HomeMy WebLinkAboutSHANE LEE ESTATES BLK 1 LT 13PL�V)nLc\
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DEPARTI.IENT !-DF- HEALTH AND ENVIRONMENTAL F'f?:TEC T I O N
25 -"L-" STREET, ANCHORAGE: AK. 99501
279-2511
PERMIT NO. 77189
APPL I CA14T EDWIN R I NNER 8 310 WELL. LEY CT44—-1:-: 1_
LOC:AT I ON
LEGAL L.12,' B:1_ SHANE LEE ESTATES 1_01' SIZE 8000 SQUARE FEET
MINIMUM DISTANCE BETWEEN A WELL. AND ANY ON-SITE SEWAGE DISPOSAL S STEM IS
'LOO FEEL- FOR H PRIVATE WELL OR 200 FEET FOR A PUBLIC= WEL_L..
WELL LOOS ARE i EQUII=:ED AND MUST BE RETURNED I -C) THE DEPARTMENT WITHIN '3-0 DANS
OF THE WELL C:OfeiPL.ETION.
`rtPEC I F I CA"r I ovis AND C:OP•dSTRUCITIC -4 DIAGRAMS GRAMS ARE AVAIL -ABLE TO INSURE PROPER
I NSTALLAT I ON.
1 CERTIFY THAT
is I AM FAMIILIAR WITH THE. REi_!f.JIREMENT= FOR ON-SITE SEWERS AND WELLS AS `=ET
FORTH BY THE 11UN I C I PAL I TY OF ANCHORAGE:.
I WILL I N'l1 iLL. THE SY STE'f' I itK ACC:LDRDANCE WITH 'THE CODES.
Ei)
APPLICANT EDWIN RIP•NER
ISSUED BY-(
Ang to the legality and status of sys
OF WASTEWATER DISPOSAL:
to the legality and status of sy:
_ t
Dayphone`
n confirmation from State
4, -1
MUNICIPALITY OFANCHORAGETy- ......
DEP
ARTMENT OF HEALTH & HUMAN SERVICES,,',
JJ,
Division of Environmental ervices,-'�.,z . . ...
7
- Services Section.'...-,
Anchoragd,'Alasidio
P.O. Bo)C196650 95
343-4'744'
�;
—CERTIFICATE OF HEALTH AUTHORITY,,,.
APPROVAL FORA SINGLE FAMILY DWELLING
6 HA.44
0 F'14 0 6
M
status of syge
5. STATEMENT OF INSPECTION BY ENGINEER:�,,:?,%
As certified by my seal affixed, I hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/orwast I ewaterd . ispo I s . at . system . I i I s safe, fu " ncti , on , a I ' and adequate for the number of bedrooms
and type of structure indicated herein. I furtheryerify that based on the information obtained from
the Municipality of Anchorage files and from . my invest!qatlon.and inspection, the on-site water
supply and/or wastewaterdisposal system is. -In compliance , lianc6 I with all Municipal .and
.. State codes,
ordinances, and regu lations in effect on the date of this inspection.
,58,5,: .. _.- ,.
ENGINEERING Phone cl 4 --,-q 79
Name of Firm.
17034 ag1w—U;Wk�"No. 204
Address Ea le River la 995"
-Z,. 3 9 S_
Date
Engineer's signature
RAE OF Au
ROBERT
COWAN,,'�
C 41
�CE-8801[-
feCK:7� ;I A. ..... . e3
. . . . . . . . . .
6. -DHHS SIGNATURE
bedroomV,�t��,_
..Approved" jor�.-,A,'
isapprovi
'fo
14 bedrooms,qwith'4 th&.,
v
,--conditicinaL. appro aV tor.,
f"W-1
V
4
HIRE=
�Th
for errors i
Back MOA W
f�j
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825"L" Street, Room 502 a Anchorage, Alaska 995010 (907) 343-4744
Health Authority Approval Checklist
Legal Description: L0 7- J3 I3 L oC / Parcel I.D.: 0 1 1% - 0 G / - 6 0la fi �
0
A. WELL DATA
Well type i0A tVAT L If A, B, or C, attach ADEC letter. ADEC water system number �n p
Log present &N) Y s Date completed a/ a 3/-7 o m
Total depth 4 Cased to q 0 Casing height (above ground) 1
Sanitary seal &N) YC 5
Date of test
Static water level
FROM WELL LOG
a/a.3 J7g
Well production g.p.m.
