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Home My WebLink AboutCAMPBELL HEIGHTS BLK 2 LT 7DHT' . L, OT' K &,c r c> a -3S' 2833 East 72nd Avenue Anchorage, Alaska DAIL'�` DRILLING LCC i- -PU"Ey J% m " U 07VNER OF I-A.N-D . ......................................... 2833 East 72nd Avenue Anchorage, Alaska DRILLER'S NAME ......................................... I ................ ; ........ ............ 07VNER OF I-A.N-D . ......................................... 75' ......... .......... ----- DEPTIl OF WELL-- ADDR'4 ES- .... . .. .... .... ............ .................... ......... ..... ..... - r 7> ',31" ... STATICLor WATER F'.. ...... DPAIV FT. ;SAIF—STAIRTED_ -------- ---- 6ALS. PER .IK.. ... .. DATE -FNDLD KIND 10F f'ASlNf7;..._ KIND OF 1011.11ATION: F R 0 0 - -7 ------ I.T.T. TO .. .... Bp. FT ...... F RO:V -V -Q` TO ....FT. TO - _ F?... -..of PFRO'll 5,T. FROM_ A .... TO_ 55 . .... .... G fty. SAVVI & fA Vq_j To ROM FT. 70. ...... .. .......... . FROM Gflat)�e_j I I. T( rFROM 72 F T. FT. '72 ... FT. TO. -74�_ "' - " 1) r. e T. 1 FT. F71. TC)__.. .. WA4 FRO}L FT. TO. ----- ------ -..----..FT. e r ... .. ............ F3011 FT- 10 FT- FRO1*1 ..... ...... ...FT. TO . . ..... ............ FT ...... . ..... .... .... FROM "T. TO FRONT_ -------- FT. TO - - ------------ - .......FT.. . ............ FROM ...... .. FRO -)l --- ----- ---- --- --- FT. TO ---- --.........._---FT........_........ PRO Vl_..._ ...... FT. TO FT... FRONU . ................ . FT. TO._- --- ------------ ...... .. . ..... . --.FT...... ........ ................. .. FRO' I ....... . . ---- FT. TO. .........._......FT....... FROM ............ .............FT. TO . ----- --------_ ....FT..------..........---...._..... . FRO`rl .... ---- -- . ..... ,JISCL. INFORMATION: ... ............ ......... FT. TO._.... ----------- .. _ ---------__---_ --- ---- DRILLER'S NAME ......................................... I ................ ; ........ ............ MUNICIPALITY OFANCHORAGE 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 1. GENERAL INFORMATION (a) Legal E)escription (include lot, block, subdivision, secJJ, on, township, range) Location (address or dire tions) . . (b) Applicant Name .~.,/t,~ Applicant Address (c) Appli~~Lending Institution ~; Owner/builder ~; Buyer ~; Other~ (explain); (d) Lending Institution /~~~ Telephone {e)~e~l ~late Company ~nd Agent Address (l') ' -.Mmf the HAA to the following address: : ~ -..~.? -'s-~ 77 - / TYPE OF RESIDENCE Single-Family,~ Multi-Family I-] Other Number of Bedrooms ~ ; · 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 Onsiter'l Public[~ Community[] Holding Tank [] · Note: If community well system, must have written confirmation from the State Department of Environmental Conservation _, attesting to the legality and status. ' ' Page 1 of 2 ;2-o25 m/s4) ENGINEERING FIRM PROVIDIf..., INSPECTIONS, TESTS, FILE SEARCH, DA ,,~ AND INFORMATION '-" As certified by my seal affixed hereto and as of the vaIidation 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 regula!ions in effect on the date of this inspection. Name of Firm S & S g~;.,,~r_;~.3 Telephone SRB 196x Address Eagle ~ver, Alaska 9957? Date 6" Approved for ~bedroomsby",7~,u?