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Home My WebLink AboutGORDON LT 1A-2 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM PERMIT PERMIT NUMBER:SW910047 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:ALASKA HOUSING FINANCE CORP OWNER ADDRESS:520 E 34th ANCH. AK 99503 DATE ISSUED: 4/05/91 EXPIRATION DATE: 4/05/92 PARCEL ID:01425122 LEGAL DESCRIPTION: GORDON LT lA-2 LOT SIZE: 0 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (ISAAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS :j DATE: 17034 Eagle River Loop Road ~ Alaska 99577 LOCATION OF WELL(Legal Description): L~ DATE DFIILLING OOMPLETED: STATIO WAI Eft LEVEL (Top of Casing): ROBERT A, SHAFER CIVIL ENGINEER 694-2979 CLOCK ELAPSED TIME SINCE DEPTH TO DflAWDOWNI PUMPING TIME PUMPING STARTED/ WATER, FT, RECOVERY RATE, GPM REMARKS STOPPED, MIN, 35 40 50 55 60 {1 hour) 90 180 {3 hours) 20 . IA:I' dlvlston plat, Unde~ no ctr¢~Jmstances should any dat~ hereon be used ¢o~ consb'uctf~n o~ fo~ ,estab- lishing bound=~,y o~ fence ~t~es, responstHl~t~ for the lntHal transacHon only. LOT./4 -z ANCHORAGE RECORDING DISTRICT ~EP~,'E g 0 I~ul & T~C~ / ....... ~¢ * ~ % ~.'~ the responsibility of '~he owner to determine ~ ~~'% ~-'~(4 the~extste~ce of any easements, covenants, or re-~% ~?~?.. u~ s~lctlons uMch do not appaa~ on the ~eco~ded s..,- / 'I;%-".....-"L, [A~E~N Tg OF RECORD ~ OTHER THAN SHOWN ~ THE ~CORD~O P~T~ Afl~ NOT 17034 Eagle River Loop Road ROBERTA,$HAFER CIVILENGINEER 694-2979 Eagle River, Alaska 99577 FT, SCREEN: DRILLER: LOOATION OF WELL [Legsl Description): DATE DRILLING COMPLETED: STATIC WA~'ER LEVEL (Top of Casing): . FT. CLOCK ELAPSEDTIME SINCE DEPTH TO DRAWDOWN! PUMPING TIME PUMPING STARTED/ WATER, FT. RECOVERY RATE, GPM REMARKS STOPPED, MIN. '_~_,,~ o ~ ~,w,I o , o , s,a~ ~.~ ~ _ ~ ~ ~ ~,. .... ~ ~ q , ~' ~,~ 45 60(1 hour) ~0 180 {3 hours) ~ ..... ,' ~4~(~ hou~) ' '~ ' ~ ~ ~,.~. ' '-.~.. . . ..... t 0 .... 0 ~ .'.~ ....... ~ ~ 7'~ ........ ~ ~ ' ~,~ .... ~0 ..... [~ X .... ~ :r ';~ :~ Flow is not Guaranteed 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 .~/~\- ~ NAA# ~:~--'~Ot\ ~)(~- 1. GENERAL INFORMATION Complete legal description Lot IA-2; Gordon Subdivision Location (site address or directions) 3106 East 84th Avenue Property owner Mailing address AHFC #6948 Day phone Lending agency Mailing address Day phone Agent Stephani¢ PaszCk CENTURY 21/NEW HORIZONS Day phone Address 2213 Ea~ Tudz~ R~ad A~e~n~a.g¢~ A£a~b~ 99507 Unless otherwise requested, HAA willbe held forpickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well XX NOTE: 562-6233 Public water If community well system, provide written confirmation from Sta¢a ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: Public sewer XX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~025 (Rev. 1/91) Fron[ 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 flies 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 Address Phone Engineer's signature Date DHHS SIGNATURE Approved for Disapproved. bedrooms. 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 H8 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~)25 (Rev. 1t91) 8ack MOA #21 Well Classification Well LogPresentl(Y/~ ~ _Date Completed Total Depth_(~ ~ Cased to ~l~Depth of Grouting ~ MUNICIPALITY OF ANCHORAGE (MOA) (~/ Health Authorily Approval (HAA) F~ClCC('~)~L st!