HomeMy WebLinkAboutLAKE RIDGE TERRACE BLK 9 LT 6
Municipality of Anchorage Page / of
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: ~Vk/~ 4~-.7. PID Number: ,~)-'~[ - ~--~- ~
Name:
~F~ ~ ~¢~¢~ ~~% wastewater System: ~ New ~ Upgrade
~d~,~:Iq~lq ~[~Lp. ~/~/~ ~[C ABSORPTIONFIELD
Phone: ¢ Ho. of Bedroom: U Deep Trench ~ ShaltowTrench O Bed ~ Mound
LE GAL D ESCRI PTI O N so, R~ting: Total Depth from~g~l grade:
GPD/Sq. Ft. ~h~
Lot: ~ BIock~ , ~ ~ubdiv~ion: Depth to pipe bottom from original grade:/ beneath pipe
Township: I Range: I SCion: Fill added above origin,, gr Gravel length:
WELL: g New g Upgr~ g~ve, wid,h: ~ Number of ,,nes:
GJ~ssiJiosJion (PHv~le, A,B,G): To~I D~ ' 08sed To: ToI~I 8b~n ~res: Pipe
Driller: ~' ~ / Date Drilled: Static Water Level: I~staller: O~te inst~lled:
SEPARATION DISTANCES D Septic ~Holding B S.T.E.P.
To Septic A~somtlon Lt. Holding PublipPrivate Manu~ ~ Capacity ingallons:
From Tank Field Station Tank ~wer Lin~ . ~
Well- -- -- __ F~l~ -- Material: ~/~/ Number of Compadments: /
Sudace
Water -- ~ / 00~+ ~ LIFT STATION
LineL°t ~ ~ ~ /~1 · ~ Size in gallons: Manufacturer:
, ~v High
Foundation ~ ~ ~ / ~ ~ ~ "Pump on" level at: el at: water alarm at:
Curtain ~ m~
Drain ~ ~ -- / ~ ~ Pu Electrical Inspections pedormed by:
Remarks: ~¢/~¢ /~2 /~P/~/ BENCH MARK
. ~/~ ~ Location and Description:~
/ J Assum~ Elevation:
~':- ENGINEER'S SEAL
Inspections pedormed by: ~¢~~ Bates: 1st J," ""-..,
Department of Health and Human Se~ices approval
Reviewed and approved by: ~ Date: G'z~'~
72-013 IRev. 9/91) MOA 25
AS-BUILT SYST£H DETAILS/SITE PLAN Pe~ swssoso7
LAKBRIDGE TERRACE S/~ 9L~CK 9 LBT 6 PIS~O51-3a2-09
May Mean~
A-C=31,4' ~ ~
] ~1250 GAL
~ ~ PREPaRE~ FBR: SCALE, NTS ..,
~a~' ' ~ I. BERT ~ YVDNNE SBUN~S
, EAGLE RIVER, AK 99577
~ :: ...... ~ (907)696-0555 .'
-~ e~, ~/~'.4~ ~ssu...: oa~[: 9/]6/9a EAGLE RIVER, AK 99577-8736
MUNICIPALITY OF ANCHORAGE
Deparfment of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Aug 17, 1998
Expiration Date: Aug 17, 1999
Permit Number: SW980307
Legal Description: LAKE~ RIDGE TERRACE BLK 9 LT 6
Design Engineer: 71
Owner Name: BERT BOUNDS
Owner Address: 14214 HAROLD LP
EAGLE RIVER , AK 99577-3948
Parcel ID: 051-323-09
Site Address: 014214 HAROLD LP
Lot Size: 24893 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] SepticTank [] Holding Tank [] Privy
[] Private Well [] Water Storage
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 ( 18AACS0 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Municipality of Anchorage
REQUEST FOR VOUCHER CHECK
FROM: Health & Human Services
TO:
DATE:
(DEPARTMENT)
MUNICIPAL CONTROLLER
September 14, 1998
R 82273
THIS SECTION FOR ACCOUNTS PAYABLE USE ONLY
1099 VOUCHER NO. PAYMENTDT. V VENDOR NO.
REFERENCE NO. INVOICE DATE INVOICE NO.
CHECK NO. CHECK DATE PREP APPR
1. REQUEST THAT A MUNICIPALITY OF ANCHORAGE CHECK BE ISSUED TO:
Name KND Engineering
Address 20441 Ptarmigan Boulevard
Eagle River, Alaska 99577
2. THIS PAYMENT IS FOR THE FOLLOWING (SUBSTANTIATION ATTACHED):
Lot 6 Block 9 Lake Ridge Terrace Waiver application #WR980050; has been requested to be
refunded. They thought at the beginning of the installation they would need this waiver to
install the new holding tank. They are going to be able to meet the proper required
distances and the waiver is not needed or required at this time. Please refund the waiver
fee.
