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Home My WebLink AboutSOUTH LAKEWOOD HILLS #1 BLK 6 LT 8 Municipality of Anchorage Page 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 Inspection Report Permit Number: ~----~*..~0i ~. ~) ;~ ~" PID Number: Nam~ ~ ~V~ ~ Wastewater System: ~ New ~Upgrade Address: Total Depth from original gr e: LEGAL DESCRIPTION so,,,~,,.,: ~,~/sq.,,. Lot: ~ Block: ~ ~Subdivisi°n:~~ ~J~ ~Depth to~ p~pe bottom from odcnal gradei~ Ft. Gravel depth beneath pipe ~ ~ Ft. Townshi~ Ran~ Section:~ FilladdedaboveoHginalgra , .,. ~ Number of lines: lD~s~a~ce betw nlines: WELL: U New ~ Upgrade srav.=~¢h: ~1~ ~Ft. ~ , [~ef ~t. CI~~): Total Depth: Cased To: Total absorption area: [ ~ Pipe materiak ~ Driller: Date Drilled: StaticWater Level:Ft. ~lnstaller: ~~ ~ Date installed: Yield: I Pump Set at: I Casing Height Above Ground: ~,u ,,. ~t. TANK SEPARATION DISTANCES ~ti~ j t~ TO Septic Absorption Lift Holding 'u blic/Private ~U~C~U~r: ....... Oap~[y From Tank Field Station Tank Sewer Lines ~ ~~~ ~ Surface Wate~ 1~'~ ~'~ -- -- ~ LIFT STATION LineL°t j ~ ~ ~ I~ ~ ~ Size in ga~anufacturer: Cu~ainDrain ~O~[~ ~0~ ~ Pump Make &Model ~ Electrical Inspections pedormed by: Remarks: BENCH MARK Location and Description: Inspections performed b~ ~~{~ates: 1st ~['t~'~'J ~-~'~ Department of Health and Human Services approval ~;~,, Reviewed and approved by:/~ (~ Date: / 72-013 (1/91)MOA25 Permit No. Page ~ of ~ Municipality of 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 Inspection Report Legal Description: 72q313 A (2/91) MOA 25 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:SW910324 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:JOST JERRY IVAN & OWNER ADDRESS:200 W. THIRTYFOURTH AVE. ANCHORAGE, AK 99503 DATE ISSUED:10/08/91 EXPIRATION DATE:10/08/92 PARCEL ID:01515125 LEGAL DESCRIPTION: SOUTH LAKEWOOD HILLS #1 B6 L8 T12N, R3W, SEC 23, SM LOT SIZE: 31455 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK 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 (ISAAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: PROVIDE PERCOLATION TEST IN ML LAYER AT TH #1. RECEIVED BY: ~_. ~k~. ~ ~ ;lJ.~0 DATE: DATE: 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 ANOREPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS September 24, 1991 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99501 REFERENCE: Lakewood Hills Addition #1, Block 6, Lot 8 Request you issue a permit to upgrade the septic system serving the referenced property. An adequacy test was performed on the existing system and the absorption capacity of the system was found to be inadequate. Two test holes were excavated and percolation performed in the area of the proposed upgrade. the proposed upgrade design. tests were Attached is As can be seen from the site plan this lot is large enough for another future upgrade. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic upgrade. If you have any questions or require additional information for your review, please contact us. Sincerely, RJS/lsu ON SITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 SCALE Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION:'~;t~11~ i~/.4~1.J_%.'~"~ .~lL,~'~"~nship, Range, Section: '~'1..~-~,~ ~¢, ~ ~ SLOPE SITE PLAN ENCOUNTERED7 ~ S L IF YES, AT WHAT O DEPTH? p Oeplh to ~onitorinD? z-".