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Home My WebLink AboutLot 096 Certified Well For ......... James_.kllan Location ............ ~(~...~...~,}l,...5~.~.a'h......~./~ ./~//~.~f~f..~/..~-~/ ...'?~ Date completed.....~Y...~ ~...~7.2 ............. . ~/~.g[....~.~.~ ........... ~..~ Depth of well ..... ~ .E.e. et .......................................................... -. Size of easing ....... ~.. ~O~.O ......................................................................... D~tance to water ........ ~8 Ee~t .............................................. Distance to wa~er wMle p~ping ..'..9~...F~e~. .......... at rate of .......... ~.Q0 ................. gallons per ~ur. Description oi F~rm~tion,' '.,~ from to ~.~r~,~ '" ""'~O.-.'LO~' ~ .... J 0 l 2S 61 ......... ..... , I Sand. ~av~'.,c~...,-,7 '." 'Z- ~""~ [' -~ - cmd .- · ...... 86 112 Blue lay, ~a~ ~.~.- , ~lack c~ . , ,,~.,., . , , -.~ .,, ~. . , /.iSiS::. ,:..> .... ,. - 130 Gravel a ~an~_~~_..,, "-, llf _..~_ Water, Sand & ~r~'~'~_.;'~'~,''' '" .'_ .[ 149 I certify the above truc~and~cor~.q~t~- ~~ ..:c ........ - .~..C '- .:.:f .... Driller 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 J~/r~ 1. GENERAl. INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name~~/~F~/ T~lephone: Home .~- Z~7~ Business (c) Applicant is (check one): Lending Institution ~; Owner/builde~ Buyer ~; Other ~ (explain); (e) Real Estate Company a.d Agent Telephone ~: ~,.=:0 (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family ~)~ Multi-Family [2] Number of Bedrooms Other WATER SUPPLY~ / individual Weh/~ Community [] Public [] Note: if corn m unity well system, must have written confirmation from the State Department of Envh'on mental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite [] Public~7~ Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department ol Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11,84) ENGINEERING FIRM PROVIDh., INSPECTIONS, TESTS, FILE'" SEARCH, D,. ,A 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, 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 compliaece with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Approved for '~L.¢~.~--' be droorns by~/L/~'f~''~7[<~~-~'-~'J''~ -~'~ te ;::rmOsV;;c~'~al Approva~iSapproved/ _ _Conditional {~/,u 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 ^laska. 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 ia not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 MUNICiPALiTY OF ANCHORAGE DEPT, OF H~ALTH & FNVIRONMENt'^L PROTECTION LegaJ.Descr, iptio.B: ,'~7''~:~' , Ptir E IXlJ ;b WELL DATA Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Well Classification _,/~,/',,~Z~,'~ if A, B, C, D.E.C. App~oved,(Y/N) Well Log Presem (Y/N) --Y Date Completed ~//. ¢/7~ . Y,el~ _ Total Depth //,~""~'.,~'~'%8.sed to,~---~/~Depth of (,routing Static Water Level ~.,~,~'~_ ~ Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead To Septic/Holding Tank on Lot ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot~ _; On Adjoining Lots To Nearest Public Sewer Line ~ ~ .... To Nearest Public Sewer Cleanout/Manhole _ Z~~7 / ~ To Nearest Sewer Service Line on Water Sample Collected by ~ ~ W~//~' ;Date Water Sample Test Results ~¢~ ~¢~ ~ Comments ~ ~¢~ / Date Installed. Size No. of Co~p~artments Standpipes (Y/N) Air-tight Caps (Y/N) ~TZ~-- Foundation Cleanout (Y/N) / Depression over Tank (Y/N) / Date Last Pumped ____ -- Pumping/Maintenance Contract on File (Y/N) // .; for __ -- Holding Tank High-Water Alarm (Y/N) / . Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tany To Water-Supply Well / To Building Foundation To Property Line To Water Main/Service Line / Course / Comments / To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 Soils Rating in Absorption Strata T~eof System Design Date Installed Lenx~fh/of Field _ Width of Field //Depth of Field Gr~t~l Bed Thickness Square Feet of Absorption Area ~,/ Standpipes Present (Y/N) Depression over Field (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: Water-Supply Well /J To Property Line To 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 To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Mar (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating I certify tha checked, ve Signed Company Receipt No. Date of Payment Amount: $ Date Page 2 of 2 72-028 (11/84) HAA Request ** all MOA and HAA guidelines in effect on the date of this inspection. CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER [] PUBLIC WA'DER SYSTEM I.D.