
The Municipality or Anchorage Develop,emt 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. ATTCHMENTS: L/
COSA Checklist
Septic System Advisory
Nitrate Advisory
Arsenic Advisory
Well Flow Advisory / Other
By:
l
(Rev. NNS)
Original Certificate Date: � —'
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: LAKERIDGE TERRACE; BLOCK 4A, LOT 6 Parcel ID: 051-321-06
A. WELL DATA
Well type PRIVATE
*PER GEG INSPECTION
**BASED UPON SURROUNDING WELL INFORMATION (SEE ATTACHED)
If A, B, or provide PWSID# N/A Well Log (Y/N)—
NO
Date completed
1976
Sanitary seal (Y/N) +
Wires properly protected (Y/N)
YES
Total depth *280+
ft.
Cased to **40+ ft.
Casing height (above ground)
12+ in.
FROM WELL LOG
Date of test NO WELL LOG
Static water level ft.
Well production g.p.m.
WATER SAMPLE RESULTS:
Coliform U colonies/100 ml.
Arsenic: ti—o—ug./L.
B. SEPTIC/HOLDING TANK DATA
Nitrate• 'f3�mg./L.
AT INSPECTION
10/11/12
196
1.75
Date of sample: 10/11 /12
Tank Type/Material SEPTIC/HDPE
Tank size 1300 gal. Number of Compartments E
Collected by: GEG. Ltd
Date installed 6/18/02
Cleanouts (Y/N)
YES
Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A
Date of pumping 1 ( 11 , 1 `" Pumper a k( 5
C. ABSORPTION FIELD DATA
Date installed 6/18/02 Soil rating (g.p.d./ft2or � 0.6 System type TRENCH
Length 50 ft. Width
3
ft. Gravel below pipe 10 ft.
Total depth *12.75 ft. Eff. absorption area 1000 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 10/16/12 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 18 in. Water added ** 1500 gal. New depth 97.5 in.
Elapsed Time:***150 min. Final fluid depth90_75in. Absorption rate >= 600+ g,p,d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
NONE
If yes, give date
635 GALLONS OF WATER WAS INTRODUCED INTO THE DRAINFIELD ON 10/11/12, BUT ABSORPTION
WAS INADEQUATE.
**LAST 500 GALLONS INTRODUCED CASED A RISE OF 19 INCHES.
***RECOVERY LEVEL AFTER 910 MINUTES WAS 77.5 INCHES.
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YM
"Pump on" level at in. "Pump ofr level at . _. High water alarm level
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/ ift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main N/A
Sewer /septic service line 25'+
Public sewer manhole/cleanout N/A
Holding tank
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line *10' Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
*ACCORDING TO AS—BUILT SURVEY PREPARED BY ROBERT JOHNSON, THE TRENCH C/O IS
10' FROM THE SOUTH PROPERTY LINE.
G. ENGINEER'S CERTIFICATION
1 certify that l have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date 1114/13
(Rev. 11105)
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Robert C.9ci:rs:r=
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AS -BUILT
I hereby certify that I have surveyed the following
described oronerty_ Lai'" -/a R/p nk 41-- l
Anchorage Recording Precinct, Alaska, and that the
improvements situated thereon are within the property
lines and do not overlap or encroach on the property
lying adjacent thereto, that no improvements on prop-
erty lying adjacent thereto encroach on the premises in
question and that there are no roadways, transmission
lines or other visible easements on said property except
as indicated hereon.
Dated at Eagle River, Alaska
this .;' ,gay of A u:'
19_
ROBERT a. JOHNSON -
SCALE: Registered Land Surveyor No. 880 -LS
V — ; Box 456, Eagle River, Alaska
Phone 694-2543
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A5 -BUILT
T hereby certify that I have surveyed the following
described property:
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t.+d i:!, -.>EJ '7-1.5-A,;
Anchorage Recording Precinct, Alaska, and d that the
.rovements situated thereon are within the property
lines and do not overlap or encroach on the property
lying adjacent thereto, that no improvements on prop-
erty lying adjacent thereto encroach, on the premises in
question and that there are no roadways, trans -mission
lines or other visible easements on said property except
as indicated hereon.
Dated at E4gle River, Alaska
this E " day of e r.. _ 192E_
ROBERT 9. JOHNSON �
SCALE: Registered Land Surveyor No. 880 -LS
Box 456, Eagle River, Alaska
Phone 694-2543
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A5 -BUILT
T hereby certify that I have surveyed the following
described property:
yF.2j l: ;-•- I F1'i r t -' , •<r" moi.'= �:
t.+d i:!, -.>EJ '7-1.5-A,;
Anchorage Recording Precinct, Alaska, and d that the
.rovements situated thereon are within the property
lines and do not overlap or encroach on the property
lying adjacent thereto, that no improvements on prop-
erty lying adjacent thereto encroach, on the premises in
question and that there are no roadways, trans -mission
lines or other visible easements on said property except
as indicated hereon.
Dated at E4gle River, Alaska
this E " day of e r.. _ 192E_
ROBERT 9. JOHNSON �
SCALE: Registered Land Surveyor No. 880 -LS
Box 456, Eagle River, Alaska
Phone 694-2543