HomeMy WebLinkAboutEAGLE RIVER MID HEIGHTS BLK 4A LT 8A
· er! Drilling
DOC Co. elba
SULLIVAN WATER WELLS
P.O. BOX 272, CHUGIAK, ALASI(A99567 · TELEPHONE 688-2759
OWNER OF LAND
ADDRESS
LEGAL D~CRI~ION ~ ~ ~&~ ~ ~ ~ ~'~ DRAW DOWN FT.
DATE:Stoned ~/t /~ Ended ~// /~ GALS. PERHR
PE~IT NUMBER KIND OF CASING
DEPTH OF WELL / ,.~'~"
STATIC LEVEl. OF WATER FT.
/goo
KIND OF FORMATION:
From O._Ft. to ~ Ft. Od~fd.< <;~,~d From ...... Ft. to. ~
From ~ Ft. to ~q Ft. ~ ~ ~,~ _~ From .... Ft. to~
From Ft. to Ft. g ~E~ From ..... Ft. to_. ~
From ~q Et. to~ Ft. ~~O ~d~ From _ Ft. to_~
From 7,~ Et. to iO! Ft. ~-~V ~ ~'~'A~e'4. From .... Et. to--Et
From i~l Et. to /~Ft. -~ · t~q~ From Ft to
From Et. to Ft. ~/ C'~ From ~ Ft. to__Ft.
From I~~ ELto /~ Ft. ~Y ~ ~~ From Et. to Ft.
From I~ Ft. toi~iFt -~ ~o~ ~ From~.Ft. to
From Ft. to Ft. ~~ From Ft. to_ Ft.
From _Ft. ta .Et ..... Fram ...... Ft. to~
From Ft. to Ft. From ..... Ft. to ....
From Ft. to ...... Ft. From .... Ft. to~ Ft
From i..Ft, to Ft. From~Ft. to
From Ft. to. Ft. From~ ~Ft. to ..... Ft .........................
From Ft. to Ft. Fr,m_~Ft. to Ft.
From Ft. to.~ Ft. From _Ft. to _Et
MISCL. INFORMATION:
DRILLER'S NAME
MUNICIPALITY'OF ANCHORAGE
Departmen~"'~f Health and Environment~'~Protection
825 ~ Street, Anchorage, AK. 39501
264-4720
* * * HANDWRITTEN PERMIT ~ * *
Permit ~ WELL .[ ~[7~C ........ PERMIT
Applicant: ~./q/t//~ g/~./7/~,~-..-~/J~Z~ Mailing Address: : ~' fD~ 72 ~/0~-- ~'~'
/
Location: Phone Number: ~Z_ ?r~
egal escription: si e:
Type of Soil Absorption System Is:
Trench: Drainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: Q Soil Rating(sq.ft/br) /.//~.
DEPTH
The Required Size of the Soil Absorption System Is:
LENGTH ~ GRAVEL DEPTH ~ WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = ~/>~' GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED ~ * *
Backfilling of any system without final inspection and approval by this departmen-
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is !00 fee'
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and musk be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 8- f* * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set for'~h by the Municipality of Anchorage.
(2) I will instal~ the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that~be~rooms..~
Date:
SWP/024 (1/81)
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 ///,-~/OC ~'
GENERAL INFORMATION
Leg a~i° n~2~,~' u d e I°~ u b~/vis~n ' se~..~w~3~
Location (address or directions)
(b) ApplicantName~/~~lephone:' ¢~-~ B iness ~
Applicant Address ~, ~ ~O /~ ~ ~~
(c) Applicant is (check one): Lending Institution B; Owner/builder~; Buyer ~; Other ~ (explain);
{d) Lending Institution ~~~~~ Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
SRB 196x
~agJe ~iver, Alaska 9957/
TYPE OF RESIDENCE
Single-Family~' Multi-Family []
Number of Bedrooms Y
Other
WATER SUPPLY
Individual Well,~ Community [] Public r"l
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 [] PubliciSt 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 I of 2 72-025 (11/84)
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 & S Engineering Telephone
Address $~_~ lg;,v
Date E~le ~lver,
DHEP APPROVAL__ (~Y/) ~e~C.~_...~~.~Conditional
Approved for
_ bedrooms by ate
Approved ,'~ Disapprov
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)
WELL DATA
MUNICIPALITY OF ANCHORAGE (MO,.,~
HEALTH AUTHORITY APPROVAL (HAA)
MUNICIPALITY OF
DEPT. OF HEA~'"I'P'I'-~r' .... / - FEBRUARY 1984
ENVIRONMENTAL P~OTECTION 264-4720
Legal Description:
2 0 lg88
RECEIVED
Welt Classification
Well Log Present ~/N)
Total Depth ~ [¢1 ~
Static Water~ Level
Casing Height Above Ground
Electrical Wiring in Conduit (~N)
Separation Distances from Well: /
To ' on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line "1 ,~
Water Sample Collected by
Water Sample Test Results
Comments
If A, B, C, D.E.C. Approved (Y/N)
Date Completed :Z--~ [ - ~'~ Yield
Cased to ~<~ I ~ ~ _--..-
Depth of Grouting
VZ'-''~' ~ Pump Set At
"~4:~~ Sanitary Seal on Casing ~)'N)
Depression Around Wellhead (Y/~J)
; On Adjoining Lots ).
lA
; On Adioining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
'~ ~,, ~ ~:;:::l~.~-,~l~"f~~-~. ;Date 1 ~ ~'
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N) Air-tight Caps (Y/N)/
Depression over Tank (Y/N) Ir~/A
Pumping/Maintenance Contract on File (Y/N) I ~ '
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
72 026(11/84)
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
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)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** 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 _A & ~ I~n.21~,~.ir~. Date ~ - ~ "~ - ~ ~
Company E~e ~r, Ma~a ~J~ MOA No. ~3 ~
Date of Payment J- ~0- ~ ~
Amount: $ ~ -0~
Page 2 of 2
72-026 (11/84)
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
TELEPHONE (907)562-2343 5633 B Stree!
Anchorage, Alaska 99518
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
yPRIVATE WATER SYSTEM
Name
(_5,,q'~/?&,v'
Mailing Address
Phone No.
City
SAMPLE DATE:
SAMPLE TYPE:
~'~Routine
State
Mo. Day Year
Zip Code
Check Sample (for routine sample
with lab ret, no.
Special Purpose
) [] Treated Water
· ~-.._Untreated Water
SAMPLE
NO. LOCATION
31
. I
s l
Time Collected
Collected
Z'YSf^ R'~L-
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
~atisfacto~
[] 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 mail.
Date Received
Time Received
Analytical Method:
Membrane Filler
* No. of colonies/100 mi,
Lab Ref. No. Result*
I
J FT-1
J
Analyst
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
TNTC
Membrane Filter:. Direct Count
Verification: LTB
Final Membrane Filler Results.,/~__~'~ .~
/; I i.,,;' /
Repoded By ~¥.-~../~ /~.7 ,l "~C'' ~
BGB
Coiltormll00ml
Coilform/lOOml
Da,e I 'Y
Time: t'~ ;~ 5 ) _ a.m.
p.m.
= Too Numberous To Count
OB = Other Bacteria