HomeMy WebLinkAboutLAKE RIDGE TERRACE BLK 1A LT 1ALake Ridge
Terrace
Block 1 A
Lot 1 A
#051-315-51
NAME
LOCATION
SEPTIC TANK:
,1 GREA I n ANCHORAGE AREA BORu utA
Department of Environmental Quality
1ILu 3330 C Street 3 I (f
Anchorage, Alaska 99503 �V
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING ADDRESS- 14FL0 S �� Adf H0NE
LEGALDESCRIPT10N6e /c '4 ^�'� r �'A��l' 40-
P_ dip e:-<�
DISTANCE /�, / NUMBER OF e
FROM WELL MANUFACTURER 5�- - MATERIAL COMPARTMENTS /
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY_?VQ-GALLONS.
SEEPAGE PIT:
NUMBER OF PITS DIAMETER OR WIDTH, LENGTHieu, DEPTH
LINING MATERIAL/ CRIB SIZE: DIAMETER __CDEPTH 19 DISTANCE FROM: WELL /00
( I TOTAL EFFECTIVE y
BUILDING FOUNDATIONf NEAREST LOT LINEAO �. ABSORPTION AREA (WALL AREA) .76, SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE CONSTRUCTION
BUILDING NEAREST
FOUNDATION LOT LINE
CESSPOOL OTHERSOURCES
NEAREST
SEWER LINE
APPROVED DISAPPROVED REMA
DISTANCES:
INSTALLED BY:
PIPE MATERIAL: r r
LOT SLOPE: 4.�:/� •:� M
REMARKS:
jo
--
�hk� DATE
DEPTH
SEPTIC
TANK_
DIAGRAM OF SYSTEM
N1
DISTANCE FROM:
SEEPAGE
SYSTEM _
?it 1 3 Spgol
,c p,
15
- APPROVED
CU
NAME OF APPLICANT
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO.
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT
INSTALLATION LOCATION
LEGAL DESCRIPTION A o 7
MAILING ADDRESS 7ffS RL'<II'�i/5 'l �l�f Pe0NE
7�
INSTALLATION OF: SEPTIC TANK �� SEEPAGE PIT �'` DRAIN FIELD , OTHER
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH TO BE INSTALLED BY
SOIL TEST RESULTS DSS - NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE TYPE ��f,U ���f%�"�' SEEPAGE AREA SIZE /a1 //,2 G�/I TYPE !�, �ll'
MINIMUM DISTANCES, REQUIREMENTS / DIAL M O S STEM
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL ks
SEPTIC TANK 5 . SEEPAGE PIT AD , DRAIN FIELD
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK w� / SEEPAGE PIT /04)
DRAIN FIELD 42 ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK 49 r SEEPAGE PIT /G ,
DRAIN FIELD /01
SEPTIC TANK, 14)01
SEEPAGE PIT DRAIN FIELD
D
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
G.A.A.B.
OR
LICENSED DESIGN
-
-�-�--
10-
-
-
---
IL
-
I
Fj
Fut
�vfe
S-
IF
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER CHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
-.__ 7-2 3- 17S' _
(Pol, v
Coniftuation gait Za.b
"One test is worth a thousand opinions"
6828 TUDOR ROAD. ANCHORAGE, ALASKA 88607 S T[L[►NON[ 333.8472
Performed For lArr !f V /R,y DatePerformed 7 %
Legal Description: L t Block/,4 Subdivision
This Form Renorts Soils Loq Percolation Test_
Denth
Feet Soil Characteristics
1 T'o pso, L
2 — B A01 weap- t�,� "
3 — P V r�.a aQ, u -,o !
4— `e 19'S t v} W N l 14
5— 6+4G JC h o e //tJ AV A
F - evArce ORr-uc-4
7 -. 6G P)
q — ao v^` 04�
4'�
10 —
Was Ground Water Encountered?—AL
If Yes, At what Depth?
I Readinq Date Gross Time Net Time Depth to H2O
Net Dron'
i--
r—
Percolation Rate Minute
Proposed Installation: Seeoaoe Pit
Deoth of Inlet Den
rnmMENTS: 3;:,J" A.
Drain Field
o Bottom Of Pit C
renc
Test Performed By .T.W MAeZ Data Certified By:
w
Public Safety/Building Department File. 4-1
Department of Environmental Quality
June 6, 1976
Lot 1A. :81. 1A Lakeridge Terrace Subdivision.
