HomeMy WebLinkAboutBERNARD BLK 3 LT 3Arnard
Block
Lot 3A
060- 3
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DOC CO. dba
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 * .......
~TTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipalit
Anchorage: Department of Health & Human Services and/or Department of Envimmental Conservation. MatSu Borougt
)epartment of Environmental Conservation.
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WATER SUPPLY PERMIT
Initial
Date Issued: Jun 22, 2004
Expiration Date: Jun 22, 2005
Permit Number: SW040212
Legal Description: BERNARD BLOCK 3A LOT 3
Design Engineer: 0000 None Required
Owner Name: BERNARD JILLY & DEBORAH HULL-JIL
Owner Address: PO BOX 771553
EAGLE RIVER, A 99577-
Parcel ID: 060-321-17
Site Address: 8130 STEWART MOUNTAIN DRIVE
Lot Size: 33139 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] SepticTank
[] Holding Tank [] Privy
[] Private Well
[] Water Storage
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 DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 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.
THE INSTALLATION OF A WATER WELL SHALL MEET ALL THE ANCHORAGE MUNICIPAL CODE 15.55.
PLEASE SEE THE ATTACHED SHEET "PERMIT REQUIREMENTS FOR A DOMESTIC WATER SYSTEM". IF
THERE ARE ANY QUESTIIONS PLEASE CALL THE MUNICIPAL ON SITE WATER AND WASTEWATER
PROGRAM AT 907-343-7904.
Receive
Issued
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak, us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
Permit Number SW
Property owner(s)'-~' ,:%o ,:.: ¢,~
Mailing address (1)
Mailing address (2)
Legal description (Lot, Block & Sub'd.)
Zip Code
Legal description (Section, Township & Range)
Lot Size '-~.
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Acres/Sq. Ft.
Number of Bedrooms
[] Well Only
[] Water Storage
[] Jacuzzi
[] Water Softening Unit
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signatu~re of propeCt'/~o/~n/er or authori~e~-C/~gen'~
Permit Fees:
Date of Payment:
Receipt Number:
(Rev. 12/00)
/~-~ Waiver Fees:
(.¢//7'/¢ H Date of Payment:
~?~? ~-/~,~, Receipt Number:
~ ~oer
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1 of 1 6/12/2004 12:26 PM
i DEPARTMENT' OF` HEALTH ~D EN~I,~'"MENTA~:~ROTECTi0~i
:~ ~ .~ ~' :': ~':~: DIVISION OFENVIRONME~TAL HEALTH'.
':[ :~ ~' . '~ .,~CERTIE!CATEOFINSPECTIO~EORHEA~THAUTHORIT~PPR0..:~.:~:~.:.
, ' ' . :. '. . '.:. . , -~ ~' OF ON-SITE SEWER AND WATER FACILITY
'~r ' ~, . .:'..' . ' .. 264-4720.'
,,~ (a).. Legal De~cnppon (include lot, block, subdw~s~on sect~on,:;,townsh~p,.range)..~..,
~:,, .~ Locabon (address or d~rect~ons) , .. '"~.?.?~ ' ,
(b) Applicant Name 3ohn Long Telephone: Home 69/4-4248 ' Business
Applicant Address S.R. 910_5 Hiland Rd.' Eagle River: Alaska 99577
(c) Applicant is (check ope): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain);
(d) Lending Institution Northland Mortgage Telephone 694-7872
Address 400 W. Tudor Anchorage, Alaska
(e) Real Estate Company and Agent Bob Wambolt, Totem Realty
Address
(f)
Telephone
MailtheHAAtothefollowingaddress:
Pickup by engineer
Other
2. TYPE OF RESIDENCE
'i ,Single-Family [] Multi-Family []
Number of Bedrooms ~
3. WATER SUPPLY
· :.'.i'~' '*" .'
tnd vidua Well [] Community [] Public [] ~:i,.'; .~.~·;;~i
,!!';'~'I' Note: If community wellsystem; must haye written ~fir'mati°~',fr'~m the State Dopartm°nt 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 co nfirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 -.
5;~''~ ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FILE SEARCH, DA. ~ AND INFORMATIoN ~r~ ~ ~ r
:'". ~iAs certified by my seal affixed hereto and as of the validation d~te 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 inspecti _n.
~.J~,l~ ~E~.Rt~.~FIEJ~IG I N E ER lNG SEBVICES ,
Name of Firm cam ,' ~,.~a Ay n~?? !Telephone
Address P. 0. BOX 773294
Date ~:~/~'/,~' & 694-5195
o
Seal
DHEPAPPROVAL ~ y ~~. ~' ~_
Approved for --'~ bedrooms b ~te
Approved ~ Disapprovc~l' Conditional ~/
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 m 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. -.
Page 2 of 2
72-025 (11/84)
WELL DATA
MUNICIPALITY OF ANCHORAGE (MO~I
HEALTH AUTHORITY APPROVAL (HAA)
WellClassification C/~s'~ '~"
Well Log Present (Y/N)
Total Depth Cased to
Static Water Level
Casing Height Above Ground
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
Cleanout/Man hole
Water Sample Collected by
water Sample Test Results
CHECKLIST - FEBRUARY 1984
264-4720
Legal Descr. iption:
MUNICIPALITY OF ANCHORAGE.