-#- 1 y P"M/3 4- PL�Malr G
WATER SAMPLE RESULTS:
Coliform O Nitrate 0.1
Date of sample: 9 / S .1 S-
B.
B. SEPTIC/HOLDING TANK DATA
Date installed Tank size _
Foundation cleanout (Y/N)
Wires properly protected &N) y
AT INSPECTION
(4 /0)s -
i
as
Ll, + g.p.m.
Other bacteria O
Collected by: S 8 S EN..INEERINO
17034 Eagle River Loop Road No. 264
Eagle River, Alaska 99577
Number of Compartments CI outs (YIN)
Depression (Y/N) High wa oKalarm (Y/1)
Date of Pumping :inper n
C. ABSORPTION FIELD DATA I
S
Date installed l r in (g.p. or ftZ/bdrm) System type
Length Width rayel(thr� ess below pipe Total depth
Effective absorption area Mortitd Tube present(Y/N) Depression over field (Y/N)
Date of adequacy test Results (Pass/Fail) For bedrooms
Fluid depth in arption field before test (in.), Immediately after gal. water added (in.):
Fluid d t (ins.) Minutes later: Absorption rate = g.p.d.
eroxide treatment (past 12 months) (Y/N) If yes give date,
3!'-'i 4Y�ipal 1 r i '-
D. LIFT STATION
Date installed Size in gallons
Manhole/Access (Y/N) "Pimp on' level
High water alarm level at* *Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot N / A ; On adjacent lots
Absorption field on lot A/ / On adjacent lots
"Pump off' level at*
Public sewer main 100 d- Public sewer manhole/cleanout
Sewer /septic service line S /-1- Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation
Water main/scrvice line
SEPARATION DISTANCE
Building
line
Surface �vatc I'd age u JZWclls on adjacent lots
i1� ORPTION FIEL� ON LOT TO:
v r�t C—
Water main/service line
Surface . er Driveway, parking/vehicle storage area
urtarn drain Wells on adjacent lots Property line
F. ENGINEER'S CERTIFICATIONOF ,q
I certthat 1 have determined thru field inspections and review of Municipal records t `
above v
�
certify ✓r�'
in con%rmance with NIA AA uideh s in effect on this date. / �'%
Signature--�?r�'�{—/ J w r� /�.ni.. a•r r.. «„rn1 �n
Engineer's Name 9006•Q �. �owf} ✓ tdtA@EigT a4�I>rtN
CE .8801 %
Date d 3 l S` ft l^,; ., ;:� AN
tib r��,`�_.,1;•,,,,+go
-------------------------
HAA
-----------------------
HAA Fee $ 3 m r " Waiver Fee $ _
c, /
Date of Payment '02 S �[ S Date of Payment
Receipt Number r/ Receipt Number
Rev. 8/95 OSS: haa.wk.doc
AILCME Environmental Services Inc.
::,&r Rat,#
95.4043-5
Allowable Ext.
_cix
WATER
Reaulta Qual
Unite Method
nt 89mple
ID LOT 13 SLK I SHANE LEE ESTATES
_—----------- '------------
'..trace -W'
'-------------------
0.10 U
:,.i nt Name
8 & S ENGINS.'ERING
WORK order
18067
9y
H- 420WAN
Printed Date
09/20/95 * 11:27 hra.
'c�red
rrolaat Name
Collected Date
09/15/95 ® 08:30 hre.
oJect#
Received Date
09/15/95 a 16:40 hra.
—'s "D
UA
Technical Director
STEPHEN C. EDL
Releaked B}/„",�i�J-.�
d..�_:a„;
mole Remarka: SAMPLE COLLECTED BY: BOH C
na..na.an......n......w*.ww...........=na=.mca..ex.........r.w...+rr...................=..:o..-e...mv-.
See Special Inatruc1JQna Above UA . Unavailable
- H®e Hampla Ra ma rka NA . Not Analyzed
Under 0001 ROporW V41UC 10 JT - I.aaa Than
secondary dilution. GT . greater Than
96b 'ONr<.
iiZtG69L06 f 9NI1S31 �d°IOa3WW0O 9ZzI 96i02i60
QC
Allowable Ext.
Anal
i`=:rameter
Reaulta Qual
Unite Method
Limito Data
Date Init
_—----------- '------------
'..trace -W'
'-------------------
0.10 U
I---- .......................
mg/L LPA 353.2
10.
09/18/95 CpIR
na..na.an......n......w*.ww...........=na=.mca..ex.........r.w...+rr...................=..:o..-e...mv-.
