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Home My WebLink AboutKRAMP BLK 3 LT 4 ?v{, .- /M ;:1.: ]i] f:ih'i !::'F:it"!i[[..!F!I:~; !,.!];TI'.! ]!..!lii[ !:;iilZi]~;!U;[!:;;i[:~]'"li'.!i;h!"!'S i::'()R Ot'.,!..-i!~;'tlTIZ SEI41~i!iFii!~; Fii.:![:, t.,.!l!~l._!....;ii; t:::!S i:::'()!:;ifT'H E?,'¥' 'T'H!ii( Hi...ii'.Ji(!Zi[F::'!:::II....[TV CI!.: ;i~: ;[ f,.! ;[ L..L. ;i] l'.,ifi;i'i::lL.i. T!.'IIF: ?'r'S !"!Zh't ]7 h! I:::I!S:(;(3i~'.DFIH(3E; !.'! i[ 'FH '1'!"!~!!; ................................................................................................................................................ ?',1(3 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # L'~\ [~- 1. GENERAL INFORMATION (Must be Completed prior to submittal) . (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (bi Property owner Mailing Address Telephone: (home) Business (c) Lending Institution Telephone Mailing Address Real Estate Company and Agent Address Telephone Mail the HAA to the following address: (or check here~ if hold for pick List contact person and day phone number below: (e) 2. TYPE OF RESIDENCE Single-Family/J~ Number of bedrooms '"~"~ 3. WATER SUPPLY Individual WelI,L~ Community [] Public [] Note; If community well system, mus~ have wr.itten confirmatio~ from the State Department of Environmental Conser(;ati0n attesting t(~ ih legality ar[d%:tat'u'§.' .... ' .......... : ' ' :"":;: ''~' '~: %' :':" 4;.SEWAGE, DiSPOSAL : .,: . ..... , ..... ~.:~ ,:,:;,,: : On-site [] : Public/~ Community [].,: '. Holding Tank [] ". . : ~ :'.':. ':- Note: If Community well' s~t~rr~, must ha~'e'written c.onfir,mation.from the.state Department"8.f. Environmental Conservation attesting to the legality an'd status. ..:.. 72-025 (Rev. 7/88) Page 1 of 2 ')JJOM s,Je@u!bue leUO!SSe~oJd eq~ u! 8uo!85! LUO JO SJOJJ8 JO~. eiq!suodsaJ ~,ou s! e§sJoqouv jo ,~l!l~d!o! u n IAI eql 'penss! s! elealJ!Pea e eJojeq ~j~p ez,~l~U~ J o suo!loadsu! ~,onpuoo lou op SNHQ ~o s@e,~otduJ:1 'm, ueuJeJ!nbeJ re, els pus I~JepeJ U!~lJeO ~jsp, ss m, JepJo u! suop, n~,p, su! 6u!puel J!aq~, pus SeLUOq ~0 sJessqoJnd o~, ~se~,Jnoo 8 8t~ 8!~, saop SHHC] eq.L 'mlSelV jo m,~lS eq~, u! peJe),s!J~eJ Jeeu~Dua i~uo!ssejoJd luapuedepu! uB Xq eAoqe ~ qdeJ~eJed u! UeA!I~ suo!l~lueseJdeJ eql uodn ~lUO peseq pel~o!j!Jeo Ie^oJdd¥/{1!Joqjnv qll~eH senss! (SHNO) 8GO!AJGS UBLUnH pue qll~eH jo lUeLUlJ~dea eB~Joqouv jo ,~j!l~d!o!unv~ eq/ A. WELL DATA Well Classification Well Log Present~l) Total Depth /// Cased to Static Water Level'"'-'~' %¢' J Casing Height Above Ground MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 Date Completed //-'CD ~¢ /~'/ Depth of Grouting Electrical Wiring in Conduit ~.~N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line ~:'~¢ ,/~ / To Nearest Sewer Service Line on Lot Water Sample Collected by ,/, ~'e ~' Water Sample Test Results ,~,~ ~:.fL: Comments ~ /)/~?Z.~.~,¢~, If A, B, C, D.E.C. Approved (Y/N) Pump Set At Sanitary Seal on Casing~N) Depression Around Wellhead (Y/~ ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ;Date ~./'~ //¢' SEPTIC/HOLDING TANK DATA Date Installed Size Standpipes (Y/N) Depression over Tank (Y/N) No. of Compartments ~ Air-tight Caps (Y/N) Foundation Cle.~a~nput~(Y/N) Date Last Pumpe~-~ Pumping/Maintenance Con!act on File (Y/N) ~"~ ; for Holding T.a~.~ High-Water'Alarn?',¥/N) / Te_.~.p. or~;y Holding Tank Permit (Y/N) SEPARA?I. 0N ~, S'I;A N G .E~S:.