The subject Int has a sewer permit for an on-site sewage
disposal system.
sr
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
L it,(1ANe'rrAP,&z
e
4
• f
s• ir•
v
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-315.51 HAA# lcl-r)ntz ,
Expiration Date: I I�t,1lor.,
1. GENERAL INFORMATION
Complete legal description _ Lot to Block 1A. Lake Ridae Terrace Subdivision
Location (site address or directions) '15032 East Lake Ridge Drive
Current Property owner(s) Jay Skaggs Day phone 622.1777
Mailing address 15032 East Lake Ridge Drive Eagle River AK 99577
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
Two 2
TYPE OF WASTEWATER DISPOSAL:
®
Individual On-site
El
❑
Individual Holding tank
❑
❑
Community On-site
❑
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
4. 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 Health Authority 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 Anderson Enalneedna Phone 522.7773
Address P.O. Box 240773 Anchoraae. AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 101512005
5. DSD SIGNATURE
__jZ Approved for 0 bedrooms.
Disapproved.
l 49th
mcmm r
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date: inu
ma 12M)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water S Wastewater Program '
4700 South Bragaw SL
P.O. Box 198850 Anchorage, AK 9951943850
www.d.an homge.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: -Lot 1A Block 1A. Lake Rdae Tertacs Subdivision Parcel ID: _ 051-315411
A. WELL DATA
wen type avjj4 If A, B, or C provide PWSID #.
Date completed 7nn975 Sanitary seal (YIN) X
Total depth _NLR Cased to _U_R.
FROM WELL LOG
Date of test 7nn975
Static water level 10 R
Well production .77 g.p.m,
WATER SAMPLE RESULTS:
Coliform -L-coloniesl100 ml. Nitrate 0.14 mg.A.
Date of sample: IQK=5 Collected by: LH
B. SEPTICIHOLDING TANK DATA
Wen Log (YIN) Y
Wires properly protected (YIN) Y
Casing height (above ground) >16 in.
AT INSPECTION
76.0 R
At g.p.m.
Other bacteria LL cotonies/100 ml.
Tank Type/Material SeptidStsel Date installed 7R9n975
Tank size 1.000 gal. Number of Compartments j Cleanouts (YIN) Y
Foundation cleanout (YIN) Y Depression over tank (YIN) 14 High water alarm (YIN) N
Date of pumping 9n5R005 Pumper ,IRs Pumping
C. ABSORPTION FIELD DATA
Date installed TI26/ M Soil rating (g.p.d.Ae or f Ax1nn)150 SFBDRM System type Ssspaae Ph
Length 14 fl. Width 14 R Gravel below pipe 6 ft.
Total depth 12 R Eff. absorption area V fe Monitoring tube X Depression over field IN
Date of adequacy test 7131fY005 Results (Pass/Fall) Pass For j bedrooms
Fluid depth in absorption field before test.% in.
Elapsed Time: jo min. Final fluid depth 14 in.
Any rejuvenation treatment (past 12 mo.) (YIN & type)
Water addedEN gal. New depths In.
Absorption rate >- 300 g.p.d.
If yes, give date
D. LIFT STATION
Date installed
'Pump on' level at _ in.
Datum
Size in gallons ManholelAccess (y/N)
"Pump off level at _ in. High water alarm level at in.
Cycles tested Meets alarm d circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/1111 station on lot >1W
Absorption field on lot AW
Public sewer main _NIA
On adjacent lots MW
On adjacent lots AW
Public sewer manhole/deanout NIA
Sewer /septic service line >2S Holding tank _NIA
SEPARATION DISTANCES FROM SEPTICIHOLDINO TANK ON LOT TO:
Building foundation >5' Property Una >,
Water main NIA Water service line Mir Surface water >111T
Wells on adjacent lots MW
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10' Building foundation >10' Water main >10'
Water Service line >10' Surface water XW Driveway, pauking"hide age >2T
Curtain drain _None Noted Wells on adjacent lots MW
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review, of Munktipal records that the above systems are in 49th
confrmance with MOA HAA guidellnes fn effect on this date. _
Engineers Printed Name Michael E. Anderson. PgaMo. c MMM No, a-aea
Date 101212005♦ee�Aaiiitt9�
HAA Fee S 4430°o 075 A4JI
Date of Payment
/0-13-05
Receipt Number 07530
(Rev. lamoi PA
Waiver Fee $
Date of Payment
Receipt Number
OCT.13.2005 9:03AM ALASKA USA MORTGAGE
p rfl,
bji:Z S�e�,a ��H.�
aa:.Ja.
