HomeMy WebLinkAboutLAKE RIDGE TERRACE BLK 7A LT 1
~~ 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 I E~NEW
/ ,
~ < l ~. ~/~ ~ / No. of compartments
~ ~ Liq~y~allons Inside length Width Liquid depth
I / ~E~ IF HOMEMADE:
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O ~ < Manufacturer Material Liquid capacity in gallons
Distance between li~es
~i ~ No. oflines / Length~f~h,ne Tota~tho¢lines Trenc~idth i(
~: : ¢ t ~O inches Total eff~v~bs,~rp~a
, p Top of t~o f~ish grade M~¢riak~ene~¢ t~le
Length WMth Cepth PERMIT NO.
~ p Type of crib Crib diame Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class~ ~ / .~ ~th~/ ~ ~_ Driller Distance to lot line PERMITNO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER ~j~
PIPE MATERIALS
REMARKS ~ ~¢
APPROVED ~ g~ ~. ~,~¢g~ DATE . LEGAL
STREET, ANCHORAGE.,, AK 9950:t. 264-4720
PERMIT NO:
DATE ISSUED:
APPLICANT:
ADDRESS:
CONTACT F"'HONE:
LEGAL DESCRIP:
LOT SIZE:
LOT I_OCAT I ON:
C/O S & S ENG'G. DOUG COOK
SRB 196X
EAGLE RIVER, Al< 99577
694-2979
SUBDIVISION: LAKERIDGE TERRACE
SECTION: 36 TOWNSFIIP: 15N
24124 (SQ.FT. OR ACRES)
LAKERIDGE DRIVE
LOT: 1 BLOCK:: 7A
RANGE: 1W
I certify that:
:[. I am familiar with the requirements CoP on-site se~.ers and ~gells as set
£orth by the Municipality o£ Anchorage (MOA) and the' State o£ Alaska.
~. I ~.,il! instaI1 the system in accordance w'ith all MOA codes and regulations~
and in compliance with the design criteria of' this permit.
-3. I will adhere 'Lo all MOA' and State o¢ Alasl<a requirements fop the ~e.t back
distances £rom any existing well, wastewater disposal system or public
sewerage :system on this or any adjacent Or nearby lot..
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL' PERMIT AND INSPECTION MUST BE OBTAINED; (~2) AS-BUILTS
WILL NOT BE APF'ROVED WITI~IOUT AN ELECTRICAl.. INSPECTION REF'ORT; ANB (3) THE
EI_EI~.RICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
S I GNED
AF'PL. I {]AFI]-:
ISSUED BY
C/O S ~7.'S Ei';IG'G.~ DOUG C-.OBI<.'./
......................
PERFORMED FOR:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SLOPE
[] SOILS LOG
PERCOLATION
TEST
SITE PLAN
10
11
WAS GROUND WATER A I S
ENCOUNTERED? ~ O OL
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE (minutes/inch)
TEST RUN .ETWEEN FT AND 4¢ . FT
, .- CEF~iiFiEDy~~j'~'/''
12
13
14
15
16
17
18
19
20
COMMENTS
PERFORMED BY:
L~MUNICIpALITY OF ANCHORAGE
Hca and Environmental Prote ~n
Fourth Floor West
825 L Street
Anchorage, Alaska 99501
279-2511, x 224, 225
-~., ,,~,~ INSPECTION REPORT ON-SiTE SEWAGE DISPOSAL SYSTEM ,
SEPTIC TANK:
' ............ COMP^RTMEN 'sNUM' ER Or
FRbB WEEL_~' _-- MANUFACI'URE"
INSIDE LENGTH IN~IOE WIDTH ~ LIQUID DEPTH LIQUID CAPACIT .__ GALLONS.
r'Tfb ~. U H^ VN-f~LD:
r~ ~>~ / g ~.~ / TOTAL LENGTH'"-~-
DISTANCE FROM WELL ~_.C~.__ _FOUNDATION NEAREST LOT L NE_._~.__~ ..... OF LINE
¢ Of L~nes -A- DISTANCE BETWEEN LINES ~/~ _ TRENCHWIDTF~_IN. TOTAL EFFECTIVE
ABSORPTION AREA ~0 SQ. F~. LENGTH OF EACH LINE
/DEPTt'{ OF FILTER
DE~TIh TOP OF TILE TO FINISH GRADE__ _ MATERIAl_ [~ENEATH TiLE ~ABOVE TILE ~ .IN.
