HomeMy WebLinkAboutLAKESIDE TERRACE LT 1 N2
MUNICIPALITY OF ANCHORAGE ~ - ,
DJ' RTMENT OF HEALTH AND HUMAN SER ,cS
Environmental Health Division O / ] 0 ~ 7-~
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Address ~ ~ i ~-~ ~ ~ Z~
Phone[s} Permit NO No o~ Dedrooms
LEGAL DESCRIPTION
Brock . Subdiwsion ~
Township, ~ange, Section
T~
~ SEPTIC : HOLDING
DISTANCES
SEPTIC
TANK
ABSORPTION
FIELD
WELL
WELL
LOT LINE
FO,NOAT O,
AS-BUILT DIAGRAM (Show Iocahon of wetl, septic system, properly hnes, foundabon,
driveway, water bodies, etc.)
Manulactu~er Capacity m gallons
Material No. of Compadments
TYPE OF SYSTEM
TRENCH [] BED [] W. DRAIN [] OTHER
Depth to p~pe bottom trom Total depth from original grade
¢ -- / FT ~ FT
Gravel length
Total absorphon area
Number el lines I Soil rating
I I
Installer
Gravel w~dth
?;~)/i ET
FT Distance between hnes
P~pe materia
Date Instatle
FT
WELLS
[] PRIVATE [] OTHER ¢ldentifv)
Classllicahon (A,B.CJ Total Depth FT Cased to
Installe~ Date Installed: FT
REMARKS:
Scale:
Inspections Performed by:
I__[), '~ -~'¢'[,,'('~', - '°/~'&<' ~ cedily Ihal this inspeclien was porlormed according to all
Municipal and State gui/~linos in effect 0e Ibis dat.~e: / :~-/' /' ~, / ~ ~ ':
.LOT 4
LUXHBRE
VACANT
INSTAL. Lt
38 L.F. DF TRENCH
Il' DEEP
8' OF ROCK
INSULATE UNITER
CONCRETE
5 CLEAN OUTS
! MONITOR TI.I~E
IE50 GAL, STEEL TANK
INSULATE OVER TANK
89' 58' W 123,66
89' ' 5!/
Cl]
123,71
SINGLE FAMILY
RESI~ENSE
S1/2' LFIT 1
L_d
z Ed
t
TDD~EN SPURKLAND P,E, II
203 W, 15TH. AVENUE
I!
ANCHORAG~ ALASKA
<907) ~79-3916
15 0
GRAPHIC SCALE
NI/~ LOT L LAKESIDE TERRACE
SEC.%TI~N, R4W
ALASKA U~A FEDERAL CREDIT UNION
f~O 75 90
II SEPTIC SYSTEM DESIGN
gATE, OCT. 18, 1987
SHEET, 1/1 GRID, 2125
(EN. G. IN E~ER'S SEAL)
~ Municipality of Anchorage
[~,~..~.~) DEPARTMENT OF HEALTH & HUMAN SERVICES
~ . 825 "L" Street, Anchorage, Alaska 99502-0650 ~..
'
SOILS LOG -- PERCOLATION TEST ~,.
LEGAL DESOR,PT,ON: ~ /& Lot I, LA~[,,b~ Township. Range. Section:
TI~_EI~,~ C F---. SLOPE SITE PLAN
. Z[
"~¢' ~O
_ ...... .~ ~3.171 I Il
WAS GROUND WATER ~
ENCOUNTERED? ~ ~
1
S
L
IF YES, AT WHAT O
DEPTH? p
to Water After :, ] Dale:I/¢/j)~/~Z'//c('& E
DeplhMonitoring? "./ I~) ~
Reading Date Gross Net Depth to Net
Time Time · Water Drop
10-
11
12
13-
14.
15-
16-
17
18
19
2O
PERCOLATION RATE /~-~'*0I ~J~ 0 ~k
minutes/inch) PERC HOLE DIAMETER __
TEST RUN BETWEEN -~ FT AND / 7 FT
COMMENTS
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFZTON THiS DATE. ~iATE!l ~_~J ,/I~"~ / ?