1Soi Z
F, tRI d f4 pr.
ert%, I.hn.na J •
Pio. rbu5 _
I
un 9r,1 c 9
r
AS -B=T
I hereby certify that i have the following described
property.-I-oT 1-A I$ i K I- A.
� �-iu.� Z3'�Tle-'w1tR 2.w 5H
Anchotage Recording precinct,' Alas", and that the Improve -
merits situated thereon are within the property Lima and do not
overlap or enaoath on the pro rty lytn6 Adjacent thereto, that
no Improvements on proingg adjacent thereto encroach
on the premises in question And that dmre are no roadways,
transmiWon Imes or other viaibk easements on said property
except as indicated hereon.
Dated at Eagte River. Aheks
'M
this d.y of 3 2005
ROB C. JOHNSON - r C W
SCALE: , RegisteredtandSurvevorNo.886L5
1" • Sox 774X%..Eagk River, Alaska 99577
Phone (907) 6W2519
t0-06-05;16:33 ;
SCS Rcf.M
1056383001
C11entName
AndcrsonEngineering
ProjectNomde
LIA B IA Lake Ridge Terrace
Client Sample ID
L I A B IA LAke Ridge Terrace
Matrix
Drinking Water
PWSID 0
Samplc Remarks:
;907 561 5301 # 2/
All Datedrimes are Alaska Standard lime
Printed Date/rlmo
10/06/2005 16:06
Collected Date/time
0927/2005 15:15
Received DrlcITIme
0927/2005 16:17
Technical Director
Stephen C. Ede
PuomcterPQL Uafu Method Allowable prep Analria
Results Container ID Limits Dote Date 1.4,
Nitrate -N
MICrobiology Laboratory
0.184 0.100 mg/l, EPA 353.2
B (<-10) 09/27/05 AL
Total Coliform 13OU, NoCall CaV100mL SM209222B A (o-1) 09127/05 TLF
10-13-05;10:31 ;
SOS/CT&E EN R NM NR ECES
%510 1 IDU�s W
Drinking Water Analysis'Report for Total Coliform Bacteria
READ INSTRUCTIONS ON REVERIE NDS BEFORE COLLSCTNO SAMPLE
I
MUST BE COMPLETED BY WATER SUPPLIER
PUSLIG WATER SYSTEM 100
SAMPLE COLLECTION:
•..e._
a" T.
;907 561 5301 # 2/ 2
200 W. POTTER DRIVE
ANCHORAGE. ALASKA 99518
Tel:907-582-2343
Fax 907.561-5301
Send Results [113andlnvoles
wWr a New
M...
IYe�.I
Y
sw.
Of
SAMPLE TYPE:
Transpuned
to Lab Dr. j�. Same as collector Other.
TO BE COMPLETED BY LABORATORY
Sample Recetvino:
Routine
O Repeat Sample
13 Treated Water
O Untreated Water
(refer to lab no. 1
0 Special Purpose
Date: 10/ 11 10-5 13ssmplge+er301tounold'. ❑ RUSH SAMPLE
Time: S'2 t9 R.emq may be untenable
Temp: 4 • DaeHovWWer Phone#:
Delivery Method: �-1
• A __&f Remote Londonh a%#:
Received By. K ✓!/ A dlsn� F (A
Comments: V v
....................
.........................................................................................................
BaeterioloDleal Water Analysts Record:
Analysis Sollon: /O/
Analyst:
Analyual Method:
embrane Filter
MMO-MUG (P/A)
MMO-MUG (►IA) RESULTS:
Total Conform:
G CoA
MEMBRANE FILTER RESULTSt
Dlr.Ct CWnt CobNos0100ml.
V.dllcadow 0.68
Sem 10 ADEC:
IWC FBK JUN
D.lorTlms•
Sent to Client
Phoned ❑ Faxed
Oatamme. MXZALc
Spoke wtth:
m...� LTB
PG
EC: Unsatisfactory ry
{ EC: ❑ Unsatisfactory
TRC •TM NI.reM. M e.W
Reported By: ✓ Date/Time:/0/0�0� /G ; O•/G : O•y as
o rune
Form S FW -0053 17/17103
\Weeslna30l%ANK GmvpDataWublc\DOCUMENTFORM51eppr eMOotl form 11217031111
a 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
f asjCERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-315-51
1. GENERAL INFORMATION
HAA " pyc-
Expiration Date: _ S`� 7- IG.?