See Special Inatruc1JQna Above UA . Unavailable
- H®e Hampla Ra ma rka NA . Not Analyzed
Under 0001 ROporW V41UC 10 JT - I.aaa Than
secondary dilution. GT . greater Than
96b 'ONr<.
iiZtG69L06 f 9NI1S31 �d°IOa3WW0O 9ZzI 96i02i60
MUNICIPALITY OF ANCHORAGE��
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROV
OF ON-SITE SEWER AND WATER FACILITY
264-4744 uu
Application Date Aptit 29, 1988
1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 13; Mock 1; Shane Lee E3tatea
Location (address or directions)
6600 Ti44any Texnace
(b) Property Owner HUD Telephone: Home
Mailing Address #111-02-4413-203
(c) Lending Institution Telephone.
KA..❑f..— AriArr.nn _..
(d) Real Estate Company and Agent MARSTON PROPERTIES/Ed To.22ey
Address 4105 Tuxnagain Boutevand, Anchotage, A.2aska 99517
Telephone 248-1717 Ext. 71
(e) Mail the HAA to the following address: or: Check here IN, if hold for pick up.
List contact person and day phone number below.
S 9 S ENGINEERING
17034 Eagte Riven Loop Road, Suite 204
Eagle Riven, Atka 99577
2. TYPE OF RESIDENCE
Single -Family Q
Number of Bedrooms 4
Business
ondened by Ed-ToUey
3. WATER SUPPLY
Individual Well b 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 ❑ Publicx 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 (Rev 61861 Front
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 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 5 & 5 ENGINEERING Telephone ���Z�2
17034 Eagle River Loop 110ad NO. 304—
Address Alaska 99577
Date
-4
. °............
s,r.. ..
atV-
6. DHHS APPROVAL
Approved for bedrooms
PP b v ���� Y Date
Approved Disapproved Conditional
Terms of Conditional Approval
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
certificates based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as.a courtesy to purchasers of homes and their lending institutions in
order to satisfy certain federal and state requirements. Employees of DHHS 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 72-0251Rev 8/86) Back
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES fQIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
{ 1ya CHECKLIST - FEBRUARY 1984
264-4744
LegaT-"es5cri ion, &_/
eS
A. WELL DATA
Well Classification ���CJ� If A, B, C, D.E.C. Approved (Y/N)
Well L ,
og Presen (Y N) Date Completed �/ Z g — Yield
/ r
Total Depth �-���Cased to Depth of Grouting
Static Water Level Z 3 Pump Set At 6 !
Casing Height Above Ground ZZ Sanitary Seal on Casin (Y N) % 1
Electrical Wiring in ConduO(Y/
)Depression Around Wellhead (y/N) /
Separation Distances from Well:
To Septic/Holding Tank on Lot �F ; On Adjoining Lots °u_ 2_
To Nearest Edge of Absorption Field o ���F ; On Adjoining Lots N F
To Nearest Public Sewer Line Z To Nearest Public Sewer r
Cleanout/Manhole /Z S To Nearest Sewer Service Line on I,o Z
Water Sample Collected by S� s���12Ke✓�%? 9 ; Date
Water Sample Test ResultsS/Tl�P/�C `�'F'!�l/T6�fi7
Comments
B. SEPTIC/HOLDING TANK DATA
Standpipes
Depression over
Size
Air -tight Caps (Y/N)
Pumping/Maintenance Contract ile (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 Li
Course
Comm s
Page 1 of 2
72-026 (Rev. 8/86) Front
L/ C��2
No. of Compartments
Foundation Cleanout (Y/N) -
Date Last Pumped
;for_
Temporary Holding Tank Permit (Y/N)
To Bl%�cj Foundation
To Disposal
To Stream --Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
Soils Rati 19
in Absorption Strata
Date Install
Width of Field
Square Feet of Absorption�Aa
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 I
To Stream/Pond/L /or Major Drainage Course _
To Driveway arking Area, or Vehicle Storage Area
Com
D. LIFT STATION
Date I
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N) _
Comments
— Type of System Design
Length of Field
— Depth of Field
I Bed Thickness
Standpipes Pres
�nt'(Y/N)
acy Test
Property Line
To Existing or Abandoned System on
On Adjoining Lots
To Cutbank (if
mensions
hole/Access (Y/N)
'ff'I,ev�at
Pumping Cycles durin Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request *"
I certify that I have checked, verified, or conformed to all MOA and AA guidelines in effect on the date of this inspection.
