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Home My WebLink AboutALDERWOOD BLK 1 LT 15 PIE'.Rr,11 T NO. BPPLICBNT LOCBTION LEGBL ROBERT VFtUGFIN SFIN[:, LFtKE LTl5 Bt ALDERWOOD SRA BX :Z6L::4 D FINCH I..OT SIZE ~45-0677 15000 SQUSRE FEET MINIMLIM [)ISTRNCE BETWEEN Ft HELL RND FIN°~' ON-SITE SEI,IRGE [:,ISF'OSFIL SYSTEM IS t00 FEET FOR 8 PR IYRTE I,]ELL OR 150 TO 2~:30 FEET FROM F~ PUBLIC HELL DEPENDING UPON THE TYPE OF PUBLIC: WELL MINIMIJM DISTFINC:E FROM Fi PRIYBTE WELL TO Fi PF.:IYBTE SEWER LINE IS '25 FEET FIN[:, ~0 R COMMUNITY SEWER LINE IS }"5 FEET. HELL LOGS FIRE REQUIRE[:, FIND MUST BE RETURNED TO THE [:,EPBRTMENT WITHIN ]:Cd DB¥S OF THE WELL COMPLETION. OTHER REQUIREMENTS MFIY FIPPLY. SPECIFICFI]'ION$ FiND CONSTRIJCTION DIBGRFIMS FIRE FtVFIIL8BLE TO INSURE PROPER INSTFILLFITION I CERTIFY THFIT :;L: I Fil"l FRMILIF~R WITH 'THE REQUIREMENTS FOR ON-SITE SEWERS FINE) P.tELLS F~S FORTH BY THE MUNICIPRLIT9 OF 8NCHORRGE. 2: I WILL. INSTFILL THE SYSTEM IN 8CCORDRNf..'.:E WITH THE CODES. ~,-,,.,~_~:,. ..... : .... ~__.~___~ ........................ .__,,~ ~;-. ... ~.. ,.. -_ ~..~.~__ i V4. 0 Static Water Level ~'0 feet Draw Down feet WELL LOG Gallons Per Minute Total Feet of Uasing~ Type Material Drilled~ 0 feet to MUNICIPALITY OF ANCHORAGE DF'~T C': I-'[".~'~ ~. .RECEI_V [D Hefty Drilling S.R.A. Box 1553 H Anchorage,Alaska 99507 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMEN"f OF HEALTH .AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AI~HORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivisionrsection, township, range) Location (address or directions) - l usines (b) Applicants Name~Wd[~t&r~ Telephone - Home Applicants ~dress ~On ~, ~D ~ h',~ ~lU~ · (c) Appl~can= ~s (check one) Le~n~ Ius~i=ution ~ ~er/b~laar~ (d) Lending Institution I~~r~- ~~ Telephone Address ~-~ ~. ~ (e) Real Estate Co. & Agent Address ~-D~I ~ Telephone (f) Mail the HAA to the following address: 2. Type of Residence Single-Family.~.. Number of Bedrooms 3. Water Supply Individual Well~ Multi-Family Other (describe) Note: If community well system= must have -~ritten confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal 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] Bn~ineerin~ Firm Providin~ Inspections~ Tests~ File Search~ Data and !nf.'r-~ation AS certified by my seal affixed hereto and as of the validation date sb,-s-a below, ! verify chac my investigation of this Health Authority Approval shows =hat the on-si:e water supply and/or w~stew-ater disposal system is safe, functional and .~dequate for the mumber 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 amd/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, a~ regula- tions in effect on the date of this inspection. & / Name of Firm / DaCe ~ DffEP Approval ~Lc_c~ Approved for ~_~ bedrooms Disapproved Approved X Teleph°ne_F~-' ?-~'G/-3'~w~ (ENGINEER SEAL) Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF H~ALTH AND ENVIRONMENTAL P~OTECTION (DREP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON TIlE REPRESEnt- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERfD IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCSL~SERS OF HOMES TREIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQULRE- MENTS. EMPLOYEES OF DHEP DO NOT CO~DUCT INSPECTIONS OR ANALYZE DATA BEFORE CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBI~ FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/nl8 [Page 2 of 2] 7-19-84 or Hmz CHECKLIST - FEBRUARY 1984 Legal Description: Well Classification ~ ~' Well Log Pmesent ~/N) Total Depth /~-' Cased to v Static Water Level O--~,O~ z ~ ,P~Set Casing Height Above Ground o~ x9 ~' Electrical Wiring in Conduit i~/N) Sepa=ation Distances from Well: To Septic/HoldinG Tank on Lot To Nearest Edge of Absorption Field on Lot If A, B, c~ C, D.E.C. Approved(Y/N) lo7 Sanit~ ~al on ~si~ ~) ~essi~ ~nd '~l~ead (Y~ ; On Adjoining Lots ~/~ To Nearest Public Sewer Line /OZP ~ To Nearest Public Sewer Cleancut/Manhole /Oo{+ To Nearest Sewer Service Line on Lot Water Sample Collected By ~. ~o< ; Date ~-/~-~- Water Sample Test Results B. SEPTIC/HOLDING TANK ~ATA Date Installed Size No. of c/C_ ~tments Standpipes (Y/N) Air-tight Ca] s (Y/N) ~z~dation Cleanout (Y/N) Depression ove~ Tank (Y/N___/)_ Da~e ~ ~ Pumped // Pumping/Maintenance Con=act on Fi~ (Y, ~ Xfor~_ Holding Tank High-Wate~ Ala~(~Y/N{ />~mporaz7 HoldinG Tank Permit (Y/Ni Separation Distances f~cm Se~ti~/~di~ Tank: To Water-Supply Well ______~/ To BuildinG Foundation To Property Line ~ To Disposal Field To Water Ma~n/Se~vice/g%ne To Stream, Pond, Lake, cr Major Drainage Course [Page 1 of 2] Receipt ~ °~"~% ~,-I Date Paid: '~.