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Home My WebLink AboutANGELA HEIGHTS LT 2 A & L DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE 694-2588 OWNER OF LAND ADDRESS ,, ,,., , ~..,, LEGAL DESCRIPTION DATE - Started PERMIT NUMBER DEPTH OF WELL /, STATIC LEVEL OF WATER F'F. DRAW DOWN FT. /' (~-J GALS. PER HR " KIND OF CASING KIND OF FORMATION: From (-} Ft. to From ~.i;~ Ft. to From q:,, Ft. to From ..':. Ft. to .-~, ~ From ~, .....; Ft. to ~:~ / Ft. to ~/~.-"7' From ~' ,,, .... From /-._.~ Ft. to /O;< From 7,,0 Ft. to / Cdev? From From From From From__ From From From From/"?"; .::) Ft. to / Ft. ~ .~ -/-'- IZ~: ~ (/~/~ From__ , ,-'2~ . ¢~' . ,~ . .. I . . From__Ft. to__Ft. From__ From__Ft. to Ft. From__ From__Ft. to Ft From__ From__ Ft. to Ft From From Ft. to.__Ft. From__ From Ft. to Ft. From__ From Ft. to Ft. From Ft. to Ft. Ft. to Ft. __Ft. to Ft __Ft. to Ft. Ft. to Ft __ Ft. to Ft __Ft. to .Ft. Ft. to Ft. Ft. to Ft. Ft. to.__Ft .Ft. to Ft. .Ft. to.__.Ft. Ft. to Ft. Ft. to Ft Ft. to Ft. Ft. to__Ft. Ft. to__Ft MISCL. INFORMATION: DRILLER'S NAME ., PERMIT NO. DEPARTMENT OF' HEALTH AND ENVIRONMENTAL PRO].'ECTION 825 "L* STREET., ANCHORAGE, Ak:. 9950t 279-2511 14El_L_ 77i99 ) AF:'F'LICANT J & J CONST P 0 BOX 75:3 E R. L..OCAT I ON CH I CKFIL. OON s-r LEGAL L2 RNGELR HGTS LOT SIZE :1.:.1_4Z-':9 SQUARE FEET MiNiMUM DISTANCE BETWEEN A WELt_ AND ANY ON-SITE SEWAGE DISPOSAL S"r'STEM IS :iE~O FEEl' FOR R PRIVATE WELL OR 20£~ FEE'/ FOR R PUBLIC 14EL. L. WE:LL LOGS FIRE F.".EQUIRED AN[:' f'IUST BE RETURNED TO THE DEPARTMENT 14ITHIN ]:0 OF THE WELL COMPLETION. SPEC I F ICR].'ION'=; AND CONSTRUCTI ON DI 8GRAMS ARE AVA ILABLE TO INSURE PROF'EF.'. INSTAL. LAT I ON. I CERTIF'¢ THAT t.: I AFl FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SE]" FORTH 89 ].'HE MUNICIPRLIT'¢ OF ANCHORAGE. 2'.: i WIL. L INSTALL THE S~STEM IN ACCORDANCE WITH THE CODES. ,:, ~.~:.y_/2. T~~/.',:,.T., '.¢_.X_., ..~ ,:,~.~,~ ,~ ,¢ ,-- DEPARTMENT OF HEALTH & ENVIRONMENTAl. PROTECTION Environmental Sanitation Division 825 L Street · Anchorage, Alaska 99501 · Telephone 264-4720 CERTIFICATE OF INSPECTION ON-SITE SEWER AND WATER FACILITY 1. Property Owner Mailing Address 2. Legal Description Ronald and Jessica Munso~ 103 Chickaloon Lot 2 Angela Heights 3. Type of Dwelling XX~ Single Family [_-] Multiple Family E] Other 'CONDITIONS OF APPROVAL 4. Sewage Disposal [-;' Individual XL)q~ Public Utility [~] Holding Tank APPROVAL FOR ,) ....... "--- ..... BEDROOMS i~] CONDITIONAL [']/DISAPPROVAL ~¢ APPROVED Water Supply X[~ Individual [.~ Public [] Community (shared) a._AT~ June 7, , 1.9~8 /' /? /"/ ( ~?fl~ A~pROVAL NOT ¢~ID ') WITHOUT DEPARTMENT SEAL ~l~lillllll~GENERAL AND SPECIFIC CONIglTI )NS FOR VA CERTIFICATE , ,. ".. '. - V v; ; . '' - ' ' '" OF REASONAgL~ VALUE (VA Form 26,4843) ~~~ NOW EXISTING OR TIIAT MAY DEVI';LOP WII.L I~F TI 1l~ RESPONSII~t[,I I'Y ()F 1111~ I'URCI IASFR.) 1. This cerlificale will lenlaJtl effeclive 3s tu lilly wlilh'n t'ollllacl tll' sale clllcltxl inh) by ;tu clllqb~e vt'h'~;H/ wilhin lln~ ~;didil3.' pctiad imliu;~ed. 2. This dwelling conRmns widl Ihe Minhnmn I'ropc~ty Requirements p[escribcd hy Ibc Adminishah~ ~1 Vetch;ms AH:d~s. properly, exccpI as provided J~ Item 12 below, may not exce~xl the teaso~mble ~aine in Ilem 14 tm VA I:o~m 26-1843, based and shall otherwise confornl fully to the VA Mininmm tS~)pe~ty Requirements. Salisl:~clmy c~,mpfetion must be ex M(mced by cilht:r A. VA Final Campliance Inspection Rep(hr (VA Fom~ 26-1830), m B. VA Acceptance of FIIA Compliance Insl)cctitm Rcporls o~ otl~er evideno: r,~ cunq'dction runlet },IIA s[!p(ylViQi>tl apl~ic,~hle h) ploposed C{/ligtI'HctiOll. 