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Home My WebLink AboutJEWELL LAKE HEIGHTS LT 8 k.~./ 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 264-4720 Application Date April 3, 1986 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 8, Jewel Lake Heights Subdivison, located in the NY 1/4, SW 1/4, SE 1/4, Sec. 10, T12N, R4W, S.M. Location(addressordirections) 4620 Emerald Court, Anchorage, Alaska 99502 (b) Applicant NameBeltaine C. Kozlow~phone:Home 243-5550 Business 266-1571 Applicant Address 4620 Emerald Court, Anchorage, AK 99502 (c) Applicant is (check one): Lending Institution []; Owner/builder:[~:; Buyer []; Other [] (explain); (d) Lending Institution Home Svqs. & Loan Assoc. Telephone 276-1451 Address 1001 Wo Benson Boulevard, Anchoraqe, AK 99503 (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: Beltaine C. Kozlowski 4620 Emerald Court Anchorage, AK 99502 TYPE OF RESIDENCE Single-Family;[]( Multi-Family [] Number of Bedrooms F i ve 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 Environmenial Conservation attesting to the legality and status. Page 1 of 2 72~025 (11/84) ENGINEERING FIRM PROVIE~h~,.~ INSPECTIONS, TESTS, FILE SEARCH, b,,~'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. NameofFirm Barter & Associates Telephone ~5~~ ~(~'(~10 10461 Hampton Drive, Anchorage, AK 99516 Address Date ~-I~-~_~ All terms of conditional approval have been met. Existing parking area was reduced so as not to encroach on the absorption area of leaching field. Engineer's Seal Approved for ~,~'~"~-~ bedrooms b~ 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 72-025 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY '1984 264-4720 Legal Description: :Lot Subdivision, Anchorage, Alaska Well Classification Private Well Log Present (Y/N) N Total Depth 240 Cased to Static Water Level ?5 feet Casing Height Above Ground t0" Electrical Wiring in Conduit (Y/N) Y Separation Distances from Well: To Septic/Holding Tank on Lot IfA, B, C, D.E.C. Approved (Y/N) .... Date Completed 1964 Yield 1 o 0 40+ Depth of Grouting .... Pump Set At Unknown Sanitary Seal on Casing (Y/N) Y Depression Around Wellhead (Y/N) N 55' To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results ; On Adjoining Lots 100 ' + 58 ' ; On Adjoining Lots 100 ' + .... To Nearest Public Sewer .... To Nearest Sewer Service Line on Lot .... Rae Kozlowski ;Date April 1, 1986 Satisfactory gpm Comments SEPTIC/HOLDING TANK DATA Pumped Estimate Datelnsta~e~i°r to 1968Size 1,500 No. of Compartments Standpipes (Y/N) Y Air-tight Caps (Y/N) Depression over Tank (Y/N) N Pumping/Maintenance Contract on File (Y/N) .... Holding Tank High-Water Alarm (Y/N) .... Separation Distances from Septic/Holding Tank: To Water-Supply Well 55 ' 30' To Property Line To Water Main/Service Line N/A 117' to Bulkhead face Course 2 Standpipe Y Foundation Cleanout (Y/N) Y Date Last Pumped June 14, 1985 ; for .... Temporary Holding Tank Permit (Y/N) .... To Building Foundation 9 ' 40' To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Unknown Soils Rating in Absorption Strata Date Installed ?r±or t:o ]_968 Width of Field Unknown Square Feet of Absorption Area Unknown Depression over Field (Y/N) N Results of Last Adequacy Test S aris fac tory Separation Distance from Absorption Field: To Water-Supply Well 5 8 ' To Building Foundation 19 ' Lot 21. 5 ' To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Crib Type of System Design Unknown Length of Field Depth of Field 154 to btm of Crib Gravel Bed Thickness Unknown Standpipes Present (Y/N) Y Date of Last Adequacy Test July 30, 1985 To Property Line 2 1.5 ' To Existing or Abandoned System on 100'+ ; On Adjoining Lots To Cutbank (if present) 40 ' to face of Bulkhead - 99' D. LIFT STATION Date ~nstalled Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certi~ th? I have c~k~ied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signe~____Z)C-z.A ~ Date '/~/4/"~0 Company~~l~'"¢,,%e'~--~ MOANo. ,~--2.~.~ Receipt No. ~.,~ Date of Payment ~;" - '' '~ .~, %. ~ .~ '~ Engineer's Seal Amount: $ Page 2 of 2 ~,~. 0E-5130 72-026 (11/84) CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHqNE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER [g/PRIVATE WATER SYSTEM .sm~ 2 0 £~em/d doan. c7~ Mailing Address Ar~/~ora~e.