-~ -%~'" Amount: ~ o , 2-15-84 C. ABSORPTION FIELD E~TA Soils Rating in Date .Installed Width of Field ~t~ata Square Feet of Absc~ption A~ea Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance f~c~ A~sc~ption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes P~esent (Y/N) of Last Adequacy Test To To ; On Adjoining Lots To Cutbank To St~eam/Pond/Lake/c~ Majon Drainage Course To Driveway, Pa~king A~ea, c~ Vehicle Stc~age A~ea Cca~ents Line or' Abandoned System cn D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Cca~uents Dimensions (Y/N) "Pump Off" Level at __ Vent (y/N) Pumping Adequacy Test. Meets MOA ** Check Pezm~itted Bed~ocm Rating Against HAA Request I certify that I have checked, verified, c~ c~nfc~ed to all MOA HAA Guidelir~s in effect on the date of this inspecticn. KSl/d5/s [Page 2 of 2] MOA MICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 ANCHORAGE56331NDUSTRIALB Street . CENTER Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPUER WATER SYSTEM: Water System Name (*) See h on back Mailing Addres~ C~ty I 0 I -I MO. Day S~RouLE TYPE: tine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose State Z~ C<~de_ _ Treated Water Untreated Water SAMPLE 4 I I Time Collected Collected TO BE COMPLETED BY LABORATORY · Analysis shows this Water SAMPLE to be: /{~Sati'sfactory . [] Unsatisfactow [] 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: 1-3 Fermentation Tube :~Membrane Filter Lab Ref. No. Result* Analyst tNo of colome$/~O0 mi et NO of POS~tw~ ;)Ort~on$ 0~-~22o ~b) Rev. 1~3 BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter:. Direct Count Verification: LTB Final Membrane Filter Results /~/ Reported By ~ BGB Date Time: TNTC-- Too Numerous To Count Col lformll00ml Coilformll00ml ALASKA I ulRO[lm FITAL COFITROL $ERo CE$, IFIC. {!nqinemnq 6 ~nuironmental Studies CAROL BURR HERITAGE HOMES ANCHORAGE, ALASKA 99501 2/14/85 ALDERWOOD SUBDIVISION BLOCK - 1 LOT - 15 A FLOW TEST WAS PERFORMED ON THE WELL. 300 GALLONS OF WATER WAS PUMPED AT A RATE OF 1.7 GPM OVER A DURATION OF 3.2 HOURS. THE DRAWDOWN WAS 59.35' WITH A RECOVERY TIME OF 10 MINUTES AND THE STATIC WATER LEVEL WAS 57.09 FEET. THE WELL IS ADEQUATE FOR THIS 3 BEDROOM HOME. 1200 LUest 33rd ~uenue, Suite [~ · Anchoraqe, Alaska 99503 °(907) 5614040 APPLIC~-~NT FILLS OUT UPPER HA.t- ONLY .~.~ Phone P'~r~perty Owner .~<~ . /.~ j~ f ,~ ~ '~,/' ~kZ Mailing Address ~, ~ ~-,,--.- Zip Code ~'~d "~ ~ J_t L 7~) ~ Buyer Address ~,,,.. ~ ~,_j ~A ,--x Zip Code Lending Institution ff..~' Phone Address ~n! ~ '~'/f~ '~"~ ..~' ~'-~,- 7-,~ ~'~.'A /~ J/"" Zip Code Realty Co. & '-- .......... Phone Address Zip Code Legal Description Type of Residence ,~ Single Family Multiple Family No. of Bedrooms [] Other Water Supply ,,~ Individual ATTACH WELL LOG. A well 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 [] ~ndividua~ Year ~ndiv~ua, ,nsta,ed: /7~''~-' When Connected to Public Utility: .2~ Public Ulility Holding Tank NOTE: TIlE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector inspector Inspector Inspector Field Notes: ~ I MUNICIPALITY OF A~.~,~'. ,'""~? C'- ~:~"T'-~ - RECEIVED (~) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CON DITIONALAPPROV&k*-- Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size 72-023 (3182) Note: DIRECTIONS TO PROP~<Ty TO BE INSPECTED' Sewer and Water Program be sure to put colour of house or other landmarks that will make it easy for the inspector to find. Accurate directions will save time and not cause delays in scheduling. SWP/025 CHEMICAL & GI LOGICAL LABORATORIES ? ALASKA, INC. TELEPHONE (907)-279-4014 274-3364 ANCHORAGE INDUSTRIAL CENTER 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: Water System Name Mailing Address I.D. NO. Phone No. City SAMPLE DATE: I l;;I Mo. Day SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose State Year Zip Code [] Treated Water [] Untreated Water SAMPLE NO. 3 I 4 I I LOCATION Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ~ Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. Date Received Time Received ,., = 'r ~ Analytical Method: [] Fermentation Tube El' Membrane Filter '1 Lab Ref. No. Result* Analyst I I I r-F1 I CFI *No of colonies/100 mi or No of Positive portions READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 (b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Date Collected Source Lab. No. Presumptive 10mi ]Omi 1Omi 10mi ~,Oml 1.0mi 0.1mi 24 Hours 48 Hours Confirmatory 24 Hours 48 Hours EMB Multiple Tul3a Rel3ort: Membrane Filter: Direct Count Verification: LTB Final Membrane Filter Results Reported By Broth 24 hours: Broth 48 hours: 1Omi Tubes Positive/Total 1Omi Portions Collforrn/100ml BGB Collform/],OOml Date Time.