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Home My WebLink AboutT12N R3W SEC 33 LT 14T12N, R3W, Section 33 Lot 14 #018-191-06 Date Drilled:_./d~ -- ~o- Static Water Level ~ ,~ DrawDown 2~//.~ feet WELL LOG f/ feet Gallons Per Minute Total Feet of Casi.n§ Type Material Drilled: feet to ~-- to, // // to ~2. HEFTY DRILLING 2540 AKULA DRIVE ANCHORAGE, AK 99516 (907) 345-0593 RECEIVED AUG ? 1995 Municipality ct Anchorag. e Dept, Health & Human Services MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAILING ADDRESS LEGAL DESCRIPTION TI~.N P~3',~ 9'5'5 ~o.+ I+ PHONE ~ ~UPGRADE LOCATION ~I~m~Man~acturor ~ mI~ISTANCE TO: I ~ I Absorp,~area Dwellin9~ O ~ Mate rial,.~i~-¢ZI IWidth .... NO, OF BEDROOMS PERMIT NO. 0 ;,~o c~ ~.,~) Inside length Liquid depth Dwelling PERMIT NO. Material Liquid capacity in gallons Foundation Nearest lot line. Trench width ~'~ inches Total length of lines Material beneath tile PERMIT NO. '¢ 7~. O ~'-~~) Total effective absorption area Length Width Depti~ PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: Driller Depth Distance to lot Jine DISTANCE TO: Building foundation Sewer line Septic tank OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS APPROVED DATE LEGAL 72-013 (Rev. 3/78) :!!: I]:¢..J J::J Ii~'. E: i= EI!:"i i,'l ): N ;!: I',~ L!I','J l:::, :l: :E;' f' R I'..! E: ~:; :LI.EI!3 I:::'Ei:ET i:;:'O~: UPON THE: i','l :t; I',! :I: i "ll...!t','l D :( ~ii;"f'l::ll'.,! E:E: 'i'13 FI E::OI4h!IJN:["i'%¢ %E;I.,.IE:f::;~ L.):NE; :[% ';:;'!5 F'EE'i'. (:)'THEIR i:;;'.ii:(i:! U F:!'v' F'I ;[ [ ..l::'l Ei~[ !!i; PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS PERFORMED BY: 72-008 (6/79) MUNICIPALITV OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST DATE PERFORMED: SLOPE SITE PLAN SOILS LOG PERCOLATION TEST ENCOUNTERED? ~AS GROUND WATER IF YES, AT WHAT DEPTH? Reading Date Cross Net Depth to Net Time Time ry~; j,i. Water Drop CERTIFIED BY: 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 Parcel I.D.# 018-191-06 "'HAA # GENERAL' INFORMATION Complete'legal description L~t~,i'14, S~ctidn 33, T12N, R3W Location (site address or directions) 2820 D'Armoun Road ,.,, '.:"?'. ..... - ,.. POA/oohn hauer ..~.'~;-%~,.'~. ?,-':'~hillip 'Sudinski r~ ....h,,,,~ 1-219-756-3911 ~/o~vowH~' : ". ~ ...... ,~ailingad'd'ress · 7649 Dove Street, Schererv~lle, Ind'. 46375 ~ ................ ...... " " · · 7 {~n~nn~eu~lst"Nat~onat/Chr~st~na Moritz D~vhbono 777-566 }uhh n: ' a ibSs:.:o u 36th A~a.. Sta 216. ~nchora'~e. Ar 00503 ~nt· - Da~ phono Address Unless Otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 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. ,~ TYPE OF WASTEWATER DISPOSAL: ndividual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality ano status of system. ' 72-025 (Rev. 1/91) Front MOA#21 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 with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection, $ & S ENGINEERING Name of Firm ~Tn~ ~._le River Leo~ Road No. 204 Phone ~¢~z~ ~ ~.c) '7 '~ Eagle River~ Alaska 9957'~ Address Engineer's signature ¢~*~/~ ~-'~,./-¢,- Date '~-j/¢~/~ DHH~, SIGNATURE ~/ Approved for '~-- bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: 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 DH HS does this as a courtesy to purchasem 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, Municipality of Anchorage ' DEPARTMENT OF HEALTH & HUMAN SERVI~^u¥~ Environmental Services Division ~V~RON~[NT^~SERV~C[S 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist A. WELL DATA Well type /i~ ~/- Log present (Y/N) / Total depth 1 Sanitary seal (Y/N) Date of test Static water level Well production Parcel I.D.: Date completed Cased to / ~"~) ' If A, B, or C, attach ADEC letter. ADEC water system number Casing height (above ground) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION I ~' + g.p.m. Z ,' f~ g.p.m. WATER SAMPLE RESULTS: Coliform ~(9 Date of sample: /Z [ /"~ / ~l~ B. SEPTIC/HOLDING TANK DATA Date installed Nitrate 0.. 5 Other bacteria Collected by: ----~ ~, ~---~'/~/G-' Number of Compartments / (Y/(~ ~ ~ High water alarm (Y/N) /~///" Foundation cleanout ~/N) /~'.L_~ Depression Dat,e of Pumping i~?~ (~'¢ Pumper / C. ABSORPTION FIELD DATA [_. ..... ~/¢(1~'~ - ,rabn ' uaze installed ~ [~ ( . ~ ~oi ' g (g,p. , ~y¢ ~ y yy , .... ' I Length [~[~[ Width ~. Gravelthicknessbe]owpJpe.~ ~ __ Total depth Dateofadequacytest/Z~ /C~'~ Results(Pass/Fail). c-]~4~SFor /~¢~-- bedrooms Fluid depth in absorption Iiold baloro tost (in.); Fluid dapth "~- (ins) Minutas lator: / ~ ~bsorption rata = '7 ~ ~.p.d. ~oroxida traatm,nt (past ~2 months) (W~) ~?~& ~ II yos. Cvo dar, 72-026 (Rev, 3/96)* D, LIFT STATION Manhole/Access (Y/N) ./'''/ High water alarm level at* Cycles tested Size in gallons "Pump on" level at* "Pump off" level at* *Datum Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service .liqe E. SEPARATION DISTANCES SEPARATION DISTANCES FROM wELL ON LOT TO: On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station.., . , ,/k,//,,/~ -- SEPARATION DISTANCES FROM SEP'~IC/HOLDING TANK ON LOTTO: .. Foundation · Absorpti,on field Water main/service line /(/-2 '-¢'- Sudace water/drainage /¢)['.~/'/~ Wells on adjacent lots /6) SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /~) / ¢-' Building foundation / (-') /"/- . Water main/service line Surface water ./(~)~-') / '/ Driveway, parking/vehicle storage area Curtain drain /~J/~zx/'('~ /~'[V/(-~/(.//x/ Wells on adjacent lots /¢~ 1'-/- F. ENGINEER'S CERTIFICATION ...... ~-,. I ceR~fy that I have determined thru field inspections and review of Municipal records ~¢ve~ ,~ are ...... conformance ~n w~th MOA. HAA gu/defines ~ effect on th~s date. Signature ' · Eng neer's Name '~/; '¢-'~'~ ~. ~ ob~,~/a ...... HAA Fee $_ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 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 ParcelI.D.# o1 -l?1 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address Day phone Day phone Day pnone_ , Unless otherwise requested, HAA will be held forpickup. NUMBER OF BEDROOMS: _~ -w 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 ,," ,,' ,0,,"~"' ~ ?')/~.~ '. If community Wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-s te . Holding tank Community on-site , Public Sewe? ~: ~' ' 72-025 (Rev, 1/91) Front MOA~21 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 verifythat based on the information obtained from the Municipality of Anchorage flies and from my investigation and inspection, the on-site water suppty and/or wastewater disposa~ system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Address ~O~ ~ /~ ~ ~ ~ EngineeCs signature ~~~ Dato 6. DHHS SIGNATURE ~ Approved for ~ ....... Disapproved. Conditional approvat for bedrooms. '~.s'~'~:¢~-~¢~'*~- ~ bedrooms, wtth the following stipulations: ;: .;~i'?;; ;. >~ Additional Comments ' ' Date ~,'Fhe Municipality of.Ahbh, brage Department of Health and Human Services (DHHS) issues Health Authority ,Approva Certificates-,based only upon the representabons g~ven ~n paragraph 5 above by an ~ndependent 'pr~Sfe~i~>nal eng~[teer registered in the State of Alaska. The DHHS does this as a courtesy to purohasem of homes and t h~,r,!