HomeMy WebLinkAboutPETERS GATE BLK 3 LT 2
erlifiei Drilling
OOC Co. elba '
SULLIVAN 'WATER WELLS
OWNER OF LAND "~7'~ O ~'~ ~'
ADDRESS
LEGAL DESCRIPTION Z :~ 7-- ':.~ /f4/
DATE - Started Ended
PERMIT NUMBER
S_..TATL~.L[VEL OF WATER
DRAW DOWN FT.
///'76 ¢~s. ~ ~ g ~ ~
~SD O~ C~S~SG (~ ~
KIND OF FORMATION:
From O Ft. to '-~ Ft.
From ~ Et. to ~ Ft.
From ~ Et. to <~ / Ft.
r~o~ ~ I rt.~o ~: r,.
. ,. ,
From Ft. to rEt.
.
From ?_'~/ Ft. to
From ('~'~ Ft. to
From~o~- Et. to c..~
From~C~ Et. to ! tot>
From Ft. to
Froml f('~ Et. to
From Ft. to Ft,
From Ft. to Ft.
From Et. to Ft.
From Ft. to Ft.
From Ft. to
From__ Ft. to .
From Ft. to
From Ft. to
From. Ft. to
From Ft. to
From Ft. to
From Ft. to
From Ft. to
From__Ft. to
From. Ft. to
"~'Fr°m" Ft. to
From Ft. to
From Ft. to
From Fl. to
From Ft. to
From Et. to
Ft.
Ft.
Ft.
Ft.
Ft
Ft.
Ft.
Ft.
Ft.
Ft
Ft
Ft.
Ft.
Ft.~
Ft.
Ft.
MISCL. INFORMATION:
, //
C,4.J',.o ~,
DRILLER'S NAME
RECEIVED
dAN 2_0 1997
Municipality of Anchorage
Dept, Health& Human Services
PAGE i OF 1
MUNICIPALITY OF ANCHORAGE
DEPARfMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW960001
DESIGN ENGINEER:DUMMY COMPANY
OWNER NAME:JOHNSON STEVE C & BARBARA A
OWNER ADDRESS:24824 MALCOLM DR
CHUGIAK, ALASKA 99567
DATE ISSUED: 1/05/96
EXPIRATION DATE: 1/05/97
PARCEL ID:05155103
LEGAL DESCRIPTION:
PETERS GATE BLK
3 LT 2
LOT SIZE: 57935 (SQ. FT.)
NUMBER OF BEDROOMS: 2 THIS PERMIT:
THIS PERMIT IS FOR THE CONSTRUCTION OF:
WELL SYSTEM
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 (18AACS0) .
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISI~BIS~
RECEIVED BY: ? ~
ISSUED BY: ~('~'~J_:..
DATE:
SULLINS
C~
30'
I
I
I
), t .....
S. O0
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME /°e IPHONE I NEw[]
~ ~ ,~' J <~"~:~,~ --o,~. ~dO UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
IWeJl .-I Absorption area Dwelling PERMIT NO.
~ ~ DISTANCE TO: / 0 ~ / ~'" ~-- / '
~ Z Manufacturer Material No, of compartments
Liq, capacity in gallons Inside length Width Liquid depth
j~oo IF HOMEMADE: ~
~ -- ~ ~anufaeturer Material Liquid capaciW in ~allons
~ ~ell / : Foundation ~ ~earestlotlin~t~ / P~BMIT~O.
~= DISTANCE TO: / 30 ~- ~
~ ~ ~ No. of lines Length of each line ~ Total length of lines Trench width Distance between lines
~ Top of tile to finish Material beneath the
m grade~ / ~, 6~/ , , _ Total effective~&absorp~jon~ ,
~a;
Length Width Depth PERMIT NO.
Type of crib Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot line
DISTANCE TO:
~ Class /~a ~ ~ ~ Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER '
REMARKS
....
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
OWNER OF LAND
ADDRESS .... p2~ go
LEGAL DESCRIPTION
DATE- Started .. 6/~5'"
PERMIT NUMBER
(,gex ttfieh ,.rilltrt <r g
[DOC Go. dba
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688.2759
Ended
DEl'TH OF h'ELL
STATIC LEVEL OF WATER FT.
DRAB' DOWN FT.
GALS. PER HR
KIND OF CASING
KIND OF FORMATION:
From 0 Ft. to ~
· Ft. to
From
__Ft.
From4 ~" Ft.
From ._'q"~/ Ft.
From._~L___ Ft.
From Ft.
From Ft.
From Ft.
From Ft.
From Ft.
.From Ft.
. Ft. to .~'
to
to
to '{~ /
to ~l
to
to
to
to
to
to
Ft. O0~'g ~0,~','~ From
· .. Ft. ~'~a~ ,~ ~,,~ ~ From
._ Ft. ~ ~~ ~ From
Ft. ~ t [~ From
. Ft. ~&~V ~ d~d ~ From
_ Ft. ~ ~ ~ r .d ~ ~t~ From
Ft. From
Ft. From
Ft. From
' Ft. From
Ft From
Ft
Ft. to_ Ft.
~Ft. to .. Ft.
Ft. to~ Ft.
Ft. to Ft,
Ft. to , Ft
Ft. to~_ Ft.
Ft. to__ Ft. .
__F,. ,o .-O-']Atl3D3 l
Ft to Q,QRI Ft.
