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HomeMy WebLinkAboutHORIZON ESTATES LT 12Onsite File S + ry 7777' #051 um 24 Municipality of Anchorage Page of Z' DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number:—�� `�02— PID Number: Name: jU`l E Wastewater System: ElNew Upgrade Address: a3 a bz28 Z� ABSORPTION FIELD Phone: No. of corns: J7 El Deep Trench 11 Shallow Trench 11 Bed ound ❑Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grad GPD/S . Ft. Lot: BI k: Subdivision: ZAtZe ;0tZ:14e T&fie Depth to pipe bottom from original grade: +15 Ft. Gravel depth beneath pipe C% S�Ft. Township: Range: Section: Fill added above original grade: Gravel length: 39 2 Ft. Ft. WELL: 11 New El Upgrade Gravel width: Number of lines: Distance bet"? en lines: / Ft. Ft. Classification (Private, A,B,C): `, �� I V14 1 c� -6 7�� -r— Total Depth: Ft. Cased To: Ft. Total absorption area/:: —/ SQ. Ft. Pipe material: ; A5 !%3b� %"✓ Driller: Date Drilled: Static Water Level:Installer: Date installed: O Yield I Pump Set at: I Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES ❑ Septic ❑ Holding S.T.E.P. To Septic Absorption Lift Holding Public/Private Ma of Ctt Capacity In gallons: r/n6 From Tank Field Station Tank Sewer Lines J/- Well /1 Z / 2 .-�-- X15 14__ Material: �_ 6e d C Number of Compartments: Surfac LIFT STATION Watee Lot —l/ Size in /_2 ✓✓ Manua�r�� Ty7Line�V Foundation r %(� ZG} / !& _ "Pump on" level at: �Z� "Pump off' leve at, 2 High water alarm at: n Curtain / yam! ' C71 l� 1 U5 �J7andDescription: Electrical Inspections f, ordby: [[��cC,/O���i Drain BENCH MARK Remarks: Loc19_34 L� Assumed Elevation: EIt}6GAJS AL Zin a OW S 8, S ENGINEERING 1st S egor ca "e ooaas,. x veorro•:no( :- EC. T Inspections performed by: Eagle River, Alaska 99577 2nd e� ;abort A. 5hetfoa Department of Health 'and Hu Services approval pp Reviewed and approved bye Date: 72-013 (Rev. 9/91) MOA 25 lt0 _ _ ✓ V , l.. J_ _ /_ :� Permit No. SW9301 62 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report LAKE RIDGE TERRACE SUBDIVISION, BLOCK 9, LOT 3 05132312 I enni naccrintinn' PID NO.: a- Torsos W C01 CO 104.5' FINAL GRADE %' INSULATION 100.5' MH rNPSIr.s,Ae R raTER aARwc SR INSULATION -: 6' SANG FILTER NEW 1250 GAL 96.6' 96.8' S.T.E.P. SYSTEM N.T.S. 1 0' WEL RADIUS K SEED W AL GRADE s, 8'C \nalm �+i 101.2' 101.7' A B Cot 31.0 16.6 MH 38.5 22.6 MT1 73.5 54.8 MT2 95.8 73.4 MT3 106.3 85.0 MT4 86.4 69.2 10 WELL RADIUS DRIVE IEW PRESSURIZED DIST. BED\ \/M a\ \ M 1\ 3 BDRM N \\ MT �, MH B HOUSE i coC010 A FCO ___'________________ NEW 1250 GAL S.T_E_P_ 20' UTIL. ESMT. SCALE i" = 40' -013 A (Rev. 9/91) MOA 25 BARWR I EN ,�IN, ER'S SEAL Sf ST.a� `Vt1't'. �atv o( `'tl 44 lai BA' f✓a c 6 �::7 ?� 5 ij ) A E6B a�44 e1+104J N1BlA n"t-. uaJ Int � )Pobar4 A. 5h�lfcx a 4J. �: 9 ro_ Mm. 1457-i6 a '9'O O FMS k C k AK�r 24 3 107363 PAGE 1 OF 1 / s i N Sr'iE c % MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES r9_ /��C/3 3�ppjp,�, P.O. BOX 196650, 825 "L" STREET, ROOM 50 O / ANCHORAGE, ALASKA 99519-6650 � ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT ao`/ q-19-9 3 PERMIT NUMBER:SW930162 DATE ISSUED: 6/18/93 DESIGN ENGINEERS & S ENGINEERING EXPIRATION DATE: 6/18/94 OWNER NAME:KRAFFT JULIE M OWNER ADDRESS:PO BOX 022826 JUNEAU, AK 99802 PARCEL ID:05132312 LEGAL DESCRIPTION: LAKE RIDGE TERRACE BLK 9 LT 3 LOT SIZE: 39015 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BV. ISSUED BY: DATE: DATE:- c'� /" = 50' UPGRADE CF "ALE n (n b 3 i v pr�R pyo �rTl O � m -- FI�30rl p(nCm �0� znO mmpm (` rr OAO D y 43 m� ? p u G N oNo 2 rnnn map cno� Ci CrTl y to D c� ? m � Z 01 � o�w H N b " 1 rn co Qz rDyo o� C 301 R coy I � z Z y � O D m + c m n m N O on N p P rrn 51 y F r +y `i n <%NDE L OPED� D m AS SHOWN SCALE So y m 0 y 3j J�. i Em May 28,1993 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907694-2979 FAX 694-1211 HEALTHAUTHORITY Municipality o6 Anchorage APPROVALS DEPARTMENT OF HEALTH AND HUMAN SERVICES Attn: John Smith P.O. Box 196650 Anchorage, AK 99519 SEWER & WATER MAIN EXTENSIONS REFERENCE: Lot 3; Block 9 Lake Ridge Terrace Subdiv.ison Dea+c Mn. Smith, SEWER &WATER Request you .issue a pe)vn t 4or the upgrade o4 the septic system INSPECTION located on the re4ereneed property in accordance with out design dated 12/8/92 and tev.ised 5/27/93. The tevision o4 the design .is the result o4 high ground water ANDEPORTSSTUDIES AND REPORTS monitotin duten May 1993. Ground water mon.itorin on May 25, 1993 9 9 y g y .indicated that water was apptoxi,mately 1k 6eet below the sur4ace og the ground. Thete4ote .it is requested that you waive the tequi.tement 6o4 2 fleet o6 un6aturated soft in this case. WELL INSPECTION &FLOW TEST The exerting septic is .in noncompliance