HomeMy WebLinkAboutEAGLE RIVER MID HEIGHTS BLK 4A LT 6A
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION
DATE - Started
PERMIT NUMBER
<erl,fie Drilling
by' DEPT.
DOC Co.
SULLIVAN WATER WELL i
DEPTH OF WELL
STATIC LEVEL OF WATER FT. ' ;
DRAW DOWN FT.
Ended
GALS. PER HR '"
KIND OF CASING
KIND OF FORMATION:
From Ft. to Ft.
From Ft. t~__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 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 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 Ft. to Ft
From Ft. to Ft.
From Ft. to Ft.
From Et. to Ft.
From__Ft. to__Ft
From __Et. 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,
MISCL. INFORMATION:
DRILLER'S NAME ·
F:'ERM I 'T N3
[:,EF'FtF?'[HENT (]F HEF~L.'FH FIN[) EN',,,'IROI'.,IHEN]"FII.._ PROTECTION
8?5 '"L" '~.:]REET., F!i'.,ICHORF!('~E., F!K,
;2 E; 4 - 4 7' 2 0
1,,,.~ EE::: L_. IL_ F" E-:::.-.. IF~:: IPl ]::
,:: 790:1_.6:1. ::,
L }T SI ZE
FEET
['i ]: i'-4 ]: MUM [::, I '_:?I"FtNCE I~31ET!.,.IEEf,I Iq HEL. L. l::!r.,~[:, f::lf-,t'¢ ON-':":'; I TE
:i..OO F'E[i-:"[' FOR F-I PRI'v'F!TE b. IEL[..: OR
.t. 50 ~'0 200 FE.'E"[ FROM F'I PUBLIC i.,.IEL. L DEPEN[:,:[I'.4G UPOI'-,t THE T"r'PE OF PUF:',LIC I.,IEL. L..
WI::i:I...L LC~G::~; RRE F'IE~:::!IJIF:E'[) FINE:' i'lLl~;'l" E',E RE"FI. IR:NE[:' TO TFIE [:,EPFIRTFiE::NT F!I'FHIN
OF THE k!ELL. E:OHF'LE'TICd",I.
OTi"iE3;.: REQLI ]: REMEI",ITS f'lFt"r' F:IPF'I...."d ':_qF'E:C: I F I CRT I ON'.'E: I':INF.:' C:C~NZ;TRLtC:T
F!',/FI ]: I...F~BL E 'TO [ NSI...IRE F'F4t(:)F'ER I I'.4:E;TI::fl_LFtT '[ ON.
]: CE':~:-i'IF"¢ ]HFYF
Z' ]: FIPi FF~MIL. IFIR N:I:'rH THE REu]LIIREMEN]"tB FiR' cN-.-.'E;ITE SEZI.,~ER:E: RN[:, I.,tE!...L:E; FI:E; :[~E']"
FO¢~:TH .:,~ THE Mt..NICIF'RLIT'¢ OF RNCHORFIGE
. ::,r.:,FEM ~N FIC:C:ORDFINCE I.d]:TH THF COC'E:S.
2' I HZLL ZNSTFtLL THE
'5 .r GNE [:, ._~
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Z[ ~;~;LtE[:, E:'.r'./~ ............ [:'FITE; ...............
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lOt, block, subdivision, section, township, range)
Location (address or directions)
(b) Property owner :,¢~-,hJ
Mailing Address
(c) Lending Institution
Mailing Address ~ /~,
(d) Real Estate Company and Agent
Address ,/k/~
Telephone: (home)
Telephone
Business
(e)
Telephone
Mail the HAA to the following address: (or check here¢~i if hold for pick up.)
List contact person and day phone number below:
TYPE OF RESIDENCE
Single-Family,~~ Number of bedrooms
WATER SUPPLY
Individual Well~,' Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
SEWAGE DISPOSAL
On-site [] Publi~/ 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.
72-025 (Rev. 7/88) Page 1 of 2
ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FILE SEARCH, utATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of th is
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional end 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 ~b?/:, ~l ..u ~/ ,I~r,~'~'OCI,4-T'~_F Telephone
Address
Date
Engineer's Seal
6. DHHs APPROVAL
Approved for ,~' _bedrooms by
Approved L~ -- Disapproved
Terms of Conditional Approval
,'~'~.~Z~ Date
Conditional
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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.
72-025 (Rev. 7/88) Back Page 2 of 2
A. ~)_,?~,:
Well Classification 'P~ ~/:, '~-~--
Well Log Present (Y/N) t
Total Depth /..~-Z ' Cased to .
Static Water Level ]~- 7 ~
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N) ~/
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description: /--c~
If A, B, C, D.E.C. Approved (Y/N)
Date Completed ~-/7~ Yield ~, Lb. ~/~ ~
~-C" Depth of Grouting !.},~ ~:,~ ....
