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HomeMy WebLinkAboutLAKE RIDGE TERRACE BLK 9 LT 13 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 4AME MAILING ADDRESS LEGAL DESCRIPTION LOCATION Well DISTANCE TO: //2 Absorption area Manufacturer Insidelength IF HOMEMADE: , --~ Well DISTANCE TO: Well DISTANCE TO: No. of lines / Length of eacl~n/e / Top of tile to finish grade Length Width Type of crib DISTANCE TO: DISTANCE TO: Dwelling Foundation i~.~/~ Total length o~es/ Material beneath tile Depth Crib diameter Crib depth Well /~///~ Building foundation Depth I Driller Buildin'g foundation I Sewer line PHONE I j~NEW NC. OF BEDROOMS / PERMIT NO. g2¢ Material Width Material Nearest lot line /~7 Trench wid, t~ // /~ inches inches No. of compartments Liquid depth PERMIT NO. Liquid capacity in gallons Distance between lines Total effect~.~a~:[¢on area ?ERMIT NO. Total effective absorption area Nearest lot line Distance to lot line Septic tank PERMIT NO. Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS :!.?? THE!; L. EN(:N'H D i HENS I ON ! S THE L.E?,iS'f'H ( .i; H I:::EET .':.' OF' TH.,E T..e. ENCH O!'-9. C, RF{ i NI:::' ! IEL!:,. THE; [:,EF'TH OF Fi 'TiRENE:H E!i:-(': PIT its THE DISTP.;F,iOE'; E~ET!,.iEEN THE SI...t~i:.~;;'l:;:!(]:l!~] IiIF THE 8R(:)L!i'qD R~-,i[:, THE E',OTTE!H OF; THE EHE:F!VFIT 1[ ON ,:11 l",! FEE'!" }. "i"HE!:;;:E IS HO SET !,.! :[ [::,"r.,"'"i is'OR TI~'.EHC!'..!ES. THE CN'.F?,/EL DFiF"TIq ](.:B THE .~"i;i:i'.,!:[i"i!..If"! DEPTH OF' GF::F!',/EL i.3E'I"iqEEN THE OLrT'FRLt. F:'ii::'E RF,![) THE .Ei:OTTOH ,,.'::iF: Ti-..i:E E',4E:RVFFi"ZOH (]:lq FEE'T). F'EF.:H ! 'J" !::;iF'r:'! T F;Fff-,Fi" HFiS -r'~_~c',, ,, .... ~,i:',::..,...~....p...."' .F.I':::,_ T.~ ............. F: I L l' T'.F '1"O 'i; FJFO~;i:H 'T'N I '.El i E'F': ~q'i',!~'NT 3,1 tl;' '[ F,If3 THE .!.r,~.::,l ~...! .... ~' ~': Fq[~i':!-:FNT Till 'T'H]i'.~; ................. i NSTFiL.LFiT i ON ' * :'" -"? 310H'i~ OF ¢d'.l',.' ~ ................. :'(:' ",p~'F T'-' FIND TI-lIE: {'.il_I!','!E:EF4: OF' RIP. E; i E' EPJ'i'ES THFIT THE .. ,EL L ,{ ! t_ SERVE. N l N i HUN D l STIqN(2E E!:E'I'HEEN .,'-';i I,.}ELL FIND FIN? OH'""'S i TE ':i:;EHFIGE [:i :[ SF'OS!';:I!_ S"i":XX.;TEH l S ::L{!fiE~ FEET FOR i::I F'R!'v'.,'::I'TE HE:!_!.~. Eh'-';;: :;!.i]i!Zt '!"E~ ~i'.l;![tEi FEE'f' FiqtOM Fi F:'LiBL. iE: HELL UPON '!"HE T'v'F'E: OF:' F:'!.JE',L!C NElL! MZ;'/,!iPiLJf'i DZSTF:!.!'qE:E F'F;:Oi"i R F'RZ',/RTE HEL. L "to F! PF,;':iVFfTE SEklER LINE Z:B 2El FLEET TEl F:] E:OHHLII'.,!iT'¢ SEHER !....iNE :,":S '?L5 FEET. OTHER F;:iEQU ]; REHENTS HR'?' F!PPL"r'. SF:'EC 11 F :.r. E:FfTZ C}!'..-.';S FiND CC$,!STRUC:T Z ON E:, !' FiGI'RRHS FIRE FiVFt I L. FiE:LE:.; TO Z HSURE PF;:OF'ER I' N:E!;TB!._L. FiT :[ Z CER'!"!F"/ THFiT J..: i RI'"! F!q!"llL. IFi!~: I,.i!TI...! -i"HE RE(.:~UIFi!E:i'"IE.NTS FOFi: ON-Si'i"E SEi.4ER:.S Fff.,!D NELL..:.T..; Fr_::.]; SET F'Eff~:'TH E?.r' THE P'!IjN ! C I PF:!L i T"/ (;)tr::. F:!HCHCJi~:F:IGE. ;'2: ! HtL. L. !!',i:E:TF~LL THE .":P-¢STEH ]:i'.,! I::!CE:Of;-%,RNE:E HZ"I"H THE .:!:: i UIq[;,E:,q:'.'.?,TFiN.r3, THFiT THE ON-SiTE SENER S'¢STE:H t'"li::!'