HomeMy WebLinkAboutLAKE HILL ACRES LT 12Lake Hill Acres
Lot 12
#051-052-39
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
(907) 343.4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY DWELLING
051-055-59
1. GENERAL INFORMATION
Complete legal description LAKE HILL ACRF.S SUBDIVISION'. LOT 12.
Location (site address or directions) 24557 RAMBLER ROAD CHUGIAK. AK 99567
Property owner JEANKTrF LOWE
Mailing address c/o FRANK STF.VENST
Lending agency
Mailing address
Agent FI~ANK STEVF.NS W/ PRUDF.NTIAL OF E.R. Day phone
Address16655 CF.NTERFIFID DRIVF' FAOI F. RIVER. AK 99577
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
Day phone
16655 CF.NTERFIF.LD OR EAGLE' RIVF.R. AK 99577
Day phone
(~07~ 689--6480
3
XXX
If community well system, provide wdtten confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site xxx
Holding Tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide wdtten confirmation from State ADEC
lng to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21 Computer Version
Note: Alaska Water and Wastewater Consultants, Inc. shall be I~aid $1,000 O0
or prior to, closing for the engineering ser~ces provfded. - - '
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 I:
disposal system Is in compliance with all Muni~
on the data Tf this lnspectio~,,...,I .,~ ~ /F'~'
Name ofF, rm. ALASKA WATER/~ ~//,~'~-~
^ddress 6go dEY ,,
Engineer's Signature ( ~'~ F/~'"'
~aPeCflon. the on-sita water supply and/or wastewater
I and State codes, ordinances, and regulations in effect
kTER CONSULTANTS, 1NC. Phone (907) 337.6179
ICHORAGE. ALASKA 99504
['"'/ Date
ovtde a therough, conscientious engineering ana~sis of ~he
In conducting this evaluation, AWWC,'--~c.~ ~
system in accordance v~th ADEC and ~OA D IHS Guidelines & Regulations. The reported results described the
performance of the system under the cenditio~ ; encountered at the time of the tes~ and separaSon distances
measured to readi~' identifiable features. The operational life of all wells and septic systems depend
on the local soils condition, ground water levels that may fluctuate dufing the year, and the water
usage of the fami~, being served by the system. These condiUons are outside the control of
the evalualor of the system. Satisfactory test results do not guarantee future performance
of the system, nor do they guarantee that there are no hidden defects or encroachments.
AWWC, Inc. can therefore not provide any warranty for future estimate of how long the
system wfll continue to meet the operational requirements of the ADEC or MOA DHHS.
The content of this report is for the sole benefit of the owner listed above. Any
reliance upon or use of this report by any other person or party Is not authorized,
nor will it confer any legal fight whatsoever.
6. DHHS SIGNATURE
L,,'" Approved for '~
Disapproved
Conditional approval for
bedrooms
bedrooms, with the following sUpulafions:
Additional Comments
Date /~.-6 -~) 0
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.
72-025 (Rev, 1/91) Bad( MOA #21 Computer Vemion
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Envtmnmentel 8erdnss Division
625 'L' Street, Rm 602 Anchorage, Alaska 99501 (907) 343-4744
Health Authority Approval Checklist
LAKE: HILL ACRES S/Di LOT 12 P~rcell.D.:
If A, B, or C, attach ADEC latter. ADEC water system number
Date compiated ~ ~eeg/oa~x~ ON ~o/~¥1e7~
Cased to 228'
FROM WFI I LOG
D
79'/19o'
7.0/12.0
A. WELL DATA
Weft Type PRNATI~
Lag present (Y~N)
Total deplh 228'
Date of test
Static water lavel
Well production
WATER SAMPLE RESULTS:
Colifolm 0
Date of sample: 11/6/2000
B. SEPTIC/HOLDING TANK DATA
Date Installed ~ 1966 Tank size
Foundation deanout (Y/N) Y~$
Date of Pumping 9/15/00
051-052-59
16"+
Casing height (above ground)
YES Wires pmbarly protected ~N) YI~S
AT INSPECTION
9/12/oo
g.p.m. 5.0 +/- g.p.m.
Nllmte
0.5 mq/L Other bacteria o
Collected by: A.W.W.C.~ INC.
(CONCRETE)
1000 Number of Compadmente 1 Claenouts (Y/N) YES
Depression (Y/N) NO High water alarm (Y/N) NO
Punlper JR'$ PUMPING
*76" MEASURE0 FROM TOP OF PIT TO BOTTOM
C. ABSORPTION FIELD DATA [PIT/TRENCH] **MEASURED IN FIELD
***ONLY PIT TESTED
Oateinstalled "'1966//6/19/69 Sollmtlllg(~fl2/bdml). 0.4. b'yetemtype CRIB/TRENCH
Length U.K./60' Width U.K/2' Gravel thickness below ptpe *U.K./8" Total depth 9' DEEP O P~T
Effecthmebonri~onarsa U.K./~20 S~. FTMonlteringTubepmsant(Y/N) YES Depresslonovertleld(Y/N) NO
Date of adequacy test 9/13/00 Results (Pe~_~Fall) P~SS For_ *,.3 Bedrooms
Flutd depth in absorption field before test (In.);
Ruld depth 56.5" (Ins) Minutes late~
Peroxide treatment (past 12 months) (Y/N)
56" Immediately after 7;~0
970 Absorption mte -
NONE; KNOWN If yes, glv~ dote
... gal. water added (in.):. _.