and serves an existing 3 bedroom house. The soil test .in the area to be used .in the upgrade shows a Aitty sandy materiat which should p4ov.ide adequate 6.i tt4at.ion .into the water table. In addition, a hour boot sand layer iz proposed SITE PLANS to be instateed a4ter the organie:5 have been removed Gram the site. It is my opinion that thi,6 is the only reasonably env.itonmentall y sa4e atte4native 6or wastewater d.i�sposat on this p4opetty. A holding tank .is the only other alte4native. It has been aur expetienee that ROAD DESIGN holding tanks are not the most env.itonmentatly sa6e way o6 disposing o6 domestic waste and where they have been .installed environmentally unsage conditions 4requentty devolop. An inovative system 4o,% this property .is not recommended since a SOILTEST Health Authority Approval .is being requested and the testing requirements 4o4 inovative systems is not compatible with the sate o4 this propetty. PERCOLATION TEST 16 you request additionat .in6ormation, please contact me.. S.ince,,rety, STRUCTURAL& MECHANICAL INSPECTIONS /gk ONSITE WASTE WATER DISPOSALSYSTEM DESIGN A. SHAFER, P.E. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 G�j9�.n$tltp HEALTH AUTHORITY APPROVALS December 8, 1992 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVILENGINEERS (907)694-2979 FAX 694-1211 SITE PLANS Sincerely, ROAD DESIGN Roger J. Shafer, P.E. JS/LSU/lsu SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 1 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, AK 99519-6650 SEWER &WATER / Jy' "'u MAIN EXTENSIONS ))) / / L�(% Q K IKKK o Srl— 323—/�. REFERENCE: Lake Ridge Terrace Subdivision, Block 9, Lot 3 SEWER & WATER INSPECTION We request you issue a permit to upgrade the septic system serving the referenced property. ENGINEERING STUDIES A test hole was excavated and a percolation test performed. AND REPORTS The approximate location of the test hole is located on the attached site plan. We do not anticipate any adverse effects on neighboring WELL INSPECTION properties by the installation of the proposed septic system. & FLOW TEST If you have any questions, or require additional information for your review, please contact us. SITE PLANS Sincerely, ROAD DESIGN Roger J. Shafer, P.E. JS/LSU/lsu SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 1 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 a 50 v SCALE a r m ' N of m m m3 UPGRADE Iu -� UNDEVELOPED (p Oo -h �O 0 m m - ro Z �uti rd (n inn ocn �ticon �m �n�� > m to m ' _ ~ cN n O �1 O W n O O w 2• Qo -n (n cii p j Z Z) O N O ZO h; 0 r r G) prnp- (n �u Qn C) y ^'ice �'P n re- R1 n�» 0 n rT o�w z 000 rT O rn rTl \ (r) 0 -� UNDEVELOPED r 0 m m - o W � x � W 0 m / N -� UNDEVELOPED AS SHOWN SCALE n y I ri y m �I O m m i I y �o n `k z', r r n y I ri y m �I O m m i `k z', -1 e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: ���/\ G t�l�Ik �%T DATE PERFORMED LEGAL DESCRIPTION: LzI-T 3 -1L 1 Township, Range, Section: SLOPE SITE PLAN T�TW (�" J—ACt<-f fTT—L—{ CCCTI 10 11 12 13 14 15 16 17 18 19 WAS GROUND WATER ' ENCOUNTERED? 2 V. 1 / 3 f IF YES, AT WHAT 4 DEPTH? S P `S 01 L► t..YIT C9►LA¢�f \- Z• �: '-A 5 2 1 t + '/ 6 Io'Sr 1� r 7 8 '/ 9 t 10 11 12 13 14 15 16 17 18 19 WAS GROUND WATER ' ENCOUNTERED? Net Drop S IF YES, AT WHAT L 11 O DEPTH? V P Z• E Depth to Water Alter + Monitoring? Date: Reading Date Gross Net Time Time Depth to Water Net Drop ;�1 Z— Z• o• S J w�.w� '-A i w 2 � r -4 t + N Io'Sr 1� r 1ti 20 I I PERCOLATION RATE c�7> (minutes/inch) PERC HOLE DIAMETER ~ u TEST RUN BETWEEN yr'AFT AANNDld n'I FT COMMENTS t7or-i/c�f1 PERFORMED BY: C R. 9 ENGINEERING I �� t� CERTIFY THAT THIS TEST WAS PERFORMED IN A17034 Ea le River Loo Road No. 2 ACCORDANCE WITH to LpTOTE-A Mlklal��GUIDELINE N EFFECT ON THIS DATE. DATE: ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS : Lake Ridge Terrace Subdivision, Block 9, Lot 3 GENERAL: 1. The scope of this project includes the installation of a 1250 gallon wastewater S.T.E.P. system (septic tank) to serve the three bedroom residence located on the referenced property. The existing septic tank is to be excavated, pumped, crushed, and abandoned in place. 2. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. Page two Lake Ridge Terrace Subdivision, Block 9, Lot 3 Construction Practices 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. PRESSURIZED MOUND SYSTEM INSTALLATION: 1. Any peat or organic matter must be removed from the elevated mound site. 2. The bottom of the basal bed area as well as the top of the sand filter is to be within two inches of level. 3. The distribution piping is to be of PVC (ASTM D3034 or equal). All joints are to be solvent cemented. 4. The side slopes of the top layer of the mound system must not be steeper than 33% (3:1). 