72-008 (Rev. 4185)
1. General Information
MUNICIPALITY OF ANCHORAGE
DIVISION OF EI~'IROI~tENTAL m%~LTH
DEP~ 0F ~TH ~ E~O~ ~O~CTION
Application Date
(a) Legal Description (include lot, block,~subdivision, section, township, range)
(b)
(c)
Location (address or d.t,~reccfoas) .
Applicants Name ~o ~
Applicants Address ~Z~ ~
Telephone - Home Business
Applicant is (check one) Lending Institution ~--~ ; OWner/builder~
Buyer[ 2; Other[ ICe. plain); / '
(d) Lending Institution
Telephone
Address
(e) Real Estate Co. & Agent
Address
(f)
2,
Telephone
Mail the RAA to the following address:
Type of Residence
Sing!e-Famtly~__~
Number of Bedrooms
Other (describe)
Water Supply
Individual Well ~--~ Comm~,ni~y ~-~ Public
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. Sewage Disposal
Note.' /If community well system, must have writtan confirmation from the State
epartment of Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
e
Engineering Firm Providin~ Inspections~ Tes.ts~ File Search~ Data and Information~
certified by my seal affixed hereto and as of the validation date shown'=~'____
As
verify that my investigation of this Health Authority Approval shows th'at the
water supply amd/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 wager supply amd/or wastewater disposal
system is lm compliance with all Municipal and State codes, ordinances, and regula-
tions in effect om the date of this inspection.
Name of Firm
DHEP Approval
Approved for .~-~ bedrooms
Approved~__ DiSapproved.
Terms of Conditional Approval
CAUTION
THE MUNiCI.PALITY OF A~CHORAGE DEPARTMENT OF HEALTH AND EN-~IRONMENT-~Ju PROTECTION
(DHEP) ISSUES ~r~.ALTH AUTHORITY APPROVAL CERTIFICATES BAS~ SOLELY UPON THE RKPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 A~OVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN T~ STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PU~.CHASERS OF HOMES
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND S~TE R~QUIRE-
HENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR F~RRORS
OR OMISSIONS IN ~ PROFESSIONAL ENGINEER'S WORK-
.(DHEP SEAL)
RR4/ej/DI8
[Page 2 of 2] 7'19-84
ae
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Legal Description: /~/~/j~ ~.~/ /
~'~tIf A, B, c~ C, D.E.C. Approved<Y/N)
Date ~leted ~ Yield
~ Sanit~ ~al on Casing (Y~/~
~;~ ~mession ~ound ~l~ead
Well Classification
Well Log P~esent (Y/N) ~l~
Total Depth ~/~ Cased to
Static Water Level ~
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances frc~ Well:
To Septic/Holding Tank on Lot
I%;/~ ; On Adjoining Lots
To Nearest Edge of Absorption Field o~n. iLot?__~___/; On Adjoining Lots
To Nearest Public Se~ Line~. To Nearest Public Sewer
Cleancut/Manhole ~ t~ To Nearest Sewe~ Service Line on Lot
Water Sample Collected By ~1~ ; Date___.l~_~
Water Sample Test Results
B. SEPTIC/HOLDING TANK DATA
Date Installed I~q Size /~0 No. of Col~a~tm~nts
· ~ Foun~tion Cleanout (Y~
Stan~i~s ~) ,~ Aid-tight Caps )
~ession o~r Ta~ (Y~)~ ~te ~st P~d ..'~,/~1~ -'
P~i~g~i~te~a~ ~~ ~ File (Y~) ~/~; for
Holding Ta~ High-Wate= ~a~ (Y~) /~]~ ~r~ Holdi~ Tank ~t (Y~)
~p~ation Distance ~ ~Ptic~olding Ta~:
To Water-Supply ~11 ~ To ~ilding Foundation ~/
To ~o~rty Li~ /~/~ To Dis~sal Field
To ~ter ~i~Servi~ Line +{~/~ To S~e~, Pond, ~ke, ~ ~jor ~aina~
[Page 1 of 2]
Receipt ~
Date Paid:
Amount: ~-~
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Stnata
Date .Installed
Width of Field
Squane Feet of Absorption Anea
Depression over Field (~
Results of Last Adequacy Test
b~/~ Typ~ of System Design ~'m.~'~
Length of Field
Depth of Field
Grail ~d Thickness
&~~ Stan~i~s ~esent (Y~))
~te of ~st A~a~ ~st.
