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Home My WebLink AboutCOLLEGE HEIGHTS BLK 8 LT 1Ati 000 PERMIT NO. bl[Jr-I I C: IF iL_ I T'T' 13IF A~-]I~H[ ~f-tGE DEPARTMENT OF HEALTH 8ND ENVIRONMENTAL Pr,.wYECTION 825 'L' STREET, ANCHORAGE, AK. 99501 264-4?20 L. IELL PEF:~IlT ( 781006 ) APF'LICANT LOCATION LEGAL CLARK & GRIFFITHS INV ~0i2 BONIFACE PKWY L2 88 COLLEGE HTS 280i BONIFACE PKWY LOT SIZE ~ 7800 i0500 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL 8ND 8NY ON-SITE SEWAGE DISPOSAL SYSTEM IS i00 FEET FOR A PRIVATE WELL~ OR i50 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS 8RE REQUIRED 8ND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS 8ND CONSTRUCTION DIAGRAMS 8RE AVAILABLE TO INSURE PROPER INSTALLATION. F"EE:rl I T E~-,;P I I;~'ES; [-~EC:ErqBER 2;::IL.. I CERTIFY THAT i: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2' I WILL I~',~LL THE~SYSTEM I~]~ ~COR~CE WITH THE CODES. ~: ~,~NED: ~ ~i__ == .... FtPPL I CANT C~8RK & GR IFF I THS~,' ............ O.T /O- 7Y ',/3:. 2 ,, -W DRILLING, INC. ~¢_.~ ..... "~ ~ ,vi,J!'*iCiF'ALiTY OF ANCHORAGE '~""~ MUNICIPALITY OF ANCHORAGD£PT. C,:: DEPT. OF', r':z ~ 8 1980 DRILLING LOG [:EB EDWARD E CLARK & ROBERT J GRIFFITtlS ............. .................. ................ Location (address of: Township, Range, Section, if known; o~ distance mare roa& Lo~ 2 B~ock 8 CoLlese HeZ~hUs SubdLvSsLo~ Anchorage Static water level ............ ft. (~$) Screen ( ); Perforated ( Describe screen or perforation ..... (below) land surface. ). Well pumping test at___3_0. ....... gallons per :~!~:~) of drawdown from static level. Da te of complet ion .......... _~__O..f'__3. 0~_7_ 8__ ......... Cased to__-8-0---Z ....feet ~ ~n sh of well (check one) open end (xx ); (minute) for ..... ! .... hours with 100% WELL LOG Deplh m feel: from ground surface · . ,>l/. :. Give details of formations penetrated, o"~e of maim'ia], co]or and hardness _TO ...... _56__'ro ...... 72_ 7_2__TO .... ............. TO. ......... TO_ .TO .... TO_ .... TO. TO. .TO TO. ___Lq 9s_e_ ~_apdy__psr.av e 1 .__ _w._a_t_ex_ gravel .... _S L__]_y y_.h.~r_ct. _ P an .... We t ~h_a_~__d. _p_~n .... S i_!_ty _h_ar.d... _pan .. ~W...a._t~r_~r ave i · 1 -- CUSTOMER JMENTA CERTIFIC,~TE OF INSPECTION FOR HEALTH AUTHC OF ON-SITE SEWER AND WATER FACILITY 264-4720 '~ ~ ' - _ ~' : . 'Application Date, GENERAL INFORMATION (a)'"*"Legal Description (include lot, block, subdivision, section, township, range) ~ o -e- 3. ~/':' ~'/~ ~. ~°//"I' "- ~;~ ~ ~ Location (address or directions) (b) Applicant Name F,~,~ ~~;~ ~ ~ Telephone:. Home (c) Business $ Applicant Address 31o~ ~'o,-,,'¢-,~.~ ?:,o.,-/~,...,,.T/ ~r-~c__,~,r-,~_3,~ H-[¢..~/o~ V?,~oc/. Applicant is (check one): Lending Institution [] · Owner/~r,J~;.; Buyer [] · Other [] (explain); (d) Lending Institution /'~.~'"¢' Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: /-/,,lu .Fo,- ?,'~-,,-p : ~°~"#r 2~ TYPE OF RESIDENCE Single-FamilyJZ~. Multi-Family [] Other Number of Bedrooms '7'-~'~-.~- ("3,) WATER SUPPLY Individual Well J2[ 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 Onmte [] Public,~ Community [] Holding Tank [] Note: If community well system, must have written co nfirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 ..: :. =~"r ~INEERINGFIRM P~I~(~IDi""I'~]~(~"~i~N$;'~TEST$~![E'~R~H;:~" :'Y ~;: As ce~ified by my seal affixed hereto and as of the validationdate shown belOW,r I verifythat my investigationof 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 fu~her 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 ~~7~1~ ~.' ~:~ / ~ ~. Telephone ~ ~/- ~ ~ G ~ Address Date Engineer's Seal DHEP APPROV,~,_ /~T.