-r' RtjE(N..J!iq'.E E:NLRt:;;:C~EH[ii:NT IF THE F%,':ES I DENCE i S RL{.I"!C~DEi. E'D TO ).; NCLLiDE i'"IOF:'.E THFiH 4. E~EDF::OOHS. [] SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: L- /3 ¢ llo Fy ~''l i C 1 3 4 5 6 7 8 9 I0 12 ~3 14 ~5 ~6 ~7 Robert A. 18 No. 19 20 COMMENTS SITE PLAN ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop ,, . .... ~[ H PERCOLATION RATE 1% ` ¢ (minutes/inch) TEST RUN BETWEEN ~ FT AND ~--' /¢ FT //7- '? F'ERH I T' RF'F'L. ! C:FiNT LOE:Ff'r I ON L.EGF!L NE:L..L.Y F'ETEF-:':':;EN 63Z! ERST TUDOR RORC, L ~.3: B ~ LRKE RZ£:,GE TERRflCE L.OT %ZZE 225(i~E~ :SF.:!URF?.E FE;ET HIF,!ZP1. UM E:,!E;TRF,!CE E:E'T'NEEN R !.,.fELl_. RND R.N'¢ E~N--E;ITE SEtqF:R3E DISPOS;RL. SYE;TEFI !S J..EnF3 FEET FOR R F'[~IVI:aTE !.4ELL O?. :~.5~3 TO ;~jEi!;~i FEET F'RO!"t R PLIBLiC: t.4ELt_ DEPENDING UPON THE TYF'E OF F'LfBL. iE: NELL.. MINIHL!H E:,iSTRNC:E FROt'd R F'?.i'-,,'RTE !.4ELL "FO R PRIVRTE: SEI.4ER LINE l~1 25 F'EET RND "FO !::~ COHf'!UNITY %E:!,.!EER L. INE l:5 75 FEET. !.,iEL. L. LOISS FIRE REQUIre:ED RND !"lUST E:E RE'f'L.If;;:~.~EC, ]"O THE [)E:PFff~:Tr'!ENT !,.II:THIN 2~:E~ DRYS OF THE HELL COi"iF'L. ETZON. O'FHER RE6!UZREHEN]":5 PIR? FIF'F'L'¢. SF'ECIFtE:FFFZONS Rf.,~[::, CON:5'FRUCTZON [:,I!qGRRid% R'¢F!ILRE;L.E TO INSURE PROF'E?. Ii'.4~;'['R~..L..R"r'ION. Z CEF?.TIF:Y ]'HAT f: t Fill FAI'!ILIAF-:: HITH ]'HE F-:.:E~S!Lt!F~:E~dEN-F:E; FOI':.': ON-.-SITE 5Ek!ER5 AND f4EL.!....'L'.; A:E; SET FOR'TH BY THE !','.IL!i'41 C :[ F'F:IL l 'TY OF RNC::HE!RRGE:. 2: Z' I.,.!!LL. IN:'.'E".;TRLL. THE 5'¢.'E;TE?! ZN RE:E:ORDFiF,R.3E [4ITH THE CO[:,ES. MUNICIPALITY 0F ANCHORAGE Department.~-~f Health and Environmenta?~-'~rotection 82-5 ~ Street, Anchorage, AK. ~9'501 264-4720 * * * HANDWRITTEN PERMIT * * * Permit ~ ~%~\~ WELL ~,~,v~ v,~ o~,~ ~,~/~-¢... ,-=.'r- ~'F-~ PERMIT Location: Phone Number: Type of Soil Absorption System Is: ~rench: Drainfield: Maximum Number~of ~edr.ooms: .Seepage Bed: Holding Tank: Soil Rating(sq.ft/br) "The Requimed Size of the Soil Absorption System Is: 'DEPTH . LENGTH G-RAMEL DEPTH WIDTH The length dimension.is ~he length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance, between the surface of the ground and the bottom of the excavation(in feet). There is no se~ width for trenches. The' gravel depth .is the minimum depth of gravel between the outfall pipe and the bottom ~of the excavation [in' feet). * * REQUIRED s'.EPTIC(HOEDING) TA'NK SIZE = GALLONS * * Permit applicant .has the-responsibility to inform this department during the in~stallation inspections of any wells adjacen5 to this property and the numbe~ of ~esidences that the well will -serve. * * * TWO(2) :INSPECTIONS ARE-REQUIRED Backfilling of any ~.system without .f~nal inspection and approval by this department .~wili be subj.ect to prosecution. Minimum distance between a well and any .on--site sewage 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. Minimum'distance from a private well to a priva-te sewer line is 25 feet and to _a community sewer line '.is 75 feet. Well logs are required . and must~he]returned to ~this_department within 30 days of the well completion. Other requir.ements may .apply. . Specffications. end"construction diagrams are awailable to insure' proper installation~ * "*' '*-PERMITCE×PI'RES .DECEMBER .31, 1 9 8 2 * * * I certify that: (1) I. am familiar with Zhe requ'iremen-ts for on-site .sewers and wells as set ~forth 'by the Municipality of ~nchorage. (2) I will install-the system in.