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SULLIVANWATER WELLS
P.O. BOR -272, CHUGIAK• ALASKA 99567 • TELEPHONE 688.2759
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OWNER OF LAND /yr G <2 L als.t 6 DEPTH OF WELL u p
ADDRESS
LEGAL DESCRIPTIO, 'h` C
DATE - Started 741' O Ended 7 a IL &0
PERMIT NUMBERQ006 79
KIND OF FORMATION:
STATIC LEVEL OF WATER FT. 13
G
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GALS. PER HR 1.4 0
KIND OF CASING 6
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MLSCL INFORMATION:
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— 49VU7EA
DRILLER'S NAME — & � '
PERMIT NO.
I)Ef:'FIRTMI:_':]t',tT F I' IEFtLTH FIND EN',,,'I RONMEi'.~TF:II,_ ' FrECT I ON
6:25 '" L I~TF:tEE"f'., I::tNCtg3~:t~IGE., I':th::. SE;,
264-...47;2E~
~..[I EE 1_ b. F" EE IF41.". E"tl ~
Ir:iF' F' L '[ I[:I':II'.IT
I.,. E I]ii I::11..
MC:CLUNF:i., Cl. ~:. }:::L. EII"L, [). F'L-I E,.,:, '~"~',' ,' ,' E.
5;TEEPLE DRI',/E E. R.
TF..'FICT ~7 I.IIGHLFIN[;, TERF".RCE ~4 LOT SIZE
6 94- ,.,. 926;D
J.,r¢IEI.C3E1EI '61'.;:!I..II..':IF..:E F'EET
': '": '"~' ::,E!-I"aE [:'I:.,F. ::,ILL """- ' '-'
H]:NIM. r,r DI..;I I~_.~::. E:ECTI.,.IEE:N F:I klEL. L F-IN[C:, I::ll'-~'.r' ON.-.:~,ITE .... ~ ..... ~--
::[.E~',.3 FEET For:,: FI F'FctI',,,'FtTE I.,.IELL. OF;: 15~1 TO 2E~E~ FEET FROM F4 I::,UE,'!._IC 14ELL DEr:'ENDING
UPOI'J THE T"r'F'E I.')F' PIJf:~I..]:C I.,.IELL.
M:[I'~:[hlUH DI:E;TFIi'.,ICE F'F?.C$1 FI r:'RI',,,'FiTE [,JELL. TO FI Pr;:.T.',,,'FiTE SEI.,.IER LINE
"FO Ft COHMUt",IIT'¢ S;I~.I.,.IER L.'fI"JE :[.'5 75 FEET.
I.,.IEI_.I... LOGS; R'F..'E REQLIIr.;:E[> RND MUST DE: I;;'.ETtJRNED TO THE [:,EF'iqRTI'IEI'.,IT I4ITI..IlN 28 DF'I"r'%
OF TrlE HELL COHF:'LETICII'4.
OTHER REQUIRF. I"IENTS I'lFl'.r' RF'F'Lk". SF'EE:IFIE:RTIONS FIND C:ONSTRUCTIOI'4 DIRGRFli?I:E; RRE
FI',,,'Iq I L. RE:L.E TO ]; N'_qURE r:'F. rOr::'ER I NSTFILLRT ]; O1'4.
I CERTIF'¢ 'I"HFII"
:1.: I RI"I F'"IaI¥1ILIRf:;'. I,.!ITr..I 1"HE F,'EQUIREMEN'FS FOF;: ON....E;ITE 2;EI.,.IER2; FINB', HEL. LS Ft'..~ E;ET
F. or~YTH E:"r' "r'HE I','IUI'.J I C I F'I::'IL l T"r' OF' FINOFIOF..'FiGE..
2: I I4II. L. II",IL=,TFIL. L THE S"r'"2;TEI'I :[i"4 FICE:OFtDFtI",IC:E I.,.I]:Tr..I THE CODES.