~-7 E 10 11 13- 14- 15- 16, 17- 18- 19- 20- Gross Net Depth to Net Reading Date Time Time Water Drop ¢ If;~:-)' I'b Ftt M ~14" al~' PERCOLATION RATE "~ (minutes/inch) P,ERC HOLE DIAMETER ~ 1( TEST RUN BETWEEN ~*~-"~ [/~" FT AND (~¢ ¢'~T COMMENTS S & ", ENGINEEEING ~ ~ PERFORMED BY: 'J 7034 Ea.le I~i~e~- [m.~.~ D~a.I ~.1= ~J~ ~[~--~; /~//~ ~ ~/~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALE STATE AND MUNICIPAL-GUIDELINES IN EFFECT'ON THIS DATE. DATE: / ~ t ~ 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE P~~ LEGAL DESCRIPTION:I~]J~)C.,~'~ /'_~: i~'1" ~ Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED?r IF YES, AT WHAT DEPTH? pO E Moniloring? I~ Gross Net Depth to Net Reading Date Time Time Water Drop I" ~-'~,~-~)1 l'l;t(:~',~ ~ ~/~"' ---"" · I~,, Jb ~d. ~'/~" ~1~" 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O PERCOLATION RATE --~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND -~' FT COMMENTS S & S ENGINEERING '~'~/"~^ /"-'~l ~ PERFORMED BY; , I ~ CERTIFY ~f' ~ ~ ~ THAT THIS TEST WAS PERFORMED IN ACCORDANCE WIT~,T~A~GUIDELIN~S IN EFFEOT ON THIS DATE.'TO~ EagJe H~ver E~p ,0,* N*. J~ ~ ~ ~ DATE: ~'~l 72-008 (Rev. 4/85) GAAB HI) ] G?ATER ANCHORAGE AREA BORO 'iH HEALTH DEPARTMENT ' 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY PHONE LEGAL DESCRIPTION Lc;: MATERIAL GALLONS. INSIDE LENGTH NUMBER OF / COMPARTMENTS INSIDE WIDTH LIQUID DEPTH SEEPAGE SYSTEM: NUMBER OF PITS LINING MATERIAl NEAREST LOT LiNE SEEPAGE PIT: / OUTSIDE DIAMETER· .OR WIDTH /~ TOTAL EFFECTIVE ABSORPTION AREA (WALl_ AREA) , LENGTH /~ DEPTH~-'~ BUILDING FOUNDATION 5(~~ZZ~ SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE FOUNDATION , NEAREST LOT LINE. DISTANCE BETWEEN LINES TRENCH WIDTH SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER MATERIAL BENEATH TILE TOTAL LENGTH ., OF LINES IN. TOTAL EFFECTIVE N. ABOVE TILE WELL: [YPE ~T i,~", DEPTH NEAREST LOT LINE .. SEWER LINE DISTANCE FROM · BUILDING FOUNDATION. SEPTIC SEEPAGE · TANK , SYSTEM WATER SAMPLE · CESSPOOL NEAREST OTHER · SOURCES DISTANCES: DIAGRAM OF SYSTEM DATE . ~ ,~EALTH AUTHORITY kAB-HD-2 ? GREATE~ ANCHORAGE AREA'~OROUGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alar, ka 99501 27912511 Case No. SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT'Aj'~J~' b;/J'E&~ I~N~£~/~ MAILING ADDRESS PHONE RESiDENCEADDRESSO"T~/g/~'f"4 /-J~"/7,~ "~ LOCATION OF INSTALLATION "L~?~ LEGAL DESCRIPTION Zvf' ~:~, /3Z. O0'~ APPLICATION TO INSTALL: SEPTIC TANK , SEEPAGE PiT TO SERVE THE FOLLOWING FACILITY ~ ~ ~ ~ , DRAIN FIELD FINANCED THROUGH -,J~-.cF TO BE INSTALLED BY '~' PERC0kATION TEST RESULTS I'~S' - / ~ ANTIGIPATED DATE 0F GOMPkETION ,OTHER ~/t;'c:.-,,e g.'q T//v ~S THIS IS T0 SERVE AS .JJ/~/~,,, Jl'~(~/~J~JL~j , PERMIT TO INSTALL A _ AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED · S~PT~C TAUK S~ZE/~ ,~[ ~,/s~[~a~ a~[~ DIAGRAM OF SYSTEM DISTANCES: ,/ "'~'/~ Health Authorit! I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that thc abov~ dgscribcd system is in aooordanoe with said DATE , APPLICANTS QREATER ANCHORAGE AREA BOROUGH' HEALTH DEPARTMENT 327 EAGLE STREET ANCHORAGE, ALASKA 99501 Legal Description: Lo~' Bleak Subd~vzszon ~ ~ ~oc~ ~ J,~C'~ ~ooO J&CO Depth Feet Soil Characteristics Was Ground Wate~ Encountered?,,/~,~ If Yes, At What Location Sketch Reading Date G~oT; T'ime ....... l'Net Drop Net Time I Depth To 1-t:20 Frop)sed Instal~Seepage Pit ~ Drain Field , Depth ,_f Intet~/~6¢/) Depth To Bottom