HomeMy WebLinkAboutLAKE RIDGE TERRACE BLK 10 LT 7Loke Rid
Tcrroce
Block 10
Lot 7
#051
323-21
GRE.~,,~R ANCHORAGE AREA BOR.
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MA,L,NG ADDRESS
LEGAL DESCR,PT,ON
SEPTIC TANK:
DISTANCE
FROM W E L k'i/'-'l '~
INSIDE LENGTH
MANUFACTURER
INSIDE WIDTH
MATERIAL
LIQUID DEPTH
NUMBER OF .~.,..
COMPARTMENTS
LIQUID CAPACITY /'D~")GALLONS.
TILE DRAIN FIELD: C~,,~¢~O~.~L&.. ~
DISTANCE FROM WELL l/'~ FOUNDATION
NEAREST LOT LINE
OF LINES
NUMBER OF LINES
DISTANCE BETWEEN LINES
TRENCH WIDTH__ IN. TOTAL EFFECTIVE
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
sQ. FT,
LENGTH OF EACH LINE
DEPTH OF FILTER
MATERIAL BENEATH TILE
IN. ABOVE TILE IN.
TYPE
BUILDING
FOUNDATION__
CESSPOOL
APPROVED
CONSTRUCT!ON ~ /~'~ DEPTH.
NEAREST NEAREST SEPTIC SEEPAGE
LOT LINE , SEWER LINE__ TANK , SYSTEM
OTHER SOURCES
DISAPPROVED REMARKS
DISTANCE FROM:
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED BY: ~"J~ L
SEWER LINE DEPTH:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
DATE /.O '~'-~ ~/'/)])APPROVED _'~' (~-. "~L~'~'-
G.A.A.B.
r
by � l
A & L DRILLING COMPANY
BOX 97, EAGLE RIVER, ALASKA 99577 s TELEPHONE 694-2588
OWNER OF LAND "' DRi"/kO &114 DEPTH OF WELL
ADDRESS be -r, A1W",), 9ri!56 STATIC LEVEL OF WATER FT. �.
y�c �
LEGAL DESCRIPTION 7 9/)(/, 10 , /[W�C!••" !�/,C.J.�: rf:7#r RAW DOWN FT. •� -
DATE - Started `+ EndedL��i. GALS. PER HR
PERMIT NUMBER —
7) /14 / KIND OF CASING t` " ' e� /i
KIND OF FORMATION:
Ft.
to
-Ft.
From
From Ft. to�Ft.
661E A10'e' '6w
From
Ft. to
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to
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From •,. Ft. to L Ft.;
C'4,40- t 6'U'UC'G
From '
Ff. to
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to
From LFt. to 17 Ft.
a'.�R�c.
From
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From
-S/i'��
From Ft. to iia Ft.
&4'7'4' 4'1' w''
From
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Ft. to
From '' Ft. toFt.
S&V IO 616 =L �" 4'`'/« _.
From -......
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From '} '•• Ft. toFt.
.5�7/iit� gip.....
From
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Ft....
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From -
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to
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to -Ft.
Ft. to
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to
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MISCL. INFORMATION:
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
- Ft.
From
- Ft. to
Ff.
'From
Ft. to
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From
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From
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From -
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by
A & L DRILLING COMPANY
BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE694-2588
OWNER OF LAND /~/..
ADDRESS /~, 2 ,~
LEGAL DESCRIPTION
DATE - Started ~/3 Y/7
/ - y
PERMIT NUMBER "7
/{¥/~Odf: ~'{?~[~RL~W DOWN FT.
Ended ~%. ~//~/'7' GALS. PER HR
KIND OF CASING
/
DEPTH oF WELL
STATIC LEVEL OF WATER FT.
//
KIND OF FORMATION:
From / '~ Ft. to ~' Ft.
From Ft. to / ~' Ft.
From ~ * Ft. to Ft.
From / ? Ft. to ~<) Ft.
From %") Ft. to ~;'i~ Ft.
From 5-~ Ft. to ~ 5~ 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:
/.)~:.., /~ "1'..) ,;:,,; r-',,,,?-.~.
d-->/ '
J:::'ER~d]T NO.
