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PERMIT NO.
APPL I CANT
LOCRT I ON
L. EGAL
DEPI=IRTMENT 0F HEFILTH AND ENVIRONMENTAL Pt.::CiTECTION
825 "L" STREET, RNCHORRGE.,
264...-47:.~8
[--~ EE L_ L F'
( 788629 )
BERNARD HOPP
TONDI LN
L. 4 HOPP
6858 'FONDI L. RNE
LOT SIZE
3:44 5:!.:12
12593: :E. QURRE FEE]"
MINIMUM DISTFINCE BETWEEN 8 WELL AND ANY ON-SITE SEWAGE DISPOSAL. SYS'T'EM IS
t£10 FEET FOR R PRI',,,'FITE WELL.~ OR
15E~ TO 20El FEET FROM 8 PIJBLIC WELL DEPENDING UPON THE T'¢PE OF PUBLIC WELL.
HELL LOGS ARE REQUIRED AND MUST BE RETURNED TO TNE DEPFIRTMENT WITHIN 3:0 DA"r'S
OF THE WELL COMPLETION.
OTHER REQLIIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIFIGRRMS FIRE
AVRI. LRBLE TO INSURE PROPER INSTALLATION.
F' E F'~ J"'l Z T' E ::-:: F' I F;-: E2 S [:, E C: E i'-1 E: E FE: ]:-]: :~_ .. :~_ Sa 7'
I CERTIFY THAT
i: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
FORTH Ok' THE MUNiCIPRLIT'¢ OF ANCHORAGE.
2: I WILL INSTF4LL TNE S'¢ST~M IN ACCORDANCE WITH THE CODES.
.. ......
Y]:. 2
December 29, 1978
~780629
Bernard Hopp
6850 Tondi Lane
Anchorage, Alaska
99507
Subject~ Lot 4 Hopp Subdivision
A permit issued by this department for well and/or
sewer system has expired.
Permits are issued on a calendar year basis, as stated
on the permit, by authority of Municipal ordinance.
If you have drilled the well, a well log should be
sent to this department to document the installation
date.
If there are any further questions, please contact
this office at 264-4720.
Sincerely,
Les N. Buchholz, R.S.
Senior Environmental Specialist
LNB/ljw
eno: copy of permit
: ,~ W A T E R W E L L
LOCATION OF ~JELL I
Subu [,~ [ ~iol~ Lo~"-'l~ Iock Frac~ ion
STAPLE OR i,
RECORD
Drilling Permit Number
OWNER
Section No, Town N/S R'nge E/~
OWNER OF WELL:
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURCES
Street Address and Area of Well Location
Z WELL LOG '
Material Ty~e
Bottom
Address:
WELL DEPTH: (completed} Surface Elevation Date of Completion
E~ Rotary E~ Driven
13 SANITARY:
Nearest Source of
Well disinfected upon completion ~es ~'lNo F"~Jet
16WATER WELL CONTRACTOR'S CERTIFICATION:
Length of Drop Pipe ?~ft. capacity
Type: ~rslble E~Other:
EReclprocatn9
This well was drilled under my jurl)dj, ctlon and this report Is true to the best of my knowledge and belief:
Registet~d Business Nam"~'' U--e ~ ' Contract LI s u
. Autho~'ized P..presentati~
7 CASING: E~Threaded ~ded Height: E~Above E~Below
ln. to ft. Depth weight /~ .lbs/ft.
FINISH OF WELL:
Slot/Mesh Size
Set between ft. and
Fi:tings:
STATIC WATER LEVEL:
Type df Measure~nt
lO PUMPING LEVEL below land surface
ft. after hrs. pumping g.p.m.
[~in Approved PIt~L~Pitiess A~apter F~12" At~¥e Grade
12 GROUTING: Well Grouted: F--lYes
Nateriat: E~fleat Cement E]Other:
PUMP: (If available)
7Z-
~ g.p.m.
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)
(b)
(c)
(d)
(e)
Location (address or directions)
Applicant Name A~,;~'~ Telephope: Home Business
Applicant Address x-',-?~,4'~ ¢.~
Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other ¢~' (explain); ..
[_ending Institution ~._~/- ?'~,,/Z,44.,-~ Telephone
Address ~~ z ~ _
Real Estate Company and Agent ~/~.g~'
Telephone ' ~ ~ ~-- ~ ~
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-F~mily,j~ Multi-Family []
Number of Bedrooms ,-~
Other
WATER SUPPLY
Individual Well,¢~ Community [] Public
[]
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite [] Pubtic~' 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.
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 S & $ ENGINEERING Telephone
SRB 196X
Address
Date
EAGLE RIVER, AK 99577
IAY 21 1986
DHEP APPROVAL
Approved for~''~,e~ ~ bedrooms by
Approved X~ Disapproved
lerms of Conditional Approval
Conditional
CAUTION
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.
WELL DATA
Well Classification
Well Log Present~YN)
Total Depth
Static Water Level
MUNICIPALITY OF ANCHORAGE (MOA)
MUNICIPALITY OF _A.b/,[:HDJ~,(~E, ........
