HomeMy WebLinkAboutT15N R1W SEC 4 LT 38
WATER
WELLS
/'-{-[%{''J~ lp'' ~ P.O. BOX670272, CHUGIAK, ALASKA99567 · TE .2
ADDRESS : ~ ' ' · , -/:b ' ? ;,' <? ':? ';" -" ~. STATIC LEVEL OF WATER F'r.
~LEGAL DESCRI~ION /' .]7? ~L~ : ~J y ~,'?~ ,,d /~ .... I)RAW DOWN FT.
DATE-Started : / ?"~ Ended .. ~ ' ~. GALS. PER HR
PERMIT NUMBER ~/0/0 ~ ] KIND OF CASING (, ~(:]~ C? :::
KIND OF FORMATION:
From Ft. to Ft. < ( ,'t2 ;,O C ,'~,'?~x<-/,'..Lt~
From Ft. to ~ i Ft c ~ ,~. ~,, ~..~/.9~,~ ~ '~
From ' t~ Ft. to ,, ,'~ Ft. ./~ *~ '- ~ , '
From -: ' FI. to r ~' Ft. ~-,'~'4''~'c '-
From Ft. to__.Ft. ~ -~f'/ '~:'<'~:' ~
From ' ,:~' Ft. to/:] -) Ft. " ' ";
From '~") Ft. to/'/ ' Ft. ,';,-~.,30 :~,-~?' ~ :~.~/.:~::
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.
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From__Ft. to__Ft.
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From FI. to F .
MUNICIPAL TY o~ ANCHOT~,~
From Ft. to
ENVIRON~ENIAL
From Ft. to~ Ft.
3
1987
ECEIVED
From:~Ft.
From FI. to
From~Ft. to__FI
From~Ft. to__Ft.
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MISCL. INFORMATION:
DRILLER'S NAME
· I
unicip xlitYo
Anchorage
P.O. BOX 196650
ANCHORAGE, ALASKA 99519-6650
(907) 264-4111
TONY KNOWLES,
MA YOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
March 13, 1987
Thomas D. Mc Guinn
Box 670424
Chugiak, Alaska 99567
Subject: Ti5N R1W Section 4 Lot 38
On-site Well Permit #860071
A permit issued by this Department for an individual well and/or on-site
sewer system has expired as of March 13, 1987.
Your permit expired on the date of issue basis by authority of Municipal
Ordinance existing at that time. A new permit must be obtained from this
Department for any well and/or on-site sewer system not installed by the
expiration date. The new permit will come under the calendar expiration
date as per the new Wastewater Ordinance (effective May 20, 1986).
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 343-4744.
R.W. Robinson
Program Manager
On-site Services
RWR/ljw
enc: copy of permit
LOT: BLM 38 i]~I....O[:;K: '~
].5N RANGE: 1W
/v unicipahCy
of
Anchorage
P.O. B,. /196650
ANCHORAGE, ALASKA 99519-6650
(907) 264-4111
TONY KNOWLES,
MAYOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
June 23, 1986
Thomas D. Mc Guinn
Box 670424
Chugiak', Alaska 99567
Subject:
T15N R1W Section 4 Lot 38
On-site Well Permit #860071 - Issued March 13, 1986
On May 20, 1986, The Anchorage Assembly approved a new ordinance
regulating on-site wastewater disposal systems (septic systems).
All septic systems constructed after the effective date of this
ordinance are subject to the provisions of this ordinance.
Our records show that you curreutly hold a permit for the installation
of a septic system. We strongly urge that you contact this office
prior to constructing your system. Auy changes in the code that could
impact the construction requirements of your septic system will be
identified and brought to your attention. Please contact the
Environmental Services Division at 264-4720.
Thank you for your cooperation.
Sincerely,
Susan E. Oswalt
Program Manager
On-site Services
SEO/SSM/ljw
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
ApPlicatior~:Date ' I 0-14- $ 7
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO suBMITTAL)· ': '
(a) Legal Description (include lot. block, subdivision, section, township, range)
Location (address or directions)
(b) Property Owner C,h~.~man/D,~.onnc~ Telephone: Home 685-5504 Business
. Mailing Address
(c) Lending Institution
Mailing Address
Telephone 276-0909
(d) Real Estate Company and Agent ;~m,~
Address 7_~00 Cente~_f~?_d v,,_~:,~. ~;;,_'~e
Telephone _x94-420n.