3. DISPOSITION OF CHECK:
fl) ~x MAILTOPAYEE
~2) [] MAIL TO PAYEE WITH ATTACHMENT
(3) [] NOTIFY PAYEE TO PICK UP IN TREASURY
Name:
Phone #:
(6) []
Org. #:
AUTHORIZED USE ONLY
NOTIFY DEPARTMENT EMPLOYEE
WHEN CHECK IS READY IN FINANCE
Phone #:
4. ACCOUNTS TO BE CHARGED:
ITEM ENTER ALL POSITIONS OF ACCOUNTING DISTRIBUTION
NO, DESCRIPTION Org/CC Acct/Obi Task Opt Cost Ctr. Wa/Wo AMOUNT
i T, Ln] :o S, tr:'a,:e W t,r W~i,e 5;0 ,;; ..... 625.00
i:
5. TOTAL AMOUNT OF CHECK $ 625.00
Employee Phone No. ~ Approving Authority
INSTRUCTIONS
a. To be used only when payment cannot be made by purchase order, travel expense report, travel authorization or petty cash.
b. Must be approved by deparlment head unless approval authority is delegated in accordance with Policy and Procedure 24-7.
c. Retain carbon copy for your file.
WR# WR980050 PID# 051-323-09
Date Received: August 12~ 1998
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
HA#
Permit
Legal Description: Lot 6 Block 9 Lake Ridge Terrace
Engineer: Ken Duffus, P.E., KND Engineering
20441 Ptarmigan Boulevard, Ea~le River, Alaska 99577
Applicant: Bert Bounds
Waiver Requested: New holding tank to be installed to the surface water of
70 feet.
Criteria: 1. Geology: Points:
A. Water Table
B. Soil Sorption
C. Permeability
Do Water Table Gradient
E. Horizontal Separation
TOTAL: ~
3. Other: .~.~j!. 7_~~
Waiver is~OT Granted:
2. Special Conditions:
Waiver is Granted:
List Conditions or Reasons for above:
Date:
Rec #: 04022/4185
By:
Amount: $ 625.00
Name of Reviewer
Date Paid: 8-12-98
(907)696-6111~FAX (907)696-8111
August 11, 1998
Municipality of Anchorage
Dept. of Health & Human Services
On-Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519-6650
Subject:
Upgrade Sewer Permit and Separation Waiver to Open Water -
Lakeridge Terrace S/D, Block 9 Lot 6
Gentlemen:
On July 15, 1998, we excavated one testhole for the subject property. The results of
this test and water monitoring are attached.
There is an existing waiver of 90 feet from the well the septic tank. Both the tank
and field are within 35 feet of slopes in excess on 25% and there is a small creek that
meanders along the south property line approximately 35 feet from the existing
field. The field area was investigated several times over the last couple of years and
the surrounding ground adjacent to the field and in the rear of the house becomes
noticeably saturated through visual inspection during certain times of the year.
Originally the system was permitted for a holding tank but was field changed to a
allow a soil adsorption bed.
Although the test hole indicates that the soils could support an on-site system, there
is insufficient area along with numerous other deficiencies that render the
placement of an on-site system at best questionable. We are therefore requesting a
permit to install a holding tank at this time pending the future extension of sewer to
the neighborhood, which is in close proximity. Although we have placed the
holding tank outside the well radius we encroach into the 100' setback from open
water, due to a small creek along the southern portion of the lot. We are therefore
requesting a waiver of 70' to an open water source, while maintaining proper
separation to the existing well.
The testhole (98-1) had tight soils at the bottom and registered 5.5" of water upon
monitoring. We do not anticipate additional fill being needed over the holding
tank. This lot slopes from northeast to southwest at approximately 2-5%, which is
away from the house and any surrounding wells. A steep slope approximately 35'
west of the existing house exceeds 25%.
There are no public or private wells within 100' of our proposed system location
except as noted. We are requesting a waiver to approximately 70 feet to surface water
Subject: Upgrade Sewer Permit & Separation Waiver to Open Water - Lakeridge Terrace S/D, Block 9 Lot 6
August 12 1998
Page 2 of 2
along the south property line as noted. With the adverse lot conditions present the
holding tank provides the greatest protection for minimizing contamination of the
surface water. Additional separation will provided if possible during construction.
