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Home My WebLink AboutBENITO BLK 3 LT 102: 0 0 0 0 0 0 0 0 0 0 0 0 0 ~o DonaI~V. Soo~ ~411 Rangeview Lane Anchorage, Alaska 99504 On August 13, 1975 you took out a well permit £rom thia department. Since Ben, ~his office has been unable to~on~c~ you by tele~h~andhae ~ceive~ ~o X~£or- marion .£romyou An ~he form of &well log to ~Acate the well was drilled. It is t~is ~epartment's poll~y that wel~ ~rmitm are office at 279-2511, o= oom~ i~to our of£io~e at 825 L S2reet~ Fourt~ Floor Wes2. Pr£ncipalEnviro~mental Control Officer ~ ~rEaTer ANCHORAGE Area BOROUGH /~/Y~/~IFIIII~'~.'~'~ ~ DEPARTMENT OF ENVIRONMENTAL QUALITY LERMIT_NO.~ . t=ztt]llnll~lll 77~ ~ TELEPHONE 274-456 ! ~ _ NAM~ OF MAILING AD ~ TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH TO BE INSTALLED BY BOIL TEST RESULTS NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION, SEPTIC TANK SIZE TYPE SEEPAGE AREA SIZE TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE Pit DRAIN fIELD SEPTIC TANK TO SEEPAGE PIT WALl SEPTIC TANK , seEPAGE Pit .,DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TaNk _ SEEPAGEP,T DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PiT DRAIN FIELD SEPTIC TANK, ., SEEPAGE PIT DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL, 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. ",,,, GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G OR LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE DESCRIBED SYSTE~ IS IN A~[::CORDANCE WITH SAID CODE. ~EEA ~OEOUGH OEDINANCE NO, 28-68 AND THAT THE ~BOVE 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. # c~'o CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING - ~"7 ~. -/ '~ NAA# ~ ~,C'~L~-ii~-~ GENERAL INFORMATION Complete legal description Lot 10; Block 3; Benito Subdivision Location (sit~ address or directions) Property owner Mailing address Lending agency Mailtng address Virginia Bryant 17246 Foothill Drive Eagle River, AK C/O Remax of Ea~le River 16600 Day phone Centerfi~ld Dr. Eaqle Day phone Agent Address Day phone AK w Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 6 TYPE OF WATER SUPPLY: Individual 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. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX 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 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 S & S ENGINEERING Phone ~'"1 ¥ ~ ~-~1 ? ~/ 17034 Eagle River Loop Road No. 204 Address Eagle River, Alaska 99577 ,,,, Engineer's signature "~J~. ~ Date ~7/,~o/~ DHHS SIGNATURE X Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date L~ '-/2 - ~[ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approvai 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 #21 'MUNICIPALITY OF ANCHORAGE ~NVIRONMENTAL ~E/tYlC~ DIVISION JUL Municipality of Anchorage J VED Environmental Services Division . 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority APproval Checklist Legal Description:Z~mZ' /0/ /3~/-,a£d' g A, WELL DATA Parcel I.D.: Well type/°~-~AF~ If A, B, or C, attach ADEC letter. ADEC water system number Log present (~N) ~'~"--(' Date completed Total depth //0 ~ / Cased to ,~"~ / Sanitary seal {~N) Y'~'~'"~ Casing height (above ground) // / ~ Wires proPerly protected ~C~/N) ,Y~' ~ FROM WELL LOG AT INSPECTION Date of test ,/ Static water level Well production WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate /, ~ ~/ B. SEPTIC/HOLDINGTANK DATA ,/c/./~. Date installed Tank size Foundation cleanout (Y/N) Date of Pumping '~ C, ABSORPTION FIELD DATA Date. installed Length .Width Effective absorption area "~ ~'/~ Other bacteria Collected by: ..