(e) Mail the HAA to the followinq address: or: Check here Y.~, if hold for pick up.
List contact person and day phone number below.
qq~77
S & $ ENGINEERING ':
Eagle River, Alaska ~577
TYPE OF RESIDENCE
Single-Family [~
Number of Bedrooms
2
WATER SUPPLY
Individual Well [] Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite ~3 Public [] Community [] Holding Tank []
Note: If community well sysmm, must have written confirmation from the State Department of Environmental Conservation
· attesbng to the legality and status.
Page 1 of 2 72-025 fRev 8/86~ Front
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seaJ 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 end from my investigation and inspection, the on-site water supply end/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 '~ ~;;'~/"'""ZP2 ~
S & S ENGINEERING
17034 Eagle Rib/er Loop Road No. 204
Name of Firm
Address
Date
Approved for ~4~/~bedrooms by /~_-,/'z~"/.//~/'¢--.~'~/---- Date
Approved , ~ Disapproved Conditional
Terms of Conditional Approval
CAUTION
The Municipality of Anchorage Depadment 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 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.
Page 2 of 2 72-025 (Rev 8/86) Back
WELL DATA
_~,I~I~IIClPALITY OF ANCHORAGE (MOA)
..~ O~'/~'¢'C¢(J~'E~H AUTHORITY APPROVAL (HAA)
'" ~O~g~ . 264-4744
Well Classification
Well Log Present (~N)
Total Depth / ~¢ ,/
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (~N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
Cased to / (.¢ I
/ 8. f::5,. ~-f
If A, B, C, D.E.C. Approved (Y/N)
Date Completed i mi5/ ~' Yield
Depth of Grouting
Pump Set At
Sanitary Seal on Casing ~N)
Depression Around Wellhead
; On Adjoining Lots / ~'/7~
/ ~ C.~c ; On Adjoining Lots /
To Nearest Public Sewer Line /~(/~ To Nearest Public Sewer
Cleanout/Manhole A][/~ To Nearest Sewer Service Line on Lot ~..~- If..
Water Sample Collected by ,~, 4- c~ (~-. t,.LL~ l¢~f~__.t.~"~,.-I/k_/t_~ ; Date /~ -
Water Sample Test Results ~ ~,~ 5r'~^~"c~,V ~=,:,,ml,_ ,~'/-"/~-A"P¢: ~'
Comments ~C-~c'~,'-/"7~"7- '~"'4'F=~c¢-'~'"¢) ZO-&J-~'~' ~-~'.'~-
B. SEPTIC/HOLDING TANK DATA
Date Installed / ~'~ ~
Standpipes Y~N) Air-tight Caps
Depression over Tank (Y,(~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
Size /'~::~¢~¢-~ No. of Compartments
Foundation Cleanout (Y~)
Date Last Pumped ---~./L'-) -
/"//~ ; for
Temporary Holding Tank Permit (Y/N) /"//~
To Water-Supply Well /c~o ~-
To Property Line
To Water Main/Service Line /O/-~'
Course
Building
Foundation
To Disposal Field '~C:> / ' -~
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
72-026 fRev 8/861 Front
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata ~ ~- ~/?~'
Date Installed ~ /
Width of Field /~'/ ~//4J~ / (.¢O~
Square Feet of Absorption Area
Depression over Field (Y/I~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot / O
TO Water Ma~/Service Line /
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field .-~ (.¢ /
Depth of Field ~/'7' /
Gravel Bed Thickness Z..~/i
Standpipes Present ¢~/N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ,~ O
To Cutbank (if present)
Comments
D. 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 ~h~.t ,~ilL~l~;il~EIl~N(~erified, or conformed to all MO~ and UAA guidelines in
Signed ~Eagle Ri'~l~°ad No. ~e ~//~ ¢
- Eagle River, Altl~ '
Co,,,pany MOANo. ~~
Receipt No, /~ ~/ ~ ~
Date of Payment /~ ./~ ~/~
Amount: $ /~
Page 2 of 2
72 026 fRev 8/861 8ack
effect on the date of this inspection.