5. The top of the mound shall be covered with a minimum of 6 inches of topsoil and vegetated sufficiently to prevent erosion. 6. The distribution pipes are to be embedded in sewer rock. Care should be taken to backfill in such a way as to prevent damage to the piping system. 7. Silt barrier material must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 8. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. Page three Lake Ridge Terrace Subdivision, Block 9, Lot 3 Construction Practices MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, it's gradation specifications must conform to AMC 15.65.060D. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. t Page four Lake Ridge Terrace Subdivision, Block 9, Lot 3 Construction Practices 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre - construction meeting will take place on-site. MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE EW L"V/n� fi�S - e (� PGRADE MAI WG ADDRE S be - E:7 s" L be ti ' LEGAL DESCRI ION LEGAL _ ClQ/�Q_ �. LOCATION NO. OF BEDROOMS v DISTANCE TO: Wei©e �� ,; Absorption area Dwelling PERM 0. _ 7 G Y 1—Z Manufacturer Material No. of compartments w< i., N Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth ❑ �' J � Z DISTANCE TO: Well Dwelling PERMIT NO. 2 Z F Manufacturer Material Liquid capacity in gallons ❑ Welh Found Nearest lot li e ( PERMIT NO. �j 'A 6:— L" w= DISTANCE TO: I'g / J E Z No. of lines Length f,each line Total le gth of lines Trench i h j Distance b�tw en lines % Z w ( inches I --[C 0 H Top of tile to finish grade j /` L q 1' Material beneath tile �/ inches Total effective a sor tion area Length Width Depth PERMIT NO. W C7 Type of crib Crib diameter Crib depth Total effective absorption area wa W rn Well Building foundation Nearest lot line DISTANCE TO: J Class Depth Driller Distance to lot line PERMIT NO. J w Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER a PIPE ATERIALS � SOIL TEST RATING INSTALLER LJ1V°� OL REMARKS t. - I ' v jr / APPROV DATE LEGAL r-1 1-3 r -.l I fl; I F I I -Flo 10 /;7- DEPARTMENT OF HEALTH AND ENVIRONMENTAL. PROTECTION 825 'L' STREET,. ANCHORAGE, Fit'. 99501 264-4720 PERK IT NO. < 790-341 APPLICANT WAYNE BULLOCK BOX 4 EAGLE RIVER 688 283E�+— LOCATION HAROLD LOOP LEGAL L3 B9 LK RIDGE TERRACE Se-�D, LOT SIZE 4_3560 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: DRAINFIELD, MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SO FT/BR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: rl, Fz:, F=• _r " - 22 - 15 L_ 1= r-4 ID _r " - _:lL C21 -1 C3F.!,l=i"gr F=_L__ THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR CERA If4FIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THE GRAVEL DEPTH 15 THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). -rn"K �127a- ::LQ_!f5493__ 0"1-1 07JV4_�H. PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL. SERVE. -Ft-40 r'. ;2> nF;7PF:r F-eF=_0l_1lF• EEP-A ---- BACKFILLIN6 OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL. BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWA13E DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL. OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF' PUBLIC WELL. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F-"'F=F._wMl'7 VDirE-1�-E-EME3FE=� A- -*=.:o �.r "F4 I CERTIFY THAT 1: 1 AM FAMILIAR 141TH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: 1 UNDERSTAND THAT THE ON-SITE SEWER -SYSTEM MAY REQUIRE ENLARk-EMENT IF THE RESIDENCE I` RUMODELED TO INCLUDE MORE THAN 4 F,,EDPOOMS-,,77 SIGNED: ------------------ C;-) APPL I -:A - T 1-0 THE ULLOCK ISSUED 81 GATE �W eeh�4`1 V2 2 n 1. ® Et E GEOTL `H N ( CAL Ej- ®E V E LO ' J� ENT CO. i•N Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 Soils 6 Foundations Land Development Performed for: Name: K1, S�,E HeILL-0GK Tel. No. 6. 9 Mailing Address: l 2aLfl 'z Legal Description: Z07 -S, AfGaC,< 9, ClOCi, Depth tfeetl_ Soil C#raracteristic 0 0 / L 2 4 A61- 5 7 C 8 9. 10 13 I)!_ 15 16 1OZ6 Ale 5e4L E Ground Water Encountered: Yes v-' No—,u_ If yes, what depth 4n I l Proposed Installation: Seepage Pit- Drain Field Corrments : C6��A . Performed by:1�' A. hall. IVU Uo. ,sex' 1303, Palmer'. j Log Of Wayne Bullock 4•lel1 .Date Completed Oct. 15, 1963 •Locatibn; Firelake b'isJ3 Hatchery goad. 0 to 3 ft. Tpp Soil 3 to 8 ft. Clay, Sand and Small Gravel 8 to 20 ft. Grey ClaySome Small Gravel. (very Soft.) 20 to 34 ft. Grey clay layers of gravel (Prod. some water 21 to 22 ft) 34 to L19 ft. Grey clay, Angular gravel, large boulders. Drilled open hole from 34ft. to 49 ft, 49 to 53 ft. Med. Size washed gravel layers of grey clay Making Water at 52 ft. RE 'ARKS : A piece of 5 inch Casing 3 ft. long And Perferated with a