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HomeMy WebLinkAboutEAGLE RIVER MID HEIGHTS BLK 4A LT 7Aosro ~'~ 0o0 AUTY O~ ANCHOrAgE !PT. OF HEALTH & by ENVIRONMENTAL PF~OTECTION DOC Co. dba ~T~ W~N JUL1 0 1981 o. RECEIVED OWNER OF LAND ADDRESS LEGAL DESCRIPTION DATE - Started PERMIT NUMBER 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. to ~' :' Ft. From__.Ft. to Ft. From , Ft. to : / Ft. From ~ Ft. to / ~ Ft, From ' Ft. to ' ? ,Ft. From___Ft. to Ft. From__FL to Ft. From Ft. to Ft. From Ft. to Ft. From Fl. 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 Ft. to Ft MISCL. INFORMATION: DRILLER'S NAME F'ERMIT NO. FIPPL I CANT LOCFtT I ON LEGRL · DEF'RRTMENT ,_,,- HERLTH RI'.4E:, ENVIF'_-NMENTSL . ~:f-iTEC:TION :--:25 "L'" STREET.. 8NCHO~RGE, R~::i. 995Ai 264-4720 l-4ibb F'EF~I""I T f ._T FIC:K FIRNOLD BRFFIN ST. LOT ? BLK 4R E. R. E B¢~X._,,=,.J F:HI IG IRK., RLRSKR MID-HTS SUB LOT SIZE i9850 SOI_RRE FEET MINIMUM DISTRNCE BETWEEN A WELL RND RNY ON-SITE SENRGE DISPOSRL SYSTEM IS i00 FEET FOR R PRIVRTE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTRNCE FROM R PRIVRTE NELL TO R PRIVRTE SEWER LINE IS 25 FEET RND TO R COMMUNITY SEWER LINE IS 75 FEET. NELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN 30 DR.'S OF THE NELL COMPLETION OTHER REQUIREMENTS MRY 8PPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. PEF:r-1 IT E:ffF"IRES [~EC:E£dBER 32.1_.. -1 98-1 I _.ERTIFT THRT - ,~ i: t RM FRMILIRR WITH THE REQUIREMENTS FOR UN-_ITE SEWERS RND WELLS RS SET FORTH BY THE Mi_INICIPRLITY OF RNC:HORRGE. o. I P.IILL INSTRLL THE _-,,r-,TEM IN RCCOR[:'SNCE WITH THE CADE$. RPF'LICRNT JRCK RRNOLD ALASKA 99501 December 31, 1979 Jack Arnold Star Route Box 585 Chugiak, Alaska 99567 Permit ~ 7905]_3 Subject: Lot 7 Block 4-A Eagle River Mid-Heights Subdivision A permit issued by this department for well and/or sewer system has expired. Pe~.~mits 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 an enginee~ has inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please contact this office at 264-4720. Sincerely, Les N. Bu~holz, R.S. ,~., Senior Enzironmentai Speci~z~ist LNB/Ijw enc: Copy oz Permit FIF' PL t CFIN'T LOCRT I L EGFtL. !'.IINIHL~H [::,IS'I"Rf.4C'E E:ETNEEN Ft HELL RND RNY ON-LE, ITE SEHRGE DISPOSFtl._ S'¢SiTEH :LCIC1 FEE"[' FrC!F~: R F'F.:IVFITE !-,.!ELL~ OF4'. J. SE! TO ;:'L'EHE1 FEET F'ROH R F'I_IE:L. IC HELL E:,EPEN[:,ING UF'ON THE T'¢PE OF PUBLIC: HELL LOGS RF::E REC!UIF'ED RND r,!LIST BE RETURNED TO THE DEF'RRTME:NT HZTHIN OF THE HELL COHF'LETION. OTHER REC!UIF'.EHENTS HR'¢ RPPL"r'. SPECIFICRTIC!N'.F., 8ND C:ONE;TF'.UC:TION [:,IRGF::F~t'!:..--.. RVRiL. RE:LE TO 1NSUF:E PROPER INSTRL. LRT~ON i C:EF.:TIF'¢ THta"f' !: I Rr'I FRMILIRR HITH THE REQUtF:EMENTS FOR ON-SITE 'E, EP,~ERS fa.ND HELL. S; tis :SET FOE:TH E:'T' THE HIJNIC:IPRLITT OF RNC:HORRGE. 2: I HILL INSTRLL_ THE S'¢STEH IN RE:C:C~R[:'RNCE HITH THE CODES. RPF~RNT 3RC:K RRNOLD , i ._E[ ._[:F. TE.. MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date /~2 (a) Legal Description (include lot, block, subdivision, section, township, range) Location_ (address or directions) (b) Applicants Name hr/ftC / Applicants Address (c) Applicant is (check o_~ne) Lending Institution uyer ; Other I I Cexplain); (d) Lending Institution Telephone - Home Business Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mai~ the HAA to the following address: 2. Type of Residence Single-Family~ Number of Bedrooms 3. Water Supply Individual Well~['~. Multi-Family~-~ Other (describe) Community~ Public~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. 