There are no known curtain drains within 50'. We do not expect that there will be
any adverse effect on adjacent lots by the development of this system.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
~bqi~) Engineering
~fus, P.~.
attachments: On-Site Water and Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
WASTE /ATER DISPOSAL SYSTEM DETAILS/SITE
LAKERIDGE TERRACE S/D, ]}LOCK 9 LOT 6
LOT 9
LnT 5
PLAN
LnT 8
LOT 7
LOT 6
LOT 4
LOT 3
SHALL CREEK
DESIGN DETAILS
ROLO
LnT 5
LOOP
LOT 4
VACANT
NO PUBLIC WELLS WITHIN ~00' DF
PROPOSED SYSTEH,
ND PRIVATE WELLS W]TH[N 800' DF
PROPOSED SYSTEH EXCEPT AS NDTED,
NO SEPTIC SYSTEHS WITHIN 200' DF
PROPOSED WELL EXCEPT AS NOTED,
INSTALL 3000 GAL. HOLDING TANK W/ALARM.
ABANDON EXISTING TANK AND FIELD IN PLACE.
IF WATER IS ENCOUNTERED DURING EXCAVATION CONTRACTOR TD CONTACT ENGINEER.
CONTRACTOR MAYBE REQUIRED TO INSTALL SADDLE TOg BY THE ENGINEER.
IF SADDLE IS REQUIRED A CHANGE ORDER WILL BE ISSUE]) DY THE ENGINEER,
NOTES~
1. USE 3000 GALLON HOLDING TANK, INSULATE TANK IF <4' COVER,
INSULATE TRENCHES WITH 2' HD BURIAL FOAM.
3. CONTRACTOR WILL ENSURE MAXIMUM aX SLOPE INTO HOLDING TANK,
4, ADDITIONAL FILL WILL BE ADDED OVER TANK TO ACHIEVE
MIN. 3' COVER. SOIL TO BE COMPACTED TO 85% DENSITY,
5, CONTRACTOR TO VERIFY SEPARATION DIST. BETWEEN WELL & TANK.
PREPARED FOR:
BERT & YVONNE BOUNDS
14214 HAROLD LOOP
EAGLE RIVER, AK 99577
(907)696-0555
FIELD BOOKS
COMPUTED:
BOUNDARY:__ DRAYS: EMD
STAKING: -- CHECKED: KMD
ASDUILT:
DWO. FILE:
ACAO PILE: 98093.DWG
OATE: 8/10/98
GRID: NW553
JOB No.: 98093
SccLe: 1"= 100'
PAGE 1 OF 1
~ ~[ ~) ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-5756
I (90?)696-6111/FAX (907)696-8111
K
WaST£WATER DISPOSAL SYSTEM DETAILS
RABBIT CREEK VIEW S/D BLOCK 4 LOT 2
T- 898-
PREPARE]] FOR:
BERT & Y¥ONNE BOUNDS
14214 HAROLD LOOP
EAGLE RIYER, AK 99577
(907)696-0555
FIELD BOOKS COMPU FED:
BOUNDARY: __ DRA'WN: EMD
STAKING: __ CHECKED:KMD
ASBUILT: -- DATE: 8/1 0/9 8
BRID: NW553
SccLe~ 1''= 20'
PAGE 2 OF 3
~) ENGINEERING
g0441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
t907)696-6!ll/FAX (907)696-8!i!
AC:AD FILE: 98093. DWG JoB Bo.: 98093
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
SOILS LOG - PERCOLATION TEST
Date Performed:
Performed for:
Legal Description: ~ .Age,r',~a/~ ~
TEST HOLE# ~-/
SEE ATTACHED SITE PLAN
FOR HOLE LOCATION
3-
4-
5-
7-
8-
9-
10-
11-
12-
13-
14-
15-
16-
17-
18-
Was Ground water encountered? ~/O What depth?
Deoth to water after monitoring:? /~,,~ * Date
Reading Date Gross Net Depth to Net
Time Time Water Drop
19- Percolation Rate
20- Test Run Between
Commer~ts:
(mia/in) Perc Hole Diameter ~"
feet and 7 __ feet
1, Kenneth M. Duffus, certify ti-tat ti'ds test ,,vas performed iu accordance with all State and Municipal guidelines in
effect on this date:
NAME
LOCATION
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
IPHONE ~/~IEW
Liq. IF HOM~MAD E:
Well
DISTANCE TO:
NO. OF BEDROOMS~
DISTANCE TO: ~' ~ ar~.~ ¢ Dwelling~ {..~_~ / / /'
Mat ' ~
'/ /
Inside length j ] Width
Well
DISTANCE TO:
No. of lines Length of each
Top of tile to finish grade
Length Width
Type of crib Crib diameter
DISTANCE TO:
Class
DISTANCE TO:
Dwelling
Trench w dth
Foundation
Total length of lines
beneath tile
Total
Building fou n?~n ! ¢_
Driller
Sewer line
inches
inches
Liquid depth .....
