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HomeMy WebLinkAboutLITTLE BEAR BLK 2 LT 7Little Bear Lot 7 Block 2 #014-061-32 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 DEF'FIF.:TMENT 'HESLTH RN[:, EN%'IRONMENTFIL' '-_TEZT.T. EN ~._,t~'3 E. TUDOR RE:,.., FtNCHORFIGE., ~K. B.,.I E L L F" E: F..: [--"l ][ T' ~ERMIT NO. ( '?E3:;-2t ) F~F'PI_ I CRNT ED RINNER LOCRT 1 ON B~F'LRCE LEGRL L7 B2 LITTLE BERR SUBD E:].<iO NELL_,LE% COlIRT LOT _,I ~.E. 3:44-4:1... ]!::1.. 8400 S:17! _ FIRE F'EET MINIMLIM DISTRNC:E BETHEEN R WELL RND RN%' ON-SITE SEWRGE DIfFF'OE:RL :,-r.: rE.II I--', :LOO FEET FOR R PRIVRTE WELL OF..: 2Ft¢.* FEET FLF.. R F"UBLIC HELl_ , '- RET_ ..' : WELL LOGS RRE REQUIRED RND, HU=,T E;E IIF.'NEE, TO THE E:,EPRRTMENT WITHIN OF THE [4ELL C:OMF"LET~ON. "" '-I-'' ' I'" '- ) F:' ' '"~ _-,FE._.IFICRTI.~N-, RND E:ONSTRUCTION E IR=RArE RRE AVRTLRBLE TO INSURE PROF'ER I N_,I HLL~I I ON. I ...ERTIFY THFIT _,.,-. .................. FIND [,JELLS FIFE; '.SFZT :L: I RM FRf,IILIRR WITH THE: REQUIREMENTS FOR I-:' ' ' - ' ~ ' I"~ FORTH BY THE MUNI,IPFtLIT% OF HNCHUF..R.,E. 2: I WILL INSTF!LL THE .S¥:STEM IN RCCORDRNCE WITH THE CODES. '":,I GNED~ '- - -~-/~--~2k,~~'~ ~ / ..................... RPPLI CRNT ED RINNER T '--; -'=.;I lED B .r' , ~._~_4~_ E:,FiTE Municipality of Anchorage Department of Health and Human Services Division of Environmental Services ©n-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 'Diq- 0(,. i - 1, GENERAL INFORMATION Complete legal description Expiration Date: Location (site address or directions) Current Property owner(s) Mailing address (/5 (~ Lending agency Day phone Day phone Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank Community On-site Public Sewer The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 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 based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm /'-~ L, b.~ ,-~ Address ~C' Engineer's Printed Name DHHS SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for __ Phone ~t-'7 ~ -,p = e,l/~' ".~. ENGINEER'S bedrooms, with the following stipulations. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Expiration Date: Original Certificate Date: Reissue Date: k'-~Municipality of Anchorage'~-'J NOV 0 3 ~000 ~ Department of Health and Human Services Division of Enwronmental Services MU~,i ....... · "L" re Ro '~u-L~t'~t"ALI fY OF ANCHoRAGE On-S'te Services Section 825 St et EI~/~t~ME-- P.O. Box 196650 Anchorage, AK 99519-6650 NTA~SERVICESDIViSiON www. ci.anchorage.ak.us (907) 343-4744 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L.o'T A. WELL DATA Well type ~-, Date completed I/7/77 Total depth ~_5 ft Date of test Static water level ~-/ Well production WATER SAMPLE RESULTS: Coliform ¢ colonies/100 mi Date of sample:. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Date installed Cleanouts Date of pumping C, ABSORPTION FIELD DATA Date installed Length __ ff Total depth ft 'bLot. c- ,q. LI TT'I..-E I~i~--A~ Parcel I.D.: If A, B, or C provide PWSID # t'//,~ Well Log Sanitary seal ~' Wires properly protected Cased to ~.-.~ ft Casing height (above ground) FROM WELL LOG AT INSPECTION g.p.m ~ g.p.m Nitrate .l~-") mg/I Other bacteriallY_colonies/100 mi Collected by: T',~~ gal Number of Compartments __ Depression over tank High water alarm __ Pumper Tank size Foundation cleanout System type ft __ Depression over field S0il rating (g.p.dl/ft2 or ft2/bdrm) __ Width __ft Gravel below pipe Effective absorption area ft2 Monitoring tube Results (Pass/Fail) For bedrooms Water added__ gal. New depth in Absorption rate >= .If yes, give date __ Date of adequacy test __ Fluid depth in absorption field before test __ in Elapsed Time: rain Final fluid depth Any rejuvenation treatment (past 12 mo.) (Y/N & type) in, in. g.p.d. 72-026 (Rev. 01/00)* D. LIFT STATION Date installed "Pump on" level at __ in Datum E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallons __ "Pump off" level at