, -- ,,F. tF, F,L...D3. FiN.~. I"lf":E:l(:,YJl"83. G. ,'.;'.~ KLETN, ~
Z 2;'F:.UED B'¢_ , .:.].~.!. x__~,. ........... [::,FITE ..........
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RE'"'ER ANCHORAGE AREA BOP"UGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME (-"~o,,~.(.~.~; ~'~('"C~A~,.~. __ MAILING ADDRESS
D E SC R i pT i O N/~ I'J)'i"¢,~,.¢ .r
LEGAL
PHONE
SEPTIC TANK:
DISTANCE
FROM WELL
INSIDE LENGTH
MANUFACTURER
MATERIAL
NUMBER OF
COMPARTMENTS
INSIDE WIDTH
__ LIQUID DEPTH__
.LIQUID CAPACITY J,0OO GALLONS,
SEEPAGE PIT:
NUMBER OF PITS
LINING MATERIAL
BUILDING FOUNDATION
ADDFI'IONAL ABSORPTION
DIAMETER (/]~" OR WIDTH
__ CRIB SIZE: DIAMETER
NEAREST LOT LINE
LENGTH I~f, DEPTH
DEPTH G DISTANCE FROM: WELL
TOTAL EFFECTIVE
ABSORPTION AREA (WALL. AREA) ~¢
SQ. FT.
WELL:
TYPE
BUILDING
FOUNDATION
CESSPOOL
APPROVED
.CONSTRUCTION ~¢,~I>A¢-{~ DEPTH ~'¢('~" DISTANCE FROM:
NEAREST NEAREST SEPTIC SEEPAGE I '
LOT LINE SEWER LINE TANK qC~' SYSTEM 3(2
OTHER SOURCES
DISAPPROVED.
REMARKS
DISTANCES:
INSTALLED BY:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form No, EQ-031
DIAGRAM OF SYSTEM
Ap p R OV E E?'"/2~¢¥/ /. ~
J, / G,A.A,B.
,GREATER ANCHORAGE AREA DOROF' < ~r~. b~r ~Y~ ~'~
Department of Environmental Qk ~.~_ ~
3330 "C" Street
Anchorage, Alaska 99503 ~
Performed for /~//C~__~_~/X/~ Date Performed
Leg a I De sc r il)t i on:.._-_~L~._~-~./~_~.~__~ ./_Z~_./_~£~_~ ~ ~]-./~_f/~ d ~_7_v~-' --T
This form reports: Soils log___ .~_~____j__ ' Pe~o~at~on ~e~
Depth
Feet
! 2 -
13 ~
14 ,-
Was ground water encountered?
___~v/_O_ ..... If yes
, at what depth?
Reading Date Gross Time Net 'rime .)~e.~Lt?~_.~_o~.a?z- Net Drop
Proposed installat-1~?--~5~¥~ge Pit .~ ..... Drain Field
:Jepth of Inlet . Dept.~-"~~m of pi t or trench
E(~ 040 ((;/74)
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 INFORMATION
(a)
Application Date Au_gust 12, ~.86
Legal Description (include lot, block, subdivision, section, township, range)
Tract7 Hi~hland Terrace #4 T14N R1W Section ~7
Location (address or directions)
(b) Applicant Name Carolin__e McClun_'¢._ Telephone: Home 6~94-_9260 Business
Applicant Address P.O. BO×_770777 gA~gle River, Ak 99_577
(c) Applicant is (check one): Lending Institution []; Owner/builder BI; Buyer []; Other [] (explain);
N/A
(d) Lending Institution Ho_m_e Saving~9 & L__oan Telephone
Address __~0]_ ]:~3ei~son Anchorage, Ak 99_508_
(e) Real Estate Company and Agent N./A
Address
276-18_51
Telephone
(f) Mail the HAh to the following address:
Plckup b,y englneer
TYPE OF RESIDENCE"
Single-Family [] Multi-Family Et
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 E]
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (11/84}
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, D/ATA 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 sate, 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 EAGLE RIVE~ ENGINEERING SERVICES Telephone
EAGLE RIVER, AK 99577
Address
.--- / ,.:t' -~Y~' 694-5195
Date ,:? '
DHEP APPROVAL J~. ~2'~' .,'j~ /~ //~ .
