HomeMy WebLinkAboutBENITO BLK 2 LT 6
by
A & L DRILLING COMPANY
BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE694-2588
OWNER OF LAND t~}
ADDRESS
LEGAL DESCRIPTION L ~
DATE-Started ~' O/~? ~'/~'d, Ended
' / /
PERMIT NUMBER '7_~ ~ 0 G
/ '!
DEPTH OF WELL
STATIC LEVEL OF WATER FT.
DRAW DOWN FT. tad
GALS. PER HR
K,ND OF caSING
7?
KIND OF FORMATION:
From O Ft. to /~'~' Ft.
From /5~' Ft. to ~ Ft.
From 3f~~ Ft. to 7._~ Ft.
From '~.] Ft. to ~'~'(~ Ft.
From q4 Ft. to /O~ Ft.
From__Ft. to.__Ft
From Ft. to Ft.
From__Ft. to.__ Ft,
From__Ft.
From__Ft. to.__Ft.
From__Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
From.__.Ft. to.__Ft.
From Ft. to.__Ft,
From__
From
From~
From
From
From
From
From
From
From
From
From
From
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.
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Ft. to Ft
Ft. to Ft
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__Ft. to Ft.
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MISCL. INFORMATION:
DRILLER'S NAME /~c,,,{,/~' "
F'ERM i 'T' NO.
~11_1[-~ l" C: I RI_ I TX OF RNC:F 'F-."RGE v , -
DEF'RRTMENT IL, r- HERLTH RNE:, ENVIRONHENTRL r~OTECTION cd- ~"7 7
· -"._ it[."[ E. TI .... IDFIR RD.., ANCHORAGE., RK.
L,~ELL F'E F~."£'1 ~ T'
RPPL t CAN']"
LOCRT I ON
LEGAL.
_E~DNAR[:, M NORMAN
LE; B;~:.' BEN I TO
P, O,
BOX 588 EAGLE RIVER AK E194-git44
LOT SIZE le~4e~8 SLt!UARE: FEET
MINIMUM DISTANCE BETWEEN R WELL. AND ANY ON-SITE SEWAGE DISF'OSRL SYSTEM IS
iOE1 FEET F'OR A PRIVATE NELL OR 288 FEET FOR A PUBLIC WELL.
WELL LOGS ARE REQUIRE[:, AN[:, MUST BE RETURNED TO THE DEPARTMENT WITHIN ~:0 DAYS
OF' THE NELL C:OMPLETION.
SPECIFICA]"IONS AN[:, CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER
I NSTRI_LAT I ON.
IF:' E: Fi.: r.1 I 'l' '..." A L I l::. F-- i"-i F.." iZi I',t E "r' E R F.: F IF;J: 131M I "__-% ~ I_l E:
I CER'I"IFY THAT
t: I AM FAMILIAR WITH THE REE~.UIREMENTS FOR ON-SITE SEWERS AND WELLS AS SE"['
FOR'I"H 8Y THE MUNICIPRLITY OF ANCHORAGE.
2: I WILL INS'['RLL THE SYSTEM IN ACCORDANCE WITH THE CODES.
......
':; I GNE[:, "__~
HFFLI[ HI'IT EE,WAF..[, J'l NIIRMHrJ
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
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)
Lot 6; Block 2; Benito Subdivision
Location (address or directions)
17215 Big Horn Circle, Eagle River, Alaska
(b) Property owner Hutchison
Mailing Address HC 2, Box 589,
Telephone · (home) 262-4260
Soldotna~ Alas ka
Business
Telephone
Telephone
(c) Lending Institution Commonwealth Mortqa,qe
Mailing Address Anchoraqe~ Alaska
(d) Real Estate Company and Agent RE/MAX OF EAGLE RIVER - Sharon Min,~¢h
Address 16600 Centerfield Drive, Suite 201, Eagle River, Alaska
694-4200
(e) 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 ENGINEERIN$/694-2979
17034 Eagle River Loop Road; S~.~Q. 204
Eagle River: Alaska 99577
2. TYPE OF RESIDENCE
Single-Family,~2[ Number of bedrooms 4
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
5. 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 end 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.
Telephone ~---~/--//.-- ~¢¢',2 ~
Name of Firm
Address
S & S ENGINEERtNG
17034 Eagle Riyer Loop Road No. 204
Eagle River, Alaska
Date
6. DHHS APPROVAL
Approved for ~ bedrooms by
Approved Disapproved
Terms of Conditional Approval
~,'///~ 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.
