HomeMy WebLinkAboutLAKEWOOD HILLS LT 8
":' ' MUNICIPALITY OF ANCHORAGE
'//~1~ DEPARTMENT OF HEALTH & ENVIRONN1ENTAL 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
M~G ~RESS '
/[ o"Trz A)-I<t 0'7/7.
Manufacture~l ~) ' Ma~a~ ~
ein gallo ns I nsidele ngth Width Liquid depth
IF HOME.DE:
DISTANCE TO: Well Dwelling PERMIT NO.
Manu[acturer Material Liquid capacity in gallons
,~ No. ofiines / I'Length°f'~in~__~>~ T°talle~hG~l~es"~ ~ ' Z~ Tren,~dth__~ inches inches Distancebetweeniines ~
· -~ Total effective a~sorption area
~ Top of tile to finish grade ~ Materi~l beneath tile
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot Pine PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s}
OTHER
PIPE MATERIALS . ~
APPROVED ' '~d~2g~ ~DATE LEGAL /
DIEPAR"I"HEN'I" OF' HEALTH AND ENV:t:ROIqMF21HTAL PRO'f'ECTION
825 I.... STFIEE:.T, AI"4[iHOF;:A(-:iE, AK' 9950 ].
2,& 4--.4'? LT-'0
F:'IiERH t 'T NO;
DATtE I,: :L4:.b;
.A F:'F'L_ ;1: CANT:
A D D R IE S S:
(30NFAC'F PHONE',:
LEGAL :OIE'L:iCI::;,' Z F':
LCI-F SZZE~
MAX BEDF;:OOMS:
WILL. (.')AY
960:1. BUD.'i}Y HE:F;:IqER
ANCHORAGL:i:, AK c795 16
346{-25'74
SUBDIVISION: LAKEW00D HILLS
SEI]T I ON ~ 14 'f'OWNSI.4 IFF': :[2. N
2996() (SC~. i:::]-. EIR ACRES)
4.
L..O]": Ei
RAIxlGE: 3W
BL.(]CI<: NA
s'ys'Len'i,, Cho:_~s(,.:.' the op't:.ior'l thai: besi:. £i'Ls your' sii'..e~
"IF' iF;i:: If]E: lt",a {:3 IF-.I!
DIEF)]"H "FO F':iiF:'E BOTTOM (Ir'T'. ) :1.0~ 0
GRAVIiii:L DIEF:"i"H (I:::"T :, ) 4 ,, 0
'I'OTAL.. DEF:'TH (~:T"['.) 14,, 0
GRAVEl_ WIDTFI (F:'T,,) 2.5
GRAVEL. LEIqGTH (l::"f',)' 75,0
GF(AVEL. VOLUME (l]l..!. YDS, ) 3 ].. 3
]"ANK SI ZE (GAl_S) ]., 250~ 0
SO]ii... RA'TIHG (S6~,,F"F, /BR) 15()
.~,e 't"ANK MUS't" HAVE A'T' I....1:.~..~. ~ 'FWO []OMF'ARTMIEIxI'i'S
:11 c(-:,rtiFy that~
...... Aricm.mage (MOA) arid the Stai:.e of' Al'asl<a.
ancl :i.l"l comi::)].&ance /~J. tl"i the design cr:i. ter'.:La oil:' this pepm:i.t.