(' /~,,v'~ Number of Compartments Depression (Y/N) g.p.m. Cleanouts (Y/N) j High water alarm (Y/N) J Pumper Soil rating Ora~~ below pipe ~ Tube present (Y/N)' ~ Results (pass/Fail) Date of adequacy test Fluid depth in abso~e test (in.); Immediately after Fluid depth ~ (ins) Minutes later: Pero~~ment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* (g.p.d./ft~ or fF/~ Total depth Depression over field (Y/N) For Absorption rate = If yes, give date bedrooms gal. water added (in.): g.p.d. D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm .[evera~. _~ed ~ level at* "Pump off" level at* *Datum 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 On adjacent lots On adjacent lots .,4,/, ,,~, Public sewer manhole/cleanout Lift station ,,'/./. ,-~'. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: ~ SEPARATION DISTANCE FROM ADS--TO: Property line .~:nTding foundation Water main/service line .Surface water ~ Driveway, parking/vehicle storage area ~ drain Wells on adjacent lots HAA Fee $. Date of Payment Receipt Number ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review cf Municipal records th~{~~tems are Engineers Name ~0~t. Aw d~ ~~ ~ ~O~E'~ ' '"" '~.¢0WAN /~ Date 7 / ~o /, ~ t¢2, C~-~0~ ,":~ g Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* · 07/26x96 16:49 CT&E ESI ANCHORAGE ~ 90?6941211 N0.354 Q03 CT&E Environmental Services Inc. Laboratory Division ~f,e~P'J,~',e',~',~'~P',~P~',~'f~'~',e',~,P',e',e'fl 200 W. Potter Drive Anchorage, AK 9951 8-1605 Tel: (907) 562-2343 Fax: (907) 561-5301 CT&E Ref.# 963116001 Cllem Nmne S & $ Project Natant ~/A Client Sample ID L, 10, B, ~, Be~to Sub. Matrix Dfi~ Wate~ Ordered By ~S~ PWSID 0 S;unpl~ R~mm'ks: Client PO# Printed Date/Time 07/26/96 08:40 Collected Date/Time 07/22/96 15:40 Received Date/Time 07/22/96 ].6:5.5 Technical Director ALLowabLe Prep AnaLysis Parameter ResuLts PQL Units Method limits Date Date Nitrete-N 1.36 0.100 mg/L EPA 353.2 07/23/96 EMS Nitrite-N 0.100U 0.100 mg/[ EPA 353.2 07/Z3/9~ ~MB Total CoLiform 0 0 coL/100mL SH18 92228 07/22/96 TAV ~~ Member of the $G$ Group ($oGiet~ GSnbrale de Surveillanoe) .. ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA. FLORIDA. ILLINOIS. MARYLAND. MICHIGAN. MISSOURI. NEW JERSEY. OHIO. WEST VIRGtNI& ,7''" r, ~', ., DATE RECEIVED INSPECTION APPOINTMENTS ~, / ~IME TIME TIME ~,.~ DATE DATE ~ ~- DATE 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL P~OTECTION ENVIRONMENTAL SANITATION DIVISION APR 3 1981 Telephone 264~720 DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be proceed. Please allow ten (10) days for processing. 1. PROPERTY OWNER ~ I PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYE'R PHONE MAILING ADDRESS ~ / / . / 3. LENDING INSTITUTION ' ' ~, / / ~ PHONE MAI LING ADDRE88 4. REALTOR/AGENT ~ / I PHON~ MAI LIN ~AD DR ESS _ 5. LEGAL DESCRIPTION STREET LOCATION 6, TYPE OF RESIDENCE NUMBER OF~BEDROOMS ~ SINGLE FAMILY [] One [] Four [] Two [] Five [] MULTIPLE FAMILY [] Three D~] six WATER SUPPLY INDIVIDUAL* []COMMUNITY []PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** ~ PUBLIC UTILITY [] Other * ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) 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 UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVI DUAL/ON -SITE []PUBLIC UTILITY Connection Verified [] Septic Tank or []Holding Tank Size: If Tank is homemade live dimensions: NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOl LS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL Septic/Holding Tank 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line Absorption Area [Sewer Line [] OTHER Nearest Lot Line 5. COMMENTS DATE [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVEDBY ¢ ~ 72-010 (Rev. 6/79) MUNICIPALITY OF ANCHORAGE Department of Health and Environmental 825 L Street, Anchorage, Alaska 279-2511, ext. 224, 225 tAUNiCIPA!.IT'{ CF AN(?I IORAGE l' l:P'h C,I- i i:., ,!,il, Protection 99501