cutting torch and2 ft. of it is exsposed below the drive shoe. This screen has a solid bot -tom. PRODUC' iON: 10 gal. bailer every 50 seconds. Top of Casing to Water 4.3 ft. 2 inches 1 Iain. " " " " " 36 ft. 2 inches equals 1021 GPM 1 Hin " ° " " " 30 ft. 0 inches equals 9 GPM 1 Alin " " " " It 25 ft. 6 inches equals V- GPM (Based on one lineal ft. of water ina 6" casing equals 121 Gal.) Static Level of 'Water 9 ft, from Surface. If mere water is needed the casing could be perfoated 21 to22 ft from top of casing, also 25 to 26 ft, and 31 to 32 ft. Also Measuring frori top of casing. This may make another 200GPH. Having; 600 G.PH. from 52 ft. sufficient water for domestic ' needs. Would suggest setting pump app. 5 ft. of bottom of well. Drilled and Logged by Otto Kockritz, Jr. Palmer, Alaska. Parcel I.D. 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING osl —3 "A-3rz 1. GENERAL INFORMATION HAA# Sn31� Expiration Date: C? Complete legal description Lot 3; Block 9- Lakeridye Terrace Location (site address or directions) 14208 Harold Loop Eagle River Current Property owner(s) . Gerald & Lana Gooding Day phone 696-8895 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone Craig, Nagunst Dayphone 694-9125 Greatland Realty 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 TYPE OF WASTEWATER DISPOSAL: U Individual On-site ®C ❑ 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 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 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. (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 S & S F.nginPPring Phone o;g4_7974 Address 17034 N. Earle River Loop Ste. 204 F.agle River, A 97577 Engineer's Printed Name Robert C. Cowan Date 77C5 eI p \ ROBERT C. COWAN / 5. DSD SIGNATURE �'eg CE -8801 ✓ Approved for 3 bedrooms. I+ Y� M1�" :_ ffsfa;?``rte_" Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments WATER AND ; rn: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: (/��/ �.✓� !l"1 Original Certificate Date: % — ' Q_ - (Rev DIM) Municipality of Anchorage !� • Development Services Department`; Building Safety Division On -Site Water 8 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 Description: L""ttKE Parcel ID: 4D61-32-517- A. S/-32'3/Z A. WELL DATA Well type7:aWm- Date completedO I s/63 Total depth -5-aLft. If A. B, or C provide PWSID # Sanitary seal (S%) Cased to —qb--L+ t. FROM WELL LOG Date of test ! b S 3 Static water level 4 r ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform O colonies/100 ml. Nitrate O.ff) mg./I. Arsenic: = mg./I. Date of sample: Aly/os Well Loa$N) I£'� Wires properly protectedo1) A5_ Casing height (above ground) W+Jn. AT INSPECTION b Zz o $ f ft. o rJ g.p.m. Other bacteria © colonies/100 ml. Collected by: S4-� FXLa6tyZ:raJ&y' B. SEPTIC/HOLDING TANK DATA / Tank TypelMaterial Date installed 181(w, 5 Tank size - gal. Number of Compartments o_Z Cleanouts &I) Foundation cleanout({ V) � Depression over tank (Y& t� High water alarm r Date of pumping 1 toPumper ae S -pvcflt , l tt9� C. ABSORPTION FIELD DATA Date installed fi ' (Shoil rating (g.p.d./ft' or ft'/bdrm) 1'%- S � t Length 3� ft. Width `�� ft. Total depth --q— ft. Eff. absorption area _ILZ ft' Monitoring tube aV5 Depression over field _K96 Date of adequacy test 1, 1 ZZ QS Results ( as ail) System type X400402' r Gravel below pipe O• S ft. For 3 bedrooms Fluid depth in absorption field before test d in. Water addegal. New depthtn. Elapsed Time: 0 min. Final fluid depthtin. Absorption rate >= 4_�O+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIH)& type) fl`OO If yes, give date A.;?04 D. LIFT STATION Date installed (6 - S/1465 -Size in gallons «160 `Pump on' level at LVu in. `Pump off" level at in. Datum 13&zTo",\ Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 1 Septic tank/lift station on lot < <Z Absorption field on lot (16, Public sewer main "it Manhole/Access etR) t C-5 High water alarm level at c{q " in. Meets alarm b circuit requirements? k4 S-. On adjacent lots I CEJ t� On adjacent lots Idlo Public sewer manhole/cleanout fel A Sewer /septic service line 2S (J- Holding tank "A A - SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation �w'o r Property line *. r Absorption field 5 1+ - Water main Ali Water service line ID 1+ Surface water} - 1 Wells on adjacent lots (M +- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 1 t ' Property line L40 Building foundation z Water main Water Service line lot }" Surface water /t7d 14-- Driveway, parking/vehicle storage (C) t•1 - Curtain drain ii,1E1it%b Com) Wells on adjacent lots I m0 1 -I- F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and f %' review of Municipal records that the above systems are in fir^ conformance with MOA HAA guidelines in effect on this date. �• d4 n ROBERT C. COWAN Engineer's Printed Name Roetzt- C. Cow -4,.i 7 �c�,.1 CE -8801 Date ^:;: ; HAA Fee Date of Payment H ?1). 