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HomeMy WebLinkAboutSCHROEDER LT 30ASch�oec�er slp 050 —oslmom g(v un�zipa ity of Anchorage MEMORANDUM DATE: June 30, 1983 TO: Mr. C. E. Tanner FROM: Robert W. Robinson, Department of Health and Environmental Protection SUBJECT: Waiver for Perforation Depth - Private Water WEll Lot 30 A Schroeder Sbdv - Eagle River Pursuant of our meeting in our office on June 29, 1983, this will serve as a waiver allowing your water supply well to be per- forated, tested and completed through perforations at a depth of 371. As we discussed by telephone this date, there are several conditions to this waiver with which you indicated your con-- currance. These conditions are as follows: 1. Hold the size of perforations to a minimum 2. After being perforated, produce the well for as long as reasonable in an effort to eliminate the silt and turbidity condition of the water. 3. Collect water samples or a monthly basis (techniques and sample containers to be furnished by this office) so as to monitor the water for possible contamination. RR1/p/D7 -010 (51761 Robert W. Robinson M -W DRILLING, Inc. P.O. Box 10-378 • 10300 Old Seward Highway (907) 349.8535 ANCHORAGE, ALASKA 99511 DRILLING LOG Well Owner Lifestyle Industries — Harry Hi-1 Location (address of: Township, Range, Section, if known; or distance main Lot 30A Schroeder Subdi.vi-cion Use of Well Domestic Size of casing 611 Depth of Hole 1-40 feet Cased to feet Static water level 35 ft. :(Ai (below) land surface. Finish of well (check one) open end Screen ( ) ; Perforated ( XX ) . .. Perforated. 33' to 37' -- 4shots per ft. Describe screen or Well pumping test at --gallons per (imecex) of drawdown from static level. Date of completion Apr -J-1 �0� 1�3 (minute) for � hours with �_OOJ ft. WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness ---TO 100 Existing Well _ 100 TO 11.0 Clay -stone .H Soft _TO Note — On 4/22 at owner's direction, well vus — —TO perforated and Li." ADS Liner i.nsta11ed, TO ` Dottoin of Liner stopped `? 105'_ Top of ——TO T,iner 5 ` , - -TO ---- — TO TO TO TO 1 —CUSTOMER H a m m 1-' C C (D n Z 3 3 K N N C JQ n (D �. CZ R. K itfl �y�, iP iW Z :FN 0 0 W:U 0 ;Ul ;tel :moi 00 O HHHHH a) :C)O © O O O 8 a 0 b 0 O O z N Z '1 ri 3 1 I e1 O O � O O O O O (D i W i W iW N N • al W O ;U, 44, 00 i0 L9 Sw iO C) N (D a H H o O d :o EE : 9 uQ r N i N :N fy ()i O K H H H -i H H 0 d :C) O H (D :O 'b r .1 O. c -h (D ct C Fry 1-4 :N p P, K ?O • :K bq (Di 7R \ 0 :cn �3, C pi i(D O C> (D C/) c+ :(D c-1- (D :E� N P : H+ p va U(1 : uq s— (D r• H, d U) !� 0 O ro Sv '(n K O 3 0110 O 0 0 ~ � R. U) v H. El O N t -F } O `JR (A W o� O r• �H (CD ��1 H H H H W O O O O O O W ^1 (D O r• �P O o P. - O 1✓ y 0 q1 • 1 •O-1 H H -rl �r (n w P� � d O N (D H a m m 1-' C C (D W Z 3 3 K N N C JQ n (D �. CZ R. K 0 W i W ? N :FN 0 0 W:U 0 ;Ul ;tel :moi 00 HHHHH a) :C)O © O O O 8 H O z r l ..1 -q O O O O O i W i W iW N N • al W O ;U, ia7 00 H H o E 0 :o EE : 9 uQ r i N :N fy ()i O K ict Oi H. i W .1 O. c -h (D ct 1-4 � i r• :K bq (Di 7R \ :(D :� m : (D va U(1 : uq s— (D H a m m 1-' C C (D W (D CU c+ K N N JQ n (D �. CZ R. K °r1C' 0 0 0 0 HHHHH © O O O 8 H H a m m TIME DRILL LOG ri; ' CASING M -W DRILLING, INC. DAT E CREW ^^N EQUIPMENT •1 � IJCNO. I�r',I ISI •{ IJf �U �• _ • NAME No. \ * \\ 4`l �� k l .0 �(� (� • ` CITY PHONE JOB LOCATION _ — 4,4 ((• ( —� NOTES:_ a DEPTH WELLLOG A1 )r _ �r<rTrvcc�-- vi r,-/ -_ / A ��� —��— � / ~ / �f��#y� [q / . ate• _ � ..Lai 1 STATIC LEVEL GPM • YIELD OWNER REPRESENTATIVE: m MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL AR/Q - Qk Z OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date — 1. GENERAL INFORMATION (a) Legal pescription (include lot, block, subdivision, section, township, range) Location (address or directions) / (b) Applicant Name SZ ad®�a6elephone: Home � � �� Business Applicant Address— (c) Applicant is (check one). Lending Institution ❑ ; Owner/builderg; Buyer ❑ ; Other ❑ (explain); (d) Lending li Address (e) Real Estal Address Telephon (f) Mail the HAA to the following address: 5 & S ENGINEERING SR 196X EAGLE RIVER, AK 2. TYPE OF RESIDENCE Single -Family Multi -Family D Other Number of Bedrooms — ,1---- 3. WATER SUPPLY Individual Well Community 11 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 DISPOSALVtIiJ' OnSite,Public X 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 1 of 2 72-025 (11)84) 5. ENGINEERING FIRM PROVIDIN" INSPECTIONS, TESTS, FILE SEARCH, DA (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. Name of Firm S it S ENGINEERING Telephone �Z%�` Z /� 75�7 Address SR B 196X _ EAGLE RIVER, AIC /Z_ Date & DHEP APPROVA Approved for �? bedrooms c Approved Disapproved Terms of Conditional Approval — CAUTION .