# ~ y P. RIVATE WATER SYSTEM ' Name.~._~ I/All ~7- P.o.eNo. Mailing Address City State Zip Cod~ Mo. Day Year SAMPLE TYPE: ,/~, Routine Check Sample (for routine sample with lab ref, no. [] Special Purpose [] Treated Water [] Untreated Water SAMPLE 4L I Time Collected Collected By ' ' .//,?/'9~ TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: '~ Satisfactory [] Uosatisfactory [] Sample too long in transit; sample should not bo over 30 hours old at examination to indicate reliable results, Please send new sample via special delivery mail. Date Received ? - c?~ -84' Time Received Analytical Method: Membrane Filter * No. of colonies/lO0 mi. Lab Ref. No. Result* I ' I ~ I I 771 Analyst BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter: Direct Count Verification: LTB BGB Final Membr~~ ~__.,~ Reported B~ ~'j~'''''~ Date_ ' ~ ' Time' Co[Iformll00ml TNTC = Too Numberous To Count OB = Other Bacteria _ CoilformllO0ml Time Date Date Inspector Inspector Date I'nspector Conditional Approval / Date Sewer Installed Permit No. Septic Tank Size Holding Tank Size Soils Reting Well To Absorption Area Well Lo.(] Received : Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Address /~/7 ~~ '~(~/~ Lending Institution ~'/~ / /u~//¢¢~E¢¢~ ' Address ~)~ l/ . . Address ~"~ Z ~/%~ J Phone / Phone Type ,ef3':resid ence [] Single Family E] Multiple Family No. of Bedrooms FJ Other Wate/.Cupply 13 Individual [] Community FJ Public Utility Sewa~e,,Dis posal L] Individual [] Public Utility El Holdisg Tank NOTE!: TH[" INSPECTION EEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Year Individual installed: When Connecrea to Public Utility: ATTACH WELL LOG. Awel log Is required for all wells drilled since June 1975. For wells drilled prior to that date, (live wsll depth (attacir log If available.) SU,r3,1~ECT PHO'I O~RAPI-IS 3/15/82 (lAMES ALLEN 3434 E 88TH AVE ANCHORAGE AK 99507 e~'~rTER JA~E5 ALLEN BUYER-GLENN GASTLETON SU BDI¥ISIO N-T12N R3W BLO CK-~ECT9 LOT-96 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A CRIB WITH AN UNKNOWN AREA. THE SYSTP, M IS CAPABLE OP ACCEPTING 100 GALLONS 017 WATER PER DAY. THE SURGE CAPAC]~I'Y OF THE SYSTEM IS 20 GALLONS° THE SYSTEM iS UNACCEPTABLE BECAUSE THE SURGE CAPACi~£Y 7~ LESS THAN 75 GALI,ONS. THE SYSTEM IS NOT CAPABLE OF ACCEPtqNG 450 GALLONS OF WATER PER DAY° THE SEPTIC TANK WAS PUMPED ON 3/12/82 ~ SEP%TC TANK ABEQUA..Y THE EXISTING SEPT.[C TANK VOLUME OF Tt~S 3 BEDROOM HOUSE. 750 IS ADEQUATE FOR 1220 [,Ucsl 25~h ~u¢,,u~ o ~Dc)~oroq~, t~losk~] 99503 ~' (901) 216-1361 SUBDIVISION: .-: --,~ ~.;'. IiULu ur,: INDICATE NORTH STREE SEWER SERVICE LINE SKETCH SHOW LOCATION OF CONTROL MANHOLES/CLEANOUTS SIZE MAIN: TYPE MAIN CONNECT DEPTH AT MAIN, ALLEY CONNECT DEPTH AT Prop. Line COMMENTS: ,, INSPECTED BY: , . DATE:_ ' DIVISION OF PUBLIC HEALTH BAC,cRIOLOGICAL WATER ANALYSb OFFICE CITY OTHER SAMPLE COLLECTEO BY ' DATE COLLECTED ~ -- '~* -- /'~'~ TiME COLLECTED /'~ I 0~,) pm Well- 0 Dug 0 Dr[v*. '~ Drilled 0 Bored Building S .... ~ ~ Seplic )~0 Records in leis mqice indicale this WATER SUPPLY fo be of: [] Satisfactory ~] Questionable J~ Unsotlsfactory Sanltary Slafus. SANITARIAN'S REMARKS ALASKA I FIUIROFIIllI FITAL CO II'ROL SE RUICeS, IFIC. ~n~ineerinq 6 ~nuironmentol $1udie$ 3/15/82 MUNICIPALITY OF ANCHORAGE ENVF ~ ,J ~ RECEIVED JAMES ALLEN 3434 E 88TH AVE ANCHORAGE AK 99507 SELLER -JAMES ALLEN BUYER-GLENN ~ASTLETON SU BDIX~LSIO N-T12N R3W BLO CK-SECT9 LOT-96 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A CRIB WITH AN UNKNOWN AREA. THE SYSTEM IS CAPABLE OF ACCEP'ITNG 100 GALLONS OF WATER PER DAY. TH~SURGE CAPACITY OF THE SYSTEM IS 20 GALLONS. THE SYSTE~M IS UNACCEPTABLE BECAUSE THE SURGE CAPACITY IS LESS THAN 75 GALLONS. THE SYSTEM IS NOT CAPABLE OF ACCEPT]i~G 450 GALLONS OF WATER PER DAY. THE SEPTIC TANK WAS PUMPED ON 3/12/82 . SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF TH]~ 3 BEDROOM HOUSE. ~750- IS ADEQUATE FOR 1220 UJ~st 251h Auenu¢ · Anchorocle, Alaska 99503 · (907) 276-1361