~ccordance with codes. (3) 'I .understand that the on-site sewer' system may .require ~nlargement if the residence 'is ~remodeled to include 'more .that 3 bedrooms. Applicant / Date: -~ .:~ P, UNICI~AL[r~; OF- ^NCHORA ~e Req~i~ fiz~ Of fha ~oi[ ~orpt~o~i ~yst~ Ls: : Pe~t app~t~a~, ha~ th~ r~po~bi).i~ ~.o [nfO~ thL-$ d~pa~t~n~ d~ing th~~ : BackfiL~in~ O~ any ~y~:am without final tn:~p~ki-on an~ a~prova), bF tht~ : tva~L~bie LO ~n~ure p~OF~' in~takiak~o~. (:) t ~ ~:~iliaK wi~h tn.. requlCe~nLs EO~ O~ ~t .~ SetT~s and (~) ~ wkl~ inskall ~h~ ~),ske~ ~ aocordai~ w~Lh - ......................... ~%e -~-t4e~:e ,~,~ --~i~'~ --~1~'~%'~~ ' '"" ~ ~_t.- d/~-'--~~--~'~'' ' n 0 Z~ © © : 'i Z ,,,4 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 1. GENERAL INFORMATION .,. Complete legal description Lot 13; Block 9; Lakeridge Terrace Subdivision Location (site address or directions) 14328 ,qa~"O] - Property owner Ron and Nelly Peterson Mailing address Day phone 696-359]. Lending agency Mailing address Day phone Agent Cindy Wilson/DON MCKENZIE REAL ESTATE Address P.O. Box 772922, Eaqle River, Alaska Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 ',~ TYPE OF WATER SUPPLY: Individual well xxx Community well Public water Day phone 694-9035 99577-2922 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 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. 72~25 (Rev. 1/91) Front MOA #21 STATEMENT OF iNSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, ~ verify that m~ investigation of this Hea~th 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 flies 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 re9ulati°ns in effect on the date of this inspection. Ph'one Name of Firm ~6¢ 17034 ~.agle River Loop Road No, 204 Date --2~____~ ':~-~ Address ~,~~¢ Engineer's signature bedrooms. DHHS SIGNATURE ~N~ Approved for ~ Disapproved. Conditional approval for bedrooms, with the following stipulations; 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. 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. Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~..ccr ~ ~v.¢. ~ ~.~c~.~-~ "¢~,¢4~,Parcel I.D. A. WELL DATA Well type ~2¢.~,j ~,1h¢,~ If A, B, or C, attach ADEC letter. ADEC water system number Log present ((~N) X/ Total depth z¢¢ L~ Sanitary seal ~'N) V Date completed \ o - °!, o Driller Cased to ,¢~fO~ jo' Casing height Wires properly ~rotected ~(~'N) FROM WELL LOG Date of test Static water level Well flow Pump level AT INSPECTI~NICIPALITY OF ANCHORAGE ENVIRONMENTAl. SERVICES DIVISION D SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot \ Absorption field on lot \ \~ Public sewer main Sewer service line ; On adjacent lots \ ~\ ~ ; On adjacent lots \'0~~¢¢ Public sewer manhole/cleanout ~.~, Petroleum tank '7..~ ~ WATER SAMPLE RESULTS: Coliform (:::;, ~'° ~l ~o~ Nitrate Date of sample: SEPTIC/HOLDING TANK DATA Date installed Cleanouts (~7N) High water alarm (Y~) Date of pumping Collected by: Other bacteria ~ $ & S ENGINEERING i7034 F. agie ~iver Loop Roa~J i~io. 2~,~ Eagle River, Alaska 99577 Tank size ['Z.