HomeMy WebLinkAboutLAKE RIDGE TERRACE BLK 2 LT 8
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[¢~6[, Z L .LO0 Municipality of Anchorage Page
'DEPARTMENT OF HEALTH AND HUMAN SERVICES.
(~ ~ A I~ 3 -~ ~ 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: ~ ~/~/ PIDNumber: ~/~ 3/~ ~/~
Name: Wastewater System: g New ~Upgrade
Addresm ABSORPTION FIELD
Phon~¢¢_~0 JNo. of.~oom,: ~DeepTrench O Shallow Trench OBed DMound OOther
LEGAL DESCRIPTION Soil Rating: Total Depth~o~ original grade:
Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe
Townshi;~/ J..ngo: Section: -- Fill added above original grade'. Gravel length:~
~ ~ ~ 5 ~ Ft. Ft.
WELL: Ex;~r'~D' New ~Upgr~' Gravel depth: ~/O~ Numberer lines: Dislance~nlines:
3 Ft. / ~ Ct.
Classification (Private, A,B,C): / -TS{al Depth: Cased To: Total absorption area: ~ Pipe material:
Ft. Ft. ~~-~ ~ SQ. Ft.
Driller: ~ Date Drilled: Static Water Level: Installer:
Date
installed:
,~ .t. ~~ ~ ~/
~ GPM Pump Set at: .,. I c.~,.0 .~,~., ~o~e ~rou;~: TANK
SEPARATION DISTANCES ~Septic g Holding U S.T.E.P.
To Septic Absorption Lift Holding ~Privale Manufacturer: Capacity in gallons:
/,
From Tank Field Station Tank Sewer Lines
Number of Compa~ments:
~ Material:
w~. /5~~ /~ ~/~ ~/~ /7~ C~g~ /
s~,~ ~ MFT ST~TIO~
LineL°t ~ / / ~ ~ [ ~/~ //~ ~/ Size in gallons: Manufacturer:
Remarks: ~¢/Sr//Y5 ~ ~Xd/Y/T~ ~ BENCH MARK
Location and Description:
Assumed Elevation:
ENGINEER~8
Inspections performed by: ~//~/~/L~ Dates: 1st ~f~//~/
-
Department of Health and Human Services approval .
./__ '~ ~.~ ........ .,~,. ~
Reviewed and approved by: ~ ~,~ . Date: / I ......
72~013 (1/91) MOA 25
Permit No.
~/o ~_~ l Page
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
PID No.:
97.
WELL
JAMES WAY
i N 89° 53' ~
145,66'
[]TH 'f
POLE
o~ NEIGHBOR'S
SEPTIC
FIEL]}
~ Z [] - TEST HOLE
~ · - MONITOR TUBE
J~ i BR~:AK LINE 0 - SEWER CLEANOUT
-~ - WELLI
IHHH"uHH - LEACHFIELD
L ........ EASEMENT
NEIGHBOR'S ~EPTIC i IAPPRDXIHATE
~--jME^N~ER LAKE
t~ GARAGE D§nR I[HRESH[]LI}
ASSUHEB ELEVi= 100,00'
PROFILE
(NOT TO
LEVEL E 99,0
72-013 A (2/91) MOA 25
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW910281
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES
OWNER NAME:JANSEN JAMES H
OWNER ADDRESS:15149 W LAKE RIDGE DR
EAGLE RIVER, AK 99577
PARCEL ID:05131519
LEGAL DESCRIPTION: LAKE RIDGE TERRACE BLK
8
2 LT
LOT SIZE: 45263 (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:
DATE ISSUED: 9/10/91
EXPIRATION DATE: 9/10/92
lC_:,. ?/z//?×
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 (18AACS0).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH
INSPECTION. THE SEPTIC TANK MUST BE EXPOSED AND VERIFIED
FOR INTEGRITY.
RECEIVED BY:
Louis Butera, P.E.
Registered Civil Engineer
August 19, 1991
Municipality of Anchorage
On-Site Services
825 L Street
Anchorage, AK 99501
Re: Lot 8 Block 2, Lake Ridge Terrace
Narrative & Variance Request
DHHS Staff:
We are applying for a permit to construct a septic system upgrade for an existing three bedroom
single family dwelling located on the above referenced lot. Two test holes were excavated with
the only acceptable area found to be located in front of the home (S.E.) between home and Fire
Lake. There is a slope grade change where a level pad was excavated to allow a driving
surface. The slope below the pad changes to a 30% slope which will require an exception as
allowed by Municipal code. We do not feel that allowing this exception will create a situation
where effluent will exit the slope face or will create instability in the slope. The slope is a
natural slope without cuts or breaks and is completely vegetated. The system will be insulated
with 4" of burial foam and 2' soil cover to allow for continued use of area as an intermittent
driving surface.