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 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 M~nicipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or w-astewater 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 Address Date DHEP Approval Approved for~f,?~V=~Jbedrooms Approved ~ Disapproved __ Telephone Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHOKAGE DEPARTMENT OF HEALTH A/~D EN~IRON~NTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABO~]~ BY MN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN ~ STATE OF AIZSKA. THE DHEP E~ES THIS AS A COURTESY TO PURCHASERS OF HOMES J~ND THEIR IZNDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDER~L AND STATE REQUIRE- MENTS. EMPLOTrEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. TItE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 MUN'C,.AL,T~ OFA.C.O.*OE SEWF~ CONNEC. PERMIT DATE OF APPLICATION WATER 8~ SEWER UTILITIES SCHEDULED COMPLETION DATE 30(:30 ARCTIC BOULEVARD PHONE- 277- 762 Z LOT/TRACT BLOCK ,/, / SUBDIVISION ,., ~: . r BUILDING ADDRESS OWNER MAIL ADDRESS [] SINGLE FAMILY [] MULTI-DWELLING ' No. A FTS.~ [] COMMERCIAL [] INDUSTRIAL DRAWING No. PHONE CONTRACTOR= (License ~ bond requ Ired ) [~N PROPERTY ONLY I-]MAINTAP-TO PROPERTY LINE ONLY r-IMAINTAP 8~ON PROPERTY CONNECT CONNECTION SIZE ~ "CHARGE iNSPECTION FEE PERMIT ",'~EE REIMBURSIBLE NUMBER DEPOSIT TOTAL ASSESSMENTS [] Paid previously [] Main extension agreement [] Subdivision agreemen! [] Extended connect agreement [] Pending-AMOUNTS PERMIT ISSUED BY= "[] PAID [] CASH ,~_ ~'CK.~ PER M ITTEI- MAI L ( PLEASE PRINT) ADDR. PHONE: IH'AVE READ THE CONDITIONS ,AND REGULTIONS ON THE REVERSE .SI DE OF THIS PERMITAND AGREE TO COMPLY WITH THEM PE~MITTEE SIGNATURE POST IN A CONSPICUOUS PLACE ATTHE JOBSITE eo-oz~ (4/8o) CUSTOMERS COPY 7 PERMIT IS SUBJr--CT TO THE FOLLOWING CONDITIONS REGULATIONS No sewer mains sewer connection or sewer extension may be covered or backfilled until inspected and approved by an authorized representative of the sewer utility~who shall be notified ~ in advance of when the construction or installation will be ready for inspection, exclusive of saturday, sunday and holidays. An application for service must be completed to initiate monthly billing All commercial and industrial structures require the installation of a control manhole for monitoring and sampling purposes. The developer, owner, or contractor shall aCquire all permits and pay all fees established by any governmental unit asa condition for the installation of a sewer connection. Permit issuance does not guarantee availability of sewer. It shall be the d ' ' evelover s ~ owner s ~ or controntor's responsibility fo check elevations of existing sewer mains to insure gravi~j service is possible. On site sewer system~ ce_~_~ools~ppt c tanks~ ~u~st be caved in and. backfllled prior to connection tothe ' ' -~ ~ mun c pahty s sanitary sewer system. This permit expires ~ in the year issued. DMSION OF ~BrIROSI~ENTAL HEALTH~oC~ DEPARTMENT OF HEALTH AND ENVIRfINMENTAL PIK)TECI%ON APPLICATIfIN FOR HEALTH ~rl/4ORITY General Infu~-n~tion (a) legal, Descrjpt~n.