~ ~t< qoso2- City State Mo. Day Year zip Code SAMPLE TYPE: i [] Routine I [] Check Sample (for routine sample with lab ref. no. [] Special Purpose .) I~/Treated Water lie Untreated Water SAMPLE NO. LOCATION Time Collected Collected By it:to ~ff TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received Analytical Method: Membrane Filter * No. of colonies/100 mi. Lab Ref. No. I I I I Result* BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter:. Direct Count Verification: LTB ' BGB Final Membrane Filter R,esu/~t? /~('"~ _, ,~ Time: Collformll00ml ..~C~ormll00ml p.m. TNTC = Too Numberous T° count OB = Other Bacteria 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 264-4720 GENERAL INFORi%{ATION Application Date August 6, ,1985 Legal Description (include lot, block, subdivision, section, township, range) Lot 8, gewe,1 Lake Heights Subdivision, ,located in the NW ,1/4, SW ,1/4, SE ,1/4, Sec. lO, T12N, R4~l, S.H., Alaska. Location (address or directions) 4620 Emerald Court , Anchoraqe, Alaska 99502 App}icant Name Beltaine C. KozlowskiTelephone: Home 243-5550 App[icantAddress 4620 Emerald Court, Anchorage, AK 99502 Business 266-1571 (c.} Applicant is (check one): Lending Institution []; Owner)~tiXl~K~](; Buyer []; Other [] (explain); Lending Institution ' Telephone Address Real Estate Company and .Agent Address Telephone (f.~ Mai! the HAA to the foilowing address: Beltaine Co Koz-1owsM 4620 Emerald Court Anchorage, AK 99502 TYPE OF RESIDENCE Sin..qie-Fami~y.'V~J Multi-Family [] NumSer of Bedrooms ~P]~ Other WATER SUPPLY Indivicuai Well [~( Community [] Public [] Note: If community weU system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL OnsiteE~ Public [] Community[] Holding Tank [] t'Jote: L-' community we!J system, must have written confirmation from the State Department of Environmental Conservation a~testin9 to the legality and status. Page 1 of 2 72-025 (11/84) ENd'INEERING FIRIV] PROVIDING INSPECTIOi~{S, TESTS, FILE SEARCH, DATA AND INFORIVtATION As certified by my seal affi×ed hereto and as of the validation date shown below, I verify that rny 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 Barter & Associates Telephone 563~7164 Address 10461 Hampton Drive, Anchorage, Alaska 99516 Date EngineerLs ,Sea Approved for F~ bedroo ate t~ Conditiona~ I~ ~ Approved Disap~oved ~ . Terms of ConditionalApproval ~~ ~~~ ~ ~ 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 WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: LI'I/\!::1 J:l d ~ Mi"IV]FI JO 'id](] Lot 8, Je~:~v F~i~Un~°~. Anchorage, Alaska Well Classification Private Well Log Present (Y/N) N Total Depth 240 Cased to Static Water Level 75 feet Casing Height Above Ground 10" Electrical Wiring in Conduit (Y/N) Y Separation Distances from Well: To Septic/Holding Tank on Lot 55 ~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line --- Cleanout/Manhole --- Water Sample Collected by Water Sample Test Results If A, B, C, D.E.C. Approved (Y/N) Date Completed ] 964 Yield 4-0+ Depth of Grouting --- Pump Set At IJnknown Rae Kozlowski Satisfactory 58' Sanitary Seal on Casing (Y/N) Y Depression Around Wellhead (Y/N) ; On Adjoining Lots 1 00+ On Adjoining Lots l 00+ To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date 7-18-85 1.0 gpm Comments SEPTIC/HOLDING TANK DATA Pumped Estimate Datelnstalle~rloP to,1968 Size 1,500 gal. No. of Compartments 2 standpipe Standpipes (Y/N) Y Air.tight Caps (Y/N) Y Foundation Cleanout (Y/N) · Depression over Tank (Y/N) N Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) ..... Separation Distances from Septic/Holding Tank: To Water-Supply We!l, 55 ~ To Property Line 30' To Water Main/Service Line N/A Course ll7' tO Bulkhead face Comments Y Date Last Pumped June 14, 1985 ...... ; for ..... Temporary Holding Tank Permit (Y/N) ..... To Building Foundation 9 ~ To Disposal Field 40~ To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84} C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date lnstalled Prior 'co 1968 Width of Field Unknown Unknown Square Feet of Absorption Area Unknown Depression over Field (Y/N) N Results of Last Adequacy Test Sari sfactory Separation Distance from Absorption Field: To Water-Supply Well 58 ~ To Building Foundation 19' Lot .... Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test Type of System Design CPi b Length of Field Un known Depth of Field 154'to btm of Crib Unknown Y July 30, 1985 To Property Line 21 o 5 ~ To Existing or Abandoned System on ; On Adjoining Lots 1 00+ To Cutbank (if present) 40~ to face of Bulkhead - 99' To Water Main/Service Line N/A To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments O. LIFT STATION N/A Siz~in Gallons ~ "Pump On" Level at ~ Dimensions ~ Ma~lme~'~~ High Water Alarm Level at ~ ~ Vent (Y/N) Tested for j,,,,'~'~-""~4&mping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) ~~ -- ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA g uidelines in effect on the date of this inspection. Signed ~ L~.,,~_J~ Date Company ~ O~_ ~)~ MOA No. "~- '~,~-~ Receipt No. ~"~ Date of Payment ~ ~ o~ Amount: $ ~-*~_-~ ~ .~ '~_~...~' %.'~ '~ ~ ~'Engineer's Seal Page 2 of 2 72-026 (1 U84) MUNICIPALITY OF ANCHOIbII~I~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTIC~ BARTER & ASSOCIATES Tony D. Barter, P.E. 10461 Hampton Drive Anchorage, Alaska 99516 RECEi. ED, August 6, 1985 Mr. Beltaine C. Kozlowski 4620 Emerald Court Anchorage, Alaska 99502 Re: Lot 8 Jewel Lake Heights Sudivision Dear Mr. Kozlowski: At your request, I visited the Subject property on July 30, 1985, for the purpose of performing an adequacy test on the existing septic system. After reviewing the layout, I asked you a few questions about the septic system. You informed me that the system is c~mposed of a two-compartment tank and crib of which no problems have been encountered. This system had been installed by the original owner and builder, Mr. Frank Risch. You also indicated that you purchased the property in 1973. I suggested that we contact Mr. Risch to determine when the system was installed. The information you received from your inquiry of Mr. Risch was that the absorption field had been installed prior to 1968 and that the well was drilled to approximately 240 feet in 1964. In the meantime, I had researched,the Municipality of Anchorage files and found no records or as-builts for this parcel. The adequacy test consisted of introducing water into the system at approximately 10 gpm and periodically monitoring with respect to time for the filling and subsequent absorbing period. The system would accept the required 750 gallons of water on the date tested. With no as-built record of the absorption system, I felt it was important to verify the integrity of the tank. This was accomplished and the tank was probed. You furnished a pumpout receipt dated June 14, 1985, to help determine an approximate volume of capacity. As best I can tell the tank would be considered to hold 1,500 gallons of sewage. The well casing was then verified to be greater than 40 feet. The static water level was recorded at 75 feet. The wiring was not encased in conduit. Since that date you have corrected this Mr. Beltaine C. Kozlowski Page 2 August 6, 1985 requirement. The mechanical properties of the pump seemed fine, although I feel that the pressure tank may be undersized and leaking air. This system was capable of producing 1 gpm at a sustained rate without showing any stress to the well. Finally, I recommended that the pipes be extended where necessary and the approved type Jim caps be installed. This was accomplished by using collar type couplings. The parking area was suggested to be reduced as it appears to be encroaching on the outer area of the field. This I'm told will be taken care of by additional landscaping of the area. If I can be of further assistance, please give me a call at 346- 1170. Very truly yours, Barter, P.E. cc: Municipality of Anchorage Division of Environmental Health PHOTOGRAPH OF WELL CASING Lo+ ~ 2~sW~L L~l~ /~.~_ C. HEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIA'I~ CENTER 5633 B Street Drinking water, Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I.D. NO. Water; Syste~ Name 4(~ 20 ~m~aid Mailing d S~te Ci~ Mo. ~Y Y~ (*) See h on back I~t one' NO. qqs~9~ Zip ~ SAMPLE TYPE: [3 Routine [] Check Sample (for routine sample with Isb ref, no, [] Speclel Purpose [] Treated Water ]~ Untreated Water SAMPLE NO. LOCATION Time Collected .Collecte~l By, TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ~Satisfactory [] Unsatisfactory ' [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results, Please send new sample via special delivery mail. Date Received Time Received Analytical Method: O Fermentation Tube .~ Membrane Filter Lab Ref. No; Result* Analyst 06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter:. Direct Count Verification: LTB BGB Reported By /----~/~ ~ ~ ~ Date Time: TNTC = Too Numerous To Count Collformll00ml CollformllOOml /:If> o ,.m. c /~ ~ ~"'°°"'"%'~E Jr- -- - 77.9~ J~