There will be no effect on neighbor's replacement areas as neighbor's septics are in place and
are located in proximity to our septic area. Drainage patterns are not going to be changed.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
~ _ JAMES WAY4-~
-- ky/ ~ ~ /~z / _,, ~ ~ ~ EXISTING SEPTIC SYSTEM TB
~ ~ /~~~ J/ TANK TD BE ~ NEIGHBDR'S SEPTIC
~ ~ /¢ / ~/ ~/~ ] EXCAVATED
~7'0 z
NEIGHB~
4 30' ~
~ - TEST HOLE
* - MONITOR TUBE
o - SEWER CLEANOUT
~ - WELL
l',llllllllf- PROPOSED LEACHFIELD
NO KNOWN CURTAIN DRAINS EASEMENf
SEPTIC SITE PLAN
JOB ff 91 0751 DATE: 07/24/911 SCALE 1" = 60' ..*
EAGLE RIVER, AK. 99577 .
(907) 694-5195 FAX: (907) 694-3297
LEGAL:
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LOT 8, BLOCK 2, LAKE RIDGE TERRACE
GENERAL
1. The well and septic plan are for a single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of Health
and State Department of Environmental Conservation requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the
field by the engineer.
5. All excavations and depths are advisory and are to be verified or modified in the
field by the contractor to meet Municipality of Anchorage, Department of
Environmental Conservation requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements
and to locate any adjacent multi-family wells.
7. The excavation is to be exactly in the area shown on the site plan, any deviation
requires engineer approval.
8. It is always recommended that a surveyor locate the nearest lot line position and
the location of any easements.
TRENCH
1. The trench is to follow the natural land contour to maintain uniform total depth
of the trench bottom.
2. The bottom of the trench shall be level, plus or minus 1.5".
3. The total depth of the trench excavation is not to exceed 8' at any point.
4. The sewer line is to replace the existing sewer line that leads to the existing pit.
5. The trench gravel is to be covered with typar fabric material.
6. Soil or combination of soil and extruded board insulation to a depth of 6' or
equivalent is to be placed over the leachfield.
7. The area over the trench is to be finish graded to prevent ponding of surface
water runoff.
8. The septic tank and leachfield must not be closer than 100' to any existing private
well, 150' to any Class "C" well, or 200 feet to any community well.
RECOMMENDED LEACHFIELD DIMENSIONS:
TOTAL DEPTH = 8' GRAVEL DEPTH = 6'
TRENCH LENGTH = 47' TRENCH WIDTH = 3'
SOIL RATING = 0.8 GPD/FT2 BEDROOM CAPACITY = 3
SEPTIC TANK SIZE = 1,000 GALLONS
Twenty-four (24) hours notice required for all inspections.
Expose existing tank for inspection & replacement or repair if necessary.
Trench to be insulated with 4" of 35 psi burial foam.
EAGLE RIVER
,ENGINEERING SERVICES
P. O. Box 773294
EAGLE RIVER, ALASKA 99577
Phone 694-5195
Lake Ridge Terrace, Lot 8, Block 2
JOB
SHEET NO. OF
L.B. 08/12/91
CALCULATED BY DATE
CHECKED BY DATE
SCALE
i ... SePti~ Sy~tem CalC~rlati~ns
i .i i i...S~ilRating i ~! i ~i....l~.3min/kt~h i i :
~ i i i Tiench~ppl{cadonRat~
~ ~ ~ ~'~50"'"~' ~63~SFR~ui~::~'"~ 3 { ~ ~
....... ~ ........ ~ ',~Wa~e/5~fiie
....... ~ ......... ~ ............ ~ ........... h-.To~Depth: ¢
....... ~ .......... ~ ~ ~
~ ~ ~ ~ Gravel Depth
PERFORMED FOR:
LEGAL DESCRIPTION:
2
3
4-
7
10
12
13
17
20
COMMENTS
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
PERCOLATION
TEST
DATE PERFORMED:
WAS GROUND WATER
ENCOUNTERED?
SLOPE
SITE PLAN
S
O
P
IF YES, AT WHAT /}, 75- ' ?//~]'1 ~E
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE 5~-. ~l~/I ~"~ (minutes/inch)
TEST RUN BETWEEN ~"" ~- FT AND ~;;'~" FT
PERFORMED BY: ]::-~ ]~--'' '1~ ~.-~ CERTIFIED BY: ~DATE: ~z//~'/~' /
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION: ~'~' ~:~
1
3
4
5
7
8
DATE PERFORMED:
SITE PLAN
10
11
12
13
14I
15
16
17
18
19
2O
COMMENTS
WAS GROUND WATER S
L
ENCOUNTERED? Y~'~" O
P
/.,~, ~: s E
t~"- 141 IF YES, ATWHAT ~-~o~,;~.,~'M
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ~ ~,o ~ (minutes/inch)
TEST RUN BETWEEN ~::~, ~' . FT AND /'~.z¥ . FT
PERFORMED BY: ~-\~'- :~o ~°
erlifie rilli g
by
DOC Co. (IDa
SULLIYAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688.2759
OWNER OF LAND
ADDRESS , ' ' ~
LEGAL DESCRI~ION
..-
PE~IT NUMBER
DEl'TH OF WELL
STATIC LEVEL OF WATER F'[.
i,c~.--.',45'/c-.~- DRAW DOWN FT.
G.&LS. PER HR
KIND OF CASING
KIND OF FORMATION:
From :,.C: Ft. to '~: Ft. : From
From Ft. to Ft. , ,'
From ~':~," Ft. to ? ~ Ft. ..) / 4 ~ From
From. Ft. to Ft._C%, q '/ .&? f N ~ '~ From~
: -- ~ .~ From~
From Ft. to Ft.
From.~Ft. to Ft, From
From Ft. to.~Ft From
From ~ Ft. to Ft. From
From Ft. to Ft. From~
From Ft. to Ft. ' From
From Ft. to Ft. From
I Ft. to__Ft
Ft. to Ft.
Ft. to Ft..
Ft. to Ft.
Ft. to__F!
Ft. to__Ft.
Ft. to Ft.
Ft. to Ft.
Ft. to Ft.
.Ft. to Ft.
Ft. to Ft.
Ft. to__Ft
Ft. to Ft
Ft. to Ft.
Ft. to Ft.
Ft. to Ft.
Ft. to .Ft
MISCL. INFORMATION:
DRILLER'S NAME
RECEIVED
APR 0 1995
Municipality of Anchorage
Parcel I.D. #
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
C) ~" I - 31~--I~/ HAA#
GENERAL INFORMATION
Complete legal description
' - I--~~
UNIL.~VALITY OF
IRONMENTAL SERVICES DIVISION
OCT 0'7 1997
RECEIVED
Location (site address or directions
Property owner
Mailing address
Day phone
Lending'agency
Mailing address
Day phone~
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup?.
NUMBER OF BEDROOMS: "~
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: 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. 1191) Front MOA #21
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 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 i~spection.
Name of Firm
Wastsw~ Services /
Address ~i .
Engineer's signature
I & £ r~ o,~ '~.f~ '
DHHS SIGNATURE
X
Approved for --~
Disapproved.
Conditional approval for
bedrooms.
Phone ¢~ 7 ~'~/7c~
Date
bedrooms, with the followin~._stipulations:
Additional Comments
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 engideer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
' 724)?.5(Rev. 1/91) Back MOA~21
Legal Description:
A, WELL DATA
Well type ~"q'
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
MUNIC, IPALITY OF ANC~H£~,~.~A(~
Municipality of Anchorage[NVIRONMENTAL s~Rvlc~$ DIVI,SlON
DEPARTMENT OF HEALTH & HUMAN SER~/~C'rE~7
1997
Environmental Sewices Division
825 L Street, Room 502 · Anchorage, Alaska 99501 ~, gg0,TL3_A3:4744
N CE VED
Health Authority Approval Checklist
If A, B, or C, attach ADEC letter. ADEC water system number
X,(~_~ ~ Date completed
Cased to
Casing height (above ground) /
Wires properly prOtected (Y/N) '"/~::::.~'
FROM WELL LOG AT iNSPECTIO~
Date of test ~/~
~ /
Static water level
Well production g.p.m.
WATER SAMPLE RESULTS:
Coliform (~ Nitrate
Date of sample: ~/~o/~ ~-
B. SEPTIC/HOLDING TANK DATA
Date installed ~2 N~,/-.. Tank size J
Foundation cleanout (Y/N) /"J Depression (Y/N)
Collected by:
g.p.m.
Date of Pumping JO/JJ ~(~ ~Pumper
C. ABSORPTION FIELD DATA
Date installed ~'/~ /
1
Length ~ -7 Width.
Effective absorption area ~'~ ~¢-
Date of adequacy test c)/~/~.~
Fluid depth in absorption field before test (in.);
Fluid depth t~ (ins) Minutes later:
Peroxide treatment (past 12 months) (Y/N)- tJor, J~:=
72-026 (Rev. 3/96)*
~o'T'- ~¢- O(?.z~,,oom-o,'J
Other bacteria
Number of Compartments__J Cleanouts (Y/N) y
/'J 0 High water alarm (Y/N) >J//~
Soil rating (g.p.d../ft2 or 2-~,z/Jg~tm~)
!
Gravel thickness below pipe
Monitoring Tube present (Y/N)
Results (Pass/Fail)
Immediately after
Absorption rate =
~ ¢-_3 System type -T''~-'~-~/
/ /4-
~ Total depth ~'~' --
Depression over field (Y/N) /'J
For ~ bedrooms
~ ~%al. water added (in.):
¢.~.
+ .g.p.d.
If yes, give date ~/~
Date installed
Size in gallons
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
SEPARATION DISTANCES
"Pump off" level at*
*Datum %
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot IOO/4..
Absorption field on lot ~ CO/'1''
Public sewer main hJ IA
/-
Sewer/septic service line / O0 ~'
On adjacent lots
On adjacent lots
I O0/4-
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation ~' ~ Property line
Water main/service line /O ~* Surface water/drainage /00 '~
Property line
Surface water
Curtain drain
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
/ /
/O ~ Building foundation 16)
/O'D /
ENGINEER'S CERTIFICATION
I certify that l have det~rmined~ru field inspections and review
in conformanc~i~_?~_luidelinesineffect on this date.
Signature (.~/ L--~ ~r--
Engineer's Name' (J ~ ~ ,'~' ~J~
Absorption field
Wells on adjacent lots / ~"O/-/- /o0'
Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots / r=, D ¥-
[00t ~-
/O (~
u~v ~) C~._ D~J v~--~-~./z~'-//
72-026 (Rev. 3/96)*
Waiver Fee $ //~"~ ~
Date of Payment
Receipt Number --~c>~ ~2~
CT&E Ref.#
Client Name
Project Name/#
Client Sample ID
Matrix
Ordered By
PWSID
Sample Remarks:
975419001
AK Water & Wastewater Services
Lot 8,Bk 2 Lake Ridge Terrace
Lot 8,Bk 2 Lake Ridge Terrace
Drip,king Water
Client PO//
Printed Date/Time 09/14/97 17:50
Collected Date/Time 09/10/97 13:00
Received Date/Time 09/11/97 09:00
Technical Director: Stephen C. Ede
Resu[ ts PQL Uni ts I,tet hod
Allowable Prep Analysis
Limits Date Date Init
Hitrate-N 4.56 0.200 mg/L SM18 4500-NO3F 10 max 09/12/97
Total Coliform 0.00 co[/lOOmL SM18 9222B 09/11/97
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
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description
Location (site address or directions) ]~1~/~ (.~), [-,~4~. ~',~ ~z._~
Property owner --~T~c~-~ ~-~',w~$c,,~ Day phone (-¢~o/~.. Z'Z c.~a
Mailing address /,~ /¢0 iJJ. [-~,~,~ C)~..~ '-~, ~P-. ~
Lending agency Day phone
Mailing address
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 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 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
Address
Engineer's signature
Phone
DHHS SIGNATURE
Approved .for / _,~ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulati~)ns:
Additional Comments
By:
Date
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 order to satisfy certain federal and state requirements. Em ployees 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.
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~,.r ~> ~-~ ~'~ Parcel I.D. ~)O~//--:~57/¢
A. WELL DATA
Well type IE>/'~/O'q~'~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
If A, B, or C, attach ADEC letter. ADEC water system number
'Y' Date completed ~5~4~ Driller
~ Cased to ~ ~/~ Casing height
~/ ~ Wires properly protected (Y/N)
Pump level
FROM WELL LOG
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
13o
g.p.m.
AT INSPECTION
O z
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank ,'f~ ~
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate
~ ,~ ~ Other bacteria
Collected by: J~
B. SEPTIC/HOLDING TANK DATA
Date installed ~'~ ~
Cleanouts (Y/N) ~
High water alarm (Y/N)
Date of pumping
Tank size ~. ?.-.~---C) Compartments ]
Foundation cleanout (Y/N) /(,/' ~ Depression (y/N) ~
'~//~ ,Alarm tested (Y/N) ,'~/'~
SEPARATION DISTANCES FROM SEPTIC/HDLDING TANK TO:
Well(s) on lot I ~ ~L- On adjacent lots
To property line ~"'/ Absorption field i ~O
Foundation
Water main/service line.
Surface water/drainage
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 TO:
Well on lot On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed Soil rating
Length ~ f' ~ ~
Total absorption area
Depression over field (Y/N) ~
Results (pass/fail)
?/5
Width
Peroxide treatment (past 12 months) (Y/N)
Gravel thickness _/~ ¢
Cleanouts present (Y/N)
Date of adequacy test
for
System type
Total depth ~""
bedrooms
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot /,'~ ~'~
To building foundation
On adjacent lots
Surface water
Curtain drain '~,///-~
On adjacent lots I°(a+ Property line
To existing or abandoned system on lot (;,o
Cutbank /~ ~'./z.. " , Watermain/serviceline
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
,' -~vJd R. Dayton P.E.
... ~?.10 Donalar St.
Signature . ..,.,.
Engineer's Name
Date
HAA Fee $ ,,/~cO
Date of Fayment
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
'D. R. DAYTON, P.E., R.L.S.
~l~xX~~f~ Chugiak, Alaska 99567
20210 Donalar St.
(907) ~x~
696-2417
April 19, 1993
WELL FLOW TEST
Legal Description: Lot 8, Block 2, Lake Ridge Terrace
Date of Test: April 18, 1993
Depth of Well: .58'
Static Water Level: 40.8'
Driller: Sullivan Water Wells
Requirements: 3 bedroom - 450 gallons per day
Test:
The well was pumped with the existing pump through an outside
hose bib. The valves were fully open.
Time, volume and._drawdown were monitored throughout the pumping
period.
Results:
The well produced 572 gallons in 126 minutes for an average flow
of 4.5+ gallons per minute. Maximum flow was 4.6 gpm with a maximum
drawdown of 0.8'
The well is currently producing adequately for a 3 bedroom home.
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
5633 B STREET
Chemlab Ref.S :93.1618-1
Client Sample ID :L8 B2 LAKE RIDGE TERRACE
Matrix : WATER
Client Name :DAVID DAYTON. P.E.
Ordered By :DAVID DAYTON
Project Name :
Projects :
PWSlD :UA
ANCHORAGE, ALASKA99518 TELEPHONE (907) 562-2343 FAX:(907) 551-5301
REPORT of ANALYSIS
Collected :04/16/93 @ 09:00 h~s.
Received :04/16/93 @ 10:45
WORK Order :65059
Report Completed :04/19/93
Technical Director :STEPHEN C. EDE
Released By : ~z~~
Sample
Remarks:
ROUTINE SAMPLE COLLECTED BY: D.R.D.
QC Allowable Extract Analysis
Parameter Results Qual. Units Method Limits Date Date Init
NITRATE-N 3.30 mg/1 EPA 353.2/300.0 10 04/19/93 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
~{~)_~r~_~ M~mh~r nfth~ SGS Grouo (Soci~t~ G~n~rale de Su~eillance~
COMMERCIAL TESTING & ENGINEERING CO. AK DIV
CHEMICAL & GEOLOGICAL LABORATORY
TELEPHONE (907) 562-2343 5633 B Street
Anchorage, Alaska 99518.
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
[] PUBLIC WATER SYSTEM I.D. #
/I~PRIVATE WATER SYSTEM
Name Ph~e No, ,
M ailing Address
City
Mo. Day Year
SAMPLE TYPE:
) [] Treated Water
~' Untreated Water
,,[~,,Boutine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
SAMPLE
No. LOCATION
31 I
41 I
I
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
atisfactory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be over 30 hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received '~'/~ ~'
Time Received ' IOz['~
Analytical Method: Membrane Filter
* No. of colonies/100 mi.
Lab Ref. No. Result*
93.1618
I
I
Analyst
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
TNTC = Too Numerous To Count ~/
OB = Other Bacteria
~S~S Member of theSGSGroup(Soc
BACTERIOLOGICAL WATER ANALYSIS RECORD
Membrane Filter: Direct Count
Verification: LSB
Fecal Coliform Confirmation
Final Membrane Filter Results
Reported By
C~
Coliform/100 mi
BGB
C°llfora/100 mi
.... /~ ~ ..m.
PART ONE OF TWO
REMAINDER TO FOLLOW