HomeMy WebLinkAboutLODGEPOLE LT 701 o I 55
..~. MUNICIPALITY OF ANCHORAGE
DEI 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
Name
- - f- . FRO~O SEPTIC ABSORPTION
Address ~ .~ ~ /~ ~ ---... TANK FIELD WELL
Peblon/it No. No. oh.~drooms WELL
LEGAL DESCRIPT,O; LOT LINE
Township, Range, Section '
AS-BUILT DIAGRAM (Show Iocabon o~ well, septic system, property hnes, loundahon,
Manufacturer~C~ ~ff'~~ ~ Capac~tg~'n gallons
TYPE OF SYSTEM
~RENCH ~ BED ~ W. DRAIN ~ OTHER
~ FT ~> .. ~ FT
Total absorpl,on area Dist .... belwee, lins /
~ SOFT ~ FI
Numberollmes JSoilrahng P,pe mater al ~ ~, ~ ~
WELLS
~RIVATE ~ OTHER (ldentifv)
Classdicahon (A,B,C) Total Depth F~ Cased to ~
REMARKS:
~ ,- . Inspections Pedormed by:
~unicipal and State guidelines in ellect on this datn:
Health Depad~e~, Approv.~~ ~:~':~ Date: ~/'~
ALASKA ENVIRONI~?NTAL
CONTROL SERVlCi INC.
1200 West 33rd Avenue Suite B
ANCHORAGE, ALASKA 99503
Phone 561-5040
S,E~T ~o I OF
CALCULATED BY
CHECKED BY DATE
SCALE
L. LTI" ." 7
RANGE :: :~{.,,,I.
Z c: ,;:: r' '1:. :L f y 'L h a'{:. ~
I am fami].iar {.4J:['!..h '!;,h~: P{~.!C]LLiJ":}~}[[J~Z,)[-]'i~.?.,} {'(:)j" (:)[']""'~]}i'i~.(':(') ~:~al4:('~'~V~t and
Z L.~:L].'! adh(.:.:.:,va, i:.c:, alI I"IE}~:~J aF~d S'Lal. a, c~f Ala:,l,::a r'~:.:.:,qL~:i.t'(:,ml0:~,r'yi{.i~ for' 'I:I'H:, !:;~,-~:L bac:k
!::.::~W0:~r age~ :;'/srLi:.)m cH-~ 'Lb i !:~ (:)i" ar'B.' adj aci~Fl'IL or i'~e:.)ar, by i cH'...
zi.. :[ L~F~(:Ji:,)r%'[:.alFiCJ i, ha-L 'Ll"~i!~ F)e:,r. mi'L :L!~; va].:i.d For a ma>::i, mLim c)F ' 4 l;~a, drc)i::)m~ aFW::l
a~B/ .~z:)F'~].arga,mu:{,r':IL ~>ii].], F'eCILi:i. Pa ai"i acldi'L:i.c:H'w:~l per'mi'L,,
LEGAL DESCRIPTION:
F/~
2
3
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6
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Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE PERFORMED:
Township, Range, Section:
(ENGINE~ ,~L)
k-if-
SITE PLAN
.~'
10
11
12
13
14
15
16
17
18
19-
20=
COMMENTS
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? p
E
Depth lo Water Alter
Monitering? Dale:
Gross Net Depth to Net
Reading Date Time Time Water Drop
~ I~po I~q~- ~.~ b~
'=2
PERCOLATION RATE O,, ~ (minutes/inchJ PERC HOLE DIAMETER ._
{-..~t TESTR~N~ETWEEN ,¢.o FT^NO ~,'-~--,. F, '~ ,,
4,. m-v' ,op~.~.. ~ .5~.,,-' ~; ia'.< e.,~._/ o~ 5:'~ /n ~.
PERFORMED,,,: &~-s n-,~ ~"~r , .~ ../~< CERT,FY THAT TH,S TEST WAS PERFORME,:, ,N
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
MUNICIp ...... oF~MUNICIPALITY OF ANCHORAGE (MOA)
APPROVAL
ENVIRONMENTAL P~OTE~KLIST- FEBRUARY 1984
264-4720
· ~ 0 l~ffi Lega~escription:~,~Y
RECEIVED
WELL DATA
Well C ass f cat on ~ /A~' f A, B, G D.E.G. Approved (Y/N)
Well Log Present (y,.~/ r ~,, Date Completed _~ ,- Yield
Total Depth/~ '-//m Cased to ~/~ ~ Depth of Grouting
Static Water Level ~ / _~~.~ump Set At
Casing Height Above Ground ~- ~ ,~)~a(nitary Seal on Cas.n~)
Electrical Wiring Jn Condui~N) ~/~ Depression Around Wellhead
Separation Distances from Well:
/
To Septic/Holding Tank on Lot .~ ~ ; On Adjoining Lots
To
Nearest
Edge of Absorption Field, Lot /'~ ~-~-On Adjoining Lots
To Nearest Public Sewer Line ~ To Nearest Public Sewer '
Cleanout/Manhole ~' T~ Nearest Sewer Service Line on Lot
.(/ // , /' .