SEEPAGE PIT:
Log Crib Rings
BUILDING FOUNDATION
DIAMETER __ OR WIDTH LENGTH , DEPTH
Crib Size: DIAMETER___DEP'FH__ DISTANCE FROM: WELL __
TOTAL EFFECTIVE
NEAREST LOT LINE ..... ABSORPTION'AREA (WALL AREA)
~$Q. FT.
Well' Ex rceh,,,.rq .
Clas's:
~ .' /Depth:
Well D'~ ~o:' Lot Line
Bldg: Sewer Line:
Pipe Materials:~s~r~
# of Bedrooms:
Installer:
Remarks:- /.~/¢
i"iFt;:.:lZl:hl!...ij"l i'-,lt..tt"11~!diiill:~: Eft::' !i!i~lEI;;:,l;i:EiEii'"l:E; .... ;;ii:
t I-.d:: LJiENG"f'H 111:, :t: i"lEi:l'.,!:':i; :!; O!'.,i :i: !ii; THE; I..l::r.,] :~ I i.'~ ,' :I: I'.,I F:'IEiET ;:, Eft: THE 'T'I-,i:ENE:H r" I:;-': [;:,F.:I:::1:1; NI::' :1: iEt....t%
'f'HIE i;::,liil;l:::"l"i...! f"t::' i::t 'i"F?.EiNE:H O1:;;: F:'ZT ;I;E; TH[il; F, ]":;; "f'I::I "I Z E; EdE'T'i.,.iEiEN THIE ':..: .l:~'l::'Fir':i::' i;;;11:::' 'i"HIE
F!il:;;u'" . i'.1i', t':li'.,![::, 'THIE E: ';1 'T'T 1'~ I',1 OF: "I",~-IE !F'X ~' i::¢v'l'::l'T' '[ Oi~.,I ,:; ;I; !'.,1 i::'EE."T 1:,.
'i"HiEi:;i:E ;i1 :iii; I",IE~ :!E;E'T t.,.! ;[ [;:,"t'H F[:)I:;~:
THiE ":i l: :'l::: ' ..... '~::' [;:qEI:::'TH :[ '_.'ii; 'THE i'1.[I41!, ' ' 'lJ' ',1 E:,EF:'"i"H CiI:: ....... . I I-I"[:"'L I:i!',EiiTI.,.!IEEN "I"HE '" . Ti:::'I::II I I::' :t11:::'IE
I::'li'.,i[;:, THE: E',O T'T'Eff,1 OF' '~,'HE I!!i2.:;C:i::i',,,'I:::IT ;t: Oi'-,I ,' :I1N I:::!iEIE'T' ',
i ".. : ::.. [i ..... :!~ii;; ~,~ii!i: F;:" '"'ii'"' 1111 I1'".'[ '%' II::::1t !',"..,..] I!'<:" :iE;; % ;',;E:: E.C: ........ ::il.._ i:.':::~ ~,:::::il ~l;:::.:.~! C::i!~ IF:l! L.. it.......
OE~E
GEOi _CHNICAL Er DEVEL~_. 'MENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster Earl Ellis
694-2774 S0~L L0(~ 688-2280
Soils ~t Foundations Land Development
Performed for:
Legal Description:
Depth (feet)
0
~Tel. No,_
Mailing Address:
Z~7- /, Z~'~ ?~,
10.
14
15
16
Ground Water Encountered: Yes
Proposed Installation: Seepage Pit Drain Fie3d
Comments: t~ Z_~_.~.z-~_.~d~-~.~(W~_~.# ~/7~....~.~/.~ /~/
. . ~~~_~ ~/~, /t~
No ~ If yes, wh~t depth
F'EI~:M I T NC
DEPRRI"MENT' IERLTH RND EN,- ' IF.. ...... JNME[I1 HL TECTION
,_-, .%, .~ ,-- , .......
...... "L :,TREET., RNCHORRGE., RK.
tl...t EE: Il_ L_ F" E: F-_" I-"1 ~
,:: 77R:_=:5 ;:,
RF:'F'L I CRNT
L.C~E:RT ~ ON
LEGRL
R';]EERT .I KRR[_L E,L,:~ 7:!. ERGLE F..I ,ER RK
N GLENN & WEST LRKERIDGE
L1 E:TR LRKERI[:,GE TERRFtCE E;UE:[:, ,LOT ~;IZE
2,:~±24. E;C!UI-:IRE FEET
fdZNIMUM DISTRNCE BETWEEN R WELL RN[.':, RN"r' ON-.SITE E;EI4RGE DISPOSRL
2b...'3E~ FEET FOR R PF.'.]~","RTE HELL OR 26.~.'3 FEET FOR R PUBI...IC WEL.t ....