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.
Distance between lines
Total effective absorption area
ption erea ¢00 ¢
Nearest lot line /~) / ,~_
Distance to lot line PERMIT NO.
Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
INSTALLER ~--~ ¢ ~/Y//~ ~'-~
, //////
DATE LEGA
PERMIT NO~
RPPLICRNT ED OR MFIRY LEMONS
L,OCRT I ON
LEGRL LOT 6 BLK 9 LRKEF".I[:,GE SUB
BOX ±F~-=233
LOT SIZE
344-4726
SQURRE FEET
TYPE OF SOiL RBSORPTION SYSTEM IS: DRRINFIELD
MRXIMUM NUMBER OF BEDROOMS = -'":
SOIL RRTING (SQ FT?BR)= 297
THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS:
[:.EF"TH= .=_; L El'-,~ G TH = 125
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE
GROUND RND THE BOTTOM OF THE EXCRMRTION (IN FEET).
THE TF:E~-~Z:H ~4 Z [:,TH l'~--~ 5. ~Z~Z~Z~ FEET.
]'HE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETNEEN THE ELTFRLL PIPE
RND THE BOTTOM OF THE EXCRVRTION (.IN FEET).
F-: E L-].~ L~ l' F-:E[:, '--;EF'T :I C: TRt'-.t~=:: ~. 'f ZE= :.IL ~-_--~ ~-Z-i~-Z~
PERMIT RF'F'LICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE
INSTRLLRTION INSPECTIONS OF RNY HELLS RD~RCENT TO THIS PROPERTY RND THE
NUHBER OF RESIDENCES THRT THE HELL HILL SERVE.
T~-4t] ,:] 2 Z:, :~ ~%~SPEE:T I Ci~--.~-_=. RF-:E F-: E f;=...~ g~ ][
BRCKFILLiNG OF RNY SYSTEM HITHOUT FINRL INSPECTION RND RPPRO'¢RL BY THIS
DEF'RRTI"tENT HILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON--SITE SEHRGE DISPOSRL SYSTEM IS
±00 FEET FOR ~ PRIVRTE HELL OR ±50 TO 200 FEET FROM ~ PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTRNCE FROM R PRIVRTE HELL TO R PRIVRTE SEWER LINE IS 25 FEET
TO R COMMUNITY SEWER LINE IS 75 FEET.
HELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN 30 DRYS
OF THE HELL COMPLETION.
OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE
RVBILRBLE TO INSURE PROPER INSTRLLRTION.
F"EF-:~'"I .1E T E:=-::F" T RF-_c. [:,FI]:EI"IE:EF-: --S::l-. 12_-~:----:_---=:
I CERTIFY THRT
1: i RM FBMILIBR WITH THE REQUIREMENTS FOR ON-SITE SEHERS FIND HELLS RS SET
FORTH BY THE MUNICiPRLITY OF RNCHORRGE.
2: I WILL. INSTFtLL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
3: I UNDERSTRND THRT THE ON-SITE SEWER ~YSTEM MRY REQUIRE ENLRRGEMENT 'IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THRN 3 BEDROOMS.
I =,b,l.lE[.,
POLJCII 6-650
ANCI!ORAGE, ALA':,:'qA 99502 0650
(~)()7) 264--4111
<Permit ~: 820871
January 31, 1983
TO: Permit Applicant
Subject: Lot 6 Block 9 Lake Ridge Terrace Subdivision
A permit issued by this department for an individual well
and/or on-site sewer system has expired as of December 31,
1982.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log needs to be sent
to this department for documentation of the installation
date and to close the permit.
If a private engineer inspected the installation of the
on-site sewer system, please have them send us the as-builts
for our files and documentation.
If there are any further questions, please call this office
at 264-4720.
Sincerely)
Robert C. Pratt, R.S.
Acting Program Manager
Sewer and Water Program
RCP/iDw
enc: Copy of Permit
SWP/057
PERMIT NO.
