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Home My WebLink AboutALPINE VILLAGE BLK 3 LT 7 STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIV]StON OF MINING & WATER MGMT LOCAT,O. OF WELL S~ qzO ~ ? ~o~../"'-~'~'--oCATER WELL RECORD BOROUGH ~~SION~ LOT BLOCK SECTION QTRS SECTION TOWNSHIP RANGE MERIDIAN '--'0 ~ 7 3 ON OE OS OW LOCATION/SKETCH: WELL OWNER: / ~..¢'4,"~ ~/~ DEPTHS M~SURED FROM:~casing top ~ground surface WELL DEPTH: DATE OF COMPL~ION ' ' Depth Of holeL / ~/_ ft ~OREHOLE DATA: Depth Depth of casing: ~/ ft ~ / // /~ Material Typ~ and Colo~ ' From To ' ' .... ~ ~ , ft ~etow ~o~ of casino ~ ~round su~ace /g & / 0 public supply 0 other WELL INTAKE OPENING TYPE: ~open end ~ screened ~~~/, /O/ Depths of openings: to ft SCRE~ TYPE: Diam: in. Slot/Mesh Size: Length: ft G~VEL PACK TYPE: _ Volume used: , D~t~o. top: ,, Dopth: from '-, ~ to ~t D~ELOPM~T M~D~ Duration: PUMPING L~EL AND YIELD: PUMP INTAKE DEPTH: ~ ft Horsepower:,, WELL DISINFECTED UPON COMPL~ION7 ~ YES ~ N0 CONTRACTOR INFORMATION: REMARKS: . , ,- S,gnature of Author zed Res;;esen~- -- Date DNRIDiVISI~0~%~t~I~u~t~Sg~TER MGMT ANCHO~GE AK 99503-5935 Phone (907}269-8639~ Fax {907}562:i~ "- .,, MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WATER SUPPLY PERMIT Initial Date Issued: Sep 03, 1998 Expiration Date: Sep 03, 1999 Permit Number: SW980339 Legal Description: ALPINE VILLAGE BLK 3 LT Design Engineer: 0000 None Required Owner Name: Telemark Construction Inc. Owner Address: 14500 Rocky Road Anchorage, AK 99516- Parcel ID: 014-133-07 Site Address: 007324 BERN ST Lot Size: 8450 SQ. FT. Total Bedrooms: 2 Permit Bedrooms: 2 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. A well log must be submitted to the department within 60 days of drilling. [] Private Well [] Water Storage Received B.y~~ ~ Date: Date: ~oT -1 I ~-CTT ¢OJ~c-e = \5.o~~ PLOT PlAN ~ ASBUILT SCAL[ ~":~' GRID ~% Project No. Kennefh G. Lan-, 17~1. Geo,_ge Bell C~mle, Anchor'age, Alaska <39515 ~ ¢907~ 522_6476 Phone Regi~fered Land Surveyor (907) 522 4625 Fax .~'"~.?....~._~.~_~. ~ m w~ln ~e ~ tim ana ao ~ ma~n o~?e ~. ~~~..L..L~...:....~. ~--~~~ m ~ n~~~ ~ ~. '~': .........' ...... ~ ..... ,-- - .-- -- .......... .._._., ___._ [~~--[-~;-~~ ~ :~;~:{¢~(;.~ ... ,./~;.:~ .-:~.~: ~ ~ .. , ~.. . ; '3^'o' ONBY. $: I MUNICIPALITY OF ANCHORAGE 1. GENERAL INFORMATION complete legal descriPtion DNiSi°n of EnvirOnmental se~i~ On-Site Services Secl 96650 ' Anch6rage, 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address ~-0oo E. 5 ooo ~t Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ TYPE OF WATER SUPPLY: Individual well':., NOTE: TYPE OF WASTEWATER DISPOSAL: Community well Public water If community well system, provide written 'confirmation from State ADEC atteSt- ing to the legality and status of system. -. Individual on-site Holding tank CommUnity on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 ~d by m~i~eai ~ff'i'~d hereto and *al ~f ihe ~a~li~ation date eh( I verify that my, ,]i~vestigation of ~i~He~lt-~-~AUthority Appr(~/-a[ap~piicati*on shows that ~e on:site water supp'lY '~'~/°r w astewa~'~Pdi~i ~tem is safe~ ft~i~'i~3n~l'':~nd adequate':f°i:t~*i~ ~:~ei~ of bedr0°'m~ a~dtype of structure indi( herein. I furt'he~ v~eHfYth'at based on t~ n 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 comP!lance with all Municipal and State codes, ordinances, and regulations in effect on the'date of this inspectionl :...r; Name of Firm Address Engineer's signature $ & S ENGINEERING 17-n?. E=~!: ~'' .... L::F ........ Eagle River, Alaska 99577 Phone ~o~/- ~,~ "7~ Date DHHS SIGNATURE Approved for ~-. Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments .'The Municipality of An(~horage Department of 'Health and Human Services (DHHS) issues Health Authority Approval Certificates 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. 1/91) Back MOA~I Municipality of Anchorage R DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division ,.lAN ] ] 1999 825 L Street, Room 502 · Anchorage, Alaska 99501 · liNVIRONMENTAL ,SERVICES DIVISION Health Authority Approval Checklist Legal Description: LoT -/ 8~-o r..~ ~ /~./,,,~ v~.~4c~_ Parcel I.D.: A. WELL DATA Well type Ie~"z4 Log present (~/N) ¥ ~- ~r Total depth I O ~ Sanitary seal {~N) Y' ~ .f If A, B, or C, attach ADEC letter. ADEC water system number Date completed 9 / t i / el ~ Cased to ! o ~ Casing height (above ground) Wires properly protected FROM WELL LOG Date of test ~ / ii / q ~ Static water level ~ '~ Well production ~ O -P g.p.m. At INSPECTION g.p.m. WATER SAMPLE RESULTS: Coliform c~ Nitrate o, I Date of sample: ~ / -7 / cl ~ Collected by: B. SEPTIC/HOLDING TANKDATA/ou~.~ c Other bacteria S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Date installed Tank size ~(Y/N) Foundation cleanout (Y/N) ~-~"~,~m~ion (Y/N) High water alarm (Y/N) D~ Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./fF or fF/bdrm) System type Length Width Gravel thickness below pipe absorption area Monitoring Tube pr~ ~~~sion over field (Y/N) Effective Date of adequacy test ~ ~~ail) ~ For Fluid depth in absorption~(in.); __ Immediately after gal. water added (in.):_ ~-(past ilr~)mMoin;~ts;;;/atN;r: . . AbSl~ryplis~ngirv~teeda;: .g.p.d. bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* High water alarm level at* ~ Cycles t~s?g.~_~~ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line ~ / 4 On adjacent lots ~ / ~ On adjacent lots ! Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation Property line r ~' W~Surface water/drainage SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Wells on adjacent lots Building foundation ...--~ Water main/service line ~ Driveway, parking/vehicle storage area Wells on adjacent lots ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal reco_r~t~t~.,~he.ab'o~...~l~ms are in conformance with MOA HAA guidelines in effect on this date. Signature Engineer's Name Date I HAA Fee $ '<~ ~ ' Waiver Fee $ Date of Payment Receipt Number Date of Payment Receipt Number 72-026 (Rev. 3/96)* /~ CT&E Envtronmen~l Sewices ]nc, CT&E Ret.# Clien! Name Pruj~c; Name/# Client Sample ~ PWS~ ~tmpl~ Rem~r~:' g9017100t Lot 7 Block 3 Alpi~ ~[~L V/cc ~.e: LOt 7 BlOCk 3 Alpine ~ v,-~ ~.¢ Drinking Wa~er Nigra~e-N 0.I00 U O.iOO m~/L EPA ~oO.O lOmm~ 01~07/99 01/07/99 $c~ 0i/13/i~99 89:85 987694i2ii S AND S ENGINEERING PAGE 83 JAN-lZ-'gli 1~:0~ FROU'CTE ENVlRONk~NTA1, 5615~01 T-$g3 P.03/03 F-f4? CT&E Environmental Services Inc. Laboratory Divigon -_. - ::-, ' ':--_.:-_- )rinking Water Analysis Report for Total Coliform Bacteria UCTION$ ON RJ;~~- ~:m£ B~.FO~E COLL£CTFN@ SA/~PL£ By'w~T~ SUPPLIER 'MUST BE ~T~D ' TO BE COMPLieD PUBLIC WATER S¥$TI~M I.D. 1~ PRIVATE WATER SYST£M SAMPLE DATE: Maatb ~ Year ~ Spettal P~r~ TI~ Catl~d SAMPLE L~ATION CoIt~ aY · Numl~ ofcol~)i ,eX/_l_O0 mi. F'blul du. MMO-MUG Re~alg: Teml Colifom ......... ..... ~:. Filter: Direct Count ......... · C.~. - ----: Veri~cat~on: LTB BGB FecM CoUfarm ConITrmidon .... . --:. ........ COLIFIRM.~ CeUform/l~ mi T~mc ENVIRONMENTAl. F&CILt'I'IE~ IN &b&~lf,,A, CALIFORWUL FLOR;O~e~ ~LuNOiS, MARYt,AND. MICHIGAN, MIS~OURI. NEW aEfl$~r. OHIO. wEST VIROINIA