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Home My WebLink AboutPETERS CREEK BLK 2 LT 4 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIROI~tENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 1. General Information Application Date (a) Legal Descriptio~n (include lot block, subdivision, section, township, range) Location (address or directions) (b) Applicants Name ~2i-Hz~ ~)~~ Telephone - Home Business Applicants Address ~, ~, ~£)~ ~ ~- (~/~ .?~/~? .~t~/~ ~?~ 5'~ . ~ ..... ~ ,~,~ ~,/ , (c) Applicant is (check one) Leading Institution ~ ; ~erlbullder~' ~ (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone Mail the HAA to the following address: 2. Type of Residence $ingle-Family~,~, Number of Bedrooms 3. Water Supply Individual Well,[~. Multi-Family ~_~ Other (describe) 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. S__ewage Disposal Onsite,~--~L 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. [Page 1 of 2] e Engineerin~ Firm Providing..In.spections~ Tests~ File Search, Data and Information Address Date 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 compliance with all Munic~iPal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm ~ ......... ~ ...."~'~.' Telephone DHEP Approval Approved for Approved Disapproved Cond i t ional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPAR~IMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE P~PRESENT- ATIONS 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 REQUIRE- MENTS. 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. RR4/ej/D18 [Page 2 of 2] (DHEP SEAL) 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Classification ~-,.~ Well Log-present~N) Total Depth /~p~ ! Cased to. . Static Water Level , C/7 Casing Height Above Ground ~ r~ Electrical Wiring in Conduit ~N) Separation Distances f~Gn Well: To Septic/H~ Tank on Lot /~[P ; On Adjoining Lots /d9~9 ~ To Nearest Edge of Absorption Field. ,o~ Lot To Nearest Public Sewer Li~~'/~ To Nearest Public Se~r Cie snout/Manhole Wate~ Sample Collected ~f ... ~- ~ _ ; Date ~/243 / ~ =ir Water Sample Test SEPT!C~IOLDINC TANK DATA Date ~nstall~d Standpi~s ~) Ai~-tight ~Ps ~) Foundation Cleangut (Y~ ~ession o~ Ta~ (Y~ ~te T~st P~d P~ing~intenanm Con=a~ Holding Ta~ .igh-Wate~ ~am (y~,)-~']/'''/v/~ ~ary .oldi~ Tank ~mt (~) W~-- ~p~ation Distanms bm ~tie~ Ta~: To Water-Supply Well /~d) TO Property Line /O. / To Water Main/Service L~i]~ Courage''/~' To Building Foundation To Disposal Field To' Stream, Pond, Lake, c~ Major D~ainage Con~n~nts [Page 1 of 23 2-15-84 Ce ABSORPTION FIELD [I~TA Soils Rating in Absorption Strata ~'0 K<. Date Installed L~./(, ~,'~,'f 7-0 /~d~ ~ . Width of Field lJ~ I~. /gp/~F.D~. 30 ~ Square Feet of Absc~ption A~ea L/,/~'. Depression over Field (Y~ Results of Last Adequacy Test Separation Distance f~cm Absc~ption Field: To Water-Supply Well /~d> /_F- To P~operty Line . /O / i/ Typ~ 'of# System Design Length of Field ~7~/~. Depth of Field ~ Gravel Bed Thickness Standpipes P~esent ~/N) Date of Last a~quacy Test ~/Z,/~ .! To Building Foundation ~-~ Lot ~//~ ; On A~joining Lots 30 /~ To ~te~ ~in/~vi~ Line ~/~ .. To ~t~($f ~e~nt) To St~e~ond~ke/~ ~jo~ ~aina~ ~ To ~i~way, Pa~ki~ ~ea, ~ Vehicle St~a~ ~a ~ /~ To Existing or Abandoned System cn Cc~ents D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Elect~ ical Codes(Y/N) Cc~ents Dime ns ions Manhole/Access (Y/N) "P~D Off" Level at ,{ ]./' Vent ~~cles du~ing Adequacy Test. Meets MOA ** Check Permitted Bed~ocm Rating Against HAA Pequest certify that I have checked, verified, c~ conformed to all MOA on the date of this inspection. KB1/d5/s [Page 2 of 2] tt' q ::5--, HAA Guidelines in effect ..,r ~ -~"'",,,"%9,_'k I ~"I~:'.,_ ." ~' I '~?~ .... ......'t,~/ 2-15-84 DEPARTMENT NATI/I .AL RESOURCES JAY S. HAMMOND, Governor August 1, 1975 DIVISION OF LANDS, 323 E. 4TH AVENUE. ANCHORAGE 99501 Re: Water Use Application ADL 68097 getha Elliott P. O. Box 487 Chugiak, Alaska 99567 Dear Mrs. Elliott: Enclosed is a copy of a leEal advertisement reFerrin? to your water use application. If you have any questions concerning this matter, please contact us. Sincerely, fred ~. Tisdel ~ater Resources ~ngineer Enclosure STATE OF ALASKA DEPART}lENT OF NATURAL RESOURCES NOTICE OF WATER PER~,JIT Pursuant to A.S. 46.15 and rules and regulations promulgated thereunder, the Division of Lands proposes to issue a water use permit to Retha Elliott, P. O. Box 487, Chugiak, Alaska 99567. The permit will be issued to provide for the use of water per day for multi-family domestic pFu.poses. 1,800 gallons of The water will be taken from a drilled well in parcel of property - encompassing Lots 3 and 4, Block 2, Peters Creek Subdivision, Sec. 10~ T1SN, RlW, S.M., and will be used in the same parcel of .. p~p~rty. Further information relative to this proaoscd withdrawal may be obtained from the I)ivision of Lands, 323 E. 4ti~ Ave., Anchorage, Alaska. Objections or other comments must be su,,nitted in writin? to the Division of Lands and received on or before Augu,st 25, 1.975 Jn order to be considered. The Division of Lands reserves the right to waive technical defects in this publ icat ion. PUBLISH: August 8, 1975 ANCHORAGE DAILY TIblES BY: x. x 2.x ,q$~6g x I~;~vxt~rx Dean J. Nat/fort,' Chief tVater Resources Section