~inglude~lQt, block,~bdivi~qa, sec~.%o~, town~hip, range) (b) (c) Applicant is (check one) Lending Institution Buyer ~-~ ; Othe~ ~-~ (explain); Address ~al Estate Co. & .~ent (e) Telephone g~- 507~ Te le phone Address Te le phone 2. T_yoe of N~sidence S ingle-Family ~ Number of Bedrooms 3. Water'Suppl~; Multi-Family O~e~ (~s~i~) Individual Well~ C~munity ~--~ Public ~-~ Note: If Cu,m~.~nity ~11 system, must have written conf/rmation frcm the State Department of Environmental Conservation attesting to the legality and status. Is the ~11 adequate fo~ the number'of bedrooms specified in this HAA (Y/N) 4. Sewage Disposal Onsite ~--~ Public ~ Co~,,',~nityt ) .Holding Tank Is the wastewater disposal system adequate fc~ the [Pa~ 1 ~f 2] 2-15-84 5. 'Engineerin~ Firm Providin~ Inspections, Tests, Data and Information I o~rtify that~_~ave checked, verified, c~ conformed to all YDA HAA Guidelines in effect on the/dat~Z~ this ~iRs~ectior~ Conditional ~-~ App~o~d for ~ App~o~d ~ Disap[~roved ~--~ Terms of Conditional Approval The Municipality of Anchorage Department of Health and Environmental P~otection dces not guarantee the continued satisfacto~i; ~erfcz-mance of the water supply and/c~ the wastsw~te~ disposal system. This approval indicates that, as of the ~alidation date shown abo%~, bssed o~ t]~ data and info~.~tion furnished by an er~ir~er ~egistered in the State of Alaska, the water supply and w~stewater disposal system is safe and func- tiopml fo~ the rumber of kedrccr~ and type of structure indicated. (D~EP SEAL) . 7. Mail the HAA to the following address: ~/o (.~' c ~. -po/z.' . . · 'rs21d5is. · ... [Page 2 of 2]. 2C15-84 ae MUNICIPALITY OF ANCHORAGE (MOA) HEALTH N3THO~TY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Lot 7A Block 4A Eagle River ~LL DATA Mid-Heights Subdivision Well Classification ~ ..~.~L If A, B, (r C, D.E.C. Approved(Y/N) ~0 Well Log Present (Y/N) ~&- Date C~pleted ~//~/' Yield Q~-~ q/9 ~ Total Depth ~ Cased to ~-- ~ ~/~ Depth of Grouting ,~///~ /' Static Water Level ~ ~ ' Pump Set At ~ /~- Casing Height Above Ground 2z" Sanitary Seal on Casing (Y~.~f Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y~)~/ Separation Distances from Well: ~ To Septic/Holding Tank ~n Lot =joining ,.ot: TO Nearest Edge cf Absorption Fiel~n ~ /~//~ ; On Adjoining Lots_~____ To Nearest Public Se~r Line ~ ~' To Nearest Public Sewer Cleancut/Mam~hole ~ To Nearest Sewer Service Line on Lot Water Sample Collected Date ~--/~-- ~ Water San~ple Test Results ~ ~ 7~:~6 ~v~/._ B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) Air-tight Caps (Y/N) Date Last Pumped No. cf Ccmpartm~nts Foundation Cleanout (Y/N) Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High-Water Alarm (Y/N) ' Temporary Holding Tank Permit (Y/N) Separation Distances f~cm Septic/Holding Tank: To Buildin~ Foundation To Disposal Field To Stream, Pond, Lake, c~ Major Drainage To Water-Supply Well To Property Line To Water Main/Service Line Course [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD [I~TA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last ~equacy Test ~- Type~ of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes ihresent (Y/N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To P--_operty Line To Existing or Abandor~d System ; On ~joining Lots To Cutbank( if present) To Stream/Pond/Lake/or Major