:3. I wi].], acJhier'e i:.c:) ali. Mi]A arid State (:;t' A~aska r. eClUirem6:.)rrLs for' the ,'.:'~':," back
d:Lsi;.ances t r'om any ex :i. st :i. ng we]. ] ........... t.~.:w~,t :..~ d:i. sposa], s'yst:em or' pub]. ic:
4,, ]: unc:lerstar~d tha'L 'Lhis per'mit :i.s va.lid for a max:i, mum oi' zt. I:)edr'ocm~s ar'id
,:~[AI 1014 :Ih :l:~c ]~,I....L.I::D IN AN AREA COVERED BY MOA BUILDING
]"HIEIq ']) AN [LLt::.CI",iCAL. I:::'IERMIT AND INSt::'E[rf'I[iN MLIS]" BE I:IB"I"AINI]ED~ (2) AS.-BUZI...TS
EL. EEC-f'FII!ii;AI... WORK F'It. JST BE DOI',IIE BY A LZCENSED ELEC1T(ICIAN:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERPORMEDEOR: y
LEGAL DESCRIPTION:
5
6
7
8
9
10
11
12
13
14
15-
16-
17
18
19
20
SLOPE SITE PLAN
S
L
IF YES, AT WHAT
DEPTH? pO
E
Depth l0 Water Alter
Monitoring? Dale:
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE __
(minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN __ FTAND __ FT ' ~ ~-~(~/L~.~
' PERFORME~BY: ~ --' ~.,, ~ I ~f~ ~' e~ ~r~ CERTIFY ~HAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
(ENG NBI~R~ ~AL): ~
PERPO.MED FOR: u c.c
/
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17,
18-
19-
20-
DATE PERFORMED:
Township, Range, Section: T'/2~ Id ' i
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? p
E
Depth to Water Alter
Monitoring? Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
__ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND __ FT
PERFORMED BY: L//~('~/('~-'~ ~-'"~z~/Ul~.~//~ , /,c~/,//. ~,,)//--~ ~ ,~,-x,._~ CERTIFY THAT THiS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THiS DATE. DATE: /'~'~ ~-~ '
unicipa* Yot
Anchorage
P.O. ~"-%'( 196650
ANCHORAGE, ALASKA 99519-6650
(907) 264-4~'k'~x 4 7 4 4
TONY KNOWLES,
MAYOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
January 9, 1987
Will Gay
9601 Hillside
Anchorage, Alaska 99516
Subject: Lot 8 Lakewood Hills Subdivision
On-site Well Permit ~860005
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of January 3,
1987.
Your permit expired on the date of issue basis by authority
of Municipal Ordinance existing at that time. A new permit must
be obtained from this Department for any well and/or on-site sewer
system not installed by the expiration date. The new permit
will come under the calendar expiration date as per the new Waste-
water Ordinance (effective May 20, 1986).
If you have drilled the well, a well log needs to be sent to
this Department for documentation of the installation and to
close the permit.
If a private engineer inspected the installation of the on-site
sewer system the original as-built inspection report (three part
form) must be sent to this office for review and approval, and
for documentation.
If there are any further questions, please call this office
at 264-4744.
S~el~
R~~.W.~/R~obinson ~'----~-
Program Manager
On-site Services
RWR/ljw
enc: copy of permit
MunicipahtYof
.Anchorage
P.O. Bt..,X 196650
ANCHORAGE, ALASKA 99519-6650
(907) 264-4111
TONY KNOWLES,
MA YOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
June 23, 1986
Will Gay
9601 Hillside
Anchorage, Alaska
99516
Subject: Lot 8 Lakewood Hills Subdivision
On-site Well Permit #860005 - Issued January 3, 1986
On May 20, 1986, The Anchorage Assembly approved a new ordinance
regulating on-site wastewater disposal systems (septic systems).
Ail septic systems constructed after the effective date of this
ordinance are subject to the provisions of this ordinance.
Our records show that you currently hold a permit for the installation
of a septic system. We strongly urge that you contact this office
prior to constructing your system. Any changes in the code that could
impact the construction requirements of your septic system will be
identified and brought to your attention. Please contact the
Environmental Services Division at 264-4720.
Thank you for your cooperation.
Sincerely,
Susan E. Oswalt
Program Manager
On-site Services
SEO/SSM/ljw
DEPAR"f'MEN'f OF ,"II:::,,..,._-tH AND E]"IVIROh. IMENT'AI._ f-:'RCYT'EC]"IC]F.I
L ~ l l"u::d::. I , AI.1L..HOFu.-d:~E., -.,~,.. 9950 J.
26 4....,- 4 7 2 ()
PERM I T NO:
~... -.~ ~ [::. .I ..... ~L~E:.D.