� 1✓ ry�Q A ° 0o n . IxvrP'ASf dcf �= ori/f6D e , 00 z 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 (11184) MUNICIPALITY OF ANCHORAGE (AAO.+) MUNtCiPA`t U Ut Pp4 HtOppGR HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 pEPT�ENT�I PRUTECTIUN 264-4720 EN�tRUN l Legal Description: Lr,>7 A A. WELL DATA Well Classification If A, B, C, D.E.C. Approved (Y/N) i -L Well Log Present (%N) — Date Completed 10'3 Yield Total Depth i ` Cased to ?/'��� Depth of Grouting — Static Water Level Pump Set At ��Ar — Casing Height Above Ground — Electrical Wiring in Conduit ®/N) rr Sanitary Seal on Casing ( /N) Depression Around Wellhead (Y/O Separation Distances from Well: /111 To Septic/Holding Tank on Lot _� �ur3uc`7c'v�ta� ;On Adjoining Lots To Nearest Edge of Absorption Field on Lot ; On Adjoining LotsI'd — To Nearest Public Sewer Line 10L)t., To Nearest Public Sewer i Cleanout/Manhole &, is To Nearest Sewer Service Line on Lot P1'0_ Water Sample Collected by G-5,� &AJ tatueliF L� ; Date f 1 Water Sample Test Results``!— Comments �✓'3cc ►�-LOw I - 0 U B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Size Air -tight Caps (Y/N) No. of Compartments Foundation Cleanout (Y/N) Depression over Tank (Y/N) Date Last Pumped — Pumping/Maintenance Contract on File (Y/N) ; for —. Holding Tank High -Water Alarm (Y/N)��y Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well To Property Line To Building Foundation To Disposal Field To Water Main/Service Line — To Stream, Pond, Lake, or Major Drainage Course — Comments _Oso � ac,6>> /ca t�,U3uc `fit; VV'ft_t KAGA-(LINU AWW(.t_5" '2 SL'f35 Page 1 of 2 72-02611 1/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Lr Type of System Design Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course — Length of Field — Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test — To Property Line -- To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) To Driveway, Parking Area, or Vehicle Storage Area Comments �J2nL>ys�cTal� 70 >cl%G(c— 77 tAA-1 orj 5 - 2-Y - fab D. LIFT STATION Date Installed Dimensions Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) — Comments Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify th$ && f b JJr1 JNG or conformed to all MOAand HAA guidelines in effect on the date of this inspection. Signed ._5R_B 196X Date —_fig g C CompanyEA E IRIVER K 99571 MOA No. 9 �C> 3 _ Receipt No. 111 Q Date of Payment l e_7ZRj Amount: $ e�,� Page 2 of 2 72-026 (11/84) 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 "Ayi 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) to vcf7�At�rt�c�vv Location (address or direc�s) — (b) Applicant Name 1� Telephone: Home Business Applicant Address --Y- ,�_ cJ2 ✓ �. — (c) Applicant is (check one): Lending Institution; Ow er/builder ❑ ; Buyer ; Other ❑ (explain); (d) Lending Institution Address N 8 r✓ IF (e) Real Estate Company and Agent -- Address — Tye�lephone (f)-2fd4atl�e HAA to the following address: Telephone U a ^j 2. TYPE OF RESIDENCE Single -Family I9 Multi -Family ❑ Other Number of Bedrooms 112 3. 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 1 of 2 12-025 (11,84) �-1 oti� � ,2�>iy 2. TYPE OF RESIDENCE Single -Family I9 Multi -Family ❑ Other Number of Bedrooms 112 3. 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 1 of 2 12-025 (11,84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verity 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. Name of Firm Address Date Telephone Crt� ay goo 6. DHEP APPROVAL Approved for - bedrooms by --- 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 A. WELL DATA Well Classification -sloe. MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) Mt1NICIPALITY OF ANCHORAGE CHECKLIST - FEBRUARY 1984 DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION 264-4720 Legal Description: �—'h MAY 2 8 1985 — RECEIVED If A, B, C, D.E.C. Approved (Y/N) 1J Well Log Present &) Date Completed "� ` B — Yield a S Cv t ff) 4 - 'Total Depth 67'' Cased to Depth of Grouting Static Water Level 1 � ' Pump Set At 01 , Casing Height Above Ground _— I —I-- Sanitary Seal on Casing( V) — Electrical Wiring in Conduit(91\1) Depression Around Wellhead (YQG Separation Distances from Well: To Septic/Holding Tank on Lot . 7(L&L i�,r -On Adjoining Lots To Nearest Edge of Absorption Field on Lot N ; On Adjoining Lots tj I To Nearest Public Sewer Line — C>C? `)" To Nearest Public Sewer Cleanout/Manhole — tv To Nearest Sewer Service Line on Lot —� — Water Sample Collected by ��-�� I �` Z ��% ; Dated— Water Sample Test Results Comments P_ \>f Wit- B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) Size M3 ?'lv;4-14API� No. of Compartments /l la4 mz3/e 7 —_ Air -tight Caps (Y/N) — Foundation Cleanout (Y/N) Date Last Pumped — Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well To Property Line To Water Main/Service Line To Building Foundation "To Disposal Field To Stream, Pond, Lake, or Major Drainage Course — Comments ( ).,I C, V.)15A✓, Mn0K, J6 N&I W L4 '7a14-6_�5` Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course 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 To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) To Driveway, Parking Area, or Vehicle Storage Area �'h�f�i��l�/) 'TrD �U�l�tc:. J��)��—� � fa•ft a �I � /�rl r�c--� Comments _ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at _— High Water Alarm Level at -rested for — Electrical Codes (Y/N) — Comments — Dimensions Manhole/Access (Y/N) ,,Pump Off' Level at __ Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed .. . MOA No. 11. W --Date d— Com pany — _�'�� „k a`t 2 Cy,W�i ffip`, Receipt No — L�+ 99iq 00ep .Ll Date of Payment' Amount: J -i. s °•99 9e 9na• '". Rvberi A. Shahr d ` No. IA ° Pt naOy J7•� Page 2 of 2 ' 72-026 (11/84) — APPI_I'- 1N1' FILLS OUT UPPER WA .'ONLY Time - ,/ Property Owner y t ; t f=' / -!_' , , s.� , •- ; - <''_• - - P Msiling Address rj t((.�-R- 11.��,-�-"I��,,. Zip Code j Inspector Inspector Inspector Inspector Buyer // }} {`:✓l / ��=JUN 1 1983 Address Zip Code /1 -DISAPPROVED Environmenta�l, Prote,ction'CONDI'IONAL�PP 1' (( DATE Lending Institution;`-^�h �;;,., , / ,- Phone 44UAAf c t1-slR �1� /l J Soils Rating Address --J ". c/ ' : / „_- 1 i ,';,,ice., Zip Code Realty Co. & Agent (/ // / Phone Address /��� Zip Code / i� �'-f _ Legal Description - - °> - co/i- Street Location Type of Residence .t4, Single Family ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply 14 Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility _-�'-•- __ Sewer Disposal ❑ Individual Year Individual Installed:— _- Public Utility When Connected to Public Utility:;L-.`.,1-tj- y ❑ Holding Tank p -�r g NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time - ,/ Time Date Date Date / q Date Inspector Inspector Inspector Inspector Field Notes:- ��=JUN 1 1983 13�e ( ) APPROVED BEDROOMS /�,G4I / C ONDITIONS 0 IW opt. off Health h & ��,�YYYUNNNl� /1 -DISAPPROVED Environmenta�l, Prote,ction'CONDI'IONAL�PP 1' (( DATE V 44UAAf c t1-slR �1� /l J Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Tank Septic Tank Size Well to 72023 (3182) Grzrz) SCNFe EDE+[ Lo Baes Inez 3�IFi� 7cfR ** RBbhA. RaPLo•arb w/',i%*"ALCAP BN L�%d"�•D.A.I'. 3o11LaNb w/MA6Na'!'ILBD BAV.AKAWhY ease, . srx.r o. v-' e.c, I I ® R 6 S T. ` AlSi To 0.90 '" �y Oe Ow 1lR ..1, �•,• V T Irra � o- � 7/ 2E 2G 27 ;1 9•0T n Hsr, �p�p C � la•yTli,<,la �O �LXO / Jf P NB9'6o'r "a i�r9.µrr \�:ip lh» e� IA6°. 31+,eo MtM NBt'da 1r"a/ 6y. AL Avr PQ CARLA - L ST ' � I ' � cwa.deert J �IytP L A seN RMRAR R�.°I'LAC60 30 LoN� w NAbN6rILM0 RAiAKAI4,AY /A.R[, Si.T O, I' 6,G, R�.• NOrE I. L07' CorwaRs 5&-r rHis IURVEy AMff ,VP"X JkO"Ra/^R,