Loading...
HomeMy WebLinkAboutSHANE LEE ESTATES BLK 2 LT 6Shane Lee Estates Lot 6 Block 2 #014-061-70 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. Z © 0 0 0 0 0 0 0 0 0 F'ERi"'I I T NO. DEPARTMENT OF HERL. TH RND Et'.~',,,'IF..'ONME'NTRL PROTEC-FION 82!5 '"L'" STREET, RNCHORRGE., RK. :_'9.950t 279-25ii 14 E: b. lt._ F" EE92 ~_' li'-~J Z ( 77i94 ) RF'F'L l CRNT LOCR"I' l ON LEGRL EDWIN RINNER t_6 B2 SHRNE LEE ESTRTES 83::L0 WEI_.L:~LE'¢ CT LOT SIZE 7:':44 - 413::t 8000 .SQUFIRE FEET MINIMUM [:,ISTFINC:E E:ETI.4EEN Fl HELL RNE:, RN"r' OI"~-L:,ITE :,E~H_~E ['.'ISP]'~:;AL f00 FEE]- FOR R PRIVRTE WELl_ 0R 200 FEET FOR R PLIBLIC NELL. WELL LDGS RRE REQUIRED RND MUST BE RETLIRNE[:, TO THE [:,EF'RRTMENT HITHtN ~:0 OF THE !.4ELL COMF'LETION. SF'ECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRiLRBLE TO INSURE PROPER I NS'f'RLLRT I ON. F' E£ ~';-': ,~"'i Z ]-' %-" f-:~ L. :]: [:. F' ~3 F-': C, ['-.~ E.: "t" E R Fit F' F:-: C) ~--1 Z :F_; :E; t...~ E; I CERTIF'¢ "FHRT t.: I RM FRMILIRR WITH 'THE REQUIREMENTS FOR ON-SiTE LC.,EHERS RND WELLS RS SET FORTH B'¢ THE MUNICIPRLIT'¢ OF RNCHORRGE. 2: i HILL I~STRLL THE S'.r'STEM IN 8CCOR[:,RNCE WITH THE CO[:,ES. FtPPL Z CRNT EDI.4 Z N R Z NNER iS%t IE[:, E"¢ ' RTF Parcel i.D. # MUNICIPALITY Of ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Sita Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING 014-061-70 1. GENERAL INFORMATION Complete legal description LOT 6. BLOCK 2. SHANE LEE ESTATES Location (site address or directions) 6601 TIFFANY TERRACE Property owner Mailing address Lending agency Mailing address BRIAN LU C./O INGRIO KIDD. PRUDENTIAL VISTA Day phone Day phone Agent !NGRID KIDD W/ PRUDENTIAL VISTA Day phone (907) 727-1051 Address 424-1 B STREET ANCHORAGE. AK 99505 Unless otherwise requested, HAA will be held for pickup, 2. NUMBER OF BEDROOMS: 4- 3. TYPE OF WATER SUPPLY: Individual well xxx 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: XXX If community wastewater system, provide written confirmation from State ADEC lng to the legality and status of system. 72-025 (Rev. 1/91) Front MOA ¢Y21 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shaft be paid $550. O0 at, or prior to, closing for the engineering services provided. J 5. 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 on the date of this inspection. Name of Firm ALASKA WA'rE Address 6901 DEBARR,~OA[ Engineer's Signature t,_ . In conducting this evaluation, AWWC, system in accordance with ADEC and performance of the system under the col measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions ara outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AVC/VC, Inc. can therefore not prot4de any warranty for future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DHHS. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DHHS SIGNATURE ~ Approved for ~ Disapproved Conditional approval for with all Municipa!,~nd State codes, ordinances, and regulations in effect H { & ¢//~S~I~WA]IER CONSULTANTS, INC. Phone (907} 337-6179_ to~¢de ~ / ,~ted a thorough, conscientious engineeri*g analysis of the ~ 'b~S Guidelines & Regulations. The reposed results described the rt~bn~ en~untered at the ti~e of the test, and separat~bn d~tances bedrooms, with the following stipulatic, ns: bedrooms Additional Comments 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/Y21 Computer Version ECEIVED Municipality of Anchorage ~ DEPARTMENT OF HEALTH & HUMAN SERVICI~ 1 0 ~}00 ~ Environmental Services Division ~ 825 ,L" Street, Rm 502 Anchorage, Alaska 99501 (907),~1~7A~ 0[- ^N(;HO~ Health Authority Approval Checklist Legal Description: SHANE LEE ESTATES S/D; LOT 6, BLOCK 2, Parcel I.D.: 014-061-70 A. WELL DATA Well Type PRIVATE Log present (Y/N) Date completed Total depth 90' Cased to 90' Sanitary seal (Y/N) IfA, B, or C, attach ADEC letter. ADEC water system number N/A YES 2/21/78 Casing height (above ground) 18"+ YES Wires propedy protected (Y/N) YES Date of test FROM WELL LOG 2/21/78 ATINSPECTION 7/8/99 Static water level 17' 34' Well production 15 WATER SAMPLE RESULTS: Coliform 0 Date of sample: 6/29/00 Nitrate g.p.m. * 5.0+ g.p.m. BY FLATFOP TECHNICAL SERVICES 0.615 mg/L Collected by: * WELL TEST PERFORMED Other bacteria 20.B. A.W.W.C., INC. B. SEPTIClHOLDINGTANKDATA PUBLIC SEWER Date installed Tank size Number ~ts (Y/N), / .