Cycles tested Septic tanldlift station on lot Absorption field on lot Public sewer main Sewer/septic service line I in Manhole/Access High water alarm level at __ in Meets alarm & circuit requirements__ On adjacent lots On adjacent lots Public sewer manhele/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Building foundation Water main Drainage Property line Water service line Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water Service line Curtain drain COMMENTS Building foundation Surface water Wells on adjacent lots __ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name "~-o/~/¢~,/ "-'-'-'-'-'-'-'-'~j~o ¥-V,.~,~ Date ~r.~-. ~.~ ~0¢-~.:~ Absorption field __ Surface water Water main Driveway, parking/vehicle storage __ HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 01106)* 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Complete legal description ~--'-J~ ~'~"~ ; Lpcation. (.site address or directions) ,,,.,~,..,..- .. ~,' .~? %,, ,..' ', .' pr~v,owo~F'~ ~1~ Mailing address ~ ~' '~ailing address. Agent ~oSm~ Unless otherwise requested, HAA will be held for pickup. 2, NUMBER OF BEDROOMS: Day phone Day phone Day phone -~ ~¢~- ?-:~ 7.~__ TYPE OF WATER SUPPLY: Individual well Community 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 from State ADEC attesting to the legality andstatus 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 inves_ti_gation 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 (_~ ~- ,~"r.~, u~.~. A [~.<~% L~,"~'~...~ i ~ ~:~ ~ Phone Address ~ ~ ~~0~~~ ~ Engineer,s signatu r~~ ~~ ..... Date o DHHS SIGNATURE Approved for '~-~/~ ~'-~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date 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 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 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: !"-~r'/ ~-/~-"~-' ~'~"' ~u(~. Parcel I.D. (:9)~4-- {_.~C~'-" ~'?--. A. Well Data Well type Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~/~/ ~' Driller Cased to ~(~ J''- Casing height Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test '/+/~ -~c- (~/' l' '~ MUNiCiPALrtX OF ANCHOI~G~ ENVIRONMENTAL SERVICES DIVISION Static water level ?-- ~' ' ti OCT 0 G 1993 Well flow '~-~' g.p.m. ~, g.p.m. Pump level1 /'J-~ '~[~ ~ RECEIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~"J. ~' Absorption field on lot Public sewer main Sewer service line /~ ~u.,,C..v'; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Date of sample: tO/~/c~ Nitrate (~, ~& ~ Other bacteria Collected by: 'T~. Surface wateddrainage 72-026 (3/93)* Front B. SEPTIC/HOLDING TANK DATA Date installe~.~--'.:i'~.~. "?~-%, ~ Tank size ~/~' Compartments Cleanog~(~[N'~"' ~~;~'t Foundation cleanout ~/N) High ~.'~l.a¢~'~{W,)¥.~"~-~-~ Alarm tested (Y/N) S EPA~'~ DIS~,~ SEPTIC/HOLDING TANK TO: Well(s) on ~~ On adjacent ots TO prope.y line ~Xfi Absorption field CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested ~'~ ,/~ SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot ~'"'~/~ On adjacent lots ~"~ '~ Surface water t/~/A~ D. A.SO..T,O. P,E.D DAT,, Date installed A LengthWidth Soil rating (GPD/Ft2) ~ Gravel thickness System type ~ .~ Total depth Total absorption area ~.~ ,~- Cleanout present (Y/N) Date of adequacy test ~'--~/~ Results (pass/fail) Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Depression over field (Y/N) for After test ~'"~, .'~ If yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation ~ ~- On adjacent lots Surface water ~'"~r-' Curtain drain On adjacent lots ~'~ '~'- Property line To existing or abandoned system on lot Cutbank [~..~k/~- Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to afl MOA and HAA guidelines in effect HAA Fee $ Date of Payment / 0 - ¢¢ .- P...