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Home My WebLink AboutRINNER RANCH ESTATES LT 7000 W.W.D. Water Well Drilling Phone 349-3809 Anchorage, AK. Well /," ,"~.; :,' '!';=: ': ': : Date Well Location : , .'" Phone ' :' " Size Casing ': Depth of Hole 'J '"' "' Cased to Static Water Level ~' :' leer Well Test :~ :.'~ Gal per Minute for Date of Completion iii':?' :'~ : feet Hours WELL LOG . ,,. ., '. ~. /. :';.,, ' AUTHORIZATION TO DRILL I hereby authorize W.W.D. Brilling to proceed with the above work. Payment shall be made in the following manner: Rig up Minimum (50% of anticipated depth) __.feet. @ per foot Balance due upon completion. In the event it is necessary to institute legal proceedings to collect any amounts due on this contract, I agree to pay an additional sum of Ten percent (10%) of the original contract price as attorney's fees, plus costs, for legal proceedings. Name Bate Address 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 GENERAL INFORIVlATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address. or directions) Applicant is (check one): Lendin9 Institution ~; Owner/builder~; ~uyer ~; Other ~ (explain}; (d) Lending Institution Address Teleph°ne~'~_ (e) Real Estate Company and Agent Address _ Telephone .... l~/ ~ (f) Mail the HAA to the following address; TYPE OF RESIDENCE Single-Family ~ Multi-Family r~ Number of Bedrooms __~z_ 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.l~ Community ~ Holding Tank [] Note: If community well system, rnust have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 ENGINEERING FIRM PROVIDING IN~ _CTIONS, TESTS, FILE SEARCH, DATA A, .~, INFORIVlATION 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 st]ows 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 tile 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 //'~'~) bt.) ~%~. '~ ~/~, Approved ~.~_,,~_ _ Disapproved 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 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 ol Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (~ 1,84) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MUi.,IiCti~ALi'¢! OF AHCIiO~,AG~ CHECKLIST - FEBRUARY 1984 pEFf. O~ tI~AL1H & 264-4720 ENVIRON~ff EN~h,L p~o~iLC'ftON Legal Description: - L, 7 ~//'~/'V~f~ ~f~C/~ ~'~r Well Classification . I IV~)l (/I ~0U/'~' L_. If A, B, C, D.E.C. Approved (Y/N) Well Log Present ~N) . ~ Date Completed ~/I/~f Yield · D.pt. to '¢ff Static Water Level ~,~ / Casing Height Above Ground ~, ~/ Depth of Grouting /V/ Pump Set At Sanitary Seal on Casing ~N) Depression Around Wellhead (Y~ Electrical Wiring in Conduit ~(J/N) Separation Distances from Well: To Septic/Holding Tank on Lot __ To Nearest Edge of Absorption Field on Lot _ To Nearest Public Sewer Line 1~- / Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments -/~ ¢~D F/_.o(.~.-.~-~.~r, ; On Adjoining Lots /'~///¢¥ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date SEPTIC/HOLDING TANK DATA Date Installed Size. No. of Compartments Standpipes (Y/N) Air-tight Caps (Y/N) Fo~la onti~C~eanout (Y/N) Depression over Tank (Y/N) / D~!,.as-~Pumped _____ Pumping/Maintenance ContracC'on de/C~'/N) ~ ; for ____ Holding Tank High-Water a~ (Y/N).~ _..--~Temporary Holding Tank Permit (Y/N) ;:Pawr~;ie~_ns~it~ynCV~llfrom I~dpticClolding T~ To Building F~undation To Water Main/Selvic~-- To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-02611u84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Type of System Design Length of Field Depth of Field Gravel Bed Thickness / Square Feet of Absorption Area Standpipes Prese~/N) Depression over Field (Y/N) Date of Last Ad.~uacy/Test Results of Last Adequacy Test Separati°n Distance fr°m Abs°rpti~el ~ To Water-Supply Well ' o Property Line To Building Foundation To Existing or Abandoned System on Lot jJ ;On Adjoining Lots To Water Main/Service Line./ To Cutbank (if present) To Stream/Pond/Lake/or Major Dr~ge Course Tc~mDrirnVeenV~y, Parking A~f/ehicle Storage Area D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dime,s o~'~ Man h~Access (Y/N) !./..j ump Off" Level at ~'/'""P Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroo~n Rating Against HAA Request ** I certify that have che~cked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~.(~f~/z~.~ Date '~/,~ Company I/~7--~ //f¢~- MOA No. Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) 1o General infot~mation (a) Legal Description (include ~ot, block, Location (address or directions) .......... MUNICIPALITY OF f~NCHORAGE DIVISION OF ENVIRON/~ENTAL ,HEALTH DEPARTMENT OF HEALTII AND ENVIRONbfl~NTAL PROTECTION APPLICATION FOR ?HEALTH AUTIIORITY APPROVAL CERTiFICA'I~J Ap plic at ion Da t a ~/_b.':: subdivision~ section~ towaship, ramge) (b) Applicants Name-2~.~. I-I.(:~oJL6/~ Telep~on~e = Home Applicants Addres,~ ~n~/0/ .~,b',l/~/ /~:/~/g~/ Zl~/f. (c) Applicant is (check one) Lending Institution . ~ Other ~ (e~plain) ~uyer [.