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Home My WebLink AboutALDERWOOD BLK 2 LT 11 PERMIT NO. £.11_1f~ I i~ I F~LIT'T' CIF DEPARTMENT O, HEALTH AND ENVIRONMENTAL F..JTECTION 825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 ~4ibb PERf4IT ( 821171 ) APPLICANT LOCATION LEGAL GRINDLE & KOON COMPANY AIR GUARD ROAD 2900 ILIAMN8 DRIVE ANCH 99505 L ii B~ALDERWOOD LOT SIZE 243~-655_~. SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS t00 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM 8 PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO R COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 50 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERM I T EXP I RES DECEf~BER _---~l. it982 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 INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. SIGNED: ISSUED V4. 0 L~'Ja~IL LOT "~ [ZIE DEP/~R ~ P~ 1' tL;,t !L ALTtt AP',[) EFW¥ ti':?Oi~?,,if % F/~,i. PI~OTEC T )N ~Permit 9: 821171 ,January 31, 1983 TO: Permit Applicant Subject: Lot 11 Block 2 Alderwood Subdivision A permit issued by this department for an individual well and/or on-site sewer system has expired as of December 31, 1982. 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 needs to be sent to this department for documentation of the installation date and to close the permit. If a private engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files and documentation. If there are any further questions, please call this office at 264-4720. Sincerer% Robert C. Pratt, R.S. Acting Program Manager Sewer and Water Program RCP/!jw eric: Copy of Permit SWP/057 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # 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 10t, block, subdivision, section, township, range) Location (address or directions) (b) -) '~ -' - /' ,~, ,J' ., Property owner/~ ~ _C~,,~.~.~.~.,.,_~ (~.~,/x/, .. Telephone' (home) Mailing Address Business (c) Lending Institution Mailing Address (d) Real Estate Company and Agent (e) Address Telephone --~ ~' '~ - "~'~-'-'.'~ 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 ~.aade River, Alaska 99577 2, TYPE OF RESIDENCE Single-Family~,,~ Number of bedrooms 3. WATER SUPPLY Individual Well ~[' Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site [] 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. 72-025 (Rev. 7/88) Page 1 of 2 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 Telephone S & S ENGINEERING Address 17034 =_:;!e g;v~r L~p Road No. 2~ Date 6. DHHs APPROVAL Approved for ~..~bedrooms by Approved ~. ' Disapproved Terms of Conditiohal Approval ~c~ ,~-,t ~T~-I- Date Conditional 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 Log Present (Y/N) J/ Date Completed ! ~ Total Depth ~ ' Cased to z/o'/'- Depth of Grouting Static Water Level ~"" ~ ~ MUNICIPALITY Of ANCHORAGE (MOA) ~',e~l~.,~ . ~1~ Authority Approval (NAA) t< ~'-;~" ~''~ i~ ~CKLIST - FEBRUARY 1984 , ~..,~,:.: '~~ .... 343-4744 ~,:.:~; ~'~ ~ Legal Description: ~o~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot /J/R I To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line '7 ~" I To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results If A, B, C, D.E.C. Approved (Y/N) - - / ~ -~- Yield C I -, 5 '-' ~/) Pump Set At O Sanitary Seal on Casing (Y/N) J/ Depression Around Wellhead (Y/N) (~J~/,k..~c~J¢¢/'., On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ;Date //- /.~ ! {oo t Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size ~ No. of Compartments Standpipes (Y/N) Air-tigh't~ps (Y/N) _ ___ Foundation Cleanout (Y/N) Depression over Tank (Y/N) ~ Date Last Pumped _ Pumping/Maintenance Contact on Fle (Y/N) ". - ; for Holding Tank High-Water Alarm (Y/N) ~ ~'"k. ' "~np°rary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TAN~: To Water-Supply Well ____ To Buil~.,~.Foundation To Property Line __~ To Disposa'1~d __ To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments ~-~J~l'-% ~ ~ ;c~,,JC~_~ 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed ~ Length of Field Width of Field ~ Depth of Field Bed Thickness Gravel Square Feet of Absortion Area ~,, Statndpipes Present (Y/N) Depression over Field (Y/N) ~ Date of Last Adequacy Test Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTI~N~i~FIE To Water-Supply Well _____ 'l'~roperty Line __ To Building Foundation '~ To Existing or Abandoned System on Lot ; On Adjoining Lot~.