5. By colltractiug to sell ploperly, as proposed collstrtlc'lioll (~r exi:~ling collstt'ucIIoll ill'~{ p:cvJouqy t)CCll?lCt] ti) ;1 V;?1i'Nilt plll'dl;~sl:r who is ll~ be asest[:d in tile purchase by a loal} itlade, gllal'Ztl~tced~ or illstlred by VA, tile builder or ()ther scllt'r agrees [o pl:uzc auy down ~m}'mcnt r~'ct'ivcd l:y tl~c scl~er oI agctlt o~ ~}/e selle~ ~ll a spedal trust ~tccoqllt afl required by seclion 1806 of Title 38, U.S. Code. 6. The VA guaranty is subject to and condilioned llp(m Ilie [ciidillg inslitutxm's c(impli:nice, ill die time of thc nx;d<m?,, increasing, ~:xtending or ]-c~lewlllg of the l)zoposed Man, with sectit>ll 102 of ILl,, q3.,234, "Flood l)isastet Prntcclion Aci of 1~)73.'' SPECIFIC CONDITIONS P[qOPERTY IN ITS "AS IS" CONDI lION OF PF OPOfiED ~O~aSFI'IUCT PREDICAI ED UPON COMPL. E~ ION OF }'tlA COMPt lANCE NS ~ECT ONS : )Ft l)l{Ol>O'.;[:l) VA COMI'[_IA[qCE INSPFC[IONS [ ] LEND[iq 1'O Cf. Ii'I'IFY Jl at oz al Mortgage Loan Department: Pouch 7-025 · Anchorage, Alaska 99510 · (907) 276-1132 July 26, 1983 Les Buckholz Municipality of Anchorage Department of Health & Environmental Protection Environmental Sanitation Division 825 "L" Street Anchorage, Alaska 99501 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENI'AL PROTECTION JUL 2 8 RECEIVED RE: Certificate of Inspection of On Site Sewer & Water Facility of Lot 2 Angela Heights Dear Mr. Buckholz: Please find enclosed a copy of your Certificate of Inspection which shows approval for two bedrooms and a copy of the Veterans Administration's conditions list which requires approval for three bedrooms. I spoke with the appraiser, Bruce Atkinson, and he confirms that there are three bedrooms. I would greatly appreciate if if you could change your application for health authority approval to reflect three bedrooms and then reissue a corrected Certificate of Inspection to indicate the well is approved for three bedrooms. You may address the new certificate to the above address at my attention. If you have any questions, please do not hesitate to call my direct line at 265-2785. Thank you for your cooperation. Sincerely, Mortgage Loan Interviewer Enclosure OFFICES S TA TEWIDE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 050-283-'38 HAA # '~'-1~"-~-, GENERAL INFORMATION Complete legal description Angela Heiqhts Subdivision; Lot 2 Location (site address or directions) 1 0021 Chickaloon Street Property owner Kieren & Diane Fallon Day phone 696-5938 Mailing address 10021 Chickaloon Street Eagle River, AK 99577 Lending agency Mailing address Day phone Agent Remax of Eagle River, Inc. Day phone Address "1 6600 Centerfield Drive, suite #201 E.R., 694-4200 AK 99577 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 "~ TYPE OF WATER SUPPLY: Individual well xx .Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ~ lng to the legality and status of system. 