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Home My WebLink AboutTURPIN #1 BLK 5 LTS 1 & 2 E2 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. ParcelI.D. # 1. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ' ' East 1/2 Lot 2 and Lot 1, Block 5,~ S/D 1st Addition Location (site address or directions) 600 Donn~ -P~operty owner McLane Day phone out of state M{~iling address ~ending agency Mailin. g address. Day phone Agent Fortune Properties/Jand Niebergall Day phone. Address' 2525 c Street, Suite 100, Anchorage, AK 99503 242-8616 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: ~ ~ 3. TYPE OF WATER SUPPLY: Individual well NOTE: Community well Public water 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. ' ~' ~ !!~ i~ :._. STATEMENT OF INSPECTION BY ENGINEER 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 s ~ s ~c.[~J;[=~[~c. Phone ~ 17034 Eagle River Loop Road No. 204 Address~ . ~'a~[~ ,".'w-, A ..... Fngineer's signature ~,~= ~ Date I)HH/S SIGNATURE · A/ A.p. proved for Disapproved. Oonditional approval for bedrooms. bedrooms, with thee following stipulations: Additional Comments By; . 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 prof ,essio nal eng inee r registered in the State of Alaska. The DH HS 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 isissued. The Municipality of:Anchorage is not responsible for eh'om or omissions in the professional engineer's work. '/2-025(/~w. 1/9?)-I~e~,MOA~1- :. ,~.:?~'.~?.; .' '. · !: . .. ~i."~,..',~;:'~, . j;. -~ ~'~ .......;.~. :~-', ;: ~. :..:~"~'"',: :~ ?,~ ~ . :':. '.:. ,,~.~A~:,~''~'~ '' ~'~ ' '".' ~-':"-..~:'~,.-~ ~'.'~¥~',.!~; '~'~'~4~ ~-~ ~t~/ ~?~.,:. ,,~..~-~,;//,;~?'~ ~,A~ Legal Description: .Le 7' / Municipality of Anchorage R E C E IV E D DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division DEC 1 ]998 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Munimpality ot Anchorage .............. Dept. Health & Human Services Mealtn Aumorky Approval uneckhst ~- E~'~ ~-~- ~ "]-u~?~/~ /~! ParcelI.D.: ~)0(o -o~JG' ~'--~ A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y~'~ Total depth Sanita~ seal (~/N) FROM WELL LOG Date completed Cased to /-/0 Casing height (above ground) Wires properly protected (~/N) Date of test Static water level Well production WATER SAMPLE RESULTS: g.p.m. AT INSPECTION g.p.m. Coliform ~ Nitrate Dateofsample: II/ ~L ~ /~ ~ B. SEPTIC/HOLDING TANK DATA - ~ ~' u ~ ~,~ ~ Collected by: Other bacteria 0 S & S ENGINEERING Eagle River, Alaska 99577 Date installed Tank size Number of Compartments ~).__ Foundation ~leanout (Y/N) _ __ Depression (Y/N) __ High wa~J~/fi (Y/N) __ _ Date of Pumping _ Pumper __~ C. ABSORPTION FIELD DATA Date installed ' Soil rating~or f~/bdrm) __ System type __ Length Width ,,.'Gravel thickness below pipe Total depth Effective absorption area ,,~Monitofing Tube present (Y/N) Depression over field (Y/N) Date of adequacy test / Results (Pass/Fail) For Fluid dept~ field before test (in.); Immediately after gal. water added (in.): FI~__ (ins)Minutes later: Absorption rate = g.p.d. ~:~roxide treatment (past 12 months) (Y/N) If yes, give date .bedrooms 72-026 (Rev. 3/96)* D. LIFT S'rATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested .~ E, SEPARATION DISTANCES Size in gallons "Pump on" level at* ~ SEPARATION DIS'lANCES FROM WELL ON LOT TO: Septic/holding tank on lot /'v/,~ On adjacent lets Absorption field on lot ~///~ On adjacent lots Public sewer main '7 ~ ~'pa,0~ T, le~ ) Public sewer manhole/cleanout /0o Sewer/septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Property line Absorption field ~/°a;:i~;;~/service line_ Surface water/drainage ~ots SEPARATION DISTANCE FROM ABSOR~ Property line ~.~31h-~g foundation Water main/service line Surfacewate_.~_~-~ Driveway, parking/vehicle, storage' ' ' area Curt~n drain Wells on adjacent lots F, ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review in conformance with MOA ~AA guidelines in effect on this date. Signature -'~/Z ~.