/t~9 '/'~21 ate TA::rmOsV::conditiona~lpprovalDisapproveg//- Condit'ona'~ CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval ce.rtificates 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 ~! ....... profession~,l engineer's work. ?' Page 2 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ,Date Installed Width 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, P~king Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bod Thickness ~ /J Standpipes Present (Y/N) / Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. 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 MO~ and H~,A guidelines in effect on the date of this inspection. S & S Engineering _ / Signed e_. ~ ~_ ~, ?...,, Date Company Eagle R;verr ~lallca ~$~r'/ MOA No. Receipt No. %~ ~((~ I Date of Payment 1 - ~ % '~ Amount: $ ( n ~ c~ Page 2 of 2 72-026 (11,84} WELL DATA We~l Classification MUNICIPAUTY OF ANCHORAGE (MO~t HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 JAN 1 11986 Legal Description: Well Log Presentl~N) Date Completed Total Depth Ca~ to ~1 Depth of Grouting Static Water Level Casing Height Above Ground ~ ~ Sanita~ ~al on Casing~N) Electrical Wiring in Conduit~N) Depr~sion Around Wellhead (Y/~. ~para~ion Distances from Well: To ~ptic/Holding Tank on Lot ~ . ; On Adjoining Lots To Nearest Edge of Absorption Find on Lot To Nearest Pubfic ~r Line ~ ~ ;~ To Nearest Public ~wer CleanouVManhole Waler Sample T~t Results Comments SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Air-tight Caps (Y/I~) 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. o! Compartments 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 Page I of 2 72-026111/84) MUNICIPALITY OF ANCHORAGE MUN~C1PAUTY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF I!.~ALTH & ~25 L St~et - A,d~, ~ 99501 ~"VIRONMENTAL F?,OT[CTION ENVIRONMENTAL ENGINEERING DIVISION T~ephon*264-4720 JAN 2 ~ 1~ REOUEST FOR APPROVAL OF INDIVIDUAL WATER AND DIRECTIONS: Complete ~dl p~r~ o~ p~e 1. Immm~m ~wB! net be prm:eme4,-~'Ml~W'~r ~110]~4~/1 rep p~g, PROPERTY OWNER -,~ ~-- /~ /2 MAILING AODRE~ // ' ~ PROPERTY HESID~NT ill dif~r~ fr~ ~) ~---?- ;C:~,~,, IRC t 2427 EAST 86TB STE.~ET 7~,,~. N~ ROm '2. RUYER L [ LENDING I~TIT~ION ' MAILING ADOR~ PHONE PHONE PHONE IPHONE 4, REALTOR/AGENT DAHL RObt.,S, ZNC. ( ~LLLZAH J. RHODES) MAILING ADDRESS 2427 ~,&ST 86T1{ S'I~EET- ANCROL&GE, A/,ASRA 99~07 IPHONE LEGAL DESCRIPTION ~ 7D. BLOCK 2 ~AI,~'R~T. 11RTf~11'.~ ~IRhTVT~Th~ STREET L~ATION TYPE OF R~IDENCE NUMBER OF BEDRO~ ~ SINGLE FAMILY r-1 MULTIPLE FAMILY 7. WATER EUI~LY ~ INDIVIDUAL· r-I COMMUNITY I--] PUBLIC UTILITY ~ EL=WAGE DISPOSAL EY~TEM I-'l INDIVIDUAL/ON-SITE*' [~ PUBLIC UTILITY I'-I One I-*1 Four I'~ Two r-I Five [] Three [] Six [] Other · ATTACH WELL LOG. A well log is required for eli wells drilled since June 1975. For wells drilled prior to that data, give well depth (~tach log if available.} **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) ? THIS SIDE FOR OFFICIAL USE ONLY ! DATE RECEIVED . INSPECTION APPOINTMENTS TIME TIME !TIME DATE DATE i DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE . ' NUMBER OF BEDROOMS l'-1 SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY r-I 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 Varified 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 TankIlAtm~rm'°" AreaIlSe~r Line J Nearmt Lm Line $. COMMENTS [~'~APPROV ED FOR ~BEDROOMS [] CONDITIONAL APPROVAL (letter must,accompany certificate) ' [] DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-O10 (Rev. 3/78l