Approved for _~'~ ~bed rooms b~. ~,~~_¢ ~ '~' Date
Approved ' ~¢ Disappr~dd __ Con;it;'oXI
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)
MUNICIPALITY OF ANCHORAGE (MO~
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: ~-r~¢7~
Well Classification
Well Log Present (Y/N) /v' Date Completed ~ ~ '~ ~ - ~o ¢/ Yield
Total Depth ~,o~- / Cased to /c¢,--'/~ '~ '¢'¢'¢'¢'¢'¢'¢'¢'¢~'~'
.,.,, Depth of Grouting
Static Water Level /¢-/~¢¢./,',~ ~.,~ ~'P ~ ~r,--,.r Pump Set At
Casing Height Above Ground 'f-./.z" ~X, ~.u~-,cg /,,~s~.~anitary Seal on Casing (Y/N) ,'~
If A, B, C, D.E.C, Approved (Y/N) /'~
Electrical Wiring in Conduit (Y/N) _,.V
Separation Distances from Well:
To Septic/Holding Tank on Lot ,~ ;~ o
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole _
Water Sample Collected by Z~
Water Sample Test Results .S%
Depression Around Wellhead (Y/N)
; On Adjoining Lots ¢'? ~ ~"
; On Adjoining Lots ¢/~'~ ·
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot ¢'~Q'$- /
~/~'-,¢~ ,-~¢¢ r/.~j ; Date ~ - 1/-."-~
Comments
SEPTIC/HOLDING 'rANK DATA
Date Installed
Standpipes (Y/N)
Depression over Tank (Y/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 ,~¢~o ~
To Property Line '75'- /
To Water Main/Service Line ¢'-/,~ /' Course
.¢ - 7 z_/ Size 1~'~'O ,.~ ~/, No. of Compartments
Air-tight Caps (Y/N) ,,v Foundation Cleanout (Y/N)
Date Last Pumped . ,/9-~.s /~f,~-
"¢~ ; for
_ Temporary Holding Tank Permit (Y/N) '~'/~
To Building Foundation ~J' /
To Disposal Field ¢72..~ /
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(1 U84)
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~' -- 7~z'
Width of Field /6 ~
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ..~ ¢'o
To Building Foundation -~ .2 /
Lot
To Water Main/Service Line f-to
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
,r¢~.,,-,,,¢/,,;/- Type of System Design
Length of Field //,¢ /
Depth of Field /~ /
Gravel Bed Thickness ,¢'"
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line ,;~L? /
To Existing or Abandoned System on
; On Adjoining Lots ¢~ 3~ /
To Cutbank (if present) '*'0,./9
LIFT STATION¢¢t
Date Installed
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 certify that I have checked, verified, or conformed to ail MOA and HAA guidelines in effect on the date of this inspection.
Signed .Y ~~ - Date ~ '- /¢¢ --'&P~-
Company /_~¢,,,~,5 , MOA No.
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
Engineer's Seal
,14"
A~BLqLT
/-%
I hereby cert~y that I have su~eyed the fo~wm
~c~se ~ ~ ~, a~ ~ ~e ~ov~
~n~ a~ ~n ~ ~m ~e ~ ~s and ~o not
~e~p or ~ ~ the ~ lym~ adj~ ~, that
~ the p~ ~ qu~aon, az~ t~t t~ ~ ~ r~ways,
~'~ md~a~ h~n.
Dated ~ Eas~ ~, ~ka
~O~T C, }O~NSON
~: ~d ~d Su~ No. ~-LS
l" - ~ ' ~x ~, ~6~ ~,