~/~'~ MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
MUNICIPALITY OF ANCHORAGE (MO,~/ ENVIRONMENTAL PROTECTION
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Descriptiqm ~ '~
WELL DATA
Well Classification ~)~//-/'~/~ If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y Date Comp[./~ed /,~'~ Yield
Total Depth __,/-. ~ C / c,~ Cased to ~ 'vt' ~ Depth of Grouting ~'~"~'~
Static Water Level /~z~--, Pump Set At C~
Casing Height Above Ground //4j ;O ! ~ Sanitary Seal on Casing(~N)
Electrical Wiring in Conduit (/~ ~ Depression Around Wellhead/N) ,/~/ '-~
Separation Distances from Well: ~ -~/
To Septic/F~+-~.J[:~9 Tank on Lot _ r .,- -/- ; On Adjoining Lots /~0"~ '/
To Nearest Edge of Absorption Field on Lot /'O '~ / ; On Adjoining Lots /~P"~
To Nearest Public Sewer Line ~ /X-'~ To Nearest Public Sewer !
Cleanout/Manhole /J/./9- To Nearest Sewer Service Line on Lot
Water Sample Collected by ~,f ~ ~'~/-'¢d-~'~/.//~b ;Date ~//~
Water Sample Test Results ~,7~ "7"/ ~",/~,,¢y~ ~ / ~.
Comments ~'-'4/~" ¢~J~"/_,~. ~"O ,~' /~/~/t,r/~d)/J~'''~ - /.-~'" 7
,/~ -F' T,/PZd~' ltJ~ 7'*,,~ z.r... ~l"~
Date Installed
Standpipes0N)
SEPTIC/I'-I;~C~q~%~i TANK DATA
/
Size ~:~ No. of Compadments
Air-tight Caps(~'N) Foundation Cleanout (Y(fN/~)
Depression over Tank (Ye Date Last Pumped "Z. - I ~"~ ~'
Pumping/Maintenance Contract on File (Y/N) _,¢-,J //'2J ; for
Holding Tank High-Water Alarm (Y/N) / Temporary Holding Tank Permit (Y/N)
Separation Distances f~'gm Septic/L'~idi~b~Tank:
To Water-Supply Wel~(;'c ~'~°
C-
To Property Line
To Water Mc~;./Service Line
Course
To Building Foundation
To Disposal Field
To Stream. Pond. Lake, or Major Drainage
Comments ~ ./~/t/' //0 5' 2',¢ z-z
Page I of 2
72-026(11/84)
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Datelnstalled _(' ,~/"(-/~"7'~)(~_VL~:~
Width of Field ~/'~¢2 /l// ///Z
Square Feet of Absorption Area
Depression over Field (YN~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
TO Building Foundation
Lot ,/42 /-~ /
Type of System'~/~Design ,"-'~/¢¢?'~'<¢://~/~'
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present ~',1)
Date of Last Adequacy Test
-/7 ~-~',-4 ¢ wo/~r ~
/
To Property Line
To Existin~ or Abandoned System on
; On Adjoining Lots ,/,¢~¢2 ,,/.L
To Water ~Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments /~.¢~ ~/-~ 4~/~ /
To Cutbank (if present)
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N):'
Dimensions
/~an ho)e/Access (Y/N)
"TnJ~' 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 $ 8, S Eaglneerl.~. Date ~- ~ ~ ~ ~ ~
SRB 196x
Company F.-~gie River, t~iaslca 99577 MOA No, ~ J~ ~O ~
Receipt NO. ~ ¢ ~
Date of Payment ~ ' ~q~
Amount: $ ~ ¢¢~
Page 2 of 2
72 026 (11/84)
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
FEDERAL TAX ID # 92-0040440
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
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
T15N R1W Section 4 Lot 38 SE¼ SW¼
Location (address or directions)
(b) Applicant Name Lou McOuinn Telephone: Home 688-2058 Business
Applicant Address P,0. Box 670424. Chugiak, Alaska 99567
(c) Applicant is (check one): Lending Institution []; Owner/builder [~; Buyer []; Other [] (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mailthe HAAtothefollowingaddress:
S&S Engineering
TYPE OF RESIDENCE
Single-Family';I: Multi-Family []
Number of Bedrooms
Other
WATER SUPPLY
Individual Well ~xx Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite E~X~Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
legality and status.