4. TYPE OF wAsTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer xx 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,~I21 5. STATEMENT OF INSPECTION BY ENGINEER 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 application 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 Phone Date Engineer's signature Alaska Water & Wastewater Consultants, shall be paid $750.00 at, Or prior to, Inc. closing ~ .;% ~ CE.7953 .. ~'~ for the engineering services provided. DHHS SIGNATURE )~ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments £ . '., '? ; Date The Mu6icipa!ity of An~i~o'rage Department of Health and Human Services (DHHS) issues Health Authority Approval Ce~'ificates:based only upon the representations given in ~mgmph 5 above by an indel:~ndent professional engine~ "~'~egistered in. the State of Alaska. The DHHS does this as a courtesY to purchasers of homes and thei~ lending institutions in order to .~tis~t c~rtain federal and'state requirements2' Employ~ of DHHS d° not conduct inspeCtions or .analyze data_ before a certificate is issued. The MuniciPality of Anchomge-:is not responsible for errors or omissions i~"the professional engineer's ~.0rk. 'i .... ' 72-(~5 (l:~v. 1/91) Back MOA ~ Municipality of Anchorage F~*EI ] 0 1999 DEPARTMENT OF HEALTH & HUMAN SERVI~;~:~p^u~-v o~ ,^rUCHO~ Environmental Services Division P-NVIRON~ENTAI.$1~RViC~ Oj¥1~ 825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) 343-4744 Legal Description: Health Authority Approval Checklist 050 - z 8~ - *~'a A. WELL DATA Well type {)&14Prt'E. If A, B, or C, attach ADEC letter. ADEC water system number II Log present (~N) ~'~$ ,: ; ,..~L Date Completed Total depth 1 7-~ I Cased to I ;Z ~ I Casing height (above ground) Sanitary seal (i~l) ~/E-~ Wires properly protected ({~)N) i sm'_+ Date of test Static water level Well production FROM WELL LOG AT INSPECTION I g.p.m. ~ °/"/ g.p.m. WATER SAMPLE RESULTS: Coliform (:~ Nitrate /. ~-~-' m.(~/~ Other bacteria / 0'~::~ Date of sample: 'Z/'2./q ~ Collected by: J~.~ Date in~ ---. ~ .-..-_ ~anouts (Y/N).~ Foundation cleanout (Y/N) D~ High water alarm (Y/N) ____ DateJ3~a~J~~~~~P ~er ABSORPTION FIELD DATA ~,~,eW~Wt u~ll'r'~ ---~b,/F_lf~ Effective absorption area ~ssion over field (Y/N) ~,~',; ;fepth in absorp~~ ,mrnediate,~):~_ iedr°oms Flu~ (ins) Minutes later: ~ .Absorption rate = g.p.--'ttL--~ Peroxide treatment (past 12 months) (Y/N) If yes, give date B. SEPTIC/HOLDING TANK DATA em 72-026 (Rev. 3/96)* D. LIFT STATION F. High water alarm level at* SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /'~/~ Absorption field on lot ~/,~ Ioo I On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station Public sewer main Sewer/septic service line SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ~ ~-~~'/~~~ Water ma~ Surface water/drainage SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Pv{~ClC_ Property line Building foundation Surface water Curtai n.0._~ Water main~ ENGINEER'S CERTIFICATION ) I certify that I~d~i~l inconforma/ce~.th~~~guid, Signature I //7///'# '" t ~ Engineer's N~/~. ~ Date 2../ ~/~ Pr!~,.',,'~wa~"~'~/vehicle storage area Wells on adjacent lots .Id inspections and review Iines in effect on this date. ;terns are Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* AI.ASKA WATI:~'.R &; WASTEWATER CONSLTLTA~TS, INC. 7320 EAST CHESTER HEIGHTS CIRCLE * ANCHORAGE. ALASKA 99504. * PHONE: 337-6179 FAX: 338-324.6 WELL FLOW TEST DATA LEGAL DESCRIPTION: L-.o'T' ~. '.. ~ ~co~c.~ ~,~.