Pump Set At /../~ ~ ~o~,;,-~
/~ ' Sanitary Seal on Casing (Y/N) ~/'
Depression Around Wellhead (Y/N) ~'~
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot ~ //:::/ ;On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ~,l//q ;On Adjoining Lots )',J //~
To Nearest Public Sewer Line "~ ' * To Nearest Public Sewer Cleanout/Manhole /OCJ.' +
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
~ /
Comments ~/~-~ --~_.~.,./~/Z'
,/
/ /- ~ -/ /
- / . .. [ { *
Date Installed ~ Size No. of Compartments
Standpipes (Y/N) X,,N Air-tight Caps (Y/N) __ Foundation Cleanout (y/N)
Depression over Tank (Y/%__ ____ Date Last Pumped _____
Pumping/Maintenance Contain File (Y/N) __; for ____
Holding Tank High-Water Alarm %N) __Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM S~IC/HOLDING TANK:
To Water-Supply Well ~,~ To Building Foundation
To Property Line ~ To Disposal Field
To Water Main/Service Line
TO Stream, Pon~.)_Lale or Major Drainage Course
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption S~ata
Date Installed
Width of Field
Square Feet of Absortion Area
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Statndpipes Present (Y/N)
Date of Last Adequacy Test
Depression over Field (Y/N)
Results of Last Adequacy Test 'X~
SEPARATION DISTANCE FROM ABSORPTION'~ELD:
To Water-Supply Well X,x To Property Line
To Building Foundation "X,% . To Existing or Abandoned System on
Lot ; On Adjoining Lots
To Water Main/Service Line To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Pa~king Area, or Veh~j~le Storage Area
Comments
D. LIFT STATION
Date Installed '
Size in Gallons
"Pump On" Level at \
Dimensions
Manhole/Access (Y/N)
High Water Alarm Level at\
Tested for (y/' (y~
Meets MOA Electrical Codes
Comments
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitte/d~droom Rati~gainst HAA~.q.uest**
I certify that I t~y,~J~ecked, v~/'if.i,e'd, or conformed to all MOA and HAA gu
inspection. /~/~// ~ __
UOA .o.
effect .,q~the date of this
i'~ ~Engineer's Seal
72-026 (Rev, 7/88) Back
u i d~LLrtes-~q
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
~ CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
FEDERAL TAX tD # 92-0040440
ANALYSIS REPORT BY SANPLE fez Work Order S 14261
Date Report Printed: JUN 26 89 ~ 11:27
Client Sample ID:EAGLE RIVER MID HGTS L6A E4A
PWSID :UA
Collacted JUN 22 89 @ 13:30 h~s,
Pxesezved with :AS REQUIRED
Clzent Name : CORWIN ~ AS$OC
Client Acct: CORWINP
P.O.~ NONE REC'D
Req ~
O~dexe8 By :
Analysis Completed ;JUN 23 89 Send Reports to:
Laboxatozy Supe:vlso: :STEPHEN C. EDE 1)CORWIN & ASSOC
Specie!
Instruct:
Chemlab hef t: 5899 Lab Smpl ID: I ~atrlx: WATER
Allowable
Parametez Iestad Result/Un/ts Method Lzm~ts
NITRATE-N ND(O.iO) m~/1 EPA 353.2
MUNICIPALITY OF ANCHORA(~
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
JUH 2 8
Sample I!OLTT [ NE SA~[~IZ RECEIVED
RemarKs: SA)L~LE COLLECTED BY ~[.L.
1 Tests Perfo:msd ' See Special Instructions Above UA=Unavailable
ND- ~one De~ected "See Sample Remarks Above
NA- Not hnalyzed tT-Less Than, GT-Gzeate~ Than
MUNICIP%7 -~. OF ANCHORAGE
DIVISION OF ~,--~UTRONMENTAL w~.4LTH
DEPARTMENT OF ~ALTE ~,-O ENVIRONMENTAL PROTECTION
APPLICATION FOR ~.ALTE_ ~.-TEORITY APPROVAL CERTIFICATE
1. General Information
Application Date
(a) Legal Description (include lot, ~-ck, sub,divtsiqn, section, township, range)
(b) Applican,s Name ~~r?~ Telephone - E.. Business
(c) Applican~is (check one) Lending-~s=itution ~--~; Owner/builder,~_ ;
Buyer~--~ ; Other~--~ (explal:~
(d) Lending Institution ~ ' ~" Telephone
(e) Real Estate Co. & Agent
Address
(f)
Telephone
Type of Residence
Single-Family~
Number of Bedrooms
Multi-Family I '
Other (describe)
3. Water Supply
Individual Well~ CommunityI Public~--~
Note: if community well system, must 'm~ve written confirmation from the State
Department of Environmental Conservat~n attesting to the legality and status.
4. Sewage Disposal
Onsite ~-~ Public~ Communi=7 ~ Holding Tank ~--~
Note: If community well system, must ':ave written confirmation from the State
Department of Environmental Conserva:i:n attesting to the legality and status.
[Page 1 of 2]
5. En~ineerin~ Firm Providing Inspections~ TestsI 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 Authori~y Approval shows that the on-site
water supply and/or wastewater disposal system is safe, functional and adequate for
the number of bedrooms amd ~ype of structure indicated herein.- I further verify that,
based on the information obtained from the Famicipality of Anchorage files and from my
investigation and inspection, the om-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 Telephone
Address
D~P A rov~ ~~. '~.~/
_ _.
