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HomeMy WebLinkAboutALDERWOOD BLK 1 LT 13 PERMIT NO RPPLICRNT LOCRTION LEGRL ROBERT VRLIGHN SRND LRKE LTi~ Bi ALDERNOOD SF.:F~ B:;..'; t68,4 D ANCH LO7' SIZE 345-8677 15000 SQUARE FEET MINIIdLIId DtSTRNCE BETWEEN R WELL RND RN'¢ ON-SITE SEWAGE DISPOSRL S't'STEM IS 100 FEET FOR 8 PRIVBTE NELL OR 150 TO ~00 FEET FROM F~ PUBLIC NELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM [:,II5TRNCE FROM ~ PRIVRTE WELL TO ~ PRIV8TE SEWER LINE IS 25 FEET 8N[:, TO ~ COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS 8RE REQUIRE[) F~ND MUST BE RETURNED TO THE [:,EP8RTMENT WITHIN OF THE WELL C:OMPLETION. OTHER REQUIREMENTS I"ltBb' RPPLY. SPECIFIC:8T'.[ONS FIN[:, CONSTRUCTION DIBGRRMS RRE F¢,,,'F~ILBBLE TO INSLIRE PROPER INST8LLRTION. F"EF:r'I I ]- E:4P I RE_~: [)Ef£:~:2[-1BEF~: Z--:t.. I CERTIFb' THRT ±: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SE]' FORTH B'¢ THE MUNICIPRLITY OF 8NCHORBGE. 2: I WILL INSTBLL THE SYSTEM IN 8CCORDBNCE WITH THE CODES. ................................. ~F'F'LIE:~NT ROBERT V~GHN I .....ED ~ ~:~' ~"~ . z ~ .... , V4. 0 Date Drilled: LOG Static Water Level 5~ feet Gallons Per Minute Draw Down feet Total Feet of Casing /30 Type Material Drilled~ 0 feet to /~ /0 to A 0 ~ 0 to L/5 ,~ to 70 to i2,5' Hefty Drilling S.R.A. Box 1553 H Anchorage ,Alaska , sill' ! Lo~' J3 BLK'[ 99507 , APPLI(' NT FILLS OUT UPPER HA! ONLY -- Phone prOperty Own~er R ~ ~ G, ~'~' ~ Mailing Address _~ ~ ~-,~ ,-) '~ Buyer ~-, ?~' ~ BeC= ~ Lending Institution Phone Realty Co. & Agent Phone Address Zip Code Type of Residence ~.Single Family [] Multiple Family No. of Bedrooms [] Other Water Supply ,~ Individual t'~L~ ~/-- ~ ATTACH WELL LOG. A wetl log is required for all wells drilled since June 1975. Community For wells drilled prior to that date, give well depth (attach log if available). [] Public Utility Sewer Disposal ~.~__~ ~.~ [] Indi¥idual Year Indi¥idual Installed: - When Connected to Public Utility: . Public ~ility Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector MUNiCi?ALiTY OF ANCH©RA, FieldN°tes: ~1--~ L.,J~.~j P'~T '?' ':z'"-'~ ~ '~ ENVh. 11 ~ ~,. : .© E - ,.u. ,~ 0 1§82u RECEIVED ( ,~ APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size 72.023 (3/82) APPLIC~ - T FILLS OUT UPPER HALf-~ ')NLY Property Owner R /':t ~/ ! ! ..... '---; Address ;/ - ' Phone , Phone Type of Residence  Single Family Multiple Family No. of Bedrooms ~ Other [] Community ' For wells drilled prior to that date, give well depth (attach log if available). [] Public Utility Sewer Disposal [] Individual Year Individual Installed: ./ / When Connected to Public Utility:  Public Utility Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time ~'- Date Date Date Date ~.~ ~_ Inspector Inspector Inspector Insp~c<~or Field Notes: MUNICIPALITY OF ANCHORAGE ENViRO;'<ME~4~'AL PR.,DTZ. C[ ION RECEIVED (~.~ ) APPROVED BEDROOMS 'GONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) GONDITIO[~L APPROVAL'_ DA~E f~ ~ ~ ¢ // Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received ~Z~:~ , Well to Tank Septic Tank Size 72-023 (3/82) MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 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) Lot 13; Block I~ Alderwood Subdivisionr Location (address or directions) 6234 Air Guard Road (b) Property owner AHFC #57852 Telephone'(home) Business Mailing Address 520 East 34th Avenue, Anchorage, Alaska 99503 (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent Address 1345 2001 REALTY ATTN: Nancy Ber~h-Pollock~ ',~ Su2.;~. #201 A~hn~g~_: A~_a~ 99_~01 Telephone (e) Mail the HAA to the following address: (or check here ~ if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17n~4 r=,3t,~ el,,,,,,' ~ .'.,'.p Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family ~ Number of bedrooms 3. WATER SUPPLY Individual Well [~X Community [] Public [] ,Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attestrng to th legality and status. 