HomeMy WebLinkAboutSOUTH LAKEWOOD HILLS #1 BLK 5 LT 2
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: _______________ Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot Property Owner Name & Address:
Pump Installation Date: _____-_____-_____
Pump Intake Depth Below Top of Well Casing: __________ feet
Pump Manufacturer’s Name: ___________________________ Pump
Model: _____________________________________
Pump Size: ____________hp
Pitless Adapter Burial Depth: _________ feet
Pitless Adapter Manufacturer’s Name: _________________________
Pitless Adapter Installer: ____________________________
Well Disinfected Upon Completion? XX Yes No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
City: ___________________ State: __________Zip: _________
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
Municipality of AnchoragePage 1 ol _'~"
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 $ Telephone: 343-4744
On-Site Wastewater Dis.~osal System and/or Well Inspection Report
Name:
_~~ ~ , ~ .~. ~..~ ~_ Wastewater System: D New ade
t~ O~O ~ I~ ABSORPTION F~ELD
Pbone:.~.[~ / Nc. of Be rooms: ~eepTrench D Shallow Trench DBed ~ Mound DOther
LEGAL DESCRIPTION SoilRating: ~.~ GPD/Sq. Ft.
WELL: ~ New ~ Upgrade Gravel~TEZ~.. ~ Ft. Numb~of lines: ]Distanc~ineF~'
Class~o~ (Private, A,B,C): Total Depth: Cased To: Total absorption area: .- Pipe material~) { O '~
Driller: Date Drilled: StaPcWater LeVehFt. ~~~ls lie,:
Yield: [Pump Set at: ~ Casing Height Above Ground:
GPM Ft Ft. TANK
SEPARATION DISTANCES _~eptic D Holding ~ S.T.E.P.
To Septic Absorption Lift Holding Public/Private anufaclurer: Capacity in gallons:
Water /~~-- LIFT STATION
Foundation ~ ~, -- -- __ ;;Pump on" level at: "off" level at: High water alarm at:
Curtain nspec ions per ormed by: '
Remarks: B~NCH ~ARK
/ E N ~L~EAL
Department of Health and Human Services approval
72-013 (1/91} MOA 25
Permit No. ~,,[~')1 ~' Page ~'~ of ~
Municipality df Anchorage
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, lnspectior~ Report
Legal Description: ~ ,'l~.~l,~J~ I~1~¢1~ '1:~'~[.~';~pID No,:
SEAL
72-013A(2/91) MOA25
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW910295
DESIGN ENGINEER:S & S ENGINEERS
OWNER NAME:BLOCK EDMOND S & B A
OWNER ADDRESS:il050 WILDWOOD DR
ANCHORAGE, AK 99516
DATE ISSUED: 9/17/91
EXPIRATION DATE: 9/17/92
PARCEL ID:01515130
LEGAL DESCRIPTION: SOUTH LAKEWOOD HILLS #1 BLK
5 LT 2
LOT SIZE: 30400 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
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 (18AAC80).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
/
DATE:
DATE:
Tom Fink,
Mayor
Department of Health and Human Serwces
825 "L" Street
P,O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
September 18, 1991
Roger A. Shafer, P. E.
S & S Engineering
17034 Eagle River Loop Road
Suite 204
Eagle River, Alaska 99577
Subject: Waiver Request for Lot 2 Block 5 South Lakewood Hills S/D
Waiver Request #WR~910042, PID #015-151-30, SW910295
Dear Mr. Shafer:
Your request for waiver of the required 10 foot separation
between a septic system and a lot line has been approved.
waived distance is 5 feet.
The
This approval applies to the existing septic system lot line
separation only. Any future upgrade to the septic system will
require all separations be met or another approval from this
department.
Sincerely,
Susan Oswalt
On-site Services
Concur:
y~rogram Manager
On-site Services
September 9, 1991
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER &WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD OESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL &
MECNANICAI.