~ ~ ~ M ~E PT I C/HrO~D~I~,~.T~ N K: ToWater-Supply:W~ll ?.i!?i~'-' : ~ ~'/To Building Foundation To Property Lin6 i.' : :'r ~:r:'>~ TO Disposal Field To Water Main/Se~vice L:in~'i: ;:~" TO Stream, Po~MajO~ ~3rainage Course 72-026 (Rev. 7/88} Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (~/~) Date of Last Adequacy Test Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~ Property Line To Building Foundation A_/....-'// To Existing or Abandoned System on Lot ./' ; (;~A-djoining Lots To Water Main/Service Line /~' / / To Cutback (if present) To Stream, Pond, Lake, or Major/E~rainage Course To Driveway, Parking ~.¢¢, roror~Vehicle Storage Area Comments ~ D. LI ,F~TATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrica.~(¥~~) Comments Dimensions ¢~ M a n h o I e/A.c~cesC~(Y/N ) -~P~mp Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have.¢~cl~ed, verified, or conformed to all MOA and HAA gu inspection. ~..~ Signed (/ Company ~ MOA N o.~¢~ ~ Receipt No, C"~(~/ Date of Payment Amount: $ / 72-026 (Rev. 7/88) Back ui~ ~,~r~.~.i~q ef!e~the date of this Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 DEPT. O]F ENVIRON~ MENTAL CONSERVATION / January 19~ 1984 BILL SHEFFIELD, GOVERNOR ~lephone:~O~274~2533 437 E. Street Sulte 200 Anchorage, AK 99501 Mr. Alfred E. Sunquist, P.E. Anchorage, Water & Wastewater Utility 3000 Azctic Boulevard Anghorage, Alaska 99503 Dear Mr. Sunquist: Subject: Kramp LID #146 Waiver Request RECEIVED. JAN 2 ~ 1984 Anch, Water & Wastewater En~ineerinq Div. The following waivers are granted for the horizontal separation distances between private wells and public sewer lines and manholes° ~le waivers are conditional on the fact that the sewer line and manholes be constructed as dictated in your waiver request letter, same subject, dated December 8, 1983. Lot 6, Block 3: Lot 5, Block 3: Lot 4, Block 3: Waive horizontal well to sewer line separation from 75 ft 50 ft. Waive the horizontal well to manhole separation from 100 ft to 95 ft. Wa 'IV e Waive to 75 horizontal well sewer separation from 75 ft to 60 ftc the horizontal well to ~nhole separation from 100 ft ft. Waive the horizontal well to manhole separation from 100 ft to 95 ft. Lo___~t 5, Block 2: Waive the horizontal well to sewer~.line separation from 75 ft to 70 ft, Lo.__~t _9, Bloc__.~k 2: Waive horizontal separation between well and sewer line from 75 ft to 34 ft, Waive horizontal separation between well and manhole from 100 ft to 75 ft, Sincerely, Environmental Engineer BEE/msm ,Time Date Inspector Time Date Inspector Comments Conditional Approval Date Inspector IvtUNICIPALtTY OF ANCHORAGE ['FrT ¢": I-['IT't n. ENVI',: ;:: I!. ],,A. ! ;O E ;i c, i: ? r,, RECEIVf D Date Sewer Instalted Soils Rating Permit No, Well To Absorptioe Area Well to Tank Septic Tank Size Holding Tank Size Well Log Received APPLICANT FILLS OUT LOWER HALF ONLY ~" ' ' INC Property Owner ROUND-HOUSE BUILD.~RS, , SRA Box i56J.-Z, Anchorage, ;2(. 99507 · Phone Mailing Address Buyer Address Lending lnstltutlon J~IsskR ~4Utusl Bsnk, Gref~g Wslker Phone . ,' Anchorage, ~ 99503 274-2551 Address 1.501 W 31,.,t, · Mealty 0o. & Agent ~eBt~u~' 2I ~ Peter Jarratt, Dottie Harness Phone Address Heritage Homes, 2 ??.L Northe~ Lights, Anch. 9950~ 276-1333 LegalOescription Lot 4, Block 3, KramP Subdivision ,. ' Street Location No~hsF]~ ~Rve~ Ty~e,,of Residence ; ..,./ ~ Single Family ~ [] Multiple Family [] Other No. of Bedrooms Water Supply :~ Individual [] Community [] Public Utility Sewage Disposal E] Individual :~ Public Utility [] Holding Tank ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.~ Year Individual Installed: ~,,,¢ ~ ~-,~ '~ When Connected to Public Utilit¢~%~ ~r~ NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCI=SSING CAN BE INITIATED.