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Home My WebLink AboutSCHROEDER LT 88Boil 17 MUNICIPALITY OF ANCHORAGE Department Health and Envi.ronmenta� protection 825 L Street, Anchorage, AK. >J501 264-4720 Permit # `� ) `� # HANDWRITTEN PERMIT # # # WELL AN �E�tJER PERMIT � T�— n Applicant :OIL -e Mailing Address: Location: Phone Number: Legal Description: Lot Sizer Type of Soil Absorption System Is: Trench: Drainfield: _ Seepage Bed: _ Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: DEPTH LENGTH GRAVEL DEPTH � WIDTH �2 The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). REQUIRED SEPTIC(HOLDING) TANK SIZE _ GALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. ' * * * TWO(2) INSPECTIONS ARE REQUIRED # Backfilling of any system without final inspection and approval by this depa.rtmen1 will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feel for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may re uire enlargement if he residence is remodeled to include more thatj�edrooms. Signed: Issued b, __ Appl 1 Date: SWP/024(1/81) SIGNED� RPPLI�8NT� CINDY SIICA LER � ^�~~- ~-~�-�--~-~�~--�-- \o' ��-�: 3: L T.. it: -F " W, 11:11, �ic]:: 11 .. 1! �F:::ll 0, ::,*�� DEPHRTMENT OF HERLTH OND ENVIRONMENTRL PRFYI' E1:, -,:TION 825 'L' STREET/ ONCHORHGE' 8K 99501 264�4720 � ONCHOROGE 694~ LE F.',IYER ��J.'!— FD,��Vv��_� PERMIT 11C).8]10O0 O1PLJC8NT IND/// SIGL[::! PHONE]45~]216 RD�RE�S� SRH 8NCHORHGE/ 8OX 1414N HK 99507 LEGHL DESCRIPTI�N - SUDD�YISION NA LOT88B LOT SIZE 0 SQFT TOWNS�IP� - RHNGESECTION� � . ..... .....��.. � CE�TIFY THRT 1 I HM FOMIL �RR WITH THE REQUIREMENTS FOR ON SITE SEWERS HND WELLS HS SET F RTH BY Ti M-NICIPRLITY OF 8NCHORRGE OND THE STRT� O� RLRSKH 2' I WILL INS~8LL THE SYSTEM IN RCCORDRNCE WITH THE CODES AND HHVE RECEIVED RCOPY 8F THE �ODE SUMMHRY RND DIRGROM RTTHCHMENTS WHICH IS PRRT OF T�IS PERMIT �I �NDERSTOND THHT THE ON^SITE SEWER SYSTEM MRY REQUIRE [NL8RGEME�T �F THE RESID[NCE IE; � O I1'-�CLUDE MORE THRN 4 BEDROOM� 7�RMIT HPFLICONT HRS T! RE R[SPONSIBILITY TO INFORM PERSONNEL DURING THE I@STRLLRTIDN INSPECTIDNS OF RNY WELLO RDJ1910E1T TO THIS PROPERTY ANC., THE NUMD[R OF F!ESID[NC THHT THE ERVE. IF H LIFT STM ION IS INSTRLLED/ AN ELECTRICRL PERMIT AND INSPECTION MUST D[ ODTRINED OS~OUILTS CRNNOT DE RPPROYED WITHOUT HN ELECTRICOL INSPECTION REPORT. TH ELECIr, RIC8L WORK MUST BE DONE DY H LICENSED [EI ECTRICIHN. SIGNED� RPPLI�8NT� CINDY SIICA LER � ^�~~- ~-~�-�--~-~�~--�-- \o' RETURN TO: Division of Geological and yslcal Surveys (DGGS) 3001 Porcupine. Drive (Tele, .e: 277-6615) Anchorage, Alaska 99501 Drilling Company Name L OLFlTION OF WELL W A T E R W E L L Please complete either Is, Ib, or Ic R E C O R D -MU`111`I�LITY OP p^Cy..QpA w I No. — DEPT. OF HEaTHIRg.Permlt No. ENVIRONMENTAL PROTECrJhlQr• L • No. STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES Ia. Borough Subdivision jc,H2oE77�"32. Lot R ock 1b. Fraction / Section No. MA Township p 'I(I'Ra'nge 10� 11 1 EIW Nerid aan -�^ � Ic. Distance and D;rection From Road Intersec[ion5 Street Address and Area of Well Location _ �v ,.r, F �11�- cA�s iddT��ddd 2. WELL LOG Material Type Fee[ Below Surface 4. WELL DEPTH: (completed)ESorl`a7coElevation ft-� Date of Completion Top Bottom 5. ❑Cable tool ❑Rotary ❑Driven E] Dug ❑Auger ❑Jetted ❑Bored E] Other: --�--- _ 6. USE: ❑ Domestic ❑ Public Supply ❑ Industry ❑ Irrigation ❑ Recharge ❑ Commercial ❑Test Well ❑Other: 7, CASING: ❑ Threaded ❑Welded T- in. to __ft. Depth Weight _^Ibs/Ft. __in. to __Ft. Depth _—� ---,---�-----_�-111 8. FINISH OF WELL: Type:-e_��-_ Diameter: Slot/Mesh Size: _ Length: Set between ft. and ft. Fittings: '---- _ I 9. STATIC WATER LEVEL: ft. ❑Above ❑Below land surface Type of Measurement: -_-'�--^v-� — 10. PUMPING LEVEL below land surface �- ft. after hrs. pumping _ g,p.m. ft. after hrs. pumping g,p,m, —�_--� 11. WELL HEAD COMPLETION: ❑ In Approved Pit ❑ Pitless Adapter -_- inches above grade ---------- 12. GROUTING: Well Grouted: ❑ Yes ❑ No Material: E1Neat Cement ❑ Other: 13. PUMP: (If available) HP Length of Drop Pipe ft. capacity �s g.p, Type: ❑ Submersible ❑ it ec iproca t ing ❑ Jet ❑ Other: _ �� ------- 14. REMARKS: 15, WATER 14ELL CONTRACTOR'S CERTIFICATION: This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief: Registered Busne ss Name Lont rant License Num er Address: _Signed^�..�_ tar Date: -- Author, edLRepre5enta[ive - 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 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) 07- ?15 �.. Location (address or directions) (b) Applicant Name Zrr i [=/�,t �� Telephone: Home Applicant Address s (c) Applicant is (check one): Lending Institution E ; Owner/builder 0 ; Buyer E (4y CC�n�;�a.r..r /]r`i 11) PIC (d) Lending Institution Address (e) Real Estate Company and Agent Address __ Telephone (f) Mail the HAA to the following address: U df 91 1��6' - Ivo i Business Other (explain); 2. TYPE OF RESIDENCE Single -Family 11 Multi -Family EJ Other Number of Bedrooms 3. WATER SUPPLY Individual Well 1,_J/ Community 0 Public E 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 Ea Public Community E] Holding Tank 0 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 en) 5. ENGINEERING FIRM PROVIDnmG INSPECTIONS, TESTS, FILE SEARCH, UmTA AND INFORMATION 6. 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 !�i7S _Telephone Address i'-�-<-O f_ p'}' -� v� _ NCI f>��,�-rc t: - — Date ' �%— ®MEP APPROVAL �!(' Approved for �'. bedrooms by Approved __ I Disapprove Terms of Conditional Approval Conditional CAUTION Engineer's Seal �( OF 4� fl0 aa.1�„\ °n neono oos 4 p / ¶ r oo p o 3) •. / (In: Dale R Merrell No. .055.4 �'ev a o 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 (MOA/ or F)Lftrn t P ;i I iq HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 t� Legal Description: l �` G" �f. A. WELL DATA Well Classification /✓�)'/� If A, E3, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed �%— Yield Total Depth ��— Cased to Depth of/ Grouting Static Water Level — 6.9 Pump Set At Casing Height Above Ground 1 - Fr_ Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) �i_—_---- Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot On Adjoining Lots t To Nearest Edge of Absorption Field on Lot e-- ; On Adjoining Lots P) To Nearest Public Sewer Line , SL2 To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot 3�i Water Sample Collected by 0 `5. PqMS� ; Date A ?/� Water Sample Test Results L-_ Comments If _ —I _ /IL y� ��✓l� a : i �A,vFr r�,zn�rc moi. B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) Size Air -tight Caps (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 — To Property Line To Water Main/Service Line Course — Comments Page 1 of 2 72-026(11/84) No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped _ ;for Temporary Holding Ta)k-Permit (Y/N) To BuildirrfFoundation Field To Stream, Pond, Lake, or Major Drainage 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 D nage Course To Driveway, Parking Aret Comments D. LIFT STATION Date Installed Size in Gallons — "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Vehicle Storage Area Type of System Design — Length of Field Depth of Field — Gravel Bed Thickness Standpipes Present(Y/N) Date of Last Adequacy T — T roperty Line _ _ To Existing or Abandoned System on On Adjoining Lots To Cutbank (if present) Dimensions Manhole/Access (Y/N) "Pump Off" Le/vel —y en�V' t (Y/N) ** Ch-eck Permitted Bedroom Rating Against HAA Request'* Pumping Cycles during Adequacy Test. Meets MOA I certify that I have cheed, v rie , o conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date Company- - o?i MOA No. Receipt No. — 5 C) Date of Payment Amount: $ tV 9 n, 9 Page 2 of 2 "J 72-026 (11/84) c Dale R Merrell 4 No. 055-r ov F w FES51�N �a Location: BESSE, EPPS & POTTS � Gr P2220 EAST 88 AVENUE ANCHORAGE, AK 99507 (907) 349-6451 Dale . Me rell WATER WELL TEST O®+g J��'No. 2055 PRO FE SS10NP,d°+s Date: Subdivision: SCu V-0DL-W Lot: Block: Client's Name: Zoos PEAT -T �rcl<, � `-� Address: g-,/-5 9" Ale Ar1 -£s Tester: �)ret�IEz Initial Reading on Meter: -// 5-3t0� TIME GPM GALLONS 0 VOLUME GALLONS TOTAL VOLUME � `-� f� NOTES: Production Rate: Sys GPM 24 -Hour Capacity2L Gallons MUNICIPALITY. OF ANCHORAGE DIVISION Or GNVIRONMENTA.L HEAL;I_'ll DEPARTMENT OF HEALTH AND ENVI.RONML:N`1'AL PROTECTION 7 TIWAL'l'El AUTI30RI111Y APPROVAL CFI."PS"rICAT[' 1. generral_ Irforrnat ton 11pl�l. kation Date (a) Legal Description (include. lot, Location (address or directions) subdivision, section, tranship, range) ( b) Applicant. Nam., C',' ( cam✓ Sy_�w . y _ _[Y l )hor /6 _. Applicants Addzess (c) Applicant is (check one) ionding InSti.tUtion I -a O.rrex/bui.l.dNr � ; Buyer_ 7 Other_ 1 (explain) ; (d) l -ending Institution Address (e) Peal Estate Co, & Agent Address /`--- Te:lephor^ 2. Thr C isicbnc Single -Family} Ni mber. of P,-droonu 3. Water Su) 1 Individual Well Conrrro_znity r --j, Odlee (i7c scari.be)- le Note: If cramuni.t:y v-1,11 sy<',tc i, roust have wri.tter, ccnfi.rnkat.ion firm the State D3aparU—tent of Ery rorurnntal Conservat-Aon attestirig to t:'r;o legality and st ttils. Is the waill adequate for the r;t-rzil)er: of: tx;dxc-ms specified in this Hlv.l A. F>ewagG Disposal Onsite _-llabltr r :?j" Yee 4" (')crrq(urity I Hol.di.:.ci 'J arr I Is the vrastewater disposal system adequate for the ruwtxnr of b9drecnti9 �✓N).._ ...-------e-�_.. [Par I of 21 2-15-8/1 a. Engineerinq Firm >Providing Inspections, ^T'est:s,_ [ Ata and Information I certify tbaC Ir<lve checked, verified, or conformad to all MK)A IMA Guick l.inas in effect on,the, daQ/4g/Ahis' inspection. S 6. DFIEP Approval Approved for / r,' q FcdGINlaE4: MiJa) tA-'dt ocirn Approved. r Disappxro` "'d r Terms of Conditional Appz,oval. By c6ndit.ional The Municipality GY Anchorage: Department of Health and 1?nvi.rOrL(v)v:t_ A PraL-ect.ion c'.a_-,s not guarantee the continued satisfactory PA rfoem.3nce of th. water supi.>1y and/cr_ t:h';, wast9water disposal system, 'Ibis apPrOv'al indicates that, at-; of 01e Validation cra;tO shoran above;, based on the data and infc;rmation furnis=hed IV ari ergir.( cer_ egi.si:r;c d in tyre State of Alaska, the orstezr supply and wastewater disposal system is safe and ful-'e-- tional for the ruccLo.,c, of lxec coc;ma and type of structure indicated. (DHEP SEAL) . Mei i l the HAA to tho fo:l.la%,i r:cl addrre s ss KB2/d5/s (Page 2 of: 21 2-15-84 Address. Signed by Date 6. DFIEP Approval Approved for / r,' q FcdGINlaE4: MiJa) tA-'dt ocirn Approved. r Disappxro` "'d r Terms of Conditional Appz,oval. By c6ndit.ional The Municipality GY Anchorage: Department of Health and 1?nvi.rOrL(v)v:t_ A PraL-ect.ion c'.a_-,s not guarantee the continued satisfactory PA rfoem.3nce of th. water supi.>1y and/cr_ t:h';, wast9water disposal system, 'Ibis apPrOv'al indicates that, at-; of 01e Validation cra;tO shoran above;, based on the data and infc;rmation furnis=hed IV ari ergir.( cer_ egi.si:r;c d in tyre State of Alaska, the orstezr supply and wastewater disposal system is safe and ful-'e-- tional for the ruccLo.,c, of lxec coc;ma and type of structure indicated. (DHEP SEAL) . Mei i l the HAA to tho fo:l.la%,i r:cl addrre s ss KB2/d5/s (Page 2 of: 21 2-15-84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 t/l1MiGIPAIITY ur . _ p%P1, OF HEALTH & EN�IROtdN,EN'tA4 PROTECTION cyq Legal Description: 11 Well Classificatio If A, B, or C. D.E.C. Approved(Y/N) 0,�5 C Well Log Present ((Y/N) Date Completed rof Yield�— " r Total Depth �c� Cased to Z I tiGroutingP p- — Static Water Level. 92-1 Pump Set At Casing Height Above Ground % it Sanitary Seal on Casing(Y AMA r Electrical Wiring in Condui (Y Depression Around Wellhead (,Y ) Separation Distances from We / To Septic/Holding Tank on Lot /,4-J G /,- ; Or. To Nearest Edge of Absorption Field on Lot A1_1A. To Nearest Public Sewer Line 4,�O / To Cleanout/Manhole '70 Water Sample Collected Bye. '- Water Sample Test Results �G-"y� Comments oro 1 B. SEPTIC/HOLDING TANK DATA Date Installed Size To Near( vJA J Adjoining Lots—/L/ On Adjoining Lots�/� _ Nearest Public Sewer 11 Sewer Servi Li on Lot Date c�" �� No. of Compartments Standpipes (Y/N) Air -tight Caps (Y/N) Depression over Tank .(YM) Date Last Pumped Pumping/Maintenance Contract on F' e for Holding Tank High -Water Alarm ) Temporary Separation Distances from Sep `c/Ho di ank: To Water -Supply Wb ll ._ To Property Line To Water Main/Service Line Course Comments [Page 1 of 21 Foundation Cleanout (Y//N) Holding Tank Permit .(YIN) To Building Foundation _ To Disposal Field To Stream, Pond, Lake, cr Major Drainage 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Type of System Design Length of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area i Standpipes Present LY/N) Depression over Field (YM) Date o Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well T Property Line To Building Foundation _ D Existing or Abandoned System on Lot ; On Adjoining Lots �e To Water Main/Service Line To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments --- -� D, LIFT STATION — J Date Installed^ Dimensions Size in Gallons nhole/Access (YM) "Pump On" Level at EPump Off" Level at High Water Alarm Level at Vent (YM) Tested for R6ing Cycles during Adequacy 'lest. gets MOA Electrical Codes(Y/N)�� Comments �-- *i` Check Per tte Bedroom Rating Against HAA Request ** I certify//that I ch ked, verified, or conformed to all MOA HPC4tidelas in effect on the date of ction. Signe i Com% Dated Compy st v traiFis=4'ti�� MOAN E. I_daF4A-1 1•+RIVER, A%.F6SK KBl /d5/S 4 x>ta,�a .�..�a •, 4 ,�, ---------- (Page (Page 2 of 21 2-15-84 P L /AV S Heil. SHEFFIELD, GOVERNOR DEPT. OF ENIVNBONMl#:N'A AL CONS :RVAIrION Telephone: (.907) 274-2533 FACILITIES CONSTRUCTION & OPERATION Address:437 E Street Suite 2.00 Anchorage, AK 99501 Mr. Robert A., Shafer, P.E. SRB 196X Eagle River, Alaska 99577 RE: Separation Waivers Lots 88A, 888 and 88C, Firelake Interceptor, Dear Mr. Shafer: May 18, 1984 Schroeder Subdivision Phase II1, 581--1., Project: No. 12718 Thank you foryour letter, of May 18, 1984 in response to my letter to you on April 16, 1984 concerning the referenced request. The letter suppl.ements the data which you provided in your original request of April 8, 1984 and answered our concerns raised during the review. Those concerns have been adequately addressed and/or corrected (specifically waterproofing rnkinholes FL ... 15 and FL -16) and the waivers are hereby granted. This letter amends my letter of October 4, 1982 to (now) include the existing wells located on Lots 88A, 88B, 88C, Schroeder, Subdivision. Sinccee1y, Z1,4 Gregg age Construction Grants Engineer ,x �:�/ \,�� .1 Zil � 0 A