__.... Foundation cleanout (Y/N) ~Depre-s~'~sion (Y/N) High water alarm (Y/N) ~M~~~~. Pumper . C. ABSORPTION FIELD DATA PUBLIC SEWER Date installed Soil rating (g.p.d./f~ or ft2/bdrm) Length Width Gravel thickness below pipe ~ Effective absorption area Monitoring Tube pr~on over field (Y/N) Date of adequacy test ~ail) For Fluid depth in absorpt~.); Immediately after . gal. water added (in.): __ Fluid depth / ('[ns) Minutes later: Absorption rate =. ~ent (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* Computer Version System type Bedmoms D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Size in gallons level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line PUBLIC SEWER On adjacent lots 100'+ PUBLIC SEWER On adjacent lots 1,30'+ 50'+ Public sewer manhole/cleanout 50'+ 20'+ Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: p U B LI C Foundation Proparty line ~ Water main/servic urface water/drainage SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: SEWER Wells on adjacent lots PUBLIC SEWER Property line Surface water Building ~~{h'~e~''---'-'-'- F. ENGINEER'S CERTIF)C/AT~ I certify that I h.~~Je~flh~ih~/¢th ~eld inspections and. review of Municipal ~cc ~, /,k~ayth~//abosystems are in conformance with MOA H~tA ~ :l~l~xj~e_.~. on this date. Signature '--~ ~,./f[" Engineer's Na~l~ lJ JEFFREY A. CARNESS Date '7/~/ ~o Wells on adjacent lots '.. HAA Fee $ ,~-~' Date of Payment '~ 72-026 (Rev, 3/96)* Computer Version Waiver Fee $ Date of Payment Receipt Number OT-03-O0 11:09 FRO~-CTE ENVIRONBENT^L ztr~ CT&E Environmental Services Inc. ~615301 %924 P.OI/OZ F-230 CT&E Client Name Project Name/g CIi.nT Sample ID MaTrix Ordered By PWSID 1003505001 AK WaTer & Wastewater Consul/anTs Inc. Shone Lee S/D Lot 6 Bk 2 Shah= Lee S/D LoT 6 Bk 2 Drinking Water Client PO# Prin~ed DaTe~ime (Y//03/2000 10:56 CollecTed DaTe/Time 06/29/2000 15 30 Received Date/Time 06/29/2.000 16:20 Technical DirecTor STephen C. Eric Released 8Y~u~ ~~g~' Sample Return-ks: A[to~a~[e prep A~Sty$is Parcel I.D. # 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING xt:CEIVl:u JUL 15 1999 ~tUNIr.,,IPALI FY OF ANCHORAGE 1. GENERAL INFORMATION com~)lete legal description Locatio.n (site address or directions) Property owner ' ~.~,¢t..,- k ~::~,~,~ e//,~_r Mailing address ~'6"~/ ~ .F'~:,~,~_~, '%~-r¢, c~ Lending agency Ky~ ~ Wo~f /~¢ Mailing address Agent ~o ~ ~o~ ~tl~ ~ Address ~/ Z~ Oe~[i 2~ ~,>~,. ~c~~, Unless othe~ise requested, HAA will be held for pickup. Day phone Day phone Day phone NUMBER OFBEDROOMS: 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. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation ~rom ~tafe /[~ attesting to the legality and status of system. 72-O25(Rev. 1/91) Front MOA#21 Engineer's signature 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 ~/d/-/~,p ?'~,~', c,~ [ ~',-- ~..r Phone Address 1~1~-20 ~:4~ ~-~. J DHHS SIGNATURE / Approved for F'o////~. Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date ~2----- --! 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 DHH8 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. T~-025 (R~. 1/91) ~ck MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SER~[~E~ 5 Environmental Services Divisiq~,. 825 L Street, Room 502- Anchorage, Alaska Health Authority Approval Checklist Legal Description: A, WELL DATA Well type Log present (Y/N) '/"~'.f Total depth ~- ~ Sanitary seal (Y/N) Date of test Static water level Well production IfA, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to ~ ~. ~{[/ / 7c-~ Casing height (above ground) Wires properly protected (Y/N) FROM WELL LOG i--/~ g.p.m. AT INSPECTION YY .5-.0+ g.p.m. WATER SAMPLE RESULTS:- Coliform 0 ¢~1 /t'oo ,~ Date of sample: 7/ ~/ ~ B. SEPTIC/HOLDING TANK DATA Nitrate ~. ? ?-5' ,~/ /~- Other bacteria Collected by: '7". ~-. /'-~o o ~ Date installed Tank size Number of Compartments __ Cleanouts (Y/N).