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Home My WebLink AboutLAKE SHORE LT 2fl "-'- MUNICIPALITY OF ANCHORAGE .... DEl, .{TMENT OF HEALTH AND HUMAN SER~ . · Environmental Health Division '~ ' 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Na"'e~-~O¢~ O k ~-%O'~) DISTANCES SEPTIC ABSORPTION Address~/~ ~,~/ · ¢0¢~ ~¢¢ TANK FIELD WELL Phone(s) -- WELL J 00 / J¢O / Permit NO. No. of Bedrooms LEGAL DESCRIPTION LOT LINE Lot ~ J Bl~c~ SubdivJs,on ~D- FOUNDATION Township, Range, Section ~C~~ AS-BUILT DIAGRAM (Show tocabon ol well. sepJic system, property hnes. Joundshon. %/'Z/~ R 4~ ~ lO. % ~. d ...... ay. waterbod,es, etc. J TANKS ~ i Manufacturer Capacity in gallons TYPE OF SYSTEM / J Distance between mines ~, ~ , Number of I .... J Soil rating , P,pe ,nateria, ~ ~ PRIVATE ~ OTHER (Identify) [ ,., ~¢ ~ ceHily Ihat this inspection WaS pedormed according lo all Ith Depadment Approval: ~' ~ " , ' : ~ (907) 243-2282 KEN JOHNSON Ronald Wo Ohlson 5153 Wo 80th Anchorage, Alaska 30 Y~;AL~tfA~ , ', DR/LLING Nr~ ¢,OrE~/O~163 LINDEN DRIVE ~O~8 1V&N~NOtlANt /JUN~ ~ o~NCHORAGE'I~ ALASKA 99502 ( Hmo 243-5569 Wko 563-3162 ) Rel Lot 2 Lake Shore Subd. WATER WELL LOG 0 ft to 15 ft 15 ft to 25 ft 25 ft to 38 ft 38 ft to 58 ft 58 ft to 65 ft 65 ft to 73 ft 73 ft to 85 ft 85 ft to 98 ft 98 ft to 120 ft 120 ft to 159 ft 159 ft to 177 ft 177 ft to 184-6 ft 184-6 ft to 185 ft 185-6 ft GL TOTAL CASING 190-8~ Static Water level 74-7 Organics-- Sand with some ~edo gravel Brown sand Dark brown sand Light brown sand Rusty brown sand--trace of medo gravo Dark brown sand Gray sand ( weeps ) Heaves 5 ft--Silty gray fine sand Dirty fine silty sand-heaves 5 ft Wi 53 ft Same with clay'seams Fine silty sand--oozes in 8 ft Clay and med grav( open hole ) Ned° gray & fine sandoovery dirtyo~ 65 ft head H20ooTest bail at 12 GP~ Bails down~opOr recovery°° Clean fine gravel & medo sandoowater bearingo~ 70 ft head.° Test bailed at 12 GPM.° 10 ft Drawdown & rising°° Bottom stable..SEE TEST PU~P DATA~ TI~'~ GPM DRAWDOWN 1342 10 90°6 1350 . 90.9 1355 3o6 1357 20 103.4 1400 20 107o0 1405 20 li4.5 1410 2O 117.7 1415 20 119o5 1420 2O 119.6 1425 17o6 119~9 1440 17.6 119.10 1455 17o6 12102 1515 16~9 -122.6 !540 16o? 123o0 1555 16o7 123o0 1615 16.7 123.0 1635 16.7 123o0 1725 16.5 123.8 Good recovery ...Bottom stable REd, APrilS very dirty black Dirty . ~clearing Dark cloudy clearing Dark milky o. clearing light milky . oclearing " " " Better Lto milkyooLto Sand clearing Same almost clear Lt 2~oudy very little sand Almost clean and clear Clean & clear Clean & clear DEPAR"T'MEIqT OF HEAL. TH AND ENVIRONMENTAL PROT'ECTION 825 L STREET', ANCHORAGE, AK 9950 264-'4'720 F:'ERM I 'I" lqO: DA't"E t ,"3SLJED: .. ,.;,.~= ENG I IqEtE:ITED ]}ES I GN 10:T,/8t5 APF'L. ! CANT' ,~ ¢ D.(. F',E.,m. , COt".tTAC T F:'H EINE: RON OHL. SON 5153 WEST 80TH · ANCHORAGE, AK 338- ~ 79 1 99502 LEGAL DESC,'R :[ I:' ~ L. OT f: :t: ZE: L..OT LOCA]'ION: SUBDIVISION: LAKESHORE SEC]'I[}hI: i0 TOWNSHIP: 12N 31'790 (SI;!,, F"T'. OR ACRES) 80TH STRIEt.ET LOT: '~' RANGE: 4W BI_OCK: NA 1, I am familiar' wit. h t. he r'equir'emen'Ls for on-site sewe~'~ and wells as~ set for'th by the M[tnicipa].ity of Anchcmage (MOA) and tl]e Stat. e Of' Alaska, 2. I will install the system in accc)r'danc:e with all MOA codes and pegulat, ions, and in c:omp].iance with the design cr'itepJ, a 'of t. his penmit.,, 3., ;[ ~:[].]. adh~r'e~ t.o all MOA and State of Alaska peqLtipe~ter'l'Es ~'or' t;..h(~ set. back dis'Lances [porn any exist, ing well, wast. el4a'[eP disposal syst. efll ~;E~Laa)l*ai~j~;~ syst. em on t.J]is or' any acJ.ja/c;erJt op nearby lclt.,, IF A L];F']" 1S'T'ATION ]:~:J II'4SI"ALL..ED I[4 AN ARIEA COVERED E ¢ MOA BLJILDING CODES, THEN I::.~_I=L, IF*iCAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AF:~-':;tiTL]"S WILL NOT BE APPROVED WITHOUT AN ELECTRICAL. IN~PE;CTION REPORT; AND ,(3) THE EL. IECTF~I CAL.. WORK MUST' BE DONE BY__A L I,~ENSED ELECTRI C:t:AN. AF:'F'I...ICANT: I:~[)1,t ...... OHL.' ' .... .SON MUNICIPALITY OF ANCHORAGE DEPARTiVIENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG-- PERCOLATION TEST [] PERCOLATION TEST PERFORMED EOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 SITE PLAN I0- 11 12 13 14 15- 16 17, 19'- WAS GROUND WATER ,/~ I.