0O Waiver Fee $ Date of Payment Receipt Number 01.045f Receipt Number (Rev. 12/01) tit,• ti �. C, r� o t� • . }. tJ ✓I r• J tire, ''•,1, � �" 8'xte' '�"•� i r�'.' `lard i AS -BUILT I hereby certify that I have surveyed the following describrd Y properly: p,�;.�_�j�.1,Tr.:r_=,_r'.,1..�.N��--•- Anchorage Recording precinct, Alaska. and that the Improve- ments situated thereon are within the properly lines and do not overlap or encroach on the property lying adjacent there- to, that no Improvements on property lying adjacent thereto encroach an 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 3 day of t• (7 ROBERT C. JOHNSON A "• SCALE: Registered Land Snrseyor No. a604.S box 456, Eagle River, Alaska More (997) 694-254:1 06-30-05 I1:IIAM FROM-CHE ESI, SGS ENV SERVICES SCS ReLM 1053679001 C7ientName S & S Engineering Project NomeM Lot 3. B9 Lakeridee Terrace Client Sample ED Lot 3. B 9 Lakeridge Terrace Matrix Drinking Water 9075615301 T-241 P.02/04 F-848 All DataflYmei are Alaska Standard Time printedltateMme 06/292005 18:52 Collected Daternme 062212005 9:25 Received Detefrlme 06232005 8:54 Technical Director Stephen C. Ede Sample Remarks: EP 300.0 - The matrix spike recovered outside of acceptance for nitrate. See LFB for QC requirements. Allowable Prep Analysis Puamew Reaults PQL Units Method Canwi=ID Limits Date Date [nit Waters Department Nitrate -N 0.100 U 0.100 MicrobioloM Laboratory Total Coliform m81L EPA 300.0 B 0101 0623/05 JIB co1/100ml. SM209222B A (o-1) 06/23105 TLF 06-30-05 11:12AM FROM-CTIE ESI, SGS ENV SERVICES 9075515301 SGSICT&E ENVIRONMENTAL SERVICES Drinking Water Analysis Report for Total Coliform Bacteria READ #WRYRIONR ON REVERSE SM 11"M COLLECT" SAMPLE MUST BE COMPLETED BY WATER SUPPLIER ' ❑ KUX WATT'.R SYSTEM Me RIVATE WATER SYSTEM E3 Boa RaeAN (3 soma sAMPLE COLLECTION: can; l�S' TOM T-241 P.04/04 F-848 200 W. POTTER DRIVE - ANCHORAGE, ALAW 99518 Tel: 907-582-2913 Fax 907.581-5901 te0 Rr N0. 053679`A - Q Bend Ren4r It39roenact now .r... K. SAMPLE TYPE: TwopmMd to Lae My: wrgemas Cdlo= OMW. TO BE COMPLETED BY LABORATORY Simple Recovino. G-25 We: '� ❑ 6xnPM owx Mwe oa: _ _�... RNuxe RraYa urwelWae ❑ {e rear waNer wivery Method: a Received BY Lo0aa0nI ❑ Routine ❑ Repeat Sample ❑ Treated Water ❑ Untreated Water (Mer to lob no 1 ❑ apeclat Purpose ❑ RUSH SAMPLE Phone ter Fax P: ...................................................................................................................... a.., ........ ............ i Anayacel Mrbod: fmwnwww FlIW MMO•MUG (PIA) Reported BY: 141110aW (►IAJ RNULTS: TOW CoRform E. Cal: MEMBRANE FM MER REStR_TS: hiw ca m cow wnooft VeA8rae0n: {BOB BEM b A{7E� ANC FBK .a1N DeWnrne: Sam b Owm Primed ❑ Fwd C3 DawTane• 8 ww: V!�-Sabsfactory ❑ Unsatisfactory Date7Tlme: IJ - a -4-e r' L2 - s.. n,.,.,,.n.r.rPubrc%DOCUMENTV'ORMS1Ap Form 121TO3s0 0e • 0r. 5a Form M Fw- DM 12/17109 6 n MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES y 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 1.D.# X23-\ HAA#, 1. GENERAL INFORMATION • Lot 3B.Eocfz 9 Lafie�vidge 'rennace Subd�,Vizion Complete legal description �,�. Location (site address or directions) 14208 Hano2d Loon Eag.Le Riven Property owner Juti.e Kaabbt Day phone Mailing address P.O. Box 022826 Juneau, Alaska 99802-2826 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX Community well . Public water 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. lZa VOVtl NOVO M/l'nay) SZO-ZL -�aorn s jaauibuo leuolsseloid all ui suoissiwo ao sao.)aa aol apsuodsaa lou si a6eaoyouy to Al!ledlolunw all •ponssi si aleollpao a aao;aq elep ozAleue jo suoiloodsui lonpuoo IOU op SHHQ }o saaAoldw3 •sluawa.iinbaa alels pue leaapal uiupoo i4slles olaapao ui suoilnl!lsui 6ulpual aiayl pue sawol }o saaseloind of Asalinoo a se slll saop SHH4 all •e WV to alels all ul paialsl6aa aaeul6uo leuolssaloid luopuedepul ue Aq anoge g ldea6eaed ui u9n16 suopluoseidaa all uodn Aluo paseq saleollpoo lenoaddy AllaollnV ylluOH sonss! (SHH(l) saolnaas uewnH pue ylleaH to luawlaedad a6eaolouy to AllledlolunW all mollelndlls buimollol ay; yl!M 'swooapaq 1...... d h $ ale(] 6 L b Z �g 9 auoyd sluawwo(] leuol;lppy ao; Ienoidde Ieuoll!puo(] •panoaddesl(] -swooapaq aol panoiddy 1— amnlVNDIS SHHO !s s�aaul6u3 ssaa ppy wail }o awsN •uolloodsul slyl jo alep ayl uo;o ay suollelnbei pue 'seoueulpio 'sapoo ale1S pue ledlolunw Ile yl!m aouelldwoo ui sl wa s I dslp as;ennalssM ao/pue AIddns aa;enn alts-uo ayl'uopoadsul pue u01ls61lsanul !w wQg-putsalt; 96eaoyouy;o Al!Isd!o!unW ayl woal paulelgo