~FFL]-.HN'[ E:,__FILE .~F. EIt.EF. , ,-'bzL' OLD HRR80R RD
LOC:RT I ON
L.EGRL L}" E:±O L.RKE R JCE:,GE ' ''- "' -
FE~I~ I-I_.E LOT SIZE
T"r'PE OF EOI. L flE:SOF.:BTICd~',I S'¢:E;TEM Z%: [:,RRTNFIELD
'~ 7 ] -7 E F~ 5
2:2250E~1 '.:::;l'/.d_ RRE FEET
MRXIMLIM 1'.41..IME:ER nF E:EDRJ]CIMS = 4
SOiL RRTING ,::SC! FT,-."E:R)= ::L50
'T'FIE REC!UIRED SIZE OF THE SOIL RE:SORPI"ION S'T'STEM IE;:
E:, E~: F' 'IF' H =~-~-' .... P~ L.. E':'- ~'-.il C'~ "T ~-~ -- ~_ C3 F~ R "..." E: L_ E::, EE F" 'T' ~..-~ .... .. ;7~:~=;
TidE: LENGTH E, IF,'IEN'ZZ]N IE THE LENGTH ::IN I::'~'T:: OF THE TRENCH OR DRFIII",tF'IEL. E:.
THE DEF'TH OF R TRENCH ]~' PZT ZS THE E:,ZSTRNCE BETI.,.IEEN THE SI...IRF:'FICE OF THE
GROUND RND THE BOTTOM OF THE EXCR',.,'RTZON ,::IN FEET::,.,_~
THE TRENCH WZDTH FOR [:,RRZNFZELE:,S ZS Z4 F'EET.~ ~~
THE GRFI',,,'EL DEPTH Z:E; THE MZNZMLIh'I DEF'TFI OF GR. RVEL BETP.IEEN THE OUTF'RL.L PZI='E
FIND THE E:OTTOM OF THE EXC:FI'¢RTZON ,:: ZN FEET).
MINIMUM DISTRNCE BETWEEN R klELL RND Ri'..l'¢ ON-SITE SEI.qFIGE DISF'O:51=IL S"r'S]"E:M IS
:1. OO FEET FOR FI PR I ',,,'RTE 14ELL OR 200 FEET FOR R PUBLIC 14ELL.
WEI_L LOGS RRE REC!LIIRE[:, RND MUS]" BE RE]"URNED TO THE DEPRRTMENT t4ITHIN ]i:O C,R'T'S
OF' THE !.,-IELL. COMF:'LETION.
SF:'ECIFICFITIONS FIN:''' CON~TRL.ICTION ['.,IFI(3RRI"IS FIRE I-9,,,'EII[..RIF;LE: TO INSURE: F:'ROI::'ER
I NSTRLL. RTI ON.
I CERTIF'.r' THRT
:L: I RM FRMtLIRR 14iTH TF.IE REQUIREMENTS FOR ON-SITE SEWERS F~I'-,ID P.IEL. L.S F~E; SET
FORTH 8'¢ THE MUNICIPRLIT"r' OF RNCHORRGE.
2: I WILL INSTRLL THE S~r'STEM IN FICCORDF~NCE 14ITH THE CO[:'E:.S.
3:: I UNDERSTFtN[.', THFIT 'THE ON-SI'TE SEI.,JE:R S"r'STEM MFI"r' RE:C!UIRE Et",II....FdROEMIEI",I'T' IF THE:
RESI[-"ENC'E IS REMODELED TO INCL..LIDE MORE THRN 4 E=EE:,ROCd'dS.
.... ........................................
....... .....
O Et-E GEe' iCHNICAL ~ DEVEL' ?MENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russe# Oyster
694-2774
Soils S-Foundations
Eaff E/lis
688-2280
S0IL LOG Laod Development
Performed for:
Legal
10~
11~
12~
~3
~4
Ground Water Encountered: Yes No If yes, what depth~
Proposed Installation: Seepage Pit~ Drain Field w/
Comments: ~ ~%~ c-~ ~tvx-J~ ~ ~>x~'~<~ ~
Municipality of Anchorage
DeveloPment Services Department
· Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak, us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORI'r , .. APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. O~"'t ",~-~- ~1
· .GENERAL INF~ORMATION
Expiration Date:
~' .' Completelegal;description Lot: 7; Block 10: Lake Ridge Terrace ~/r)
'i..'.~ .. Loc~tion (site addr'.es$ or directions) 14305 Harold Ln Ea~le River, AK 99577
~, Current PropertY 0wner(s) Norman Crosb¥ Dayphone 696-4561
,~. Mailing~d.dress 14305 Harold Lp Eagle River, AK 99577
[_~nding agency Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBEROF BEDROOMS: 3
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
Individual On-site ~
Individual Holding tank
E~] Community On-site ~]~
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public
water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional
engineer's work.