~> ~~..) ' Approved for .~~ bedrooms ~y~l' [%/0 ,~,~9~'~-- ~.Date Approved ~'/ Disappro;~. Conditional(~ Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Enwronmental 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 (MOAi HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: f...o MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION o F CEIVED Well Classification P~.; ,, ~-~--e._ If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) /~ Date Completed ~',~,',--~-,~ [? & ~ Yield Total Depth ~ ~, ' Cased to ~ o '-f- Depth of Grouting ~'~o ~',~ Static Water Level .1 ~, ~ .~,¢~-- ('~_~ ~'~.,, ~) Casing Height Above Ground 2_.. 3' ~r'~. Electrical Wiring in Conduit (Y/N) ~/ Separation Distances from Well: Pump Set At ~o ~e...~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot tv/4- - To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line /(1 Cleanout/Manhole ! ~ ? Water Sample Collected by ~",- Water Sample Test Results -~;~-~or~ - -~-~- Comments o, ~, :~x'~,, ~, .r----,--,,--~,' ; On Adjoining Lots ; On Adjoining Lots ~'/,~ To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date '~ ,7',~,, ~ B. SEPTIC/HOLDING TANK DATA Date Installed Size No. of Compartments Standpipes (Y/N) Air-tight Caps (Y/N) Foundation~nout (Y/N) Depression over Tank (Y/N) Date Last~ Pumping/Maintenance Contract on File (Y/N) / /'P' ~ary'~ 'for Holding Tank High-Water Alarm (Y/N) ~ Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ..~" To Building Foundation To Property Line To Water Main/Service Line ,./ Course / Comments To Disposal Field To Stream, Pond, Lake, or Major Drainage 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 To Water Main/Service To Stream/Pond/La_.~ Major Drainage Course To Driveway.~ing~Area, or Vehicle Storage Area Comme. o~' Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Preson~ Date of ~..efl~acy 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/~ Dimensions Manhole/Access (Y/N) "Pu~ ~'~ Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Com men..t,~~ ** 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 ~.~ ~ ~ Date ~ .7',.,..t ~ G Receipt ,o. ~ ~ ¢ ¢ I ~' & ''.;~I, Date of Payment w/49 ~ .~~ :~'~'%~"~ Engineer's Seal Am cunt: $ _ '~.......-..--.--..-**..**.~***..- ~ Page 2 of 2 ~. ~;O~cS~~ 72-026 (11/84) CItEMICAL & 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., F-I I I /[~. PRIVATE WATER SYSTEM Name Phone No. Mailing Address SAMPLE DATE: ~ Mo. State Day Year Zip Code SAMPLE TYPE: ;.. Routine Check Sample (for routine with lab ref. no. [] Special Purpose sample E] Treated Water 1~ Untreated Water SAMPLE NO. ~ I ~ I . 1 I LOCATION Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: /~Satisfactory [] Unsatisfactory [] S¢,mple ~oo long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send now sample via special delivery mail. Date Received Time Received ["'?(' 4 ~ Ant, lyrical Method: Membrane Filter * No. of colonies/lO0 mi. Lab Ref. No. Result* l¥' ,z-., ,/'4 [ I [5[-1 l I l 1 l I Analys~/ BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter: Direct Count Coilformll00ml BEFORE COLLECTING SAMPLE Verification: LTD Final Membrane Filler Results (i) Repoded By '"~' /' '/ ''J~ TNTC = Too Numberous To Count OB = Other Bacteria BGB .......................... December 29, 1978 9781006 Clark & Griffiths Investments 2801 Boniface Parkway Anchorage, Alaska 99504 Subject~ Lot 2 Block 8 College tteights 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 enc: copy of permit