uollewaolul ay; uo poseq;eylAjlaanaaylan} I •ulaaay paleo!pul einlonals;o ads l pue swooapaq;o aagwnu ayl ao; alenbope pus leuolloun; 'ales sl welsAs Iesodslp aalemalsem ao/pus /lddns aalum alls-uo ay; ley; smogs uollsolldde Ienoaddy Al!aoylny y;IeaH sly; ;o uolle6llsanul Aw;eyl A}laan I 'nnolaq unnoys alep uollepllen ayl;o ss pus olaaay poxll;e leas Aw Aq pellpso sy a33NION3 A8 NOLLOUSNl d0 LN3W3JLV.LS 'S /m._ .9 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 73L Parcel I.D. A. Well Data OS'/ 5 2 3/ 7� Well type J -If A, B, or C, attach ADEC letter. ADEC water system number x )./7& . Log presentfY/N) Date completed Total depth 53 Cased to Sanitary se N) FROM WELL LOG Date of test Static water level to -lam Lo�j Driller ©77Z' l� dG/G2i i� J A�� -/__ Casing height Wires properly protecte (Y N) Well flow /d. —9•P.M. Pump levell % 5 0446e57,'D SEPARATION DISTANCES FROM WELL TO: AT INSPECTION /-:;? "-f- E C I V FD uIC Dept, Fleaitit & ;urnan Services Septic/ Iiag tank on lot On adjacent lots l Absorption field on lot On adjacent lots l 6D Public sewer main _ /�O�-I ` Public sewer manhole/cleanout Sewer service line Z4�5 /-i' Petroleum tank SIL WATER SAMPLE RESULTS: Coliform D Nitrate J -FD Other bacteria cy Date of sample: 9 / Z93� Collected by: d B. SEPTIC/HOLDING TANK DATA Date installed ��� �J Tank size 12 -SO 4 �AL Compartments Z_ Cleanouts ( /N) Foundation cleanout YJV) Depression (Y& High water alarm / ) Alarm teste/N) _T Date of pumping AJC 4 Pumper�- SEPARATION DISTANCES FROM SEPTIC/HGI5;PM TANK TO: Well(s) on lot � /Z / On adjacent lots Foundation To property line �JCa Absorption field —Water main/service line /-.C- Surface water/drainage /C)C-� CONTINUED ON BACK PAGE 72-026 (3/93)` Front C. LIFT STATION Date installed /�g� ManufacturerCffd��� Size in gallons 1250 Manhole/Access(ii�) � Ven (Y N) "Pump on" level at "Pump off" Level at �2 High water alarm level 11 Cycles tested Meets MOA electrical code�YY N SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot %� Z / On adjacent lots I Surface water D. ABSORPTION FIELD DATA /"3D -�- Date installed Fh :9 & Soil rating (GPD/Ft2) G S System type Length �� / Width Z� / Gravel thickness / d• 5 r Total depth Total absorption area2 18u� esent�) Depression over field ti�a i Date of adequacy test A-) /44. Results (pass/fail)S �SrYI/j for Bedrooms Water level in absorption field before test _ Peroxide treatment (past 12 months) (A After test If yes, give date AJ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot On adjacent lots / Property line To building foundation ,-2% / To existing or abandoned system on lot On adjacent lots X70 Cutbank Water main/service line Surface water Driveway, parking/vehicle storage area ` Curtain drain IJ I� E. ENGINEER'S CERTIFICATION I certify that l have checked, verified, or conformed to Signature i HAA guidelines in effect on the date of this inspection. Cfl 17034 Eagle Rive Ld o /d No 204 Engineers NameEagle ffival 10 Nil u 9 Date 71 HAA Fee $ CAC), a ) Date of Payment 1 C�A- 1 () _16 ?A,q G WY Receipt Number 72-026 (3193)' Back Waiver Fee $ Date of Payment Receipt Number COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES SINCE 1908 REPORT of ANALYSIS 5633 B STREET Chemlab Ref . # :93.4398-1 ANCHORAGE, AK 99518 Client Sample ID :L3 B9 LAKE RIDGE TEM. TEL: (907) 562- 43 FAX: (907) 561-55330101 Matrix :WATER Client Name :S & S ENGINEERING WORK Order :70232 Ordered By :R. SHAFER Report Completed :08/31/93 Project Name Collected :08/24/93 @ 14:00 hrs. Project# Received :08/27/93 @ 19:30 hrs. PWSID :UA Technical DE ReleasedcByr:S�C Remarks: Parameter Nitrate -N SAMPLE COLLECTED BY: RAY. QC Allowable Results Qual Units Method Limits 0.10 U mg/L EPA 353.2/300.0 10 Ext. Anal Date Date Init ----------------- 08/30 LLH * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than ,rahsGs Member of the SGS Group (Societe Generale de Surveillance) 1111110 1,.11, .00CMV eni iru nAoni ince ei�. ria. �a Y COMMERCIAL TESTING & ENGINE RING CO. AK DIY CHEMICAL & GEOLOGICAL L4BORATORY TELEPHONE (907) 692-2343 tr ,4, (frig Water Analysis Report for Total C011f a a TO BE COMPLETI^D BY WATER SUPPLI ER ER ❑ PUBLIC WATER SYSTEM I.D. i� � 1 I 19 PRIVATE WATER SYSTEM , Name Ph" No. Cny s7 m caw ar+mr'LEDATE: LwLk� Q [Hy Me. Y. Year -, SAMPLE TYPE: Routine ❑ Check Sample (for routine sample .