Complete legal description Lot 1A; Block IA: Lakeridge Terrace Subdivision
Location (site address or directions) 15032 East Lakeridge Dr. Eagle River
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Larry Yahnian
same
Dayphone 696-7535
Day phone
Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup. ?W2 Z1
2. NUMBER OF BEDROOMS: _2
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
:L/7/0 3
TYPE OF WASTEWATER DISPOSAL:
I
Individual On-site
❑
Individual Hcldina tank
❑
❑
Community On-site
❑
❑
Public Sewer
❑
The Municipality of Anchorage Development °e.wices Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for prcperties served by a sincie-family cn-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date cf issue for properties served by a private or Class C well and may be reissued with
new water sample results. (Certificates may be reissued for a per'od of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or B we!ls or a public water system. The
Municipality of Anchorage is net responsible fcr errors or omissions in the professional engineers work.
4. 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 Health Authority 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 dispcsal system is(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
a & S ENGINEERING
Name of Firm 17034 Eagle River Loop Road No. 2G Phone �'`I �i— _X `1 -
Address =agle River, Alaska
Enoineer's Printed Name 483 _,L 7 C — Co wh.� Date -,;i- /C, 3
. ..
?.
5. DSD
/SIGNATURE �����i;;.� cs-a3o1 '�
v JrF •• ...• :.'� w
Approved for Z bedrooms.
1�1 vrL'Z,Ld�
Disapproved. \"'^��=—'''
Conditional approval for bedrooms, with the following stipulations:
,::(!ll(til
Additional Comments = WATER AND
�- �11A (+Tr, n n---.
PROGRAM .=
J�'%illlli)li)1)�'
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
6y: J. , Original Certificate
.J
)Rev. 01102)
Date: Z I T Ic?
Municipality of Anchorage *A9
' Development Services Department Building Safety DivisionOn-Site Water & Wastewater Program _
4700 South Bragaw St
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal DescriptionLer I &-,or-K (Al o(rgc,— parcel ID: �%fJ'/ "3/ S = :5/
A. WELL DATA 2� sly
Well type If A, B, or C provide PWSID # Well Log (YIN)
Date compieted Sanitary seal (Y/N) Wires property protected (Y/N)_
Total depth ft. Cased too Casing height (above ground) /46min.
FROM
�WELL
LLLOG AT INSPECTION
Date of test
Static water level I O ft /3 b ft.
Well production Qt ?!3 g.p.m. 0-4.3/ g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 ml. Nitrate ja?� mg./I. Other bacteria ,,_ colonies/100 ml.
S R S ENGINEERING
Arsenic: &612,g, mg./I. Date of sample: I 03 Epi* Rtw�, Alaska 99577 Collected bA70�4 Emnla Rive. I.,.,^ OMA No. 204
B. SEPTICIHOLDING TANK DATA
Tank Type/Material 45* % & &'11 Date installed 9L 2jS
Tank size gal. Number of Compartments L Cleanouts (Y/N) '77
Foundation cleanout (YM).� Depression over tank (Y/N) N High water alarm (Y/N) ^1
tN5 r 0�
Date of pumping O Z Pumper 'STN 11 -!Ly
C. ABSORPTION FIELD DATA
Date installedi/ Soil rating (g.p.d./ft, o M T System type CiQRC / I i
Length ft. Width 14 ft. Gravel below pipe (_ ft.
Total depth 10 ft. Eff. absorption area 2&e_fe Monitoring tube _ Depression over field AJ
Date of adequacy test I D O Results (Pass/Fail) For bedrooms
Fluid depth in absorption field before test LJ- in. Water added1twhal. New depth n.
Elapsed Time: lw_ min. Final fluid depth in. Absorption rate >= 34 � g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN &type) ***J If yes, give date
D. LIFT STATION
Date installed
`Pump on" level at in.
Datum
E. SEPARATION DISTANCES
Size in gallons
"Pump ofr level at _ in.