~ .,.,CHE~KC~SrD - FEBRUARY 1984 -" ~ 343-4744 MAR 2 7 lJ'99~ Legal Description: Pump Set At Sanitary Seal on CasingS) 7 Depression Around Wellhead (Y4~j~) Static Water Level,,.4c.~..,.¥. Casing Height Above Ground Electrical Wiring in Conduit 4~¢~N) SEPARATION DISTANCES FROM WELL:. To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot If A, B, C, D.E.C. Approved (Y/N) _ Yield (.-¢,/-Jr ~ · On Adjoining Lots r---lo ; On Adjoining Lots To Nearest Public Sewer Line .-~,~ I.j¢ To Nearest Public Sewer Cleanout/Manhole \ c::~:::)l'~ To Nearest Sewer Service Line on Lot '~'¢~-~ I'JF- Water Sample Collected by '~ :~ ~ '~;:~ \~lt~;Date _-"-~--~'~::::~_~ Water Sample Test Results ~/~.~'~-~1'"--O¢~ -- "'~~ ,¢~ ~ ~~ Comments _ B ' :: tPe:l:~ T A N K _Ds:zTe~ No. of Compartments Standp!pes (Y/N) ~ Air-tight Caps (Y/N) _ Foundation Cleanout (Y/N) epression over Tank (Y/N) ~'% Date Last Pumped ...... umping/Maintenance Contact on~~ ; for .... Holding Tank High-Water Alarm (Y/N) ~ary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: ~ To Water-Supply Well To Building Foundation-'"~"'-~ To Property Line To Disposal Field ~ To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA ',S,~ils Rating in Absorption Strata Type of System Design Daf~stalled ____ Length of Field Width of~__ Depth of Field Gravel Bed Thickness Square Feet of Absortion AYes.._ Statndpipes Present (Y/N) Depression over Field (Y/N) -~ Date of Last Adequacy Test Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIE~ To Water-Supply Well To PropeTty..L~e To Building Foundation ToE'xJ~gor Abandoned System on Lot ; On Adjoining Lots To Water Main/Service Line To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parkinzg Area, or Vehicle Storage Area Comments '~'-"'/O"~--~ \C_~ ¢/~ D. LIFT STATION Date Installed Dimensions ,S, i/u~~ M a n,~;~ em/~ c(~;~ SL(6~/e~ )a t High Water Alarm Level at ~'"'~_ Vent (Y/N) Tested for ~'""-~._ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) 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 inspection. Signed Company Date MOA No. Receipt No, Date of Payment Amount: $ 72-026 (Rev. 7/88) 8ack Receipt No, Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL I .4BORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEEFIING 5633 B STREET ANCHORAGE, ALASKA99518 TELEPHONE (907)562-2343 ANALYSIS REPORT BY SAMPLE for WOR~order$ 32762 Data Report Printed: MAR 23 91 @ 12:22 FAX: (907) 561-5301 Client Sample ID:LIA-2; GORDON SUBDIVISION PWSID :UA Collected MAR 20 91 0 16:30 hrs. Received MAR 21 91 ~ 1~:30 his. Preserved with :AS REQUIRED Client Name :S & S ENGINEERING Client Aeot :SNSENGP BPO $ PO $ NONE RECEIVED Roq $ Ordered By :R. SMAFER Analysis Completed :MAR 22 91 Send Reports to: Laboratory Supe~lsgz_.'~gPHgN C. EDE t)S & S ENGINEERING Releaeed By :~C ~/~ 2) Chemlab Ref $: 911032 Lab Smpl ID: 3 Matrix: WATER Allowable Parameter Tested Result Units Method Limits NITRATE-N ND(O.IO) mR/1 EPA 353,2 10 Sample ROUTINE SAMPLE COLLECTED BY: RDJ Remarks: 1 Tests Performed * See Special Instructions Above UA-Unavailable ND- None Detected "See Sample Remarks Above NA- Not Analyzed LT~Lese Than, GT-Greater Than