DEPFIRTMENT ' HEALTH AND ENVIRONMENTAL .0TECTION
825 "L STREET., ANCHORAGE., AK. 99501
264-4728
I-.-IELL I----~'~l[-'. rll"-.l--S 'r TE SEIbIER F'ERI'I I T
( 82087± )
APPLICANT
LOCATION
LEGAL
EDWIN D LEMLN_-,
L6B'-~. LAKERIDGE TERRACE
F'O BOX
LOT SIZE
~44-4726
999999 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM I$~ DRAINFIELD
MAXIMUM NUMBER OF BEDROOMS = 4
SOIL RATING q-,Q FT.,~8R)= t9~
'- -~ '-] - 'c- - ~-~c IS
THE REQUIRED --,I~-E OF THE --.L IL ME,_,URPTION _-,T_,TEM :
[)EPTH= 5 L EI'-.t IS T H = '~1,, 67 G RI]'-.-' E L [-" E P TH = _~:
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELDo
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE E×CAYATION (IN FEET)~
THE TRE~C:H ~4I[)TH ISi 5. 088 FEET.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
8ND THE BOTTOM OF THE EXCAVATION (IN FEET).
F~'E~-!~J I RED SEPT I C: TI=ti-II-( S I ZE= -'i ;--'5~.3 Ci;]i LC~I'-.IS
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF 8NY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
TWL] ( 2 ], I ~'-~SF'EC:-T I ~]~S FiRE RE;]-~.U I ~:FD
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TQ PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
t00 FEET FOR 8 PRIVATE WELL OR t50 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIYBTE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS M~Y APPLY. SPECIFICATIONS 8ND CONSTRUCTION DIAGRAMS ARE
AYAILABLE TO INSURE PROPER INSTALLATION.
PE~blIT E~:F'IRES 'DEC:EblE:ER-- ~l .. I '_=~-E:~-'
I CERTIFY THAT
t: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3,: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
APPLICANT EDWIN D LEM[N=,
ISSUED BY_~ ~~' _-_DATE-
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
[] SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
7
8
9-
,/ /'/ DATE PERFORMED:
SLOPE SITE PLAN
10-
12
13
14
15-
16-
17-
Rot~erl A,
18- No. 1457.E
19.-
20-
COMMENTS
ENCOUNTERED?
O
P
/ E
IF YES, AT WHAT ~"]
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE (minutes/inch)
DATE: '~
Drilli B-" og
by
[DOC Co. dba
SULLIVAN WATER WELLS
P.O. BOX272, CHUGIAK, ALASKA 99567 · TELEPHONE688-2759
OWNER OF LAND ......
ADDRESS i" ~ ,"~',"'>~
LEGAL DESCRIPTION '::', <.' / ~ ~ ,/W
DATE-Started ~c,~- / L~/rfr~- Ended
PERMIT NUMBER
DEPTH OF WELL c:'(, ~.
STATIC LEVEL OF WATER FT.
' DRAW DOWN FT.
GALS, PER HR ~" "'~ )
KIND OF CASING (':~ :'~: ~.: "'
KIND OF FORMATION:
From ~ .' Ft. to ~'>~
From ;- Ft. to ~a ~
From Ft. to
From , Ft. to
From ~'] ~J"; Ft. to ~i;~ ,.; Ft.
From__Ft. to.~Ft.
From ~, -, Ft. to :~ ~.~ Ft.
From ' (~ Ft. to (~/ Ft.
From Ft. to.__Ft
From Ft. to Ft
From__Ft. to ,Ft
From Ft. to Ft
From Ft. to.__Ft
From Ft. to Ft
From Ft. to__ Ft
From Ft. to Ft.
From Ft. to Ft
From__Ft. to Ft
From Ft. to Ft
From Ft. to Ft
From Ft. to Ft
From__Ft. to Ft
From__Ft. to Ft
From Ft. to__Ft.
From__Ft. to_ Ft.
From Ft. to Ft.
From__.Ft. to Ft.
From__.Ft. to--Ft.
From__Ft. to__Ft
From Ft. to__Ft.
From__.Ft. to~__Ft.
From Ft. to__Ft.
From Ft. to__Ft.
From Ft. to__Ft
MISCL. INFORMATION:
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
-' .- ~ HAA #
1. GENERAL INFORMATION
Complete legal description
1'/2/¥
Location (site address or directions) .~.. ~.,~.,/;. /,~. ;. ~ ,/zq b~:
Prope~y owner '~,~ ~ ~'~,qag- ~'~ (r ''--' ~ Day phone
.
Lending agency Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
,X
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
NOTE:
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, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/orwastewater 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.
KND Engineering Phone ~ ~-~' ' /,'~.././/
Name of Firm 29~i Pi~rmlgan Blvd.
Address Eagle River. AK 99577.873
Engineer's signature
DHHS SIGNATURE
v/ Approved for ·
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
By:
-['he 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 tending 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 engineeCs work.