4. SEWAGE DISPOSAL On-site [] Public ~' Community [] Holding Tank [] Note: If community we'll'\ system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 o 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 Address Date 17054 Eag|e Ri~er Loop Road Telephone 6. DHHS APPROVAL Approved for '-~ bedrooms by Approved ~ [~at~l~amd Terms of Conditional Approval Date 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 Well Classification ~ t~ 1"~ \,,J ~, ¥~O ~ MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: ~ Well Log Presentd._-'C:?N) "~ Date Completed If A, B, C, D.E.C. Approved (Y/N) '~p- ~'Z--~,'Z.- Yield '~,'~-~--~ ~'p'l .-~ Total Depth Static Water Level ~ Casing Height Above Ground \ Electrical Wiring in Conduit~C~/N) SEPARATION DISTANCES FROM WEI3L~/' To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line '~ To Nearest Sewer Service Line on Lot Water Sample Collected by ~~ Water Sample Test Results Comments Cased to \'5c:>~ Depth of Grouting ~...~-"5 I Pump Set At Sanitary Seal on Casing (~TN) "/ Depression Around Wellhead (Y/J~ I i~/,~ ;On Adjoining Lots/'~,/~ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ~ (:::~1..~ ;Date B. SEPTIC/HOLDING TANK DATA Date~talled Size No. of Compartments Standpi~/N) Air-tight Caps (Y/N) __ Foundation Cleanout (Y/N) Depression o~/N) __ ____ Date Last Pumped _ Pumping/Maintenance ~(Y/N) ____; for Holding Tan H'k ~gh-Water Alarm (Y/N)-"'-----... Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HO~ To Water-Supply Well To Buildin~~ To Property Line To Disposal Field To Water Main/Service Line -'"'""'"""~_, To Stream, Pond, Lake or Major Drainage Course Comments '~'~::*~ ~--.' ~ 72-026 (Rev. 7/88) Front Page I of 2 C. ABSORPTION FIELD DATA Soil~k~Bating in Absorption Strata Date In~.~d. ____ Width of Field~~.~..~ SDqe;ression over Field (Y/Nam Feet of Absortion A~ea ~--...~ 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, parkipg Area, or Vehicle Storage Area Comments ~J'~ ~-~ Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test To Existingor Aba~'r1~ed System on ; On Adjoining Lots To Cutback (if present) D. LIFT STATION Da{e~nstalled Size i ~a~.~s "Pump On" L*~&....~ High Water Alarm Level at-"---~ Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **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. ~: :'!~i:. Signed Company Date MOA No. .~ & $ E.HG!NF~RING 17034 Eagle River Loop Road No. 2U4 Eagle .River, Alasj~a 99577 Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 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 WATERSYSTEMI. D.# I I I I I I ] RIVATEWATER SYSTEM Phone No. $ & $ ENGINEERING Malng Ad~e River', AlasEa 99577 City State Mo. Day Year SAMPLE TYPE: Routine Check Sample (for routine sample with lab ref. no. [] Special Purpose Zip Code [] Treated Water [] Untreated Water TO BE COMPLETED BY LABORATORY Date Received Time Received Analytical Method: Analysis shows this Water SAMPLE to be: /~ Satisfactory [] 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. Membrane Filter * No. of colonies/100 mi. SAMPLE MO. LOCATION 31 4 I s l I I I Time Collected Collected~ ~' (~)f Lab Ref. No. Result* I?~- ~ I F~ I ICJ I F~ I F~ I F~ Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter:. Direct Count. Verification: LTB Final Membrane Filte/~esult~ "" '~/¢/~r TNTC = Too Numberous To Count BGB Date Time: Collform/100ml , Collform/100ml OB = Other Bacteria CHEMICAL & GEOLOGICAL LABORAI~RIES OF ALASKA, INC. / ~i:,~i~"~.'"'~ 5633'B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 582-2343 g-~~'~k ~E~ERA~ ~AX ,~ # 9~-00~0~0 ANALYSIS REPORT BY SAMPLE for Work Order # 19120 Date Report Printed: JAN 10 90 @ 12:30 Client Sample ID:L13 Bi ALDERWOOD Client Name : S & S ENGR PWSID :UA Client Acct: SNSENGP Collected JAN 3 90 @ 13:00 hrs. P.O.{ NONE RECEIVED Received JAN 3 90 @ 16:00 hrs. Req { Pxeserved with :AS REQUIRED O~dered By : R.J.$. Analysis Completed :JAN 6 90 Send Reports to: Laboratory SupRr, v)s9~ :STEPHEN C. EDE 1)S & S ENGR Releas.d By :~~.~ 2) Special HOLD UPON COMPLETION FOR ?ICE-U?. Instruct: Chemlab Ref #: 9088 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result Umts Method LinLits NITRATE-N ND(O.iO) mg/1 EPA 353.2 i0 Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY S & S. 1 Tests Performed ' See Special Instructions Above UA=Unavailable ND- None Detected "See Sample Remarks Above NA- Not Analyzed LT=Less Than. GT-Greater Than