SigncoS ENGINEERING Z
Road No. ate
Comgegte River, Alaska 99577 MOA No.
Receipt No. �
Date of Payment p; i R
Amount: $
65� 0 3 .,...,....,..,,.� -.
4�k+ DMrA
F
Page 2 of 2
72-026 (Rev 8/86) Back
CkIMM & arwaaw L aoyrowa oFALAsxa, INC.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343
\ FEDERAL TAX ID # 92-0040440
Client Sample ID:L 13, B 1,
PWSID :UA
Collected APR 29 88 @
Received APR 29 88 @ 18:00
Preserved with :NONE
ANALYSIS REPORT BY SAMPLE for Work Order # 6405
Date Report Printed: MAY 3 88 @ 13:07
SHANE LEE Client Name S & S ENGINEERING
Client Acct SNSENGP
his. P.O.# NONE REC D
hrs. Req #
Ordered By
Analysis Completed :MAY 2 88
Laboratory Supervisor :DANIEL J. BACON
Released By
Special
Instruct:
Chemlab Ref #: 9880 Lab Smpl ID: 1 Matrix: Water
Parameter Tested
NITRATE -N
Sample ROUTINE SAMPLE.
Remarks:
Result/Units
-----------------------------
ND(0.10) mg/l
Send Reports to:
1)S & S ENGINEERING
2)
Allowable
Method Limits
--------------------------------
EPA 353.2 10
1 Tests Pexformed See Special Instructions Above UA=Unavailable
ND= None Detected '° See Sample Remarks Above
NA= Not Analyzed LNUH Than, GT°GIWE Than
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information
(a) Legal Description (include lot, block,
IApplication Date CSIB 4
ion, section, township, range)
Location (address or directions)
(o LOO T Au' 7—� s��< Cd' Cop Crl%
(b) Applicants Name=ipgv��LocC<w���� Telephone - Home�?f33�3yBusiness
.y.pplicants Address
('e),App licant,is (check one) Lending Institution ; Owner/builder ;
luy,.er , Other pM (explain); 2e-
1.11
(d)=,Lending Institution Telephone
Address J
(e) Real Estate Co. & Agent �_n
Address
Telephone
(f) Mail the HAA to the following address:
I
?.. Type of Residence
Single -Family Multi -Family Other (describe)
Number of Bedrooms 2
I
3. Water Supply
Individual Well Community E=j 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 F2zl Community Holding Tank
Noce: iP eommuaitr waif 57s =, must have written coraf irmacion from the State
Department of Environmental Conservation attesting to the legality and status.
[Page. 1 of 2]
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
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 f1les 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 regula-
tions in effect on the date of this inspection.
Name of Firm gC�/� syr /r�Pr,�w .u� Q 1�"/� �£�rec�.0 TelephoneL� --S?J-�/()_
Address
Date q -S--eq
6. DHEP Approval
Act
4 lL
(ENGINEER SEAL)
Approved for bedrooms
Approved \ Disapproved
Terms of Conditional Approval
By
CAUTION
Conditional
Date
sa.ces.ss s%•q_69'�p
a9 s.
sseincuF"e. w 8 �
ey C. Rohl, V. w;
Na 2259.9 .. [,�so
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINiEER 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 REQUIRE-
MENTS. EMPLDYEES 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.
(DHEP SEAL)
R4/ej/D18
age 2 of 2] 7-19-84
MONIGIPALITY OF ANCHORNc,
DEPT. OF HEALT:I &
ENVIRONMENTAL P" ON
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA) '� 8
CHECKLIST - FEBRUARY 1984 f� p 1.
E !' E I V E
Legal Description:
A. WELL DATA
Well Classification P& 0 If A, B. or C, D.E.C. Approved(Y/N) ��i�
Well Log Present (jA�) Date Completed oZ/78 Yield
Total Depth o4 Cased to (g<%� Depth of Grouting
Static Water Level 0 Pump Set Atj%.
