HomeMy WebLinkAboutKING (PLAT 67-87) BLK 1 LT 5King
(Plat 67-87)
Block 1
Lot 5
#014-252-29
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F 0izBrs I`.11tj I "; i' zzzxxxx PROPOSED
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I Ir
ire UnACA ��'�a POir�N 6-650
ANCHORAGE, ALASKA 99502 0650
(907) 264-4111
Anchorag TONY KNOWLES.
_ MAYOR
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Permit #: 840528
January 31, 1985
TO: Permit Applicant
SUBJECT: Lot 5 Block 1 King Subdivision
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of December 31,
1984.
Permits are issued on a calendar year basis by authority
of Municipal Ordinance. A new permit must be obtained from
this Department for any well and/or on-site sewer system not
installed by the expiration date.
If you have drilled the well, a well log needs to be sent
to this Department for documentation of the installation
and to close the permit.
If a private engineer inspected the installation of the
on-site sewer system, the original as -built inspection report
and the yellow copy must be sent to this office for review
and approval, and for documentation.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
WIT (,
Keith E. Ban dFt, upPervisor
Environmental Engineering Program
KEB/ljw
enc: Copy of Permit
SWP/057
I certify that:
�amilLar, with
Lhe requirements
ior on-site
sewers anJ wells as sri
horth by the Municipality
o[ Anchorage (MOA)
and the Sta�e o� Alask.;.
2. I will instail the
system
accmrdance wiLh
all MOA cohes aoJ
and in comp!iance with
�in
th�
design c/`iteria of
this permiL.
3. l will adhere to all
MOA and
Wats: of Alaska
L |'`!.
distances �rom a���
exist�n�
we1l, wastewater
disposal system ur pubiic
s�*erage sysLem on
�his or
any adjace�nt or nearhy
lo�.
SIGN�D
'��
.
DATE'
�ep~
APPL)C>Nl M&MIR
ISSUED �Y
DATE:
gal
Date Drilleds
Static Water Level ?` feet
Draw Down feet
Type Material Drilled:
0 feet to
4 fP�-r to
9;1 Pl,""t to 1 n ) r1A", ��rnyol
1''`2 Y to 110 (7ravel. G- /Iwgtpr
to
to
Hefty Drilling
S.R.A. Box 1553 H
Anchorage,Alaska
99507
Gallons Per Minute_`
Total Feet of Casing ""
ANCI'IORAGE
MkjNICIPAUT 0A1 PRO E 10
DEPT. OF
EWIP,00m N
MUNICIPALITY OF ANCHORAGE }
DEPARTMENT OF HEALTH & HUMAN SERVICES
• '� Division of Environmental Services ~
On -Site Services Section
P.O. Sox 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel 1.D.#QLQ-a) HAA# 0f�0I�ci
1. GENERAL INFORMATION
Complete legal description Lir r, p I
Location (site address or directions)�!�� . � � ky/it A -K
Property owner
Mailing address
Lending agency
Mailing address
AgentLZ'11 r�'��' Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA 921
5. STATEMENT OF INSPECTION BY FNGINEER
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 application 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 lgtt D Gl"CkJ ��+C, i n9 (,F `LAJ Phone L-' yy
Address PQ 0.77-Y �r�t �n�tM�c' � J✓ X19 ��
Engineer's signature �' r�� -�• �°�� Date
M
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS 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.
72-025 (Rev. 1/91) Back MOA k21
1.:7.
,4a
J
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1 � l
C�to ooc�j00yb�,m ,au--
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Jo
6. DHHS SIGNATURE
Approved for
bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
/)n,,/z�-
Additional Comments
M
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS 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.
72-025 (Rev. 1/91) Back MOA k21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: � I �. I%Kl. I\INInjpr,> Parcel I.D.
A. Well Data
Well type ./ If A, B, or C, attach ADEC letter. ADEC water system number n
Log presen (Y/N) 1 Date completed 0 Driller NGiy PKI W NI(r
� , n
Total depth �0 Cased to
p Casing height Z�
Sanitary seal (Y/N) Y Wires properly protected (Y/N)
FROM
�WELL LOG
Date of test
,
Static water level 7
Well flow g.p.m.
Pump levell L w'd.