Approved ~ Disapproved ~ Co~i~ion~
Terms of Conditioual Approval
CADTION
T~E MUNICIPALITY OF ANCHORAGE DEPARTMENT OF h~.ALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN T~E STATE OF ALASKA. THE ~HEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
0R OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RK4/eJ/D18
[Page 2 of 2]
7-19-84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
Well Log P~esent~_~N~, Date C~,~leted ~--/7. ~
Total Depth /~-- ~__ ~ Cased to /~---~ ' Depth of G~outing
Static Water Level /~'-/ ~ Pump Set At c{ ~
Casing Height Above Ground/~ { ~ '/~ Sanitary Seal on Casing~/~, '
Electrical
Wiring
in ConduitA~/~ Depression A~ound Wellhead (Y~
Separation Distances f~cm Wall:
To Septic/~ Tank on Lot /~///~ ; On ~djoining Lots
To Nearest Edge of Absorption Field on Lot ~///~ ; On Adjoining Lots
To Nearest Public Sewer Line ~ {/ To Nearest Public Sewer
Cleanout/Manhole //~ '~ To Nearest Sewer Service Line on LOt
Water Sample Test Results ~ -~/~G~-~v ~ ~ ~
B. SEPTIC/~ TANK DATA
Date Installed
Standpipes (Y/N)
Size
Air-tight Caps (Y/N)
No. cf Ce~a~tments
Foundation Cleanout (Y/N)
Depression over Tank (Y/N) Date Last P, umpe~
Pun~ping/MainteDmnce Contract on File (Y/N)/ /; f~
Holding Tank High-Water Alarm (Y/N) /~/ Te~r~x}_lding Tank Peri, it (Y/N)
Separation Distances f~cm Septic/Holing Ta~._ _/~
To Water-Supply Well To/BuildiPg Foundation
To P~operty Line To Disposal Field
To Water Maim~service Line To Stress, Pond, r~ke, c~ Major D~ainage
Course
[Page 1 of 2]
Receipt 9
Date Paid:
Amount:
2-15-84
C. ABSORPTION FIELD ~ATA
Soils Rating in Absorption St=ara
Date Installed
Width of Field
Square Feet of Absorption A~ea
Depression over Field (Y/N)
Results of Lest Adequacy Test
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes lhresent (Y/N)
?/o~Lest gr:l~quac¥ Test
Separation Distance f~<mn A~sorpticm Field:
To Water-Supply Well / To P~operty Line
TO Building Foundation To Existing or Abandoned System cn
Lot ; On Adjoining Lots
To Water Main/Service Line To Cutbank.(..if present)
To Stream/Pond/Lake/or Majo= Drainage Course
To D~iveway, Parking Area, or Vehicle Storage Area
Cor~nents
D. LIFT STATION
Date Installed
Size in Gallons
"Pta,%~ On" Level at
High hlater Alarm Level at
Tested for
Electrical Codes(Y/N)
/ '~~ Level at
--// / 7/ Vent (Y/N)
Pumping ~Yc~s/du=ing Adequacy Test.
Meets MOA
Cc~rents
KB1/d5/s
** Check Permitted Bedroom Rating A~ainst HAA Request **
certify that I have ~hecked, verified, or conformed to all MOA HAA Guidelines in effect
on the date of 'this inspection.
i/:, /
[Page 2 of 2]
2-15-84
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPi' C,,= '; &
825 L Street. Anchorage, Alaska 99501 ~, ~ ~ ,,LJ, ~ ,~: ~, IAL F C: ;ECT ON
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER I PHONE
C&za,an.c~ ~ ~} 694-3175
MAll-lNG ADDRESS
8ox 935 ~ F~.x, ~
PROPERTY RESIDENT (If different from above) PHONE
2, BUYER PHONE
MAILING ADDRESS
3. LENDINGp~.Z)~_~sINSTITUTION~ [ PHONE
MAILING ADDRESS
4. REALTOR/AGENT I PHONE
/Vor~
I
MAILING ADDRESS
5. LEGAL DESCRIPTION
~ot d ~o~ 4
STR E ET LO~AT~ DN
6. TYPE OF RESIDENCE
NUMBER OF BEDROOMS~_~...
[] One {~ I~J r
[] Other
[] SINGLE FAMILY
[] MULTIPLE FAMILY
~ Two [] Five
[] Three [] Six
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE**
PUBLIC UTILITY
**If individual/on-site, give installation date .... '
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78)
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K'INO 35N 'lVlOI:I'IO ~lOJ 3OI5 $1H/
March 20, 1980
TO: ?~o~ It May Concern
Subj~ct~ Lot 6 Block 4A Eagle River~idHeigh~s Su}~ivision
?he public water system is not available to the ~bove
subject property. It is served by an individual well,
which has been ~pproved by this department.
Therefore, it is economically unfeasible for this lot
to connect to the public water syste~u.
If there are any further ~aestions, please contact this
offic~ at 264-4720.
Sincerely,
P~bert C. Pratt, R.S.
Associate Specialist
RCP/ljw