~"C~ ~.~p.-t~ Compartments ~ Foundation cleanout .~N) ~ Depression (Y/¢~ /'~ t~ Alarm tested (Y/N) ~1/~ Pumper ~'.~_ (_.¢.~ ¢~o &.. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot \ \"~'~ To property line \0~4" Surface water/drainage On adjacent lots Absorption field Foundation Water main/service line 72-026 (Rev. 7/91) Front i CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level les tested Meets MOA electrical codes (Y~F'/ SE ROM 'l T STATION VCell on lot On adjacent lots Manufacturer Manhole/Access (Y/N) ~vel at Surface water D. ABSORPTION FIELD DATA Date installed ~ --"1 ~-¢~,. Length ~\~ Width Soil rating \ ~;~ ' Gravel thickness Total absorption area Depression over field (YZ~ Results ~fail) Peroxide treatment (past 12 months) (Y/~ Cleanouts present Date of adequacy test for ~"~o ¢~ (.._,~ If yes, give date System type Total depth bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot \\~ To building foundation On adjacent lots Surface water \ Curtain drain On adjacent lots ~,~o~4' Property line To existing or abandoned system on lot Cutbank '~'(~" Water main/service line 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. 5 & S ENGINEERING 17034 E~rjle River Loop Roa~ ~a.gle River, Alaska 99577 Signature Engineer's Name Date HAA Fee $ ,/ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE MEMORANDUM DATE: TO: FROM: March 18, 1992 To Ail Parties Concerned J. Smith, P.E. ~<~%C/'~ SUBJECT: Lot 13, Block 9 Lake Ridge Terrace HAA 920137 Ail parties concerned are advised that the well serving the subject property has a production.capacity of 0.87 gallons per minute. The required minimum production capacity of a well serving a 4 bedroom h6use is 0.42 gallons per minute. The production capacity of the well may seasonally fluctuate. Water conservation may be required during low production periods. by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX670272, CHUGIAKi ALASKA99567 · TELEPHONE688-2759 STATIC LEVEL OF WATER F'F. Ended [ ~O' GALS. PER HR -~ {) KIND OF CASING (~; "¢'" ~)/) OWNER OF LAND /~ ADDRESS LEGAL DESCRIPTION DATE - Started PERMIT NUMBER / 00 KIND OF FORMATION: From () Ft. to c:-,) o ~ Ft. ~ t~/-~ )~'t ,~J C ;.el ~l ~. From.~ From )~ ~O Ft. to ~'J~5.~~ Ft. ,X" t~OZ ~ From From~':~5'] ~'> Ft ........ From From Ft. to Ft. ~'-Z'~"~i3~ L(OE [ From From --3 {3 D Ft. to . Ft. t~ From ~ :C':) Ft. to i?_. :;' Ft. /.3i?-0l;. SC~ ?(6/~cC:' " ~ ° ~--~ From__Ft. to__Ft. ~X,)/ t~ O,q47~ 5-rz~7~!.l~ From.C(_~}5~Ft. to 4~/(~3 Ft. ~ /~,,/) ~, (7 (3 [(,. (:,d,(/'~*'d 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 From From From From From From From From From From From 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-REC E iV E D Ft. to Ft. Ft. to .~...l~-I~t- 4 1~ __Ft. Municipe~y of Anchorage FtDept. Health & Human Services ; to Ft. Ft. to Ft MISCL. INFORMATION: DRILLER'S NAME CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA99518 TELEPHONE ~0~ 562-2343 FAX:(907) 561-5301 ~NALYSIS R~SULTS for INVOIC~ ~ 51455 Chemlab hef.