~hdi~g institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or anal~e, data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the p?ofessional engineer's work. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501e (907) 343-4744 Health Authority Approval Checklist Legal Description: ~.. 0 T' I L} i~.o_.~'~?~' '"~ I rg. bJ; IPff~l'~/parcel I.D.: A. WELL DATA Well type Log preseot (Y/N) _ y Total depth ] '~O Sanitary seal (Y/N) Date of test Static water level Well production Olg-- Iql- oLo If A, B, or C, attach ADEC letter. ADEC water system number g.pm. Date completed Cased to I .'~0 FROM WELL LOG I0, 'z-o. q I Casing !~eight (above ground) Wires properly protected (Y/N) AT INSPECTION '7,2. ,/ WATER SAMPLE RESULTS: Coliform (l~ Nitrate ~J ,D Date of sample: ~'/ I/~ _."~ Collected by: B. SEPTIC/HOLDING TANK DATA Date iastalled ¢~/~/8~. Ta,tk size I~ Foundatioo cleanout (Y~) ~ ~ Depression (Y~ IN} DateofPumpmg ~/I /q~ Pamper I~,L'~ Ntlmber of CompaltllleHts Other bacteria <' r..~.. Cleanouts (Y/N) y High water alarm (Y/N) ~%~ z C. ABSORPTION FIELD DATA Date installed Leagtb ]t~O Width Effective absorption area / Date of adequacy test Fhfid depth in absorptioo field before test (in.); % hnmediately after/dt.'O gal. ~vater added (in.): Fhfid depth dr3 Minutes later: tm.) Absorption rate = ? 7t.5'"'~ g.p.d. Peroxide Ireatment (past 12 mm~tbs) (Y/N) H If yes, give date Soil rating (g.p.d,/fi2 or ft2/bdrm) ~/~/ System type '//f..t.44 Gravel thickness below pipe ~p,~.l Total depth Monitoring Tobe preser, t(Y/N) "'/_ Depression over field (Y/N) Results (Pass/Fail) '~ For .~ bedrooms D. LIl~r STATION Date installed Size m gallons Manhole/Access (Y/N) "Pump on" level at* "Pump oW' level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot I ~->~O> : On adjacent lots '~/.~ 0 Absorption field on lot Public sewer main Sewer/septic service line ,' On adjacent lots Public sewer manhole/cleanont Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Fotmdation 7 ~ Property line ) ~-L.~ Absorption field Li Water raain/service line ~> 75~ Surface water/drainage {q 1t29 Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Surface water Curtain drain ~'//0 ENG~EER~S CERT~ICATION Water main/service line ) / ty--O Driveway, parking/vehicle storage area Wells on adjacent lots ~ I certify that I have determined thru field inspections and review of Municipal recbrds tha[ thd above ~3~stems are in conformance ~h~ MOA HAA guidelines in effect on this date. (, . ' :.= ' SignaturT, ~ 5~ EngineersNalne '~Ol~lO~'~t ?~;>t/c ~C, l/A. lx,~ ~ Date A~"'t~ Receipt Number Waiver Fee $ Date of Payment Receipt Number Rev. 8/95 OSS: haa.wk.doc APPLI( NT FILLS OUT UPPER HAl ~NLY Property Owner , ,' , '~ ~ Phone Buyer /- /' Address ' '" ~/ L / /i Zip Code LegalDescdption / //, ['2 j~ /;? ~/,t'"- f . j Time Time Time Time ~o~I~/~ Date Date Date Date ~ -;:~-~ Inspector Inspector Inspector Inspector Field Notes: MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTECI'ION RECEIVED ( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size