~ , SL ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) , TEST RUN BETWEEN , FT AND . FT , -- //~ PERFORMED BY:~/~ ~~ CERTIFIED BY: DATE: SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG-- PERCOLATION TEST [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 7 8 SLOPE SITE PLAN WAS GROUND WATER ~V S ENCOUNTERED? ~C~ 0L P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST. RUN BET~,EEN , __ FT AND __ FT . CERTIFIED BY: DATE:~ 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 26~4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name _ i~o,,,] OIt~?.~,'~ Telephone: Home ~-~¢~--~'~'~'-¢ ~' Business _~.~-"~¢~-~/~-' Applicant Address ~::~o~ OLI o,¢ (c) Applicant is (check one): Lending Institution~ Owner/builder []; Buyer []; Other [] (explain}; (d) Lendinglnstitution /~,¢-~_ ~'~,~%~L~v'~Telephone Address /00 I -'-~'~'/~O/~ 'iSZ-V~ (e) Real Estate Company and Agent Address (f) Telephone Mail the HAA to the following address: 41 o,o TYPE OF RESIDENCE Single-Family, J~' 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. 4. SEWAGE DISPOSAL Onsite~¢ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. 72-025 (~ 1~84) Page 1 of 2 ENGINEERING FIRM PROVIDIN- INSPECTIONS, TESTS, FILE SEARCH, DA, A 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 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. Name of Firm ~-¢4//,~'"~¢C/~ ~x~,~/~4 Telephone ¢~'-~/'--~'-//0 7 Address ~O ~ ~~ ¢ ~, ~ ~ ~0 ~ Date Engineer's Seal Approved for .~,~-* (~_~bedrooms by /~ ate Approved ~ - Disapproved Conditional Terms of Conditional Approval 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 MUNICIPALITY OF ANCHORAGE (MOA} HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~o¢~ WELL DATA Well Classification Well Log Present (Y/N) tT~ Total Depth */"~*~-' /cased to /'¢~' / Static Water Level ~' ~ / Casing Height Above Ground ~ / ELectrical Wiring in Conduit (Y/N) ~ ~'~-,('t V'/oJ~ If A, B, C, D.E.C. Approved (Y/N) Date Completed Yi%ld Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) /0o z _/_ Separation Distances from Well: To Septic/Holding Tank on Lot /~;;~D ? -/- ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot /'¢-~¢---~/'/-; On Adjoining Lots To Nearest Public Sewer Line /&c/O,~./z~- To Nearest Public Sewer Cleanout/Manhole /'¢/O/¢'''~ To Nearest Sewer Service Line on Lot Water Sample Collected by /~~ /.~~ ;Date Water Sample Test Results ~'~/*¢'~'~-~¢-'¢'~"'"') Comments /"~e._~,.~ ,~e.~ ' ,¢ ~' ~,/I.~, ¢,~-z~ B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) ,/'/' Air-tight Caps (Y/N) Depression over Tank (Y/N) /-'1../ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: / No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped /¢,/-e.~O ; for Temporary Holding Tank Permit (Y/N) To Water-Supply Well To Property Line To Water Main/Service Line Course Comments C) uO ~ ~ To Building Foundation / O / To Disposal Field /OO / ""¢/~'/ To Stream. Pond. Lake, or Major Drainage Page I of 2 ABSORPTION FIELD DATA Date Installed ~//7/~' ,--'~'~- Length of Field ~ '~' Z ~z '"z' "'¢'~-'~-- Width of Field ?~ / Depth of Field Gravel Bed Thickness ~ Square Feet of Absorption Area -~7 ¢,~Z_ ,(--~,, ~/~-, Standpipes Present (Y/N) Depression over Field (Y/N) ~ Date of Last Adequacy Test Results of Last Adequacy Test /'~.~-,~J ~' ~ Separation Distance from Absorption Field: To Water-Supply Well / 'OO / ~/Z. ~ To Property Line To Building Foundation / ~' / To Existing or Abandoned System on Lot ~- /O~ (' ; On Adjoining Lots '~ c:) "' To Water Main/Service Line '.'.'.'.'.'.'.'.'.~O "' ~ To Cutbank (if present) ~ /' "~ To Stream/Pond/Lake/or Major Drainage Course / O O / '--/L~z> ,/~.../('~'~--'~ ~ - To Driveway, Parking Area, or Vehicle Storage Area .~'/L-O ( D. LIFT STATION Date Installed ~'//~'~,~"' -- ~//?. ,~/~> 'L/~ Size in Gallons .,~ ~ "Pump On" Level at High Water Alarm Level at ~ ~/t Dimensions Manhole/Access (Y/N) "Pump Off" Level Ve.t Tested for ~J~-5~ f'~CJ. Pumping Cycles during Adequacy Test, Meets MOA Electrical Codes (Y/N) ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have~he~verJfie~ or conformed to all MOA and HAA guidelines in Sign~~ ~%-~ate ~/~' ~' effect on the date of this inspection. Beceipt ~o. Dateof Payment ~/ ) ~/~ Amount: $ Page 2 of 2 72-026 (11/84)