~ 92.0748 Sample # 1 Matrix: WATER Client Sample ID PWSID Collected Received Preserved with LiS S9 LAKERIDGE TERR S/D UA FEB 25 92 ~ 16:30 FEB 26 92 @ 15:30 AS REQUI~ED Client Name :S & S ENGINEERING Client Acct :SNSENGP BPO# : Req# : Ordered By :R. SHAFER PO# :NONE RECEIVED Analysis Completed : FEB 28 92 Send Reports to: 1)S & $ ENGINEERING 2> Parameter Results Unite Method Allowable Li~tts NITRATE-N NDCO.iO) mE/1 EPA 353.2 Sample ROUTINE SAMPLE COLLECTED BY: RAY. Remarks: 1 Tests Performed ' See Special Instructions Above UA=Unavailable ND~ None Detected "See Sample Remarks Above NA- Not Analyzed LT:Less Than, GT=Greater Than SG-~ Member of the SGS Group (Soci0t~ G0nOrale de Surveillance) CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. TELEPHONE (907) 562-2343 5633 S Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER [~' PRIVATE WATER SYSTEM Narr~ Mailing Address Phone No. $ & S ENGINEERING 17034 Fa.n!t~ I~iv~. L~? I}~ael ~n 9~ Eagle River, Alaska 995~ Cay State Mo. Day Year SAMPLE TYPEi TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ~ Satisfactory [] 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 '~-"/2-~/~ ~- Time Received ) l~L Routine [] Check Sample (for routine sample ' with lab ref. no. [] Special Purpose SAMPLE No. LOCATION ) .r-I Treated Water [] Untreated Water 41 Analytical Method: Membrane Filter * No. of colonies/100 mi. Time Collected Collected By Lab Ref,. No. Result* Analyst I I F-T-] .~/,~/1/~/~'0'~'" /'/!~(/~'~'J'~ BACTERIOLOGICAL WATER ANALYSISt RECORD ~./~/ A.D,E,C. ;.:, . = .- . - - ~ Ver]flcation:~B- - " ' ' ' BEFORE Fecal Coliform Confirmation COLLECTING SAMPLE Fin. I Membrane Fi,~ults J Coliform/lO0 mi TNTC = Too Numerous To Count i, PART ONE OF TWO: , - p.m. h-'. :,' · W - ' '_: ¥-. REYlAINDEE TO?OLLO OB = Other Bacteria [:.: L?~?.::~..~,-.-_~..~: :.~:?./~ -¥;--~-'~.,/~,,: :?.~; -{-::: .? ' ~ 17034 Eagle River Loop Road ROBERTA. SHAFER ~, ~ ~ .~ / Eagle River, Alaska 99577 CIVIL ENGINEER LOCATION OFWELL(Leg~ D~pt~o.): ~m ~ ~ ~ ~~,>~ ~~ ~ WELL DEPTH:. ~ ~ FT. CASING: ~ ~ FT. SCREEN: ~ DATE DRILLING COMPLETED:. ~ ~ ~ ~ DRILLER: ~ V~ STATIC WATER LEVEL (Top of Casing): ~ O~ FT. DATE: ~ -- ~ ~ CLOCK ELAPSED TIME SINCE DEPTH TO DRAWDOWNI PUMPING TIME PUMPING STARTED/ WATER, FT. RECOVERY RATE, GPM REMARKS STOPPED, MIN. 15 20 25 30 35 40 45 50 55 60 (1 hour) 90 150 ~',~ 180 (3 hours) ~o' 31~' ~ ~p~ ~ Pump 210 RECOVERY I 0 0 5 10 15 20 25 3o 35 Comments: 'Fl~w is not Guar. ntee~ ' ~ubsequent Var|atiom MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEAL TH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 · Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, towns~bjp~range) LocatiOn (address or directions) (b) Applicant Name ]1,.~.-.~_~/ ~'z,~¢,~O Telephone: Home ~,.~' - [ S'~/ Business Applicant Address / ~ ~ ~.-~ p¢,/~)~,~ ~. oc~ (c) Applicant is (check one): Lending Institution [~-~', Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution Address ~'~S' ~-- ,~, ~,-~z~'~ p,'t-~-~'~. (e) Real Estate Company and Agent ~/~.. Address Telephone Telephone (f) Mail the HAA to the following address: 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family [~"/Multi-Fam~-~ ~e~ Number of Bedrooms WATER SUPPLY " Individual W~II [~ Community [] Public [] Note: If community well s~siem, must have written confirmation from the State Department of Environmental Conservation attesting to the legality'and status. 