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HomeMy WebLinkAboutSHANE LEE ESTATES BLK 1 LT 42 ,,, RLL 04,4v..) +4 O l I Ail r� r� ~ '' C_ I". -L- I CP F:_ F=g P-4 f �FA 9.-,�� DEPARTMENT UF HEALTH AND ENVIRQNMENTHL r'ROTECTION 825 'L' STREET, HNCHORHGE, RK. 99501 279-2511 9 ., I L -U-. F-4 E-_ 1-1]["Y~ PERMIT NO. ( 77180 ) APPLICANT EDWIN RINNER 8]10 WEL,LSLEY CT ]44-41]1 LOCATION LE( -JAL L4 Bi LOT SIZE 8000 SQUARE FEET MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS �00 FEET FOR H PRIVHTE WELL OR 200 FEET FOR H PUBLIC WELL WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ]0 DAYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTHL�HTION. I CERTIFY THAT 1� I HM FHMILIHR WITH THE REQUI�EMENTS FOR ON�SITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INS HE SYSTEM IN ACCORDANCE WITH THE CODES SIGNED:��._-�~���_�____����.�__�__.�-~_���~~~�~~~ APPLICANT EDWIN RINNER � -2- �^'� ��� �f_�~'� `em, provide status of syst ALAI...., 5. ,STATEMENT OF INSPECTION BY ENGINEER _ r As certified by my seal'affixed hereto and as of the validation date shown below, l verify that my . investigation of this Health Authority Approval'application 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 furtherverify that based on the information obtained from . the Municipality of Anchorage files and from my investi!c ation 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 & S ENGINEERING Phone 6 4J 17034 Frogle River Loop Ra Address ca ie klv r, Alaska 99 77 Engineer's signature Date =� ` zy ! g S� OF 4 k S I j I-. ` RO$ERT C COWAN t 6a t� ce aso► -, r,: R9fESS17� r 6 r t DHHS SIGNATURE < i J. za Approved for r bedrooms t4 ,u §5r z ? t t4 iei� - r }t�-�Y! :1 a ti•1 i I + i '.-gkS1Yt.4.lt a.T± i v�.2k� r7> � �v v4Z k i !i Ir 5 t 35y r r ,3j .j t+,E 3 t ) 1 41 liU'3.F i { I ii ylY 3 llu:ST Dsappoved hn MURK - ';''.Conditional ?approval rfor, ' ` "' ?ll,bedrooms" withi the following"strpulatrons F, { II r I.'app ai ' ra r .. -•n ;--},..,r N,'>pYa xet! }. k1tl, ,,.5, .� _ :.,g rIT z• r, $ ,'a ,1 ,1".!+hJ F'Yt „7.e.r rK.. r, r. 18 .9.F .r ', f ;u .r F t -a 'T �a•� -:r I L� a ,,�''4 r� tai f a r � r 'Tna. r,S,r * y.f x' a..r � d A: a— .r '- 3 Jx- t "F -., •s k5F:1 k S(t s +i� ., + _r s. i F S �' i a r i. n _�rcr r T�'tjS+f•+Yi �dx'vifi'T -fit f.11 'Sii` {i j! • 4 31'. f d (I A' - i � :t f,J1t1A.Y9a17'.1 ��..)"s : ... En� `Y za + ✓, Ti -o i�rt l-r�. L{�� zT J r. 0 - �,� j{ Additional `Comments w'" 21 " r ` 1 By Date 7 � e The Municipality of Anchorage'Department of Health and Human, Serv)ces'(DHHS)r issues Health Authont ;.Approval 'Cert)flbates based only upon the representations given, in paragraph 5'above by'an )ndepender professionalengrneerregisteredintheStateofAlaska TheDHHSdoesthrsasacourtesytopurchasersofhome and their fending )nstitutions in order to satisfy certain federal and state requirements `Employees of DHHSrdo nc conduct inspections or, analyze data before a `certificate'is issued The: Mun)c)pality of Anchorage.. )s;nc tt responsible for errors or omissions in the professional engineer's work `T I ` I `« s I, 12-025IRa 1rB1) Back+ MOA#21 w. 1 , [II��VJ.�k�T.i;'•�n ��s; serif i1mS,r. ::1e �., , ,1 l..;.J I = .e,.,kr�a,�;r95. r'•17{:,T i`�'..w.