~"r.5 . STREET ADDRESS: ~ OD ~ ~ c~/~,~oo ~ ~ CUENT: ~-¢P -t., O~l~ ~"P'cc=~J PHONE NUMBER: NUMBER OF BEDROOMS J-~ F.H.A. - FOUR~/HOURNo FLOW TEST: '~, ur=.~suarua~rs TEST DATE START ~/'z.'l "~"~ TEST DATE END [ t q "'--'~"---"__ WELL DEPTH (PER WELL LOG)i i'"2.~I CASING DEPTH (PER WELL LOG): {'7~'~ ...- '"'--'"" CASING HEIGHT (ABOVE GROUND): t~'t' ~ DEPRESSION AROUND WELL: YES /(~ FLOWRATE WATER LEVEL TIME METER READING (G;P.M.) (BELOW TOP OF CASING) DRAWDOWN io'.~-'~ ~ ~3oo STATIC = [c,~'~ COMMENTS: 33' ~dlCK ¥~ ImprOvement& on the ~allawln~ dlacrlbe4 [Oll~l~tl of rt~ord, oth~ ~th~fl thoB8 T-880 P.O,/OS F-8~8 S~npl~ Rem~ks: Client FC~ Printed Date/Time 02/05199 ~. 1:23 Collected Date/Time 02/03/9~ R~eived Date/Time 02/03/99 t7:15 Technical Director: Stephen C. Q.lO0 mg/L MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA # GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: -'~ '" TYPE OF WATER SUPPLY: Fn-d[v-i d U-a I well .......... ~, ~ Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. ...... 4;- -TYPE OF WASTEWATERDrsPosAE'.'- .......................................... Individual on-site NOTE: Holding tank Community on-site Public sewer ./'~' ~ 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 STATEMENT OF INSPECTION BY ENGINEER 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 application 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. David R. Dayton P.E. Name of Firm ~'~,, ,,---,-- ,-- Phone ~ Chugiak, Alaska 99567 Address ,// ..;.~)~..?/./-/, -,// Engineer's signature ,C.~,.,~-,~ ./,~, ,;~ -~- '~/~_/(~.,.z~_ Date ///~ ~:'/~'~ J-- DHHS SIGNATURE ~ Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage 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 requi[ements...Employees, o~'J~l-J~S dor~ot ..... 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. 72~25 (Rev. 1/91) Back MOA ~21 Municipality of Anchorage ~ Department of Health & Human Services HEALTH AUTHORITY APPROVAL, CHECKLIST Legal Description: L.c,'~- ~-- ,~~ ~-/4H'I~ Parcel I.D. ~.,1,~) -~_...~- ~.~ A. WELL DATA Well type Log present (Y/N) Y Total depth Sanitary seal (Y/N) y Date of test Static water level Well flow Pump level If A, B, or C, attach ADEC letter. ADEC water system number Date completed ,.,47// ~,/ ,?' ? Driller A ~/,-- ~/~.L~ Cased to ! ~ Casing height [ ~" '-'"' Wires properly protected (Y/N) FROM WELL LOG g.p.m. SEPARATION DISTANCES· FROM WELL TO: Septic/holding tank on lot Va ~u~ Absorption field on lot /I~ ~v~r Public sewer main 7~,~ Sewer service line ; On. adjacent lots ~'~' ; On adjacent lots ~ / 430 Public sewer manhole/cleanout ~4:3~ ~7~- Petroleum tank ,4,//~ WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) Nitrate Collected by:~'~--~- ' ' Tank size -, Foundation cleanout (Y/N) ComPar~tments · ~Depressi°n (Y/N) Alarm tested (Y/N) Pumper High water alarm (Y/N) Date of pumping SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line On adjacent lots Absorption field Foundation Water main/service line Surface water/drainage 72-026 (Rev, 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA ,,1////./ Date installed Length Width Total absorption area DePression over field (Y/N) Results (pass/fail) Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Surface water Soil rating Gravel thickness Cleanouts present (Y/N) Date of adequacy test System type Total depth 