NIL. L GAY
9601 HII_L.S:i::OE:
ANCH[)I:::-'.AGE:, AK
:~!; 46 '"'::.:'. 5 74
...Gt SIZEi:~
SUBDIVISION: I....AI'..,EWL)UD HILLS
· .~"',' I .]~.,,".'ol ] I I . t
.- ~ .... ~.- (!::;[;!. i':']' ,, OR ACF;,'IES )
LOT '.' El
f4:ANGE :: 3W
BLOCI<: I;IA
cer"L :i..,c y that:
I. Z[ am f'am:i, liar, wi't:.h the r'equJ, cemerYhs for' c:)n-...s:i, te sewel's and (.~el:l.s as set
f'or'th by the Nur~:LCil::~a:l. ity of Anchor'age (IdOA) and 't:.he StaLe c:~f' Ala. ska.
2.. I t.~]:i.:l.t :i. nsta11 'l:.he system J. ir'~ ac:c:cir'danc;(:;, ~,~J.t:.h a].l MOA cc:ides and
and in c:(::)[i~p].iar'ic:E~, ~,gith 'l:he desigr'i c:pit(epi/::t ,c)[' tl'J:i.s per'mit,,
:2;,, I w:i. li acth(.;.me tci' a~t MOA and S1:.a'[:.~:::,'c,{ Alaska 'r'-equJ. r'(mn¢.~r'yLs {(:n'¢ the set back
d:i. s1:.arn::es fr'o[A any e::<:i, st:i.r'~g ~¢,~(.:a1.1., was'Lev,~at(:.:.:,r, d:i. sposal sysCem ol' pubt:Lc
GNE:D .~.. . ..... .~ ...............
<:?F'LZCANT'~ W" ~
.. ~ ........ GA Y
A,I~CHORAGE~ ~LAI~KA
SIX INCh WATER WELL DRillED_
DrillED AT THE rate Of
PROPERTY OWNER /~/,° c~
lOCAtiON Of Well SiTE
DRILLER
_OUT TO THE DEPTH
PER FOOT. S,~P_-P-J- ¢J/~'~
WELL LOG:
0 ....
23---67' Coa..~e ~.a.~e,L, 1~ c,t~,
67---92' Sa.n.&~.f, tn.6
92--165~ ttwcdp, a.n.. g ccr~e.n~e.d
MUNICIPAUTY OF ANCHORAGE
DEPT, OF HEALTH &
......... ~:. ,~ ^~ DDF~TFI2TJOJ~J
165-219' get ~,td.i~ ,oan, d. 25% ota,t. 15% ,fd~z
lmgg°t~, Stthae, t~gh&., pu.r~Iz, 0/4 o,z 1 ko,z~e.) ~l~ottJai h~ ,trot. ad. Zed ~U. tr~ ,~o eddvf. ~et
.[.o~ c,z~,t, wL ~. ~ az~o~ o~. ,ggaz .~.idv6 hack. ,Or ,f.h.e ~a..-t.e..~,
$23°00 pe,z ~ X 225 7e~t: $5, 175.00
COST INCLUDES All LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING.
WRITE CHECK PAYAble TO RAMPART DrilliNg WOrkS FOR THE SUM OF $~ 17~o00
THANK YOU VERY MUCH.
BERNie CLAUS OF RAMPART DRilliNG WORKS
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.#
1. GENERAL INFORMATION
Complete legal description
Lo'r' g
Location (site address or directions)~:) ~1;~/N/~.~
Property owner . .
Mailing address ~g ~ ~ l 0 ~ [~ ~~, ~/~
Lending agency ~]O~ Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
NOTE:
Individual well
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and--status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev, 1/91) Front MOA #21
sluewwoo leUOH!pp¥
:suoHelnd!]s 6U!MOIIOJ eq~ q~!M 'suJooJpeq
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JOJ peAoJddV ~
a~ln.lVNglS SHHCl
'uoHoedsu! S!blt jo e~ep eql uo joejje u! suo!lelneeJ pue 'seoueu!pJo
'sepoo re, etS pue ledp!unlAJ lie qJ!M eoue!ldcuoo u! s! Luels/~s lesodslp Je~eMeiseM ]o/pue ,qddns
JeleM elfs-uo eLl~ 'uo!~oedsu! pue uo!leeRse^u! XLU uJO]~ pue sel!J eBeJOLIOUV Jo/~iled!o!unlAI eLll
UJOJJ pau!elqo uoHeguJoJu! eq1 uo peseq teql~Jpe^ JeqpnJ I 'u!eJeLt peleo!pu! eJm, onJ),s Jo ed/q pue
suJooJpeq ~o JequJnu eLI1JOJ etenbepe pue leUO!~ounj 'ejes s! LumsXs lesods!p JeleMelSeM Jo/pue
~lddns JeleM e~!s-uo eql ~eq), SMOqS uoiteo!ldde le^oJddv ,~pOgllnV LHleeH 9!LP, Jo uoHeeHse^u!