72-02S (Rev. 7/88) Back Page 2 of 2
~' ~~O~V~UNICIPALITY OF ANCHORAGE (MOA)
(~'-~ Health Authority Approval (HAA)
o~,~il~j~/ CHECKLIST - FEBRUARY 1984
~ ~ ¢, 343-4744
~,,b~(~,~-'~ '~'X'~Ob~ (,,~) LegalDescription: L...c>"T- (,~c~ '~z~.td._
A. WELL DATA
Well Classification ~)'~' [ ~ ~ ~J ~ t'~~~ If A, B, C, D.E.C. Approved (Y/N)
Well Log Present ~.~N) ~ Date Completed .~, c:>/"7 ~::~ Yield ~',~ ----~ "~
Total Depth ~,,,"~ Cased to l<::r~ Depth of Grouting "-'---' ~ -\ -
Static Water Level '"7'=1~ Pump Set At
Casing Height Above Ground {'~../~.-)r-' Sanitary Seal on Casing(~N)
Electrical Wiring in Conduit (Y/N) ~ Depression Around Wellhead (Y/I~ t',J
SEPARATION DISTANCES FROM WELL: !
To Septic/Holding Tank on Lot ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot 14//~ ; On Adjoining Lots
To Nearest Public Sewer Line P)~ ~"O~''('' To Nearest Public Sewer Cteanout/Uanho"l~ee'~ ~"c~'..~
To Nearest Sewer Service Line on Lot'~'''~-
Water Sample Collected by ~ ~. ~'~ ~"1~ 1~~ ~' ; Date ~ [ - ~ ~
Water Sample Test Results ~~'-~, ~ ~'~'~-~-'~--~ '- ~ '~ ~ ~
Comments'
B, SEPTIC/HOLDING TANK DATA
D~ed Size No, of Compartments
Standpipes ~ Air-tight Caps (Y/N) __ Foundation Cleanout (Y/N)
Depression over Tank ('~....,~,,......~____ Date Last Pumped ___________
Pumping/Maintenance C~ntact on ~__; for ____
Holding Tank High-Wate~ Alarm (Y/N) Temporary Holding Tank Permit (Y/N) _
SEPARATION DISTANCES FROM SEPTIC/HOLDING TA~
To Water-Supply Well. __ To Building Found~....~__
~ PwraOtPe~ rtMYa~;e rv ice L~n e To Disposal Field~
To Stream, Pond, Lake. or Major Drainage Course
Comments ~"~ 0 J~, C-.~ 1~'"~
72-026 (Rev, 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
So' s~l~ating in Absorption Strata Type of System Design
Date Ins~__ __ Length of Field __ __
Width of Field -'"---.._ Depth of Field __ __
Gravel __ __
Bed
Thickness
Square Feet of Absortion Area -'"--..._ Statndpipes Present (Y/N)
Depression over Field (Y/N) __~ Da~ Adequacy Test
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well .... To Property Line
To Building Foundation .... To Existing or Abandoned Sys't~n
Lot ; On Adjoining Lots
To Water Main/Service Line
To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Park. ing Area, or Vehicle Storage Area
Comments
D. L'i~TATIO N
Date I~ Dimensions
Size in Gallons'"'--.. Manhole/Access (Y/N)
"Pump On" Level at~'~'~- "Pump Off" Level at
High Water Alarm Level at ~ Vent (Y/N)
Tested for ~ g Cycles during Adequacy Test.
Meets MOA Electrical Codes (Y/N)
Comments ~~
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines
inspection,
Signed 5 & S ENGINEERING
17034 ~agie ~iv.r L~p
Company Eaale River~ Alaska
//
MOA No. ~ /
Receipt NO. ~ 0 F? ~ ?b Receipt NO.
Date of Payment
Waiver Fee: $
/ ? ~ C,~ C-~) Date of Payment
Amount: $ [ ~-
72-026 (Rev. 7/88) Back Page 2 of 2
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343
FEDERAL TAX I.D. #92-0040440
ANALYS!S RE?ORT B! SABLE foe Work Ordex ~ 26073 Date Repozt P~lnted~ AUG 6 90 @ 13:19
Client Sample ID:L6 B2 BE~ITO S/D
PWSlD :UA
Collected AU$ I 90 t 16:50 hrs.