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L StJ~e~
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Lot 2; Block 5; South Lakewood H~ls Subdivision;
RequeSt you issue a p~u~t to upgrade the septic system s~rving the
referenced property and gra~ a waiver for the distance between the
proposed leachfi~Id and the south property ~ine ~ 5'.
There curre~y exist~ a c~sspool which was installed in approximately
1963.
As can be seen from the at~ched site plan there is ~ittle area on the
property for the upgrade. The proposed trench is to be installed along
the ~asement line off the sauthside of the propeJ~ty. A waiver of the
d~tance to the property is requested to maximize the separation
distance to the existing cesspool. The property to the south is vacant
and ~so owned by Edward Block.
We do not anticipate any adverse effect~ on n~ighboring properties by
the installation of the proposed septic upgrade.
If you have any questions or reqaire additional inform~ion for your
review, plebe conta~ us.
Sineer~y,
ROGER J. SHAFER, P.E.
RJS/gm
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
SCALE
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE PERFORMI
LEGAL DESCRIPTION: L-,,~'~'
1
2
3
4
5
7
8
tO
20-
COMMENTS__
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT ~
DEPTH? p
E
SITE PLAN
Deplh to Water Afler
~Y~"~! DaLe: ~- ''~ 'c'l I
Meniloriflg?
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE ~c:~ (minutes/inch) PERC HOLE DIAMETER
~2 FTAND 1 FT
TEST RUN BETWEEN
PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN
72-008 (Rev. 4/85)
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. ~'I 01515130
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description
L(:/da'tion (~¢.,Al;ldress or directions) ' ,] Dr{w, Annhm*Rge_,_A~
~ ,. ~ ~
Property ow~,r~ ,.~ ~w~n Day phone 346-1876
Lending agen~¢~:l Day phone
'-Mailing addressz~
Agent Day phone
Address
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
3
NOTE:
Individual well x
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OFWASTEWATER DISPOSAl.:
NOTE:
Individual on-site x
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev. 1/91) Front MOA #21
Be
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that ~y
investigation of this Health 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 files and from my inves!i_gation 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 Criterium Alaska Engineers
Address P.O. Box llLT~, Ano~8~Fe, AK 99511-1790
DHHS SIGNATURE
~ Approved for '~
Disapproved.
Conditional approval for
bedrooms.
Phone 349-1003
Date 6/14/94
bedrooms, with the following stipulations:
Additional Comments
By:
. 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 DH HS does this as a courtesy to purchasers of ho mes
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 and Human Services
HEAl. TH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. Well Data
Lot 2 Block 5 South Lakewocd
Hills ~7
Parcel I.D. 01515130
Well type Private
Log present (Y/N) Y
Total depth 16Q'
Sanitary seal (Y/N) __Y
If A, B, or C, attach ADEC letter, ADEC water system number
Date completed 7/25/63 Driller Sunset
Cased to 40+' Casing height _ 26"
Wires properly protected (Y/N)
g,p.m,
FROM WELL LOG
Date of test 7/25/63
Static water level 97 '
Well flow 7
Pump level1 Unknown
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot 103'
Absorption field on lot 101 '
Public sewer main Nr~n~
Sewer service line None
; On adjacent lots
; On adjacent lots
140+
140+
Public sewer manhole/cleanout None
Petroleum tank None
WATER SAMPLE RESULTS:
Coliform O Nitrate 0.34 Other bacteria _
Date of sample: 6/8/94 Collected by: Eric Johnson
SEPTIC/HOLDING TANK DATA
Date installed'? 9/24/9:[. ':,.,. Tank size 1,000 9al. Compartments 2