72-025 (11/84)
ENGI~IEERING FIRM PROVIDIN6 'SPECTIONS, TESTS, FILE SEARCH, DA'[/~,ND INFORMATION
As certified by my sea[ affixed hereto and as of the validation date shown below, I v~rifY 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·
Name of Firm Telephone
Address
Date
Engineer's Seal
This department has received written confirmation from the engineer
regarding the Conditional Approval of February 26, 1986.
The corrections have been accomplished and an inspection has been
completed by the engineer.; The subject property meets With Municipal
standards and is now approved.
DHEPAPPROVAL ._~ '~ '~'~' Date June
Approved for th~_e¢ (3)_ bedrooms by
Approved _}~Xy~X~XY.2XXXX×Disapproved _ Conditional -
Terms of Conditional Approval
1986
The Munci
CAUTION
of Health and Environmental Protection (DHEP} issues Health Authority
DaF
upon the representations given in paragraph 5 above by an independent professional
The DHEP does this as a courtesy to purchasers of homes and their lending
t federal and state requirements. Employees of DHEP do not conduct inspections or
ROBERTA. SHAFER
CIVIL ENGINEER
694-2979
June 18, 1986
HEALTH AUTHORITY
APPROVALS
SEWER&WATER
MAINEXTENS[ONS
SEWER&WATER
INSPECTION
ENGINEERINGSTUD]ES
ANDREPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
Muni~ipalZty of Anchorage
Department of Health and Human S~rvices
825 L Street
Anchorage, Alaska 99501
ATTENTION: Susan 0swalt
REFERENCE: Lot 38~ Section 4~ TI5N~ RIW
Your office issued a He~h Authority Approval for the residence located
on the referenced property in February, 1986. That approval was conditional
and required additional work to be completed no later than June 15,
1986.
A reinspection was performed on June 18, 19~6 and it was found that
a new well had been dri~ed and connected to the hoase. The old well
had been disconnected and was p~opcrl~ abandoned. The trallcr which
was connected to the existing septic system and water supply system
has been disconnected and removed. It is our opinion that all the conditions
specified §y the MOA have been accomplished in a satisfactory manner.
Request you issue a final HAA at this
-R~RT A. SffAFER, P.E.
~AS/ss
¢¢: Lou McGwinn
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN SRB 196X EAGLE RIVER, ALASKA 99577
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
264-47'20
Application Date c:~// ~///~ ~'
GENERAL INFORMATION
(a)
(b)
(c)
Legal D~scription (include lot, block, subdivision, section, township, range)
Location (address or direcEons) ,
AppliCant Name*/..~///(~ .--'¢'~z.cz...,~.J Telephone: Home ~,J"¢t" ~- ~ Business
Applicant Address
Applicant is (check one): Lending Institution []; Owner/builder
(d) Lendinglnstitution ,~4--~'~./~~ ~elephone
Address
(e) Real Estate Company and Agent
Address
(f) NMafh'he HAA to the following address:
TYPE OF RESIDENCE
Single-Family.~ Multi-Family []
Number of Bedrooms ..-.do
Other
WATER SUPPLY
Individual Well ,~ 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 confirmat on from ihe State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-c25 (11/84}
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 and adequate
for the number of bedrooms and type of structure indicated herein, t further verify that based on the information obtained
from the Municipalit.y of Anchorage flies 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 $ & $ Engineering Telephone
SR~ 196x
Address
Date '2~ ~ 7_?_~- ~'~'
Approved for ~ bedrooms b Date
Approved Disapproved Conditional
Terms of Conditional Approval /¢ ,~' ~'/.c) ¢O ~'Z.t /¢./&¢ ~ ~ ~
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 omissi(~ns in the
professional engineer's work.
Page 2 of 2