~ Receipt Number ~ o~,~ d~te of this inspection. Waiver Fee $ Date of Payment Receipt Number  MUNICIPALITY OF ANCHORAGE ~ Department of Health & Human Services . DIVISION OF ENVIRONMENTAL SERVICES ~ 343-4744 - · CERTIFICATE OF INSPECTION FOR'HEALTH AUTHORITy APPRovAL OF Oil-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) B2, LITTLE Location (address or directions) (~(02o BfiBY B~ b~ (b) Property owner ~)EFF'REY Mailing Address (c) Lending Institution Telephone: (home) 3¥~ -~'d'~,¢ Business Telephone Mailing Address (d) Rea EstateCompanyandAgent HEL'E~ ~EC, b~So~ , H~T~E I~,E, Address .~23o ~(~" (e) Mail the'HAA to the following address: (or check here BI, if hold f~[ pick up.) .' . ._ List contact person and day phone number below: , '- ."' 2. TYPE OF RESIDENCE Single-Family~ Number of bedrooms 3.. WATER SUPPLY Individual Welly- Community [] Public [] ~ Note: If com~un ty we system- must have wr tten confirmation from the State Department.of Environmental, Conservabon attesbng to th legahty and status. ' ': .' ..................................... : ..... ':':' 4. SEWAGE DISPOSAL :' On-s te FI-, ':-, Pub C .: Note: It community:well syste~ must have written confirmation'from tho StatO 15¢~art:~'br~t Of Em; ~onmenta 724)25 (Rev. 7/88) Page 1 of 2 ')pOM s,Jeeu!6ue leUO!SSe~oJd eql u! suolssiuJo Jo 9JOJJ~) JOj elq!suodseJ lou si e6~Joqouv jo ,~lllediolun~ eq/'penss! s! e~o!j!lJeo e eJo~eq ejep aZ~leUe Jo suoijo;dsul lonpuoo ~ou op SHHCI ~o ~e@~oId~S '~)u~me~!nb~] e~ls pu~ 'l~JeP~ u?~J@o ~!l~s o~ JepJo u! suo3n~!lBui I~u!pu~l J!Gql pue SeLuoq ~O sjGseqoJnd ol /~$@lJnoo 9 $8 $!q), s@op Shha eqj. 'e~selV ~o elelS eql u! peje),s!l~eJ je~uJ6ue leUO!SSejoJchuepuad@pu! u~ ~q e^oqe ~ qdeJSeJed u! u~^!6 sUOjl~lUeseJd9J eq~, uodn ~lUO peseq pel~O!1!Jeo le^oJ'ddv/~!JoqlnV q],lee H senss! (SHHQ) seo!AJeS u~t.unH pu~ qlleaH ~o ~ueLulJedec] e6~Joqouv jo ~l!led!o!un~ eqJ. leUOR!puoo MUNICIPALITY OF ANCHORAGE (MOA) ~ , Health Authority Approval (HAA) IPALI'r ~' ©!~i~i'ECKL[ST. FEBRUARY 1984 ENT,~_ ,~E,R,,, ~ ~ ~V~3.4744 N!AY2 Legal Description: Z 7, ~2 ~ITTLE ~ WELL DATA Well Classification Well Log Present (Y/N) Total Depth gS' Cased to __ I Static Water Level 8..5 Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line ?Ri VfiT ~c Date Completed I/7/'7 35 t Depth of Grouting N, Pump Set At If A, B. C, D.E.C. Approved (Y/N) N.,~, Yield ~,~0 GP't'I m~ ~//71,o0 Sanitary Seal on Casing (Y/N) ',/£ 5 Depression Around Wellhead (Y/N) hq2 To Nearest Public Sewer Cleanout/Manhole ; On Adjoining Lots tJ.,A- · ; On Adjoining Lots ¢, ~ ' To Nearest Sewer Service Line on Lot Water Sample Collected by FLATTOP -rg¢~/, ,5'£R, ; Date Water Sample Test Results ~'~$'~-~/.or,y.., - ~ coh~-~ /?o~/~ Comments ?~.r &"/t~l~K (~/~r :~;'o~ ~ ~o~w~ ~ SEPTIC/HOLDING TANK DATA H0H E Date Installed Size No. of Compartments Standpipes (Y/N) Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) Foundation Cleanout (Y/N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Building Foundation To Disposal Field To Water-Supply Well To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments ~'; f,y ~cv ~r 72-026 (Rev. 7/88) Front Page 1 of 2 ; . , C. ABSORPTION FIELD DATA ~ Soils Rating in Absorption Strata Date installed Width of Field Type of System Design Length of Field Depth of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutback (if present) D. LIFT STATION ~ONE Date installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA.g.uC.~eti~t~p. effect on the date of this inspection. Signed ~~ Company F/~f~ ~ ........................... ¢ Engineer's Seal Date MOA No. Receipt No. /~ ..... Receipt No. 