__ Foundation cteanout (Y/N) Date of Pumping ' ' : ' C. ABSO~P, TION FIELD DATA Date ,installed Length ': ~'~" ' ~ :' width Effectiv® absorp~t~6n area Date of adequacy t~t Depression (Y/N) High water alarm (Y/N) Pumper Soil rating (g.p.d./ft~ or ft~/bdrm) Gravel thickness below pipe Monitoring Tube present (y/N).__ Results (Pass/Fail) Fluid depth in absorption field before test (in.); Jill0) I~1irl[lliiil Iiil[~ri Peroxide treatment (past 12 months) (Y/N) System type Total depth Depres?!on over field. For Immediately after gal, water added' (in,): If yes, give date .bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION H. Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot ~l- /~. Public sewer main Size in gallons "Pump on" level at* *Datum "Pump off" level at* f~ ~"¢'"- 1 On adjacent lots '-,> -¢¢~e~') Onadjacentlots ~> Public sewer manhole/cleanout ~, ton ' Sewer/septic service line '2' ~ ~' Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation Property line Water main/service line Surface water/drainage SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Building foundation Surface water Curtain drain ENGINEER'S CERTIFICATION Absorption field Wells on adjacent lots Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots I certify that I have determined thru field inspections and review in conformance with MOA HAA guidelines in effect on this date. Signature ,o-~~,~__ .~. ~ Engineer's Name -F~A~ ~_~,,-~ /=. /'-¢o~,--'~ HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment. Receipt Number JL~.-.1z-gg 15:$T FRO~CTE EfiVIRON~ENTAL 561530! T-T36 P.OZ/05 F-Zg3 CT&£ R~f.~ 993282O01 :--~-~:' Name Fla~[op Tr, chaical PI~ Na~at/~t N/A ~-~t~~- Drialcing Wa~r Ordered By PWSID At towabte Prep TO[~L coti~orm 0 cot/100aL ~ln18 92Zt~ 07~0~/99 O.iO0 ,n~;c EPa 3~0.0 i0 rr~ 07/08/99 07108/99 DATE~-~ECEI V ED ~, INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE ~UNICIPAU~ OF ANCHO~E ~UNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT~IRONMENTAL P~OTE~ION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION NOV ? 1979 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FAClL OIRECTION~: Complete all parts on page 1, Incomplete reques~ will not be proce~ed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE ~AI LING ADDRESS f / PROPERTY RESIDENT (I~ differ~m *rom ~bove) PHONE 2. BUYER PHONE MAILIN6 A~BRESS MA LNG ADDR~88 4. REALTOR/A~ENT I PHONE MAILING A~RE88 B, LEGAL DESCRIPTION 6. TYPE OF RESIDENCE [~;]---'"S i N G k E FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four [] TJ~.o [] Five [~'~/Three [] Six [] Other 7. WATER SUPPLY -'E~ 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.) s. 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. 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 -E~ INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED~'~t~ ~t ~ 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. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line §, COMMENTS [~JAPPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate} [] DISAPPROVED ~V~ DATE BY 72-010 (Rev. 6/79) 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE I~,1. SULLIVAN, N1AYOIR DEPAP,'N'MENTOF HEALTH AND ENVIIRONMENTAL PROTECTION November 29, 1979 V~nce TelstrBp P~st ~ffice Bex 4-1563 Anchorage, Alaska 99509 Subject: Lot 6 Block 2 Shane Lee Estates Subdivision Approval for your individual sewer and water facilities can not be granted until the following items have been completed: (l) The depression or pit around the well casing needs to be filled with impervious type soil so that it slopes away from the well. casing. .) The water analysis report be delivered to this office from Chem Lab, 5633 B Street, for our review. Please notify this department for a re-inspection when the noted descrepancy has been corrected. If there are any further questions, please contact this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw CC: Security National Bank Mortgage Loan Department 880 H Street 99501 N 3788 (86-187 FO. /t~¢=$~.' (77-12B). R3W 9691,00110!