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as cf the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is(are) 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(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations tn effect at the time of installation.
$ & $ ENGINEERING *
Name of Firm ..... ,, ,,.,., .,.~.~,.; .-.~;.=:. ,..~ ~e,_~ ~,, e~
Address Eagle River, Alaska ~577 ~.,/~.
Engineer's Printed Name /~ ~ ~ 7- C~ Cd ~,,f~ Date f~//o/
Phone
DSD SIGNATURE
~ Approved for "~
Disapproved.
Conditi(~nal approva~ for
bedrooms, With the following stipulations:
Additional Comments
~=~.; WATERAND '. ~".,
· -. , ~,t~C:T!=WATI::R .' ·
'.
Attachments:
HAA Checklist
Septic System Advisory .
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
· Original Certificate Date: ~ ' '~ 0 - 4) I
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Westewater Program
4700 South Brogaw St.
P.O. Box 196650 Anchorage, AK 995196650
www.ci.anchomge.ak.us
(907) 343-79O4
HEALTH AUTHORITY APPROVAL CHECKLIST
A. WELL DATA
Date completed ~.~'~
Total depth ~ ~' fl.
If A, B, or C provide PWSID # --'""-
Well Log (Y/N)
Wires properly protected (Y/N)
Casing helght (above ground) / ~-~'~'in.
FROM WELL LOG AT INSPECTION
Static water level ~ ft. ~ 'Z. fl.
Well produc~on ~ g.p.m. I ' 4 a.p.m.
WATER SAMPLE RESULTS:
Coliform O colonies/100 mi.
Date of sample: ~/~.~/0[
B. SEPTIC/HOLDING TANK DATA
Nitrate 0,?~/3 mg./L Other bacteria O colonies/100 mi.
Foundation cieanout (Y/N)
C~eanouts (Y/N)~
Depression over tank (Y/N) fao High water alarm (Y/N) ~l/,~-
Daie~pumping C~'/~(~7 Pumper ~ Ij
C. ~SO~ON FIE~ DATA ~
Len~ ~ fl. W~ ~ fl. G~el bel~ pipe ~ fl.
Totaldepth ~"'%. Eff. absorpUonarea ]~t2 Moniteringtub, ~'~ Depression over field ~
pete o edequaw te,, ,esu,. For 3
Fluid dep~ ~ absomtion field ~f~ t,t ~ in. Water add~. N~ dep~.~n.
Elap.. Time: ~ min. F~,' fluid d~ ~ in. ~sWfi~ rate >= ~
g.p.d.
~y mju~fi~ ~a~ent (p~t 12 mo.) ~ & ~)/ ~O If yes, give date ~
O. UFT STA'nON
Date installed
'Pump on' level at/w/__ in. ·
Size in gallons
'Pump off' level at in.
Cycles tested
Manhole/Acness (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
in.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank,~'t~on on lot
Absorption field on lot
Public sewer main
/.~...
Sewer/septic service line
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation
Water main
Wells on adjacent lots
Water service line
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank ~//
Absorption field
Surface water
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation / O 14- Water main
Property line
/oo
! /
Water Service line //~) ,-t'- iSurface water $ ~ ~ Driveway, panV, ing/vehide storage
cumin on adjace.t lots.
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through fie.Id inspectJons and
review of Municipal reconfs that the above systems ere in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name /xO0/~'~7" C.
Date ~ j ~' ~/0/
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12/00)
Waiver Fee $
Date of Payment
Receipt Number
9 .. '.'l�' •-1 '✓moi
• .. ,,; o+• , 11
AUG -28-01 10:51 FROM -ME ENVIRONIENTAL SRV 9015615301 T-471 P.01/02 F-376
\ CUE Environmental Services Inc.