%__ _ To Water Main/Service Line To Cutback'Ct.present) _ To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at 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· Signed Company Date MOA No. Receipt No. Date of Payment Amount: $ S & $ 17034 Eagle River Loop Road No. 2~ Eagle River~,laska¥~77 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 LAB INSTRUCTIONS £or Work Order $ 48219 Date Report Pr, inted: NOV 13 89 @ 21:03 Client Sample ID:nil B2 ELDERWOOD S/D PWSID :UA Collected NOV 13 89 @ 13:50 hrs. Received NOV 13 89 @ 14:00 hrs, Preserved with :AS REQUIRED Client Name : S & S ENGR Client Acct: SNSENGP P.O.# NONE RECEIVED Req # Ordered By : S ~ S ENGRS. ChemLab Re£. $ :8495 Analysis Completed : //--/$/-~/ Send Reports to: Laboratory Supervisor :STEPHEN C. EDE 1)S Q S ENGR Released By : ~z~.% 2) Special Instruct: Chemlab Client Parameter Sample $ Sample Description Matrix To Test Method Units Result 1 Lll B2 ELDERWOOD S/D i 20153-NITRATE-N EPA 353.2 mR/1 ND[O,I~ 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 COl [] PUBLIC WATER SYS' ~ PRIVATE WATER SY: Name S -o Mailing Address Eag] City SAMPLE DATE: SAMPLE TYPE: 2~ Routine ~ Check Sample (for with lab ref. no. [] Special Purpose SAMPLE NO. LOCATION 2 3 4 5 I READ INSTRUI BEFOR[ COLLECTING TNTC = Too Nu OB = Other Bac vIPLETED BY WATER SUPPLIER ;TEM Phone No. 'EHGIHEERING River, Alaska 995X~. State Day Year routine sample .) ~TIONS ;AMPLE Zip Code [] Treated Water [] Untreated Water Time Collected Collected ~ 'U TO BE COMPLETED BY LABORATORY 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. Date Received Time Received Analytical Method: ? Membrane Filter * No. of colonies/100 mi. Lab Ref. No. Result* BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter. Direct Count Verification: LTB Final Membrane ~:~s Reported By ///,/' ~ BGB_ ~berous To Count teria /~st Collform/lOOml Collform/lOOml a,mo 17034 Eagle River Loop Road Eagle River, Alaska 99577 ROBERTA. SHAFER DATE OF TEST: LOCATION OF WELL (Legal Description): '4'~'~P' /'/.~ -L~IOC' -~.2! -~..!~*~'u''~)~3/ .~. 6 CIVIL ENGINEER 694-2979 FT. SCREEN: Comments: L/~."[/ ~('oaL)oe.~ [3t i/v'r~id~J,~°(/Y~' o( ~.~'-~{~//TY~ FlowisnotGuaranteed o~)~£ ~ ~ /~ oor ~)~£1o~, S~JbsequentVarlations Can Occur. ELAPSED TIME SINCE DEPTH TO DRAWDOWNI PUMPING CLOCK PUMPING STARTED/ WATER, FT. RECOVERY RATE, GPM REMARKS TIME STOPPED, MIN. t=,~-/~ (.~ 0 ~ C <sw') 0 0 Start ~-"-/0 ~ lO ~,5 J /~ / o oo '- ~'~4~r~ ~~'7 ~ 0 120 (2 hours) -~"C.'~ / S~4 0 180 (3 hours) 7~ ('' ~ ( /~~ ~, o 2,0 ~ I ' ;~~ ~ '~'~ -~?~ RECOVERY o~ , o ~ ~ /~ o 5 20 25 30 35 FT. DATE: WELL DEPTH: <~ ~' FT. CASING: DATE DRILLING COMPLETED: I-~ - ( ~ ~ '~- STATIC WATER LEVEL (Top of Casing): ~'(z:) APPLIC-' NT FILLS OUT UPPER HA~ ~ ONLY Address ~00 /f ~'/~ / Zip Code Realty Co. & A~nt Phone Address Zip Code Legal Description ~ ~/ ~/C ~ ~d~ ~ ~ Type of Resi~nce ~ 8inoIo Family Multiple Family No. of Bedroom : Other Water Supply ~ Individual A~ACH WELL LOG. A w~l 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 ~ Individual Year IndivMual Installed: ' ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: MUNICIPALITY OF ANCHORAGE /-'-/~-~' DEPT. OF HEALTH FNVIRONM":NTAL PROTECTION. ~ AU6 RECE! ED L-/A~PROW~ .~.ROOMS 'CONOmONS OF APPROVA, DATE ,~'--/ ,F Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size 72.023 _~.' CHEMICAL & G~.-LOGICAL LABORATORIES ' ALASKA, INC.~~ TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street ~ Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I.D. NO. Phone No. Mailing Address Sta~ City Mo. Day SAMPLE TYPE: ,outine hack Sample (for routine .ample with lab ref. no. D Special Purpose Year Zip Code SAMPLE NO. LOCATION , 3 I 4 ] 5 Rev. 1978 TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: J~Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 48 33burs old at examination to indicate reliable results. Please send new sample. Date Received Time Received ~italytical Method: Fermentation Tube ~Membrane ~ilter ~b Ref. ~, Result* Analyst i~ :~f co,onies/lO0 mi: ~;h~ (~f Positi~rtions. READ INSTRUCTIONS BEFORE COLLECTING SAM PLE Date CoJlected Source Dire Recelve4~ Time Recelv4KI __ p.m.I. Ib. No. Presumptive 1Omi 10mi 10mi 10mi 10mi 1.0mi 0.1mi 24 Hours 41 Hours Conflrmatoo/ 24 Hours EMB Broth 24 hours: Multiple Tube Report: Membrane Filter: Direct Count Varlflcet Ion: Fin,, M.m.,ne FI, t....iI, ~'~ Broth 48 hours:, 10mi Tubes Polltlvlfrotal 10mi Portions Collform/100ml BGB