't ~'~' Date of Payment ~ 4.J~ (7 Cb Waiver Fee: $ Amount: $ /~---/~/~-),~¢ ;' Date of Payment z~-0,6 ~R,v z/~ ~ Page 2 of 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF iNSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 7, Block 2, Little Bear 6/6/86 Location(addressordirections) 6620 Baby Bear Rd. (b) Applicant Name Jeff Strike Telephone: Home 349-6606 Business Applicant Address 6620 Baby Bear, ANchorage, AK. (c) Applicant is (check one): Lending Institution []; Owner/builder'S]; Buyer []; Other [] (explain); N/A (d) Lending Institution Alaska Mutual Bank- O'Mal~:e~gphone Address Pouch 4-9003, Anchorage, AK 99509 (e) Real Estate Company and Agent N/A Address 349-5800 Telephone (f) Mail the HAA to the following address: pickup by engineer ,TYPE OF RESIDENCE Single-FamilyJ~] Multi-Family [] Number of Bedrooms 3 Other 3. WATER SUPPLY Individual Well [] Community [] 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 [] Public [] Community [] Holding Tank [] AWWU connect Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-025 (11/84) ENGINEERING FIRM PROVID. .i INSPECTIONS, TESTS, FILE SEARCH, £ ~A 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 regulations in effect on the dateofthisinspection.*requires wavier of well to public sewerline/manhole dist· Name of Firm ~.~m i~ DltlED ~M~_IM[~DI~I~ qI::~II~FR Telephone Address EAGLE RIVER, AK 99577 /'/',~/,P*4' P. 0. BOX 773294 Date 5// 694-5195 Engineer's Sea! DHEP APPROVAL Approved for "'/"/~'"~¢'L~'-'~)bedrooms by ~ /'~' ""/~/~ Date Approved Disapproved Conditional Terms of Conditional Approval 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 coudesy 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) P.O. BU,, 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNOWLES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES June 18, 1986 Lou Butera, P.E. Eagle River Engineering Services P.O. Box 773294 Eagle River, Alaska 99577 Subject: Lot 7 Block 2 Little Bear Subdivision Waiver Request, WR86-074 Dear Mr. Butera: The sewer line serving the subject property was constructed at a time when the required separation between a private well and sewer line or sewer manhole was 50 feet. The required separation between a well and private sewer line was unspecified at the time of its construction. Waivers are therefore not required. Sincerely, Stephen S. Morris Civil Engineer On-site Services SSM/ljw WELL DATA MUNICIPALITY OF ANCHORAGE (MO~i HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Leg.C2Description. ,~ MUNICIPALITY OF ANCHOi~GE D~Plr, OF' HEALTH & ENVIRONMI~N I'AL PROTECTION Well Classification /¢/¢; Well Log Present (Y/N) Total Depth ~'5-- / Cased to Static Water Level '~ ~' ~ Casing Height Above Ground /z/ Electrical Wiring in Conduit (Y/N) Separation Distances from Well: If A, B, C, D.E,C. Approved (Y/N) /b'// Date Completed 17~' ~, /~ P 7 Yield Depth of Grouting Pump Set At ~ 7~.~,-~ Sanitary Seal on Casing (Y/N) ')/ Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot /*M,,/.4 To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by ,~2 ¢,~¢,~¢ ~,Z.~ 5-¢¢~.¢,'- ; On Adjoining Lots /~'./-4L ;On Adjoining Lots To Nearest Public Sewer / To Nearest Sewer Service Line on Lot /.5- £~'.~ ~ ~"~ ~'~-~ ;Date ~"/~'/"~ d Water Sample Test Results Comments SEPTIC/HOLDING TANK DATA Date Installed Standpipes (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 Main/Service Line Course Size No. of Compartments Air-tight Caps (Y/N) Foundation Cleanout (Y/N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 ABSORPTION FIELD DATA ~,,~ Soils Rating in Absorption Strata Date Installed Width of Field Type of System Design Length of Field Depth of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test 'Fo Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.~ Signed J'~'~ Date ~/~'/~¢' ,,~2,,,;-~ ~.v',¢,~-~ o.-,=,.,,m__¢~' 1-~, MOA NO. ~ ,4,~ ¢/,.~f Company Receipt No. Date of Payment Amount: $ Eagle River Engineering Services ~ 0. Box 773294 Eagle River, AK 99577 694-5195 Page 2 of 2 72-026 (11/84) Engineer's Seal EAGLE RIVER ENGINEERING SERVICES Lou Butera P.E. P.O. Box 773294 Eagle River, Alaska 99577 Telephone (907) 694-5195 June 6, 1986 Mr. Steve Morris Civil Engineer, On-site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 REF: Lot 7, Block 2, Little Bear Subdv. Dear Mr. Morris: On behalf of my client, Mr. Jeff Strike, I am submitting the information necessary for your determination of a wavier of separation distances for a private well located on the above