�,!th lab rot. no. ) ❑ Treated Water E7 Special Purposer 11Untreated Water 4 SAMPLE Tlme' Collected No. LOCATION Coftroted By y 7;:, j'3lrtQ - '�btaa 3 n 5 READ INSTRUCTIONS BEFORE TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: Satisfadary ❑ Unsatisfactory Lj Sample .too long In transit; sample should not be ver 30 hours old at examination to indite reliable results. Please send new sample via special : ':Very mail, Data Received I I Time Reeetved _ SL -d" Analytical,Method' Membrane Fitter " Na: gi colonios/100 mi. Lab f. No. Resrnuk" Ann yat FEI 3+i9 -_ m 13ACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count d callforntlf 00 mi Verification: LSD Fecal Coliform Confirmation BaB COLLECTING SAMPLECoilfornvtoo ml Final Membrana Filter Recut s/ Reported ey Date TNTC : Too Numerous TO Count Time:. p.m. OB o Other Bacterla r'I"IMB e7 Member of the SOS Group (SociW 0$n6rale de Survoiilanoe) 4 Municipality of Anchorage • � DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Services Division Telephone: 343-4744 -•---- ON-SITE SERVICES FEE DOCUMENTATION Date Paid: Permit Number: Name of Payer: (Name on Gheck) 5 Receipt #: D©az Mailing Address: Off of check),g95 7? /-7n.34Z W Check # AS-` 25129 Legal Description(s): /L k2- Type ZType of Payment: (Indicate Amount Pr (�` (0//. WAIVERS: Health Authority: ,-I ){5m4 h Excavator Permit: Lot Line: Sewer & Well Permit: Engineer Permit: Well to Tank: Well Permit: Pumper Permit: Well to Field Sewer Permit: Well Driller Permit: Field to Surface Water Copy Request: Tank Manufacturer: Tank to Surface Water (Waste Treatment) 72-034 (Rev. 10/87) DISTRIBUTION: - WHITE—MASTER FILE CANARY—PROGRAM FILE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 1. GENERAL INFORMATION Application Date - - ! - (a) Legal Description (include lot, block, subdivision, section, township, rang -e.) 3 %3C,/e47 6,12- / D6 6 (b) (c) Location (address or directions) crr 6,514 �JAV7,W .q 100A Q 0_Nj ALA,,Lo cIn Z_"!�P o/' Applicant NameTelephone: Home 376 " 13 r/3 Business Applicant Address SPeg toC-� tlLIA-SIL1,A 95�_-f7 Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer; Other ❑ (explain); (d) Lending Institution AK. ItIliz-7"U Ai Telephone Address (e) Real Estate Company and Agent /11-i Address Telephone (f) � HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well Pr Community ❑ Public ❑ 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. Pagel of 2 72-025 (1v84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate forthe number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Addre Date Telephone rR° 9nberl A. 3bahr No. 1457.6 "t 6. DHEP APPROVAL Approved for bedrooms by e ¢ Approved Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 A. WELL DATA vAUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE ( MOA DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MAY 2 8 1985 Legal Description N Well Classification 4S, P If A, B. or C, D.E.C. Approved(Y/N) 'JJA Well Log Present dS/N) Date Completed Jc)-I5-G3 Yield SSP%� Total Depth Cased to AD' --I, Depth / of Grouting Static Water Level C-1 Pump Set At Casing Height Above Ground 12 ti Sanitary Seal on Casing Yi ) Electrical Wiring in Conduit oy)N) Depression Around Wellhead (Y Separation Distances from Well: To Septic/H' Tank on Lot F)p On Adjoining Lots 1 To Nearest Edge of Absorption Field on Lot ( d C -)I ; On Adjoining Lots >�� (4- To Nearest Public Sewer Line tv A To Nearest Public Sewer „Jr Cleancut/Manhole A To Nearest Sewer Service Line on Lot jm> •+" Water Sample Collected By � S is - ; Date Zzz�- -&6_ Water Sample Test Results Convents A WLL_ F=1_-&V'J -r6 )' '5)�Vw o V.J`rg-t-L `7b %alzyot/L_E B. SEPTICAO=WG TANK DATA Date Installed " HO Size I V-00 -k- No. of Compartments USA, 0 Standpipes M) Air -tight Caps N) Foundation Cleanout (Y,{ Depression over Tank (Y Date Last Pumped -' Pumping/Maintenance Contract on File (YIN)IO A ; for Holding Tank High -Water Alarm (Y/N) "JZL Temporary Holding Tank Permit (Y/`17A Separation Distances from Septic/i3ellding"-Tank: To Water -Supply Well ( l To Building Foundation To Property Line 1,�` 1 To Disposal Field 5 i To vqatrarSprvice Line &0"� To Stream, Pond, Lake, or Major Drainage Course �//4 Comments Receipt # aA ka_a1 Date Paid: -fig -5 Amount: _4_73100 [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ZS lU Type of System Design L rJ�tC-3-� Date Installed q Length of Field ll1 + Width of Field (pC> Depth of Field Z ' Gravel Bed Thickness (0 " Square Feet of Absorption Areabt-V' Standpipes Present V) Depression over Field (Y/c_ Date of Last Acbquacy Test Results of Last Adequacy Test CJ 2 p { Separation Distance from Absorption Field: To Water -Supply We11�C:;,e� k To Property Lire 1� To Building Foundation 15,.+, To Existing or Abandoned System cn Lot X70 _f ; On Adjoining Lots . '14 To Water Ma�tn/Service Line (ate i .:�: To Cutbank(if present) To Stream/Pond/Iake/or Major Drainage Course fl—d A To Driveway, Parking Area, or Vehicle Storage Areal"� Comments D. LIFT STATION Date Installed 0 - rN Dimensions a& Size in Gallons Manhole/Access &N) "Pump On" Level at "Pump Off" Level at o, K, High Water Alarm Level at ().