~btJ leLJl /~Jpe^ I 'MOleq UMOqS m, ep uoHeP!le^ eq~ jo se pue oteJeq pex!jJe lees ,~uJ ~q peij!peo sV
UB:INI~DN~ AB NOI.LO=IdBNI _40 1N_=IIN~J. V19
'9
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ,Z ~ /.~ ~K~ ~JDO~ /.i~IL.Z..~ Parcel I.D.
A. WELL DATA
Well type ~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed (,,-30-?/~ Driller /~4"//~/~ 7'
Cased to Z. 7..,~ / Casing height ~O #
IY" Wires properly protected (Y/N)
MUNICIPALLY' OF ANCHORAGE
AT INSPECTION ENVIRONMENTAL SERVICES DIVISION
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
· , OCT 2 4 1991
7¢ g.p.m. ~7,5- CEIVED
2. Z5'/
SEPARATION DISTANCES FROM WELL TO:
Septic/holding'tank on lot
Absorption field on lot /~L)
Public sewer main '/' /OD~
Public sewer service line
; On adjacent lots ¢-/O0
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date of sample: /0'/~,
Nitrate
Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed /[' /~' ~-"~" Tank size [
Cleanouts (Y/N) )'/ Foundation cleanout (Y/N)
High water alarm (Y/N)
Date of pumping ] O -/Z. - ~ /
Compartments
Depression (Y/N)
Alarm tested (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot /~,~ ~ On adjacent lots -/-/O 0
To propertyline ~,¢' ! ('~ '
' Absorption field
Surface water/drainage 4- /~>D /
Foundation
Water main/service line
72-076 (Rev. 3/91)Front MOA21 ' CONTINUED ON BACK PAGE
C, LIFT STATION -
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION 'FO:
Well on lot On adjacent lots
Surface water
O. ABSORPTION FIELD DATA
Date installed /
Length ~A''~ / Width
Total absorption area
Depression over field (Y/N) /%/
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/N)
Soil rating /'PO jt~'/~,~, System type "~E
Gravel thickness ~' / Total depth
Cleanouts present (Y/N)
Date of adequacy test
for
bedrooms
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot /~'(P /'~ On adjacent lots ~/00 ~
- Property line
To building foundation ~'/¢// To existing or abandoned system on
On adjacentlots '¢' ,~¢ / '
Cutbank -/-/.o 0 Water main/service line
Surface water +/~ ¢ Driveway, parking/vehicle storage area
Curtain drain ¥' /~¢
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in .~/fect (2~,~th¢?l.b~f~CCJ, his inbpection.
Signature ';.:
Engineer's Name
HAA Fee $
' '~ Waiver Fee:$
Date of Payment /¢.~ ¢ /~/ Date of Payment
Receipt Number~/ ~ ~ ~ ~ ~oco~pt Numbor
Constructing Engineers
9601 Buddy Werner Drive
Anchorage AK 99516
Attn: -
NORTHERN TESTING LABORATORIES, INC,
3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 · FAX 456-3125
2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 · FAX 274-9645
Report Date: 10/21/91
Date Arrived: 10/14/91
Date Sampled: 10/13/91
Time Sampled: 1300
Collected By: HW
Our Lab #:
Location/Project:
Your Sample ID:
Sample Matrix:
Comments:
Al14748
L8 Lakewood Hills
Water
Definitions
MDL = Method Detection
Limit
B = Below Regulatory Min.
H = Above Regulatory Max.