referenced lot. The waviers required for approval are, well to private sewer line 15', well to public sewer line 51' and well to manhole distance of 59'. The enclosed plot plan shows the well location in relation to the sewer lines. The sewer line was constructed in 1976 with the well construction taking place in 1977. The surface topography of the site is favorable with the well located upslope from the sewer lines at a 5% grade. The road is paved and ditched so that any surface runoff is directed away from the well location. The well has a total cased depth of 85' and draws from a sand and gravel aquifer which is overlain by layers of grey clay and hardpan soils. This aquifer is confined under a pressure head as the well water has a static level of 33' The aquifer contains an adequate supply of water as the test well was pumped at 10 GPM with only a 5' drop in static level after 90 minutes of pumping. The immediate subsurface soil data is limited as the availability of public sewer has eliminated the use of septic systems. The public sewer line is construced of ductile iron, there are no special construction notes on the sewer line asbuilt enclosed. The sewer line is a gravity type which will be at 0.0 psi working pressure. With a gravity sewer line there is usually more concern with infil- tration of surrounding ground water than with exfiltration. A coliform bacteria water sample taken from the well water shows a 0 coliform count. If there are any questions or if additional information is required please feel free to contact me at 694-5195. Sincerely, Lou Butera, P.E. EAGLE RIV, ENGINEERING SERVICES INC. P. O. Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694-5195 JOB- SHEET NO. CALCULATED BY CHECKED BY. DATE iac~u~l diStafices and relative ':POsition ~re[a~ s~°~n So :no~ ~ttemPt ~:tO aCg!~ OX determine Se~a~at~on~.distances othe~..thah those as s~o~n. '~MUNICIPALITY OF ANCHORAGF--', DEPARTMENT~uF HEALTH AND ENVIRONMcNTAL PROTECTION' 825 L 99501 1st Inspection: Street, Anchorage, Alaska 279-2511, ext. '224, 225 Date Received: Time 9:30 a.m. 2nd Inspection: Date 4-7-77 Thursday April 6, 1977 Time Date Inspector Dixson Inspector REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. ' Lending Institution Request: AmfaCt Mortgage Mailing Address: 705 West 6th Avenue 99501 Phone: 277-8588 Property OWner: Mailing Address~ L.J. Sebring Phone: 344-3069 Star Route A Box 1540C 99507 Lot 7 Block 2 Little Bear Subdivision 3. Legal Description: 4 Sing].e Family ReSidence: Multiple Family Residence: (x) Number of Bedr0eNs:3 ( ) Number of Bedrooms: 5. Well Data: Type Individual Construction c~,~~/~?/~-~7~ o Depth 83' Bacterial Analysis Well Log Filed (~/ Sewage Disposal System: On-site system ( ) Public Utility Permit # ~7~_~Installed j ' Installer ii" '" ' Soils Rate ./'"'" Material Absorption Area Distances: Well to Septic Tank. /./~/~ to Absorption Area tO Sewer Lines ~2~ ~~ Nearest Lot Line Absorption Area to Nearest Lot Line Page ~wo ~ - Department of Health and Environmental Protection ~ ~ Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 7 Block 2 Little Bear Subdivision Comments: Affadavit Attached: (') Approved: _~~ Disapproved Letter Attached: ( ) Date: Department Worksheet: 'MUNICIPALITY OF ANCHORAG[ ';t' Department of Health and Envfronmental"Pro~'~l~,'oF 825 L S~reet, ~chorage, Alaska ~quest for Approval of Individual Sewer and Water Property Owner: Mailing Address: Name of Buyer: Mailing Address: Phone: e Lending Institution, ~//~. Mailing Address: Phone Realtor/Agent: Mailing Address Phone: Street Location: Single Family Residence: Multiple Family Residence: ( ) Number of Bedrooms: o Water Supply: If Individual Well, well depth f--~ If Community System, name of system * Individual Well ~ Public/Community System ( 8. Sewage Disposal System: On-site System ( ) Public System If On-site System, date of installation: *NOTE: A well log is required on ALL wells drilled since 6/75. 3/77