~eoe~ved AUG 2 90 e ~6:~5 hrs.
Preserved w~th :AS REQUIRED
Client
C!xent
~eq #
Analysis Completed :AUG 3 90 Send Reports to:
Labo=atozy Supervisor :STEPHEN C. EDE 1)$ & S ENGINEERING
I~tzuct:
Chemlab ~ef ~: 902800 L&b'Smpl ID: ! Matrix; WATER
Allowable
Paramete~ ~ested Result Uruts Method Llmts
NITRATE-N 1.4 mg/1 EPA 353.2 10
Sample ROUTINE SAMPLE.
Remarks: SAMPLE COLLECTED BY RJS,
i rests Performed ' See Special Instructions Above UA-Unavailable
VD- ~one Detected "~ee ~a~ple Rea~ks ~b~ve
NA- Not Analyzed lT-Less Than, GT-Greate~ lhan
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 COMPLETED BY WATER SUPPLIER
[] PUBLIC WATER SYSTEM I.D.#
.,~RIVA, TE WATER SYSTEM
Name Phone No.
Mailing Address
_~'~ L4_~.~ ¢~21~ /State Zip Code
City
Mo. Day Year
SAMPLE TYPE:
)~Routine
[] Check Sample (for routine sample
with lab ref. no. .) [] Treated Water
[] Special Purpose [] Untreated Water
SAMPLE Time Collected
TO BE COMPLETED BY LABORATORY
SatiS shows this Water SAMPLE to be:
isfactory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be~over 30 hours old at examination
to indicate reliable results. Please send
new sample vta special delivery mail.
Date Received oc''-. 2.-/~ iD
Time Received
Analytical Method: Membrane Filter
* No. of coloniesll00 mi.
Lab Ref. No. Result* Analyst
NO. LOCATION
31 :;;: I I I~
41 I I II--~
51 t I Ir-T-~
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
BACTERIOLOGICAL WATER ANALYSIS RECORD
Membrane Filter:. Direct Count
Verification: LTB.
TNTC = Too Numberous To Count
OB = Other Bacteria
Collform/lOOml
Final Membrane Filter Reeulta Collform/lOOml
Reported By<~~~L~~
,' ~ ,,
· , DATE RECEIVED '
INSPECTOR INJ~JCTO~ INS~JCTOR ~ ,
~U~ICI~ABITY OF A~C~O~AGJ
~ ~ 825 L Street - Anchorage, Alaska 99501
~! ~/ ENVIRONMENTAL SANITATION DIVISION
.~ Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts o~ page 1. Incomplete requ~ will not be pro=~d, please allow ten (10) days for processing.
1. PROPERTy OWNER _ i PHONE
MAI LIGG, A DDR ~S~/
PROPER~Y RESIDENT (If different from above) PHONE
2. BUYER . . ' ~ -- PHONE
~AI LIN~ ABDR~SS
~AILIN~ ~OR~SS '
MAILING ADDRESS
5. LEGAL DESCRIPTION
STREET LOCATION
6. ~V'PE/'OF RESIDENCE
SINGLE FAMILY
[] MULTIPLE FAMILY
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTI LITY
NUMBER OF~BEDROOMS
[] One ~ Four [] Other
[] 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.)
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE**
~ PUBUC 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)
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY
[] INDIVIDUAL
[]' COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. $'EWAGE DISPOSAL sySTEM
I-q INDIVI DUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Septic 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
5. COMMENTS
THIS SIDE .FOR OFFICIAL USE ONLY
NUMBER OF BEDROOMS
[] ONE [] THREE [] FIVE []
r
OTHER
[] TWO [] FOUR [] SiX
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE I NSTAELED
'INSTALLER
SOILS RATING
MANUFACTURER
MATERIAL
Septic/Holding Tank Absorption Area lSewer Line ~ Nearest Lot Line
I
I
~PPROVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE
72-010 ( Rev. 6/79)
INDIVIDUAL
UTiLiTY
Municipality of Anchorage
DEPAR!, ~NT OF HEALTH & ENVIRONMENTAL Pk ;ECTION
POUCH 6-650 ANCHORAGE, ALASKA 99502
279-2511
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. TYPE OF LOAN ~ 2. ASSESSORS PARCEL NUMBER
[] VA [] F.H.A. [] CONV []
I
3. LENDING INSTITUTION 4. REALTOR OR AGENT
5. SELLER 6. BUYER
Ed Norman ,i :~;? ,i
Eagle River, 99577
7. LEGAL DESCRIPTION 8. LOCATION/STREET ADDRESS
Lot 6 Block 2 Benito Subdivision See directions attached.