(C, Vent 6*, ) Tested for (2,X, Pumping Cycles during Adequacy Test. %ets MOA Electrical Codes(Y/N) Comments //'l 5'rAY7f/O/Q 7�-A^IK EC -1-1 14, l9 7i 7 --J '7 - `7> �.i ✓c�ii� /�fr���.i�yv * Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, cr conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed 10 a fdGiH7Er tilKt Date S2 8� Company ;�, `;i�flwB. ALASM VwJ7F MOA No. BSba 3 KB1/d5/s (Page 2 of 21 c n;, E � ✓,. c� .F. no.�7� P ns .r�•. u�c No. 1457•G S 2-15-84 OF.WDEVFNOf�{ CHEMICAL & GEOLOGICAL LABORATORIES OF.ALASKA, INC. TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER A ;5633 B Street Drinking -Water -Analysis Report forTntal ZoliformBacteria ?O BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY js F,'•5= _ t .�'t - o - < 7 � t .:.�e .k.�:=.5 y:r._ �: .o - .., 4, 4 . WATERSYSTEM; - C) See h on.back `t Analysisahows this Water SAMPLE to be: 1 I.D. NO. 7gSbtisfactory- �YJ `D Unsatisfactory Fp c s Water SystemName Phone No. •> s ":. , fltample`too long transit; sample should not be over 30 hours old at examination to rta;rng Address indicate reliable results. Please send new sample via -special delivery Emil cl city - .State Zip Cade. w ��'j� Date Received 5.23415 SAMPLE DATE;_`l_YJ�2J Mo. Dar Yew :'_ Time ��ac% ;r• =` w APPLIC;` -"T FILLS ®UT UPPER M�Lt ,)NLY �Property Owner i4 �'� -;, f, Phone - - r ,�' Mailing Address Z/ -- °'- Zip Code Date Date Buyer Address Zip Code 11 Lending Institution �� ;t � j _y -j C �j Ci 1 'c- i O ),j Phone Address Zip Code Inspector Realty Co. & Agent Phone Address Zip Code Legal Description Street Location GG Type of Residence , IT) Single Family � ' ❑ Multiple Family No. of Bedrooms (� ❑ Other SC�� � U �[ /� Z ECEIVED Water Supply C] Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log it available). ❑ Public Utility `CONDITIONS OF APPROVAL ! ( ) DISAPPROVED Sewer Disposal ' 0- Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank BY: j ' NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Tim Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: \ MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH C� GG ENVIRONMENTAL PROTECTION ����[�•1l � ' JUL els 0 140� � (� 7-�.� A SC�� � U �[ /� Z ECEIVED 0-lo� 1-�Z v ( APPROVED BEDROOMS '7 V `CONDITIONS OF APPROVAL ! ( ) DISAPPROVED ( ) CONDITIONA�LL APPROVAL' v DATE BY: j Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size f (� (� U � � �/79 Well to Tank -0 I. : DRILLING Co. Ji ox' X. calmer r, Log Of Wayne Bullock Well DateCompleted Oct. 15, 1963 -Location; Firelake Fisji Hatchery Road. O to'3 ft. Tpp Soil 3 to 8 ft. Clay, Sand and Small Gravel 8 to 20 ft. Grey ClaySome Small Gravel. (very Soft.) 20 to 34 ft. Grey clay layers of gravel (Kidd, so1.�e water 21 to 22 ft) � - 34 to 119 ft. Grey clay, Angular gravel, large boulders. Drilled open hole from 314.ft, to 49 ft. 49 to 53 ft. Med. Size washed gravel layers of grey clay Making Water at 52 ft. RFS' ARKS A piece of 5 inch Casing 3 ft, long And Perferated with a cutting ,torch and2 ft. of it is exsposed below the drive shoe. This screen has a solid bottom. PRODU C'TiUN : 10 gal. bailer every 50 seconds. Top of Casing to Water 14.3 ft. 2 inches 1 Rin. " " it " " 36 ft. 2 inches equals lOz GPM 1 Hin " ° " " " 30 ft. 0 inches equals 9 GPM 1 Plin " " " " " 25 ft. 6 inches equals 72 GPM (Based on one lineal ft. of water ina 6" casing equals l2 Gal.) Static Leval of Water 9 ft. from Surface. If more water is needed the casing could be perfoated 21 to22 ft. from top of casing, also 25 to 26 ft, and 31 to 32 ft, Also Pleasuring; from t.op of casing, This r=ay make another 200GPII. Having 600 G.PH. from 52 ft. sufficient water for domestic needs. Mould suggest setting pump app. 5 ft. of bottom of well. Drilled and Logged by Otto Kockritz, Jr. Palmer, Alaska. 9 r. Mr. Bullock P.O. Box 770004 Eagle River, Alaska EXCAVATION WORK 99577 August 8, 1983 ROBERT A. SHAFER CIVIL ENGINEER 694.2979 Dear Mr. Bullock, Reference: Lot 3; Block 9; Lakeridge Terrace Subdivision A sewer system adequacy test was performed on the system located on the referenced property as you requested. The septic tank was pumped and verified to have a capacity in excessof1000 gallons. The absorption trench was tested by a continuous f ow of water over a period of 24 hours without any adverse effect on the system. It can be concluded from this test that the waste water disposal system serving the three bedroom residence located on this property is current y nctionins_ adeauatbly. However, the system cannot be guaranteed against subsequent failure. If we may be of further service please do not hesitate to ichoxage Depattment of Health and Environmental Protection