E = Below Detection Limit
Estimated Value
Date
Method Parameter Units Result Flag MDL Analyzed
EPA 353.3 Nitrate-N mg/1 3.1 0.1 10/18/91
Reported By: William E. Buchan
Anchorage Operations Manager
NORTHERN TESTING LABORATORIES, INC.
2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 · FAX 274-9645
3330 INDUSTRIAL WAY FAIRBANKS, ALASKA 99701 (907) 456-3116 · FAX 456-3125
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY CLIENT
/PRIVATE WATER SYSTEM
SAMPLE TYPE:
XR';Jtine
[] Special Purpose
[] Check Sample (for original contaminated
s~mple wl~ lab reference no.
State Zip Code
/~3 ?/ Phone 3¢~ '~ O-~J~
Day Year
Purchase Order No. - ~
[] Treated Water
.~Untreated Water
Laboratory Ref. No.
Collected by
9
Signature of Representative ~~/~~~
FOR LABORATORY USE ONLY /1
TO BE COMPLETED BY LABORATORY
Received at: ~/Anch.
Fbks.
Date Received/' / ~'~ -- / ¢ ~ /
Time Received /
Next Sample Due
COMMENTS:
SATISFACTORY
U N SATI S FACTORY U
RESAMPLE R
OTHER BACTERIA OB
TOO NUMEROUS TNTC
TO COUNT
DATE ANALYZED 10/14 17:00
ME~BP~NE FILTER
Direct Verification Final
Count LSB BGB Result*
?L~of Total Coliform%/ColoCes per/t00 mis.
Rephh~cT by , / J
INVOICE
SEWER AN D DRAIN
",~ ~ ~¢~,~ CLEANING SERVICE
RO. BOX 112688 PHONE 345-2513
JobAddress //.~ 7//
ANCHORAGE, ALASKA 99511-2688
//
DATE SALESMAN ~ TERMS-- 30DAYS
ROTC-ROOTER SERVICE CALL HRS.
STEAM THAWING HRS.
TRIPCHARGE HRS.
OVERTIME CHARGE HRS.
ADDITIONAL LABOR CHARGE HRS. @
PUMP,N SERV,CE.I / ; ? GAL. .RS. / @
HYDRO-J ET SERVICE HRS. .,~/
MATERIALS
PLEASE PAY FROM THIS INVOICE
TOTAL
TOTAL FOOTAGE CLEAN ED O R THAWEd, BLADES US ED ~ .
LINE CLEANED
[] JOB NOT GUARANTEEb FOR FO, LLGWIN/~_~R'~ASON
/ J / / ~/ ~'_'~..
WORKACCEPTEDBY ~ ~ /C.~ .~
AI'~CHORAGE, ALASKA
SIX INCH WATER WELL DRILLED_
Drilled At The rate OF ~23o00 PER FOOT.
ProPErtY OWNER 1]!2~o ~
LOCATION OF WELL SITE
DRiller
.__OUT TO THE DEPth Of 225 ~ce~e~o
S~c~L c.~4~ c~J~ £o 225 ~.
346-2574
WELL LOG:
0 .... 23' S.td~i. oo.o.&d. ~e.L, 355~ cd-mi- ~,Coxte~,
o~.~ ,bo,Lto=. Th.e. taa4.e/c pw~..bed cd. ewg,. 7h~ ~..,edd, raa4F
.,.~,t, c_,,W~ cd.,a.ca~y.. /?d.n. dma,,L a~otm~,_.,0 o~ J',ZOte- o.&&L ba.c.k. 40, ,th, e- taa.,Le.~-ot,w..itm.
To4.a.L coo.t, o~ g2d. d.d_~¢: ~'t23o00 p.e.,~ ~e/c X 225 7e-e.4.: ~5,175.00
ivlu~ic:i:,,.~ii~¥ oi/\nchorajj..9
Dept. Hr~alti~ & Human Serwces
COST INCLUDES ALL LABOR AND MATERIAL FOr COMPL~ION OF SAID DRILLING.
WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF ~1~5.00
THANK YOU VERY MUCH.
BERNIE CLAUS OF rAMPArt DRILLING WORKS
SERVICE CHARGEOF 1~% PER MONTH~L BE ASSESSE ·