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/liif ,station on lot IVO 14 -
Absorption
4"Absorption field on lot l 14 -
Public sewer main
Symgr�lseptic service line
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots 1 040 I' -
Public sewer manhole/cleanout
Holding tank N Z'44 -
SEPARATION DISTANCES FROM SEPTICAJOLBIlIG TANK ON LOT TO:
1 r
Building foundation *5 +_ Property line 5 4- Absorption field S
Water main Water service line F- Surface'water l �%
Wells on adjacent lots
in.
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
i r /
Property line t40 4- Building foundation / D �
Water main
Water Service line l 1+ Surface water (00 r I` Driveway, parking/vehicle storage r�
Curtain drain ty4w&kQ Wells on adjacent lots �f
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 ir.
+'. �,. ....y .....,.,;.....�
conformance with MOA NAA guidelines in effect on this date. � *� -, AN
�y
Engineers Printed Name eo tg"LT �. Co -Y jA�'� %
Date t
HAA Fee $ 3 73% 1 Jf 0 . � � (-14 tt Waiver Fee $
Date of Payment G / o -3 _ Date of Payment
Receipt Number o 3 I o C 3 Receipt Number
(Rev. 12101)
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WELL nLCOVERY TLST DATA rnx(90 )69,l 1211
CLIENT:
WELL LOCA11OH (lelpall: /—'/ /7- - 13J xt' Z,4 v c:.�. Qrt-r_ 'T-�rar�_-e-�
TEST DATE:: 3, f7� 05 -- TESTEb BY:
WELL bEpTll: S?OC7' WELL MULLER: /1-L
CASING DEPTll: MATE bhlLLED:-7-/ —
IES- t Phoa0JL1 j
11 Draw water down to pump.
2) Shut ptlnlp oil 15.60 hlln.
-tecord little
-record Itleler readmit
2) 'turn pump on. browdown.
Al Shut pump all.
-tccorcl lime
-record meter readlllo
51 Calctllale pal./tltht. iccovery.
Mlsc bA]A,
cashltj ltehihl:
Saldlary Seat?
Wires In Concltlll?
EAndillp 0.1(.?
pump beplh:
Samples lakes?
bale:
/B "-1-
Y
M -TJ AI& STAhi11ME: 140 ?2 STAiICWAIERLEVEL: J 3D.__,._,_
TRIAL ��UMP
TIME
METER r��
GAUMIN.
i
Orr- -�,
ON
—orr-_
U0 3 0
/ ��
/ _
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—
_orr_
Flo S
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OFF
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at 3
orr
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17(1:)4 tlolil l l EA(111: Illvr.lil EXIT' • 61111C204 • EAGI E lOVEII. AI ASKA (M1577
02-05-03 16:15 FROM-CTBE ENVIRONMENTAL SRV
A&L CUE Environmental Services Inc.
9075615301 T-641 P.02/03 F-743
Cr&E Refit 1030567001 All Dates/rimes are Alaska Standard Time
Client Name S & S Engineering Printed Date/time 02/05/2003 9:52
Project Name/// LIA. DIA, Lake Ridge Terrace Collected Date/rime 01/31/2003 13:30
Client Sample ID LIA, )31A, Lake Ridge Terrace Received Date/time 01/31/2003 14:43
Matrix Drinking Water Technical Qirector C79
Released Dy Sample Remarks:
Allowable Prep Analysis
Parameter Results PQL Units Method Limits Date Date Init
Metals Department
Arsenic 0.00200 U 0.00200 mg/L FPA 200.9 (<=0.05) 02/04/03 02/04/03 IMP
Waters Department
Nitrate -N 0.200 U 0.200 mg/L EPA 300.0 (<=10) 01/31/03 IS
Microbiology Laboratory
Total Coliform 0 col/100ml- SM189222D (<—I) 01/31/03 SKW
UAKt KIUUt I tKKAUt JUbUIVIJIUP
LOT 1 A, BLOCK 1 A
349291 S.F.
z
GAST'ALDI LAND SURVEYING
JEFF A. GASI'ALDIt R.L.S.
4726 WEST SM AVENUE
ANCHORAGE. ALASKA 99502
PHONE 248-5454
GRID NW553 TE 003
I HEREBY CERTIFY THAT I HAVE SURVEYED THE:
PROPERTY DEPICTED ABOVE AND THAT NO
ENCRMIiME NTS EXIST EXCEPT AS INDICATED.