Cleanou, ts (y/N): y~- , ;,~'},~_oundation__ cleanout (Y/N) _ y Depression (Y/N)
~[",,' I ..... h*f~leanout was installed at edqe of deck
High w~er,alar~ . (Y/N) N/]~., ,'.,:~,~""! Alarm tested (Y/N) N/~
Date of~l'~l~p'g: :6/~/94 ?"~ Pumper McDonalds
'~ ¢,%" .... ,~ "; O
SEPARATION DISTANCES FRQ'¢CI~SEPTIC/HOL. DING TANK TO:
Well(s) on I; .~ 1.0,,3'~ . '~ ' ' On adjacent lots 140+' Foundabon 43'
To property line 18 ' Absorption field 6 ' Water main/service line 80+
N
Surface water/drainage 100+
72-026 (3/93)° Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed N/A
Size in gallons N/A
Vent (Y/N) N/A "Pump on" level at
High water alarm level N/A
Meets MOA electrical codes (Y/N) N/A
SEPARATION DISTANCE FROM LIFT STATION TO:
Manufacturer N/A
Manhole/Access (Y/N) N/A
N/A "Pump off" Level at
Cycles tested N/A
N/A
Well on lot
D. ABSORPTION FIELD DATA
Date installed 9/24/91
Length 47' Width 3'
Total absorption area %4 '
Date of adequacy test 6/8/94
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
On adjacent lots N/A Surface water N/A
Soil rating (GPD/FF) 0.8 GPD/ft2 Systemtype Trench
Gravel thickness 6 ' Total depth 13 '
Cleanout present (Y/N) y Depression over field (Y/N) N
Results (pass/fail) Pass 3 for 3 Bedrooms
2,0 ' After test 1.9 '
No If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ] 0] '
To building foundation
On adjacent lots 30'
Su dace water ]. 00+
Curtain drain None
On adjacent lots ] 4,5 Property line 6'
45' To existing or abandoned system on lot ] 0 '
Cutbank None Water main/service line 90 ' +
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that l have checked, verified, or conformed to all MOA and HAA guidelines in effe.~ [_~f this /nspection.
· ee , , · eee,ge~,ee~
Date
HAA Fee $
Date of Paymen
Receipt Numar
72-026 (~)' ~ck
Waiver Fee $
Date of Payment
Receipt Number
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
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D,# _t'~)\~. - ~:;L\ ~,-%~ HAA# ~o\
1. GENERAL INFORMATION '"
Complete legal description SOUTH LAKEWOOP HILLS #1, 8LOCK 5, LOT 2
Location (site address or directions) 11050 WILDWOOD DRIVE~ ANCHORAGE, AK 9951&
Property owner~c/cr'tumaC.$A~D 6.,. A,I $£OCK
Mailing address
Lending agency
Mailing address
Agent JACK WHITE, KRIS KURTZ
Day phone
11050 WILDWOOD DRIVE~ ANCHORA~E~ AK 99516
Day phone
346-1676
Day phone 563-5500
Address ~L01 C S,f~¢.¢~ Su~'.;k¢. 100;
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3
'TYPE OF WATER SUPPLY:
NOTE:
Individual well XX
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
lng to the legality and status of system.
4. TYPE-' OF WASTEWATER DISPOSAL:
NOTE:
individual on--site XX
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State AIDEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA#21
5= 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/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
Address
S & S ENGINEERING
17034 Eagle River Loop Road, No. 204
Phone
Engineer's signature
DHHS SIGNATURE
Approved for
Disapproved.
bedrooms.
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.
72~25 (Rev. 1/91) Back MOA #21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAl,. CHECKLIST
Legal Descriptionr'/~d;~Jlq¢ L,I~I,L~¢'~.)~ 'J~L~ ,2~1 Parcel I.D.
A. WELL DATA
Well
Log presen~
Totaldepth
If A, B, or C, attach ADEC letter, ADEC water system number
Date completed '¢'5 -- --vC'L)Ly ~¢-~.~ Driller
Cased to Casing height
Sanitary seal(~CTN)
Wires properly protected.......~N) __ y
FROM WELl. LOG
Date of test '7 '¢ g~ ~'/~'~
Static water level
Well flow "7
Pump level
g.p.m.
AT INSPECTION
~. ~ ,~.~'~ / MUNICIPAUTY OF ANCHORAGE
~fVtRONMENTAt, SERVICES DIVISION
-7,3 W SEP 2.6 1991
g.p.m.