~----~ Engineer's Name /~ ~ ~*~ ~ Date Ii ~ 30 / c~ ~ HAA Fee $ ~7'~, ZT-C) Date of Payment ~/.,~-/~>,//~ Receipt Number Z/2--~'~/ ' ("~' ~-- ~) Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* CT&E Environmental Services Inc. Laboratory Division 200 W, Peffer Drive Anchorage, AK 99518 Tel: (907) 562-2343 Fax: (907) 561-5301 ChemLab Ref. #: Client Name: Project Name: Client Sample ID: Matrix: 98.6864-2 S&S Engineering n/a L1 & L2 B5 Turpin #1 Drinking Water Client PO#: Printed Date/Time: Collected Date/Time: Received Date/Time: Technical Director. PWSID n/a Sample Remarks; n/a 11/27198 07;00 11/23/98 14:00 11/24/98 13:40 Stephen Ede Released By:^ ,~ . , . J Parameter Results PQL Units Allowable Prep Analysis Method Limits Date Date Init Total Coliform (MF) Nitrate 0 col/100 mi 0.19 0.1 mg/L SMg222B 11/24/98 KAP EPA 300 10.0 11t24/98 GCP RECEIVED Mutlicipality of Aacborage Dept. Health & Human Services £0×T0'ci TO£gTgg£OE, 3Dtd21OHDNU IS]~ 3'9±:D ~LG:2.O B66'C-,L2-~ON £0'd ]U±O± CT&E Environmental $~rv~ces Inc, Laboratory Division 200 W. Pot~er Drive Drinkhng Water Analysis Report for Total Coliform Bacteriatal:^"*ho'e~"°~O*l se2-aa4aaK .9.~.4.os RI~AD INSTRUCTIONS ON ~E SIDE BEFO~ COL~CT~G s~LE Fax: ~7} 561-5301 MUST BE COMPLieD BY WA~R S~PL~R [] PUBLIC WATER SYSTEM ~ PRIVATE WATERSYSTEM ~ SendItesuln ~i~ Sendl~vol~e S&SE Day Year 0 St~dRosuR~ El Set~dln~Jl~o Month SAMPLE DATE: SAMPLE TYPE: ~ Routine O Treated Water 0 Repeat Sample (for routine sample ~ Untreated Water' with lab ref. no. ) O Special Purpose Time CoUeded SAMPLE LOCATION Collectff] By Lt ~' 8~< ~ Tu~,~t _..~:a°~'~ BO~ C. TO BE CC~MPL~IED BY LABORATORY Analysis shows this Wat~ SAMPLE to be: ~2 Sample ov~r 30 hours old, msulB may b~ unrcli~le gmple too long in ~sig sample s~ouM not bc ov~ 48 ham old at ex~i~a~on to in~*am r~liable ~sul~. PIc~c new ~le via sp~i~l d~l~v~ mail. An~ Me~." ~ M~e Fil~ L.* Nmb~ of ~loni~100 mL ............... ; ........ 'esult* Analyst ~ Fbks Jun Time: CHeat notified of tm,afllfactor7 Phenol Spoke ~tb Da~ . Ti~: BACTERIOLOGICAL WATER ANALYSIS RECORI) MMO,MUG Rflu~ To~I Coliform E. CaR Membrane Fll~t: Direct Count ~ Verification: LTB BGB Focal Coliform Confirmation Final Membrane Filter R~ul~ Reported By ~ Date Colenl~lO0 mi RECEIVED [] Faxed Comments: M u r d ci¢~/it~/yr ~¢/,C...,h orago Ocpt, Health & Human Se~Jces Collfo~lO0 mi ~ ~i, Momber of tho SGS Oroup iSociet6 Ofin~elede Su~velllence) £0/£0'd TO£~Tg~LO~, 39d;qOHDNld ISB Bgl3 Bg:LO B66'[-&Z-AON ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FILE SEARCH, DA ~ A AND INFOR{VIATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this'-Realth 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 alt Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Date DHEP APPROVAL..~ Approved for ~J~'~-t.,.¢,,"~ bedrooms b Approved ~- Disapprov~Cd. Terms of Conditional Approval Conditional 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) A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: /~¢;/~ ¢~ E¢¢4 ,¢/¢¢~.' ¢,,, ~-,~¢~, ~'~. Date Completed ~-.-.,~ ~v~- ~ ~ ~ Yield Well Log Present¢/N) t Total Depth ~¢;¢' Cased to ~;~'~ Depth of Grouting Static Water Level ~ t Pump Set At c~.--/-'T Casing Height Above Ground Electrical Wiring in Conduit (~/N) Separation Distances from Well: To Septic/Holding Tank on Lot Sanitary Seal on CasinO'S)N) Depression Around Wellhead (Y/I~- ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments /¢.