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
., o 'lg86
If A, B, C, D.E.C: Approved (Y/N)
Date Completed Yield
De ;)th of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed Size
Standpipes (Y/N) ,Y Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
No. of Compartments
,Y Foundation Cleanout (Y/N) A,/
Date Last Pumped ,..,T,, i.~
'for
Temporary Holding Tank Permit (Y/N)
To Water-Supply Well ~'.~o
To Property Line '/'/~"
To Water Main/Service Line
Course
To Building Foundation ~ /
To Disposal Field -~)-'? / ~,~. ~ ~"~'
To Stream, Pond, Lake. or Major Drainage
Comments
Page I of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed /
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/N) ,~/
Results of 'Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well 7",.L~
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 ~3 ~- /¢~J~'
Type of System Design
Length of Field
Depth of Field //'*'
Gravel Bed Thickness ~"
Standpipes Present (Y/N)
Date of Last Adequacy. Test
To Property Line ~-"'g
To Existing or Abandoned System on
; On Adjoining Lots ~',..T~ /
To Cutbank (if present)
/,,-/~
LIFT STATION ,//,//~
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed J'~~~--~ Date ~//~//'-~'~'
Company ~,~,, ''''~ ~ ~ MOA No.
Receipt NO.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
LouisA. Butera
ingineer's Seal
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA g9501
BILL SHEFFIELD, GOVERNOR
Telephone: (907)
Address:
274-~533
DATE:
June 18, 1986
PWS I.D.# 212754
To Whom it May Concern:
According to records on file in this office the
SUBDIVISION
Water Regulations
BERNARD STEWART
Water System is in compliance with the State Drinking
Sincerely,
Michael P. Lewis
Environmental Engineer
/~ iNSpE~..,Ti 0N APPOINTMENTS ' - _ ,. r_, :RECEIVE '
' ,~'1: '-'- · · ' '*' ' TiME- r,., r tIME . ' ' '
DATE .... DATE r ' DATE
INSPECTOR ' ' ' NSPECTOR , INSPECTOR ..,
_ MUNICIPALI~ OF ANCH~KA~
- MUNICIPALITY OF ANCHORAGE DEPT OF HEA~H &
~~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~ONMENTAL PROTECTION
{{~4 ~) ENVIRONMENTAL SANiTATiON DiVISiON-AUG /981
Telephone 264-4720
. , RECEIVED
'~' ~ 8 ............ ~HO~ ' '
M~ LInG ADDRESS ' ~ ~ . '
PROP~RYY RESIDENT (If differen~ from above) ...... PHONE - '
'2, ~UYER . ~ ~ ~ '~ ' ' ' '' PHONE
3, LENDING I~STITbTION ......... I PHONE' '
MAI LI'NG ADDRESS ..... ' .......
4. REALTOr/AGENT .... ~ / ' I ~Ho~E- -'
MAILING ADDRESS ' ~
ENCE
I E~ SINGLE FAMILY [] Two [] FF~vUer [] Other,, ,
I E~] MULTIPLE FAMILY,, ~ ~ ,Three, ?' Six . ,. ,
I 7. WATER SUPPLY ' . . · ,
[ [] INDIV! DUAL* * ATTACH WELL LOG. A well IOg'is required for all wells drilled
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON -SITE
[],PUBLIC UTI LITY
Connection Verified
THIS SIDE FOR OFFICIAL USE ONLY
NUMBER OF BEDROOMS
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] -SIX
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
t,:::t ?'z....
[]Septic Tank o£ [] Holding Tank
Size: /~)~:)~ If Tank is homemade
give dimensions:
, INSTALLER
SOILS RATING
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA
[] OTHER
MATER AL
Septic/Holding Tan k lAbs nArea ]Sewer Line [ Nearest Lot Line
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
DATE
72-010 (Rev. 6/79)
ALASKA E~rlUIROrlmeI'ITAL cOrlTROL SeRVICeS, I[1£.
I~nqineel'incI 8 ~nuironmental $1udies
MUNICIPALITY OF ANCHORAGE
DEPT. OF H!],',.LTi-i &
ENVIRONtv~ENTAL
6/22/81
RECEIVED
ALASKA STATEBANK~
310 EAST NORTHERNLIGHT BLVD
ANCHORAGE AK 99503
SELLER - MENO
SUBDIVISION-BERNARD BLOCK-3 LOT-3
THE TYPE OF ABSORPTION SYSTEM IS A PIT WITH AN UNKNOWN AREA.
THE SYSTEM IS CAPABLE OF ACCEPTING 500 GALLONS OF WATER PER DAY.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
3 BEDROOM HOME.
THE SEPTIC TANK WAS PUMPED ON 6/22/81 .
1220 U Jest 2§th/~uenue · J~nchoraqe, Alaska 99503 · (90?) 276-1361
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received 3/22/74
Time of Inspection 10;00 am .
Date of Inspection 3/26/74
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
CMRO
1. Approval requested by: CMRO Office
Mailing Address:
lfi30 ~mbmll St_ Anehnr~a~ AK
Phone:
2. Property Owner: Bernard Stewart
Phone:
Mailing Address:
3. Legal Description: Lot 2, Block 3, Bernard Subdivision
4. Location: Hiland Drive, 2nd place on Right- gold house
5. Type of facility to be inspected
6. Well Data:
A. Type Drilled
C. Construction St~nd~rd
7. Sewage Disposal System:
e
4-plex
B. Depth
No. of bedrooms
A. Installed 1972.
C. Septic Tank: 1.
D. Seepage Pit: 1.
E. Disposal Field:
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
D. Bacterial Analysis Satisfactory.
Lo.,g
B. Installer Stewart Excavating
Size ~ 2. Manufacturer
Absorption Area 8×R×6 2. Material
Total length of lines
, Sewer Lines __
, Absorption area
, Other contamination
, Absorption area
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
Page 2 of two pages - R~....st for Approval of Individual ~ .,er & Water Facilities
Legal Description
Comments
Appr .... o~ Disapproved
°~/ ~ Approval Valid for one year from date signed
V Greater Anchorage Area Borough, Department of Environmental
DIAGRAM OF SYSTEM
Quality
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.
SIGNED
Date
EQ-034 (1/74)