450+
D. UFT STATION
Date Instelied
Manholo/^_ _,~_ ss
High water alarm level
Size In gallons
level
*Datum,
*PER 1969 INSPECTION
REPORT. NO PIPES IN TRENCH
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WEU. ON LOT TO:
Sep0c/holding tank on lot .50'+ On adjacent lots 100%
Abeorplion field on lot 50'+ 'to SEEPAGE Prr ,, *too'+ TO TRENCH On adJacent lote 100'+
Publio sewer main N//A Public sewer manhote/cteanout N/A
Sewerlseptlc service line 25'+ lift ~tet[on N//A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 5'+ Property line 5'+ Abeorptton field 5'
Water main/service line 10'+ Surface wate#dralnsge 100% Wells on adjacent lots 100'+
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+
Surface water 100'+ Driveway. peddng/vehlde storage area 25'+
Curteln drain N.ONE KNOWN Welis on adjacent lots 100+
of Monlclpal !~ ~/l~ /hll /abo~ systems are In conformance ~.~' J ~ /,. I~'/~ '...'T'...,~
/- / -
Water maln/sentlce line 1 o'+
I-IAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
09/08/00 FRI 09:16 FAX 6896499 VISTA REAL ESTATE ER ~001
.. t'6635 Ce~,tcr~d([Dr. #103 E~le~ver, ,~ ~9577
A Fax From
.FRANK STEVENS'
.4ssoc/ate
(90~ 689-6464 lOft/ce) lgo'zl 689-6499. (~'~} (90~ 689-6480 IDkeet)
DATE~ ~' ~, ~ ·
TO= '~
~easage: ~ ~ .6 ' '
NOTICE
· This transmission Is Intended ~o4' t~e sole use of t~e Individual and e~tity to whom It Is addressed and may co~n
Infom~tion that Is privileged, confldenUal end exempt from ~isdosure unde~ nppr~cable
any dissemination, distribution or duplicatio~ of this transmission bY some<x~e other than t~e Intended addressee ~ its
designated agent Is stdcUy prohibited, if your recdpt ol t~is transmission is In errm', please tm~Y t~ls §~m immedi~Y
at (907) 689-6464 .~, 689-64
09/08/00 FRI 09:16 FAX 6896499 VISTA REAL ESTATE ER ~]002
G..,.r, ¢ ER ANCHORAGE AREA BOR~'
~ HEARTH DEPARTM£NT
~---"---"-'-~ INSPECIIO~ REPOal O~C'lE SEWAGE OlSP~SAt'~YSIEM
N~ _ ~ ,~oo~ss ~'
SEPTIC 1ANK~ ~ S ,~
t~UIO :I~AC~TM ~ ~ ,GALLONS. INSIDE [[NG1H ~I~NS~ WIDTH ~'~
~?:~..
:~: 6¥' ~ ~
~ : IlO'
09/08/00 FR! 09:16 FAX 6896499 VISTA REAL ESTATE ER [~003
'Record of Well.
.., ~11 .~-...~,~ ~.~ ................
Drlll~l for . , .__~.~.~,:-v.~.;.~ ...... ~-- .
................
~P V~ ~ ...... ,i~&. _ ...... in~eA o~. - .... --.in ............
~ee~ ss
.' FOR~TIONS ~AS3~ ~OUGH
; ~-'~-~X~nd of C~lor of Started nt Ended nt
~ "Formation . . Fo~a~on ~lt Depth ~a~ Depth
f
Total 5'hlcknesa
of Formation
.~?/
09/08/00 FRI 09:17 FAX 669._~6499 VISTA REAL ESTATE ER [~004
· ,~. · [~-W DR~LMNG, Inc.
· ' P.O. Box 4o1'~28 · 2811 Dawson
A C 907.279-1741
Al'lC}lOP. AGE, ALASKA 99509
DRILLING LOG
Well Owner t!.. gtll T.~. ,T~-.
Location (address of: Township, l~an§e, Section, ii known; or distance main rosd
Size of c~sin~.__~.t~..Depth of Hole 91 ? feet Cased to 91 ? feet
Static water level 1 9,~ it. (alz~o~) (below) land surface. Finish of well (check one) open end (
Screen ( ); Perforated ( ).
Use of WellD°~-~
x );
Describe screen or perforation
Well pumping test a? l ? _gallons per (~zr)
of drawdown irom static level.
Date of completion ~1~+. Ih: 1_o71
WELL LOG
(minute) for ~./? hourscwith lO~.~'
Depth in feet from
~round surface
Give details of formations l~enetrated, size of material, color and hardness
TO
TO
TO
TO
.TO
TO
· ,TO
TO
TO
TO
TO
,09/18/00 ~0N 09:~4 FA][ $$95499 VISTA REAL ESTATE ER ~002
ASBUILT
I I HERESY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
AND THAT NO E'NCROACHMENTS"EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION 'PLAT. UNDER NO CIRCUMSTANCES SHOULD
ANy DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTAI:~LISHING BOUND-
ARY LINES.