R M THE RESPONSIBA.TTY OF THE OWNER TO
DETERIAINE THE EXISTENCE OF ANY EASEMENTS,
COVF2WM OR RE5TR MONS WHICH DO NOT
APPEAR ON THE RMOROED SUBDIVISION PLAT.
UNDER NO CIRCU14STANCES SHOULD ANY DATA
HEREON BE USED FOR CONSTRUCTION OR FOR
ESTABLISHING BOUNDARY OR FENCE UNFS.
ANCHORAGE RECORDING DISTRICT, ALASKA
1 F.S. I JOB NO. i . I -
,o jvlLl& <
PSE ••OF..
* • 4914
100600*04*00**
j.j rkNen a 0
'� �•. is—eon
-♦ A)-ofersi01M
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 051-315-51
1. GENERAL INFORMATION
HAA# lAnCQ,L\Q�
Complete legal description Lot IA; Block 1A; Lakeridge Terrace
Location (site address or directions) 15032 E. Lakeridge Drive
Eagle River AK
Property owner Larry Yahnian Day phone 696-7535
Mailing address 15032E Lakeridge Drive Fagla Rivar, AK QAF77
Lending agency Bobbie Rawcliffe/Seattle Mortgage Day phone 762-3224
Mailing add
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 2 \'
3. TYPE OF WATER SUPPLY:
Individual well xxx
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL: .
Individual on-site XXX
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
7MP.5 IRav 1/Q11 Frnnt MnA II91
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm 5 & S ENGINEERING
---Yr�g�-E�r�{e-F�ive�Loop I�aad No 204 Phone C 2 �/ - Vic/ 7 6/
Address Eagle River, Alaska 99577
-- � 14
Engineer's signature
6. DHHS SIGNATURE
/ Approved for I bedrooms.
Disapproved.
Conditional approval for
Additional Comments
W,4
Date
bedrooms, with the following stipulations:
ow AA\Jly--
Date i/ Lf f
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Aw. 1/91) Back MOA #21
Legal Description
A. WELL DATA
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES R E C EI V Ej
Environmental Services Division ���� (�I�j"t�
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 34��4Y7
Municipality of Anchorage
Health Authority Approval Checklist Dept. Health & Human Services
t-AKE flrpv,i:
r'-ac4L I I-1 Parcel I.D.: 0 -3, 5__ �
Well type j?V_,t\J0Mi - If A, B, or C, attach ADEC letter. ADEC water system number
Log present ( N) Date completed / 7:
Total depthCased to 15 52. Casing height (above ground) i2'
Sanitary seal(�XN)
Date of test
Static water level
FROM WELL LOG
Well production '06 LOA g.p.rn.
WATER SAMPLE RESULTS:
Coliform
❑s
Nitrate
Wires properly protected (Y?V) Lj r --f'
O.igZ
AT INSPECTION
U
Other bacteriay
Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed Tank size Number of Compartments Z, Cleanouts y)N) S
Foundation cleanout (Y r� 0 Depression (Y I,�` �'f'(� High water alarm (YO f\10
(1
Date of Pumping I I ° Pumper
C. ABSORPTION FIELD DATA
Date installed l `G Soil rating (g.p.d./ft2 o ft2/bdrin3 System type Y-3
Length ° � Width 14, Gravel thickness below pipe_ Total depth i
Effective absorption area 3 36 Monitoring Tube present (FY I) Depression over field (Y torib
Date of adequacy test Result (Pass Fail) PAe- �:,-S For :E"o bedrooms
/ h
(?
Fluid depth in absorption field before test (in.); J5 ti Immediately after ' gal. water added (in.): �Z
r/
Fluid depth 5 (ins) Minutes later: 1:59 nn in Absorption rate = g.p.d.
Peroxide treatment (past .12 months) (Y/N) t erir- ff" c_NJ If yes, give date
72-026 (Rev. 3/96)"
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at' _
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
"Pumf'p-4an" level at"
`Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot loci /'k.
Absorption field on lot lbj> 7
Public sewer main N lo
Sewer /septic service line 2 14
On adjacent lots
On adjacent lots
"Pump off" level at"
Public sewer manhole/cleanout
Lift station
�f
/00
,4
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
rfi1.�. f ]
Foundation 5 Property line bJ Absorption field
Water main/service line Iv Surface water/drainage 100 Wells on adjacent lots I oL)
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 101k Building foundation Ib' � Water main/service line ID }
Surface water 100 1J �Driveway, parking/vehicle storage area i I)
Curtain drain 1007; koo,l Wells on adjacent lots lbo r
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal recor�,trrd!Zt�3 s are
in conformance with MA guidelines in effect on this date.