4. SEWAG[~/~SPOSAL. 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. 72-025 (11/84) Page 1 of 2 ENGINEERING FIRM PROVIDIII NSPECTIONS, TESTS, FILE SEARCH, D, i~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 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 flies 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 .... S & $ ENGINEERING Address Eagle River, Alaska 99577 Date DHEP APPROVAL Approved for ~ bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional Date 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 72-025 (11/84) ROBERT A. SHAFER March 3, 1987 CIVIL ENGINEER 694-2979 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHAN(CAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage Department of Health and Human Services 825 L Street Anchorage, Alaska 99501 ATTENTION: Dan Bowles REFERENCE: Lot 13~ Block 91Lakeridge Terrace Dear Dan, Attached is a revised cheek sheet for the Health Authority Approval on the referenced property. The original HAA approved by your office on February 23, 1987 approved the on-site wastewater disposal system for three bedrooms. This approval was based upon our request per the owner. However, it has been d~termined that the r~sidence actually has four bedrooms. Since the original system was installed for a four bedroom residence we had p~rformed the adequacy t~st to d~termine its adequacy for four bedrooms even though the owner had requested an HAA for only three bedrooms. The owner has realized the error and now requests the approval for four bedrooms. By the attahced check sheet and our initialing the original HAA change from three bedrooms to four bedrooms we are certifying the system for four bedrooms. Request you change item six on the HAA from three bedrooms to four bedrooms and initial and date that change. Sincer~,~ SRB 196X EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description' ~" ~'~ WELL DATA Well Classification Well Log Present ,~N) Total Depth ,~o~ ~ Cased to Static Water Level /c~ ~' ' Casing Height Above Ground Electrical Wiring in Conduit ~.~N) Separation Distances from Well: To Septic/Holding Tank on Lot If A, B, C, D.E.C. Approved (Y/N) Date Completed (,¢/~¢//~ ~. Yield z.-/'~ /-¢ Depth of Grouting Pump Set At L.~, )/,, l ~'~ t Sanitary Seal on Casing (~N) Depression Around Wellhead (Y/~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ; On Adjoining Lots '//~'/¢ ; On Adjoining Lots / ~'/¢ To Nearest Public Sewer /~/~ To Nearest Sewer Service Line on Lot ~ ~ ~ ~/~1~ ;Date B. SEPTIC/HOLDING TANK DATA Date Installed .~//:"""~f/,~- Stand pipes Y~.~N) Depression over Tank (Y/~J~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) /"¢//'~ Separation Distances from Septic/Holding Tank: Size Air-tight Caps ~N) No. of Compartments ~> Foundation Cleanout ~N) Date Last Pumped 2~ / / ~D/~ ' for Temporary Holding Tank Permit (Y/N) / To Water-Supply Well ?