'for Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot On adjacent lots If yes, give date bedrooms Property line To building foundation On adjacent lots ~Cutbank Surface water Curtain drain E., ENGINEER'S CERTIFICATION To existing or abandoned system on lot Water main/service line Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. David R. Dayton P.E. 20210 Donalar St. Engineer's Name ~'~~~~ Date '/' ~/ -/~ ~-~ HAAFee$ /'~ Date of Payment / ~/~-'~' Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number D. R. DAYTON, P.E., R.L.S. ~l~xX~]~]~T~]~ Chugiak, Alaska 99567 20210 Donalar [907] ][~[t~~ 696-2417 January 14, 1993 WELL FLOW TEST Legal Description: Lot 2, Angela Heights Subdivision Date of Test: January 13, 1993 Static Water Level: 97 ft. below top of casing. Depth of Well: 128 ft. below top of casing. Requirements: 150 gallons per day per bedroom - 450 gallons per day Test: The well was pumped for 2 hours at 6.6 gallons per minute with a drawdown of 1.8 ft.. Total water pumped was 797 gallons. Results: The well is currently producing adequately for a three bedroom home. 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 ~'.~ -3~ - ~ NAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 2, Angela Heights T 14 N , R 2 W , Sec. 12 Location (address or directions) 10021 Chickaloon St. (b) Property owner VA Mailing Address 235 E. 8 th Ay. (c) Lending Institution n/a Mailing Address Telephone:(home) Anchoraqe AK. Telephone n/a Business 561-2488 (d) Real Estate Company and Agent Coldwell Banker Bob Martin Address 4105 Tudor Centre Drive~. Anchorage.. ~_K. 99508 Telephone 561-2488 (e) Mail the HAA to the following address: (or check here I~, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Number of bedrooms Single-Family [] 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 '~pOM s,Jeeu!§ue i~uo!sse~oJd eq~, u! suo!ss!wo JO sJoJJG JOlt elq!suodsaJ lou s! e6eJoqouv jo ~l!l~d!o!unlAI eql 'penss! s! eleoy!lJeo B eJo~eq BleP ezXl~Ue Jo suo!loedsu! lonpuoo lou op SHHQ ~o see/~oldUJ~l 'slueuaeJ!nbeJ ei~ls pu~ I~Jepe~ u!~lJeo ~s!~,~s o~ JepJo u! suo!lnj!lsu! §u!puel J!eq~ pue sewoq ~o sJes~qoJnd ol ~sejJnoo e s~ s!q~ seop SHHa eqj. '~tS~lV ~o e3~lcj eqi u! peJels!~eJ Jeau!§ue i~uo!sse~oJd luepuedepu! u~ Xq eAOq~ S qdeJSeJed u! ue^!6 suo!l~jueseJdeJ eq~ uodn XlUO pes~q pel~oWJeo I~AoJddv ~l!Joqin¥ q31~eH senss! (SHHQ) seo!^Jes ueuJnH pu~ qll~eH ,to lueLulJ~dea e§l~JOqOU'¢ ~O Xl!l~d!o!un~ eq.l_ leUOp,!puoo le^o~ddv I~UOR!puoo )o suu~e/ peAo~ddes!Q ~ pe^o~ddv ~q SLUOO~peq ~ ~0~ pe^o~ddv 'lYAOl:lddV SHHQ '9 euoqdele£ ~6~8Z/_ X08 '0 'd SB91A~FiS 9NIIJq]NIgNB EI3AIEI 3'19V] sseJppv MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 Legal Description: A. WELL DATA Well Classification ,,~r, ,~,~ Well Log Present (Y/N) Y' Date Completed Total Depth /.zg' Cased to /.,zg Static Water Level ~'? / Casing Height Above Ground /..Z" Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: 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 ~,/-,~-'.,-,-.-, --- If A, B, C, D.E.C. Approved (Y/N) "~/~ Yield Depth of Grouting ///4 /~/~ ~,,~ ~..r,,5~ Pump Set At //o~ ' ¥-~'.-,,.