W~ter 8~mple Gollecte~ by ~./~ V ~ ~ ~ D~te ~
B. SEPTIC/HOLDING TANK DATA
Date lnstalled~ ~ --/,~2~ ize . No. of Compartments
StandpipeS) \~-~ ~ Air-tig.~Dap~) ...~?~__<:~ Foundation Cleanout4~)
Depression over/T'~aank (~ /'P/~:?~//"' Date Last Pumped ,~.~'~
Pumping/Maintenance Contract on File (Y/N) .-~././/~ ; for
Holding Tank High-Water Alarm (Y/N) /¢~//~ Temporary Holding Ta_nk Permit (Y/N) ..~/~×'
Separation Distances from Septic/Ho.~ing Tank: /
To Water-Supply Well /'/~)¢ --,/ To Building Foundation
To Property Line /',-d'~/¢'~ To Disposal Field ~-Dc-
To VV~Ib~/Service Li~e'/ ..~-~'~/~ To Stream, Pond, Lake, or Major Drainage
Course ~d',~-'/z"~ ~' ~'~-~' ~ -~-~-4~'~-
Page 1 of 2
72-026(11/84)
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata /~,, ¢/2' //./-~/~?/--P-xt'~e/"Z//Type of System Desi~7
Date Installed
~ ' Length of Field
Width of Field
Square Feet of Absorption Area
Depression over Field (~') /'f'//~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ,/'~
/
To Building Foundation .-//
Lot ~o /
To VYete~M~in/Service Line ~_.Z~'TD //~7z-
To Stream/Pond/Lake/or Major Drainage Course
Depth of Field
Gravel Bed Thickness ~'~ ~'~""-
--%- ~ Standpipes Presentr4~)
Date of Last Adequacy Test
/
To Property Line /~' ~
To Existing or Abandoned System on
; On Adjoining Lots -~ ~
To Cut ban_k_.(if present)
/
To Driveway, Parking Area, or Vehicle Storage Area ~-~¢ % ....
Comments .-~-'-~-"~ ~-~)~/ - . >/p/-~ / ./~- ./~.~/z~
LIFT STATION ~~
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checkedCerified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed /~//~.~.74~. /~//~ .-'~-~'Z ,~] Date __
Company/~ '?.~,¢7.~:~,.~. /~..'~,.~-~ / /-~/biO"A No.
Receipt No. --~ (__%'--'[ \
Date of Payment Lo
Amount: $ (¢:~' ~'('-~'
Page 2 of 2
72-026 (11/84)
/~-~i~IUNICIPALITY OF ANCHORAGE ~'
DEPARTMEN, OF HEALTH AND ENVIRONMENTAL PRO..~CTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions) ~ ,~,
(b) Applicant Namox'~/~E '-~/~-~-~/,,~-~c, ,~j Tole_.pJ39~e: Home .~-~-.~//'~,~'~'~"~'~:~ Business .~ ~' ?/ ~'~.'~_-~
Applicant Address .~'-~ ~/' ./.~//~'~//-/ .//[ 'f'-'¢-/~ '
is (check one): Lending Institution []; Owner/builder']~ Buyer []; Other [] (explain);
(c)
Applicant
/
(d) Lending Institution Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to th.~ following address:
TYPE OF RESIDENCE
Singte-Famil~/ 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 Environmental Conservation
attesting to the legality and status. '
Page I of 2 72-025 (11/84)
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ·
/~'§ 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 wat~: 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 disposat system is in compliance wit, h all Municipal and State, codes, ordinances, and regulations in effect on
the date of this insRection.
Name of Firm /'~-~,~-~"'-~,~P./c~-~P' ?' .~-~ -Telephone --~ ~.~
. ~ // ~ . ~ - .-~ ~
Address ~ ~ ~ ~: ~ ~~'~ ~ .~ ~
Date ~ ~ ~ ~ ~
DHEP AP-PROVAL~'
Approved for ~ d~) bedrooms by ~
Approvedi X - Disapproved
Terms of Conditio~ial Approval
Engineer's Seal
Conditional
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
July 3, 1986
Susan Oswalt
DHEP
825 "L" Street
Anchorage, Alaska 99509
Re:
"-'! 9 [
NOI/D~IO~d T~IN3WNO~IANa
'~ H£~V3H JO '.[d~(]
a~V~ON~N¥ ~O AlllVdlDINflV~
Additional Health Authority Approval Documentation
Lodgepole Subdivision, Lot 7
Dear Su~an:
This is to document the completion of improvements to the well
on the above-referenced lot. These improvements were identified
as deficiencies per requirements of DHEP during recent Health
Authority Approval application review.