Separation Distance fnom Absorption Field:
To Waten-Supply Well /~3//~ To P~ope~ty Line
To Building Foundation ~L/ To Existing or Abandoned System on
Lot y~v/~/~ ; On Adjoining Lots .~ ~ /
To Water Sain/Senvice Line ~ ~O/ To Cutbank(if p~esent)
To St~eam/Pond/Lake/c~ Majon Drainage Course
D. LIFT STATION
Dimensions
Date Installed
Size in Gallons ' ~ ! ~/}~Manho~
Electnical Codes (~q~
Meets MOA
C~f~nts /
** Che~k Permitted Bedroom Rating A~ainst HAA Request
I certify that I have checked, verified, on confcz~ed to all MOA HAA Guidelines in eff~c~
on the date of this inspection.
Company
[Page 2 of 2] w~,:,.~ . -
2-15-84
D[PT.
MUNICIPALITY OF ANCHORAGE qVIRoh ,'LN[/_
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 L Street- Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720 R
REOUE~T FO~ APPROVAL OF INDIVIDUAL ~ATE~ A~D ~E~E~ FA~ILITIE~
DIREgTIO~; Gomplete all parts on pag~ ~, In~ompl~ requosts ~ill no~ b~ pro~, Please allow ten (~0) days for pro~ssin~.
~. ~ROPERTY O~R PHONE
MAI LInG ~DDRESS
PROPERTY RESIDENT (If different from above) PHONE
2. BUYER PHONE
MAILING ADDRESS
3, LENDING INSTITUTION ~ PHONE
I
MAILING ADDRESS
4. REALTOR/AGENT PHONE
MAI LING ADDR ESS
5. LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE
'~ SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] One [] Four
[] Two [] Five
~ Three [] Six
[] Other
7. WATER SUPPLY
[] INDIVIDUAL~
COMMUNITY
PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
~ INDIVIDUAL/ON-SITE~
[] PUBLIC UTILITY
individual/on-site, §ive installation date ~/~, ¢O~'~,
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
NSPECTION APPOINTMENTS
'TIME TIME TIME
DATE DATE DATE
INSPECTOR I NSP ECTOR INSPECTOR
DIRECTIONS:
NUMBER OF BEDROOMS
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SIX
[] OTHER
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTI L~TY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[~]INDIVIDUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Septic Tank or []HoldingTank ,
Size: If Tank is homemade '
give dimensions:
TYPE OF TANK
TOTAL ABSORPTION AREA
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
])ON
LOG RECEIVED ,
PERMIT NUMBER
DATEINSTALLED
INSTALLER
SOILS RATING
MANUFACTURER
MATERIAL
Septic/Holding Tank
2932 'C' STREET
BROKER RES. (907) 3, 063
TORTHLAND REALTY
CORNER 'C' STREET & BENSON
276-1919
o ANCHORAGE, ALASKA 99503
Absorption Area Sewer Line I Nearest Lot Line
5. COMMENTS
~]~PP RO V E D FOR
DATE
LEGAL DESCRIPTION
._~_ BEDROOMS
CONDITIONAL APPROVAL (letter must accompany certificate)
DISAPPROVED
72-010 (Rev. 3/78)
ALASKA [/UIRO[lm IqTAL CO[1TROL S RUIC S, II1C.
(~n§in~erinq 8 ~nuironm~nlr~l $iuJi~s
JANUARY 4 1985
KEITH & KAY FIERO
6906 TERRY PLACE
ANCHORAGE AK 99502
SELLER - BARB~RtA GARDNER BUYER -
SUBDIVISION - LAKESIDE TERRACE BLOCK - 0
LOT - N 1/2 OF i
ADEQUACY TEST FOR SEWER SYSTEM
THE TYPE OF ABSORPTION SYSTEM IS A UNKNOWN WITH AN UNKNOWN AREA.
THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 450 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
3 BEDROOM HOME.
THE SEPTIC TANK WAS PUMPED ON SEPT 5 1984 .
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR
THIS 3 BEDROOM HOUSE.