SEWARD & ASSOCIATES LAND SURVEYING
SCALE,
DATE: /
FB:
DRAWN
umczpa Acy
,
Anchorage
ANCHORAGE. ALASKA ~951g-6650
TONY
HUMAN S~R~qCLS
October 31~ 1986
~acencly we have Tevievad aevexal Ra&lch Auch~ieyAppr~vale
~eques~e~ app=~al ~ undoc~en~ad sysce~. ~ of ~hese were
~ns~sHet prio~ ~o.e~abl~e=t e~ tbs then Greater ~aahorase A~ea
3orough code ~ 19~o~hars yore e~ply ~acallad ~th~u~ ~ane~i~ o~
~he ~l~nce o~ o=-sice ~s~ewace~ *ys~e~
a natural ~ensto= of ~h~ ~osi~ton is ~o en~e
~ sys~e~ mee~ Frope= sepa:a~io= =c ~8~lyt~g
~erefore, ~he ~ollo~n~ policies have bee= establiGhet end.st be
a~he~ed ~o ~ !u~re su~als, effective ~e~a~aly.
I. ~a~er mo~r~ adJacenk ~e ~he u~oc~en:et ~ys~e~ v~l be
rsq~rat (~u= seven days). In lla~ of a~ actual ~es~ hole,
va ~11 accel= ay!dance fro~ cbc a~ineer ~ich conclusively.shove
~hrough suppor=i~g doc~en=a~ic~ ~ha~ ~here is
~c~dwa:ar~chiz four fee= ol the bo==~
ins=ante, l~ ~hese holes ~ logs su~ro~ut~g ~he subJec~'lc~ all
sh~ moni:ore~ ~:e~ ~able results ac
las=ailed a~ 8 ieet, em approval coult p=oceefl.
n~dooumencad syscom l~s~alled prior to 1968. and It also meets
proper desi~ criteria for ~he ~er o~ bed~oo~ zetues~ed, no
app~oval~ll ~e si~e~ for mo~e ~han ~hree (3) bedroom. Appropriate
so~ ceg~ would ~e a ~c~d for ~bcatn/n~ approval ~or a g~eacer
n~bcr o~ bed~. '
v~ich ara undocu~e=ced muse have the e=sineer provide d~ecslon~ o~
ch~ sysc~ and v~r~y cyme an~ size o~ ca~k. lpp~a~a soil ~esci~
~ b8 =elui~e~ as ~I1 as wacer~uicorins. ~is ~1 apply even ~
the depar~euc has previously si~ed a Realch Au~hari~y Appr~ om the
propers.
you.have any quescloms cn chess policies, please feel fre~ co call
ou~ eca~m~bers ac 26~-67~6,
,
, .... l~t Deod~ to Net
~ 'Tirol, ~ ? TIn~ Wlw'
al ~escrintion: Lot 3S Blocl:
,is form Renorts Soils Lon
2204
Robert Z~cker O~t'e PerformedR-~R-TR
Subgtvisi'nn ~-.~. ~tll Acres "
Percolation Test_
.neath' '"
Feet :.' "Soil Characteristics
Bro~ .SiZty Saady Gra~;61'
· '-. "" ..-;~.
:~, · ..'.~ ..
8--
10--
!4--. Bo:tom of-Test H~le
16--
I : ,'
Vas Ground 1~ater £ncoun{ered?
].r Yes,. At wh~t Depth?
FercolatSnn Rate - -,". llinute
Prn~ose~ 2astallat~on:. Seenao'e Pit Drain Field
Doeth of Inlet Depth To Bottom Of Pit Or ~rench
rest Performed' BY:' .-" David Paul' . · "_ .Data]Certified E~:. .' ~'"..-
.... · Date: 8-26L78 "'
I Readinq Date. Grnss T~me Net Time' Depth to 'H20 l!et Dr
;
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
LEG'~'DESCRIPT,O.= ~/--/~/o~ ,Z
825 L* Street, Anchorlge0 Alask& 99501 264-4720
SOILS LOG - PERCOLATION TEST
1
2
3-
4-
5-
6~
7-
8-
9-
SLOPE
SOILS LOG
PERCOLATION
TEST
DATE PERFORMED: 2~ f6 ~:~ ~:~
SITE PLAN
10-
11
13-
14-
15-
16-
17-
18-
19-
20-
~,o. 14'.7-E
COMMENTS
.ASGRO~NO.ATER /d o t
ENCOUNTERED? pO
E
IF YES. AT WHAT
DEPTH?
Gross Net OeDth to Net
Read;rig Date Time Time Water Drop
-
I:~_ " ~':~ .2~,~ 2%~
PERCOLATION RATE {minutes/inch)'
TEST RUN 9ET~NE~N ~ FT AND ~' FT
/
NORTH MUNICIPALITy AR~A REFERENCE MAP - lB