� 'e�1'.dt9'�i�a N � Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: L-0 3- Y Q i tc / S/fANt 2 1;,� P-5 7 • Parcel I.D.: A. WELL DATA Well type P/t v'4t Log present ((`S,%' N) Total depth Sanitary seal ON Date of test If A, B, or C, attach ADEC letter. ADEC water system number );a to rn Y,=_ S Date completed 16:4 ry (D 0 Cased to 24 D } Casing height (above ground) t V ­ft so W Y'� S A -TI Zn Wires properly protected 6)N) %� FROM WELL LOG it // �-/ -77 Static water level i c t_i a 64,3 L£ Well production i S g.p.m. _ -1t AfJ-.e,�)'_*a 1Y &,"r WATER SAMPLE RESULTS: Coliform O Nitrate 0.1 AT IINSPECCTION C►(zY</9S- a s' g.p.m. Other bacteria 0 Date of sample; `L l t `1 (tel S Collected by: S & S ENGINEERING 17034 Eagle River hoop Read No. 204, B. SEPTIC/fffOJ DI1NQ TANK -DATA ole [aver, Alaska 99517 Date installed Tank size Foundation cleanout (Y/N) Date of Pumping Pumper C ABSORPTION FIELD•DATA Number of Compartments anouts (Y/N) Depression (Y/I� High er alarm (Y/N) Date installed k Length Width Effective absorption area Date of adequacy test Somg UK - or ft2/bdrm) System type 00el thickness below pipe Monitoring Tube present(Y/N) Results (Pass/Fail) Fluid depth inalfsorption field before test (in.) (ins.) Minutes later: Total depth Depression over field (Y/N) For bedrooms Immediately after gal. water added (in.): Absorption rate = Peroxide treatment (past 12 months) (YIN) If yes, give date , p.d. D. LIFT STATION Date installed Manhole/Access (YIN) _ High water alarm level at* E. SEPARATION DISTANCES Size in *Datum at* "Pump off' level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot N 14 : On adjacent lots Absorption field on lot N A : On adjacent lots i Public sewer main Public sewer manhole/cleanout tV / H A/ 1A 9 '7 r i Sewer /septic service line a 1 Lift station T✓ �q wEL, -- y,n 5-£wE,2 ioYS7f1LLFc,(J P4io% TD /983, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Water main/service line Surface SEPARATION DISTANCE FROM ABSQ Building foundation Surface water Absorption TO: Water ntan/service line Driveway. parking/vehicle storage area lots Curta'67un Wells on adjacent lots Property line F. ENGINEER'S CERTIFICATION 1 certify that I have determined thru.field inspections and review of Municipal recordsa*v v ai in conformance with A,10 1L4A guideline )z effect on this date. Signature Engineer's Name ¢ Cd wA/✓ �r itee : tg deal• ro•. •..9 Date 9 /a Y( ``I' S— HAA Fee $ rQd c� -- Waiver Fee $ Date of Payment /9 ` 7��tt,,J Date of Payment Receipt Number / 3 3 �✓ Receipt Number Rev. 8/95 OSS: haa.wk.doc -A ` RO11kT C. COWAN Io- CE -8801 '��' S. Allowable zxt. Anal parameter ReflUlta Qual ME Environmental Services Inc. Date Init "" ----""""-- .-------------------------------------------------------------------------- liltraes•N 0.10 U Laboratory Division "--'-----------"""'"" 30. 09/20/95 CN:2 T&E Rot,# 9S.4096-1 Laboratory Analysis Report .-."rix WATER ^Bent Sample ID L4 BLK1 BHA= LEE BST `Li_6nG Name 5 & 8 ENGINEERING WORK Order 18157 Mrd©red By R. COWAN Printed Date 09/22/95 0) 14:37 hra. roject Name Collected Date 09/19/95 @ 13:30 hrs. , oject* Received Date 09/19/95 ® 14:00 hra. Bl3YD UA Technical Director STEPHEN C. EDE Released ,inpls Reimrks: SAMPLE COLLECTED BY: BOB C. QC Allowable zxt. Anal parameter ReflUlta Qual Unita Me Chod Limits Date Date Init "" ----""""-- .-------------------------------------------------------------------------- liltraes•N 0.10 U mg/L EPA 353.2 "--'-----------"""'"" 30. 09/20/95 CN:2 r�- •�-; ..._..n........a,.maaan..azamzanaannannzzzmmazaaananaxzcnzmmszzzaazaazcmxxsamamn.amnnsmanman.nmmmaasammm.maaannnnanvme.mnna See Special inatxuatlons Above UA n Unavailable Aee sample Aama rka Abova NA. m Not Analy2Ad uhllocAgud, Reported VAlUA ie Cha practical quantification limit, LT W Add Than SeeondaKy d11ue1on. =t� GT Greater Than 200 W. Potter Drive,_A_nchor_Age, AK 99518-1605 -- Tel (907► 5`0-2343 Fax: (907) 561-5301 a ENVIRONMENTAL FACIOTIES IN ALASKA, CALIFORNIA. FLORIDA, ILLINOIS. MARYLAND MICNiGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA lei GZS'ON iTZTb69L06 9NI1WW0o OZ:ST 96/EE/60 r� MUNICIPALITY OF ANCHORAGr� DEPARTk,,'r OF HEALTH AND ENVIRONMEK ,L PROTECT 00 !� ti 825 L Street, AnchoraaP. Alaska 9950 264-4720 Date Received: January 19, 1978 #1: Time #2: Time #3: Time Date Date Date Inspi�nc, sX�l, Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Arctic First Federal Savings Mailing Address: 701 West 4th Avenue 99501 Phone: 278-9541 2. Property Owner: Mailing Address: Raymond D. Medeiros 4021 East 65th 99507 Phone: 344-7329 3. Legal Description: Lot 4 Block 1 Shane Lee Estates Subdivision 4: Single Family Residence: (x) Multiple Family Residence: ( ) Number of Bedrooms: Three Number of Bedrooms: 5. Well System: individual Well (x) Community/Public System ( ) Permit # `'jjgC) Depth of Well 60' Well Log on File (x) Construction D040,_ CA Bacterial Analysis YI�Lo�2 c�nr 6. Sewage Disposal System: On-site System ( ) Public Utility (x) Permit # Installed Installer Septic Tank Size Manufacturer Absorption Area Soils Rate Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line Page `ro Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 4 Block 1 Shane Lee Estates Subdivision Comments: Affadavit Attached ) Letter Attached: ( ) Approved: c Date: -7e Disapproved: Date: Department Worksheet: ' s' EdL-086 -�0 ELg1 : Od0 > i (eplr ,eyTo eal 11dW 1VNOI1UNH31NI Vol !ON —0301AOdd 30MA03 33NVHOSNI ON 008£ IL61 •idy �0$ — 111 •....�1be ae�__AH3All30wiod .7��eixe) Sd y pSE 1V103dS _ AWO 33553840=AI730 AluO aassaipp 01 Alam r�SE " - ai a pa�an4aP aJa4M Pue a e I P 41!M AIUQ aassaiI P 'wo4,x 01 SM04S •L' S391A83S PST ........... PPe 01 Al .� Al a -- _ pa e I aP 04, Pu_lu0! P 4,!M 1,113338 S33d 1UN01110S *1 NUIF1138 0V 80,1 4S331A83S4WIN yp I � I fAl 3009 d1Z ONV 31tl1S "0'd +I SON 31VO 80 ONV 13 XMISOd (ate;sod snld) yJoe—'11VW 011N3S ------------------- V 031d11?130 80:1 1d13038 — MUNICIPALITY OF ANCHORAGE Department of Health and Environmental Protection �® 825 L Street, Anchorage, Alaska 99501 264-4720 j i - equest for Approval of Individual Sewer and Water Facilities 1. Property Owner: !e ON b D, M F_ Mailing Address: '1od l E /9Si &s- -r/./ APic l %%Scj7 Phone: 3 41q, 73 d- 2. 2. Name of Buyer: A f` F_ Mailing Address: Phone: 3. Lending Institution: /9 X c T! C F i 6 5 T I i b F fl n L Mailing Address: �6( W is S T FoUflTN 4ry c.lj- 99So/ Phone: L�DV5 �/ 5! 4 . Realtor/Agent : D I N /y Mailing Address: g 3 J 0 `A% k LL 5 t_Ey (,7, Phone: 5. Legal Description: �ri3aUle Lei GSr /�PQS Bldckl J G�f z1 Street Location: Tffo),l/ Tyrace o! 1 5&srt WLIL 4 4OKe 611s 6. Single Family Residence: Number of Bedrooms: 3 Multiple Family Residence:'\( ) Number of Bedrooms: 7. Water Supply: *Individual Well Public/Community System ( ) i If Individual Well, well depth 0 If Community System, name of system 8. Sewage Disposal System: 'On-site System ( ) Public System k If On-site System, date of installation: *NOTE: A well log is required on ALL wells drilled since 6/75. **If on-site sewer system,is over two(2) years old, an adequacy test is required by this department. A £c c o P q25_00 mus t a c c omPan Y e a ch r e du c st b a£ o z a pro e e s s i n g can be initiated. 3/77