72q)?.5 (Rev, 1/91) 8ack MOA t~21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental 8ewices Division (g~4_~.._,,,~,, ~E~VtCES
8~5 L Street, ~oom · Anohomge, Al~sk~ gg~0J ·
Health Authority Approval Checklist
A. WELL DATA
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N) Y
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to ,~-~) t
Casing height (above ground)
Wires properly protected (Y/N)
FROM WELL LOG
AT INSPECTION,
Date of test ~'//~'~/9S
Static water level
Well production g.p.m. ~---~, ~'~
g.p.m.
WATER SAMPLE RESULTS:.
Coliform
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Nitrate /~/.~' Other bacteria
Collected by: /I/,A////~ ~"-/'~g UA' ~,'~'[
Date installed ~/~/9~ Tank size ~0 Number of Compa~ments / Cleanouts ~,N).~
/ /
Foundation cleanout ~/N) ~ Depression ~/N) ~ High water alarm ~/N)
Date of Pumping ~ Pumper
ABSORPTION FIELD DATA / /
~ 2 / e
Dateinstalled ~ Soil rating (g.~orff~d~) / System~pe.~
Length ____~ ~el thickness bede T~, depth~
Fluid de~so.tion field, test (in.); ~mmediately after/aL w.er added (in.): _
72P~ide t''ment¢'m°nths)Fl~ ~epth ~~s;;;r:'/026 (Rev 3196),' ; If ¢ive d'e/ ~s~ti~ ~ = . g.p.d.
bedrooms
LIFT STATION
Date installed /
Manhole/Access (Y/
High water al~evel at~
Cycles toasted
"P~p on" level at*
*Datum
E. SEPARATION DISTANCES
Size in gallons
//Pump off" level at*.
,/
SEPARATION DISTANCES FROM WELL ON LOT TO:
Absorptkm field on lot
Public sewer main
Sewer/septic service line
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
/D() ¢4-
Foundation /'~) /'¢'' Property line /~0 /'-// Absorption field
Water main/service line .~ ~ Surface water/drainage /~/_.) ~c
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Wells on adjacent lots
Property line _Z/ __
Surface water /
Curtain drai/
F. ENGINFER'S CERTIFICATION
Building fp~ndation // Water main/~'ervice line
/ Drivewa ,y~/parking/vehicle sto a.~ge area
// ~ on adjacent ,o~
HAAFee $ ~OO'~
Date of Payment ?/;Z.~ '
I certify that I have determined thru field inspections and review of Municipal record~~;[o, ve systems are
in confc,rmance with MO~ HAA guidelines in effect on this date.
,/ (
Signatur~ ~~~,
Engineer's Name ~7~ /n' lJ~S
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
SEP 10 '98 0E:SZPM HTL ~NCHOR~GE P,i/I
KND Engineering
20441 ]~nnigan Blvd.
Eagle River, AK 99577-3736
Attn:
Client ii):
Client Project #:
Sours:
Sample Matrix:
Comments:
NORTHERN TESTING LABORATORIES, INC.
~330 INDUSTRIAL AVENUE r"A~RBANKS, ALASKA 99'701 (807} 4§6.3116 - FAX 4~$-3125
8005 SCI'lOON STREET ANCHORAGE, A!.A~;KA 99518 (907! 3~9.'1000 - FAX 349.10111
POUCH 3400,~13 PR~JDHOI~ BAY. ALASKA 99734 {907) 6S9-2145, FAX 659-2146
Harold Loop - Botmds
A158006
Water
M¢~od Parameter Units l~sult
Report Dat~: 9110/95
Date Anivzd:
Sample Date:
Sample Time: 11:00
Collected By:
** ~**
MP.L = M~:la~l~-pottLevol
MCL
B -
£ ,- B~ia~d V-rue
M - M~tix In~'ft~m~c
- Alive MCL
D = Lo~ To Dilutio~
Date Date
SM 4500 NO3
Nitrate~;N mg/L 1.15
0.50 919198
Repo]ffd By: Jorma K, Kuusisto
ChcmisL, y Supervisor
SEP 08 ~98 03:43PM MTL AMCHORA~E P.i~i
NORTHERN TESTING LABORATORIES, INC.