AT INSPECTION
(�K&Afap e2f 406 1 C�3
�g.p.m.Cn
v
Uu�cl�.
11� cO
SEPARATION DISTANCES FROM WELL TO: c,+
Septic/holding tank on lotl` ; On adjacent lots
Absorption field on lot M,, ; On adjacent lots _
Public sewer main
ublic sewer
Sewer service line %! / Petroleum tank NO 40 4ply, aN
WATER SAMPLE RESULTS:
Coliform ev Nitrate .10 LV4 / I. Other bacteria
Date of sample: Collected Collected by:
B. SEPTIC/HOLDING TANK DATA NIA-
Daitinstal.Led iv Tank size
Cleanouts (Y/N)
High water alarm (Y/N)
Date of pump
SEPARA(nt
Well(s) on lot
Compartments
cleanout (Y/N) L
tested (Y/N)
Pumper
DISTANCES FROM SEPTIC/HOLDING TANK TO: ��At
To property line
Surface
(Y/N)
ie
72-026(3193)' Front CONTINUED ON BACK PAGE
C. LIFT STATION �//4�
Date installed
Size in gallons—
Vent (Y/N)
allonsVent(Y/N)
High water alarm level
Meets MOA elecWsf
"Pump on" level
(Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
D. ABSORPTION FIELD DATA Ix/A
Date
Length
Total absorption area
Date of adequacy test
Water level in absorption
Peroxide
Manufacturer
Manhol s (Y/N)
off" Level at
Cycles tested
On adjacent lots Surface water
test
12 months) (Y/N)
Soil rating (GPD/Ft2)
Gravel thickness
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots_
Surface water
E. ENGINEER'S CERTIFICATION
On adjacent lots
To existi
Total depth
Depression over field (Y/N)
for
After
yes, give date
coned system on lot _
Water main/service line
, parking/vehicle storage
/ certify that I have checked, verified, or conformed to all MOA and HAA
SignatureC� t i c -ra a ,
11j14 L A A, ,) IJ
Bedrooms
nes 0504ct on ti e''datq of this inspection.
Engineer's Name /LP, 6yLL--L ( U - i 4381 L
Date
HAA Fee $ 71) Waiver Fee $
Date of Payment z ,J/ �% / Date of Payment
Receipt Number o���� �k� 5% Receipt Number
72-026 (3/93)' Back
7
h
- Static VaterLare2"
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Mayor
Well Drilling Permit Number:
Development Services Department
Building Safety Division
On -Site Water d Wastewater Program
e�
4700 Elmore Street
=•�``
�o
r y
P.O. Box 196650
- -
Anchorage, AK 99519-6650
S A C T Y
www muni,ora/onsite
(907)343.7904
Pump Installation Log
Date of Issue:
Parcel Identification Number: 01't'-AS5j,SLq 000 1 $
Legal Description Block Lot Property Owner Name & Address:
K�InOC (plat 10-)-8?> I 5 d- 31 a 86+mAv u��al�
Ankara e Q45o
Pump Installation Date: /D-Iq-O_
Pump Intake Depth Below Top of Well Casing- 9� feet
Pump Manufacturer's Na1me mV e.Cs
Pump Model: P tALle r
Pump Size VA hp
Pitless Adapter Burial Depth:
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer:
feet
Well Disinfected Upon Completion? ❑ Yes k No
Method of Disinfection:
Comments:
repkac_e Qu y^9 syskerrt
Pump Installer Name: T06 V,\ t i c keyko f -
Company: Lohe_04-o^ WOAD -r• WeAtc, J =ne,
Mailing Address: Po jeOX Mal?
II City: wa%; tkA —State: RK Zip: 491077 II
Attention: The pump installer shall provide a pump installation log to DSD within 30 days of pump installation.
a
WELL FLOW TEST
Location: �Q'rT �r Ki o& •�-1 ,
Well Depth: 110 (f t . ) Casting Above Ground Z (f t . )
Static Water Level: ,5 (f t.)
(Measured from top of tooting)
6 19 3
ate
Inspector
Project *
Time
N
Water
Level°alms
(ft.)
g
Volume
(gal.)