UlL. RECEIVED
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot ~),~ 7
Public sewer main
Sewer service line
;On adjacent lots /~-~'~
;On adjacent lots
Public sewer manhole/cleanout
Petroleum tank ~o ~./¢
WATER SAMPLE RESULT/S:
z~-} .,"2--~:~.. /
Coliform _ (-¢./ ,~'~/.),4,.,¢ Nitrate
Date of sample: ~ '- '~ ('~!
~'~)~ '~4¢ '~.,~? Oth¢r bacte, ria
Collected by: -~'~¢~'~
B. SEPTIC/HOLDING TANK DATA
Cleanouts~N) Y--/*F°undati°n clean°ut~"i)~l~- /
High water alarm (Y/N) Jk_.'/,I,,~, _ Alarm tested (Y/N) JJ/,b~;, .
Date of pumping _~;:~,_~ '%]~ . Pumper "~
(; Nq , u'7'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot JC)~;)l '
On adjacent lots I~'~-) ~
To property line I~'~ ~ Absorption field (.~ I
Surface water/drainage J /'~ /'~
Compartments
. Depression (Y~)
Foundation ~t~
Water main/service line
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent(Y/N)
"Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N) /
Manufacturer ~
Manhole/Ac~
· -"'"'"'"'~"~Cycles teste'''~ "Tp off" level at.
Surface water
D. ABSORPTION FIELD DATA
Date installed ~:~ / "~2~/~¢ !
Length -.~'2~¢' I Width
Total absorption area ~ ~
Depression over field (Y/~)
Results (pass'fail) ~l,~t.,L~
Peroxide treatment (past 12 months) (YN~
Soil ratingb/~;2~ 4~P7~'~/~:~,;i'""~ System type '"~N..~,~' ,
Gravel thickness /Z:) t Total depth ~ ~ /
Cleanouts present~)N) y
Date of adequacy test ~/~- .
for '~ bedrooms
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on Ipt ~
To building foundation
On adjacent lots
On adjacent lots 1/'~r ~ Property line
"~-:'2 / To existing or abandoned system on lot
Cutbank ~*..~0 ~ ~ Water main/service line
Surface water
Curtain drain
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
of this inspection,
Signature
Engineer's Name
Date
S & S ENGINEERING
Eagle River, Alaska 99577
HAA Fees /?O
Date of Payment
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
72-026 (Rev. 3/91) 8ack MOA 21
17:i0 CT&E ENVIRONMENTAL LAB SERVICES
Commercial Testing & Engineering Co,
Environmental Laboratory Servioes ~'~,~-~f~a-,~'~'JJJf~,~'JJ~J~J~
LABORATORY ANALYSIS REPORT
CT&,]3 Il. eft#
Client Sample ID
Matrix
94.2~0g-1
L2 BLK$ SOUTH I,AKEWOOD I.I~LS #7
WATER
Client Nan~.e CRiTEKII )M AK ENGR WOR. K Order 79236
Or&red By Prh/tedOate 06/13/9~1 Q) 15:34 hrs.
Project Name Collected rYate 0fi/08/94 (/_'~) 13:15hrs.
Project# Kcceived Date 06108/94 ~) 15:30 hrs.
PWSID IJA
Teehtlical Db'eater 8'tEPH~]N C, EDE
Released By: _Z>- 'TF ..... ~..-~-.... ~
Sample R¢-inarka: ROUT~12, 8AMI"LE COLLECTI/D klY: E,lvl,J,
QC Allowable 13xt. Antg
;
Nitrate N ( [') 34 '"~ lll~t~ .~,i'A 353 2/300 0 10 06/10/94 DJB
'~ See Special Lns~ructl m~s Abova UA = l./naveilablc
* * See Sample K,~nm'ks Above NA = Not Analyzc~[
Il ~ Un(bt~te~ Rc~ olted vah~ i~ lhe praotical qmntifieation limit. UI'= l~as ~an
D = 8econtbry ~l~ion, f~= ~eater
No. 5595
Shipped To.
DATE ' "·
CUSTOMER'$~ORDER