HomeMy WebLinkAboutALYESKA #3 BLK 22 LT 2
P.O. BOX 665O
ANCHORAGE, ALASKA 99502-0650
(907) 264-4111
TOh," <NOWLES.
DEPARTMENT OF HEALTH & HUMAN ,SERVICES
January 10, 1986
TO: Permit Applicant
Subject: Permit # 850630
Lot 2 Block 22 Alyeska Subdivision
A permit issued by this Department for an individual well and/or on-site
sewer system has expired as of December 31, 1985.
Permits are issued on a calendar year basis by authority of Municipal
Ordinance. A new permit must be obtained from this Department for any
well and/or on-site sewer system not installed by the expiration date.
If you have drilled the well, a well log needs to be sent to this
Department for documentation of the installation and to close the permit.
If a private engineer inspected the installation of the on-site sewer system
the original as-built inspection report(three part form) must be sent to
this office for review and approval,and for documentation.
If there are any further questions, please call this office at 264-4720.
Sincerely,
Susan E. Oswalt
Program Manager
On-site Services
SEO/ljw
enc: Copy of Permit
DEPARTMENT OF HEAL'TH AND ENVIRONMENTAl... PROTEC'T*~
825 L S'TI~EET, ANCHORAGE., Al'::: 9950
,:~, (2~,,,~l*'**'*..s-p/,-', .,.
F'ERM I 'T' I',10:
DATE ISSUED:
-~[ I* L .I. CAI',I I ~
A D D R E
CONT¢'~[FT' PHONE:
DICK MCC. ANN
2.4 11 BELMONT'
ANCHORAGE, Al.,:: 99507
337-8865
LIEGAL DESCRIP:
L 0 T S I Z E:
SUBDIVISION: ALYESKA
~E.C[ION: 16 TowNSIHIP: 10N
11241 (SQ. FT. OR ACRES)
L.O T .* '"-'
RANGE. R2E
BLOCK: 22
.1.,, Iatn familiar with the r'equir'ements for' on-site sewePs and wells as; set
for'th by the Municipality o[ Anchor'age (MOA) and the Stat. eef Alaska.
2. I wi].l inst. all the system in a(::c(~r, dance with all MOA crudes and Pegulat. ions,
and in compliance with the design cn'itePia of this per'mit.
3. I will adher'e to .all MOA and State of Alaska r'equirements fc:)r' the set bac:k
distances fPom any existing well, wastewateP disposal system of pl,(b].ic
sewePage system on t. hi~ of any adjacent oP neanby lot.
S I G N E D D A"r'E = .
APPL. I CANT = D [ CI<~;[:ANN
BILL SHEFFIELD, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
437 'E' STREET, SUITE 303
ANCHORAGE, ALASKA 99501
274-2533
June 20, 1986
Municipality o¢ Anchorage
Department oF Health and Human
Services
PO Box 6-650
Anchorage, Alaska 99502-0650
MUNICIPALiTy OF ANCT'IOf{A(B~
DEPT. OF HEALT~
ENVIRONM=~, .... H &
.... ,'~ I.~L pROTECTioNr
RECEIVED'
SUBJECTt Waiver Horizontal Separation betueen Well and
Alyeska Basin L[D 60-6~ Lot 2, Block 22,
ALYESKA BASIN SUBDIVISION, Girduood
8621-WA-115
Dear Sir:
The Department has revieued the subject uaiver request and
hereby uaives the horizontal separation betueen the uell and
seuer line to 51 Feet and 75 Feet to the manholes on the
subject property For a single Family residence only.
Sincerely,
SWEtpkk
cc: Oft Water Engineers, Anchorage
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date ~
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
LOcation (address or directions)
(b)
(c) Applicant is (check one): Lending Institution I-1; Owner/builder []; Buyer []; Other ~ (explain);
(d) Lendinglnstitution-S~.~..~',~'~4 ~1~,~,~. Telephone ~'~'~/
Address '~'~O
(e)
Applicant Name ~ Telephone: Horjle ~ Business
Applicant Ad d res ~~L~L~'~-. ~ ?~
Real Estate Company and Agent
Address
Telephone ~ ~ ~ --
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family J~ Multi-Family []
Number of Bedrooms ~
Other
WATER SUPPLY
Individual Well J~ 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
Onsite [] 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.
Page 1 of 2 72-025 (i 1,84)
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,
Firm~' ~hone ~'-~-~ /" ~'/'(~ 7
Name of __~.,~ Tele[
Address ~
Date ~
Engineer's Seal
DHEP APPROVAL
Approved for _7%~c',(~"~',~L'bedrooms by ~ ~' '~~ Date
APproved ~ ' , isa ed Co nal
Terms of Conditional ApProval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental 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.
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