Ad&* v.rrr r...rirrrra..r�rrrrrw
ME M.N
1015593001
Client Name
S & S Engineering
Project NamelN
L7, B10 Lake Ridge Ter
Client Sample 1D
W. BIO Lake Ridge Ter
Matrix
Drinking Water
Ordered By
PWSID
0
:'A -
Client PON
Printed Datemme 08128/2001 10:43
Collected Date/Time 08/23/2001 9:30
Received Datefrlme 08/23/2001 15:45
Technical Director Stephen C. Ede
Released By A n n #J
`Allowable Prep Analysis
Psrunenr Results PQL Units Method Limits Due Date lot
waters Dayartmant
Nitrate -N 0.742 0.500 mg/l. EPA 300.0 (<10)
lljcrebielogy�r.ahoratezv '
Total Coliform 0 0 coV100mL SM1892229 (Q)
08123101 SCL
08/23/01 SKW
MUNICIPALITY OF ANCHORAG?i~
DEPARTMI .... = OF HEAL.TH AND ENVIRONMEb "L
8~J L Street, Anchorage,
279-2511, ext. 224 or 225
Date Received:
PROTECTION
99501
August 25, 1977
Date ~-~-~1-1 [~t3h-~ Date ................... Date
Insp .... .
REQUnSi FOR APPRO!/AL OF INDIVIDUAL SEWER I~D WATER
It3: !lme
Lena lng Institution Request: Y .........................................
MailJ_ng Address: _~pp~__9.~.~_{,?p__~?_N_A.%q~?9p~?_ ...... Phone: 278-9579
2. Property Owner: Dale Griener Phone: 333-7505
MailJ_ng Address:
7630 Old Harbor Road 99577
Legal Description: Lot 7 Block 10 Lake Ridge Terrace Subdivision
4: Single Family Re,~lden .... : (x)
Number of Bedrooms: Two
_ Re .....ctenc=: (
Multiple Family ' ~oi" ,-~ ,
Number of Bedrooms:
Well[ Systen:
Const:uction.
Individual Well (x) Community/Pub]lc System ( )
3~,*.h F,F Well Well Log on Fi. lc ( )
Bacterial Analysis
6, Sewage Disposal System: On.-s.ite System (x) Public Util:.ty ( )
AbsorDtJoIl~ Area om1 s ............. [~ MaterJ. al
'1. Distances: Wei! ~o Septic '",:~' . .... ~ ..... ~ .- ._
to Sewer Lip. e
Lot ]./Lne
Area
to Nearest Lot Line
Page ~Two
~- De[p,:lrtmen~ of -(' and Envirom~ea~xai Protection
Requests for Approval of IndivJ.dual Sewer o. na Wa~er Facilities
]legal DescrJ. ptJ. on: Lot 7 Block 10 Lake Ridge Terrace Subdivision
-'omment s:
Affadav!t Attached: ( j :[,et-her
A_pprov£;d: ~ ................... Date
Disapproved; .............................................
Date
Dei:~artment ~r-~k~-' ~ -
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ~:NVIRONMFNTAL PROTECTION
825 L Street, Anchorage, Alaska 99501
279-2511, ext. 224, 225
REQUEST FOR APPROVAl OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection:
2. Property Owner:
Dale Griener
VA FHA.. CONY xx
Mailing Address: 7630 Old Harbor Road, Eagle Riv~ay Phone:
Name of Buyer: Norman W. Crosby
333 7505
Eagle River, AK
Mailing Address:_ Box 62, Fish Hatchery Rd. Day Phone:_ 278 9579 X 242
4. Name of Lending Institution: Coast Mortgage Co.
Mailing Address: P.O. Box 1200, Anchorage, AK Phone: 99510
Anchor Realty, Patty Morgridge
5. Name of Realtor or Agent:_
Mailing Address: 511 E. 5th Ave., Anchorage AK Phone: 272 8481
6. Legal Description: Lot 7, Block 10, Lake Ridge Terrace S/D
Location:
NHN Harold Loop, Eagle River, AK
7. Type of Facility to be Inspected:
8. Water Supply
Type of Supply:
Single family
No. Bdrms. 2
Public Utility
Individual.
XX
If Individual, number of dwellings presently served
If Individual, depth of well
Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation 1977
Individual (on-site)
72-003(3/76)