HomeMy WebLinkAboutEAGLE RIVER MID HEIGHTS BLK 4A LT 3A
SULLIVAN WATER WELLS
P. O. BOX 272, CHUGIAK, ALASKA 9~B67 · TELEPHONE 688-2759
~WNER OF LAND xJ ~',~e ~" ~oL~/°~'~'.d DEPTH OF WELL
~Og~ ~_. Y2K ~ ~ STAT1C LEVEL OF WATER FT.
~L D~RI~ ~ ~ ~ I' ~AW ~WN FT.
DATE - ~ 4/~ E~~~ GA~. PER HR
~ff ~MBER ....... ~ND OF CASING
KIND OF FORMATION:
From Ft. to Ft. ~ ,'q~'
From ~
From.
From
Fmm
From/"~/ Ft. to~Ft. ~,~,~,,~,1(~ ,~.~.,'~C,, ~ From
From Ft. to__Ft .... ~ ,'~ ~' ~','~, From
From~Ft. to , , Ft. , From
From Ft. to . Ft From
From Ft. to Ft From
From Ft. to~Ft From. .
From__ Ft. to Ft. From__
From~Ft. to Ft.. From . . .
From . Ft. to Ft. . , From
, Ft. to . Ft
Ft, to~Ft
Ft. to, Ft,
Ft. to OF ~,, ..........
,~ DEPTr, tOF HEALTH &
, , Ft. '"~cik~AL p~,OTECT,!OI~I
Fi. to
, Fi. to
Ft. to
Ft. to Ft.
Fi. to Ft
Ft. to Ft
Ft. to Ft
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. Ft. to Ft
Ft. to__Ft.
.Ft. to__Ft.
Ft. to Ft
Ft.
p. .CE!VED
~SCL. INFORMATION:
DRILLER'S NAME /,~-t~~'~x
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 I\ ~ .~.-t - ~;~'
1. GENERAL INFORMATION
(a) L ~gal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name ~ ~ Telephone: Home t,¢~"~'~--1~1~ ~, Business
Applicant Address "~,,r,_.~, ~...-.~==~-- \c::,L.¢~- ~::Z>.~ ¢L-U,/tr==¢..~' /~ '=~.¢-'t.'~']"7
(c) Applicant is (check one): Lending Institution []; Owner/builder/'[~Buyer []; Other [] (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(f)
~the HAA to the follo~ving address:
TYPE OF RESIDENCE
Single-FamilyJ~ 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 [] Public.J~ 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 (11/84)
ENGINEERING FIRM PROVIDII,~ INSPECTIONS, TESTS, FILE SEARCH, D,~ I'A 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 ail Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm
Address ., ~ ~?]~, ~.~L~ ..~.
Date
Telephone
Approved f~r- f.~.'J[.¢--~.-~ bedrooms b ~
Approved .~r/' Disapprovec~/i ' '-- '5 Con d,~ o~re~
Terms of Conditional Approval
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.
Page 2 of 2
72-025 (11/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4720
Legal Description: ~
NIUNICIPAUTY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRON/~ENfAL PI~'OTECTION
x0V 26 1985
RECEIVED
WELL DATA
Well Classification
Well Log Present
Total Depth /~¢ I/~. t Cased to
Static Water Level /~.,~'
Casing Height Above Ground
Electrical Wiring in Conduit~J~/N)
Separation Distances from Well:
To S~;~.,~¢~-~a~ on Lot
TO Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
"~" · If A, B, C, D.E.C. Approved (Y/N)
Date Completed 1-¢,- ~'~..~ Yield
~ t4--- Depth of Grouting -
Pump Set At ¢.~¢"~,
';'~ ~' Sanitary Seal on Casing~N)
Depression Around Wellhead (Y,~j)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (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
Air-tight Caps (Y/N) Foundation Cleanout (Y/N)
Date Last Pumped
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
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
Type of System Design
Length of Field
Depth of Field
/~/~vel 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)
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area. or Vehicle Storage Area
Comments (--~,,,,~z,J~';~-'~ ,-/-~ ~,P<_3/~/_-
D. 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)
"PL)mp Off" Level at
/,,~/ Vent (Y/N)
A 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 Me,and HAA g uidetines in effect on the date of this inspection.