.Vv Jr
Signature'•"
.
Engineer's Name ����i_. COciyJ M,. ..•�..�;
ROBERT C COWAN
"CE 8801 p ��
Date
HAA Fee $ '2) C L 0'�7 Waiver Fee $
Date of Payment S Q OAS Date of Payment
Receipt Number 0,;19 I Receipt Number
72-026 (Rev. 3/96)'
MUNICIPALITY OF ANCHORAGE
M E M O R A N D U M
WATER WELL ADVISORY
HEALTH AUTHOR?TY APPROVAL NO .Rk1 w lZ 1
Durina a recent Health Authority Approval on-site inspection
and test of rile potable water supply well on Lot i
Block i A of �._{�� �;�(�� �E2P GE subdivision, the well's
productivity was determined to be(�'._ gallons per minute.
The minimum well productivity required by this Department
(AMC 15.55) for a �_ bedroom residence is 0.21 gallons
per minute. Although the subject well currently exceeds this
minimum requirement, all parties concerned are advised that the
product -"on capacit-v of the well may fluctuate. Restriction
Of non-critical water uses such as washing cars and watering
lawns and gardens may be required.
This advisory mus-- be attached to all copies of the subject
Health <u�.-hor_icy �pproval.
MAY -21-1998 11:22 CT&E ESI ANCHORAGE
CT&E Environmental Services Me.
CT&E Ref.#
Client Name
Project Name/0
Client Sample ID
Matrix
Ordered By
PWSID
982276001
S & S Engineering
NIA
Lt IA Bk IA Lakeridge Terrace
Drinking Water
9075615301 P.02i05
Client PO#
;'Anted Date/Time 05/21/98 11:08
Collected Date/Time 05/14/98 15:50
€ wolved Date/Time 05/15/98 11:30
Technical Director. Stephen C. Ede
=Meased BY /0 ,9 w _/
Allowable Prep Analysis
Parameter Results POL Units ;Method Limits Date Date Init
Total Goliform
0
col/700ML
W18 9222®
05/15/98
TMW
Nitrate -N
0.192
0.100 m9/L
ePA 300.0
10 max 05/17/98 05/17/98
RMV
13
HEAITHALTTHORITY
APPROVALS
SEWER& WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
ANDREPORTS
WELLINSPECTION
& FLOW TEST
SITE PIANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL.
INSPECTIONS
ONSITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
LS&S
i ROBERTO. COWAN, PI
a1f1L�f21f1G ROBERTA. SHAPER, P.
(qTqAANN[j CIVIL ENGINEERS
% ALWA
(907) 694-2979
p WELL FLOW TEST DATA FAX(g07)694-1211
CLIENT: �Mll L jA {1A11.4 DATE: _5_1191m
LEGAL DESCRIPTION: G.Tr I A ewcx I A LAKe IZTiI L;, ixl. 'g2 4r
WELL DEPTH: 306, CASING DEPTH: -15 1 �rj\jlv P_
DATE DRILLING COMPLETED: DRILLER:ASL. CO:
MISC. DATA: CASING HEIGHT: iz"-1 SANITARY SEAL:
WIRES IN CONDUIT: * it) GRADING O.K.:
BACTERIA AND NITRATE SAMPLES COLLECTED (date):
TEST DATA:
CLOCK
TIME
METER
READING
(GAL)
PUMPING
RATE
(GPM)
DEPTH TO
WATER
(FT)
REMARKS
4z,004
-
7 r swl
F o --J Fv�<
ty 961-
3.7-
ran`
43o
12 l 5
1-3 111
I?-'. 3iT
,-314 5
214.7
So�S
11,,'56
43tO5
Z.o
o
11ZG
43232�,�
3E5,
1.35
r`
4
.J!
3fJ
l/5r••+Z� A �i vG kl=, -^ J�I.B7;'
T
OiF
��
I
RESULTS: WELL CURRENTLY PRODUCES 4 GPM WITH A 33 DRAWDOWN
TESTED BY: Z
FLOW RATE NOT GUARANTEED --SUBSEQUENT VARIATIONS CAN OCCUR.