/~ To Property Line [O/7z To Water Main/Service Line /0/._/ Course To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11184) MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION RECEIVED ABSORPTION FIELD DATA Soils Rating in Absorption Strata ,/_~-~z. ¢/~ J~. Date Installed Width of Field / ~'~ Square Feet of Absorption Area Depression over Field (Y/(~ Results of Last Adequacy Test Separation Distance from Absorption Field: f To Water-Supply Well // To Building Foundation Lot To Water Main/Service Line Type of System Design Length of Field ~? / Depth of Field Gravel Bed Thickness ~ / Standpipes Present t~/N) Date of Last Adequacy Test To Property Line /Df'l' To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S & $ ENGINEERING Signed ~.7~54 ~=~|e .~::.-ei-: ¢.,;F' A~',~J ;~.~ ~ ~ ~ ~ Compan~agle River, Alaska 99577 MOA No. ~~ Receipt No. ~/'~ C. ~. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) 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 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, towns~bJp~range) Location (address or directions) (b) Applicant Name ~-"'~-?' .j~,.~.,~o,~ Telephone: Home ~, ?~' ~ ~ ~'~/ Business Applicant Address ? c~ ~ ~_.~ ¢~',,'~-~,~ Z. ~¢~' (c) Applicant is (check one): Lending Institution ~, Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution ~'"¢,-~G ~Jo)'~/' Telephone Address C/'~/~ ~- ~"-"-"-"-"-"~ ~ ~ ~ ~ ~ (e) Real Estate Company and Agent /,~ Address Telephone (f) Mail the HAA to the following address: 5 & S ENG!NEER!HG 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 TYPE OF RESIDENCE Single-Family [~'"Multi-Family Number of Bedrooms Other WATER SUPPLY Individual Well [~/Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE ~ISPOSAL 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. Page I of 2 72-025 (11/84) ENGINEERING FIRM PROVIDIN,_ ,NSPECTIONS, TESTS, FILE SEARCH, DA . 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 for the number of bedrooms and type of strugture 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 ...... G S & S ENGINEERIN Name of Firm ,-,~',.~ =,-,o R!..-_~-. L'~?,"- .1:,_~__,:I N~ ~P,4 Telephone L~ ¢~'~ ~-- ~7 ~' Address Eagle River, Alaska 99577 DHEP APPROVAL Approved for .?~',~,~'~(-~J'~ bedrooms by Approved /~ Disapproved Terms of Conditional Approval Conditional 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 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: WELL DATA Well Classification .~, Well Log Present CN) Total Depth ~..~O" Cased to ~/~ Static Water Level [ ~;~ Casing Height Above Ground / 5 Electrical Wiring in Conduit (~N) Separation Distances from Well: If A, B, C, D.E.C. Approved (Y/N) Date Completed (-~,/~//~ ~-- Yield Depth of Grouting Pump Set At C.P/f, Sanitary Seal on Casing~)/N) Depression Around Wellhead (Y/~ To Septic/4~Tank on Lot / / ~ t ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ! / ~ t ; On Adjoining Lots To Nearest Public Sewer Line h.//~ To Nearest Public Sewer Cleanout/Manhole t,.~///~ To Nearest Sewer Service Line on Lot ~---~/''/' Water Sample Collected by ~ d-- ~ ~- h4L~z~.4,.~L.~/'~¢-- ;Date ~....//! / Water Sample Test Results ~ v~/"7 .~'~'/'T64'~ 5/ Comments '~,/~-L, "/1~.