Signed
Receipt No.
Date of Payment
Amo..t:
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.#
PRIVATE WATER SYSTEM
Nsrne
Mailing Address
City
SAMPLE DATE:
SAMPLE TYPE:
[] Routine
· Phone No.
State
ZlpCode
Mo. uay DEPT?~ HEALTH &
ENVIRONMENTAL PROTECTION
NOV 2 6 1985
Check Sample (tor- rcuttne sample ....
with lab ref. no.. RE~ E~¢ 'I~1~ecl Water
Special Purpose ted Water
SAMPLE
NO. LOCATION
31 I
4 I I
Time Collected
Collected
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
XSatisfactory .
[] Unsatisfactory
[] 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 mall.
Date Received ~
Time Received ~
Analytical Method: Membrane Filter
* No. of colonies/100 mi.
Lab Ref. No. Result*
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Membrane Filter:. Direct Count
Verification: LTB
Final Membrane Filter Res
TNTC = Too Numberous To Count
OB = Other Bacteria
BGB__
Coilformll00ml
CollfomtllOOml
o.t, //,-
Time: /---~:~""(~), a.m.'
p.m.
ir
1. ~eneral Information
,MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL ~E, ALTH
DEPARTMENT OF ~n~.ALTH AND ENVIRONMENTAL PROTECTION
A~PLICATION FOR R~.ALTH AUTHORITY APPROVAL CERTIFICATE
Application Date
(a)
Legal Descriptiom (includ__e lot, ,block_~ subdivision, section, township, range)
Loc,a~o~ (address or directions)
Applicants ~dress ' "~ ~:V:P. ~
9H, 69~2~79
(c) Applicaat is (cHec~ oae) Le~ing
(d) Lending Institution ~0 ~ ~
Business
~-~; Owner/builder_~..;
Telephone
Address
e
(e) Real Estate Co. & Agent
Address
Telephone
~ the HAA to the following address:
~ & ~ ENGINEF-P, IN~
Type of Residence
Sing!e-Pamily~.
Number of Bedrooms
Multi-Family~-~
Other (describe)
Water Supply
Individual Welling._ 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 ~--~ Public ~ 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]
5. En~ineerin~ Firm Providin~ 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-si~
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 M-nicipality of Anchorage files and fro'~ my
investigation and inspection, the on-site water supply amd/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 Telephone
Address .~...,r~w~ ~ ............. ~,' ~ . . ~.
Approved ~ Disapproved ~ Co~i~ioug
Te~s of Co~ition~ Approv~
OA~ION
THE MUNICIPALITY OF ANCHORAGE DEPART~fENT OF HF~kLTH ~ ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORI!"f APPROVAL CERTIFICATES BASED SOLELY UPON TH~ REPRESEW!-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA. THE ~P DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
T~IR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQULRE-
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ~NALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF kMCHORAGE IS NOT RESPONSIBLE FOR ERP. ORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DHEF SEAL)
gR4/e~/D~8
[Page 2 of 2]
7-19-84
ao
Well Classification
Well Log Present ~/N)
Total Depth /~Z ¢2- / Cased to
/
Static Water Level /'~,~
Casing Height Above Grcund
Electrical Wiring in Conduit _~/N)
Separation Distances frcm Well:
To Septic/Holding Tank cn Lot
. _~.,~¢4ICJPALITY OF ANC"HOEA(~E
MUNIC[PALTTY OF ~~ (~ DEPT. OF HEALTH &
~ ~~ ~~ (~VIRONMENTAL
PROTE~O~
C~I~ - F~R~Y 1984 JAN 1 6 1985 Legal Descriptio~:c~
~te ~,~le~d ~/~ Yie 1~,
.