///~ ; On Adjoining Lots ~-/ To Nearest Public Sewer / /c'12 t4'¢ To Nearest Sewer Service Line on Lot '~d~- ~_ /~o~-- ; Date /;'~ -- B. SEPTIC/HOLDING TANK DATA Date Installed Size Standpipes (Y/N) Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Mai No. of Compartments __ Foun Cleanout (Y/N) ; for )orary Holding Tank Permit (Y/N) _ g Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page I of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Type of ~gn Length o~rd __ ~,~of Field __ Gravel Fed Thickness Depression over Field (Y/N) ,~. )j~.l~" Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption ~ To Water-Supply Well ~" To Property Line To Building Foundation J To Existing or Abandoned System on Lot J ; On Adjoining Lots To Water Main/Serv~ee/Line To Cutbank (if present) To Stream/Po~ake/or Major Drainage Course To Drivew/~vCParking Area, or Vehicle Storage Area LIFT STATION Date Installed Size in Gallons ~ \~ j _/~Manhole/Access (Y/N) "Pump On" Level at ~..~,,'~t''~ "Pump Off" Level at High Water Alarm Level at J Vent (Y/N) Tested for J Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) .~' Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify t ha,~/J~h ave chec~,~d, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~ ~-~¢"-~ Date 1-~- (/~ -~=~'- Company /'~~'E~- ~ J~ ~-~ '~- MOA No. Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 {11/84) ALASKA [ UIBOFIm rlTAL COI TROL S RUIC S, ~nclin~e~in§ g- ~nuironm~nla[ Studies InC. CAROLYNN WAIT 600 DONNA DRIVE ANCHORAGE ALASKA 99501 SELLER-CAROLYNN WAIT 12/16/85 CAROLYNN WAIT 600 DONNA DRIVE ANCHORAGE ALASKA 99501 50822 LEGAL:TURPIN SUBDIVISION BLOCK 5 LOT 1 1/2 OF LOT 2 FLOW TEST ON WELL WELL FLOW DATE-12/12/85 A FLOW TEST WAS PERFORMED ON THE WELL. 477 PUMPED AT A RATE OF 5 GPM OVER A DURATION OF 2 THE DRAWDOWN WAS 7 ' WITH A RECOVERY TIME OF 5 AND THE STATIC WATER LEVEL WAS 75 FEET. THE WELL IS ADEQUATE FOR THIS 4 BEDROOM HOME. GALLONS OF WATER WAS HOURS. MINUTES 1200 [Uest 33rrJ A~nu¢, Suit,~ B oAnchora~e, AlosEo 99503,{907) 561-50z10 CH~EMI~AL & Glo.LOGICAL LABORATORIES ~£ ALASKA, INC. Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER Water System Name !](;/~ %ne No Mailing Address City State MO. Day Year Zip Code SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ret. no. [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. 2 I 3 I LOCATION Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ~_ Satisfactory [] I~ nsatisfactory [] Sample too long n transit; sarr 31e should riot De over 48 hours old at examination To indicate reliable results. Please send new sample Date Received Time Received Analytical Method: [] Fermentation Tube ~[] Membrane Filter Lab Ret. No. Result* Analyst -~ ~ 1' .-'"-' ~ .'.-.l? ~.[-~. ~. ,., I I r-~ READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-].220 {b) Rev. ]*978 BACTERIOLOGICAL WATER A~ALYSIS RECORD Date Collect ecl Source Lab. NO Presumptive 10mi 10mi ]*0mi 10mi ].Omi 1,0mi 0.1mi 24 Hours 48 Hours connr re&tory ,. DATE RECEIVED INSPECTrON APPOINTMENTS TIME TIME TIME ..~ AN-HORA;E,[; ',J MUNICIPALITY OF ANCHORAGE ~ MUNICIPALITY OF DEPT. OF ,~:,,Lr ~ & ~]]~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI(~ViRONMENI. 'L ) 82§ L Street - Anchorage, Alaska gS§01 DEC 1 6 Ig80 ENVIRONMENTAL SANITATION DIVISION ~'~ REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW DIRECTIONS; Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER I PHONE Albert MaffeiI 277-2503 MAILING ADDRESS 600 D~nna St Anchorage, Ak 99054 PROPERTY RESIDENT (If different from above) PHONE Same 337-4294 2. BUYER PHONE David Waites 243-4480 MAI LING ADDR ESS 9210 Elgin Circle Anchorage, Ak 99504 3, LENDING INSTITUTION ~[ ~ P~; lONE Alaska USA Federal Credit Union (Diana) CID ~ 76-5100 MAILING ADDRESS 2600 DeBarr Rd Anchorage, Ak 99504 4. REALTOR/AGENT PHONE Jack White Company / Doug Taylor 277-1553 = MAILING ADDRESS 3201 C Street Anchorage, Ak 99053 5. LEGAL DESCRIPTION Turpin First Addition~ Block 5 LOt 1 & the East half of Lot 2 STREET LOCATION 600 Donna Drive 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four [] Other__ [~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six 7. WATER SUPPLY [~ INDIVIDUAL* 80 Feet * ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER [~Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS / ~ APPROVED FOR BEDR~ S ~ CONDITIONAL APPROVAL (letter m ~ accompany certificate) ~ DISAPPROVED DATE ~) ~( 0--~ BY 72-010 (Rev. 6/79)