~ b."i~-0 ::c~ S: ~', .... ,.
rmn IIl,,~t -~-~,.,.I /~,,~,,~ .%i~. B · ~nchordo~: ^bsb 99503 *[907) 561-5040
P.E. 4303 North Star Street
PERFORMED FOR:
SOIL ABSORPTION SYST~4 TEST
Anchorage, Alaska, 99503 907,279-8056
NEW PHONE NUMBER 276L~i'~]13.... ........
· ' ..i~..._ , . f
z?4 -~o4-3 '-'
TELEPHONE: ~.7 ~-~4'7~
DATE OF TESTS: ~/ZZ.
RECORDS ON FILE: '/w~_ ..'
DRAINFIELD · OTHER' ~ .,._,,.
IN ACCORDANCE WITH JML STANDARD ,PROCEDUREACCEPTED~,BY '~'
ANCHORAGE, DEPT. OF ENVIRO~,~MENTAL QUAEIT¥'ON'J~
THE FOLLOWING MODIFICATIONS:
'.CITY: " : ~'-~
0RPTION SYST~4 (SAS)
sEPTIc TA~UK PLUS SAS "
'ION RATE '~m~ '~ '~ ..:. .: .~..
s ~ STEADY STATE ..... ~-'- ~ RISE
JML
P.E.- 4~3 North S'~ S'13'~t
r. EXISTING DP~IN FIELD TEST r. PERCOLATION ADEQUACY
REFEP~NOE:
....~. ~ . ~.. ~. , .',"./, .,,_.'.7..'-.;
~ ~ . _.~:.._ 0 . .~/t,,s /-.
.-.~ ~~ . · ' ~- ~- - '..~. ', :. I' ~ ~ o l "'-:
:...... . . .' . , -- ,. . .' . , ~' - ?. .,~ .
· '" .~': : ', ~'~,~.~ 4' -" -
, . ~._ ~ ~ ~ . ~ ' . , ~ ., ~. - '~: ::.
~ .. .- I~.,~
,/~: . ,, ., _
4303 North Star SU-eet 907-279~8056 ·
· REFERRNCE:
% ':.. -~,'.~.,, DATE .~-~'fl'z-'T/?~'~ P~ml~E~ BY:
~ ~ / r
Anchmage, Alaska, 99503
?~,."}DF~'~' Bk~OW METER READING GALLONS PUMPED - .. TIME -
. . . . ~ , ~ . . ~..:
· _ ' ' '" ' I "~.~ ' "' " '~"-' ~. ~-
' .> - . ...,, '...'::- ..
~DEPTH BELOW ' METER READING GALLONS PUMPED -: T~n~E .4 'i:'__;
~F~, m~CE :_. · ( ~LLONS ) ' ( ,N~ ) ~.,., :'.' :.-, .
. · , :~ ~.
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3500 Tudor Road, Anchorage, Alaska 99507 279-8686
Date Recetved__.~.~~
Time of Inspection
Insoection \\'~'~' \
Date of . _ ,\-,
REQUEST FOR APPROVAL OF
I~IVIDUAL SEWER g WA~R FACILITIES
FOR
2. Prooerty ner, _
3. Legal Description: ~ /~ / ~7~ /
5. Type of Facility to be Insoected:
Number of Bedrooms:
5. Well Data:
A. Type B.
C. Construction
Sewage DisOosal Svstem: __
C. Septic Tank: 1, Size/.,~>~
Phone:
Phone:
Depth ,,
· Bacterial Analysis
Installer -~,~'
~anufacturer
D. o~epage Pit: '1. Size 2 Material
Eo Disposal Field: Total·~ength of Lines
Distances: ~,0
A. Well To: Septic Tank d~w'~'"'-' , Absorption Area
, Sewer Lines
, Nearest Lot Line , Other Contamination
Bo Foundation to Septic Tank ~t-~' "~ Absorption Area
C. Absorption Area to Nearest Lot Line
R$.q.ms.t for Approval of I~divzdual Sewer & Water Facilities
9~ Comments ~' ~.~.~,---~ ~
.Aonroved~Disapproved
Approval Valid for One Year From Date Signed
Greater Anchorage Area Borough, DeDartment of Environmental Quality
DIAGRAM OF SYSTSM
I certify that the information contained in this request for approval to be a true
and accurate representation of the subject sewer and water facilities located at:
SiGned