The existing concrete vault has been abandoned by extending the
well casing to at least 12" above surrounding ground, the
pressure tank and electric Controls have been relocated from the
vault to inside the house, and the vault has been backfilled to
surrounding ground elevation. Positive drainage away from the
:well head wasestablished.
This should allow for the on-site water and sewer systems to
receive Health Authority Approval.
Very truly yours,
Carey SS ~eyer/ ~PE
· ,.~./ '~j
ENGINEERING, PLANNING, SURVEYING
2220 E. 88th Ave./Anchorage, Alaska 99507/Telephone 907-349-6451/344-1352
"Providing a quality personalized service to those building Alaska's future"
Client's Name:
Address:
BESSE, EPPS & POTTS
2220 EAST 88 AV~rJE
ANCHO~AC~-, AK 99507
(907) 349-645].
WATER W~T.L TEST
Initial Reading c~ Meter:
~C,0 UN!VEBSITY PLAZA WEST. SUITE A FAIRBANKS, ALASX. A 99709
6957 OLD SEWARD HIGHWAY, siJITE 101 ANCHORAGE, ALASKA 99518
907-479
~07-349-8623
TO BE COMPLETED BY CLIENT
~. PUBLIC WATER SYSTEM I.D, # I
_-- PPdVATE WATER SYSTEM
Drir]kin§ Water Analysis Ftep(Jh for Total Coliform Bacteria
TO BE COMPLETED BY LABORATORY
Received at: y Anch. [] Fbks.
State Zi~ Code
SAMPLE DATE:
Mo. Day
SAMPLE TYPE:
,~' Routine
i~ Special Purpose
~ Cl~eck Sample (for original contaminated
sample with lab reference no.
1
2
3
4
5
Lcc~tlon
.d/
/~ Phone ..~ .~-.¢h
Year
Purchase Order
[] Treated Water_
UfiS(Untreated Wa't er'
9
10
Signature of Representative
FOR [~,BOP-~,TORY USE O~',~LY ~
Time Received _ /.~ ~ c'?~.
Next Sample Due
COMMENTS:
SATISFACTORY ~ ~
U N SATJS FACTO FlY U
RESAMPLE R
OTHER BACTERIA OB
TOO NUMEROUS TNTC'
TO COUNT
Direct Ver~cat;on Final
Count [.SS F~GB Result°
*N0."o~' Totat Coliform Colonies per 100 rn;s
Reported by
Date
/ unicip[ 'itYof
Anchorage
P,.. JCH 6-650
ANCHORAGE, ALASKA 99502-0650
(907) 264-4545
TONY KNOWLES,
MA YOR
May 30, 1986
OFFICE OF THE MUNICIPAL ATTORNEY
William F. Strane
P. O. Box 111230
Anchorage, Alaska 99511
Dear Mr. Strane:
Your recent letter to the Mayor regarding wastewater problems at
14244 Hancock Drive was referred to several municipal agencies
with the hope that you could be provided with meaningful answers
to those questions that can be addressed by the Municipality.
With respect to your concern that the issuance of a municipal
waiver violates city and state laws and amounts to fraud, we will
investigate the facts and circumstances under which the permit
was issued to determine if there appears to have been any wrong-
doing on the part of municipal employees. These questions will
be investigated by the Municipal Health & Social Services
Department, and you can expect a reply from the Director, Jewel
· Jones. I will assure you now that the Municipality had the
authority to issue waivers, and that in .the absence of fraud or
misrepresentation, we intend to stand behind those waivers with
respect to any systems installed under their terms. In short,
whether the issuance of a waiver in 1981 was or was not a wise
exercise of discretion, it was, in the absence of proof of fraud,
a valid exercise of discretionary authority, and will be honored
by the Municipality.
Very truly yours,
DEPARTMENT OF LAW
'Jerry Wertzbaugher
Municipal Attorney
JW:gml
CC:
Jewel Jones, Director, H&H~
Mayor Knowles
"~" "~'~ INVOICE N_o 3 4 2 2
"'M-W DRILLING INC. DA~'E ~-~Z "~C
UNIT
--''~''----------~UKAgL, ALASKA 99511 QTY. MATERIALS PRICE AMOUNT
PHONE 349-8535
LEGAL DESCRIPTION
.TOTAL MATERIALS
DESCRIPTION OF WORK
DATES
AY charges shay be paid in fuY within ton
days un/ess other arrange~onts are made
prior to dr/i/lng. The customer shay pay in-
terest at the rate of I ~ % par month on any
amount not paid w/thin ten days. Pa//ure to
pay may result in a Yen against the property.
,-~,8, 6-,~3Ia.w, /~:.~/S '^"°R /:~. ('S~- 1/3 ,~,