Of Pit Or T~ench' Test Performed By: ~ Data Certified 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 8; Block 6; $ou~,h Lakc,~ood H,CS~S SubdJ. visZon Location (site address or directions) 11150 Ridgecrest Drive Property owner Mailing address Lending agency Mailing address Agent Address J~ry Jost 200 W~st 34th St. Anchora.qe, Ak. 121 W. 265-8347 Day phone 99503 Warren Goss~ CITY MORTGAGE Day phone Fir~v~ed Anchorage, Ak. 99503 Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: 5 Individual well Community well Public water If communify well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: X× 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 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 inspectior~, 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 S 8, S ENGINEERING Address 17034 Eat~le River Loop Eagle River, Alaska 9~5~7 Engineer's signature Phone DHHS SIGNATURE X Approved for ~:~¢'¢ f//'~) Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: ~ (~z..o~,~L.~C'7- 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.~L-~~'~'lc L~,~,[~:)~ J~[~rc'c'c~el~l.D. (~1~1~ A. WELL DATA Well type'~lV/J~'~-~ Log present (Y~') .~ - Total depth ~ ~-~' Sanitary sea'N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed /c::~ {z:>~ ~ Driller Cased to ~c::'l ''~ Casing height Wires properly protected~'N) FROM WELL LOG AT INSPECTION Static water level / I ~ 1 Well flow g.p.m. ~' :~ Pump level [ ~. I SEPARATION DISTANCES FROM WELL TO' -- Septic/holding tank on lot /./3 ~. ~u.J ~.o7) ~,~ ~.--r',~; On adjacent lots Absorption field on lot l'~'~' J' ; On adjacent lots Public sewer main ~,-~O ¢J ~ Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform ~' Date of sample: ll/l~/~l Nitrate 0,~ r~ ~ Other bacteria ¢ Collected by: ~+ ~--~ ¢d4!* t~-~_ J¢~¢,-)4 SEPTIC/HOLDING T,.ANK QATA Date installed J! Cleanouts (~N) High water alarm (Y/N) Date of pumping '~''~,.~,[ Pumper ~'+- '~'~t~----~/l~--~."_~'~ SEPARATION DIST~.NCES FROM SEPTIC/HOLDINC~TANK TO: Well(s) o n lot ~lnC~adCac~e~ts~"~'/~ I ¢(~ ' + Foundation To property line I 0 t .~_ Absorption field )0 ' '~- Water main~service line Surface water/drainage I ~"/') ~ '~ ~ ¢ ' NuED ON 72-026 (Rev. 7/91) Front CONTI BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level Manufacturer Manh~91~oT~cc~ss (Y/N) "Pump on" legel at .~ ' "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE F~ROM LIFT STATION TO: Well on lot ~ On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length [z¢¢~'l Width ~ / Total absorption area l ~ ~ Depression over field (Y~/~ ~ Results (pass/fail) ~,._[l~-_. _U,~[ Peroxide treatment (past 12 months) (Y/b? Soil rating 0.~' r~S~em type Gravel thickness ~ ! Total depth IL") ( Cleanouts present,N)y Date of adequacy test . _ ~ for .¢~ bedrooms If yes, give date SEPARATION DISTANCE.-' FROM ABSORPTION FIELD TO: Wellon lot ~ .//,~ f ..,L To building foundation On adjacent lots ~"~) ! ~ Surface water l~f-~ '-~' On adjacent lots 1 (~'~J ~J¢ Property line l 0 '-~ To existing or abandoned system on lot __ Cutbank ~ ~) f,--[.;~ Water main/service line Curtain drain Driveway, parking/vehicle storage area ,~/,~ ~ cF- 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. Signature Engineer's Name Date S & S ENGINEERING Eagle River, Alaska 9952'7 HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3191) Back MOA 2~ Waiver Fee: $ Date of Payment Receipt Number