3330 INDUSTRIAL AVENUE FAIRBANKS, ALABKA 99701 (~07)4{;6-3115·FAX 456-3125
8005 SCHOON STREET ANCHORAGE, ALASKA 99~1S [~07) 349-10g0 , FAX 3't9-1016
POUCH 34004:3 PRUDHOE BAY, ALASKA 99734 [907) 659-214~ ' FAX 6S9-2145
DRINKING WATER ANALYSIS REPORT FOR TOTAL COLIFORM BACTERIA
KND Engineering
20441 Ptarmigan Blvd.
Eagle River, AK 99577-:3736
Date Received: 9/3/98 Time Received: 14:10
Date Analyzed', 9/3/98 Time Analyzed: 16:45
Date Reported: 9/8/98 Time Reported: 15:10
Next Sample Due:
Comments
Phone Number: ( )696-6111 S =
Fax Number:. ( )696-8111 U =
POS =
Colleoted by: KAY ND =
TNTC =
Sample Type: Private water Systems CG =
Method of Analysis: Membrane Filtration (SM 9222 HSM []
B] SA
Comments:
Sample Sample Total* Fecal Other*
Date Time Coliform Coliform Bacteria
Old
R
NT
* # Colonies/100 mi
HPC**
Result Lab~
Sati=factory
Unsatisfactory
Positive Test Result
None Detected
Too Numerous To Count (>200 Colonies)
Confluent Growth
Heavy Sediment Masking, Results May Not ae Reliable
= Sample Age >30 Hours But <48 Hours, Results May
Not Be Reliable
= Sample Age >48 Hours, Too Old For Analysis
= Resample Required
= No Test
** # Colonies/mi
Looation Comments
9/3/98 11:00 0 ND
0 NT AC10240 HAROLD LOOP
Satis[actory
Sherd L, Track Environmental Analyst
Northern Testing Laberaturies, In= Anchorage, AK
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HF~%~LTH
DEPART~LENT OF HF~'~LTH AND ~IR~NMENTAL PROTECTION
APPLICATION FOR [~JLTH ,~i]THORITY APPROVAL CEBYrIFICATE
General Inf~rmtion Application Date _L .... ~
(a) Legal rescriDtion (inclu~ lot,Block, subdivision, section, towaship, range)
Location .(add~ess or direr%ions)
<c)
Applicants Address
Applicant is (check one) Lending Institution ~; Owner/builder ~;
(d) Lending Institution
Te lea.hone
Address
(e) Peal Estate Co. & Agent
Address
o
0
Telephcne __
Type of .~esidence
Single-Family~
Nu~mber of Redrcoms
Water Supply
Individual 'I4~ll~
Multi-Family~
Other (de sc£ibe)
Community ~ Public
Note: If cc~nity '~11 system, must ha~ ~it~n ~nf~tion ~ ~e State
~pa~t~nt of ~vironmental Conservation attesting to t}m ~gality ~d s~tus.
Is the ~11 ade~ate ~or the nmmber of ~drcoms s~cified in this ~(~)
~wage Disp~al
Onsite~ Public ~--~ ~mmuni~ ~--~ Holding Ta~ ~ '
Is the wastewater dis~sal system a~quate f~ ~e number of ~dr N)
[Page 1 of 2]
2-15-84
5. Engine?_ ri_rig Firm Proj~~ctions, Tests, Data and Information
Date
6.DHEP Approval
Apt~e ore d for
Approved ~
(ENGINEER SEAL)
~sap~oved~
or conformed to all YDA HAA Guidelines in
Date
The Municipality of Anchorage Dapa~tn~nt of Health and Environn~ntal Protection dc~s
not guarantee the continued satisfacto~'y performance of the water, supply and/or the
wastewater disposal system. This approval indicates that, as of tJte validation date
shown abcve, based on the data and information furnished bf an engir~er registered in
the State of Alaska, the v~ater supply and wastewater disposal system is safe and func~
tional fo~ the numbe~ of bedrcc~as and type of structure indicated.
(DHEP SEAL)
7. Mail the HAA to the following address:
KB2/d5/s
-[Page 2 of 2]
/-15-84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
A. WELL DATA
Well Classification
Well Log P~esent ~/N)
Total Depth ~O /~ ~ Cased to
Static Water Level ~ !