14ELL L..O6L-] RRE REQLIIRE[:' RND ftUL=;T BE RETURNED TO THE r~EPRF..'-f'I','IENT WZTHII'.~ ~;~.--~
OF THE WELL COMF'LETION.
SPEC:IFICFITION'.-] RND CON':;TRIJCTION DIRGRRblS RRE R',,,'RILI--.IE,'LE TO ZN';SURE PROF'ER
I NSTRLLRT :[ ON.
I CERTIFI"¢ THFIT
t: I RM F'RMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH B"r' THE f'ILINICIPRLIT'T' OF' RNCHORRGE.
2: I WILL INSTRLL THE 'S'T'S;TEM IN RCCORDRNCE WITH THE C:O[:,ES.
...........................
.............. .....
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES_
Division of Environmental Services
. : ~ On-SiteServices Section.
P.O. Box 196650 .Anchorage, Alaska 99519-6650
_.. 343-4744 .
.. .- ~-.-~ ;. .~ . ~ ~ - '~
'. - CERTIFICATE OF HEALTH AUTHORITY
. APPROVAL FOR A SINGLE FAMILY DWELLING
0 '1
Parcel I.D. #
1. GENERAL INFORMATION
,Complete -legal description
Location (site address or directions) 74532 W. Lake.~Zd,qe Drive
Prope=rty owner '-"'~..Do~g a~d McJ~y Coo~ Day phone
Mailing address 14532 W. Lak~dg~ D~v6 E~l~ ~u~, AK
Community well
Public water
Lending agency
Mailing address
. Agent' l/irgi~ KohficZd/ REMA× OF EAGLE RIVER
· Address 16600 C'~rut~fie. ld "Ea,ql~
Unless otherwise requested, HAA will be held for pickup.'
2. NUMBER OF BEDROOMS:~ - "."
696-3644
9957~
Day phone
Day phone
AK 9957~
694-4200
If community well system, provide written confirmation from State ADEC attest-
NOTE:
lng to the legality and status of system.
4. TYPE oFwAsTEWATE DISPOSAL: ......... --" .... - ' '
Individual on-site X×X
-- :.: _* .: - co mm~jn'ity o~:~site '." !."; 'i --' "' ::'
· , ,- ....: . .:. __.. :--.-~ ..... -,~. :C~,-:. _:.,.- :, - .....
. -~ ~:: ~:. ;.~;' NOTE: ,, ifcomm~ni~.wastewater sYStem,'proVide Wri n confirmation from State ADEC ..",;::.:~
.' ', .-: ~: a~estmg to the legahty and status of system.· v.; :-.: ~:~ .., - ::. .- . :.. :.:- :? :~ -:.:' ~ ~.~-:/~:
:J¢:'.~..--'.-~..-'.. -. ' : '..,'. '- : '. "~.:-'~": ., :~--~ -),'t-~ct~-i'. ,;$'. ~/~ '- ';.: ,.. ~" · '
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date sh own below, I verify that my
investigation 0f 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 Munici pal and State codes,
ordinances, and regulations n effect on the date of this inspection.
Engineer's signatu
6. DHHS SIGNATURE
..... ' ..... Approved':'"¢'~: ""; for'
DisapprOved.
Conditional approval for
bedrooms.
'¢'Additional C6mments
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 courte~yto purchasers of homes -i ~_-.
and their lending institutions in order to satisfy certa n federal and state requirements. EmPloyees of DHHS do not "
'cohduct"ins~ectio'n,~ :~or analyze :data before 'a certificate is iSSued. The" Mun c pa ity of Anchorage~ is not !'
Legal Description:
A. Well Data
Well type
Log present (Y~.
Total depth
Sanitary seal
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
I~L,,~'~A ~?..~o~,£ Parcel I.D. --~._
If A, B, or C, attach ADEC letter. ADEC water system number
/~ Date completed ~',~" . Driller
Cased to ~7/° ~ ~ casing height
Wires properly protected
g.p.m.