--, Sanitary Seal on Casing (Y/N) )/ Depression Around Wellhead (Y/N) ; On Adjoining Lots ""/,'¢ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ;Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) No. of Compartments Air-tight Caps (Y/N) Foundation Cleanout (Y/N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/Service Line To Stream. Pond. Lake or Major Drainage Course Comments To Building Foundation To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Type of System Design Length of Field Depth of Field Square Feet of Absortion Area Depression over Field (Y/N) 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, Parking Area, or Vehicle Storage Area Comments Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutback (if present) 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 guid.eli?es ih effect on the date of this inspection. -;' ':: .... ~, ' ~ ~ Signed Company Eagle Riv0r Endneerin_~ P. 0. Box 773294 Date /;z/~./,¢-~ Ea~lle River. Al( 99~;77 694-5195 MOA No. ,¢,r Receipt No. Date of Payment Amount: $ Receipt No. Waiver Fee: $ 72-026 (Rev. 7/88) Back Date of Payment Page 2 of 2 Client ~cct ; E~GL£hP Sp~clal Instruct: ?~re~ete: ?e~t~d ~esult Onlts Met~ ~t~te ge:~pl~ ~.OUiIN~ S~.KPLE. ~k~LE COLLECTED ~D~ ~ona D~t~c;~ "See 5anple =' -- ' ~ DATE RECEIVED ~ INSPECTION APPOI NTM ENTS ~TIME TIME TIME DATE DATE DATE ~..~ __ ~ II~ISPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & I DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTi!~tiRONM~NTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 MAY ENVIRONMENTAI. SANITATION DIVISION Telephone 264-4720g~k~ ELJ~VEsED DIRECTIONS: Complete all parts on page 1. Incompleta raquests will not be processed, Please allow ten (10) days for processing. 1. PROPERTY OWNER j PHONE Ronald and Jesstca MunsonJ 694-9831 MAILING ADDRESS 103 Chickaloon PROPERTY RESIDENT (If different from above) PHONE 2, BUYER PHONE Ernesttne B. and Michael Geter 561-0388 MAI LING ADDR ESS 1300 W. 47th Ave. Anchora~e~ Alaska 3. LENDING INSTITUTION J PHONE National Bank of AlaskaJ 265-2785 ~r thern Lights (~/ 4. REALTOR/AGENT J PHONE Charlotte Schnteders listing agentJ 694-3626 MAILING ADDRESS Dyanmtc Realty Inc. P.O. Box #677 Eagle River, Alaska 5, LEGAL DESCRIPTION Angela Heights Lot 2 STREET LOCATION Second house on right on Chickaloon off Eagle River Road 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four [] SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six 7. WATER SUPPLY /~ [] INDIVIDUAL* ~~ * ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) [] Other 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTI LITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] IN DIVI DUAL/ON -SITE · .. /77 PUBLIC UTILITY Connection Verified []Septic Tank or [] Holding Tank Size: If Tank is homemade give dimensions: [] ONE [] TWO PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line NUMBER OF BEDROOMS [] THREE [] FIVE [] FOUR [] SiX [] OTHER Septic/Holding Tank IAbsorption Area ISewer Line Nearest Lot Line 5. COMMENTS DATE I~;~"~APPROV ED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79) 4881 SOLD ~y 5H320 KEEP THIS SLIP FOR REFERENCE :' - ' ' MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE ~-~.~ DEPARTMENT HEALTH ENVI PROTECTIOI~EPT. OF HEALTH '& OF & RONMENTAL ~/~q ~ ~ j~ 825 L St.et - ~,chora~, Alaska 99501 ENVIRONMENTAL P~OTECTION ~ Telephone 2~.4720 DIRECTIONS: Complete all pa~s 0n page 1. Ineompl'et~ requ~ will net~ proc~d, Please allow ten (10).days for Processing~ h' PROPERTY OWNE~ ......... . J PHONE " MAILING ADDRESS ' ~ ' ' ' PROPER~Y ~ESIDENT (If differefl~from above) - - / ~HONE ' ' ' ' PHONE ' ~ .... 