~]; ' (d) Lending Institution Address (e) Real Estate Co° & Agent (f) :ail the ~ to the following ~dress: 2o Type of Residence Number of Bedrooms 3o Water Su~,_~t Individual Well L~/~._~ Multi-Family Other (describe) Community l ..... [ Public Note: If community ~,~ell system, must have wi-ittan confirmation from the State Department of Environmental Conservation attesting to the l.egality and status. 4. Sewage Disposal 0nsite ~ Publlc']~_[ Community :: ~o!ding Tank ~ Note: If community well system, must have ~,r~itten confirmation from the State ~: Department of Envi~:onmental Conservation attesting to the legality and status. [Page 1 of 2] §o E_~nsineering. Firm Providin$__I~js_pe?~t_io_~n~s_~ Tesgs~_=..File~ ~S~a_rj~h). Data and Information DHEP Ap~r oval Approved for ~ bedrooms Approved f_,.~_~.. Disapproved Terms of Conditional Approval 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 wager supply and/or wastewater disposal system is safe~ functional and ~equaUe for the number of bedrooms and ~pe of structure indicated herein.. % further verify that~ based on the info~ation obtained from the b~nicipality of ~chorage files and from my investigation ~%d inspection~ the on=site water supply and/or wastewater disposal system is in compliance ~.rlth ~1 Municipal and State codes, ordinances~ and regula= tions in effect on ~he dace of this inspection, ., . /, Conditional CAOTION TiD~ MTrNICIPALITY OF ANCHORAGE DEPAftTbff]NT OF tIEALTH AND ENVIRObIb~NTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASSO SOI~LY UPON THE REPRESENT~ ATIONS GIVEN IN PARAGIIAPH 5 ABOqE BY ;2q INDEPENDENT PROFESS!ObhkL ENGINEER REGISTEP~ED IN THE STATE OF ALASKA° TILE DItEP DOES THiS AS A COURTESY TO PURCthkSERS OF I{OMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND SqCATE REQUIRE~= MENTSo EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED° 'file MUNICIPALITY OF ANCtt0RAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IxN THE PROFESSIONAL ENGINEER'S WORK° (DHEP SEA&) RR4/ej/Dt8 [Page 2 of 2] 7~19 ~84 Well Classification ~ Well Log P~esent ~) Total Depth ~ ~'-~ _ Cased to Static Water Level ,, ~)~ Casing Height Above G~Ound /' ~/ Electrical wi~ing .in Conduit ~N) Separation Distances f~cm Well: MUNICIPAlitY OV Ap~.m~,*'~ DEPi. O[: I iEALiII {~ [:NVII~ONiv'~EN'fAL PE_,~ [ C]'IOH i.1985 Legal Description: A~~ F~ ~d~/ If A, B, ~'C, D.E.C. ~p~o~d(Y~) ~/~ Sanit~ ~al on Casing ~) ~ession ~ound ~l~ead (~,~ _ To SePtic/Holding Tank on Lot_~ ; O~ Adjoining Lots_~_~ To Nea~ast Edge of Abso~lDtion Field on Lot~; O~ Adjoining Lots To Nearest Public Sewe~ Line /~DJ/ To Nearest Public Sewer Cleancut/Manhole /~/ To Nearest Sewe~ Service Line on Lot Wate~ sample Test P~sults B. SEPTIC/HOLDING TANK DATA . Date Installed ~ Size Standpipes (Y/N) Ai~-tight Caps (Y/N) Depression ove~ Tank (Y/N) Date Last Pumped Pumping/Maintenanoa Contract on File (Y/N) Holding Tank High-Wate~ Alarm (Y/~ Separation Distanoas To Wate~-SupDlY Well To P~operty Line To Water Main/Se~vi No. of Cleanout .(Y/N ) Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, c~ Majo~ D~ainage Cou~ se Contents Receipt ~ Date Paid: Amount: [Page 1 of 2] 2-15-84 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date .Installed Width of Field Square Feet of Absorption A~ea Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from To Water-Supply W~ll To Building Foundation Lot ; To Water Main/Service Line To Stream/Pond/Lake/c~ To D~iveway, Parking Corm~nts Typ~ of Length of Field Depth of FieJ Gravel Be( Design S P~esent (Y/N) Adequacy Test To P~o~erty Line To Existing or' Abandoned System cn Lots To Cutbank(if present) D~ainage Course or Vehicle Storage Area D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Ala~-m Level at Tested for Electn~ical Codes (Y/N) Comments Dimsnsions Manhole Y/N) Level at Vent (Y/N) Cycles during Adequacy Test. Meets MOA on the date of this inspe~tic~. Check Permitted Bedrocm Rating Against HAA F~quest ** I certify that I have checked, verified, or ~onformed to all MOA HAA Guidelines in effect KB1/d5/s [Page 2 of 2] 2-15-84 CONTROL SERVICr INC. 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 561-5040 SHEET NO.____ . OF CHECKED BY BATE / 65' ' ..... Alaska Now-Well/ STAR ROUTE A - BOX 1560 - ANCHORAGE, ALASKA 99507 - (907) 345-44t 7 December 31,1984 Rainbow Realty 6701 Downy Finch L~ne Anchorage~ Alaska Well at 6810 Shane Place, test pumped at eight gallon's per minute for four hours. Total water pumped 1,920 gallon's. At no time during flow test did water level drop to pump int~e. Well depth on log-99.5 feet. DATE RECEIVED I NSPECTI ON APPOi NTM ENTS TIME TIME TIME DATE DATE DA.T~?¢ _ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for pr0cossing. 1. PROPE~TYOW~ER . PHONE MAILIN~ ADDRES~ PROPERTY RESIDENT (If different from above) PHONE 2, BUYER PHONE MAILING ADDRESS 3, LENDINGINSTITUT~ON ~~'- ~, I PHONE M~L~N~ADDRE~S 4. R~ALTORIAGENT '/ ~ PHONE I MAILING ADDRESS s~r R ~-~? i~OCATi ON - ~-, - 6, TYPE OF RESIDENCE ~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [~ One [] Four E~ Two [] Five ~ Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** ~ PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010 (Rev. 6/79) [-I ~