Meter
Reading
gal/sec
Flom)
9P
Comments
o
v
0
O
5'2
1:34
10
la,,O
n.r
eu„e C
is`J a COMMERCIAL TESTING & ENGINEERING CO.
a, ENVIRONMENTAL LABORATORY SERVICES
SINCE 1908
tF.PORT- of ANALYSIS
-
-
Cheml:ab Ref . #
:93.2907-1
5633 B STREET
Client Sample
11) -L5 B2 KING $/D
ANCHORAGE, AK 99518
Matrix
:WATL.R
TEL: (907) 562-2343
FAX: (907) 561-5301
Client Name
:COMBS, ROBERT
WORK Order
:67416
Ordered By
Report Completed
:06/24/93
Project Name
Collected
:06/21/93
@ 10:45 hrs.
Project#
Received
:06/21/93
@ 11:00 hrs.
PW ID
:UA
Technical Director.:C,TEPHENV.
EDI,
-
Releases By
Sample Rern o.ks: 'SAMPLE COLLECTED BY: ALAN
QC Allowable Ext. Anal
Parameter Results Qua]_ Units Method Limits Date Dace Init.
---------------
Nitrrate-N 0.10 U mg/L EPA 353,2/300.0 10 06/23 LLH
See Special Instructions yAbove -� -- -_M - UA Unavailable
See Sample Remarks Above NA = Not Analyzed
U = Undetected, Reported value is the practical qu7ntification limit. L! = Less Thar)
D = Secondary dilution. GT := Greater Than
%N 'L'H 3S Member of the SGS Group (Societe Generale de Surveillance)
ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA
COMMERCIAL TESTING & ENGINEERING CO. AK DIV
J o
CHEMICAL & GEOLOGICAL LABORATORY
d
;F
U e
LABORATORY TELEPHONE (907) 562-2343 5633 B Street
Anchorage, Alaska 99518
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
❑ P,UBLIC WATER SYSTEM I.D. #
D -PRIVATE WATER SYSTEM
'�';��':
Name Phone No.
Mailing Address
/,. e, /-r
i _
City State 2p Code
SAMPLE DATE: 2 /
Mo. Day Year
SAMPLE TYPE:
6Yl*outine
❑ Check Sample (for routine sample
with lab ref. no. t ❑ Treated Water
❑ Special Purpose ❑ Untreated Water
SAMPLE Time Collected
No. LOCATION Collected By
/
1 L o T 5;
2 1 I
3
4 1 I
5 1
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
�1 Satisfactory
///❑ Unsatisfactory
❑ Sample too long in transit; sample should
not be over 30 hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received A J
Time Received lion
Analytical Method: Membrane Filter
' No. of colonies/100 mi.
Lab Ref. No.
z
93.29+J7
Em
An
7
READ"�`��— BACTERIOLOGICAL WATER ANALYSIS RECORD
INSTRUCTIONS /�
Membrane Filter: Direct Count l 1 Coliform/100 ml
BEFORE Verification: LSB
Fecal Coliform Confirmation
BGB
COLLECTING SAMPLE Final Membrane Fi Results Coliform/100 ml
Reported By �� `� Date
TNTC = Too Numerous To Count
OB = Other Bacteria PART ONE OF TWO p.m.
10E3GS Membt REMAINDER TO FOLLOW
L
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information
Application Date
(a) Legal Description (include lot, block, subdivision, section, township
Location (address,ordi ections)
/___ A S7 �41 s- Aei_•JC_41-t
(b) Applicants
Name4_}f fiV/�(,
CONS_? , Telephone - Home Bus
Applicants
Address 2.8 3
(z-,. �4 _te`
IALC_�LKCC" : 74le-
(c) Applicant is (check one) Lending Institution ; Owner/builder
Buyer E::1 ; Other E::l (explain); '
(d) Lending Institution /7/ S-I'%�f� �'�JUis- ..��� Telephone s
Address
(e) Real Estate Co. & Agent /'1 ": i:!_X
Address
Telephone
(f) Mail the HAA to the following address:
2. Type of Residence
Single -Family r_\71 Multi -Family Other (describe)
Number of Bedrooms
3. Water Supply
Individual Well W Community El 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 [_-::I Public Community Holding Tank E]
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]
J;
5. 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 regula-
tions in effect on the date of this inspection.
Name of Firm C^j-E0(_ / r) Telephone -j y` c�e
Address
Date Z- 12- Z�j V-
6. DHEP Approval
eA
(ENGINEER SEAL)
Approved for bedrooms
Approved ,,/ Disapproved
Terms of C�ndondi-tional Approval
ih
d
By
Conditional
CAUTION
o � oo d fi•
o
a �y
0 0 00000000/o/qry�°°s eoa�
gooao6dogoro o aoeo.a;`:
THOMAS R. s,111TH e
2248-E ..
x
't,°'
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
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.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 21 7-19-84
A. WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
ENVIRONMENTAL PROTECTION
DEC 3 4011,'
RECEIVED
Legal Description:
Well Classification A, B. or C. D.E.C. Approved(Y/N) AJr4
Well Log Present (Y/N) -� Date Completed '"�%T �� "� Yield
Total Depth/` Cased to / /�� Depth of Grouting �) �
Static Water Level 7 Pump Set At
Casing Height Above Ground /� " Sanitary Seal on Casing (Y/N)�
Electrical Wiring in Conduit (Y/N) yps Depression Around Wellhead (Y/N) 1�&
Separation Distances from Well:
To septic/Holding Tank on Lot /L/ On Adjoining Lots /l. A
To Nearest Edge of Absorption Field on Lot- A-1 On Adjoining Lots
To Nearest Public Sewer Line v To Nearest Public Sewer
leancu Manhole
Nearest Seer Service Line on Lot (J'J
S
Water ample Collected By /�'�- Date
Water Sample Test Results s � a_
Comments
B. SEPTIC/HOLDING TANK DNrA
Date Installed Size No. of Compartments
Standpipes (Y/N) Air -tight Caps (Y/N) 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 Tank:
To Water -Supply Well
To Property Line
To Water Main/Service Line
Course
Comrents
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, cr Major Drainage
pl_�C_-1-1 31S'SbS�-
12--�s-'N
(Page 1 of 21 Qc" LO�Jc)b 2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata / Type of System Design
Date Installed Length of Field
Width of Field Depth of Field
Gravel Fled Thickness
Square Feet of Absorption Area Standpipes Present (YIN)
Depression over Field (YIN) Date of Last Adequacy Test
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water -Supply Well
To Building Foundation
To Property Line
To Existing or Abandoned System on
Lot ; On Adjoining Lots
To Water Main/Service Line To Cutbank(if present)
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Corawnts
D. LIFT STATION
Date Installed �&IA Dimensions
Manhole/Access (YM)
"Pump Off" Level at
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes(Y/N)
Comments
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect
on the date of this inspection. AW _
Alt
44
Signed �.( Date ? z- c All opo007
&®
Company MOA No. �%�
KBl/d5/s
[Page 2 of 21
-" 2-15-84
CHEMICAL & GEOLOGICALLBORARIS OF ALASKA, INC.
°r fi4 TELEPHONE (907) 562.2343 ANCHORAGE INDUSTRIAL CENTER
5633 B Street
uw�.rowiet
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
(') See h on back
WATER SY,STEM�j /
I.D. NO.
2..
Water System Name Phone No.
Mailing Address
A tl`ICN okA CsE (}k a45i)
City State zip Code
SAMPLE DATE: ay � J
Mo. Day Year
SAMPLE TYPE:
goutlne
r ❑Check Sample (for routine sample ❑ Treated Water
with lab ref. no. t NMntreated Water
❑ Special Purpose
SAMPLE Time Collected
NO. LOCATION Collected ! �By
� .
a9 �I . $sem
2 1
3
4
5
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
,XSatisfactory
❑ Unsatisfactory
❑ Sample too long in transit; sample should
not be over 30 hours old at examination to
indicate reliable results. Please send new
sample via special
,delivery mail.
Date Received t r
Time Received / -7
Analytical Method:
❑ Fermentation Tube
❑ Membrane Filter
Lab Ref. No. Result' Analyst
.No of colonies/100 ml. o, No of Posmve portions
06.1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 1983
READ INSTRUCTIONS Membrane Filter. Direct Count
Coilform/100ml
Verification: LTB ( BGB
Final Membrane Filter Results y` Collforml100ml
BEFORE��(
Reported By —�' >�r �. Date
Time: Sc a.m.
P.M.
COLLECTING SAMPLE TNTC = Too Numerous To Count