Casing Height Above Ground .15 /
Electrical Wiring in Conduit ~N)
Separation Distano~s f~om Well:
To Septic/k~l~t~ Tank on Lot
Date Completed
Pump Set At
To Nearest Edge of Absorption Field on Lot
To Nearest Public Se-~r Line ~/ /~r
Cleanout/Manhole /J / /~ To Nearest Sewer Service Line on Lot
Water Sample Collected By ~L~ ~'~-~. .; Date .. ~'2c~ ~-'~:~-~ z''/~
Water Sample Test t~sults ~-~/~-/~r/~C ~7~g~ /
; On Adjoining Lots /~)P /~
/D~ r,~ ~ on ~djoining Lots /~ ~
To Nearest Public Sewer
· Date Install. e~ .~--~- G ~ Si~ /~
Standpi~Yb -- Ai.-ti~t Caps~) FO~t~ Clear. ou(~
~pression o~ Ta~ (~ Date ~st ~d
P~ing~intenan~ ~n~a~ ~ F~i~ (~' ; for
Holding Ta~ High-Wate~ ~a~ ~/ ~ Te~ra~y Holdi~ Tank Per~t (~
Separation Distance ~ ~pt~olding Tank:
To Water ~ervice Line /dP
Course
Comnents
7~ To Stream, Pond, Lake, o~ Major Drainage
[Page 1 of 2] 2-15-84
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed 7~L- ~
Width of Field 2 CQ /
Design ~)~4
~'4~ Type of System
Length of Field ~- /
t~
Gravel Bed Thickness ~ _~.~ ~ 0
Square Feet of Absorption ~A~ea ~O~) Standpipes P~esen~
Depression over Field ~¥~)~ Date of Last Adequacy Test
Results of Last Adequacy Test ~//~
Separation Distance from Absorptioo Field:
To ~ter-Supply Well ///Q ~ J To P~operty Line /'0
To Building Foundation /d3/ / To Existing or Abandoned System cn
Lot /J ?/~ ; o~ Adjoining Lots /d'~/
To Water-.~m~/Se~vice Line ~ Cb 7~ To Cutbank(if present) °/-/
TO St~eam/Pond/Lake/o~ Major D~ainage Course /~ //'~
To D~iveway, Parking A~ea, or Vehicle Storage A~ea (,/J ~--f~_.D ~J
Co,~:ents
D. LIFT STATION
Date Installed Dimensions
' Manhole/Access (Y/N)
Size in Gallons
"Pump On" Level at !, / / ~Pump Off" Level at.
High Water Alarm Level at~~'/ .///fl Vent (Y/N)
Tested fo~ Pumping Cycles du~ing Adequacy Test.
Electrical Codes(Y/N)
M~ets MOA
Con, rents
** Check Permitted Bedroom Rating Against HAA Request **
I certify th~w.~ checked, verified, or conformgd to all MOA HAA Guidelines in effect
on the dat~.of th~/si~.~3Dg~tion.
Si ed ~ Date.,
DEPT. OFENVIRONMENTALCONSERVATION
SOUTHCENTRAL REGIONAL OFFICE
437 "E" STREET, SUITE 200
ANCHORAGE, ALASKA 99501
June ll, 1984
Mr. Robert A. Silafer, P.E.
S&S Engineering
SRB 196X
Eagle River, AK 99577
Dear Mr. Shafer:
BILL SHEFFIELD, GOVERNOR
Telephone: (907)
Address:
274-2533
O AI]D3
'NOLL:D3 J.O~d 'IVIN]WNO~JIAN::i
~ HZ1V3H JO 'ld](]
BO',fCiOHDNV 40 A, LIqVdIDINflI~'
Subject: Waiver Request Lot 6, Block 9, Lakeridge Terrace Subdivision
A review has been completed of your May 29, 1984 submittal for a waiver
for separation distance of a private well to a septic tank. Based on
the submittal and the additional clarification that the well log sub-
mittal was in fact for Lot 6, Block 9 and not Lot 9, Block 6, your
request is hereby approved.
Sincerely,
District Office Coordinator
BEE/msm
cc: Robbie Robinson (MOA)
' APPLI(--NT/~FILLS'OUT UPPER HA~"-"
~'ro~p(~ty O~'ner ~
_
Address
ONLY
z,p Code
Zip Code
Phone
Phone
Phone
Realty Co. & Agent
Address .~
Legal Description J ~. ' ~__~ L. -'
Type of Residence
~ingle Family
[] Multiple Family No. of Bedrooms ~
[] Other
Wa_ter~ pply
t¥~lndividual
[] Community
[] Public Utility
Sewer Disposal
~"~ndividual
[] Public Utility
[] Holding Tank
Zip Code
ATTACH WELL LOG. A wetl log is required for all wells drilled since June 1975.
For wells drilled prior to that date, give well depth (attach Icg if available).
Year Individual Installed:
When Connected to Public Utility:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes: MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH
/_/.? ~ ENVIRONMENTAL PROTECTION
/~. : ~ ~ / ~._ .-:. ~/~ ~ ~ N~AR 9 !983
· _. ....... ; .......... ........ RECEIVED
'/x..,.:.:,: . :.. ..... -,-,,..., · '
( ) APPROVED BEDROOMS ~ '-~-~ ....................... ~ '"~ ...... CONDitIONS OF APPROVAL
( ~'~ CONDITIONAL APPROVAL*
DATE °~ ~ / ~'~ ~ '~
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size