Casing Height Above Ground 0.7 ` Sanitary Seal on Casing /N)
Electrical Wiring in Conduit f`N) Depression Around Wellhead (Y
Separation Distances from Well:
To Septic/Holding Tank on Lot �`/} On Adjoining Lots 4A -
To Nearest Edge of Absorption Field on Lot on On Adjoining Lots
To Nearest Public Sewer Line ���'7°r ---Tn Nearest Public Sewer
_i _
Cleanout/Manhole
Water Sample Collected By
Water Sample Test Results
CcmTents (i)nec,� Wivl'w u
Line on Lot
/�cF G/-1 it 4 -.
alI
71;
N °
B. SEPTIC HOLDING TANK DATA ty �(%�"� l
46:X
u ,
Date Installed Size No. of Compartments
�A
W_
/%
Standpipes (YM) '��� Air -tight Caps (YM) 1� Foundation Cleanout (Y/N)
Depression over Tank (Y/N)�11lI� Date Last Pumped L
//
Pumping/Maintenanoe Contract on File (YM).. 4,A—; for "A -
Holding Tank High -Water Alarm (Y/N) PJA_ Temporary Holding Tank
Permit (YM)
Separation Distances from Septic/Holding Tank:
I
To Water -Supply TAbIl qA- To Building Foundation q
To Property Line O(A- To Disposal Field AJI14-
To Water Main/Service Line Of A- To Stream, Pond, Lake, cr
Major Drainage
Course 1JIia-
r
Com nt's 9-
s
Date Paid! ktf
'Y
A Amount:
[Page 1 of 2]
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata t'l%f- _ Type of System Design &(A_
Date Installed N(A _ Length of Field JkA
Width of FieldDepth of Field Vii. {>
Gravel Bed Thickness t _
Square Feet of Absorption Area 0 A- Standpipes Present (Y/N) %¢
Depression over Field (Y/N) A -J Date of Last Adequacy Test
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water -Supply 4\bll To Property Line 41/1'a
To Building Foundation r�r[i To Existing or Abandoned System cn
Lot_ ov(�7_ _; On Adjoining Lots 'L)(A
To Water Main/Service Line To Cutbank(if present) 4)1
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
CommentsS-ew
D. LIFT STATION
Date Installed PLA::: Dimensions &' &
Size in Gallons IA�11Manhole/Access (Y/N) W -(A--
"Pump On" Level at ! I A"Pump Off" Level at _ _
High Water Alarm Level at ��Lt Vent (Y/N) PU
Tested for A_�)(k_ Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes(Y/N) %U(ej
Co=ents P&-h)ic S&w E0
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conforrred to all MOA HAA Guidelines in effect
on the date of this inspection.
Signed—Date 9/` h/
Company • MOA No.
KB1/d5/s
[Page 2 of 21
15-84
ALASKA �i lUIROWnTAL COnTROL SEROUS, InC.
Engineering & 6nuironmental Studies
September 5, 1984
Department of Health and
Environmental Protection
825 L Street
Anchorage, Alaska 99503
Attention: Keith Bandt'
Subject: Shane Lee Estates Subdivision, Block 1, Lot 13
Dear Mr. Bandt:
On August 30, 1984, this office performed the flow test on the subject
property's well. The static water level was 25.95 feet. Maximum
drawdown was 37.58 feet, which occurred during the first 30 minutes of
the test and maintained at this level throughout the pump on period of
the test. The flow rate averaged 4.9 gpm. Within the first 30 minutes
of recovery the well had regained approximately 5 feet. Estimated time
for total recovery (from maximum drawdown level) is 70 minutes.
If this office can be of further assistance, please contact us 561-5040.
Sincerely,
1o1�
Larry Montgomery
Engineering Technician
Approved By:
OF 44,4%t4
°o V
i ••tee• H. 1rs�a H
J AcHeid, Jr.
• �.ti
• s
2451•$ •' `G'�e
1200 West 33rd Auenue. Suite B • Anchorage. Alaska 99503 9 (907) 561-5040
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EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON.
WOcD FEt4cE
AS -BUILT NO CORNERS SET THIS DATE
I hereby certify that I have performed a Mortagee's in-
spection of the following described property: LaT i31
1TCX / 1 SNA/ - LES E57ATE s
Anchorage Recording Precinct, Alaska, and that the improve-
ments situated thereon are within the property lines and do
not overlap or encroach on the property lying adjacent there-
to, that no improvements on property lying adjacent thereto
encroach on the premises in question and that there are no
said property exeeptas indicated hereon° isible easements on
Dated at Anchorage, Alaska
this _Z/ 41, day of_ -4 U G UST 19 E4–
FRED WALATKA & ASSOCIATES
Engineers and Surveyors
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41
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TERRACE
EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON.