From Ft. to Ft
From' Ft. to Ft From Ft. to Ft.
From__Ft. to Ft. From___Ft. to Et.
From__Ft. to Ft. From Ft. to Ft.
From Ft. to Ft. From Ft. to Ft
MISCL. INFORMATION:
DRILLER'S NAME
EJ~EZ;'T' ]: E)N :: :L :L 'T'C)!4NE;H ;Il I:::'
,:::. ,, :3:',',i (E~E;! ,, F:'T. E)I::;; :qC'J::;'.l!ii:E~ )
:.~!;
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
~. SOILS LOG
[] PEF{CO LATION
TEST
PERFORMED FOR: ~"-O ~-~
DATE PERFORMED:
LEGAL DESCRIPTION:
SLOPE
SITE PLAN
10
11
12
13
14
15
16
17
18
19
20
Louis A. [~ufera
CE-6736
Z e .e.J ;.' ',
WAS GROUND WATER
ENCOUNTERED? ]~"']/') SL
0
P
E
IF YES, AT WHAT
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERFORMED BY:
TEST RUN BETWEEN FT AND FT
CERTIFIED BY: ~
72-008 (6/79)
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)
Lot 2 Block .~a~ Peters Gate T15~N__a_R1W~ ~e_c.
Location (address or directions)
Malcom Drive
(b) Applicant Name Barbara Johnson Telephone: Home 688-9782 Business 276-7034
Applicant Address P.O. BOX 103373, A__n_c__h_o~ AK. 99510
(c) Applicant is (check one): Lending Institution [] · Owner/builder ~ · Buyer []; Other [] (explain); ..
(d) Lending Institution Home Savings and______~.oan____Telephone
Address 100~ E. Bensorl' Anchorage AK
(e) Real Estate Company and Agent
(f)
Address
Telephone
Mail the HAA to the following address:
P ic k_u~__By Applicant
TYPE OF RESIDENCE
Single-Family ~ Multi-Family []
Number of Bedrooms .~
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.
sEWAGE DISPOSAL
Onsite [~ 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 72-025 (11/84)
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. 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 ____EAGLE RIVER ENGINEEBING SERVIO_ES Telephone
EAGLE RIVER, AK 99577
Address ~
Date ~;~'///./,~ 5'- ~EI~E~0X~T*CZ~'
694-519L_ _
Engineer's Seal
Terms of Conditional Approval
,nd~nai
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 omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
MUNICIPALITY MUNICIPALITY OF ANCHORAGE (MOA)
L DEPT ,.,,.O. ~L ANCHORA~EALTH AUTHORITY APPROVAL (HAA)
ENVIRON'I~E"~A~E~L~T--.H--& -- CHECKLIST- FEBRUARY lg84
"r~utECTION. 264-4720
SEP 1 o~ 1985 Legal Description: ~-~ ¢'-
WELL DATAR E C E / V E D
Well Classification ' ~r
Well Log Present (Y/N) ~ Da.~te ~ted ~/~c'5-~'''''-~
Total Depth ~:,c.. / t I//..~~
~~. ~:)~' ~ Depth of Grouting
Static Water Level ~"/ /
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N) ,,I/'
Separation Distances from Well:
To Septic/Holding Tank on Lot /42~ ~'' "-'
To Nearest Edge of Absorption Field on Lot
If A. B, C, D.E.C. Approved (Y/N) /[-2/,¢1
Yield
Pump Set At ,~¢~., ~
Sanitary Seal on Casing (Y/N)
D, epress~on Around Wellhead (Y/N)
· On Adjoining Lots
· ~"~ ¢' ; On Adjoining Lots
To Nearest Public Sewer Line /¢/'/~1 "~
",; '- ;. To Nearest Public Sewer
Cleanout/Manhole ~,/,/~,,,4. To Nearest Sewer Service Line on Lot
Water Sample Collected by ~'~,~ /'~""'~ ~'~'~¢', ~"*~-"-"' · Date
Water Sample Test Results ,-~,~r ¢-~,~ r~-/"~U.'
Comments
SEP.-I'~&C/HOLDING TANK DATA
Date Installed ..,.z---/.~/.~j.--,,,.. Size
Standpipes (Y/N) /v Air-tight Caps (Y/N)
Depression over Tank (Y/N) ~
Pumping/Maintenance Contract on File (Y/N) /b///~
Holding Tank High-Water Alarm (Y/N) ~
/,¢'~42 ~'~/No. of Compartments -:~"
~ Y Foundation Cleanout (Y/N)
Date Last Pumped /3/~,
'for
Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Taak~-
To Water-Supply Well / ~ ~' / ~
To Property Line Z/'~ /
TO Water Main/Service Line ,/~ '~
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Course
Comments
Page 1 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) /L,)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well /~'~
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
Type of System Design
Length of Field
Depth of Field ~',
Gravel Bed Thickness
~'(. ],~/t:~, -', Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line ~7'0"
To Existing or Abandoned System on
· On Adjoining Lots ~'--~ ~'-
To Cutbank (if present)
Comments
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 ~ ~_¢,_,~:~ Date ~//~'/'~'
Company ,'~'~'~ '~-~' ~. MOA No. ''y 2- -- ~'~'J'"'
Receipt No. ~C~
Date of Payment
Amount: $ L.|
Page 2 of 2
72-026 (11/84)