/-40
Pump Set At
Depth of Grouting -
Sanitary Seal on Casing ~_~N)
Depression Around Wellhead (Y~N~
/~W~L?~ ; On Adjoining Lots
To Near, st Edge of Absorption Field on LOt PV6I.~l~- ; On Adjoining Lots
To Nearest Public Sewer Line ~ ~' ~ To Nearest Public sewer
Cleanout/Manhole /~9 /~-- To Nearest sewer Service Line on Lot
Water Sample Collected By ~ ¢ ~< ~&/~/~, ; Date /-//-
Wate~ Sample Test Results
/
C~,~nts ·
B. SEPTIC/HOLDING TANK E~TA
Date Installed Size No. cf Cu[~artments
Standpipes (Y/N) Air-tight Caps (Y/N) Foundation Cleanout (Y/N)
Depression over Tank (Y/N) .~e.~_t Pumped
Pumping/MainteDmnce Contract on/F~/le/YfN) ; for
Holding Tank High-Water Alarm (Y/N)/ /~ Temporary Holding Tank Permit (Y/N)
.
Separation Distances frfmu Septic~ing Tank.
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
c ,. nCs PU 51.
To Building Foundation
To Disposal Field
To Stream, Pond, r~ke, or Major Drainage
[Page 1 of 2]
Receipt %
Date Paid:
Amount:
2-15-84
C. ABSORPTION FIELD CI~TA
Soils Rating in Absc~ption Strata
Date Installed
Width of Field
Squaze Feet of Absorption A~ea
Dep~ssion over Field (Y/N)
Results of Last A~]e-quacy 7bst
Type of System Design
Length of Field
Depth of Field
/Gravel Bed Thickness
Standpipes lhresent (Y/N)
te of Last Adequacy Test
Separation Distance ~r<mn A~sc~ption Field:
To Water-Supply W~ll
To Building Foundation
Lot
To Water Main/Service Line
To P~operty Line
To Existing or~ Abandoned System cn
; On Adjoining Lots
To Cutbank(if p~esent)
To St~eam/Pond/Lake/c~ Major Drainage Course
To Driveway, Parking Area, (mr Vehicle Storage A~ea
/
LIFT STATION
Date installed
Size in Gallons
"P~,~ On" Level at
High Water Alaz-,u Level at
Tested for
Electlrical Codes(Y/N)
//~ing
Din~nsions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Cycles du~ing Adequacy Test.
** Check Pe~Tnitted Bedroom Fating Against HAA Request **
I certify that I have checked, verified, or confom~ed to all MOA HAA Guidelines in effect
on t_he date of this inspection.
Signed $ & ~ 'l.q~X .... ~ Date
· Bi/d5/s
[Page 2 of 2]
2-15-84
TELEPHONE (907) 562.2343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
W^T~R SYSTEM: II I I I I I ~'~'"h°"b"~
I.D. NO.
Water System Name Phone No.
city State
Mo. Day Yem*
Code
SAMPLE TYPE:
[;~Routine
E:] Check Sample (for routine sample
with lab ref. no.
[] Special Purpoae
) [] Treated Water
[] Untreated Water
SAMPLE
NO. LOCATION
2 I ,/~( V~-~')?.-~
3
4 I
, I
Time Collected
Collected
I
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
Satisfactory
[] Unsatisfactory
[] sample too long in transit; sample should
not be over 30 hours old at e~amination to
indicate reliable results. Please send new
sample via special delivery mail.
Date Received
Time Received
Analytical Method:
[] Fermentation Tube
,~Membrane Filter
Lab Ref. No. Reault* Analyat
I I-C]
I F-I-]
I ~-~
I rtl
o6-122o (b)
Rev. 1~3
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Membrane Filter. Direct Count Collformll0Oml
Verification: LTB BGB
Final Membrane Filter Resulta ~'~ CollformllOOml
Reported By ~-_~ _~"~;~- Date ~' -- ' :~ - ~'~'--'
~ Time: / ,'~'.: -"~'~ a.m.
D.m.
TNTC = Too Numerous To Count