WOcD FEt4cE
AS -BUILT NO CORNERS SET THIS DATE
I hereby certify that I have performed a Mortagee's in-
spection of the following described property: LaT i31
1TCX / 1 SNA/ - LES E57ATE s
Anchorage Recording Precinct, Alaska, and that the improve-
ments situated thereon are within the property lines and do
not overlap or encroach on the property lying adjacent there-
to, that no improvements on property lying adjacent thereto
encroach on the premises in question and that there are no
said property exeeptas indicated hereon° isible easements on
Dated at Anchorage, Alaska
this _Z/ 41, day of_ -4 U G UST 19 E4–
FRED WALATKA & ASSOCIATES
Engineers and Surveyors
Indicate North
w T T
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5. LEGAL DESCRIPTION
DATE RECEIVE
INSPECTION APPOINTMENTS
STREET LOCATION
TIME
6. TYPE OF RESIDENCE
TIME
TIME
DATE
CY7—��INGLEFAM ILY
DATE
DATE
- ` 1
7. WATER SUPPLY
[1] --INDIVIDUAL*
INSPECTOR
❑ COMMUNITY
INSPECTOR
INSPECTOR
depth (attach log if available.)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 L Street - Anchorage, Alaska 99501
•
❑ INDIVIDUAL/ON-SITE**
ENVIRONMENTAL SANITATION DIVISION
Q]�PUBLIC UTILITY
Telephone 264.4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1.
Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER
V41_4 lz_..a.
I
PHONE
MAILING ADDRESS
PROPERTY RESIDENT (If different from above)
PHONE
2. BUYER
PHONE
MAILING ADDRESS
3. LENDINXNSTITU ON
PHONE
MAILING ADDRESS
4. REALTOR/AGENT
PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTION
7
J
G_P_X_X ..
STREET LOCATION
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS
❑ One ❑ Four ❑ Other
CY7—��INGLEFAM ILY
❑ Two ❑ Five
❑ MULTIPLE FAMILY
❑ Three ❑ Six
7. WATER SUPPLY
[1] --INDIVIDUAL*
* ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
❑ INDIVIDUAL/ON-SITE**
YEAR ON-SITE SYSTEM WAS INSTALLED.
Q]�PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
1-1'>,a
�z,Qp.
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATEDRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON -SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATE INSTALLED
INSTALLER
❑Septic Tank or ❑ Holding Tank
Size: If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL TO:
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
(� OAW at,t W 2�
❑ APPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
R�IDISAPPROVED
DATE
BY
72-010 (Rev. 6/79)
`fin Q�-�-
5. LEGAL D/ CRIP N
(
DATE RECEIVED
INSPECTION APPOINTMENTS
t"_)Y ,gin
TIME -
6. TYPE OF RESIDENCE
TIME
TIME
❑ One ❑ Four ❑ Other
-TWO ❑ Five
n
i
DATE
-
DATE
DATE
*ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
� -,g q Mal
INSPECTOR -
8. SEWAGE DISPOSAL SYSTEM
INSPECTOR
INSPECTOR - a y )
YEAR ON-SITE SYSTEM WAS INSTALLED.
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF 1 `/'.LTFi &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PR tNviK6?ff, ,,EST,' - ' ,..� -CTION
825 L Street - Anchorage, Alaska 99501
•
tvIAR 19 1980
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 cc EE II F
jjES
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE�ER-FA�ILI�
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROP RTYOWNER
PHONE
G --
I T I
MAILING ADDRESS
n,
(0
-PIRUPERT RESIDENT (If different
from above)
PHONE
a7,�-.
2. BUYER
PHONE
MAILING ADDRESS
-
3. LENDING INSTITUTION
PHONE
Hca cua��1TL-
MAILING ADDRESS
-
4. REALTOR/AGENT
PHONE
MAILING ADDRESS
5. LEGAL D/ CRIP N
(
STREET LOCATlIIb
'
t"_)Y ,gin
o
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS
It SINGLE FAMILY
❑ One ❑ Four ❑ Other
-TWO ❑ Five
❑ MULTIPLE FAMILY
❑ Three ❑ Six
7. WATER SUPPLY
A5r INDIVIDUAL*
*ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
-
IDUAL/ON-SITE**
YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLIC UTILIT
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79) 1�
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE
❑ TWO ❑ FOUR ❑ SIX
❑ OTHER
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON -SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATE INSTALLED
INSTALLER
❑Septic Tank or ❑ Holding Tank
Size: If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL T0:
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
4,---PPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPP13OVED
DATE
=BY
-1710
72-010 (Rev. 6/79)