Drainage Course TO Driveway, Parking Area, or Vehicle Storage Area Co~t~,~nts D. LIFT STATION Date Im~talled Size in Gallons "P~tp On" Level at High Water Ala~,m Level at Tested for Electrical Codes (Y/N) ~ /Dimensions Mar~hole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Mee ts ~DA Cc~nents ** Check Permitted Bedroc~ Rating Against HAA Pequest I certify t~a~/~_ .ave checkej~ verified, o~ conforr~d to all MOA HAA C~di~eli~s in effect 2-15-84 ADEQUACY TEST WATER AND SEWER INSPECTION WELL INSPECTIONS AND FLOW TEST SITE PLANS ROAD DESIGN SOl L TEST ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN EXCAVATION WORK ROBERTA. SHAFER February 27, 1984 CIVIL ENGINEER 694-2979 ~V~OHDN¥ JO g~llydlOlNflp~ Municipality of Anchorage Department of Hea£th and Environmental Protection 825 L Street Anchorage, Alaska 99501 REFERENCE: Lot 7A: Block 4A: Eagle River Mid Heights Subdivision Request the Health Authority Approval be provided for the residence located on the referenced property. The following documents are provided for your information$ A. Application for Health Authority Approval Certificate B. Health Authority Approval Checklist, February 1984 ~/ C. Sewer connect permit. D. Well log ~ E. Drinking water analysis report for total coliform bacteria The residence located on this property is connected to the Municipal sewer system and is served by a well. A well y~eld production test was performed and it was determined that the well can provide a minimum sustained yield in excess of 0.104 gallons per minute per bedroom. However, this well cannot be guaranteed against subsequent reduction in yield or failure. If we may be of further service, or provide additional information please do not hesitate to contact us. Sino~w~ // -RAS/ss cc: Dave Richards SRB 196X EAGLE RIVER, ALASKA 99577 ADEQUACY TEST WATER AND SEWER INSPECTION WELL INSPECTIONS AND FLOW TEST SiTE PLANS ROAD DESIGN SOIL TEST ON SiTE WASTE WATER DISPOSAL SYSTEM DESIGN EXCAVATION WORK Dave Richard ROBERT A. SHAFER February 19, 1984 CIVIL ENGINEER 694-2979 Dear Mr. Richard, REFERENCE: Lot 7A~ Block 4A: Eagle River Midheights Subdivision A water sample was taken from the kitchen sink in the residence located on the referenced property as you requested and was submitted to Chemical and Geological Laboratories of Alaska for coliform bacterial analysis. The results of this sample were satisfactory. If we may be of further service, please do not hesitate to contact us. cc: Municipality of Anchorage Department of Health and Environmental Protection SRB 196X EAGLE RIVER, ALASKA 99577 Time Time Date ' Date Date Inspector Inspector Inspector Comments Conditional A~proval Date Sewer Installed Permit No. Septic Tank Size Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner ff~ ~~ _ ~~ Phone MailingBuyer Address~ ~~ ~ kondino Institution ~ ~ Phone Realty Co. & Agent Phone Address ~ - Legal Description ~ ~ .-~ ~ Typel~esiOence ~ ~ ~ Single Family ~ Multiple Family No. of Bedrooms ~ Other Water Supply ~ Individual A~ACH WELL LOG. A well log is required for all wells drilled since June ~ Community 1975. For wells drilled prior to that date, give well depth (attach log if ~ Public Utilit~ available.) Sewage Disposal ~udiVidual Year Individual Installed: blic Utility When Connected to Public Utility:_ ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.