~ "~*...'"F~P-~"~ ~ ~-~/[_~ /:~ ~' B. SEPTIC/HOLDING TANK DATA Date Installed ~/':~-/~,~-- Standpipes (~N) Depression over Tank (Y~) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: I To Water-Supply Well To Property Line To Water Main/Service Line Course t-,.//~ Size / ~'6.~ No. of Compartments Air-tight Caps ((~N) Foundation Cleanout(_~N) Date Last Pumped 2~//Z~/,c~,~ ~ t--//j~ ;for ~///~ ' -- Temporary Holding Tank Permit (Y/N) /',.//,/~1 //~.- /o tV' To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72 026(11/84} C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date installed Width of Field Square Feet of Absorption Area Depression over Field (Y~:~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well / / To Building Foun,dation ~-"~" Lot Type of System Design / Length of Field Depth of Field Gravel Bed Thickness ,~.._- Standpipes Present (~N) Date of Last Adequacy Test To Water Main/Service Line /°/¢' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abaq:doned System on ; On Adjoining Lots , ~/'¢' ' '-"- ' To Cutbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed S & S ENGINEERING Date 17034 Eagle River Loop Road No. 204 ~gl ....... ~..~~ ~,o,""~ MOA No, ece pt ,o._ '- / Date of Payment Amount: $ ' Page 2 of 2 72-026 (11/84} NOl~l/,Id S3DI^~i:]S 'IVLN~FINO~IAN~ ::IOV'cIOHDNV :JO AtI'IVclIDINF~I CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER E~RIVATE WATER SYSTEM Name Phone No. Mailing Address City State Mo. Day Year SAMPLE TYPE: ] .-¢' Routine ~ Check Sample (for routine sample with lab ref. no. © Special Purpose Zip Code Treated Water Untreated Water SAMPLE NO, LOCATION 3 1 4 [ Time Collected Collected By //~ _Lo,~ TO BE COMPLETED BY LABORATORY Date Received Time Received Analytical Method: Analysis shows this Water SAMPLE to be: [~ Satisfactory [] 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. /~ cE Membrane Filter * No. of colonies/100 mi. Lab Ref. No. Result* ~-~ °-Df I~ I FT-I FTq FTq Analyst BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter: Direct Count Verification: LTB FinalMembran~R~,lts , / TNTC = Too Numberous To Count OB = Other Bacteria BGB Coilform/100ml Date 0 '~'//~'/ Time: / SD O Coilform/100ml : APPLI(-'NT FILLS OUT UI~PER HA ..... ? ONLY /~ t,/, ,¢>~ ~' ' ' phone Property Owner ~ ('r Lqr-~ I,-'¢~,, '~ :' 1''~ { ~ I ~ ,._~- ~ ~ Address Zip Code Lendinglnstitution " -, /',ic*,: ~ (? /~ "-:~, ~X ., ,*-'f ~ [~ ~4'~:~ ~%{~'~] k' ~% Phone Address Zip Cede Realty Co. & ACnl ~ Phone Address Zip Code~ Legal Description Z : '~' t :~ ~:' /<~ ~ [ '-3 ~ /, ~.~ <, ~ '7-~ ~ ~ c, ¢ e.. Typ~ of Resi~nce ~ · ~ Single Family ~ Multiple Family No. of Bedroo~ L~-/ ~ Other Water Supply ~ individual A~ACH WELL LOG. A w¢l Icg is required for all wells drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach Icg if available). ~ Public Utility Sewer Disposal l '/¢'¢., ~ Individual Year Individual Instalfed: - ~ Public ~ility When Connected to Public Utility: ~ Holding Tank NOTE: THE iNSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED. Time Time Time Time Date Date Date Dar ~e~,.~r/ Inspector Inspector Inspector Inspector F,e . ,.., ( ~ APPROVEU BEW:' ~ROOMS ¢ ~ *CONDITIONS OF APPROVAL ( ) CONDITIONAL APPROVAL* OAT~ / ?-/~ Soils Raling Date ~wef Instated Well To Absorption Area Well Log Received