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HomeMy WebLinkAboutHAMANN ADDN #1 BLK 1 LT 9 DEPARTMENT £" HEALTH AND ENVt~RONMENTAL ]]:EC'¥ION ~.< ~TRLE] ~ ANCHORAGE~ AK ,__. o4-/4.7,-.:. 0 PERM I T I',10: DATE ISSUED:~ ~., .;'._ 12?. .06 / 18/85 AF'PL I CANT: ADDRESS: CoN'rACT I='HONE: LEGAL DESCRIP: LOT SIZE: RAYMOND/EILEEN HAMANN 1603 EAGLE RIVER ROAD IEAGLE RIVER)AK 995'77 694-:];643 SUBD I V I S I ON: HAMANN ~4~ 1 SE[.,II[]II, 15 TOWNSHIF': 14N ,~'~.98A (SQ.FT. OR ACRES) L. OT: 9 BLOCI<: 1 RANGE: IW t certii'y that: 1. I am ~'amiliaP' witl"'~ the requirements for on-site sewers and wells as set £or"l:h by the Municipality o¢ Anchorage (MOA) and tine State o~' Alaska,, 2. I will install tine system in accordance with all MOA codes and regulations, and in compliance with the design cr'iter':i.a oF this permit. 3. I will adhere to all MOA and State oI' Alaska requirements for' the set back distances t'Pom any existing well, wastewater' disposal system ov public sewerage system on this ov any acljacent or near'by lot. ...................... OWNER OF LAND ADDRESS / ' LEGAL DESCRIPTION DATE - Started ~ PERMIT NUMBER DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 /"/ i ,'; .*: ENVIRONMEFqTAL PROi'ECTION gut 2 7 Sfi_ ,RECEIVED DEPTH OF WELL / ~; '~ STAWIC LEVEL OF WATER FT. ; I)RAW DOWN FT. GALS. PER HR ' e ~' KIND OF CASING ~'~ ; KIND OF FORMATION: From Ft. to :i Ft. From ~ Ft. to , Ft.~ From____Ft. to Ft. From ," Ft. to ~':? Ft. From ! Ft. to ' /;' Ft. From___Ft, to , Ft. From. 'i :: Ft. to :"?;~: Ft. From. :/ Ft. to_: '~ Ft. From Ft. to__Ft. From__Ft. to__Ft. From r' Ft. to. /~ ' ,Ft. From__.Ft. to_ Ft. From Ft. to___Ft. From Ft. to _Ft. From __ Ft. to___Ft. From_ Ft. to___Ft. From Ft. to ___ Ft. From From From From From From From From From From Ft. to Ft. Ft. to___Ft _ Ft. to Ft. Ft. to Ft Ft. to Ft Ft. to _Ft. c Ft. to__Ft Ft. to__Ft. Ft. to Ft.__ Ft. to Ft. MISCL. INFORMATION: DRILLER'S NAME %~, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAI-'~ ~ ~ oF ON-S,TE SEVVER AND VATER FAC,L,TY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) LOT 9: BLOCK 1: HAMANN #1 T1;4N~ R1W, SEC. 15 Location (address or directions) 16o3 EA~LE ~v-SR RD. EAGnE F~TVE~, AK (b) Applicant Name RAY HAMANN Telephone: Home 694-3643 Business N/A Applicant Address 1603 EAGLE RIVER RD. (c) Applicant is (check one): Lending Institution D j Owner/builder. r~; Buyer []; Other [] (explain);' (d) Lending Institution N/A Telephone ' Address - (e) Real Estate Company and Agent - · -'-7': ~-C'',?iT~iepl~0ne ............ '" v:we svstem 'must '' :' ):. ':';:': :N°te' f community wel system must have wriEen cOnfirmatidn from'the sta{e Depa~ment Of Environmental Cohse~atio'n : :' attesting to the legality and status. ' '; : 72-025 (1i/84) Page I of 2 .. : ENGINEERING FIRM PROVIDINC SPECTIONS, TESTS, FILE SEARCH, DA'[ ,ND 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 flies 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 F~AC, L~ R~'I~R ~N'C-'[NEI~P~C- $]~RV~CES Telephone Address P_O. RO× 773294 ~,Ae, f,~, RZVBR, A~( 99577 Date DHEP APPROVAL ~,~'', APproved for by ......... Date - Dmapproved Oond~bona Terms of Conditional Approval The Muncipality'~f Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representatibns given m paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courmsy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not condu ct ~nspections or analyze data before a certificate is issued, The Municipality of Anchorage is not responsible for errors ar omissions in the professional engineer's work. Page 2 of 2 72-o25 (11/84) A. WELL DATA MuNIcIPALITY OF ANCHORAGE (MOA) UT.OmTY APPROVAL (HaA) /~1 J~RE~KLIST - FEBRUARY 1984 264-4720 ~ I /~0]~ Legal Description: ~ NOtSlAICl $:tDIA~FIS tVLN]WNO~I^N::I :]©V~OHDNV JO ,,k£1'IVdlDINRW Well Classification/-~/~'///~ ~ Well Log Present (Y/N) iv Date Completed ~/'/~¢-5'- 'Yield Total Depth J¢'~ / Cased to /~¢-'~"~ ~.z.-.~,~.Depth of Grouting Static Water Level /,:~ /z¢~?,...- ~-~.~ .¢,¢ ~"~-.'.~.¢ Pump Set At Casing Height Above Ground J.~'-/' Electrical Wiring in Conduit (Y/N) Y Separation Distances from Well: To Septic/Holding Tank on Lot /.¢¢2' To Nearest Edge of Absorption Field on Lot ¢'./~ / To Nearest Public Sewer Line ./'///9 Cleanout/Manhole ~/t~,'/~ Water Sample Collected by ~/^'~'- Water Sample Test Results ~,'¢-'/¢~-'-'"~ ~ ifA, B, C, D.E.C. Approved (Y/N) ¢~ Y Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ./ ; On Adjoining Lots ; On Adjoining Lots //¢*~ / To Nearest Public Sewer To Nearest Sewer Service Line on Lot ;Date //../~/'2.//~ ? Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) ~ Air-tight Caps (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 To Property Line ¢/~ / To Water Main/Service Line ¢-/~" Course Size ,//M.:2~¢~ ~./. No, of Compartments Foundation Cleanout (Y/N) ~\/ Date Last Pumped .¢'/~ ;for Temporary Holding Tank Permit (Y/N) To Building Foundation '~'¢ / ~ To Disposal Field ~'~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /~' 7 ,¢~ Width of Field ~'~g' // 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 To Driveway. Parking Area. or Vehicle Storage Area Comments -~¢-¢'~-~'~ ,,~.~,..r- ~ 3 '" m/' 7- .,/,,,~.~./c Type of System Design Length of Field ?~,~"- '/ Depth of Field //-/ / Gravel Bed Thickness ¢/,, ,7 / 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) LIFT STATION 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 all MOA and HAA guidelines in effect on the date of this inspection. Signed ~.~ --~' ~-~¢, -:'"~ -~- -~:7~-- Date Company ~¢~'~'~¢'~'¢"£' MOA No. Z' ~- - -~.~5- Receipt No. ~/ Date of Payment Amount: $ t~ ~ ~%;3-; ngineer's Seal Page 2 of 2 72-026 (11/84)