2, BUYER MAILING ADDRESS 3. LENDING INSTIT6tlON .... ; J 'PH~'N~" MAILIN~ADDRESS _. / / - 4, REALTOR/AGeNT ~ '' P~bN :' M~ILiN~ADORESS " STREET LOCA~I'I ON 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS ' .I SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUPI~LY~ .... INDIVIDUAL* COMMUNITY [] PUBLIC UTILITY 8. SE~/AGE DISPOSAL S'YSTEM " [] INDIVI DUAL/ON-SITE** PUBLIC UTILITY [] One J~ Two [] Five [] Three [] Six ATTACH WELL LOG. A well log is required for all wells drilled Since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required by this Department, [] Four [] Other NOTE': THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72~)10(3/78) THIS SIDE FOR OFFICIAL USE ONLY TIME INSPECTION APPOINTMENTS TIME DATE RECEIVED TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE [] SINGI'E FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVI DUAL/ON -SITE []PUBLIC UTILITY Connection Verified I--'lSeptic Tank or [] Holding Tank Size: If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line NUMBER OF BEDROOMS [] ONE' [] THREE [] FIVE [] TWO [] FOUR [] SiX PERMIT NUMBER DEPTH OF WELL DATE DRI L.LED LOG RECEIVED PERMIT NUMBER DATEINSTALLED INSTALLER SOl LS RATING MANUFACTURER MATERIAL [] OTHER Septic/Holding Tank .IAbsorption Area ISewer Line INearest Lot Line 5. COMMENTS [] DISAPPROVED IDATE APPROVED FOR ~- BEDROOMS CONDITIONAL APPROVAL (letter must accompany certificate) BY (Title) ~~ MUNICIPALITY OF ANCHORAGE DEPARTMENq F HEALTH AND ENVIRONMENTA PROTECTION 825 L Street, Anchorage, Alaska 99501 279-2511, ext. 224 or 225 Date Received: August 4, 1977 #1: Time Date Insp Time # 3: Time Date Date Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Institution Request: Mailing Address: Phone: Property Owner: Mailing Address: 3. Legal DesCription: Phone: Lot ~ Angela Heights Subdivision 4: Single Family Residence: ( ) Multiple Family Residence: ( ) Number of Bedrooms: Number of Bedrooms: Well System: Individual Well ( ) Community/Public System ( ) Permit # 7719~ Depth of Well Well Log on File (x) Construction Bacterial Analysis Sewage Disposal System: Permit # Septic Tank Size Absorption Area On-site System ( ) Public Utility Installed Installer Manufacturer Soils Rate Material Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line MUNICIPALITY CF -, MUNICIPALITY OF ANCHORAGE i~!~PT, C.'..F //?'"~"":~, D(-partment of Health and Environmental p~'~'~'~L /[~~ ' 825 L Street, Anchorage, Alaska 99501 ..... Request for Approval of Individual Sawer andl%L~..'. ~._~~.~[~ 1. Property Owner: Mailing Address: Phone: Name of Buyer: Mailing Address: Phone: Lending Institution: Mailing Address: Phone: Realtor/Agent: Mailing Address: Phone: Legal Description: Street Location: Single Family Residence: ( ) Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: Water Supply: *Individual Well ( ) If Individual Well, well depth If Community System, name of system Sewage Disposal System: On-site System If On-site System, date of installation: Public/Community System ( ) ( ) Public System ( ) *NOTE: A well log is required on ALL wells drilled since 6/75. 3/77 ~Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: L~t ~ Angela Heights Subdivision Comments: Affadavit Attached: ' (~ Letter Attached Approved: Date: Disapproved: Date: Department Worksheet: