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Home My WebLink AboutPURINGTON LT 11 Wall Owner rv~-W DRILLING, P, O. Box 4-1224 · 1310C Intecnatl~nal Airport Road (907) 274¢611 ANCHORAGE, ,~LASKA 99509 DRILLING~ LOG Location (address of; Town~hip, Range, Section, if known; or distance m~dn road .............. Lot 1~. Blcok 10 Purington SuMivi~ion Size of casing.. 8!L._Depth of Hole___80,~____feet Cased to.~.--6-~- ........ feet, Static water level_~--.__ft. ~D.~o'4~ (below) land surface. Finish of well (check one) open end Screen ( ); Perforated ( ; {.. ),. :".' ~.:; ~I Describe screen, or perforation ~ None :: Well pumping tes%'at .... %0 gM'ohs ~er,~ (mfnu~e) for 1, hours wit~lO~ o~ drawdown from statfe revel, .: :-: ;, WELL LOG ); Depth in feet fi'om ground aurfaee ..... o__eo, 2_TO ..... · '.___3,~,,,,TO ..... ~? .' _,. iz ,TO.__ 4o., iD .TO .... 60, TO ~_.TO ... TO_ __~ TO TO .......... ~O ......... TO TO ............ Give details of formations penetrated, size of material, color and hardness I~CUSTOMgR PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM PERMIT PERMIT NUMBER:SWg10142 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:VOGEL DANIEL M OWNER ADDRESS:3407 SPENARD, NO. 24 ANCVHORAGE, AK. DATE ISSUED: 6/10/91 EXPIRATION DATE: 6/10/92 PARCEL ID:00803223 LEGAL DESCRIPTION: PURINGTON LT 11 LOT SIZE: 6925 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: RECEIVED BY: ~~/~/'~/~ /~/ l/~///// THE ATTACHED APPROVED DESIGN. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL (18LAC80). ISSUED BY: -~Z~-I~. ,~'~ll'Tl-~ DATE: ; >c ~' ~!'1 ~. "/ ' .... ~ ,,, I,'!.) LOT I~ ~ ~- DRIVE WAY , 0 ..... '-:- ': ::-.. ': .. 17 o . . ~: ~ ~. oo LOT I0 · NOT STING STRUCTURE TO BE REMOVED PRIOR TO CONSTRUCTION. SCAL~ ZN F~T II Descrlption Recert Update Date Scale Legal 1/25/91 1-=30 . Lot 11 ~Block ~~ Grid Plot Plan Subdivision 340 PETTIS ~. 1734 XXXXX Anchorage, Alaska 99515 Drawn by As-Built PU~INGTON (907) 349-1488 F~(907) 522-4600 C.E.F. I hereby certify that the property described hereon has been surveyed by me, or at my direction, and that the improvements situated ~hereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto unless otherwise shown. That no improvements on the property lying adjacent thereto e~croach on the or other visible e aseme,ts o, said p rope,ty except as show,. It is the responsibility of the owner or builder, prior to construction, to verify proposed building grade relative to finish grade and utility connections and to determine the existence of any easements, covenants, or restrictions which do not appear on ~he recorded Listed distances prevail over scaling. Reproduction may cause distortion. ,% ., _~-£~ :~- ~- ! PROPOSEDiiousE ~'"/DRiVE"'~::';;'"J'~WAy, .... -~; ~ ~.oo '' - ' ' ~a.oo MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O, Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # _ 1, GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner _ Mailing address _ /'/I Lending agency Day phone Day phone Mailing address- Agent _ Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: individual on-site Holding tank Community on-site Public sewer ~ If community wastewafer system, provide written confirmation from State ADEC STATEMENT OF INSPECTION BY ENGINEER 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 application shows that the on-site water supply and/orwastewater disposal system is safe, functional and adequate for the number of bedrooms and typeofstructureindicated herein. I furtherverifythatbasedontheinformationobtainedfrom 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 t:::/~x/'~,~ T~¢~z:/Ic~/ ~gr~'~<~_/ Phone ~' '/5-' ~'5"~ Address Engineer's signature DHHS SIGNATURE ~( Approved for bedrooms, Disapproved. Conditional approval for Date ~/ /5-/~) / bedrooms, with the following stipulations: Additional Comments By: Date 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. Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ]-II PUR IN¢oTON Parcel I.D. A. WELL DATA Well type Log present (Y/N) ! Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. (~=~clo.rc,~t} Date completed Cased to ~ _5' / Date of test Static water level .-~ .~' Well flow l O FROM WELL LOG Pump level ADEC water system number ~/20/g2 Driller_~' Casing height Wires properly protected (Y/N) AT INSPECTION g.p.m. :> ~'' ~' SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot _ ~ /~ Absorption field on lot ~/~ Public sewer main ~ lO0' Public sewer service line '~' 8.¢' ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform 4~ ./~ oo m 4¢ __ Nitrate Dateofsample: ~ /~.~/q/~ ~/1o/~/ B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size ~k~ /'~ Other bacteria Collected by: Foundation cleanout (Y/N) Compartments Depression (Y/N). Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Surface water/drainage On adjacent lots Absorption field Foundation Water main/service line 72-026 (Rev. 3/91)Front MOA21 CONTINUED ON BACK PAGE C. LIFT STATION hi'.,4. Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA A/, Date installed Length Width. Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested On adjacent lots Soil rating Gravel thickness Surface water System type Total depth Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Cleanouts present (Y/N) Date of adequacy test for SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain If yes, give date On adjacent lots Property line To existing or abandoned system on lot Cutbank Water main/service line Driveway, parking/vehicle storage area bedrooms E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guideline~ in. effect on the date of this inspection. Signature i,, , ,, r., ,. ..,,. -',,\, Engineer's Name . Date HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number