DEPT. OF HL~,','~-~I'&~R-'~u'nunHT APPROVAL (HAA)
ENVIRONMENTAL PROT~KLIST- FEBRUARY 1984
264-4720
MAY 2 2 1986 Legal Description: ~
R ECEIVED
/-'~'~¢' If A, B, C, D.E.C. Approved (Y/N)
Date Completed ///~ /~:) ' r7
Cased to 't~ ' Depth of Grouting
~r Pump Set At ~'~,T::~
Casing Height Above Ground
Electrical Wiring in Conduit ~N)
Separation Distances from Well:
To ~ank on Lot
To Nearest Edge of Absorption Field on Lot
Sanitary Seal on Casing~D~/N)
Depression Around Wellhead (Y~
; On Adjoining Lots
~1/~ ; On Adjoining Lots
To Nearest Public Sewer Line cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
~"/'/~/-~ ¢" '¢
SEPTIC/HOLDINO TANK
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot ~/,4'
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 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
Page 1 of 2
C. ABSORPTION FIELD DATA r
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 Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
/, 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)
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
/)n hole/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 S & S ENGINEERING Date
SR B 196X
,o^,o.
Receipt No.
,,-4
Date of Payment
Amount:
Page 2 of 2
72-026 (11/84)
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
TELEPHONE (907) 562-2343
5633 B Street
Anchorage, Alaska 99518
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
[] PUBLIC WATER SYSTEM I.D.#
~g~ PRIVATE WATER 'SYSTEM
Name
Mailing Address
City State
Mo. Day Year
SAMPLE DATE:
SAMPLE TYPE:
It~ Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
Phone No.
Zip Code
) [] Treated Water
[] Untreated Water
SAMPLE Time Collected
NO. LOCATION Collected Bv
~I I
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
/~_Satisfactory
[] Onsatisfactory
[] Sample too long in transit; sample should
not be over 30 hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received
Time Received
Analytical Method: Membrane Filter
* No. of colonies/100 mi.
Lab Ref. No. Result*Analyst/
I?'"?o.1¥~ rna
l I
l I rTl
I Fiq
READ INSTRUCTIONS Membrane Filter, Direct Count Coilform/100ml
BEFORE
COLLECTING SAMPLE
Verification: LTB.
Final Membrane Filter Results
Reported By ....
BGB
Date
Time:
TNTC = Too Numberous To Count
OB = Other Bacteria
: ' APPLIC IT FILLS ouT UppER H 4L ONLY
Phone
RealJy Co. & Agen~ '"~. Phone
Address Zip Code
Type o~ ~es~nce
Single Family
Multiple Family No. of Bedrooms ~_D
~ Other
Water Supply
~ tndividual:~ A~ACH WELL LOG, A well log is required for all wells drilled since June 1975,
Co~munit~ For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility ~ ~<:.~ ~ 74
Sewer Disposa~
~ Individual Year Individual Installed:
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Date Date Dates
Inspector Inspector
Field Notes:
Inspe~or
Time
Inspector
( ' ) APPROVED BEDROOMS
:,2} DISAPPROVED
) CONDITIONAL APPJ~J3~/~L*
*CONDITIONS OF APPROVAL
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well to Tank
Well Log Received
Septic Tank Size
CHEMICAL & GF¢. OGICAL LABORATORIES (f-'~'.ALASKA, INC.~
TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER
:~~"~"~ D nk ~ ysis 5633 B Street i'
ng Water An '
ri i al Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY
WATER SYSTEM:
Water System Name
Mailing Address
City Sta.~e
Mo. Day: Year
SAMPLE TYPE:
[] Routine
[] Check Sample (for
with lab ref, no,
[] Special Purpose
SAMPLE
NO.
1
LOCATION
Zip Code
Analys~s shows tms Water SAMPLE to be:
~..~atisfactory
[] Unsatisfactory
[--] ~am~31e too ong ,n transit; sample should
not be over 48 hours old at exam~naUon
to mdicate reliable results Please send
r3ew sample.
Date Re0elved
Tithe Received
A~lytical Method:
[] Fermentation Tube
~.~; Membrane Filter
Result* Analyst
Rev, 1978
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE:
Date Collected Source
Pr~.~mpt lye 10mi 10mi 10mi 10mi 10mi 1.0mi 0.1mi
24 Hours
48 Hours
ConfirmatorY
EMB Broth 24 hours: i Broth 48 hours:
Multiple Tube Report:
Membrane Filter: Direst Count
Verification: LTB.
Final Membrane Filter R~ult~
10mi TuDes Posltlv~/l'otal 10mi Portions
Collform/100ml
.. Collform/lOOml
Time: I,m,
August 15~ 1983
Bernard P. and Mabel E. ~lopp
6850 Tondi Lane
Anchorage, AK 99507
Subject: Lot 4 Hopp Subdivision
Approval for the individual sewer and water facilities cannot
be granted until the following item, s have been completed:
~ Exposed electrical ~ires to the well head are in violation
of the Municipality of Anchorage codes and must be encased
in conduit.
Please notify this Department for a reinspection when the
noted discrepancies have been corrected. If there are any
further questions, please call this office at 264-4720.
Sincerely~
~(obert C. Pratt
Associate ~nvlronmental Specialist
RP29/p/E