9. TYPE OF DWELLING 10. WATER SUPPLY 11. SEWAGE DISPOSAL SYSTEM
[] SINGLE FAMILY RESIDENCE BDRMS [] PUBLIC UTILITY [] PUBLIC UTILITY
[] MULTI-FAMILY RESIDENCE~ BDRMS [] PRIVATE ON-SITE [] ON-SITE
YEAR INSTALLED
INSTRUCTIONS TO REOUESTOR
1. Complete Items 1 to 11 above 3. Send to address above 5. Response will be returned to lending
2. Remove the carbon 4. Please allow 10 days for processing institution
DATE RECEIVED DATE OF INSPECTION TIME OF INSPECTION INSPECTOR
June 6, 1977 June 8, 1977 2:30 p.m. Pratt
TYPE DEPTH YEAR DRILLED PERMIT REFERENCE
..J
-~ FT.
UJ
~ CONSTRUCTION BACTERIAL ANALYSIS LAB REFERENCE NO.
YEAR INSTALLED INSTALLER TANK SIZE MANUFACTURER
~ DIMENSIONS CRIB CONSTRUCTION
[]
~ TOTAL LINE LENGTH TRENCH DEPTH GRAVEL DEPTH
~ ~ DISPOSAL
~ FIELD
~ FT. FT. FT.
TOTAL ABSORPTION AREA ~ PERMIT REFERENCE
SQ. FT.
72-010 (11/76)
ILl
SEPT, C TANK IA, ~RPT~ON AREA
WELL
TO:
I
iI sE~TIc TANK I ABSD.PTION AREA
FOUNDATION TOI ."~' ~
SEWER LINES.
IWELL _ ~
~OT LINES
ABSORPTION
SYSTEM 'TO:
OTHER
LOT L NE
[] APPROVED
[] DISAPPROVED
[] CONDITIONAL APPROVAL
[] UNABLE TO INSPECT
DATE INSPECTOR
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities
and these facilities are operating satisfactorily.
DATE SIGNATURE
Municipality of Anchorage
:DEPAR, ,-'NT OF HEALTH & ENVIRONMENTAL Pt, /ECTION
POUCH 6-650 ANCHORAGE, ALASKA 99502
279-2511
1. TYPE OF LOAN
[] VA
[] F.H.A.
LENDING INSTITUTION
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
~ [] CONV [] 1 2. ASSESSORS PARCEL NUMBER
I
4. REALTOR OR AGENT
SELLER
,~,, ?~ ~.i':~ .' Ed No:~'3tlan
/~1';~ ~ ~i, ~.:::~:~ Box 588
Eagle Rive
99577
7. LEGAL DESCRIPTION
6. BUYER
Lot 6 Block 2 Benito Sub~ivision
8. LOCATION/STREET ADDRESS
See directions attached.
9. TYPE OF DWELLING
', [] SINGLE FAMILY RESIDENCE BDRMS
*' [] MULTI-FAMILY RESIDENCE BDRMS
10.
WATER SUPPLY
[] PUBLIC UTILITY
[] PRIVATE ON-SITE
SEWAGE DISPOSAL SYSTEM
[] PUBLIC UTILITY
[] ON-sITE
YEAR INSTALLED
~YPE: DEPTH: DATE RECEIVED
--J
::: ';- ~;~%~ ~.;;,~0NSTRUCTiON BACTERIAL ANALYSIS DATE INSPECTED
,, 1977 June 8, 1977 3 30 p.m. P::att
:!::' !~;~ ~E A R IN STA L L E D I NSTA L L E R
~ SEPTIC TANK SIZE MANUFACTURER
~ DIMENSIONS CRIB CONSTRUCTION TOTAL ABS(~RpTION AREA:
~' [] SEEPAGE PITS:
L.LJ
¢/3 TOTAL LINE LENGTH
[] DRAINFIELD: "', so. FT.
I.__- SEPTIC TANK ABSORPTION SYSTEM WELL LOT LINE
C,~ ·
~ FOUNBATION TO: ABSORPTION AREA TO:
LI.I
[] DISAPPROVED [] UNABLE TO INSPECT ~- ~ Department of Health & Environmental Protection