FROM WELL LOG
Date of test
WellStatic water level flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
AT INSPECTION
~/~
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform ~)
Date of sample: c~ . \ 5' - Cl z~
Nitrate
~. ~% ~5 Other bacteria
Collected by: ~
B. SEPTIC/HOLDING TANK DATA
Date installed
Cleanouts Y~)
High water alarm
Date of pumping
Tank size \ ~ c~ ~ Compartments
Foundation cleanout (Y~ /'~ Depression (Y~
/~ Alarm tested (Y/N)
~ ~ Pumper _.~/~.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot to(-~ v~ On adjacent lots
To property line l ~ ~ ~' Absorption field
Surface water/drainage / (> c,
Foundation
Water main/service line
:, · , CONTINUED ON BACK PAGE
72-026 (3/93)° Front : : ....
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
"Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N) ~
SEPARATION DIST~IGE-F~OM LIFT STATION TO:
On adjacent lots
Manufacturer
Manhole/Access (Y/N)
Surface water
D, ABSORPTION FIELD DATA
Date installed / '~ ~ ~
Length ~'~ /
Total absorption area
Date of adequacy test
Width
~,¢O ¢ Cleanout present. N)
~-'/,5"¥- ~ ~ Resuit~fail)
Soil rating (GPD/Ft2)
5" ' Gravel thickness
/
Water level in absorption field before test '~ '~
Peroxide treatment (past 12 months) ("~ /-/,~J ~ ~Z~.J',~ ~/,/
~" ~ Total depth
Depression over field (Y/J~.
for ~ Bedrooms
After test -~
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot / o ~
To building foundation
On adjacent lots
Sudace water
Curtain drain
adjacent lots \ ~. ~''~ Property line
To existing or abandoned system on lot
Cutbank "J'/,~.-- Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I cerb'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature
Engineer's Name
Date
HAA Fee $ ,~ ~E¢)' ¢'~
Date of Payment
Receipt Number
Date of Payment
Receipt Number
CT&.E R~f.#
Client Sample tD
Matri×
Commercial Testing & Engineering Co.
Environmental Laboratory Services ~~
LABORATORY ANALYSIS REPORT
94.4756-5
LOT l BLK 7A I ,A KI='.ILU'{GE
WA 1'1~'1~.
C1[e,~tt Name S & 8 I-;NGINEERING WORK Ordcr 82338
Ordered By R, 81L&F£R prjat~d Date 09/20/94 @09:30 tu's.
ProjectNa,ne ', Collec.ted Date 09/15/94
Project# I~ceiv cd 1)~t¢ 09/16/9,1 (..& 10:ti0 hrs.
PWSID ISA
'l'echnleal Dircul
Stunpl~ P,.e~larks: lXOlrl"hN~E SAMPI.ECOLLECTED BY: _RAY.
QC Allowable Ext. Alu'~l
Parameter Resul'~s Qual l.l~lit.q Method I,imlts Dale Date Init
1.98 mg/L ISPA 353.2/300.0 10
Nitrate-N ...........................................................
* Sec Spc¢iul Instn~ctim)~ Above
** S ,~. Sample Renuu'ks Above
t.f = Und~t ~cte~ Reported val0c is thc practical q~mtifi cation I imit.
1) = 8eco~da~7 dilution.
UA. =. Ulmvailable
N'A = Not/malyzed
LT = Le,q.q Than
OT = Greater Than
5633 El Street, Anchorage, AK 99,518-1600 -- Tel: (907) 562-2343 Fax: {907) 551-5301
~ ' - DA~E RECEIVED
~ INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
~ ~UNICIPALI~ OF ANCHO~OE
DEPT. OF I~gALTH &
MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL FF, OTECTION
825 L Street- Anchorage. Alaska 99501 JAN 2 2 1980
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROP~Y OWNER PHONE
~AI LING ADDreSS
P~OPE~TY ~ESlDENT~ifferen~ from 8hove) / P~ONE
3, L~DINGINSTITUTION J PHONE
I
~. ~E~O~/~g~NT~ X ~, ~ ~ J PHONE
MAI~ADDRESS " ." ~ .'"~. /
5. LEGAL DESCRIPTION ~ ""'~ ~' ~ Ou~
STREET LOCATION
6. TYPE OF RESIDENCE J NUMBER OF~BEDROOMS
[] One [] Four [] Other~
[] SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
7. WATER SUPPLY [] INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
*ATTACH WELL LOG. Awell Icg is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach Icg if available.)
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79) i/
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tank or [] Holding Tank
Size: i ~h(!)() If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
-4. DISTANCESwEL.L TO: Septic/Holding Tank Absorption. Area Sewer Line t L
~Absorption Area to nearest Lot Line
PPROVED FOR .~.-~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY